Your Questions
Your Questions
Q: Dr. Eppley, I have the exact condition of the 24 year old male described on your web page as “Case Study: Reduction of the Prominent Nipple in Men”. I’m 45 years old and enjoy running marathons and I think this surgery would greatly help my situation. I would hope I wouldn’t need to wear band aids during the marathons after the procedure, but even if so I would also would like to look better if I’m wearing a thin t-shirt or dress shirt. I don’t know what your schedule is like at the moment, but if at all possible I would like to get the procedure done right after my next marathon which is in May as I will be taking two weeks off after that before resuming training for my next marathon in the fall.
A: Nipple reduction is a very simple procedure that offers a permanent solution to the prominent and protruding nipple. I hear stories from men every week that speak to the same problem…’I can’t find shirts that hide my nipples’ or ‘Everyone asks me if I am cold’. Nipple reduction surgery is done in the office under local anesthesia. One only wears band-aids for dressings for a few days. One can shower and work out the very next day. Men do not report much, if any, discomfort. Once removed, the nipple will never grow back and one can wear shirts comfortably or take off their shirt without the embarrassment of nipples that stick out too far.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had gynecomastia surgery performed, but there are areas where liposuction was done that I am very unsatisfied with. I would like to know if there is anything I can do with these areas in regards to slim lipo or laser. I’m not looking for perfection by any means, but currently I feel like the job is half done and am looking for someone to help me finish it.
A: When it comes to dissatisfaction with liposuction, anywhere on the body, the issues primarily revolve around whether adequate reduction was done or that areas of irregularities or indentations exist. While both can be treated, the methods and the success of secondary revision are different. Irregularities pose much greater challenges than inadequate reduction. On the chest, I suspect the liposuction issues are more inadequate reduction. This is because the chest skin and tissues are thick and are less prone to irregularities than other body areas. Further liposuction reduction may be possible. If the issue is persistent areolar fullness or puffiness after liposuction, it may be that you really need open gynecomastia excision to remove the remaining excess breast tissue.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am contacting you in relation to an inherited issue with width of the zygoma and my face more generally. When my face is viewed from a perpendicular angle it is quite clear to see that zygomatic area adds width of 1cm either side of the face. Now I am not sure whether this is to do with lateral projection but given that I have quite small eyes, it makes the facial features appear too small for the width of my face. I know that zygomatic width is an issue that people of Asian ethnicity usually suffer from and that a reduction malarplasty can to some extent tackle it. But my question is to what extent is that feasible given that the width of the face is an issue in relation to the forehead as well, is it the case that the skull base will likely simply be too wide or can the forehead be tackled simultaneously? Is what I am seeking actually capable of being done?
A: If I understand your inquiry correctly, your question is whether zygomatic arch reduction in your case would be beneficial. The zygomatic arch is a separate entity from the skull base so it can be reduced. The question is whether a 5mm to 7mm cheek (zygomatic)reduction per side would be beneficial. I would question that given that the temporal fullness is also adding width which can not be reduced. So in the spirit of an overall facial narrowing, I would not be enthusiastic that such an endeavor for you would be highly beneficial.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I got Medpor cheek implants five weeks ago and I am totally unhappy with the result. Is there something like a deadline for Medpor implant removal? I was told that it can be more difficult to remove Medpor if you wait too long.
A: There is no deadline for removal and/or replacement. Does it make it a little more difficult to remove later…yes. But it is not a big problem to remove later in my experience. The issue of bone ingrowth into the implant and being impossible to remove later is a myth. You are better off giving the face time to settle down and shrink around the implant shapes before possibly make a premature decision about revision/removal. My minimum time for facial implant removal/adjustment, particularly in men, is three months.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested to find out about a surgery known as ribcage reduction or waistline narrowing. The lower part of my ribs stick out and makes my body look funny. I would like that area to be more narrow or go in. I have heard that some of the ribs can be removed which will make for more of a tapered look. How is this surgery done and what is the recovery like?
