Your Questions
Your Questions
Q: Dr. Eppley, I have an abdominal scar directly down the middle of my stomach which measures about 15 inches along with train tracks. I had exploratory surgery done decades ago. I would like to have it removed. It’s not that its ugly but I am tired of looking at it and I want it removed. It makes me insecure and I don’t think that Icould ever be in a relationship with this scar. Please help.
A: There are two concepts about your abdominal scar that important to understand. First, the idea of scar removal is not possible. No scar can be completely eradicated from visibility. Scars can be reduced and made less noticeable but completely normal skin contour and color can never be achieved. There are limitations as to what scar revision can do. Second, the width of the train track portion of the scar is important as this will determine how much of the scar can be excised in a single scar revision procedure. If the train tracks are too wide, a staged scar revision procedure may be needed. A picture of your scar will suffice to answer this question.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had cheek implants and fat grafting 3 weeks ago. The left implant is sitting too close to the lower eyelid and the end of the implant can be seen and felt at the end of the eye. I have numbness in the upper lip and teeth. Is this normal? Implant was silicone and attached with screws.
A: Cheek implant asymmetry is not a rare problem. As the swelling subsides, usually about the three week time period after surgery, the position and symmetry of the implants becomes apparent. The most common form of cheek implant asymmetry is that one of the implants is sitting too high as evidenced by the lateral wing of the implant being palpable close to the corner of the eye. While it is something that you can tell now, the question is whether it is an aesthetic issue that ultimately you will want improved. If it is not seen or causes a visible lump, then it is an issue that most patients can live with. If the end of the implant is visible, you likely will wanted it adjusted for better symmetry. Intraoral placement of cheek implants almost always cause some temporary numbness of the infraorbital nerve with decreased feeling of the upper lip and teeth. This is a temporary issue, which is expected, and should resolve over the next month or so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, do you have any recommendations for topical ointments for my forehead laceration which was fixed about a month ago to help with the scar. Which are the best on the market? Do you have any knowledge or recommendations of using supplements like enzymes and vitamins to help reduce the scarring? I have read serraptase like in Vitalzym helps break up and remove scar tissue and was thinking of trying it. I’m trying to do anything I can to reduce it. Thanks very much for your time and advice!
A:I don’t think there are any magical scar creams, lotions or potions…despite how they are marketed and promoted. I also don’t think there are any vitamins and enzymes that help scarring either. While you can use any or all of them, they are as much psychotherapy as anything else for the typical non-problematic scar or surgical incision. This is not what most patients want to hear as understandably everyone wants to do the most they can for their scar. Time will create as much improvement as anything else. I think if it makes you feel better to use them then you should. There are other early scar treatments to consider, such as fractional laser resurfacing and broad band light therapies, that may have more profound effects than topically applied creams and ointments. This should not be construed to imply that the treatment of known problematic scars, or those that might potentially become so, will not respond well to the use of silicone gel sheeting and topical silicone gels and oils. But whether these are of benefit in many lacerations and wounds that might otherwise do well on their own is a matter of debate.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am in the process of correcting my jaw. I have had SARPE for my first phase. My main concern for the second phase of the surgery is to correct my flat under eye region. I would like implants to corrects this region of my face. I have a negative vector, flat upper cheeks, however I have moderate submalar projection. I have been told that my cheeks will fill out and the cheek fat of the submalar region will be pushed upward creating a fuller cheek effect, which I am seeking. I was also told, if I am still unsatisfied with my cheeks, it’s best to wait a year after orthognathic surgery to augment my cheeks. I have been reading that these procedures can be done at the same time and that orthognathic Lefort I osteotomy will not provide the same results as cheek implants/augmentation. I keep reading mixed reviews, Please help.
A: Let me answer your two questions directly and unequivocally.
1) A LeFort osteotomy, no matter how it is done, will not create a cheek augmentation effect. Based on where the bone cuts are and the how the bone is moved, this is simply not possible. Anyone that would suggest otherwise does not understand cheek augmentation.
