Your Questions
Your Questions
Q: Dr. Eppley, I recently had augmentation rhinoplasty to build up my bridge a and bilateral spreader graft to widen my nose. I am not sure the use of ear cartilage was appropriate for my wants. I wanted my radix to tip slightly augmented and my Dr. used ear cartilage. I never had an over done rhino before either it was a just tip work on my first. I just decided I wanted a more masculine nose. I am looking for some answers about a possible third rhinoplasty yikes. I have never had cartilage taken out of my nose. I am 25 year old caucasian male. I am looking for a surgeon who works well with rib grafts.
A: My assumption is that based on your description that the ear cartilage graft was used to build up the radix. But that has left you with more of a ‘scooped out ’ dorsum with too high of a radix and the rest of the dorsum too low or that the entire dorsum is now too high and more of a hump? When trying to build up the entire dorsum, I find it difficult to do that with a curved piece of cartilage that simply doesn’t have adequate shape for the complete dorsal line. But it is often used when a septal graft is not available and the concept of a rib graft seems too extreme. In a subsequent revisional rhinoplasty, the ear cartilage graft can be removed and replaced with a rib cartilage graft which offers a straighter piece that can be more assuredly shaped to the desired result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a deviated septum after getting a broken nose. I’ve dealt with this for about 12 years now and am working to becoming a chef and would like the full use of my nose as this would be a great plus for my job in getting my sense of smell back. The only allergy I have that I know of is I am allergic to Lortabs, If you would like to know more about me just ask I would like to know how much this would cost?
A: Septoplasty, the most recognized surgical name/procedure to improve an obstructed nasal airway, is just one aspect of nasal airway improvement. Straightening a deviated septum is often combined with inferior turbinate reductions as well as spreader grafts to the middle vault to open up the internal nasal valve. Whether one or all of these intranasal procedures are needed would depend on an internal nasal examination. What needs to be done will affect the time to do it and the subsequent cost. As a general cost guideline, a ‘septoplasty’ could cost anywhere from $2,500 to $ 4,000. In regards to your sense of smell, there is no guarantee that just because your nasal airway exchange improves that your smell will as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had cheek implants in 1991…through the years they have shifted upward….more on the right, the right also is sore when applied pressure on it. I’m interested in having a revision.
A: All facial implants when placed ultimately form a layer of scar around them known as a capsule. This capsule not only envelopes the implant to separate it from the rest of the body but also serves to anchor or maintain the implant in its location. It is interesting as to why, years later, that the capsule somehow changes and allows the implant to change location even if it is only slightly. This is not unique to facial implants as it is seen in some breast implants as well as they bottom out or move too far to the side over time in some patients. What this indicates is that the interaction between implants and the body’s tissues is not just a static one. This is why I feel it is important to screw all facial implants into place when possible so implant micromotion and sliding around is not possible.
The question with your current indwelling cheek implants is whether they should be merely repositioned and secured with screws or replaced with new ones. That would depend on how you feel they look now and whether you have had any significant facial tissue sagging over them over their twenty years of implantation. Seeing some pictures of your face would be very helpful.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am an 37 Asian male with very prominent bulging eyes (I believe it is due to having a relatively flat skull with shallow eye sockets). From a side profile view, my eyes protrude farther than my nasal bridge. To my knowledge, I have never had Graves disease or any other eye condition other than myopia. I think it is simply a genetic aesthetic condition. But it seems to me that browbone augmentation could be an ideal way to reduce the prominence of my eyes. I can send you pictures I have taken of my eyes from different angles. I would like to know if I am a candidate for this surgery. Thank you!
A: What you are referring to is known as pseudoproptosis, the eyes appear to stick out because the surrounding bones are underdeveloped or not string enough. I think it is true that brow augmentation would be beneficial. But one may also consider lateral and inferior orbital rim augmentation as well (and maybe nasal augmentation) to provide a more complete orbito-malar augmentation to more effectively produce a less ‘bulging’ eye. This type of midfacial skeletal hypoplasia is very common in Asian patients as brow and forehead augmentation are frequent aesthetic procedures considered with this type of craniofacial skeletal development.
Q: Dr. Eppley, I am a speech therapist, and while I would like to look into a possible vermilion advancement for my extremely thin lips (my upper lip is virtually non existent) I am worried about both the cost and the time to heal since I make a living using my lips to help my students and make a living.
