Your Questions
Your Questions
Q: Dr. Eppley, I am quite old (66 years old) andI want to know if there is help for severe under eye bags and puffiness?
A: At 66 years old you are far from being too old to have surgery to improve your lower eyes. Such surgeries are safely done on patients up into their 90s. The cause of under eye bags and puffiness is largely herniated orbital fat. As we age the ligaments that hold the fat around the under eye weaken. The fat then gradually spills over the lower bony rim creating the bags that you see. Since such fat is very susceptible to water retention it can get very puffy particularly in the morning or after very salty foods.
Such lower eyelid bags are not treatable by any creams or other topical treatment methods. They can be dramatically improved by surgical reduction/repositioning of the herniated orbital fat to smooth out the lower eyelid. Usually a small amount of lower eyelid skin is removed as well. This is known as a transcutaneous lower blepharoplasty. While there will be some temporary bruising and swelling after surgery, the improvement can be dramatic once it is fully healed weeks later.
If you have any pictures off of your phone that you cane send me I can give a definite opinion as to the benefits of this type of eyelid surgery for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How long does a fat butt lift take? Am I a good candidate for it based on my pictures?
A: The Brazilian Butt Lift is a procedure that does take from where you don’t want it and puts it into your buttocks. However, the caveats to the procedure are that only so much fat can be transferred, based on what you have to give, and thus the final results will be affected by that volume. Secondly, since much of the donor site will come from your abdomen and flanks, this will create a create a greater overhang of stomach skin that is probably best to deal with at the same time. While a tummy tuck could be delayed until later, it is more ideal to have it done at the same time as the Brazilian Butt Lift
Depending on what is done, the time of surgery will vary. For a Brazilian Butt Lift using only liposuction, the procedure is around 2 1/2 hours. If a tummy tuck is done at the same time this would extend the total operative time up to 4 hours
Given these issues, the best way to get the greatest understanding of the benefits and limits of the Brazilian Butt Lift procedure would be to come in for a consultation to discuss these issues in detail.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to know if there was any way to make my mouth smaller. I am 22 years old and I have always been self-conscious about my mouth. It has become a major problem in my life. I want to know what kind of recommendations you might have.
A: To some degree you have a bit of bimaxillary alveolar protrusion which makes your overall mouth area project further out from the frontal plane of your face. This makes your overall mouth look big. Also, by pure measurements, the horizontal width of your mouth from one corner to the other is wide as it exceeds a vertical line drawn down from the pupil of your eyes.
One method to make a mouth look smaller is to narrow its width by bringing in the corners of the mouth. While this can be down, it does leave scars at the corners of the mouth which with your natural skin pigment will probably not be very good scars. Eve if they were good and acceptable scars I do not think that would help that much as your problem is as much a protrusive issue as it is about its width.
An alternative strategy to dealing with a protrusive mouth is to increase projection of other areas of your face to better balance the mouth. You do have a retrusive chin and flat cheek bones. Increasing their projection through chin and cheek augmentation will probably help make the mouth look less protrusive and create better overall facial balance. This is a scarless and safer approach to smaller mouth surgery. The potential benefits of improving these facial areas on the appearance of the mouth could be demonstrated by computer imaging.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 20 year-old female who is 5′ 4′ and weigh 119 pounds. I leave for college in two months but would like to get liposuction on my belly and thighs yet this summer. I’m not sure if I need something invasive like liposuction or maybe non-invasive like fat freezing. I know you haven’t seen me but would be interested in your thoughts.
A: It is hard to imagine that you have too much fat on you at 119lbs but that is always a relative perception. The most effective and efficient fat removal method is going to be liposuction because it offers an immediate effect and will remove the most fat. Non-surgical fat reductions methods, of which fat freezing (cryolipolysis) is one of them, always requires multiple treatments done over months that ultimately will remove much less fat than a more invasive method. That is the fundmental difference between invasive vs. non-inavse fat reduction…surgery equals quick results with a recovery while non-invasive offers less results over a prolonger period of time with no recovery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Please send me information on the new Sientra breast implants. I am interested in information and having a breast augmentation done within the next twelve months. Thank you.