2) Cheek implants can be done at the same time as a LeFort osteotomy. I have done it many times without any problems. It is as good combined procedure for the right patient. Just because someone had not done it before or is unwilling to do it does not mean it can not be done.
I hope this is helpful,
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a scar from an accident that runs vertically on the middle of my forehead. The accident happened approximately one month ago. I am interested in hearing your thoughts about whether scar revision will significantly help as I am very self concious about it now.
A: As a general rule, one month after an injury would be way too early for scar revision for the vast majority of facial scars. The wound has barely healed and the scar is undoubtably very red due to the influx of blood vessels needed to help it heal. While being impatient is very understandable as it sits on a prominent facial area, patient is going to be urged in most circumstances.
That being said, there are two indications for early scar intervention. If the wound edges are horribly mismatched and it is apparent that no amount of healing time will improve its contour, then excising the scar and aligning the skin edges may be advantageous. The more common indications for early scar intervention is either fractional laser resurfacing and/or BBL. (broad band light therapy) These non-surgical approaches are done to help the redness of the scar fade sooner or to smooth out some fine edges early. Good wound approximation has to be present so there is no reason to suspect that scar excision would be needed later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 25 year old man with a normal mandible angles but a slightly weak chin that has a little steeper angle then the rest of my jaw. Anyway I have been considering a square wrap-around or extend chin implant to slightly increase the width and moderately increase the forward projection of my chin But I am concerned that a chin implant will make my jaw angles appear greater so I was thinking a combination of a chin implant with jaw angles might be right for me. So my question is generally speaking do you think that those people who undergo chin augmentation would benefit from jaw angle implants that increase the vertical height of the ramus decreasing the angle.(for me I think part of the reason my angles seem so square is because my chin is undersized and the angle is about 90 degrees but then after the groove increases to about normal dimensions) And then my second question do you have an photos that demonstrate the depression that is formed when off the shelf chin and jaw angle implants are used together?
A: There are no general statement that can be made about the influence of the chin on the appearance of the jaw angles. Each patient’s jawline and facial anatomy is unique and must be considered individually. The best way to answer your question is through computer imaging…change the chin without the jaw angles and see what it looks like. That is the best way to answer that question. You are correct in assuming that most standard chin and jaw angle implants do not meet in the ‘middle’ (body of the mandible) and, even if they do, these are thinnest and most tapered aspects of the two implants. Thus it is possible the jawline might not be perfectly straight from the chin back to the jaw angles and usually isn’t. But whether that occurs or not and is aesthetically significant depends on each patient’s jawline anatomy and the implants used.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a depressed scar across almost the whole of my forehead, cheeks and chin. I have tried chemical peel and microdermabrasion, but all seem to burn that arena alone precisely. I think the tissue or skin in that area is pretty damaged and I would like to have it excised.
A: Based on our description of a long depressed facial scar, I am not surprised that microdermabrasion or chemical peels were ineffective for its improvement. Neither of these are appropriate treatment strategies for scar reduction. I am glad that you went through those though so you could prove to yourself that scar excision, radical as it may seemed initially, is usually the only effective treatment for a depressed scar. A depressed scar by definition has a thinner and more atrophic skin composition and a surface contour discrepancy to that of the adjacent normal skin. No treatments are really going to lower the shoulders of the edges of the normal skin to match the depressed scar and that would not be appropriate even it could. Removing the abnormal scar tissue and leveling the skin edges by bringing normal tissue together (surgical scar revision) is almost always a better approach…even if it is surgery and does take time to heal and for scar maturation to occur.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in neck liposuction, revision rhinoplasty, and cheek augmentation. I want to get rid of neck fat, define my jaw and neck line, straighten nose-one side of nose is bigger, and add volume in mid- and lower cheeks and under eyes. I have attached pictures for your review and assessment.
A: In looking at your pictures and your areas of interest, I can make the following comments/recommendations:
1) You jawline is ill-defined because your chin is both horizontally and vertically short. This makes your lower face look very deficient and creates a lack of any jawline definition. What you would ideally benefit from is a vertical-lengthening chin osteotomy which adds lower facial height and creates a more obvious jawline. This will also improve the appearance of a fuller/fatter neck although some submental liposuction done with the chin procedure would complement that improvement.
