Your Questions
Your Questions
Q: Dr. Eppley, I’m 25 and have one child, I would like to have breast implants but I’m afraid the cost and recovery time is too long. Can you give me any advice and info on the payment plans and the recovery times. Thank you.
A: Cost and recovery are always the biggest issues when any women is considering getting breast implants. So every potential patient has to contend with these issues so let me discuss the facts on both of them. The recovery from breast augmentation is really a physical therapy one since the implant is placed under the muscle. (in reality, partially under the pectoralis muscle) So how does one recovery from a muscular injury…use it! I place all patients on arm range of motion exercises the night of surgery and no physical restrictions thereafter. The more you use your arms (within reason) the quicker you will recover. With there be discomfort after surgery…absolutely, but most patients do not find it severe enough to be very limiting for very long. I would have to know what type of work you do to better answer how many days you would need to return to it. From a cost standpoint, the issues are the type of implant where does one get financing to do it. Saline breast implants are the most economical and we have all of our patients use Care Credit for financing. They are a national company that we have found to be the best to work with and has the greatest option of repayment plans.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, can the pubic lift affect the nerve supply to the penis or interfere with erection in any way?
A: This is actually a common sexual function question whether it is liposuction or a lift in the pubic region. Men are concerned that it will affect erection while women are concerned that it may interfere with having an orgasm. While the pubic region is near the sexual organs of either gender, neither a pubic lift or pubic liposuction will interfere with their function. The nerves to the penis lie deep and way below the tissue planes for either procedure. While the female clitoris is just below the pubic fat pad, liposuction does not traumatize it even though there is the possibility of some temporary labial or clitoral swelling and bruising as gravity pulls down any blood released during the procedures. Conversely in a handful of cases, I have had reports that a pubic lift in women has enhanced orgasmic sensations which may be due to changing the exposure of the pubic area. For men, pubic reduction may improve penile exposure and length.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am sending you some pictures of my lower eyes so please let me know what you think. I have bags and many wrinkles under my eyes even though I am only 29 years old! It’s so much worse when I smile because the wrinkles show much more!! I’m really excited to do something about it but scared of surgery!!
A: Thank you for sending your pictures. What I see is not really much infraorbital fat herniation. Rather I see some infraorbital rim hollowing and a lot of skin wrinkles when you smile. The infraorbital hollowing could be treated by fat injections and perhaps a little lower eyelid skin removal. But many of those lower eyelid wrinkles are impossible to treat surgically because they mainly appear when you smile, thus they are dynamic wrinkles. Much of your lower eyelid wrinkling needs to be treated by Botox injections to stop the muscle action.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am an active lady just turned 80 and I have a small amount of normal puffiness under my eyes. My concern is that I have puffiness in the corner of my eyes between my eyelid and nose bridge. It looks like a lump or a swollen gland and is puffy. Is there anything I could apply that would reduce that puffiness cosmetically or is this a surgical issue? Would cold or hot compresses reduce the size of this area of the eye? Could the fat behind the eyeball be causing this area to swell? What works best? Thanks for any suggestions you might have for this problem.
A: Undoubtably the puffiness that you see between your nose and your eye is not swelling. That is actual tissue, a combination of skin and fat, that is causing the bulge. Your assumption is correct that it is bulging eye fat. It will not be remedied by any type of external compression. Rather it is going to require surgical excision to remove the now protruding and excessive upper eyelid tissue. This can be done through an upper eyelid incision. (blepharoplasty)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had read online some of your comments about jawline reduction for square faces. So far, I have only seen jawlines that look like they have been cut and it looks unnatural and too short from the sides, and also, from the sides it shows no angles at all. I am therefore hesitating to do this surgery. Asymmetries (I wonder how that can happen since X rays are being done) and sagging skin. I am just looking for the angles (the whole jawline?) to be rounded off just enough so my face doesn’t look square; I have done Botox but it created some jowls and my face got hollow and it only reduced the masseter muscle, I had a hard time smiling too and the muscle would bulge when I ate.
What should I do to have a more feminine, natural, softer jawline? I want to avoid sagging skin too (I’m 42 years-old); will shaving only a bit would avoid this? Is it worth it then?
