Your Questions
Your Questions
Q: Dr. Eppley, I had liposuction of my stomach done three weeks ago. A total of nearly 1500cc of fat was removed. The very next day I looked great and my stomach was flat. But by the next few days, my stomach got bloated and bigger. Then I got my period and got even more bloated. For now my belly pouch is back although it is smaller. Is this normal and will it ever go flat again?
A: What you are describing is a very typical sequence of events after liposuction. When you see yourself the next day due to the compression applied by the garment and with no real swelling yet present, the amount of improvement created by the fat removal is seen. Then the swelling and the temporary impairment of lymphatic outflow occurs and some of the improvement appears to be lost. What I tell my patients is that what they see the next day will eventually return but it will take at least 4 to 6 weeks to get back to that. This is the time needed for all swelling to go away and much of the normal lymphatic circulation to return. So you will get to where you want to be but it requires more time and patience. This is a normal part of the recovery process from liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a facelift just one week ago. I expected to be a little swollen and bruised but not like this. I was told before surgery that I could return to work two weeks after the surgery. I was also told that by that time I would not be completely healed but that no one will notice that I would have had surgery. Based on the way I look now, I can’t see how this will be true in just another week. I am a bit panicky now because I can’t go to work remotely looking like this. I’d have to quit my job if I went in looking like the monster that I do now. Any suggestions or advice on how to make this swelling and bruising go away faster?
A: The amount of swelling and bruising after a facelift that any patient gets will vary and is most affected by the type of facelift that one has. Unless it is a very limited type, I would never tell a patient that they will comfortably be able to go back to work in just two weeks. Three weeks after a more complete facelift is more realistic. That is now water under the bridge so to speak so what can you do now? Largely the speed of the improvement you are going to get is by your won natural healing process. But the use of Arnica tablets and topical gel for the bruising, don’t sleep completely flat (head up) and taking some bromelain (for swelling) may be of help. You may also be surprised what another week of recovery will do. I suspect you will be much better by next week and with a little makeup you will be largely ‘undetected’ for having a facelift.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I had liposuction six months on my stomach, saddle bags, flanks and inner thighs. The doctor told me he removed 4 liters of fat. I am very happy with the results with the exception of my inner thighs. I now have some saggy skin and irregularities of the inner thighs. Is this common afterwards? Can some form of non-surgical skin tightening be done to make it better?
A: Liposuction can be tremendously effective for many body areas and the inner thighs are no exception. But inner thigh skin does not usually have much ability to contract so only conservative fat removal should be done in this area and patient expectations should be tempered as to how much size reduction can be done. If too much fat is suctioned out, the inner thigh skin can be made to sag with irregularities. There are numerous non-surgical skin tightening devices that can be tried and they have all have some effect. My current favorite device is Exilis which uses monopolar radiofrequency energy to create skin tightening through a series of treatments. If this is not successful, you may need a definite inner thigh lift which will solve this concern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I am an amateur bodybuilder and I have very large pectoral muscles as you can see in my photos. I feel I have achieved as much size as I can through exercise and that my only options for increased size are implants or anabolic steroids. Since steroids are illegal, I am interested in knowing whether I would be considered for pectoral implants and what amount of size and projection increase I could expect.
A: The common use of pectoral implants is for men who either need reconstruction for congenital pectoral/chest asymmetry or cosmetic chest enhancement for those that have not had good success with pectoral enlargement. Your chest shows considerable pectoral muscle enlargement as you have mentioned and your picture shows. The question is not whether you can have pectoral implants but whether the sizes that are commercially available will make enough of a difference to justify the effort. The typical size of the largest pectoral implants is around 350ccs with maximal projection of about 3 cms. How much of a difference that will make in your chest size in not exactly predictable. Knowing your exact chest dimensions in height, width and thickness for each perctoral area would be helpful in answering this important question. Based on the picture alone, I would estimate that the change would be in the range of a 20% to 30% increase…but that should be interpreted as a guess based on inadequate information as of yet.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I would like to get Medpor malar and paranasal implants. However I am a bit concerned about the possibility of implant infection. Although I know that impregnating these porous implants in an antibiotic solution prior to implantation combined with good oral hygiene usually works well, I also would like to go for a dental dam that limits the contact of the implant to the mucosa during surgery. Would you use a dental dam if the patient asks for this? Do you think a dental dam can lower the risk of implant infection if the implant is placed through the mouth?