2) Your nose shows numerous secondary rhinoplasty issues. I do not have the benefit of knowing what you looked like before but I see issues relating to lack of upper dorsal height, tip asymmetry/thickness, nostril asymmetry and a deviated columella.
3) The need for volume in your cheeks and lower eyes is a bit perplexing to me. I see no benefit to lower eyelid volume augmentation. Perhaps with the chin lengthening, more volume in the lower cheeks (submalar implants) may be aesthetically beneficial to you. I have left those areas unimaged so you can see the other more important areas of facial change first.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, how big can custom facial implants be made? Can I get any size and shape that I want? I know you design a lot of facial implants for people having read your blogs. You talk about how it is better to be more conservative than extreme for many patients. Why can’t I just get any size facial implant I want?
A: I have make these comments in my writings based on a lot of experience with men trying to design their own implants or providing me with very specific dimensions of what they want. I have seen too many cases where such outcomes have resulted in the need for revisional surgery because the outcome turned out to be different than they thought it would be based on its size and/or shape. I am always happy to accomodate patient requests and provide implant dimensions that one may desire, but I do so with the understanding that they then take responsibility for the outcome should the implant be too big or oversized. I make implant suggestions/recommendations based on my experience of seeing how a lot of facial implants turn out afterward as well as knowing the technical and tissue limitation difficulties that can come when trying to place large facial implants. While one can design anything on a 3-D model, that doesn’t always mean that the overlying soft tissues can equally accomodate its size. Custom implants must be designed with an appreciation of more than just how they sit or look on the facial bones.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a tummy tuck six months ago and although I am happy with my lower abdomen I am not with my upper. It is still fairly thick and not as slim as the lower half. From the side view, the upper abdomen shows no difference unlike the lower. The only explanation that I can come up with is that my plastic surgeon refused to do liposuction of this area even though he did it to the sides of the tummy tuck. I can’t help but wonder if that had been done also it would look much better now. Can I get the upper abdominal area liposuctioned now and will it result in more loose skin afterwards?
A: Your question/concern of a tummy tuck result is a common one and one in which I review with every patient before surgery. Tummy tucks do their best work in the lower abdomen, where tissue is actually cut out, and offer more modest improvement in the upper abdomen. Your plastic surgeon was very prudent to not liposuction the upper abdomen during your tummy tuck as the risk of major healing problems can ensue at the central closure line . Thus many tummy tuck patients will have an upper abdominal fullness after their tummy tuck due to a persistently thick fat layer. This can be addressed after tummy tuck suction out extra fat and thin out its thickness. It will not cause any extra loose skin as that has been adequately tightened by the previous tummy tuck.
While we wish we could address the upper abdominal fat at the same time as the tummy tuck, it is wise to remember this basic motto in aesthetic surgery. It is far better to have two surgeries done safely than going for the perfect result and suffer a major wound healing complication which ca takes months to heal and leave a more devastating aesthetic problem than what one was initially trying to treat.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a large square chin implant that was placed 6 months ago that I am not happy with. As the swelling went away it became apparent quite quickly that it was not whaI wanted. The improvement is too small and it has little if any square definition from the front view. I have a 3-D jaw model done after the implant which I have sent to you. I am requesting a chin implant that is 19 mm thick and 3 inches wide from the front. I know that the implant is going to be fitted directly on the bone which means that it is going to curve around the chin to the side.That being said the squareness and the size of the implant is going to deviate from the criteria that I am trying to achieve because as the implant proceeds backward from the mid point of the chin it is going to take a different shape and size. Knowing that to maintain the squareness of the implant along the 3 inch width we need to increase the size of the implant as it proceeds backward from the midpoint of the chin. Please tell what you think.
A: I have received your 3-D model of your mandible with the existing chin implant you now have. The current implant you have appears to be a Style I square chin implant of 9mms horizontal projection. It is significantly asymmetric due to placement with the right wing of the implant being very high and right up against the mental nerve location.