A: The key to jaw angle reduction is understanding whether jaw angle ostectomy (amputation) is needed or whether jaw angle outer corticotomy (width slimming) is needed. Unfortunately, the historic concept of jaw angle amputation persists and is commonly used, whether that is what the patient really needs or not. That is why you see faces, as you have described, that have had jaw angle reduction and look like they have no angles at all. Your jaw angles would need to be reduced using removal of the outer cortex only, thus reducing width but not losing the support of the bony angle completely. Your ‘failure’ with Botox injections indicates that the muscle is not the primary reason for the excessive contour. Whether reducing the outer cortex of the jaw angles is worthwhile depends on how much the bone is contributing to the flair that you have. The Botox treatments you had is a favorable indicator but it would be conclusively helpful knowing what the bone looks like as well. Therefore a simple AP facial/jaw x-ray view would be most helpful to decide either way if this procedure would be helpful.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello! I found you searching the internet and I find your work great. I just can find information about recovery for lips enlargement for this kind of operation http://exploreplasticsurgery.com/wp-content/uploads/2009/01/lip-advancement-surgery-indianapolis-dr-barry-eplpey1.jpg .How long does it take for scars not to be visible anymore? Or how long it takes for it to be slightly visible?
A: Other than some moderate lip swelling, there usually is no bruising with lip advancement surgery. Patients report little to no pain as the upper lip will have some temporary numbness. So the recovery is very quick as there are no physical restrictions after surgery. The scars from lip advancements heal very quickly and are minimally visible in 3 to 4 weeks after surgery although that will be somewhat dependent on the patient’s age and the preoperative shape of the lip. (younger patients take a little longer than older patients) Full scar maturation is a process and one should anticipate that the final appearance of the scar is one of months and not weeks. As there will always be a permanent lip scar, one has to have a thin and small lip that justifies that trade-off. One can wear lipstick one week afetr surgery so scar camouflage is easily done through the scar maturation process.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I’m 22 and I’ve had bags under my eyes for a long time. I believe in my case it’s hereditary. I’m tired of hiding my eyes behind my glasses. I would like to know about procedures( a little scared) and around how much it would cost.
A: Given that you are only 22 years old, any bags under your eyes is congenital herniated infraorbital fat. You are too young to have any excessive skin of the lower eyelids. This could be improved by a transconjunctival (through the lower eyelid) blepharoplasty procedure. By going inside the lower eyelid, bulging fat can be removed from the lower eyelid area without an external incision underneath the lashline. This is a procedure that has a very rapid recovery with minimal bruising and swelling afterwards. There is usually a little drainage from the eye area for a few days from the incision inside the lower eyelid. (the incisions are not closed as sutures would rub against the eye ball and risk a corneal abrasion) Patients report little to no pain after the procedure. The typical cost of the procedure would be around $3500 which would include all associated costs.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am hispanic and I had rhinoplasty ( alar reduction) almost 4 years ago. A revision was subsequently performed as well because my nostrils were uneven and I also noticed one side had a depressed scar. Fast forward 4 years, my nostrils are even but the scar stayed the same. I started with Kelocote scar gel, then at-home glycolic peels, and surface microdermabrasion but these have only worked for a minimal amount of time. I have done all sort of research regarding scar removal but, wanted to have a professional opinion on what other options I may have for diminishing the appearance of my scars.
A: Without seeing pictures, it would be impossible for me to say what scar approach would work. But knowing that you are Hispanic and have tried most topical approaches, I suspect that only excision of the scar would be beneficial. But this would only be advised if the scar was wide. If it is a narrow but visible scar, there is likely no improvement that can be done. In this case, you may be searching for a scar revision solution that does not exist. Unfortunately in patients with greater skin pigments, this is always a risk in alar reduction surgery. However, I would not commit to any of these statements before seeing a picture of your alar scar concerns.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have been searching the Internet for resources on augmenting the brow ridge and have come across your very informative website. I would like to have deeper and a more masculine brow ridge. I understand that it can be done with bone cement. However, would fat transfer to the area work if only a moderate correction is needed as I would prefer to avoid the scalp scar.