A: Rib removal is a real operation that can be done. It specifically refers to removal of any of the ribs on the lower end of the rib cage, from 8th to the 12 th ribs. All of these ribs are largely made of cartilage with some bone on the back end of them. Usually only the cartilage portion is removed. Which cartilaginous ribs are removed is matter of what one is trying to achieve. This is not, however, a waistline narrowing procedure since the ribs do not go down that low. This is to achieve a more narrow upper trunk/abdominal region around the ribcage area. This operation is, however, fairly ‘radical’ since it will leave a small scar and is associated with a fair amount of pain afterward. Realistically it would take four to six weeks to have most of the discomfort subside.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I had custom jaw implant surgery a while ago. The sizes are 9mm for each side. I would like to increase the sizes but I’m not sure how large I should go for. I was thinking 12mm for my left side and 14mm for my right. Is this too large?
A: I would not think that jaw angle implant change is too large aesthetically. I would worry more that it may not be big enough. On pure ratios of measurement change that is a 25% increase on the right side and a 45% increase on the left side. From a tissue stand tolerance standpoint, you could double the size of the implants and the tissues would have no problem expanding too them. Your issue is one of desired amount of aesthetic change not what is physically possible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering what are the prices of your procedures I have been looking into mommy makeover for several years, (breast life/augmentation,tummy tuck, and some liposuction of the inner thighs and back flanks. I’m not looking to be a supermodel/size 6, I would be quite happy size 12 – 16. I just want a flatter tummy, non droopy boobs and thighs that don’t rub together. I have attached several pictures, could you please tell me what the cost would be, and if there is anyway to have our insurance company pay. I’m very depressed with the way I look, I just want my outside to reflect the way I feel on inside. I want to be that sexy person for my husband, and confident for myself. I hate trying to find clothes that hide my tire ring for a tummy, and replace pants because they got worn in the thigh area. I would also like to wear shirts without having my breast hang down to my tummy area. I need help, can you help me………..
A: Thank you for sending your pictures. I can not comment on your breasts since the pictures have a bra on but I will assume, for the sake of this discussion, that you need a full breast lift. Otherwise, you would benefit tremendously by having a full abdominoplasty to get rid of the overhanging pannus combined with liposuction of the flanks. This is the one procedure that will provide the greatest overall change. You do not have enough of an abdominal pannus to qualify for insurance coverage based on my experience. From a thigh standpoint, I don’t know that liposuction can ever take you to the point where your thighs don’t rub, that is not a realistic goal. Some improvement can be achieved in their fullness but to say they would not rub together would not be an accurate statement about the achievable result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have breast asymmetry with two completely different sized breasts. One is like a B cup and the other one is more like a D cup. I’m a thick girl so I would probably want a lift, a smaller areola, and reduction in size on the bigger breast maybe down to a C cup. I know the other one will need an implant but my frame is too large for something like a B cup. I want both breast to be a C cup. I just want to finally be happy with my breasts and not hiding them all the time. Please let me know what you think this would take as far as cost and down time. Thanks.
A: The most difficult challenge in cosmetic breast surgery is management of the significantly asymmetric breasts. This is because one invariably will require some form a reduction/lift and the other one will need a breast implant. This also places scars on one breast and not the other and one breast will have an implant while the other one won’t. What this implies is two important concepts. First, breast symmetry can be improved and made a lot better but it is not attainable to have perfect or close symmetry between the breasts. Secondly, the difficult in trying to match the breasts with two different procedures indicates there is a high probability of the eventual need for a revision of the initial surgery for the best result possible. Expect to pay for total costs in the range of $ 7500 to $8500 for the initial surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have stretched earlobes that I would really like to have reversed so that I can join the Marines. How is the procedure done and how much does it cost?
