Your Questions

Q: Dr. Eppley, I had saline breast implants placed under the muscle 11 years ago. While I know they have not ruptured, they seem to be less full and firm that they used to be. Is it possible that they are slowly leaking saline but without a rupture. Do saline implants get weaker over time and more likely to rupture? Are they more fragile now and more prone to rupture? Should I stop doing strenuous physical activities?

A: Your breast implant experience and questions are common. Many augmented breasts, although not all, over time will feel softer and less full years later. This is not the result of something going on inside the implants but rather what has happened on the outside. The pressure of breast implants over time will cause the loss of some breast tissue between the implant and the skin. This is known as pressure atrophy. With the loss of some breast tissue, the breasts will feel softer and less firm. With saline implants, the breasts may really feel loose and ripply as there is no longer as much tissue between the implant and the skin to act as a cushioning buffer…and this then reveals the more rippled surface of a saline implant.

The second part of your question is actually true. The shell or bag of a breast implant does get weaker over time, no different than any other manmade device. The constant stretching of the bag does over time create flaws or weak spots in the silastic shell which will eventually lead to a spot of rupture. While this is inevitable, there is no reason to stop doing any type of physical activity that you enjoy. This is not different than one stopping driving so their car tires will never wear out.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am now 10 weeks after cheek implant removal. Implants were removed because of infection and incorrect asymmetry. I am now thinking of getting Sculptra, Radiesse or Juvederm but am getting different answers as to how long I should wait to get the injections after removal. I still have some fluid, swelling and lip numbness after 10 weeks post op. My implants were put in October 2 and removed November 2, so they were only in for one month. I am very concerned about my health and healing from this and want to wait long enough to make sure the filler injections are safe. But my face looks worse than it did before the implants. Your expertise is very much appreciated!!

A: I would agree that complete healing should take place before you place any injectable fillers, even though the tissue plane where they will be placed is differngt from that were the implants were. That would be a minimum of three months. But a better barometer rather than just raw time is when the cheeks are no longer tender and any signs of numbness has completely dissipated. In short, don’t do fillers until your cheeks feel completely normal again.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I had jaw augmentation and a little lipo in the neck area…It was performed 2 weeks ago today….I can’t move my bottom lip in a downward motion which means I can’t smile….I still have a great deal of swelling although significantly less…Is this nerve damage permanent or could the swelling have something to do with it.Your advice would be greatly appreciated as I am very nervous. Thank you. It was performed by a very reputable surgeon but none the less I now bad outcomes can happen to anyone.

A: What you have is weakness of the marginal mandibular nerve branch of the facial nerves. This tiny nerve branch, which supplies the depressor muscle of the lower lips, crosses over the jawline on the side of the chin. It is not really at risk from the jaw (chin) augmentation since that is down at the bone level which is deeper. It is at risk from liposuction of the jowls particularly if liposuction is done at or above the jawline which is exactly where the nerve runs. Nerve injury from liposuction , because it is a blunt instrument, does not cut the nerve but bruises it. This may make it weak for a period of time (unable to lower lip) but recovery almost always occur. Nerve recovery does not parallel swelling reduction, however, and usually takes much longer. In most cases llike yours, full functional nerve recovery can take up to three months or longer. Given that there is no other treatment, patience is all you can do for it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like some information about breast augmentation re: price of inital consultation and surgery fees. Also, I am currently breastfeeding but am weaning and plan to be done within the next week or two. I would have to have the surgery between the end of March or before mid April due to when I can take vacation from work. How long does the surgeon require to be done breastfeeding before doing the surgery? I’ve researched and it looks like a lot say a minimum of 6 weeks? Thank you for your time.

A: The issue of when to undergo breast augmentation after breastfeeding is a relatively common question and there is no real exact timetable. Delaying having breast implants placed until after breastfeeding is based on having a non-engorged breast (so one can estimate breast implant size better) and having an increased risk of infection due to breast milk leaking onto the surgical field. Thus the key questions are how quickly does the breast deflate and assume its normal deflated size and when does the milk production dry up. Once can see that will vary tremendously for many women. I feel that breast size reduction is more important than absolute cessation of milk production, since I do not use nipple incisions and the nipples can be covered with sterile shields (dressings) during surgery. Therefore, I do find the general estimate of six weeks after breastfeeding to be a reasonable schedule to undergo breast augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am really interested in a new procedure called “Fractora Firm”. Do you do that and if not, do you know anyone in the state of IN or surrounding states who does? This would be much less costly than a facelift.

A: The procedure or technology behind the Fractora Firm is radiofrequency (RF) energy driven into the skin to creatre a mild firming or skin toning effect. What has caught your attention to it most likely is its recent appearance on the Dr. Oz show. The use of RF and a variety of other energies (ultrasound, pulsed light, galvanic electrical currents, etc) to try and improve sagging skin is not new. Over the past decade there have been a slew of these energy-driven technologies, all of whom capture media attention as they have become available for patient use. They capture the public’s attention due to the widespread concern of sagging facial tissues as one ages and the hope that it will avoid the need for a ‘facelift’.