A: I would certainly agree that fat injections would be a very reasonable alternative to the formal placement of bone cement for modest/moderate changes in brow bone projection. There is always great uncertainty as to how much fat would survive and its potential for asymmetry/unevenness. But those risks seem as very tolerable when one wants to avoid a scalp scar in brow bone augmentation. In other words, there are not other non-incisional options and this is a very safe and low risk approach using one’s own natural tissues. I have used an injection approach numerous times with synthetic injectable fillers and good results have been seen even if they are only temporary. The thickness of fat allows it to give a better tissue ‘push’ than the softer synthetic fillers.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I live overseas and am interested to fly over and get the corner of mouth procedure as shown on your website. I have had many small surgeries so I am not at all apprehensive and understand more or less what will happen. The only request I have is will there be a scar?
A: While a corner of the mouth lift is a fairly simple procedure, it is important to understand that there may be a small outward scar from the corner of the mouth in most patients. In many cases I try and keep the scar to stay along the vermilion-cutaneous border (lip-skin border) particularly in younger patients. In looking at your pictures you will note that the downturned corner of the mouth is also associated with an upper lip vermilion (pink part of the lip) that completely tails off before it ever reaches the corner of the mouth. This is actually very common and indicates that it may need to be part of the solution as well. Thus the most effective corner of the mouth lift in your case is one where the skin removed also involves a vermilion advancement that encompasses the outer 1/3 of the upper lip border.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have contacted you in the past about questions I had regarding indentations I have on my skull, and about fixing them with a cranioplasty. You responded by telling me that I would require an open approach cranioplasty and the incision would be bilateral from ear to ear. Along with having a large indentations on my skull, I also am going bald. I am interested in getting a cranioplasty done by you and also am planning on getting a FUE hair restoration at some point.
My questions are:
1. If I was to get a FUE hair transplant/restoration would it be better to do it before or after the cranioplasty?
2. Would it make sense to do it after, so it mite be able to help cover the scar? or does it even matter?
3. Also can you diagnose what the name of the medical term/condition is that I have wrong with my skull by looking at the attached pictures I have here?
A: In answer to your questions, you would always want to do hair tranplantation AFTER a cranioplasty. This is because it would also give one the opportunity to place hair grafts along the scar should that be necessary. While this could always be done after, you would like to have that option during the initial FUE procedure. Usually that is not necessary but it is a theoretical option that you want to keep available given that bothi of these procedures are elective and can be done anytime in any order.
I believe what you have is a very incomplete form (microform expression) of bicoronal craniosynostosis. This is because you have deep indentations (like a constricting band) right along the exact location of the underlying original coronal suture locations.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, What is the difference between liposculpture And liposuction? I am 55 years old and scared of the skin sagging or wrinkling At my age with liposuction, I would love my inner thighs, knees and saddlebags gone forever.
A: On the one hand, the difference between liposuction and liposculpture is largely one of marketing. The term liposculpture implies a greater degree of finesse and precision than the historic term of liposuction . As a result some doctors use this term for any form of liposuction because it simply sounds better. That does not necessarily mean, however, that it is or that the body is truly sculpted. Conversely, if applied to the right situation, the term liposculpture may have some real meaning. The right situation in my experience is when one is doing smaller areas of fat reduction using smaller cannulas where getting a more precise result and truly creating a visible contour change occurs. In short, liposuction implies large volume fat reductions where a simple size change occurs. (i.e., a full abdomen) Liposculpture implies smaller and more precise volumes of fat removed to create curved contour changes. (i.e., neck, knees)
Based on your age and areas of concern, however, these liposuction concepts are not what is important for you. You are appropriately concerned about what will happen to your skin at your age with any form of liposuction. The effects of liposuction on the overlying skin change based on the area being treated. I would not be concerned about the knees as skin never sags in this area no matter how much fat is removed at any age. Conversely, the inner thighs are a treacherous area for irregularities and skin sag at any age. I would approach the inner thighs with modest fat removal or none at all. If any significant skin sag exists now you would be better off with some form of an inner thigh lift if you want to go that far. As for the saddle bag area, this is a good area to treat but the key is to not remove too much fat as skin sag as some irregularities will occur with too much deflation. You may also have to accept some negative changes in the skin in the saddle bags no matter how much fat is removed.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, how much do jaw implants cost roughly? If someone already has a decent jawline but would like to enhance it would that cost be less as opposed to someone who needs a lot of work done?