A: One of the most common reasons patients present for stretched or gauged earlobe repair is because they want to enter some branch of the Armed Services. All branches of the military have a strict rule about any size hole in the earlobe. If you have any form of ear piercing, the test is to place a white 3 x 5 card behind it. If any white is visible through the hole, then it must be repaired for medical clearance for entrance. Earlobe repair is done as a simple office procedure under local anesthesia. It takes about one hour to complete for both earlobes. The holes are cut out and the earlobe reconstructed with the remaining tissue. In almost all cases the size and shape of the original earlobe is restored with a very fine line scar down through the center of the earlobe. The cost for both earlobe repairs is $1500.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am two months after having a rhinoplasty. Th swelling has gone down considerably and my doctor said that about 75% of it is gone. But my tip is still rock hard. It is so stiff that it barely moves and the tip is very numb. I have not had a significant other since my operation, but am afraid my very stiff nose will affect kissing. Will my tip ever soften or am I stuck with a hard numb tip?
A: Hardness of the nasal tip after rhinoplasty is very common. It initially occurs due to swelling but persists much longer after the swelling has subsided due to scar tissue and what was done to the tip cartilages during surgery. In most rhinoplasty surgeries the tip is narrowed, lifted and strengthened with sutures and cartilage grafts. This helps give it a new shape but also prevents it from shifting or changing shape after it has healed. This causes protracted stiffness of the nose for up to nine months to one year after surgery. It will eventually be much softer and can be moved around normally again but it is an issue of more healing time. As the stiffness finally goes away, normal feeling to the tip skin will return.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 21 years old and have lost 65 lbs over the past two years. This has left me with a lot of excess skin and an overhanging abdominal apron. I have been researching tummy tuck surgery to remove it. My main concern is if I will still be able to have children in the future? I am not planning on having children anytime soon as I still young but I know someday I will when I meet the right man. I just need the tummy tuck now so I can feel better about myself. Will the tummy tuck scar in any way interfere with my belly stretching during pregnancy?
A: There is no problem with becoming pregnant and having children after a tummy tuck. This is not a rare occurrence at all. The slow stretch of tissues during pregnancy easily expands the abdominal skin. Since you are young and have never had children (and likely will), the muscle should not be tightened during your tummy tuck. The overhanging skin and fat should only be removed. This will make a dramatic change in your waistline and provide you years of feeling better about your body.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am scheduled to have liposuction of my abdomen, thighs and hips in two weeks. Three weeks later I am scheduled to leave on a ten day cruise in the Mediterranean. Do you think I will be Ok for this trip and fully recovered, my doctor says I should be just fine by then?
A: The simple answer is no and this would not be how I would schedule those two events. Liposuction takes much longer to fully recover from than almost all patients think. It is one thing to try and go back to work in a week or two because you have to and can’t get the time off work or extend it any longer. It is another to go on an elective trip that is prescheduled/prepaid, involves overseas travel, and is done for the purpose of pure enjoyment. While you no doubt can make the trip, you will not find it as enjoyable as you would like. Being swollen and sore is no way to go on a pleasure trip. While I fully understand the desire to look good and have a more sculpted body for the trip, you would be well served to postpone your surgery until afterwards. The minimum amount of time I recommend to my patients after major liposuction surgery is six week recovery before embarking on vacations, extended travel and cruises.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, will I go back to the smallest size I was right after liposuction? It’s been three weeks now since I had liposuction of my stomach, flanks and back. Right after I got out of my surgery and for a week or so after that, my stomach was really flat. But then I swelled up and I don’t look quite the same. While I am not big or back to where I started, I thought by now I would be smaller since all of the swelling appears to be gone. Does one ever get back to what they were right after surgery?