I know that malar and paranasal implants are inserted into the same pocket through the same incision. Considering this, do you usually charge for the combined malar and paranasal procedure like this would be two separate facial implant procedures or do you charge only a bit more than for a malar procedure alone plus additional cost of the implant material? Thank you in advance for your reply
A: Porous implants like those comprised of Medpor material do have a higher risk of infection in my experience. Thus everything that can be done to limit this potential problem is done from antibiotic soaking and irrigation, limited insertion and removal for try-ins, and a change in gloves when the implants are finally inserted. You are correct in assuming in assuming that the risk of infection is highest when placed through an intraoral approach due to potential contamination from the oral mucosa. The dental dam is an interesting but impractical method of recipient site isolation. The dental dam is used in tooth restoration because it wraps around the neck of the tooth being worked on so the rest of the mouth is covered. This places the tooth in front of the covered mouth. It can not be used effectively in reverse because the inside of the lips and the maxillary vestibular mucosa is still exposed to the recipient site even if the teeth are not. So no I do not think it would be an effective method for reducing the risk of implant infecrion.
While the malar and paranasal implantation sites can be done through the same incision, the work to place the implants is still doubled. Shaping, placing and fixating the implants is the bulk of the operation. Four implants require twice as much work as two implants. Making the incision and closing it is but a minimal amount of time for either operation. Some cost reduction is seen when both types of facial implants are done together based on the time saved as it relates to incisional management.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I was born with a condition known as right hemifacial atrophy, also known as Romberg’s syndrome. I was operated on two years ago with corrective orthognathic surgery. Both my upper and lower jaws were cut, leveled and my bite put back together. The result is good but I still have some right facial asymmetry. I want to reshape my right cheek bone, nose and orbital region. I would appreciate if you can give me some advice on what procedures I need. I have attached some pictures and x-rays from my surgery.
A: Thank you for sending your pictures. You have made good improvement from your orthognathic surgery. To further improve your hemifacial hypoplasia/asymmetry, I would recommend the following right-sided facial reshaping/augmentation procedures:
1) Right orbital floor-infraorbital rim implant
2) Right lateral canthoplasty
3) Right cheek implant
4) Rhinoplasty
5) Right jaw angle implant
6) Opening wedge genioplasty (right side lengthening) – I was little surprised they did not do this during your orthognathic surgery
This would be my optimal plan to address all of your right facial issues. While all of these procedures do is to lengthen and expand the shorter right side of your face. I think you would get as good, if not even better, aesthetic improvement than you have had from your prior orthognathic surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I consulted with a board-certified plastic surgeon who says he can round the corners of my chin and reduce about 5mms of projection without any ptosis or deformity. I have seen his before and after pictures and they are stunning. Best I’ve seen. Should I still be concerned about sagging. Also he wants to put me on a course of antibiotics, steroids and put a drainage tube in my chin to make sure no fluid collects for several days. What are your thoughts?
A: There is no chin reduction procedure of any significance in which the risk of soft tissue sagging does not exist. By definition when you make the supporting bone structure smaller, you have an excess of overlying soft tissue. With proper soft tissue management and suspension this potential concern can be avoided whether it is done from an intraoral or submental approach. The use of antibiotics and steroids are standard practice. The use of a drain is surgeon’s preference. It is not something that I have ever used for any chin procedure but I know there are some surgeons that do.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a nose job six months ago from which I am not at all happy. It was a closed septorhinoplasty with the objective of lifting the tip of my nose and narrowing it. While right after surgery the tip was up, it fell down just weeks later. My nose is now not only pointing downward but is bent to the right to boot. I am very unhappy. The doctor told me that the stitches either became loose and weren’t strong enough to hold it up. What should I do now?