A: The main difference between the cost of jaw implants, and I will assume you mean combined chin and jaw angle implants, is whether off-the-shelf implants can be used or whether custom ones have to be designed and made. Since you already have a decent jawline and ‘only need a little work’, I will assume standard chin and jaw angle implants can be successfully used. There are differences in these types of implants and the materials from which they are made and this also affects cost. But I will make the assumption that silicone chin and jaw angle implants can be used. Using those inmplants, the total cost of chin and jaw angle augmentation would be around $ 6500.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had fat injections done under my eyes to correct some hollowing that I naturally had a month ago. I understand that there is still some swelling, but the areas around my eyes that were injected with fat have become really lumpy and uneven. Is there anything that can be done about this? I have tried massaging the area but there doesn’t seem to be much difference.
A: Fat injections are notorious for irregularities in the lower eyelid area. While they can look and feel smooth in the first weeks after surgery, any irregularities become apparent as all swelling subsides. And irregularities are the norm not the exception. This is because fat injections, unlike synthetic injectable fillers, are not linear and smooth as they are injected. Fat is more ‘clumpy’ and as a result does not come out of the injection port in a completely smooth fashion. The goods news is that your fat injections are in a state of healing and this is not the final result. This would be a different story if it was 6 months from now. You have to massage and knead them fairly firmly. You need to work the lumpy areas against the underlying infraorbital bone, pressing on them to try and flatten them out. This is a process in evolution whose final result in terms of smoothness will not fully evident until 3 months out from surgery.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, my question is regarding your last article about cranioplasty. Near the end you include the following statement: “The limiting factor is that the narrow skull beyond the temporal lines can not be augmented with material as it is covered with temporalis muscle.” I’m considering having a cranioplasty for enlargement (aesthetic reasons, exclusively) and you are my first option to having the procedure done but I would like to have the aforementioned area enlarged as well as all the others. I would like to know if there’s a solution for this.
A: The normal anatomy of the skull is that under the scalp across the top (between the temporal lines) is only bone while at the sides there is a layer of relatively thick temporalis muscle under which the bone lies. Whether it is a cranioplasty that involves temporal skull augmentation or bone reduction, the temporalis muscle must be considered and managed. There are two basic approaches when extending skull augmentation beyond the temporal lines down along the sides. The first approach is to leave the muscle alone and merely place the material on top of the temporalis fascia. When so doing, it is critical to feather the material to a very tapered edge to avoid a palpable or visible edge demarcation. This approach is best used when the amount of material/augmentation that needs to extend beyonf the temporal line is minimal. When more substantial augmentation is needed that extends further down into the temporal region, a submuscular approach is used. The upper edges of the muscle are released and the material is placed undeneath it. The key to this approach is that the muscle must be resuspended back up over the material to the temporal line as much as possible. This is done by suturing the upper edge of the temporalis fascia to the material as close as possible to the original temporal line.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a craniotomy for an aneurysm over a year ago with radiation. This has left me with many effects from facial nerve paralysis. It has affected my face from the brow the whole down to the neck with a facial droop. I have attached pictures for your assessment. When I lay down my right eye does close which it did not do for quite awhile. The only movement I have on my right temple is a slight lift of the inner tip of the eyebrow. When I try to wrinkle my brow it goes slightly past center but it curves downward. The corner of my mouth was much further down than now. Originally there was no movement at all. I am now able to turn the corner up and the area of movement still seems to be increasing.
A: Thanks for sending your pictures. What they indicate to me is the following:
The frontal branch of the facial nerve is gone which is why the eyebrow does not lift up. As long as the eyebrow has not drifted lower than the opposite normal left side, I would not do any procedure for it. (i.e., browlift)
It is good news that the upper eyelid does now nearly close. As long as it closes completely when you lay down, I would not place a gold weight in the upper eyelid which is the normal treatment for a partial or slow closing upper eyelid.
