Your Questions
Your Questions
Q: Dr. Eppley, I plan on getting a rhinoplasty, chin, cheek and jaw angle implants this summer. It makes sense to me to have them all done at once. I have limited time off from work and only have a few weeks to recover at this time of the year. The one plastic surgeon I saw said he wouldn’t do them all at once as it would be too hard on me. I am not sure what he is talking about as I am young and healthy. I am aware that doing more surgery increases the overall risk of potential problems such as infection, but are there other risks to be taken into consideration, such as blood loss, that I am not aware of? Do you think it is safe and reasonable to have all of these facial procedures done at the same time?
A: In my experience and practice, I routinuely perform three, four, five or more facial procedures at the same time. For the reasons you have mentioned, such as recovery and other considerations such as cost, it is desirous to do a ‘facial makeover’ as a single stage procedure. There are no increased health risks for doing combination facial surgery in an otherwise healthy person. Blood loss is not a concern. With that being said, there is one risk that occurs in multiple facial restructuring procedures particularly those that involve facial implants…an increased aesthetic risk of implant asymmetries and the need for revisional surgery. The more procedures you do, the more risk there is for less than perfect results. Each individual procedure comes with its own aesthetic risks which are increased as more procedures are combined. Patients need to appreciate that the likelihood of the need/desire for revisional surgery is multipled as procedures are combined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 42 years old and I had Smartlipo last month. My main reason for having it was to get rid of my neck and chin waddle. I see a difference in my lower face and chin, but I still see the waddle just like before surgery. I have worn my neck garment faithfully but I see next to no improvement in the neck waddle. When should I be seeing results? The doctor told me it would take up to three months to see the final result as it takes time for the skin to tighten.
A: At your young age, it would seem logical that whatever neck and chin fat you have should respond well to liposuction. But the final results of liposuction performed anywhere depends on how well the skin tightens. Again at your age the skin should still have good elasticity. It is true that you should wait a full three months to see the final neck contour results. While the Smartlipo liposuction method does have some skin tightening capabilities, I emphasize to patients that this should be perceived in millimeters and not centimeters. Thus depending upon how much skin your waddle has, you may or may not see significant reduction over the next several months. If not you may need to consider a secondary tightening procedure such as some form of a necklift.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 49 years old and am interested in the LeFort 1 procedure. Please see attached photos and give me your advise, I had brace work done twenty years ago because my top teeth were behind my lower front teeth. I think a LeFort 1 procedure would have been more appropriate. Can it be done now? Please advise me as to what surgery would give me a more attractive face.
A: Thank you for sending your photos. What they demonstrate is that you have a midfacial hypoplasia and you are correct in that a LeFort I advancement done years ago would have been better for facial balance and midfacial fullness. But doing it now is not possible because it will change the way your teeth meet. This is why LeFort surgery and orthognathic surgery in general is done in conjunction with orthodontics. I have done them in patients your age and older but only if they were edentulous and wore dentures as new dentures are relatively easy to make.
What you can do now is camouflage your midfacial hypoplasia with paranasal/premaxillary facial implants to bring the base of the nose and the central maxilla more forward. This can be demonstrated with computer imaging.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been trying to figure out certain things about chin surgery. I have asked a couple of Plastic Surgeons about what is the difference between chin filling with injectable fillers and chin implants? Will either give you the same type results? Also, I would like to have a more pointed chin like that of the feminine version. Which procedure would give me this look, a chin shaving or chin implants?
A: The use of injectable fillers vs an actual implant in the chin creates very different effects. One should not be confused with the other in terms of outcomes obtainable. Injectable fillers create small changes in chin projection and shape that are temporary. Implants create large amounts of chin projection and shapes that are permanent. The only role for injectable fillers in the chin in my practice is a test for some patients who are uncertain about proceeding with the placement of a permanent implant.