A: One of the problems with a closed rhinoplasty is that it can be more difficult to get idelal tip shaping and rotation. This is not to say that it can not be done but it takes more experience to do so than in the more commonly used open rhinoplasty. There are numerous reasons why a tip does not get or sustain adequate rotation including a suture retention issue, inadequate caudal septal reduction, inadequate columellar tip support or some combination. Regardless a revisional rhinoplasty procedure will need to be done through an open technique now because of internal scarring and a failed first procedure. As long as this approach is used, you should be confident that you still can get the end result that you initially desired.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am very disappointed with my Smartlipo results. Over four months ago, I had the procedure on my abdomen and flanks to try and improve my waistline. The laser was used but no suctioning of the fat was done. While everytime I go back the doctor tells me to be patient, I surely would have thought I would have seen some improvement by now. I am getting frustrated as I spent all this money and have yet to have anything to show for it?
A: I am afraid to tell you that if you have not seen results by now, you are not going to. It is not common practice, nor do I think it is even reasonable, to perform Smartlipo without simultaneous aspiration. While there is some heat-related effect to Smartlipo, you simply can’t rely on that effect alone to create a result. The main benefit of Smartlipo is that it makes the fat easier to suction out and enables better fat removal. Smartlipo is not a Star Wars game where you shoot and vaporize the fat instantly. Nor does it cause enough fat release that lymphatic drainage will remove enough to make a visible difference. Without simultaneous liposuction, it is not possible to make a significant improvement. It pains me to see some practitioners use this non-suction approach to Smartlipo and its lack of results which makes people unhappy as well as gives Smartlipo a bad name. This is a doctor problem not a device-related one.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been bothered by the appearance of my nose for a long time. The problem is that the tip is big, long, and droopy. Because the tip hangs down, it also affects my smile. It makes my smile look unnatural as the upper front teeth are barely visible. I have spent a lot of money on orthodontic work and I want them to show. Would a rhinoplasty improve this problem?
A: I think you have to separate the nose problem from the lack of upper tooth show. While the nose and lip are next to each other, they do not often directly cause a cosmetic problem for the other. A long downturned nasal tip does not cause the upper lip to be pushed downward. Therefore, while a rhinoplasty will make a very visible difference in the shape of the nose and how the overall face looks, it will not have the effect of improving upper tooth show. Pulling the tip of the nose up will not create a shorter upper lip or at least not significantly. You will need to consider some type of upper lip shortening to create that effect, such as a subnasal lip lift.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need to get rid of my saddlebags. I don’t know why they are there as they do not fit the rest of my body. I am 5’4″ and about 110 pounds. My body fat percentage is quite low as you can probably tell from my weight. I work out all the time and no matter what I do I can not get rid of these pesky saddlebags. Quite frankly, it drives me insane as I just hate them. I was trying on clothes in the store this past weekend and could really get a good view of them from behind in the jeans I was trying on. Given my small size do you think liposuction will work to get rid of them?
A: Despite being lean and very weight appropriate for their height, I have seen many women who have this saddlebag problem. While I suspect it is a problem of small saddlebags given your height and weight, they are nonetheless disproportionate. The good news is that this is an easy problem to solve with liposuction. Just because you are small doesn’t mean they are not abnormal collections of fat. I would guess your saddlebag problem could be treated by an office procedure under local anesthesia using Smartlipo. This would minimize the process and recovery and provide a solution that truly matches the problem.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had liposuction of my neck and jowls several days ago. The doctor who did my surgery told me to keep my head elevated when sleeping with two pillows and wear a neck compression garment. How important is it to wear this garment and does it affect the final result?