A: For the pencil-thin upper lip, there is no better lip enhancement procedure than a vermilion advancement. It physically increases the vertical height of the lip vermilion and reshapes the cupid’s bow area and can be done for subtle or more dramatic changes to the lip. When done by itself, it is performed as an office procedure under local anesthesia. Its cost will usually run around $2,000. It does cause some moderate swelling but much of that is gone by a week after surgery. There are no restrictions after surgery but how that would impact someone performing speech therapy services is not clear to me. I suspect after one week you would be just fine, maybe two weeks at the longest.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is there a permanent solution for treatment of the hyperactive mentalis muscle? It manifests in a very subtle way, just on the right lower part of my chin, and instead of repeating injections on a semi-regular basis, I’m much more interested in finding a permanent method of altering this very slight irregularity. Thank you for your time.
A: The use of Botox is the easiest and most effective method for treating a hyperactive mentalis muscle. While it is not permanent, a few units skillfully placed works very well. It is possible to do a partial transection of the mentalis muscle through an intraoral approach and this may provide a more permanent solution.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 25yr old male who was born with club foot. I went through life playing sports and excelling in every aspect. At this point in my life I am currently coming to a financial point to pursue a calf implant surgery. Can you please inform me of what the procedure is all about, how often it is performed, success rate, and cost. Thanks you for your time and I look forward to moving this process along!
A: Calf augmentation can be done by either an implant or more recently fat injections. The more guaranteed method of permanent calf augmentation is with an implant. Calf implants, like all body implants, are made of a very soft and spongy solid silicone rubber material which feels very much like muscle tissue. It is inserted through a small incision in the back of the knee in an outpatient procedure done under general anesthesia. The procedure is most commonly done in body builders or non-athletes who feel that their calfs are just too small. The most challenging patient in my experience is the club foot patient because, not only is the calf too small but the surrounding skin is very tight. This makes the insertion of an adequately-sized calf implant more difficult and it will not be possible to match the circumferential size of the smaller calf to the larger one. The club foot patient must be willing to accept improvement in calf shape but an ideal result will not be achieved.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know which one of the two approaches for chin implant surgery is better, intraoral or submental incision? How do you avoid cutting the branch of the facial nerve. When you do the submental incision and how likely is it to injure this nerve by the submental incision?
A: There are advantages and dusadvantages to each chin implant approach. Neither one is necessarily ‘better’. Both are acceptable chin implant approaches and produce similar results if technically done well. The submental approach avoids the intraoral incision and the need for disinsertion of the mentalis muscle from the bone when coming from above and that may make the recovery process a little bit easier. The submental incision should have virtually no risk of injuring the marginal mandibular branch of the facial nerve. The course of that nerve lies way to the side of where the submental incision is and is in a much more superficial tissue plane than the subperiosteal approach to the chin bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, how long does it take to completely recover from liposuction? I had stomach, back, thigh and knee liposuction one week ago. I had a lot of initial swell and bruising and still do. I had lot of pain in first week, and my doctor told me I would be normal after one week but I am far from that. I still have pain, my body is sore, its hard to sit and sleep and I need to take pain medications to get any sleep. Certain areas of my stomach, leg and knees are numb. I can not go back to my work and I am very worried that I might not be able to do so even after 2 weeks from surgery?
A: While liposuction can produce some really significant body changes, the recovery is also equally significant for most patients. The concept that you would be fine in a week after almost any liposuction procedure sounds great in a marketing advertisement but is not based in reality. Everything that you have mentioned sounds exactly like what I would have predicted for just one week after surgery. While the next week will make some great strides in improvement and you will likely be able to go back to your work in another week, the true recovery from most liposuction procedures is closer to 3 weeks for being active again and up to 3 months to see the final contouring results.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I came across your website in my search for 5fu injections. I have/had a cyst in my chin/jaw area last august. I have had it injected with cortisone/kenalog multiples times and it has helped but something is still there. I believe it is scar tissue because it’s hard and turning white. But because it never came to a head I’m not totally sure that theres nothing in there but scar tissue. So my question is this; are there any issues with having 5fu injections into a cyst or more likely a scar? Because I know cortisone has risks of fat atrophy and skin thinning. Does 5fu have any side effects like that? And also can you put 5fu in a scar that has had cortisone put into it? Thanks so much.