A: What you are experiencing is extremely common and affects all liposuction patients. The more areas that are treated by liposuction, the more this rebound swelling phenomenon occurs. This is known as lymphedema which is fluid build-up throughout the tissues. This is not a localized collection of fluid but it is spread throughout the tissues. This is due to partial obstruction of the lymphatic channels and normal lymphatic outflow in the treated areas. This is a temporary phenomenon that occurs in all liposuction patients for the first few months after surgery. It appears within days to a week after the surgery. It is a self-solving problem as the lymphatic channels heal and reopen. This will restore the shape back to what you saw right after surgery. In addition, swelling after liposuction takes months to fully resolve not weeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am 17 years old and want to get my nose fixed. I can’t breathe real well through the left side of my nose. I also don’t like the bump on it and the tip of my nose is too fat. Is it safe to get a rhinoplasty and septoplasty at the same time and does the bone grow after the thinoplasty?
A: The usual recommendation is to wait until the nose have completed its growth before having it surgically manipulated. On a practical basis this is going to be in the mid- to late teens. A female’s nose mature earlier than a male’s so for a teenage girl the nose is usually done growing by 15 to 16 years of age while a teenage boy’s is closer to 17 or 18 years of age. Depending upon the magnitude of the breathing difficulty, surgery may be done at any earlier age than these ‘minimums’. At 17 years of age, your decision about a septorhinoplasty is not a growth issue but one of parental consent.
Much of the makeup of the nose is not bone but cartilage. Regardless of bone or cartilage, there is no growth of the nose after skeletal maturity is reached.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 19 years old. My father made me take diet pills when I was younger and my breast went from a D cup to maybe a B now. I’m finally losing weight and my dream is to get my breasts big again. I don’t have the finances to pay for it through. What can I do?
A: Breast augmentation is an elective procedure that has numerous fixed expenses to perform. It is going to cost money to have this surgery and the fees vary based on whether one chooses saline or silicone gel breast implants. You will have to set a financial goal to reach based on the cost of the procedure and await the day when it will be financially achieveable for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 20 year old male and have what I would describe as a long and narrow jaw. I am wanting to get my face/jaw to be wider and more masculine to that of a square jaw type face and understand this can be done via mandible implants? I want to know would these implants last forever as I hear a lot of stories that the implants get infected or shift. I wouldn’t want to have them for say 25 years then on the 26th year something goes wrong. I could have a wife and kids then and would be a whole new person. Are these implants successful?
A: All facial implants, including any used in the mandible, are made of synthetic materials that do not degrade or resorb. Thus the implants are permanent, will not wear out and will last the rest of one’s life. This does not mean that they can not have problems as any implant surgery in the body may have. In facial implants, the risk of infection is an early one related to the time period around implantation. Once well healed, the risk of infection is very rare. Shifting of one’s implants can occur over time but can be completely prevented if the implant is secured into position by the use of bone screws. Well placed, well secured facial implants have a very low risk of any long-term problems. To be most successful, like any plastic surgery, choose your surgeon carefully as implantation technique has the greatest influence on long-term prevention of potential problems.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my fiance recently had a breast augmentation done in early March 2012. After the surgery the doctor came to me and said she had issues closing up her right breast. She said her tissue was very weak and started to rip due to the sutures. After the surgery we kept a close eye on the healing process. This past weekend, five weeks after the surgery we noticed that the ‘scabbing’ had grown a lot. My fiance had me take a look today and it appears that the implant is actually showing. It looks as if the skin has opened up from the sutures and the implant is about to fall out. Is this a normal problem? She saw the doctor today and it appears that the implant must be removed and she has to wait until it heals up before replacing it again. Have you ever seen this problem before?
A: This is an unfortunate and rare complication after a primary breast augmentation. It is not one that I have seen before but the sequence of events are such that tissue necrosis occurred from wound tension over the inframammary fold incision site. Why it happened is relevant for the future since you do not want to have a repeat experience after implant replacement. I can only assume that the size of the implant placed too much stress on the incisional closure. If this was a problem, during the first procedure, that effect may be greater the second time. You may have to consider either a smaller implant or go through a process known as tissue expansion prior to implant placement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to reduce the length of my upper lip. I have attached two pictures, which although low in quality (web cam shots), illustrate my concerns. My upper lip is too strong for my face – dominant, long and protruding, with considerable vermilion show. The distance between the root of my nose and the pink park of my upper lip is 18 mm. If I’m aiming for a 14 cm distance, does this mean you will need to remove only 4 mm of skin? Or does the skin incision has to be greater than that to achieve a shortening of the upper lip of 4 mm? My other concern is that as a man I don’t my lip pout to increase from doing this procedure.