As to your dimension request for a new custom chin implant, this needs to be carefully thought over as 19mms of horizontal projection is significant and would be roughly twice of that you have now. The 3 inch squareness width, or 7.5 cms frontal width, is considerable and is about a 3.5 cm width increase over the implant you now have. It would be unusual to need more than 5 or 5.5 cms in most men to develop a square chin look from the front. With such a wide frontal square width, this necessitates the need for a wide width around the corner of the implant as it transitions back into the side of the jaw.
I would be careful to oversize the implant and it is easy to do. It may seem that these dimensions are needed/desired, but it can be surprising as to how these translate to one’s appearance once in place due to the overlying soft tissue thickness. You do not want to end up with a ‘Jay Leno’ chin afterwards which is way too big and result in the need for revisional surgery.
I would suggest some smaller dimensions to the custom implant, more like 15mm in horizontal projection and 5.5 cms square chin width.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had my buccal fat pads removed over 10 years ago which looked great. Then I lost a considerable amount of weight, over 50 lbs, and now look too sunken in. What is the best filler used to replace where buccal fat pads have been removed?
A: The answer to your question partially depends on how much volume is missing (how sunken in you are) and what method (surgical vs non-surgical) you want to pursue. But using the injectable filler criteria as your question posed, I will answer based on that one variable only. Because of the volume of the buccal fat pads (usually 5 to 10cc per side), the best replacement filler is fat injections. While the injection of fat is unpredictable, it offers an unlimited amount of volume for facial injections and it has the potential for some permanent volume retention. While there are many proponents for the various synthetic injectable fillers that are currently available, one has to recognize the cost of the volume needed per side based on the volume lost and that none are permanent. But if one had to go for a synthetic injectable filler, I would first use one of the longer-lasting hyaluronic acid fillers, like Perlane or Juvederm, to see if you like the effect. While there are longer-lasting fillers, such as Sculptra, Radiesse and Artecoll, they can be associated with higher risks of lumpiness and irregularities than the non-particulate hyaluronic acid-based injectable fillers when it comes to larger volume augmentations.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just need info on getting my belly button repaired. I don’t need a tummy tuck, literally just need my belly button put back after it “popped” during my pregnancy.
A: What has undoubtably happened is that you have developed an umbilical hernia as a result of your pregnancy. This has changed your belly button from an inne to an outie. The attachment of the belly button to the abdominal wall is an inherently weak point along the midline attachment of the vertically-oriented rectus muscles and their enveloping fascia. The enlarging fetus during pregnancy puts a lot of pressure directly behind the umbilicus. For some women this results in the area around the base of the umbilicus to separate. This results in the base of the belly button coming away from the abdominal wall and some intraperitoneal fat protruding outward. This push of tissue from underneath creates the change from an innie to an outie. You can probably push your outer in and feel a small hole underneath it. This can be repaired through an umbilicoplasty procedure, closing off the hole and re-attaching the umbilical stalk back down to the abdominal wall.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need some help with an issue. I had an orbital floor fracture repair done a year ago with mesh implant. Since then I now have enophthalmos and nerve damage in my face. I want to know at this point is there anything you can do for me or suggest? PLEASE help me if you can I would greatly appreciate you!
A: I will assume that you had an isolated orbital floor blow-out fracture. When that occurs, the supporting thin bony floor of the eye drops down. If significant enough (greater than a 1 cm floor defect) the eye will drop down. (enophthalmos) In addition, the large infraorbital nerve runs just under the orbital floor so it frequently gets trapped or pinched as the floor drops down. This is a sensory nerve (maxillary division of the trigeminal nerve) that supplies feeling to the cheek, lip and side of the nose. If injured or entrapped, patients may suffer long-term numbness or pain.
During an orbital floor repair, I always check for this nerve and make sure it is not entrapped in the blow-put fracture. Sometimes the nerve may be irreversibly injured, other times it may be entrapped and needs to be released. Reconstruction of the orbital floor can be done by a wide variety of synthetic implants or bone. There are proponents for all approaches and any of them can work with good surgical technique. The goal of orbital floor reconstruction is to prevent long-term dropping of the eye, known as enophthalmos, due to loss of support.