A: 5FU is not as significantly effective for scar reduction as steroids. This is also why is has none of the side effects of steriods and also why you will often see it combined with steroids for injectable scar therapies. It helps reduce the concentration of steroids needed to lessen their potential side effects as well as enhances the effects of 5FU. It works best in the early treatment of scar tissue formation. But it would not be an effective treatment for a true cyst. I am assuming that what you had may have been for cystic acne which is really an inflammatory condition so steroid injections would have been an appropriate treatment. But a true dermoid cyst is not going to go away long-term with any injectable scar therapy.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, I am a 19 year old female with a high rounded hairline. I’ve always been picked on and teased due to it. Causing me to quit sports in high school because of my bangs blowing back when I’d run… Im always hiding behind my bangs but unfortunately I won’t be able to in Navy boot camp in six months . I am enlisted in the delayed entry program for the US Navy and I just know that in boot camp the RDC’s will make fun of my hairline as a part of breaking me down. I just want to know if your facility does any sort of military discount for the hairline lowering procedure? Or if fees can be waived out of generosity. I don’t know how that works but I figure it’s worth asking. If this is not possible, thanks anyway for your time!
A: Thank you for your inquiry. A hairline advancement/lowering can be a very effective method forehead reduction if one fulfills three criteria. First the scalp must be naturally mobile enough that it can be moved one to two centimeters forward. You can have a pretty good idea of that by pushing around your own scalp and seeing if it moves forward anyy. Secondly, one has to have a good frontal hairline with adequate follicular density to position a well-designed incision. Lastly, one has to be willing to accept a permanent fine line scar along the frontal hairline. Please send me some pictures of your forehead for my assessment. I have asked my assistant to pass along the cost of such a procedure to you and she is the one to whom you can direct your financial questions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in forehead recontouring. As you can tell from the pictures I’ve provided, I have two prominent structures protruding from my forehead which gives the appearance of two “horns.” I would like to know if it’s possible to “shave down” these bulges for a more natural look; they are completely bone in structure that began forming when I was around 11 years old. I’m particularly interested in how the procedure might be carried out and the approximate cost of the surgery. Thank you in advance.
A: Thank you for your inquiry and sending your pictures. Your forehead shows two symmetric areas of frontal bossing. This is to be differentiated from frontal osteomas. Osteomas can be a source of forehead ‘horns’ and they represents a growth of new bone that usually has a well-defined separation or edge from the underlying forehead bone. This makes it fairly easy to separate it with an osteotome through an endoscopic technique from two small scalp incisions. Frontal bossing projections are different in that they are expansions of the natural frontal bone itself rather than just new bone growth on top of it. Thus they must be burred down and can not be done with an endoscopic osteotome technique but rather requires more of an open incision placed back in the scalp to do the forehead contouring. They can be very easily burred down to a perfectly smooth forehead contour but requires more of an approach to do it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have two small scars that are indented from a laser to removal 1-2 mm skin inperfection. I now have 1/2cm divots in place from procedure a year ago. I would like to just have scar revision where they cut out scar and bring the area together with stitches! Is this possible to have straight line scar without having indented wide divit? I am scared to ever have laser. One scar is in my furrow by eye brow and other is in location of where your fat bags under your eye/cheek area are. I can submit pictures. I am really just wanting area with flesh lined scar. Do not want fillers either. I’ve had good luck with past incision lines and guess I’m just old fashioned. Thank ou for your time in helping me find a verbal answer without actually seeing a picture at the moment.
A: Generally, indented scars or divots can be nicely treated with excision and closure to level out the skin edges with the trade-off of a scar as you have mentioned. The adviseability of this scar revision approach depends on the size and location of the indented areas. Seeing a picture of the scars would be most helpful. You just want to sure that the straight-line scar trade-off is worth the exchange for what you have now. It is not a question of whether you can do such scar revision but whether you should. You certainly are so motivated to do so and that seems to be based on sound reasoning.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, are you familiar with 2ndary rhinoplasty.? I also need to correct my septum which is crooked. My projection needs to be reduced and I need cartilage grafts placed in my nose because I can’t breath.