A: To reduce an 18mm philtral lip height to 14mms using a subnasal lip lift technique, you need to remove just 4mms. But without question that will cause some increased lip pout. By definition, a subnasal lip lift causes increased vermilion show. That will settle down over a few months but may or may not return to what it was before the lip lift. That is why you can either do it in two staged of 2 -3 mms each or do a 4mm skin exicison with an internal mucosal roll of the upper lip. You do have a lot of vermilion so I don’t think this will give you excessive tooth show. If you do the two together (subnasal lip lift and horizontal mucosal excision, you may want to do that under some IV sedation with local injections)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a breast augmentation six months ago with silicone implants placed under the muscle through a lower fold incision. I developed a hematoma which needed to be drained by the next day. Now that all has settled down and healed, my breasts are asymmetric. They were not asymmetric prior to surgery and now they are. My doctor says that is just the way I was before surgery but I know I wasn’t. I have attached some before and after surgery pictures from different angles that I got from my doctor. Can you tell me what you think?
A: In looking at your before and after pictures, I believe your doctor is correct. There is subtle asymmetry of the breasts before surgery with the right breast being the ‘good sister’ and the left one being the ‘bad sister’. The left one has a bit of ptosis and a slightly higher inframammary fold. That is a setup for what you are seeing. The implants may be reasonably well placed but the preoperative asymmetry has now become magnified. As you increase the size of the breasts, what was once a little difference can become much bigger. You may also have a bit of contracture on that breast from the hematoma surgery but that is speculation since I have now examined your breasts. Given the relatively minor postoperative asymmetry, I would be hesitant to undergo a revision. You would have to go in and lower the implant to reduce the upper pole fullness. Whether that is worth the effort to undergo a breast implant revision is debatable.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very large head that sticks out in the back (about one inch), is pointy on top, and comes out on each top-corner as well. This has caused me much mental distress ever since I was a chiold, and now that I am in my late twenties, and my hairline has receded a bit, I am noticing it even more. I am unable to wear most hats becuase they do not fit. I am wondering what sort of optiond I have to reshape/reduce my skull size. I don’t think there is anything that can be done to make it completely normal, but anything would be better than what it currently lokos like. I would appreciate any feedback you can give me. I have a few specific questions that I hope you can answer.
- As an African-Americn man that wears relatively short hair cuts, I ama concerned about having a large scar across the back of my skull. Are there any other otpions that would work equallya s well as an open procedure?
- What are the general costs for the procedure i m requesting?
- If an open procedure were to be done, how long of a scar would it be?
- If an open procedure were to be done, what happens to the excess scalp skin? is it removed as part of the procedure?
A: Since I have not seen your particular skull problem, I can only provide some general answers. The question will come down to…can the back of the skull be reduced enough to justify an occipital reduction cranioplasty surgery by burring? That will ultimately require a plain skull film from the side view to take a measurement and see how much can safely be removed.
To answer your specific questions:
1) No.
2) Probably in the range of $6500 to $8500.
3) 10 cms. (4.5 inches)
4) A little maybe, although it usually shrinks back down.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a double upper problem but am not sure if a lip reduction of the redundant mucosa would be all that is needed to correct the problem. I am being told the underlying issue is the orbicularis oris muscle, although some surgeons want to just excise the extra tissue that is folding. From my research “double lip is a variant of occult (hidden) cleft lip, which occurs due to mal-alignment of muscles acting on the lip. Correction needs both removal of excess fibro-fatty-vascular tissue as well as restoration of normal lip muscle orientation and frenum lengthening”. The reason I included this is because most surgeons are saying mucosa reduction, or it’s the muscle, but nobody has mentioned in addition to a reduction of the mucosa fold, restoration of normal lip muscle and frenum lengthening would also be needed.