The lower eyelid, as previously mentioned, needs a procedure which will help it considerably. It needs to be lifted and tightened up against the eyeball. To achieve this more is need to be done than just a traditional lateral canthoplasty. (tightening the lateral canthal tendon at the corner of the eye. That procedure needs to be combined with a fascial sling (harvested from the temporalis fascia) that would be placed from one corner of the eye to the other, much like a clothesline. Together this is the most effective method for lower eyelid tightening and resuspension.
The right face and lower corner of the mouth appears to be in some state of gradual improvement although it is probably not realistic to think that completely normal mouth movement will ever occur. However,, as long as it is improving, I may defer any type of static corner of mouth resuspension until later although that is still up for further evaluation.
The entire right facial droop may be treated with a complete facial resuspension (facelift) on the affected side. That is certainly reasonable to do at anytime. This may be combined with a corner of the mouth lift, both of which will not negatively impact any ongoing facial nerve recovery.
The right temporal area is sunken in due to the effect of the combined craniotomy and radiation, which has caused the temporalis muscle to shrink or atrophy. This is a very common effect from this exact neurosurgical procedure. The temporal area could be built back up using a variety of techniques which would depend on the dimensions of the volume lost. I can not tell exactly from the pictures to give you a better idea on how that would be done yet.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am wondering if I want to do Ulthera and laser hair removal laser at the same time in the same area? The area is my temples to my outer eyes or upper cheek bone. Is that dangerous?
A: While the energies used for Ulthera and laser hair removal is different, their effects are the same…heating up tissues under the skin. Given that both technologies generate considerable heat, I would not do the both during the same treatment as you risk creating a burn injury. There is no benefit in taking this risk for cosmetic enhancements. These two skin treatments should be spaced at least a week apart to avoid this skin damage risk. While they should not be done together, their effects are somewhat synergistic if they are not staged too far apart. The heat creation form both will help create a better skin tightening effect than if Ulthera was just done alone. It is also theoretically possible that the heat from Ulthera may help inhibit hair growth as well.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am 42 years old and had a tummy tuck two years ago after my third and final child. While I had some rather dramatic improvement and am pleases with the overall result, there is one area that still remains problematic. I have this persistent swelling between my tummy tuck scar and the pubic bone. It has never gone down completely and I don’t understand why. It sticks out in dresses and tight pants like a bulge and is a visible ledge if I try and wear a swimsuit. What can I do to get rid of this swelling?
A: What you have is not swelling and is a not uncommon finding for some patients after a tummy tuck. It is residual fat in the pubic mound area that is below the effect of a tummy tuck. The tummy tuck scar in most patients becomes the narrowest part of the waistline and can look like a constricting band above the puffy pubic mound. Sometimes this is recognized before the tummy tuck and its reduction by liposuction done at the same time. In others, it becomes obvious after a tummy tuck. It can be very effectively reduced with a small liposuction procedure. (pubic mound liposuction)
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had one of those TV-advertised facelift procedures last year. Having had it done under local anesthesia of which I would not go through again or every recommend, but that is a different story. What I am considerably bothered by are the scars in front of my ears and that my earlobes are pulled down. They never bothered to mention that either of these two issues could ever occur after surgery. I have read that my ear problem is known as pixie ears. What can be done to fix them?
A: The pixie ear deformity occurs after a facelift due to inadequacies in how the procedure was performed. This is what can happen when all the lifting of the skin flaps is supported by the lower part of the ear. Not to soon after surgery the tension on the non-cartilaginous earlobe will result in it being pulled down creating what has been described as a martian or pixie ear deformity. Poorly placed scars in front of the ear and the distorted earlobes often happen from those poorly trained in facelift surgery who does not understand the basic principles of the operation.
There are two basic approaches to correcting the pixie ear deformity. A simple release of the ear and shortening of the earlobe can be done but this will leave a small vertical scar below the earlobe. The other alternative is to readvance the facial skin flaps (repeat facelift to some degree) and tuck the scar up under the released earlobe as well as behind the tragus of the ear. This will reposition all scars into more aesthetic locations which should have been the result of your first facelift procedure.