Since you have enophthalmos and infraorbital nerve dysesthesia, I suspect that further surgery may be beneficial by removal of the mesh implant, exploration and decompression of the nerve and a new floor reconstruction done. The first place to start, however, is with a good CT evaluation. I would get a 3-D CT scan of the involved orbit to first look at the anatomy. Based on that information, surgery can be planned appropriately.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting fat injections to my face as I have lost some volume in the cheek area as I have aged. As I read about fat injections it seems like there is some controversy as to how well they work or how long they last. I have read several doctors who claim if the procedure is done right the results are excellent with good long-term survival. How do I know if my doctor will do the fat injections the right way?
A: It doesn’t really matter what anyone claims about fat injections. They are unpredictable in terms of survival no matter how it is done and anyone that would use the statement…’if done right’…is either misinformed or full of themselves. If there was a good and reliable way to do them that assured predictable long-term results, then so many people wouldn’t be talking about the different methods of how to do it. If one way really worked everyone would be doing it and that would be the end of the discussion. There are some basic principles of fat harvest, concentration and injection that are currently used, but no one doctor can claim any proprietary method of how best to do fat injections. Much of the science of it remains unknown at present. In addition, anyone that talks about long-term fat injection results is either speculating or commenting on their own personal observations as there have never been any long-term clinical studies that have shown in a quantitative objective manner how stable the results are.
That being said, I think fat injections is a very useful technique and the only good solution for some aesthetic augmentation issues. But the patient has to know that the result is unpredictable and can not be assured or guaranteed how well it will work. Fat injections are great as they are a natural tissue but the result is a gamble.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am Yoga Weight Loss System interested in skull reshaping. I am a 28 years old man and the point being that the width of the upper part of my head above the ears is big and rounded on both sides. Can it be reduced and flattened ?
A: The wide or more square head shape that you have is due to a pronounced temporal ridge which is where the top part of the skull joins/transitions to the skull bone at the side of the head. This actually a ridge or line that starts in the forehead and goes to the back of the head. While this is always a transition area like two walls coming together in a corner but is usually a gradual transition. Your temporal line is very acute almost being 90 degrees.
This area can be snoothed down and made to look less square or wide. But the important question is whether it is worth the scalp scar trade-off to do so for the skull reshaping benefit. To access the area an incision is needed across the top of the head so both sides can be treated. While the skull width can be reduced, I am not sure in your case that is a good tradeoff.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had my cheekbone broken two years during an assault. At the time, I did not have it fixed by having plates inserted and it has since healed. My cheekbone is flatter on this side and my face is slightly asymmetrical and uneven. Since then, my friends misinterpret my facial expressions thinking I am smirking or grimacing when I am not. I am sensitive about my facial asymmetry and am wondering if it is worth the time and effort to repair. Thank you so much.
A: Cheekbone or zygomatic fractures display a classic pattern of displacement when fractured. The body of the cheekbone rotates down and inward with partial displacement into the maxillary sinus. This reduces the prominence of the cheek bone by this inferior rotation, making the cheek flatter and the face asymmetric. Primary surgical repair repositions the cheekbone back into place and holds it there with plates and screws. But once the fracture is healed, this is no longer a good option in most patients. Rather than moving the bone, it is usually better to treat the facial asymmetry with an implant to restore fullness to the cheekbone. This is a far simpler surgery than major zygomatic osteotomies and repositioning. A one-sided cheek implant is a simple surgery that takes 30 minutes of surgery and improves much of the aesthetic asymmetry of the fractured but healed cheekbone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a mini tummy tuck with muscle repair 6 years ago. I am unhappy that my belly button is lower than I would like. I have some loose skin elasticity—is it possible to pull my belly button back up to more of the placement it was prior to my surgery?