A: The purpose of the compression garment, as the name suggests and it is probably obvious, is that it applies some pressure on the treated area. Its only benefit is that it may help keep down some of the swelling in the first week after sugery. In most cases of liposuction, compression doesn’t usually make a big difference long-term in the result. You undoubtably are asking this question because neck compression garments, in particular, are a nuisance to wear. What I tell my patients, whether it is neck liposuction or a facelift, is to wear it regularly for the first two days after surgery and then just at night for the first week after surgery. Thereafter it may be discarded as it no longer provides any benefit and the patient’s tolerance for it has been reached.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a rather big nose (and it become much more bigger when I smile or grimace). How much of it can be reduced by rhinoplasty? Can I have nose like, for example, Angelina Jolie? And the other question is will my nose get bigger the (when I smile or grimace) after nose job?
A: The first concept to grasp about rhinoplasty surgery is that you can not have a nose like someone else. While it is important to have a surgical goal, looking like someone else’s nose is not realistic. This is particularly true when it comes to a large nose with thick skin. There are simply limits as to what can be achieved based on the amount and thickness of the nasal skin cover. Whether rhinoplasty is worthwhile for you, or any patient, requires some sense of what the result may be using computer imaging. When done carefully by an experienced rhinoplasty surgeon themselves, you will get a much better sense of whether rhinoplasty can make enough of a difference to justify the effort. When I do rhinoplasty computer imaging, I always show the most conservative or least achieveable result that I think can happen. That way if the patient chooses to have rhinoplasty surgery, they will not be disappointed and make even be pleasantly surprised if even more of a result develops.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting my cheeks lifted. I am 48 years old and my cheeks sag which makes me look sad. My face is plenty full as it is very round. What is the best non-invasive method to lift them up?
A: The first thing that I would tell you is that there is not a non-surgical way to lift up the cheeks. There is almost nothing that I know that can lift any part of the body without some form of surgery. Some doctors may tout that they can lift up parts of your face with injectable fillers and in some small amounts that may be possible for some patients in some facial areas. However, with an already full and round face this injectable approach is likely to make you even rounder…and have no real lifting effect anyway. There are cheek lifting operations but really good results from these procedures come from very careful patient selection. Whether you would be a good candidate or not would depend on seeing some pictures of you. As a general rule, very round and full faces are chcallenges for any lifting operation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am going to get breast implants and need some help in selecting size. I am currently a 34B with one breast about a quarter of cup larger than the other. They are perky but just not full. I am uncertain on whether to get saline or silicone implants and am looking for the most natural result possible.
A: When it comes to getting a natural breast augmentation result, it does not matter whether a saline or silicone implant is used. That has nothing to do with making a difference between looking augmented or not. Rather it is a function of implant size and implant location (above or below the muscle) as well as what your breast tissues look like now. As a general rule, it is almost always better to go below the muscle so that there is a natural slope in the upper pole of the breast. If you keep the implant base width at the same size or less than that of your natural breast base width, you will almost always look fairly natural. The size of breast implants is directly related to their base diameter. The larger the base diameter, the larger the implant. A simple tape measurement of your breast base diameter would help considerably in making a good implant size selection for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I am a young women and am very insecure about my forehead. It’s very large and I’m tired of bangs. As you can see in the pictures, my forehead sticks out because of the “horns” I have smacked in the middle of my forehead. It feels hard. It may just be the bone but I still want to see if any procedure can be done to make them go away or, if not, make them less noticeable when light is shown on them.