It would be a far reach to consider it or any similar technology as a replacement or substitute for what a surgical facelift does. Calling it a non-surgical facelift is a marketing concept not a clinical reality of what actually happens. It is better to think of it as a skin toning or firming method not a sagging tissue lifting method. As a result it is best used on younger patients with early signs of facial aging such as a small amount of jowling or just a little loose neck skin. It is not for someone who has more moderate to advanced facial aging with really evident jowls and a neck wattle. Its success, therefore, is highly dependent on proper patient selection.

What is also not evident on the Dr. Oz show is that Factora Firm requires multiple treatments, usually 4 to 6 treatments spaced a week or so apart, to get the optimal facial toning effect. Thus the cost is not really $300 (as stated on the show and the website) but $1200 to $1800 for a series of treatments. Whether that cost and the effect that it creates is a better value than a ‘facelift’ would depend on the degree of facial aging that one has. If one does not really need a facelift then it is a good treatment that may be worth the cost. If one really needs a surgical facelift, then such treatments are a poor value.

In my practice, we offer a similar non-surgical treatment to Factora Firma using RF energy (Exilis) combined with more superficial fractional laser resurfacing for skin tightening and a mild amount of facial skin lifting. This combined treatment is superior because it combines heating up the underside of the skin (dermis) with a more superficial (epidermis) treatment. This produces the combined effect of skin tightening AND wrinkle reduction. For some patients a more intense single treatment is fine while others may be best served by lighter treatments done in a series.

I would be happy to review any pictures of you to determine whether you are best served by considering a non-surgical RF skin tightening approach or whether something more surgical is more appropriate. While every patient wants to avoid surgery and their associated costs and recovery, most patients would also like to avoid throwing their money away on a treatment concept that never had a chance to achieve what they wanted.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a very active 28 year old man who has both a scar and bump at the top of my forehead. They have both bothered me for years. I have been meaning to contact your office for quite some time, but have been a little hesitant. I would like to learn more about my options. I guess we can discuss everything in more detail once we make contact. I tried to take the best pictures possible to make out my concerns. I took one with a ruler just to give you an ideas of the length of the scar, its about half an inch long. You can semi make out the bump I’m concerned about, the high point of it is around the location of the scar. I look forward to hearing from you.

A: Thank you for sending your pictures. I can see the forehead bump which I view as more prominent and obvious than the small scar. The scar can be used for incisional access to burr down the forehead bone bump. The real question is whether the concomitant revision done on the forehead scar would end up much better after it healed. This is because of two factors, your ethnicity with darker pigment (which notoriously scars poorly) and that there would be some stretching of the skin edges for the bone bone burring. (which could potentially cause the scar to hyperpigment or widen after healing)

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I had fat from my hip added to the left side of my face. I had a hollow side due to radiation, it’s been about 7 to 8 years since I had this done. And the fat has dropped and looks terrible, what can I do about this? It sticks out and hangs down.

A: You undoubtably had a dermal-fat graft taken to reconstruct the soft tissue atrophy on one side of your face due to the radiation. While dermal-fat grafts are an excellent means of subcutaneous fat reconstruction, they are notorious for ‘sliding off the face’ or falling down to the jowls if they are not anchored securely to the cheek bone and along the zygomatic arch bone. What could be done now is a resuspension of the dermal-fat graft back into the desired position with permanent sutures. This would be very similar to the original procedure to place the graft minus the harvest site. It is, in essence, like a one-sided facelift procedure. It is clear that the dermal-fat graft has taken  but it probably developed descent before it completely healed, thus falling down to the jowl line.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 35 years old. I had a child nearly 18 years ago. I have excess skin and stretch marks. I would like to consider getting a tummy tuck. My chief concern is down time and cost involved. I am recently divorced and self conscious about my looks. But worried about going through plastic surgery.

A: The thought of elective plastic surgery is certainly scary for most people, particularly an operation like a tummy tuck. Such a procedure, while making a dramatic improvement in one’s stomach and waistline area that is not achieveable by any other means for someone with excessive abdominal skin, requires a commitment of both time and resources. It is not for the faint-hearted and there is no easy or simple way to do it.  The bigger the change, particulalry on the body, the mopre of everything it takes to do it. The best way to think about it is that you will need three weeks to have an adequate recovery and total costs would be in the range of $7500 to $8500. Those two basic considerations are good screening tools to determine if you should move forward with taking your desire for a tummy tuck to the next level of an actual in-office consultatiobn.

Dr. Barry Eppley

Indianapolis, Indiana

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, 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