A: One of the potential disadvantages of a mini-tummy tuck is that the belly button can be pulled down because, unlike a full tummy tuck it is never transposed. It remains with the skin that is pulled down and often looks and is lower. Usually this is not a problem in most cases but umbilical distortion can occur as the funnel of the belly button is turned downward. This problem can be difficult to fix but not impossible. There are two potential approaches. First, a superior umbilical lift may be possible based on the elasticity of the surrounding abdominal skin. By removing a small crescent of skin at the upper umbilical hood, there can be some upward tilt to it giving a slight superior repositioned look. Secondly, there is a vertical umbilical lift which is very similar to the lollipop breast lift. This is the most effective approach to lifting the belly button but will result in a vertical scar that is left in the wake of where the belly button used to be. The choice of either umbilical lift approach depends on how much upward movement one wants to achieve. I would need to see a picture of the current position of your belly button and then another one which shows where you would like it to be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting my chin narrower as it is too wide from the front view. In addition, it is longer on one side than the other. I know that you can burr or shave down the chin to reshape it. I have some concerns and questions about the procedure.
1. I want my chin to be narrower by at most 1/4 inch. I want the same squared shape only narrower from the frontal point of view. Is that easier to do by cutting out a long narrow vertical strip in the middle of the chin and pushing the sides together thus preserving squareness or is it just better to burr down tubercles of chin on outer edges? I do NOT want a pointy chin nor an oval chin. Slight square is better just like it is, but narrower. Don’t know how narrowing would change smile lines as they arise from chin though. Nor am I clear of how the jawbone to chin transition would change in a burring. May be difficult to preserve some squareness. Don’t want too small a chin for my size. I also fear that a subsequent face lift will feature a prominent bony masculine chin.
2. I do NOT want my chin profile to be changed. I think it is fine as is. Would burring down of sides affect this?
3. Also want the bottom of the chin to be evened out. One side is longer than the other. Hopefully the asymmetry in the rest of my face (the right side is fuller in the cheeks) won’t be accentuated by any chin narrowing.
4. Will intra-oral approach allow you to visualize the submental nerve adequately? Will it increase chance of infection?
5. Percent likelihood of numbness of chin? Tongue? Typical resolution time? Ever seen permanent numbness?
6. What is most catastrophic thing that could go wrong with a chin reduction? Lower face paralysis or worsening of my already incompetent lower lip?
A: In answer to our questions:
1) It is better to simply burr down the side of the chin for such a small amount of chin narrowing. Technically I actually use a reciprocating saw to remove the bone. That stills keeps it square in the front view, just narrower by the amount removed. I don’t think this would have any great impact on the smile lines nor change the jawline-chin transition…it is just being made slightly smaller/narrower in the frontal view. Also, a facelift does not really pull and shift tissues in the chin area so I don’t think that it will accentuate or create more of a square chin appearance.
2) Taking down the sides of the chin will not affect its horizontal projection. (profile) The most projecting part of the chin bone is not being affected.
3) The longer vertical side of the chin can be reduced as well. The computer imaging done previously should show you what the impact the chin surgery has on the look of the rest of your face.
4) The intraoral approach will allow the mental nerves to be seen completely. Intraoral surgery does nto increase the risk of infection unless an implant is being placed. There is nothing wrong with going from beow the chin through a skin incision, it is just that it is not necessary. (no advantages in doing so)
5) There will always be some temporary numbness of the chin because the mental nerves have been exposed. I have not seen permanent numbness from an isolated chin reduction/burring procedure. No risk of tongue numbness, the tongue is innervated from the lingual on the floor of the mouth which is a long way away.
6) There are no catastrophic events that can happen from this procedure. It is just an issue of aesthetics, how close do we come to the desired aesthetic goal. Lower facial paralysis is an impossibility because the facial nerve the moves the face is back near the ear. If your lower lip is incompetent to some degree I will resposition the mentalis muscle and chin soft tissues to try and improve that problem at the same time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need to have age spots on my hands, arms and legs removed. Does the doctor do this procedure? If so, I would like to have a consultation with him to discuss the type of procedure and cost.