A: I can see by your pictures that you have an upper frontal bone bulges, often what people refer to as ‘horns’. There are two approaches to making your forehead smooth and less prominent. The simplest approach, and I suspect the one of most interest to you, is to do a burring reduction of these bumps to make your forehead smooth and less prominent. This would be done through an incision way back in the scalp. The other approach to forehead smoothness is to build up the forehead below and around it with a cranioplasty material. This would not only make your forehead smooth but would also give it greater convexity which is viewed by many women as a desireable forehead feature. Both of these forehead reshaping/reduction approaches will work to make the forehead smooth adn get rid of the bumps, it is just that the shape of the forehead in profile view will be different depending upon which one you would choose.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I had a submaxillary Gore-Tex implant placed at the same time as a rhinoplasty over fifteen years ago. It was done to elevate the area below my nose to improve the shape of the angle between my lip and nose. Later it was determined by an oral surgeon that I needed upper jaw surgery but that would be extremely difficult as this implant sticks to the bone and therefore he would not operate on me. I can live with all of the above; however, this implant is annoying as on the right side it continues to dig down into my right upper gum area. I have been told that this type of implant can be very difficult to remove and that it would be best to just leave it alone. What is your opinion on getting it removed?
A: To clarify the issues in regards to your Gore-tex facial implant, here is what I think:
1) To be exact, it is a premaxillary implant not a submaxillary implant. Because it is Gore-Tex and placed during a rhinoplasty, it was inserted through a nostril base incision initially. It was done to open up the nasolabial angle.
2) Gore-tex does not adhere to the bone and is the one of the least ‘sticky’ implants to remove. It is smooth and the body places a capsule around it.
3) Because it was placed long ago, it is likely a multi-stranded Gore-tex implant rather than a solid one-piece implant composition. This makes it a little more difficult to remove but certainly far from impossible.
4) Your premaxillary implant can be removed through an incision inside the mouth as that is just as close as going through a nasal base incision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I am 32 years old and two years ago I weighed 220 pounds. By diet and exercise, I have been able to get down to 170 lbs and I seem to be stuck at this weight now. It won’t budge no matter what I do. The skin on my stomach is very loose and I have old stretch marks that I want removed. I want a tummy tuck but do I need to lose more weight before having surgery?
A: Your question is both a good and a common one. While many people have been successful with a fair degree of weight loss, they sooner or later ‘hit the wall’ and can just not lose anymore. Ideally, I tell my patients that if you are within 15 to 20 lbs of the weight they desire then a tummy tuck is reasonable. If you weigh much more than that then you should wait until you lose the extra weight so you do not create loose skin after surgery should you undergo more weight loss. Realistically, however, once the weight wall is hit for most people that is as far as they will usually get so that has to be taken into consideration. Most patients that I see for tummy tucks appear when they are frustrated with their ongoing lack of weight loss results. You should also understand that only the stretch marks from your belly button to you pubic hair line will be removed. Any stretch marks above the navel will still be present after surgery, they will just be moved lower to a new position below the belly button.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I had a browlift several months using a hairline approach. While the surgery was uneventful, I have had a persistent scab along one side of the scalp incision that only recently I was able to get off. The scab was stuck to what appears to be the dissolveable sutures that were used. It now looks like an area of infection with some sort of red tissue between the scalp and foreheads of a few millimeters wide. Why is this and what do I do now? I have attached a picture of the area so you can see what it looks like.
A: It is now clear as to why you have had this scab this long and why it looks the way it does now. The scalp has a tremendous blood supply and this is why infection and necrosis of skin and scalp tissues is very uncommon. Neither of these have been what has happened to you. It appears that you have had separation of the wound edges in the early weeks after surgery, undoubtably due to the combination of tension on the scalp closure (which is normal) and the dissolveable sutures used. It appears that in your case those dissolveable sutures were just not sturdy enough to hold the skin edges together as they were healing. I used these all the time and have never seen this problem before.
Whenskin edges come apart, the body then creates its own bandage (i.e., scab) to cover the open wound it as it heals underneath it. This explains why the scab was stuck on so well for so long. That is a natural reaction of the body to an open wound. Once the gap in the skin edges fills in with granulation tissue (beefy red tissue that you see in your wound), the scab will get loose and be capable of being removed. This now leaves the gap filled in with granulation tissue that is now level with the surrounding skin. This is a good and healthy sign of a healing wound despite how it may look. This granulation tissue looks very red and angry but this is just due to the many blood vessels that it contains.