Q: Dr. Eppley, I had porex cheek implants implanted then removed a year later. It has been about 8 months since the removal and I look ok and do not have any sagging, however, I do have excess scar tissue that is built up on the bone of the cheek. It is not that bad (meaning hard to see without feeling the face) but it is quite lumpy in some spots (especially on the one side) and I would like it reduced if possible. I heard steroid injections work well, but not sure. Your opinions? I am a 27 year old male. No other plastic surgery or intention for future surgery. Thanks!
A: What you are referring to as scar tissue is the residual capsule left after removal of the cheek implants. In most cases, much of that capsular scar tissue will resorb over time but it may well over a year for maximal absorption. While steroids are commonly used for scar issues, most of that is done at the more superficial skin level where control of placement of the steroids can be visually done. While steroids could be injected deep into your cheeks, I would not do it because you have no assurance as to exactly where it is being placed. Indiscriminate use of steroids can be associated with fat tissue loss and tissue thinning. Given that your scar problem is not visible, I would not risk potentially creating another problem that may turn out to be just as bothersome or worse than what you have now. You are better off to live with what you have, no matter how it eventually turns out.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had gastric bypass surgery, and my breasts have flattened out and sag now but so far my actual cup size hasn’t altered all that much. I need a consultation to see what can be done to improve the look and shape of my breast. They have been large my whole life so I definitely do not want larger breasts at all.
A: With your weight loss, you undoubtably have lost some breast tissue volume or they would have not have flattened out and sagged. For a good breast shape, you simply have too much skin for the amount of breast tissue volume that you now have. A full breast lift does not remove any breast tissue but rather only the amount of skin needed to lift and reshape your breasts to a restored position back up on your chest wall. With that the nipple is moved up considerably to a central position on the respositioned breast mound. Interestingly, most breast lifts will actually make the breasts look smaller and never larger. But by your own description, you would not be offended if your breasts do look somewhat smaller. The only negative aspect of a breast lift is that there will be scars. These will be the classic anchor or inverted T scars that are typical of a full breast lift or a traditional breast reduction surgery.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I would like to have an otoplasty done for my protruding ears. But I have seen numerous otoplasty results on the internet on doctor’s websites and many of them look overdone to me. The middle part of the ear seems to be pulled back too far and the upper and lower parts of the ear still stick out. Can I get an otoplasty performed in which the ear is closer to the side of head but it is smooth from top to bottom?
A: The setting back of the ear through cartilage reshaping (otoplasty) is as much an art as it is a science. And how much setback a patient desires does vary with each individual case. It is important to have a good understanding before surgery as to how much setback you consider to be adequate or even too much. Many of the untoward otoplasty results to which you refer is not the result of how the cartilage was repositioned but by a lack of setting back the earlobe at the same time. The earlobe has no cartilage in it and is thus not affected by any cartilage suturing. It is an often forgotten part of an otoplasty and can make the middle part of the ear look like it is pulled back too far if it is not changed. In those protruding ear patients that also have an earlobe that angles out (and many do) it is important to set the earlobe back at the same time as the cartilage to ensure that the outer helical rim is a smooth line.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had saline breast implants placed under the muscle 11 years ago. While I know they have not ruptured, they seem to be less full and firm that they used to be. Is it possible that they are slowly leaking saline but without a rupture. Do saline implants get weaker over time and more likely to rupture? Are they more fragile now and more prone to rupture? Should I stop doing strenuous physical activities?
A: Your breast implant experience and questions are common. Many augmented breasts, although not all, over time will feel softer and less full years later. This is not the result of something going on inside the implants but rather what has happened on the outside. The pressure of breast implants over time will cause the loss of some breast tissue between the implant and the skin. This is known as pressure atrophy. With the loss of some breast tissue, the breasts will feel softer and less firm. With saline implants, the breasts may really feel loose and ripply as there is no longer as much tissue between the implant and the skin to act as a cushioning buffer…and this then reveals the more rippled surface of a saline implant.