As to the best method of creating a more feminine pointed chin, that would depend on whether you are happy with your current chin projection both vertically and horizontally. If the present chin position is satisfactory, then it can be reshaped by lateral ostectomies through an intraoral approach . If the chin position is deficient in any dimension then a chin implant can be used to improve projection as well as shape. To obtain a pointy chin with an implant, a central button style should be used.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I read about your method of skull surgery. I am a young man with male pattern hair loss. Since no real cure is available I think I should just cut it very short or even shave it. The problem is that I have a skull indentation. I have never heard of this treatment. Should I go to a plastic surgeon or to a neurosurgeon to get some advice on this matter? Since I deliberately do not cut my hair that short for it to be noticeable I could not take a picture of it where you would be able to see it. I have attached a picture of a human skull and circled the area. It is an oval shaped indentation about 2″ long or thereabout and slightly less wide. It is at the part of the skull that is bending towards the top of the head. For this reason it is noticeable even though it does not appear to be a very deep indentation. I hope you are able to get a general idea of what I am talking about.
A: The relatively small skull indentation that you have is ideal for the minimal incision/injectable cranioplasty technique. Using Kryptonite bone cement, it is injected into the indented skull area after the scalp has been elevated. This is done through a very small incision of less than 10mms. Once the cement is injected in a putty state, it is molded from the outside until it sets firm, a process that takes about ten minutes from injection to set time. The trick to this technique is to get a smooth result that is not overcorrected.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 22 years old and had 12 IPL treatments. My entire face has gone flat with no underlying support as the laser had a laserlipo affect where all the fat was melted, turned into liquid and digested by my body. However I read your article on fat returning after liposuction, so in a couple of years will the fat cells and all fat regrow back in my face, especially if I gain weight?
A: IPL is not a laser but high intensity pulsed light, hence the acronym IPL. Regardless of the semantics, it creates a subcutaneous heating effect which can affect fat. While not a typical effect, reports do exist like yours where facial fat has been resorbed. Whether the effect you are seeing is temporary or a long-term result is unknown. You will know your answer by one year after your last IPL treatment or if you attempt to gain weight. If not you may need to consider injectable fat grafting for restoration of certain facial areas if they are aesthetically problematic.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a subnasal lip lift last month and I hate the scar that has resulted. The scar is around 2mm height, goes from one nostril to the other and is indented about 1mm in depth. Would a scar revision help and would it cause any change to the current lip shape? (I want no more changes only want the scar removed) Another surgeon told me fat grafting to the scar can help. Is it true? How would a scar revision differ from the original cutting technique and closure? If it is the same, would it will lead to the same problem? Thank you again for taking time to answer my questions.
A: In theory scar revision may eventually be helpful but it is too early to make a final judgment on what your scar will look like in its mature state. But to answer your specific questions, any scar revision would not change your lip shape long-term. There is always lengthening and relaxation of the lip even when 4 or 5mms of vertical height is removed. While I love fat grafting and it can be very useful for many facial volume problems, I fail to see its benefits in your subnasal lip scar concerns.I would not think that any type of scar revision would be radically different from the initial procedure…other than less tissue is being removed and that places less downward tension on the scar. That may may the difference in the outcome.
The most useful comment that I can probably make is to not jump too soon into doing anything, particularly in the first months after surgery. The tissues are chronically inflamed and will not respond well to manipulation no matter how well done or cleverly designed the procedure will be. Ideally, you should wait it out for six months before having scar revision (if eventually needed) and allow all tissues to heal completely and undergo scar relaxation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was looking at possibility of laser resurfacing for my arm scars. My left forearm arm is completely covered on the bottom side from about two inches from the wrist to my elbow. Many are not deep, but several are. There are more than I can count. All scars are at least 2 years old. Also I was wondering if you had an estimated cost for something like that. I don’t have much money, but will be saving for this because it would allow me greater freedom with work and life in general, but we need a target to save for.