A: What are often called age spots are a variety of long-term aging and ultraviolet light exposure changes. Some of these age spots are different shades of brown, some are are flat and others are raised with a rough texture. Based on the type of age spot, a variety of treatments are available including pulsed light therapy (BBL), fractional laser resurfacing and shave excision. I would have to examine you to determine which treatments options are best, often two or all three are needed to treat the various types of age spots. Cost would ultimately be based on what treatment method is used and how many brown spots are being treated.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had buccal fat removal a few months ago. That helped a little but I want an overall smaller face so I would like to get liposuction around my neck area, neckline my lower cheeks, areas surrrounding my jowl and chin area. I want all the fat that I have from my mid face down, ear to ear, to be all 100 percent removed.I just don’t like the fact that I have fat on my lower face instead of in my upper cheeks. When I smile I feel like the muscles or perhaps the fat pulls my nostrils out making them look wide. I thought that may be fixed with liposuction or it might just be fixed with rhinoplasty.
A: When it comes to facial liposuction, the reality is what you are asking for can’t be done with the result that you want. There is no such thing as ‘removing all of the fat’ no matter where on the body liposuction is performed. Facial liposuction is particularly unique because the fat is in very select and limited compartments, thus limiting how much facial slimming can be achieved. There are several discrete compartments of the face in which face can be reduced and includes the buccal space, perioral mounds, submental, lateral neck, lateral face and jaw angle area. Liposuction can help provide some refinement and mild sculpting to the face but it is best not to overestimate its facial slimming potential. Facial contour improvement is possible but removing all the fat is the face is impossible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just had my cleft chin reduction surgery on this past Thursday October 11th. I’m having a difficult time opening my mouth and am wondering if this is normal after this kind of procedure. It feels like there is some kind of resistance on the left side of my jaw (which is the same side of my mouth where fat was taken from) whenever I try to open my mouth past an inch or so. It doesn’t hurt, it just pulls.
A: What you are experiencing is perfectly normal. For your chin cleft correction a small buccal fat graft was harvested through a small incision high in the maxillary vestibule. This requires going through the buccinator muscle and then closing the incision with a few dissolveable sutures. This will definitely make in the first few weeks a sensation of tightness when opening your mouth widely. That is because the intraoral mucosa and buccinator muscle stretch when opening and now have a little constriction. This is a temporary minor problem which will be self-solving in a few weeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I don’t live in Indiana but I haven’t been able to find a plastic surgeon in my state that does the type of procedure you do. I have for my entire life had an extreme amount of fatty tissue in my mons pubis region, even when I was 125 pounds (I’m about 140 pounds now) it was just insane how big of a bulge I have down there. I am in a situation financially where I might be able to afford some type of financing arrangement, some type of payment plan… and if that were a possibility I would be more than happy to make the trip out there to Indianapolis to speak with you! I just want to be able to wear a swim suit or tights or just tight jeans without this source of embarrassment! 🙁 I am 26 years old and this has been a major issue for me ever since I was about 10 or 11. I’d give anything to finally have it reduced and just look in the mirror and feel ‘normal’ although I hate that term. I know nobody else would notice a difference because I’ve gone to such extents to hide it but just for myself I know it would give me something that I need more than anything right now in my life. It would give me the peace of mind to just wear whatever I want to wear, to do things that other people do without thinking about how to hide this part of my body… please, if there is any forseeable way you think I could work out the financial aspect of this pleasse let me know if I can meet with you! I would so appreciate it. Thank you for your time, I hope to hear from you soon…
A: A large suprapubic mound is not uncommon in many women although it is more unusual in thin women. But its presence in an otherwise non-heavy woman suggests that it is here to stay and will not be eliminated by any amount of diet or exercise. Surgical reduction by liposuction can be remarkably effective and a lot of ft can be quickly removed, In some patients, a suprapubic lift with the liposuction may be needed if there are any excess skin issues, But that would seen unlikely with someone of your weight range and stability.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, for nasal surgery can you use calcium phosphate cement to build up the nose? Please advise.