The second part of your question is actually true. The shell or bag of a breast implant does get weaker over time, no different than any other manmade device. The constant stretching of the bag does over time create flaws or weak spots in the silastic shell which will eventually lead to a spot of rupture. While this is inevitable, there is no reason to stop doing any type of physical activity that you enjoy. This is not different than one stopping driving so their car tires will never wear out.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am now 10 weeks after cheek implant removal. Implants were removed because of infection and incorrect asymmetry. I am now thinking of getting Sculptra, Radiesse or Juvederm but am getting different answers as to how long I should wait to get the injections after removal. I still have some fluid, swelling and lip numbness after 10 weeks post op. My implants were put in October 2 and removed November 2, so they were only in for one month. I am very concerned about my health and healing from this and want to wait long enough to make sure the filler injections are safe. But my face looks worse than it did before the implants. Your expertise is very much appreciated!!
A: I would agree that complete healing should take place before you place any injectable fillers, even though the tissue plane where they will be placed is differngt from that were the implants were. That would be a minimum of three months. But a better barometer rather than just raw time is when the cheeks are no longer tender and any signs of numbness has completely dissipated. In short, don’t do fillers until your cheeks feel completely normal again.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had jaw augmentation and a little lipo in the neck area…It was performed 2 weeks ago today….I can’t move my bottom lip in a downward motion which means I can’t smile….I still have a great deal of swelling although significantly less…Is this nerve damage permanent or could the swelling have something to do with it.Your advice would be greatly appreciated as I am very nervous. Thank you. It was performed by a very reputable surgeon but none the less I now bad outcomes can happen to anyone.
A: What you have is weakness of the marginal mandibular nerve branch of the facial nerves. This tiny nerve branch, which supplies the depressor muscle of the lower lips, crosses over the jawline on the side of the chin. It is not really at risk from the jaw (chin) augmentation since that is down at the bone level which is deeper. It is at risk from liposuction of the jowls particularly if liposuction is done at or above the jawline which is exactly where the nerve runs. Nerve injury from liposuction , because it is a blunt instrument, does not cut the nerve but bruises it. This may make it weak for a period of time (unable to lower lip) but recovery almost always occur. Nerve recovery does not parallel swelling reduction, however, and usually takes much longer. In most cases llike yours, full functional nerve recovery can take up to three months or longer. Given that there is no other treatment, patience is all you can do for it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like some information about breast augmentation re: price of inital consultation and surgery fees. Also, I am currently breastfeeding but am weaning and plan to be done within the next week or two. I would have to have the surgery between the end of March or before mid April due to when I can take vacation from work. How long does the surgeon require to be done breastfeeding before doing the surgery? I’ve researched and it looks like a lot say a minimum of 6 weeks? Thank you for your time.
A: The issue of when to undergo breast augmentation after breastfeeding is a relatively common question and there is no real exact timetable. Delaying having breast implants placed until after breastfeeding is based on having a non-engorged breast (so one can estimate breast implant size better) and having an increased risk of infection due to breast milk leaking onto the surgical field. Thus the key questions are how quickly does the breast deflate and assume its normal deflated size and when does the milk production dry up. Once can see that will vary tremendously for many women. I feel that breast size reduction is more important than absolute cessation of milk production, since I do not use nipple incisions and the nipples can be covered with sterile shields (dressings) during surgery. Therefore, I do find the general estimate of six weeks after breastfeeding to be a reasonable schedule to undergo breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am really interested in a new procedure called “Fractora Firm”. Do you do that and if not, do you know anyone in the state of IN or surrounding states who does? This would be much less costly than a facelift.
A: The procedure or technology behind the Fractora Firm is radiofrequency (RF) energy driven into the skin to creatre a mild firming or skin toning effect. What has caught your attention to it most likely is its recent appearance on the Dr. Oz show. The use of RF and a variety of other energies (ultrasound, pulsed light, galvanic electrical currents, etc) to try and improve sagging skin is not new. Over the past decade there have been a slew of these energy-driven technologies, all of whom capture media attention as they have become available for patient use. They capture the public’s attention due to the widespread concern of sagging facial tissues as one ages and the hope that it will avoid the need for a ‘facelift’.
It would be a far reach to consider it or any similar technology as a replacement or substitute for what a surgical facelift does. Calling it a non-surgical facelift is a marketing concept not a clinical reality of what actually happens. It is better to think of it as a skin toning or firming method not a sagging tissue lifting method. As a result it is best used on younger patients with early signs of facial aging such as a small amount of jowling or just a little loose neck skin. It is not for someone who has more moderate to advanced facial aging with really evident jowls and a neck wattle. Its success, therefore, is highly dependent on proper patient selection.