A: The usual scar pattern for arm scars secondary to self-inflicted injury is fairly typical. A large number of horizontal scars are usually present, often between the elbow and the wrist. Some may be longer and more wide but most are more narrow and short. The large number of the scars makes the consideration of surgical excision to narrow them impractical. A few large ones can be excised but most of the smaller ones will not be improved by excision and re-closure. While laser resurfacing seems like it would be effective, it rarely is. The scars go full-thickness through the skin so thinning of the skin by burning off the top layer will only expose more of the scar not less. In some cases I have performed laser ablation to create the effect of a full-thickness burn. This creates a large scar which is easier to explain than the many small ones from knife wounds. I have also done a wide excision of the entire area of arm scars and then covered it with a split-thickness skin graft. This creates a skin-grafted arm appearance which again provides a visual appearance that is easier to explain. When considering this route, a skin graft would be preferable to creating a full-thickness burn.
To give you a quote for surgery, I would first need to see some pictures of your arm scars to determine the best approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been debating about getting a Brazilian Butt Lift for the past two years and I’m finally ready to do it. I have waited so long out of fear that I will pay all this money and then the fat will just resorb. Is there any further encouragement that you can give me?
A: All surgery has risks and there is no doubt that the biggest one in the Brazilian Butt Lift is the unpredictability of how much of the fat will survive later. Fat survival rates vary widely but my observation is that up to 50% of the injected fat is retained after six weeks. There is a lot of variables that go into a successful fat injection transfer from the harvest method, to fat preparation and to the injection technique. You, of course, have no control over how the surgery is performed so make sure you choose your surgeon wisely and one that has a proven history of successful patient outcomes with fat grafting. The one benefit that you will absolutely be assured, however, is the contouring that will come from the fat harvest. Most commonly, fat is taken by liposuction from the stomach and flanks as these areas offer the greatest amount of available donor material. Other sites can be used as well but usually only contribute small amounts of fat. Regardless of the harvest sites, you can be assured of the contouring benefits of the procedure. That is the one guarantee result that comes with every Brazilian Butt Lift.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what can be done to fix my muffin tops after a tummy tuck? Six months ago I had a full tummy tuck and and a new belly button made. Right after surgery I noticed these bulges above my hips. My surgeon say it was swelling and it would go away but that has not been the case. They look terrible with my now flatter tummy. When I asked what he could do about them at my last check up, he told me to exercise and do abdominal twists and they would go down. I feel like he is just avoiding my concerns and doesn’t want to deal with me anymore now that she has my money. What are your thoughts on my dilemma?
A: Abdominal contouring for many patients is not just a 180 degree proposition. The excess fat can wrap around the whole way to the back. Thus abdominal and waistline contouring should be thought of as at least a 270 degree or greater approach. A tummy tuck, even a full one, however only affects the front of the trunk and its benefits stop at the front of the hip bones. This is why flank liposuction is a part of many tummy tucks in my Indianapolis practice. If not noted before surgery and left out of the operation, one could be left with very visible muffin tops after a tummy tuck. The goods news is that it is an easily solveable problem with liposuction and those bulgy muffin tops can be turned into a very pleasing inward curve to the waistline. The bad news is that it does require further surgery but it is a much smaller operation with a very quick recovery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant and buccal fat removal several years ago to make my face less round. While that has provided some significant improvement, I still feel my cheeks are too fat. The fullness that bothers me is the fat pad below the buccal fat area. I have had several consultations with differing opinions. One surgeon suggested liposuction with a mini face lift while another recommended a deep plane facelift with removal of fat under the cheek muscle. I am confused.
A: The specific cheek area to which you refer is below the buccal fat pad and is known as the perioral mounds. This is a fat layer that is separate from the buccal fat pads and will not be affected by their reduction/removal. It is a common misconception that buccal fat removal will thin out this area as well. Perioral mounds can be reduced by small cannula liposuction done through a small incision inside the corners of the mouth. I have found that ‘chubby cheek reduction’ usually needs a combination of buccal fat pad reduction and perioral mound liposuction to get the best reduction possible. In some cases, small cannula liposuction also needs to be done above the level of the nasolabial fold at the subcutaneous level. While a mini-facelift may help with tightening loose jowl and neck skin, it will not make a significant effect on the thinning of your cheeks. Skin tightening will not make a dent in the thinning of full cheeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in skull reshaping if that´s possible. I´m a 45 year-old male and I wish to know if there is any procedure to implant some type of material at the occipital area in order to increase that part of my skull and make it a little more aesthetic, because I have that part very flat. I would also like to know if that would leave me with very visible scars? I would like my skull elongated in the anteroposterior axis. Thanking you in advance.