What will now happen is that the surrounding skin can now grow over it to make it a completely healed wound. This should take just a few more weeks to happen. The combination of granulation tissue, with a very high level of cells that contract, and the new skin will make the width of the wound and final scar once it heals much smaller. In the interim, of course, you have to persist with this unsightly wound in an area that is impossible to hide.
This leaves you with two approaches at this point and each has its own advantages and disadvantages. The first approach is to let the wound heal and contract and manage the residual scar at a later date. This is the most ideal approach from a long-term scar standpoint. This will leave a much more narrow scar area to excise and the tissues will be of better quality to manipulate so there is not a recurrent problem. The disadvantage is that you have to exist with this unsightly area in the interim. The other approach is to intervene earlier before it heals and excise and re-close the wound now. This has the advantage that it deals with the cosmetic appearance of it earlier but the tissue quality is not as good and how well the wound edges will hold together is a bit unpredictable.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about nose hump removal. I know that rhinoplasty surgery works well for taking down a large bump on the bridge of the nose. But I would like to avoid surgery if possible. May I ask if you`re familiar with nose magic product? Is it worth trying? The company responded quickly to my inquiry, saying that it can help by moving cartilage.
A: I am very familiar with Nose Magic and use a companion device occasionally on my postoperative patients to manage their persistent tip swelling. Do I think it will work to permanently take down a nasal hump…no. Did I think you have anything to lose by using it…no. It has its effect by temporarily squeezing the fluid out of the tissues causing a slight change in shape, just like when you pinch it and hold it for awhile. The problem with a nasal hump is that at least half of it is bone whose shape will not be altered by any form of external pressure. While nothing sells like hope, at least you can prove to yourself one way of the other, of this non-surgical approach to nose reshaping. You will find in the end, however, that only a surgical rhinoplasty will really work.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Earlier this year I had breast augmentation using 400cc saline implants under the muscle. I really wanted bigger implants above the muscle but my surgeon told me that they would ripple too much and the folds of the implant would be seen when I bent over. I went from a 32A to A DD cup but they don’t look that big at all. I would like to go bigger but still want to look natural. Would I have looked bigger if I had the implants placed above the muscle? If I wanted to go bigger can I have them switched to above the muscle?
A: There are a lot of advantages to having breast implants under the muscle, only one of which is less risk of rippling. Lack of mammographic interference, a less acute transition at the upper pole into the implant, and most importantly, a thicker and more vascularized soft tissue cover. (even if only the upper half of the implant is covered) I think you are confused that there will be some perceptible size difference if the same implant is placed above or below the muscle…there is no appreciable difference. While you certainly can increase the size of your existing implants, I would leave them in the same submuscular location. Being a thin-framed woman I would be cautious about getting too big of an implant that may not have adequate soft tissue support in the long-run. This can result in the breast implants bottoming out, a difficult problem to fix satisfactorily.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have two large earlobes and would like for them to be smaller. They seem to be getting bigger as I get older. I am now 57 years of age and I don’t think they were this big when I was younger. Do earlobes grow as one ages? I am also wondering about the cost for this type of earlobe surgery. Could I get an estimate and would any permanent scars result from it? Also how long does it take to heal or until I can take the bandages off? Thank you very much for your time.