One surgeon has told me that I have a midline diathesis of the distal orbicularis oris muscle resulting in a lack of movement of the central lip relative to the lateral portions. A few surgeons have mentioned that they think the underlying issue is the muscle and that the redundant mucosa may come back down the line after an excision of the redundant mucosa. Some are also cautious with doing a reduction because they think it will thin out my top lip too much relative to my bottom lip. I guess because I keep receiving mixed opinions, I have not moved forward, even though there is the redundant fold.
I know you would probably need to see me for an in person consultation, but any feedback from my notes and photos would be appreciated.
A: You do have a variant of the double lip anomaly although it is not the classic presentation. Most double lips are merely redundant wet mucosa and can be elliptically excised as they lie behind the we-dry vermilion border. They are usually present both at rest and smiling but are accentuated with lip elevation. Double lips have nothing to do with cleft lip deformities and no one knows why they occur.
Your double lip phenomenon, however, has a visible indentation in the dry vermilion anterior to the wet-dry junction. Thus, removal of the ‘overhanging tissue’ would indeed likely thin out your upper lip and, at the very least, give you more visible tooth show at rest and a much thinner upper lip on smile accentuating a mild gummy smile that you have now. (although you may have accentuated that for purposes of showing the tissue roll better) I do not believe your lip issue is a simple ‘too much tissue’ problem and would not do an elliptical excision. I would be wary that would not improve things and may make them worse.
When it comes to a discussion about the orbicularis muscle component, be aware that this is a theoretical supposition. The orbicularis muscle runs parallel to the lip margins not vertical. There is not a vertical cleft in it, which is what is referred to as a midline diasthesis, and if there were the overlying skin would reflect that by having a notch or some variant of a cleft. In addition, such a theoretical diasthesis can not really be effectively repaired even if there was one. All that would do would be to make upper lip tighter and more stiff.
I would think more about a lip rearrangement where a V-Y lengthening of each side of the folds or a running W-plasty along the vermilion indentation is done. Preservation of lip tissue is the objective not removal. It would also be interesting to know what your maxillary frenulum looks like although this would not change how one would approach the double lip problem in any substantative way.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Do you use pre-jowl implants for the chin?
A: I have used every commercially available chin implant style available and many custom fabricated ones. The choice of chin implant style depends on the problem and what the patient needs. A prejowl implant is best used when minimal horizontal chin augmentation is needed but the pre-jowl sulcus needs to be augmented for correction of notching along the inferior border of the jawline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am going to have temporal implants next month and have a few questions. Will the silicone be cut and shaped after my physical consultation or prior? The reason I ask this is because the pictures I provided show less indentation than there is in reality. I feel I will need quite a thicker implant to fill the area especially since I would like the widest part of my face to shift from below my eyes to in level with my eyes or slightly higher.Will the implants be even with my zygoma arches? I have prominent cheekbones and because they’re a bit lower, they have made my face look short when I wear bangs. I would like my temples filled in to slightly wider than my cheekbones to make my face appear longer since right now it has the unwanted “hour glass” shape and separates the forehead from my lower half.Unfortunately I only have 48 hours to recover and this makes me nervous, can I take Sinnech 3 days prior to surgery?