A: I am very familiar with secondary or revisional rhinoplasty procedures. Your use of rhinoplasty terminology suggests that you have not only had a primary rhinoplasty but have done some homework as well. What exactly did you have done in your original rhinoplasty and how long ago was it done? I assume your septum has always been crooked and was not corrected during your initial procedure or was it the result of an inadequate straightening from the first surgery? Were any cartilages grafts harvested from the septum in your first rhinoplasty? I will assume that your use of the term ‘projection’ refers to the tip. Is it too high now because of the first surgery or has it always been too high? Are your breathing difficulties a result of the first surgery or have they always been present? I will also assume that you did not have spreader grafts placed during the first surgery.
Please feel free to send me any pictures of your nose with these answers. Secondary rhinoplasty can be a very effective procedure but the surgeon must have a thorough knowledge beforehand of what occurred in the initial rhinoplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like a smaller waitst and larger buttocks. Would fat injections to my buttocks accomplish both goals? Here is a picture of me from behind in my underwear.
A: Based on this one rear view picture, it appears like you would be a good candidate for fat injections to the buttocks. (aka Brazilian Butt Lift) What makes one a good candidate for the procedure is whether one has enough fat to harvest. Your one picture clearly shows some flank fullness so I will have to assume that there is also some abdominal fullness as well. Your fat supply is not enormous but narrowing of the abdomen and flanks will help make the buttocks look bigger as well. As long as you have enough fat to harvest (1.2 to 1.5 liters is usually the minimum needed) then it is worthwhile to place the subsequently concentrated fat (600cc to 700ccsor 300cc to 350cc per side) into the buttocks. One also has to accept the reality that fat injections into the buttocks usually make a modest change in size and the amount of fat survival is not always predictable.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting my nose. I am a 22 year-old female who has a nose in which the tip does not match the rest of my face. My nose tip is too fat and there is like a line running down the middle of it. The rest of my face and nose is actually small and well proportioned. The tip of my nose does not match the cuteness of the rest of my face. Can this be fixed? I have attached a few pictures for you to see what I mean.
A: Thank you for your inquiry and sending your pictures. What I see is that the tip of your nose has the classic bifid tip deformity. This means that the lower alar cartilages do not come together or meet in the middle of the tip of your nose. As a result, this leaves a central groove down the tip of your nose the whole way down to the base of the columella. This also creates a wider or fatter tip due to the lateral cartilage displacements. Outside of tip the pictures show only one angle so I can not comment on the shape of the rest of your nose. The bifid tip deformity can be corrected by bringing the lower alar cartilages together by sutures as well as thinning their size. This will make your tip more refined, narrow and get rid of the groove or cleft down the middle of it. I have attached some rhinoplasty imaging based on these potential changes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am curious to the cost of Botox in specific areas on my face. My biggest issue is my eyes as I am only 31 and am very attractive and often to I don’t look my age but I’m feeling as though I’m beginning to these days :-(. Also, am interested in the cost of breast augmentation. Thank you
A: Thank you for your inquiry. When it comes to Botox, the cost is completely related to the number of units delivered. Such units are usually very consistent for the area treated and so the cost can be well estimated. For between the eyes (glabella), which is the most popular area on the face for Botox injections that will take 20 units with a cost of around $300. For the crow’s feet area (beside the eyes) the number of units usually needed is 16 with a cost of around $225. When the two are done together, the total units can be reduced to 30 with a cost of around $425. For breast augmentation the cost is completely related to the type of implant used. Total surgical costs for saline breast implants is around $4700 while that of silicone implants is around $5800.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 21 years old. In March I have planned some maxillofacial surgeries. Currently I have a chin implant large anatomical. I have a problem in my maxillary prognathism which is vertically long. A maxillofacial doctor also diagnosed me with micrognathia. I have no problems with my bite. My upper jaw is too long like my upper lip. Then I realized I needed an upper lip lift and a Lefort 1 osteotomy. The only plastic surgeon I have seen thinks I need a upper lip lift (remove 6-7 mm) but the problem is that I have a gummy smile. My question is what is best to do first? And how long should I wait to do them?