A: Earlobes do in fact grow with age somewhat although not in the classic sense of growth. They do not grow anymore than your sagging jowls and neck grows. Rather it is an elongation process where the tissues stretch due to gravity and ear ring wear. As the earlobe is the only part of the ear that does not contain cartilage, the skin and fat has no resistant internal structure. Earlobe reduction is an office procedure done under local anesthesia. There are different earlobe reduction techniques that vary only in where the final scars are located. The scar locations can be down the central area of the earlobe, at the junction of the earlobe and the face, and along the bottom rim of the earlobe. Which one is best depends on the shape of your earlobe and where you would prefer the scar. There really is no recovery after this procedure nor are they any bandages used afterwards.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I am interested in getting a rhinoplasty and I want to know if my expectations for the result are realistic and achievable. I would like my nose to have a more delicate and feminine appearance as it is too wide. I think it doesn’t fit my face as fat as it is now. I would like it to be less wide and fat and to not project as much. My nose seems to stick straight out with very little sloping. Can this be fixed and how much can the fat tip be reduced? My nostrils also flare out considerably when I smile which I also dislike very much.
A: Rhinoplasty surgery can make very visible improvements in making a wide nose smaller but there are limitations in how much can be achieved. While the underlying cartilage framework can be resculpted and narrowed, how much that is reflected on the outside is highly influenced by the thickness of the overlying skin. Thick nasal skin not only retains swelling for a long period of time but it can only shrink so much. Taking a wide fat nose and making it a delicate one is a virtual impossibility. That dramatic a change may not be realistic. You should have computer imaging done first to determine if rhinoplasty can make enough of a change, particularly in the tip of the nose, to make surgery for you worthwhile.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have a lipoma of size 4″ on my back shoulder which happens to be most common place for a lipoma for many apparently. I want to be cured non-surgical way. I can travel to your location if needed. I heard about Lipostabil treating lipomas. Is it something I should consider? Please advise.
A: The standard method of a lipoma removal is complete surgical excision. While this is the proven medical method, it will result in a scar in the shoulder area. Scars in that area are very prone to becoming hypertrophic and red, although not all will. The use of a chemical injection (Lipostabil in Europe, generic name of Lipodissolve or mesotherapy in the U.S) to treat lipomas is not new. I have injected quite a few lipomas in the last five years for patients who did not want surgery. I have made the following observations about this treatment method. Lipodisolve injections have always made a visible reduction in their size. In some patients it has been a cure but some regrowth is possible if all the fat tumor cells are not adequately treated. It will take at least two and sometimes three injection sessions, spaced a month apart, to get the maximal response. There is some swelling and mild discomfort of the injection site for a week after treatment but it is in no way physically limiting.
While Lipodissolve injections can be effective, it is important to realize that neither the compounds used nor their use in lipoma treatments are FDA-approved.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very flat butt and have been researching buttock augmentation with fat transfer. (aka the Brazilian Butt Lift) I have a good amount of fat to take from my stomach area so I think I am a good candidate for the procedure. I know that not all fat survives after it is injected, so how does one compensate for that problem? What are realistic expectations for how much fat will survive? How does one know how much fat to transfer in a buttock augmentation surgery? How much fat can I expect to retain with my new butt and will it be permanent?
A: While fat grafting is very popular and can be highly successful, it is far from an exact science. There are so many unknown variables in doing it that no one can predict with any accuracy how much fat will or will not survive afterwards. Every patient and their fat is somewhat different leading to a wide variety of results. What we do know about fat grafting is that it is very safe and many people have more than enough to donate. What I have observed about fat injections into the buttocks (aka Brazilian Butt Lift) is that it often will produce less of an effect than many patients want. This is because of the combination of unrealistic buttock size expectations for some and the variable retention of the injected fat. As a general rule, I inject as much fat as possible (between 300 to 500cc per buttock) and judge the final outcome at three month after surgery. There is never a fear that the result will be too big. The real question is whether it will be big enough.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in getting breast augmentation. At 25 years of age with one child I have a height of 5’ 3” and a weight of 137 lbs. What size breast implants do you think I need? I have attached a picture of my breasts to help you decide.