A: Temporal implant sizing is done either the day before or just before surgery. There are two basic sizes of temporal implants. Most likely you will only require the smaller size given your face, stature and being female. That implant thickness is 6 to 7mms which is actually quite substantial when actually in place. Whether the implant needs to be reduced in any manner is determined during surgery if I feel that it might be too big or give too much fullness. The implant is placed under the fascia down to the zygomatic arches. In some cases, the fascia is actually released at that point to allow the fullness of the temporal implant to be in the same plane as that of the zygomatic arch tissues. Usually the recovery from temporal implants is quite quick. There is virtually no pain and minimal swelling. Bruising can occur if the fascia needs to be released. But if not there can be virtually none. But taking Sinnech before and after surgery is always a good idea.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, the areas around my eyes is starting to look really bad over the past five years or so. My eyes used to be one of my best features but now they are just getting old looking. I am 47 years old and have wrinkles around my eyes and some extra skin on the eyelids. My brows now seem a little low too. I don’t want to go through surgery such as an eyelid tuck or a browlift so what can I do? Do I need some special cream or some type of laser treatment?
A: There is no non-surgical equivalent to what eyelid and browlift surgery can do, but there are some laser treatments that offer some mild to moderate improvement… certainly far better than what any type of topical cream can do. These are the newer fractional laser treatments and they offer some really good improvement around the eye area. Fractional lasers are different than traditional ones because they treat only a fraction of the skin surface but each tiny laser point or dot penetrates deeper. This allows for actual skin rejuvenation through collagen remodeling and less down time and recovery. Because eyelid skin is so thin ( the epidermis is only 0.04mm thick), it requires a series of light laser treatments ( one to four) to prevent a burn injury and get some really visible improvement. Studies have shown patients get a 25% to 50% improvement with half of the patients maintaining a 1 to 2mms eyebrow lift one year later. Recovery is usally anout 3 to 4 days after each treatment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had weight loss surgery and now need plastic surgery to reduce my mons pubis area. It is very large and sagging. It is uncomfortable and is creating self esteem and intimacy issues.
A: The reduction of a large mons pubis can be done by two techniques, either liposuction or a pubic lift. In some cases, both methods need to be done together. Since you have had weight loss surgery, there is undoubtably a significant skin component to your mons as you have described it as sagging. This will require a significant lifting procedure which is essentially a reverse or inverted mini-tummy tuck. The skin resection is taken out from below and the mons is lifted up. This is in contrast to a traditional mini-tummy tuck where the skin is removed from the lower abdominal region and the remaining skin is moved downward or tucked. Whether the mons will also require liposuction depends on an examination. But my experience, even in the weight loss surgery patient, almost always needs to thin out the mons as well by fat removal. The other pertinent question is if you have a sagging mons from weight loss surgery do you have loose overhanging abdominal skin as well. This may also necessitate some form of a tummy tuck as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have chin ptosis after the removal of a large chin implant. So what needs to be primarily done should be a mentalis resuspension. I am considering sliding genioplasty despite the risks of bone osteotomy, longer surgery time, and longer recovery time, only if it helps the result of the mentalis resuspension procedure. If genioplasty would have any negative effect or no effect on the mentalis resuspension procedure (i.e. more bleeding, swelling, more complications than the resuspension procedure alone), I would not want to have it done.
My question is, first of all, regarding [mentalis resuspension alone] vs. [mentalis resuspension + sliding genioplasty], would there be any difference in the result concerning the ptotic chin and lower lip disturbance? If there should be no actual difference, then I probably wouldn’t want the sliding genioplasty done due to longer recovery time and more risks. But, if the genioplasty should give any positive effect, I should consider it be done along with the mentalis resuspension procedure.
Secondly, my implant insertion and removal were both done by intraoral approach. Should the mentalis resuspension procedure be performed by intraoral approach again?
Lastly, you have mentioned the disruption of the attachments of labiomental sulcus as the cause of lower lip eversion disturbance. By the “attachments of labiomental sulcus”, do you mean the mentalis muscle attachment to the bone? Or is there any other muscle involved in this area? Does labiomental sulcus muscle repair simply mean resuspension of the mentalis muscle? Are there any other muscles that should be repaired to fix the attachments of labiomental sulcus?