A: With a vertically long maxilla and an overlying long upper lip, it is an interesting question as to which one should be done first. If I make the assumption that you really need both bone and soft tissue shortenings, whichever one is done first will leave you with an increased aesthetic deformity before the second stage correction. In these situations, it is always best to do the underlying foundational change first. Because the bone surgery is more involved and may change what is eventually done in the amount of upper lip lifting, the LeFort impaction procedure should be done first. Once the bone level is set then the upper lip lift can be done based on the position of the lip to the maxillary anterior teeth. Also dependent upon how long your upper lip is and how much vertical maxillary shortening is needed, it is also possible to both together…but using only a conservative upper lip reduction as more can be done later if needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had breast lift surgery about seven weeks ago. They were fine until three weeks after surgery when the bottom part of my incision opened up to about the size of a quarter. It has now finally healed but the healed areas are very sensitive and it hurts to touch. I can’t wear any type of bra and as light as shirts are, I can’t stand it touching it, I lay down and sleep at night but when when I roll over it rubs against the mattress and wakes me up throbbing. I have attached a few pictures for you to see. Is there anything I can do to be able to wear clothes?
A: Based on your pictures it looks like your breast lift wounds have nearly healed and now you just some sensitive scar formation over the wounds, which is very typical at this point in the healing. That sensitivity of the scars will decrease over time but the question is what you can do now. They would be best treated by either silicone topical gel or silicone scar sheets, both of which are available over the counter in a drugstore. Either way you need to keep them covered so they don’t get rubbed on which is obviously uncomfortable due to the scar’s sensitivity. As the scars settle down and mature more this sensitivity will go away. The silicone sheeting can be particularly helpful in providing both coverage of them and expediting the scar maturation process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had a ‘cottage-cheese’ butt my whole life. I hate and want to get rid of it. Would liposuction help smooth out the dents on my butt by removing some of the fat? Besides making it smoother would it make it smaller as well?
A: The search for an effective cellulite treatment has been ongoing for years and to say that it is elusive is an understatement. The buttocks is a prime location for the cottage cheese look of the skin. Over the years such treatments as Endermologie and VelaShape have been promoted but their effects are short-term and any improvement requires regular maintenance treatments. Liposuction surgery, however, is exactly what you don’t want to do. Liposuction removes the superficial layer of fat and removes the support from the overlying skin…this has the high likelihood to make the appearance of cellulite even worse. The newest cellulite treatment, Cellulaze, may offer improvement of buttock cellulite on a more sustained basis but long-term results (years) remain to be reported.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like information on breast augmentation. I have breastfed 2 of my children and my breast sag considerably. I compare them to a much older woman. It is very difficult to buy bras that fit well without adding any padding and I am not happy with the way I look shirtless. I would like some info emailed to me so i can think about my options.
A: Based on your own description of ‘ my breast sag considerably’, it sounds like you would need some type of a breast lift if implants were placed. Breast implants have no capability of lifting up a breast and moving the nipple to the center of the breast mound if the starting position of the nipple is below the lower breast fold. Therefore you have to think about the trade-off of scars for fuller and uplifted breasts. You will also have to consider whether you would want saline vs silicone breast implants. I would be happy to look at any pictures that you want to send to me to give you a more exact recommendation. But for now I will assume that you need full breast lifts with implants. I will ask my assistant to send you some cost information for such a procedure for your further education on the matter. If you have any other questions, please let me know.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have very thin skin under my eyes and they are puffy 🙁 I always look so tired and worn out) Just curious if surgery could correct this ?! 🙂
A: The puffiness under your eyes is a common problem and is due to intraorbital fat that is now sticking out. This is a typical development that occurs as we age. Normally the fat around the eyeball is contained behind the eyelids by certain supportive tissues. As we age these tissues weaken and the fat begins to protrude against the lower eyelid. This creates the classic lower eyelid puffiness or bags that many people have. With time these lower eyelid bags can become quite pronounced. Because fat has a high content of water, this is why these eye bags may be bigger in the morning or after eating foods with high salt contents. While some people have these bags naturally even as early as their teens, most people develop them to varying degrees after the age of 40 or so. This fat removal is a common component of most lower eyelid blepharoplasty procedures, If one does not have any or too much loose skin, the fat can be removed from inside the eyelid. (transconjunctival lower blepharoplasty) When loose and sagging skin needs to be removed and tightened as well, an external transcutaneous lower blepharoplasty technique is used. (traditional method) Both techniques can result in a significant change that removes that tired look.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have thin uneven lips due to an injury as a child. When I was seven years old I fell of my bike and split my face open on the concrete. I had a long laceration that ran from my lip down to the underside of my chin and now it is a long wide scar. My lips are naturally thinner but this scar as it crosses the lip also makes the lip uneven as well. Is there a surgery that could correct this lip step-off and in the process make them a bit fuller as well? I don’t expect Angelina Joile lips, but just some normal looking lips. I would appreciate any help you can offer me.