A: In looking at your breasts, your most important decision about breast augmentation is not what size implant should be used. You have a moderate degree of breast sagging, meaning the position of your nipples is at or below your lower breast fold. Contrary to the perception of many, breast implants will not have a breast lifting effect. You are in need of some type of a lift if you are going to get breast implants. With implants alone your sagging breasts will be pushed lower, a look that I doubt you will find as an improvement. All breast lifts result in some scarring, a definite cosmetic liability. Whether larger and more uplifted breasts are worth the scars as a trade-off is what you need to think about first and foremost.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am 28 years old and I have lost about 95 pounds over the past year and a half. While I am very happy with my weight loss, I now have.a bit of loose skin around my stomach area. I work out a lot and do a lot of core work and abdominal crunches but this loose skin won’t go away. Is there some type of cream or device that will tighten this skin or do I need plastic surgery?
A: You are to be congratulated on your weight loss efforts and results. Reduction of fat can be rewarded with diet and exercise but your loose abdominal skin will not. Skin is not metabolically responsive like fat nor can it be toned like muscle. Do not waste your money and hopes on miracles in a jar or an exercise device. Only the manufacturer will benefit from your purchase. You will need to consider some form of a tummy tuck to get rid of this loose skin and tighten your abdomen. Whether the scar and the surgery expense is worth it merits a thorough discussion with a board-certified plastic surgeon.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a bad car accident three years ago which left me with many scars. Most of them are on my arms and back and and don’t bother me much because I can’t see some of them and I am tan enough so that they don’t show. However, the one on my face is awful. It isn’t a flat scar, but more of a jagged edge, indented spot on my face. It looks like a large unnatural dimple when I smile along my jawline. Can this scar be removed? I am planning a wedding for next year and would love scar free photos!
A: In looking at a picture of the scar, it can be seen to be a wide and indented scar along the jawline. Scars that cross the jawline rarely do well because of going over a transition zone between two facial planes and being exposed to tension. This will cause the scar to become wide. I think scar revision can make a big improvement but it is important to realize two important realities about scar revision. First, there is no such thing as scar removal or being scar free. There is improvements that can be made to an existing scar and it is all about how inconspicuous it can be made. But you will always have some permanent scar. Secondly, scar revisions take time to mature meaning that it will be red for months afterwards before the color blends in better to the surrounding skin.With a wedding coming up sometime next year, the sooner you undergo the scar revision the better.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have a small area of fullness on my chest that I just hate. There are bulges on both sides near my armpit that sticks out and it has always bothered me. While I am not fat and am actually fairly lean, this unusual fat bulge exists for not apparent reason. I can’t get rid of it by exercise and it does not fit the look of the rest of my chest. How can I get rid of these unsightly armpit bulges?
A: Most of the time when one refers to ‘fat in or under the armpit’ , they are speaking of fullness at the top of the bra around the strap creating what is often called ‘axillary breasts’. Most of the time this is not true breast tissue but simply fat as it is sitting above the pectoralis muscle. This can be removed very effectively by liposuction. If the fullness is more towards the inner aspect of the armpit below the edge of the pectoralis muscle then it may be real breast tissue. This needs to be removed by direct excision with a resultant scar as opposed to liposuction.
Q: I had my nose broken seven years ago that has left me with a crookedness to it that I am pretty sure is due to the bone. I also have had trouble breathing since the injury through the left side of my nose. I would like to get my breathing problem fixed and the nose straightened again like it was before. In addition at the same time I would like to get the tip narrowed and shortened which I think would make it look better overall as well. Will insurance cover all the costs of the procedure since most of my nose problems were due to the injury?
A: The complete corrective procedure to which you refer is known as a septorhinoplasty. This is a combined reconstructive and cosmetic procedure. Insurance will usually cover the medical necessary parts of the operation that relate to breathing improvement, the septoplasty and turbinate reductions. Changing the outward appearance of the nose known as the rhinoplasty portion, however, is not covered by insurance since it results in improvement in appearance not function. Both septoplasty and rhinoplasty are commonly done together and the out of pocket expense for the rhinoplasty is often less when done together with an insurance procedure than when done as a stand alone operation.
Dr. Barry Eppley
Indianapolis, Indiana