What is also not evident on the Dr. Oz show is that Factora Firm requires multiple treatments, usually 4 to 6 treatments spaced a week or so apart, to get the optimal facial toning effect. Thus the cost is not really $300 (as stated on the show and the website) but $1200 to $1800 for a series of treatments. Whether that cost and the effect that it creates is a better value than a ‘facelift’ would depend on the degree of facial aging that one has. If one does not really need a facelift then it is a good treatment that may be worth the cost. If one really needs a surgical facelift, then such treatments are a poor value.
In my practice, we offer a similar non-surgical treatment to Factora Firma using RF energy (Exilis) combined with more superficial fractional laser resurfacing for skin tightening and a mild amount of facial skin lifting. This combined treatment is superior because it combines heating up the underside of the skin (dermis) with a more superficial (epidermis) treatment. This produces the combined effect of skin tightening AND wrinkle reduction. For some patients a more intense single treatment is fine while others may be best served by lighter treatments done in a series.
I would be happy to review any pictures of you to determine whether you are best served by considering a non-surgical RF skin tightening approach or whether something more surgical is more appropriate. While every patient wants to avoid surgery and their associated costs and recovery, most patients would also like to avoid throwing their money away on a treatment concept that never had a chance to achieve what they wanted.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a very active 28 year old man who has both a scar and bump at the top of my forehead. They have both bothered me for years. I have been meaning to contact your office for quite some time, but have been a little hesitant. I would like to learn more about my options. I guess we can discuss everything in more detail once we make contact. I tried to take the best pictures possible to make out my concerns. I took one with a ruler just to give you an ideas of the length of the scar, its about half an inch long. You can semi make out the bump I’m concerned about, the high point of it is around the location of the scar. I look forward to hearing from you.
A: Thank you for sending your pictures. I can see the forehead bump which I view as more prominent and obvious than the small scar. The scar can be used for incisional access to burr down the forehead bone bump. The real question is whether the concomitant revision done on the forehead scar would end up much better after it healed. This is because of two factors, your ethnicity with darker pigment (which notoriously scars poorly) and that there would be some stretching of the skin edges for the bone bone burring. (which could potentially cause the scar to hyperpigment or widen after healing)
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had fat from my hip added to the left side of my face. I had a hollow side due to radiation, it’s been about 7 to 8 years since I had this done. And the fat has dropped and looks terrible, what can I do about this? It sticks out and hangs down.
A: You undoubtably had a dermal-fat graft taken to reconstruct the soft tissue atrophy on one side of your face due to the radiation. While dermal-fat grafts are an excellent means of subcutaneous fat reconstruction, they are notorious for ‘sliding off the face’ or falling down to the jowls if they are not anchored securely to the cheek bone and along the zygomatic arch bone. What could be done now is a resuspension of the dermal-fat graft back into the desired position with permanent sutures. This would be very similar to the original procedure to place the graft minus the harvest site. It is, in essence, like a one-sided facelift procedure. It is clear that the dermal-fat graft has taken but it probably developed descent before it completely healed, thus falling down to the jowl line.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 35 years old. I had a child nearly 18 years ago. I have excess skin and stretch marks. I would like to consider getting a tummy tuck. My chief concern is down time and cost involved. I am recently divorced and self conscious about my looks. But worried about going through plastic surgery.
A: The thought of elective plastic surgery is certainly scary for most people, particularly an operation like a tummy tuck. Such a procedure, while making a dramatic improvement in one’s stomach and waistline area that is not achieveable by any other means for someone with excessive abdominal skin, requires a commitment of both time and resources. It is not for the faint-hearted and there is no easy or simple way to do it. The bigger the change, particulalry on the body, the mopre of everything it takes to do it. The best way to think about it is that you will need three weeks to have an adequate recovery and total costs would be in the range of $7500 to $8500. Those two basic considerations are good screening tools to determine if you should move forward with taking your desire for a tummy tuck to the next level of an actual in-office consultatiobn.
Dr. Barry Eppley
Indianapolis, Indiana