A: There are numerous methods of skull augmentation or expansion. They all rely on adding synthetic materials to the deficient skull area in the desired shape. The two basic methods are cranioplasty materials, such as PMMA (acrylic) and hydroxyapatites, and a custom-fabricated silicone or silastic skull cap or prosthesis. There are advantages or disadvantages to each approach which fundamentally comes down to cost and the ability to get a smooth contour and the maximal amount of expansion. The limiting factor in how much expansion can be obtained is how much the scalp can expand and to get a relatively tension-free scalp closure over the augmentation material. In my experience, a safe amount of skull augmentation is about 10mm in thickness. That may not sound like a lot but it creates an effect more significant than the number suggests. All of these methods require an open approach with a scalp incision to place them. This results in a fine line scar across the upper back of the head, somewhat similar to the location of a hair transplant harvest scar.
Dr. Barry Eppley
Q: Dr. Eppley, I’m interested in having Smart Lipo to remove some fat on my chin. However, I have a chin implant that I got 16 years ago. One doctor told me that the risk of infection would be higher and the heat from the laser could move or melt the implant. He advised me to get another opinion and to ask the doctor before I make the appointment because some doctors’ immediate answer may be no. Can you please tell me about the risks and whether this is a good idea or not. Thanks very much.
A: My question to you is what you mean by ‘chin liposuction’. Do you mean having liposuction on the chin pad proper (which is highly unusual and associated with risks of irregularities) or do you mean liposuction under the chin area, formally known as the submental region?
Either way, I would see no negative effect of the laser probe on a chin implant. The location of a chin implant is deep and against the bone and is beneath the fat layer of the chin. There is also the mentalis muscle which exists between the chin fat pad and the implant. In addition, the melting temperature of polymerized silicone is quite high (over 350 degrees F) and the heat generated by a fiberoptic laser probe does not create or should not create field temperatures higher than 145 degrees F. In addition, inadvertent touching of the end of the laser probe to the implant (which should not happen based on the previous description of where the implant is located) will still not cause it to melt.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a breast reduction done when I was a teenager (now age 30)and now, if you can believe it, am thinking about getting breast implants. I am currently a 34B and was thinking of getting 350cc silicone gel implants if this will not make me too big. I am trying to get some fullness not necessarily be really big again. My main concern is am I more likely to have something go wrong or it is more difficult since I already have had breast surgery?
A: Surprisingly it is not rare that a former breast reduction patient will one day later desire a breast augmentation. This is a testament to the fact that a woman’s breasts are not stable throughout life. Their size and shape are affected by many factors. Teenage breast reduction has the potential for this to happen in particular as the reduced breast will be exposed to pregnancies which cause breast involution or breast tissue shrinkage. When coupled with the prior breast reduction, a woman can eventually end up with almost no breast tissue at all. The desire for augmentation after reduction may also occur if the amount of breast tissue removed was excessive.
Prior breast reduction surgery has no negative influence on the subsequent placing of breast implants. Reduction surgery occurs above the muscle, implants are generally placed below the muscle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a few wrinkles and extra skin on my lower eyelids that I would like to get rid of. I don’t think I need any blepharoplasty surgery and have read about lasers and chemical peels. Which of these two lasts the longest or do they both last a comparable amount of time? Which is most natural looking result or is there no difference? Which is least likely to excessively tighten skin? I am curious as to why laser resurfacing is so popular over chemical peels. Which has the least downtime?
A: There is no evidence that either method, laser vs TCA chemical peel, is more effective or long-lasting on lower eyelid skin rejuvenation. Laser do have a higher risk of hypopigmentation. Both are commonly used and it is a matter of comfort and experience as to which method plastic surgeons use.
It is likely you may also benefit by a pinch lower blepharoplasty with a TCA peel but I would have to look at your lids to answer that question. This is a favorite method of mine for the lower eyelids because it works very well with a very small amount down time. It is also the most minimalist method to guarantee that lower lid skin would be tightened to some degree.