A: The mentalis muscle suspension is infinitely improved by the concomitant sliding genioplasty as this procedure addresses one anatomic element that intraoral suspension does not…excess skin and subcutaneous tissues. Bone-occupying volume expansion with muscle tightening addresses all the issues of the ptotic chin problem.
The intraoral approach has disrupted the superior attachements of the muscle and, if only the mentalis muscle resuspension was going to be done, then you would do an intraoral approach for repair.
Labiomental sulcus disruption means the complete loss of superior mentalis muscle attachments. That is addressed in the intraoral mentalis muscle suspension procedure through the use of bone anchors.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Why is Sculptra not permanent although it stimulates the growth of the body´s own tissue? Is there a certain percentage of the augmentation effect, that can be considered permanent?
A: Sculptra creates its collagen effect through the implantation of small polmyer crystals known as PLA. This is a well known slowly dissolving polymer material. Its implantation causes collagen tissue to form around it as a reaction to the implanted material. This scar tissue will only persist as long as the PLA crystals persist. Once they are broken down and absorbed, the surrounding collagen tissue fades away. On a much larger scale think of the collagenous capsule that forms around a breast implant. Once the breast implant is removed, the capsule will eventually be largely absorbed. This explains why there is no permanent effect to Sculptra injections. It is long lasting for sure but not permanent unless treatments are eventually repeated.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How much does rhinoplasty cost in your practice?
A: This simple question unfortunately defies a single answer. There are many variables that affect the cost of rhinoplasty related to how much work is needed and how much time it takes to do it. These variables include whether it is a tip or full rhinoplasty, does it require any grafting (cartilage or synthetic implants) and is there any septal or turbinate work needed. Without knowing the specific needs of your nose, the best cost estimate I could give you is a range from $4500 to $8500, all costs included.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, The Lifestyle Lift (lower 2/3 of face only) left me with bunching/folding of skin at the sides of my face next to my eyes when I smile, which looks very unnatural. They are now recommending a forehead or temporal lift to try to correct this problem at my expense. Do you think this would be effective? I am looking for other opinions as I don’t want to waste my money. Thanks!
A: There are no other options for this problem. Although I would not make this effort until you are at least six months after the lift procedure to give it plenty of time to settle and relax if possible. This can occur as a direct result of this ‘cookie cutter’ type of facelift where all of the pull is vertical in front of the ear, creating bunching or ‘excess skin to the side of the eye and in the temple region. This is avoided by having the anterior vertical scar go well into the temporal hairline or out along the temporal hairline The excess skin created by the facelifting pull has to go somewhere and be redistributed. But if the incisional pattern is too limited, all it can do is bunch up at the point of the end of the skin excision. Not everyone’s facial aging problem benefits by a direct vertical lift, many need a more superolateral directional lift with a resultant longer scar on the back of the ear.
Your best treatment would be some form of a temporal lift. But that must be carefully designed to get an effective result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is there any upper lip lift procedure that you perform that successfully shortens the upper lip but does not increase the red lip (vermilion) (i.e. no roll out, no extra visible red upper lip)? I’m a male and the last thing I want is a fuller, more feminine red upper lip, although I could greatly benefit from the upper lip shortening procedure. Maybe upper lip lift at the same time with upper lip reduction? Is that possible?
A: All of the lip lifting procedures do create that exact effect, more exposed vermilion although it is not a one:one ratio in a subnasal lip lift. The amount of skin removed under the nose does not create an equal amount of vermilion exposure below, usually less than half. But the effect is there nonetheless. In theory doing an internal lip reduction at the same time would negate the increased vermilion ecposure. But it may do at the price of increased incisor tooth show which may not be a good trade-off. The other option to consider is a staged approach to the subnasal lip lift only removing about 4mm in two stages. This would give the upper lip time settle (vermilion relapse) while not causing too great of an immediate increased vermilion effect.
Dr. Barry Eppley
Indianapolis, Indiana