A: Mismatched vermilion-cutaneous edges along the lip line can be easily corrected by either reopening the lip vermilion and realigning the edges or doing a transposition of the edges through a small z-plasty scar revision. Making the lips fuller at the same time can most effectively be done by an upper and lower vermilion advancements. But whether that fine line scar along the lip lines is a good trade-off depends on how thin your lips are and if you have enough vermilion that a filling material or an implant may offer enough size change that would avoid the need for vermilion scars.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was just curious if you personally perform orthognathic surgery on a routine basis (I know your website primarily focuses on plastic surgery procedures rather than maxillofacial ones) and if so, whether you ever perform it in an outpatient setting? I know that I have a long road with dental work and orthodontics before I could even consider it, unfortunately, but I think the only way I could realistically afford to have jaw surgery is in an outpatient setting as I have heard how outrageously expensive it is in the hospital setting (and I do not expect insurance coverage in my situation). My understanding is that some surgeons do in fact perform it in outpatient facilities (which is a more recent development due to the high cost) and I was wondering if that is something you have personally done or are familiar with.
A: Various forms of orthognathic surgery have been performed in surgery center locations for decades. While it is true that increasingly limited insurance coverage has made the concept of out of pocket orthognathic surgery more common, it is not new to perform it outside of a hospital setting. The key concept is that some orthognathic procedures can be performed this way but not all. Isolated maxillary (leFort 1), mandibular (sagittal split) and chin (sliding genioplasty) procedures can be safely done as an outpatient. It is when these procedures are combined, which often may be needed, that a hospital setting is not only preferred but should not be done outside of it due to aiway and recovery concerns.
Dr. Barry Eppley
Indianapolis, Indiana
Rich Text Area Toolbar Bold (Ctrl + B) Italic (Ctrl + I) Strikethrough (Alt + Shift + D) Unordered list (Alt + Shift + U) Ordered list (Alt + Shift + O) Blockquote (Alt + Shift + Q) Align Left (Alt + Shift + L) Align Center (Alt + Shift + C) Align Right (Alt + Shift + R) Insert/edit link (Alt + Shift + A) Unlink (Alt + Shift + S) Insert More Tag (Alt + Shift + T) Toggle spellchecker (Alt + Shift + N) ▼ Toggle fullscreen mode (Alt + Shift + G) Show/Hide Kitchen Sink (Alt + Shift + Z) Format – Paragraph Paragraph ▼ Underline Align Full (Alt + Shift + J) Select text color ▼ Paste as Plain Text Paste from Word Remove formatting Insert custom character Outdent Indent Undo (Ctrl + Z) Redo (Ctrl + Y) Help (Alt + Shift + H) Q: Dr. Eppley, I was just curious if you personally perform orthognathic surgery on a routine basis (I know your website primarily focuses on plastic surgery procedures rather than maxillofacial ones) and if so, whether you ever perform it in an outpatient setting? I know that I have a long road with dental work and orthodontics before I could even consider it, unfortunately, but I think the only way I could realistically afford to have jaw surgery is in an outpatient setting as I have heard how outrageously expensive it is in the hospital setting (and I do not expect insurance coverage in my situation). My understanding is that some surgeons do in fact perform it in outpatient facilities (which is a more recent development due to the high cost) and I was wondering if that is something you have personally done or are familiar with. A: Various forms of orthognathic surgery have been performed in surgery center locations for decades. While it is true that increasingly limited insurance coverage has made the concept of out of pocket orthognathic surgery more common, it is not new to perform it outside of a hospital setting. The key concept is that some orthognathic procedures can be performed this way but not all. Isolated maxillary (leFort 1), mandibular (sagittal split) and chin ( sliding genioplasty) procedures can be safely done as an outpatient. It is when these procedures are combined, which often may be needed, that a hospital setting is not only preferred but should not be done outside of it due to aiway and recovery concerns. Dr. Barry Eppley Indianapolis, Indiana Path : p » span
Q: Dr. Eppley, I want to have CO2 laser resurfacing to reduce my facial scaring and would like to explore the possiblities of custom facial implants and a subtle chin dimple. The look I seek to obtain would be simular to Mario Lopez. Attached are some pictures of my face so you can see the acne scarring.