A: The information that is available on breast implants is quite extensive and you have to be more specific as to what information you are seeking on Sientra breast implants. Sientra is the company name that was formed to distribute Silimed breast implants in the U.S. in 2012. Silimed is the world’s largest breast implant manufacturer out of Brazil where the implants are manufactured. Thus, Sientra breast implants are not really new, only new to the U.S.. Prior to their approval in 2012, the only two approved breast implant manufacturers were Allergan and Mentor.
Sientra uses a highly cohesive silicone gel in their implants, which is now done by the other two manufacturers as well. They offer both round and shaped textured gel implants in standard sizes from 175cc to 800cc volumes.
While all breast implant manufacturers tout the benefits of their silicone breast implants, what ultimately counts is their long-term rupture and capsular contracture rates. To date, the Sientra clinical study data shows the lowest rupture rates in the industry today. Thus they are my current breast implant of choice.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have consulted with you in the past in regards to jaw/chin implants, and I just had a few questions for you in this regard.
I have read a lot of things about the difference between Medpor and silicone. The main concern I had was in reference to the issue of bone resorption. I know that there are many opinions out there, and I just wanted your experience and expertise as to what the pros and cons of each are.
I am especially worried about the issue of bone resorption, as I don’t want to cause myself a lot of pain and misery in 10 to 20 years. I read that silicone causes more bone resorption compared to Medpor. However, I also read that fixing the silicone implants with screws eliminates a lot of the pressure of the implants. Furthermore, I had read that bone resorption occurs at the chin. Would any occur with jaw implants as well? I would appreciate any clarity on this issue.
I also wanted to know which material feels more natural (if they do at all) when implanted.
A: The concern about bone resorption around any type of facial implant is overstated, largely clinically irrelevant and biologically misunderstood. It is not an active inflammatory response that is eating the bone away. Rather it is a passive bone remodeling response to the pressure of the implant on the underlying bone caused by the tight overlying soft tissues. It is simply put a biologic response to relieve the pressure of the tension band effect on the implant. This can result in a few millimeters or less of the implant settling into the bone which then stops once an equilibrium of pressure redistribution occurs. While largely reported in chin implants, probably because they are easy to evaluate by panorex and lateral cephalometric x-rays, this normal biologic phenomenon to an implant can occur anywhere in the body. Similar examples including breast tissue thinning with breast implants and gluteal muscle thinning in buttock implants.
You have to remember that putting a synthetic implant into the body is not natural and the tissues have grown and work based upon their natural tissue attachments and thicknesses. Once you introduce an implant into these tissues, the natural tissue volume and balance is altered and it will respond by adapting to it. A little bit of implant settling (tissue loss) is a very small price to pay for whatever aesthetic benefits that an implant may provide.
As for facial implants specifically, the chin seems to be the only location where this biologic response is seen. This is due to the natural tightness of the chin tissues and the thickness of the underlying chin bone. In most cases that I have seen, the chin implant is almost always placed or become displaced higher up on the chin bone over the thinner cortical bone.
I have seen this biologic phenomenon in both Medpor and silicone chin implants, which makes sense since both materials are non-resorbable polymers. It is just less reported with Medpor because the vast proponderence of chin implants done involve silicone materials both historically and currently.
I would not think that screw fixation would affect this biologic response either favorably or unfavorably.
Either Medpor or silicone facial implants can feel natural or unnatural based on their size, orientation on the bone, tissue location, thickness of the overlying tissues and the patient’s perception to them. Their physical characteristics (firm) are similar so their postoperative feel, all factors otherwise being the same, should be no different.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, upon a consultation, the maxillofacial surgeon informed me that
I had facial asymmetry and that my right malar bone was posterior. I had always known there was a serious problem with my facial appearance which has caused me
much emotional distress throughout my life. However until this consultation,I couldn’t
articulate exactly what the problems were. More importantly, it hadn’t even entered my mind until this consultation that it might be possible that my facial asymmetry could be surgically corrected.
I have attached two photographs that I think illustrate very well the facial asymmetry. The main problems with the facial asymmetry are that the right malar is depressed and possibly the right eye and brow are slightly too low.
I would really welcome your professional opinion on possible treatment options for the facial asymmetry.
A: I can see quite clearly that your facial asymmetry is based on the right periorbital region and is largely skeletally based. The right orbital box (brow bone, lateral orbital wall and zygoma) are smaller/underdeveloped. This leads to the overlying soft tissues following the pattern of the bones, leading to a right brow and corner of eye/lower eyelid sag and a flatter cheek in that side.