Lasers are more popular than peels today for a variety of reasons. First they are more ‘high-tech’ and with that comes the assumption that they produce better results. In addition, their high cost and the need for the manufacturers to sell them drives a lot of more visible marketing efforts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What is the cost of the brow bone procedure on average and what would the consequences of this procedure be if they were to occur?
A: While brow bone reduction can be a very effective forehead reshaping procedure, the two most important issues for any patient to consider are cost (average total cost $ 8500), of course, but also that a scalp incision will be needed to do the procedure. For many men based on their hair style and density, such a scar may be a disadvantageous aesthetic trade-off. While there are many other minor considerations to be aware of from this procedure, these are the first two hurdles to get over before one can ponder the less significant issues of brow bone forehead reshaping.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had a chin implant which was done four years ago. Now I want to get a jaw angle implants to achieve a subtle outwards projection and a slight vertical projection such that the lower 1/3rd of the face becomes ever so slightly longer in the back. I only want subtle changes and do not want a very prominent square jaw. Instead, I want to retain the V shape ending of my lower 1/3rd of the face but just slightly stronger. Am I correct to assume that this can only be achieved through custom implants?
A:You are not correct in assuming that custom jaw angle implants would be needed to achieve your goals. While they could be done in a custom fashion, it would be more cost effective to modify existing stock jaw angle implants. Custom facial implants are almost always done when the size of the facial projection needed exceeds those implants which are commercially available. You are going the opposite and more favorable direction. Based on your description, I would recommend Medpor RZ jaw angle implants, small, which could be intraoperatively modified to 3mms lateral width extension and 5mms vertical length extension. That is about the size to me that you are talking about when you mean subtle increase in jaw angle projection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I currently have 300cc cc moderate plus silicone breast implants in place whichi were placed eight years ago. I have decided to go bigger and am going to get 650cccc high profile Mentor silicone breast implants through my old inframmary fold scar. My current implants were originally placed under the muscles with complete muscular coverage. Now that I am getting new implants I have read that most plastic surgeons now put them in a dual plane position instead of completely under the muscle. Do you think this dual plane location is better than what I have now and will it give me better results?
A: Historically breast implants were placed in a completely submuscular location. That technique today is largely passé and has been replaced by the dual plane method. What this means is that only the upper half or so of the implant is covered by muscle while the bottom half sits below it. The dual plane technique has become popular because it produces more natural looking results by not having the implants too high. This has also become necessary because the average size breast implant placed today is larger than that which was placed fifteen to twenty years ago.
This discussion for you, however, is largely irrelevant. When making a more than 100% increase in your breast implant volume, it will not be possible for the implants to remain completely under the muscle…even if you wanted it so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know your experience with breast augmentation revisions. Is this something that you have done often? I am considering revision from saline to silicone and believe I’d like to go smaller. My previous surgical site for the augmentation was axillary and can this be done again with a revision? Any information you can provide would be greatly appreciated.
A:Any plastic surgeon that performs a substantial number of breast augmentations will perform secondary breast implant surgery, given desires of changes in size later in life, change in breast shape due to pregnancy and weight loss and the eventual failure of most breast implants over a patient’s lifetime. So yes I have done many breast implant exchanges and revisional surgery.
I believe you are asking if your existing saline implants could be replaced with smaller silicone implants through your already present axillary scars. The answer to that question is maybe…and it depends on what size silicone implant needs to be inserted through such a small incision. In days past, I would say it would not be adviseable unless the silicone implants are fairly small (under 350ccs). But with today’s funnel insertion technique, much bigger silicone breasts implants can now be placed through much smaller incisions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an eye problem. My right eye is lower than my left by a few millimeters, I can tell because when I look straight in the mirror it looks lower as judged by the level of the pupil. I got punched in the face about five years around broke some bones around my eye but never had surgery. They said it wasn’t bad enough to have surgery at the time. But my eye has slowly sunk down over time. Is there a way to fix this?