A: The question in any facial acne patient is how much scar reduction can be achieved and what is the best method to do so. Your pictures show a rolling hill-type pattern of acne acne scars across the cheeks. These would not be able to be improved by laser resurfacing. Rather they are best treated by a technique known as subcision and fat grafting where the base of the scars are released and then filled underneath with a fat filler. This is best way to make rolling hill acne scars have less indentation. Whether you would need custom implants to achieve your desired look is up for discussion. Chin dimples are straightforward and subtle is always a more achieveable result than a deep dimple.
Dr. Barry Eppley
Indianpolis, Indiana
Q: Dr. Eppley, I had an unfortunate fat graft and if englarged my masseter muscle (among other things). I am looking to reduce the masseter area surgically. I do not think that botox will help as some of the bulk is fat. I was told that it was placed UNDER the masseter. Do you know or can you suggest any local maxillofacial drs that could help me with this? I am worried about nerve damage. I also had too much fat along the lower jaw and it looks like jowling. What are your thoughts on smart lipo type procedures? I had regular liposuction to try to fix this with no positive improvment at all. Thank you for your informative website and any advice you can give me.
A: Given that you had liposuction of the masseter/jowls with no improvement, this would indicate that the fat is not in the subcutaneous space (of which you have already mentioned) and therefore no form of liposuction will work. This means then that the fat is either under the masseter muscle, in the masseter muscle or a combination of both. I would think it would be very difficult to get all the fat under the masseter muscle and some of it is likely in the muscle as well. Thus removal would require an intraoral submasseteric approach to get access to the fat. There is no risk of nerve injury in doing so so that should not be a concern. The only issue, in my mind, is how much fat could be removed from this approach and whether any masseter can or should be taken if there is not much fat visible in subperiosteal/subfascial plane. One way to really know where the fat is is to get a high resolution MRI of the masseter area. That would give a good idea beforehand of the success of such a procedure. The jowling fullness is another issue and, if not improved by liposuction, may have to consider some form of a jowl lift for improvement.
I can not give you any recommendations for any local doctors that may perform such procedures as I would think it would be very uncommon and may even make most uncomfortable.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Am I too old for a tummy tuck? I am 61 years old and am 5’5″ and 165 pounds. I have an abdominal skin overhang that has been there for years which will not go away with exercise or anymore weight loss. I had a consultation with a doctor who said that liposuction wasn’t right for me. I now know that a tummy tuck is the only thing that is going to work. Despite my age, I am healthy and take no medications. Do you think I can still have a tummy tuck done at my age. I don’t want to live the rest of my life with this overhang if I don’t have to and I don’t want to regret later if my health ever worsens that I could have had it done. I would value your opinion on this matter.
A: Age is a minor issue compared to your health when considering a tummy tuck. Many women over age 60 have successful body contouring procedures such as breast augmentation, breast reduction and tummy tucks. While twenty years ago this wasn’t that common, it is today. As the contemporary phrase goes…today’s 60 is yesterday’s 50. If one is concerned about the magnitude or length of the operation, tummy tucks can be done that do not include the muscle repair and just focus on removal of the skin overhang. That simplifies the surgery and removes much of the discomfort of it. The one thing that age does do in any plastic surgery procedure is to draw focus to the most efficient way to do the surgery to lessen operative time and sometimes actual recovery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 27 years old. I need your help to correct my facial cosmetic problem. I had chubby cheeks and broad nose tip, a saddle bulbous appearance. It did not go well with my body as I’m of medium built. I always wanted to have chiseled face and sharp nose. I finally went to a cosmetic surgeon to get this corrected. The doctor performed a face liposuction, rhinoplasty and he also made a cut in my upper eyelids as I had some fat there as well. This procedure was done in January 2009. After this I developed facial asymmetry. The outcome of this surgery is listed below:
Cheek liposuction :
– The right side of the cheek looks more chubbier than the left one.
– The right corner of the mouth does not move as much as the left one.
– The right side cheek pad is sagging in mid cheek region towards the nose.
– Both cheeks lack toning.
– Face still looks chubby & not chiseled.
Rhinoplasty :
– Hardly any difference.
– Nose still looks bulbous.