In terms of improvement, you can consider for your facial asymmetry surgery a small right cheek implant. right lateral canthopexy, and right brow lift and possibly brow bone augmentation as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can you do surgery or a procedure to remove this facial cyst, which is by my eye on the right side? It’s small now. It has previously gotten infected and the whole side of my face swelled up. I worry that it could get infected again.
A: Most facial cysts are known as dermoid cysts. They come from the skin and have a small pore associated with them if one looks close enough on the overlying skin. This is the pathway by which they get infected. Their internal shedding of their skin lining accounts for why they gradually enlarge.
Infections are common behaviors in facial cysts and speaks to the need for their removal. Once infected they become more adherent and harder to remove because of the scar that is created around them that becomes attached to the cyst capsule. The location of your facial cyst at the mid portion of the zygomatic arch is also in the path of the frontal branch of the facial nerve so greta care must be taken in its removal to prevent injury to the nerve that is responsible for moving your forehead an brows. For this reason, its removal in the operating room even under local anesthesia nye be advised.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, can I get my nipples lifted higher on my chest? How much nipple lifting is possible? I have attached a picture of my chest so you can see how low my nipples are.
A: Nipples lifts can be done on a male chest but the amount of movement is much more limited than what can be done on a female breast. Men do not have the leeway of allowing or tolerating a vertical scar to raise a nipple very far on their chest that a woman does on a female breast. Thus the procedure for a nipple lift in a male is technically known as a superior crescent nipple lift. This is a simple procedure where a small crescent-shaped segment of skin is removed right above the nipple. This leaves a small fine line scar at the junction of the nipple and skin on the top edge of the nipple which usually heals very well without any significant scar. But the amount of movement upward is limited to usually 8 to 10mm (1/2 inch) at most in a single procedure. This means that even if done in two stages, the best you could hope for is 3/4 of an inch or slightly more.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have orbital, cheek, jaw and nose asymmetry (see attached picture). Please advise as to what can be done surgically to resolve the facial asymmetry. I would be very appreciative of your answers and expertise.
A: What I see in your picture is a right-sided facial asymmetry which is smaller and deviated to that side. The most visible component of your facial asymmetry is a lower right brow and entire orbital box and eye as well as the cheek bone. Since it is not possible to lower the left brow and eye, facial asymmetry surgery would be focused on the right side. The right eyebrow could be lifted and the brow bone augmented. The right eye can be lifted by orbital floor augmentation and the corner of the eye moved upward. Lastly the right cheek bone could be augmented as well. There are other areas of facial asymmetry, such as the nose and jaw, but I would focus first on the most distracting aspect of the facial asymmetry around the right eye. This would be the most important focus of your facial asymmetry since it is what most people focus on during conversational interactions and in pictures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in skull reshaping surgery. When I was a baby I had torticollis and i’m pretty sure this is what caused my plagiocephaly. My head looks like it was pushed in on the right side. I think the torticollis made me sleep on my right side a lot when I was a baby and thats why the right side of my head is more flat than the left. Here are some pictures of when I shaved my head. As you can see I would need an implant on the right side just above the ear and on the left side on top of my head to make my skull symmetrical. The back of my head is ok. Could you tell me if this is possible? Also maybe this could be done under local anesthesia with sedation? One last thing, I still have a head of hair and I’m a bit worried that an implant would put pressure on the hair follicles and blood flow resulting in hair loss. Is this a possible risk?
A: Certainly skull reshaping can be done for augmenting these two areas. The only question is which implant material to use. It could be done using either intraoperatively applied bone cement or custom computer-designed implants for each area. Given the asymmetric nature of the skull problem and the various shapes of implants needed, I would prefer to use custom designed implants as the most assured method of obtaining the best skull shape result.
Placing a skull implant is not something that can be comfortably done under local anesthesia/sedation and would not save you any money even if it could. Because a major cost of surgery relates to the time spent in the operating room, local/sedation cases take longer to do than when under general anesthesia. So any cost savings obtained by leaving out the anesthesiologist’s fee is wiped out by the longer time spent in the operating room
Lastly, raising scalp flaps and placing implants has no adverse effect on hair survival or growth.
Dr. Barry Eppley
Indianapolis, Indiana