A: What you have is called enophthalmos where the eyeball has dropped lower due to lack of bone support or fat support underneath. Most likely you had an orbital floor fracture which was not significantly displaced so surgery to fix it was not done at the time. But over time, fat atrophy may have occurred which is another well known cause of enophthalmos after such floor fractures. The best approach is to build the floor back up with a synthetic orbital floor implant. The question is whether you have enoughenophthalmos to justifiy the surgery. But then you likely would not be asking me about it if it was irrelevant to you. If done through a transconjunctival approach then the procedure would not create any new skin scars. The risks of such surgery would be persistent undercorrection, overcorrection, implant shifting and potential infection. The aesthetic side of these risks are more likely.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 25 years old and have a chubby face. I am slightly overweight but not as fat as my face makes me look. I am very self concious about my oversized cheeks. I also have a double chin which is very noticeable and unattractive. Do you think a buccal fat pad removal would help me? I have read on the internet that removing it may make your face look too thin down the road. However, I feel that I will always be stuck with a fat face and chubby cheeks as both my parents look the same way. Please advise on what you think would be the best way to help reduce the fatness in my face. Also, are there any less aggressive or non-surgical ways to lessen the fullness of my cheeks and chin? I have attached some pictures of me for your review.
A: In looking at your pictures, I can assure you that nothing short of surgery will help reduce the fullness in your face. I would recommend buccal fat removal, submental/neck liposuction and maybe even a small chin implant. These are some standard techniques in faces such as yours to make a visible difference. While these will not necessarily make your face, they will go a long way to reducing some fullness. It is also important to realize that buccal fat removal does not address all areas of the cheek region in reducing fullness. You will also benefit from liposuction of the perioral mounds and above the nasolabial fold, two areas that are full but lie outside any effects of buccal fat pad removal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have previously had breast implants placed below the muscle and donut lift around the nipple. While I thought that would be the best way to get my breasts uplifted and have a batter shape and avoid skin scars, it did not turn out like I thought it would. My breasts are too big and the nipples point slightly downward. I have read that the nipple can die in these more aggressive or full breast lift surgeries. Obviously I don’t want that to happen. What can I do or how should the surgery be done that would afford me the least chance of blood supply problems and loss of the nipple?
A: When it comes to getting the sagging breast really uplifted, I have rarely found the donut breast lift very satisfactory. So I am not surprised that you have had a similar experience. The one important thing that you can do with any type of breast lift or reduction surgery is to not smoke before or after surgery. If you are not a smoker, great. If you do smoke, you should quite one month before and continue cease smoking for one month after surgery. Fortunately, your breast implants are below the muscle so the blood supply to the nipple has not been previously disrupted. This makes the potential problem with nipple healing after more extensive breast lift surgery unlikely.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I don’t like the idea of losing consciousness under general anesthesia or IV sedation. Would it be possible to undergo cheek augmentation with malar cheek implants with only local anesthesia? I am very tough and I am not afraid of surgery or the sounds of surgical instruments at all, but I don’t want to feel any pain during the procedure. Is it possible to numb the midface area completely? Would you do cheek augmentation under local anesthesia if the patient is aware of the fact that this might be very uncomfortable?
A: While any type of procedure can theoretically be done under local anesthesia, that does not mean it is always a good idea. I have never done cheek implants under straight local anesthesia since it is a bone-based operation. I am sure one could get through it, but I could not promise that it would be completely pain-free. In addition, the most important aspect of the procedure is to get the implants into the correct position. You would not want anything to limit that objective. Always remember the purpose of the operation is about getting the best surgical result, not about how little anesthesia is needed. There are no rewards for seeing one ‘tough;’ one can be. In short, this would not be something I would advise or do… as I know well how this story would play out. To quote an anesthesiologist whose skill and experience I admire…‘the patient who states that will be just just fine under local anesthesia is exactly the patient who won’t be’. I would recommend that you do not have this operation unless you can come to the acceptance of doing it under sedation or general anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to get a flatter tummy, actually very flat. My hips may be a little big, which I can not change, but I know I can do something about my stomach. I have thought about a tummy tuck but wanted to know if a flat tummy is possible with just liposuction? If not am I a good candidate for a mini tummy tuck with less scar or do I just need a regular tummy tuck? I originally just wanted a regular tummy tuck to get rid of stretchmarks around my belly button. However, I think that if my tummy was flat by liposuction then the appearance of the stretch marks would be reduced. Does this make sense? I have attached some pictures for you to see what I look like.