I went to the same doctor asking for correction but he never agreed to these flaws and in fact tried to ignore. I felt cheated and went to another surgeon. He extracted the buccal fat from my cheeks. However, still my cheeks look chubby. For my nose he has just placed the L-shaped implant through inside of the upper lip without making any other changes to the nose. I like the upper half of my nose as i needed little augmentation there but not in the later half. This has not solved my bulbous nose or wide tip problem. The shape of my nose has not changed. It just looks ” Over Augmented” specially in the lower part. This was done recently in September 2012. The surgeon says he can remove the implant if I don’t like it and give a stitch in the tip to narrow my tip.
I really wish to get this fixed as soon as possible as my life has stopped I really need to move on. Although I belong from a middle class family, I went out of the way to get this done but just ended up wasting my hard earned money. I am a focused person about what I want to achieve in life. I know things have gone wrong but I have not lost hope as I believe nothing is impossible if you are hopeful.
I just need right guidance & skilled specialist who can help me correct this. I have read good reviews about you and seen your picture gallery. I really appreciate your contribution in the field of cosmetic surgery. Please help me with whatever best can be done. I have attached my photographs for your kind reference. Please revert to me and let me how we can take it further.
A: Thank you for your inquiry and sharing your unfortunate cosmetic surgery experiences. Your issues break done into two areas; your nose and your chubby face. It looks like you have had some negative effects of liposuction including asymmetric fat removal and weakness of the buccal branch of the facial nerve on one side. Since you have already had the buccal fat pads removed, ti is not clear how much more improvement, if any, can be gained by further attempts at subcutaneous facial liposuction. I know that you are very unhappy with your fuller cheeks, but I do not think there is any ‘magical surgery’ that can provide the amount of facial slimming that you desire. It may be worth an effort to do some small cannula liposuction to try and get some areas more even but there is no operation that is going to make your face chiseled…it simply does not exist from where you are now.
Conversely, I think your nose does have room for more significant improvement from a further rhinoplasty effort.. What is not clear to me is exactly what has been done. (or even why) It is not clear at all what was done on the first rhinoplasty and the second rhinoplasty appears to merely have been the placement of an L-shaped silicone implant. It does not appear that you have had any real tip work done other than to try and stretch it out with an implant…which may have only pushed the wider tip up higher. I think you would benefit by some tip work for narrowing but the real question is what to do with your L-strut that is in place. There is dorsal augmentation benefit to it being there but it has also now stretched out the tip skin so removing it and not replacing it with something is going to make the tip situation worse. Normally I would opt for a rib cartilage graft replacement but that may further than you want to go.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had my saline implants since 1997 and my pockets have stretched. I am looking for breast revision. I’m interested in the techniques used along with before and after pictures.
A: When you refer to having your breast implant pockets stretched, I will assume that means your implants have both dropped (too low) and are even too far to the sides. (particularly when you lay done) Revision of your breast implants by etightening the implant pocket (making it smaller) is done by two fundamental techniques. The most common method is to remove part of the inferolateral capsule and tighten the pocket and lift the implants into a higher position using permanent sutures. This will be successful in the majority of cases. In patients that fail this method or have very thin capsular tissue and overlying skin, the entire lower breast pole may be supported by a sling of allogeneic dermis to provide the necessary lower pole support. This is not a first choice method due to the high costs associated with it although it is commonly used in breast reconstruction because insurance pays for the material. (the dermis material alone can cost anywhere from $4,000 to $6,000)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting my hairline as well as my forehead bone reduced. I was wondering do you also reduce the brow bone as well as the area below them and above the nose? I think it’s called the glabella and the bone around the eye socket. Do you do hair transplant procedures too? Do you think I should have my hair line lowered first or get my hair transplant before?
A: There is no question that if you were going to do both a hairline lowering/scalp advancement and hair tranplants, you would always do the hairline advancement first. It would be counterproductive to do hair transplants first and those would need to be cut out for the hairline lowering. Hair tranplants are used after hairline advancement to hide either the hairline scar better or to lower the frontal hairline further than what the scalp advancement can achieve. Whether the brow or lateral orbital rim (eye socket) is reduced with a forehead reduction depends on two factors. First what does the patient want to achieve. Would reducing those areas be aesthetically beneficial? It is really up to the patient to determine if that is needed to get the look they are after. Secondly, what is the thickness of the brow bone over the frontal sinuses. Is it thick enough to allow enough burring to make an external visible change? That can be determined by a simple skull x-ray beforehand.
Dr. Barry Eppley
Indianapolis, Indiana