A: While liposuction will reduce fat, it does not get rid of loose skin or stretch marks. It sounds like you intuitively know that a tummy tuck is a better choice but are hoping that you could get by with liposuction alone. Your gut instincts are correct. You will be happier with the results from a tummy tuck as excess skin is as much your stomach problem as fat. The debate between a full vs a mini tummy tuck is a classic one for many patients. The reality is that a full tummy tuck provides the best stomach contouring and is usually worth the extra scar length. Mini- tummy tucks are usually best in thinner women where a large skin excision would leave a very high scar placement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a scar in on my abdomen (from surgery on my pancreas and spleen) running from my diaphragm to just below the belly button. It goes through my belly button, and thus my previously “innie” belly button is now a bloated mess, let alone the “train tracks” on the scar running through my abbs. I wish to remove the train tracks, fix my belly button (make it an innie again) and fade the scar as much as possible. I’m mainly looking if it can be done and how effective would it be?
A: I would like to see a picture of your abdominal scar to determine what is possible. But having seen many such scars before, I would imagine that it can be completely excised including the suture tracks if there is enough lateral abdominal skin laxity. At the least, the scar can be narrowed considerably. The convex shape of the belly button can be converted back into a concave or inverted form at the same time. Given that the vertical abdominal scar runs completely vertical and perpendicular to the relaxed skin lines of the trunk, a subcuticular skin closure needs to be done with a secure suture such as that offered by the Quill line of barbed resorbable sutures. This can produce a very nice improvement from abdominal scar revision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in reduction rhinoplasty, alar base reduction, cheek bone reduction, and jaw reduction. I have diamond face jaw bones and cheek bones which are prominent and also have a big nose with an asymmetric alar region. I need a beautiful symmetric face with small nose and beautiful cheeks. Do you think this is possible? I have attached some pictures for your review and imaging.
A: Thank you for sending your pictures. I have taken a careful look at them and have imaged an open reductive rhinoplasty. Your nose, as you know, is the largest feature on your face and is disproportionate in size to every other facial feature. While there is a limit as to how refined your nose can become given the thickness of the overlying skin, you most certainly can obtain significant improvement. When it comes to cheek bone or jaw angle reduction, however, I fail to see how those procedures will make any significant improvement. Your facial skin and tissues are too thick to reveal any bone reduction underneath. You are better off leaving the bone structure as it is to support the thick heavy overlying soft tissues. Your soft tissues will simply not permit a delicate and more refined facial structure that you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have read about nipple reduction surgery and think that it is what I want to have. I am 45 years old but have long had nipples that stick out too far. There is barely any type of shirt that I can wear that hides them. My teenage son who is 15 years old has the identical problem (bad gene!) and I don’t want to see him suffer as I have over the years when there appears to a good solution. Would he qualify for this surgery? Also since we are from out of town can we have a consult and the surgery the same day? Thanks!
A: With parental consent, your son would qualify so there is no concern with that issue. Consults can be done by phone, Skype or e-mail so there is no reason to come for in for ani nitial evaluation when the problem is so visually obvious. I would just send me a picture or two of your and your son’s nipples for my assessment. Obviously they are too long and protruding but it would be nice to see them anyway in advance.
Usually nipple reductions are done under local anesthesia as a simple outpatient procedure. They should not be confused with more complex procedures like gynecomastia reductions.Whether a 15 year-old could handle that or not under local anesthesia I do not know although I suspect so. The toal cost of the procedure is $1500. You would just book the procedure(s) through our office after I have evaluated the pictures so it would be a one-time visit. Dissolveable sutures are used so there is no return follow-up needed.
Dr. Barry Eppley
Indianapolis, Indiana