A: As you may know there are a large number of materials, both synthetic and autologous, that are used for nasal augmentation. The term, nasal augmentation, can be used to describe a variety of dorsal nasal procedures but in most cases refers to a build-up from the nasal bone area down to or just behind the tip. It is important to realize that the underlying anatomy changes along the dorsal line. Only the upper third of the dorsal line is comprised of bone, the lower two-thirds is cartilage. Therefore, when considering a bone cement material for nasal augmentation it would need to be restricted to that of the upper third where the cement can actually attach to the bone. Bone cements would not be good for any other dorsal line area because it will not attached to the underlying cartilage.
Can hydroxyapatite bone cements be used for nasal augmentation? Yes but it would be restricted to very limited nasal augmentation indications. Does bone cement offer any advantages over the wide variety of other more commonly used nasal implant materials? That is a matter of debate and would highly depend on the specific need and indication. But, in general, it is a very uncommonly used nasal implant material even for the bony bridge area of the nose.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in getting a jaw reduction surgery done. I am a 25- yr old female with a jawline significantly wider than cheek bones area. My jawline alone is wider, adding to that strongly developed mandibular muscles makes my lower face evidently out of proportion.
1) Do I need anything additional done besides the jaw reduction surgery?
2) For how many days would I ave to remain hospitalized?
3) I live out of state, so how could the follow up appointments happen?
4) how many follow up examinations does Dr Eppley usually do? And what is their time frame?
5) what is the approximate cost I would be looking at (including hospital stay)?
Thank you!
A: In answer to your questions:
- I would need to see some pictures of your face to determine what, if anything, else make be helpful in achieving your goal of a more narrow lower facial width.
- This type of facial surgery is done as an outpatient procedure. There is no reason to be hospitalized for jaw angle/jawline reduction surgery.
- As a general rule, my out of state/country patients follow-up by e-mail, phone or Skype. There are no regularly scheduled in-person follow-up examinations needed. When it comes ti changing appearance what matters is how things look and that can be discerned with modern technology from afar.
- as per #3 above
- I will have my assistant pass along that information later today or tomorrow. Although be aware that this is a cost estimate for a procedure on a face that I have not yet seen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in brow and forehead augmentation. I feel like my eyes are very flat. I would really love deeper eyes. I believe deeper eyes are the most attractive eyes there could ever be. I love Adriana Lima’s eye. Her eyes are very deep and I believe that is what makes her very beautiful. I believe having deeper eyes will give my profile a better definiton. I have the thing that changes the feature of your face on my Iphone, so I played around with it and structured my face with deeper eyes and I actually really how it came out and I can only imagine coming out better in the actual procedure.
A: In looking at your pictures, I would agree that you have a relative lack of any brow bone prominence and a vertical forehead inclination. I have done an imaging picture based on what I think the general changes can be with brow bone and forehead augmentation. The brow bones need to be augmented at least 7mms (if not more) and the forehead shape needs to be converted to a more convex and less straight vertical inclination in profile. The amount of brow bone augmentation is open to discussion as more or less can be done based on your preference. The amount of brow bone augmentation will determine how deep set your eyes will look. In looking at the one model’s pictures which you have shown, she not only has more brow bone but it is very horizontally-oriented, a key feature of brow bone augmentation to get deeper set eyes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants but don’t know if making the breast bigger will also lift may nipples up. They have a little sag but not bad. I have read about a nipple lift but am not sure what it does or how it works.
A: A nipple lift, also known as a superior crescent mastopexy (SCM), is the simple removal of a half moon-shaped piece of skin above the nipple. This allows the nipple to move up higher based on the amount of skin removed. This leaves a very fine line scar that is usually imperceptible along the upper areolar-skin margin. A nipple lift is almost always an adjunctive procedure when placing breast implants if the patient has some mild breast sagging. An extra 1/2 to 1 inch of upward nipple repositioning can be helpful. But a nipple lift is not a replacement for a formal breast lift in cases of more significant breast sagging. In breast augmentation a nipple lift is usually done for one of two reasons. First, in women with very small amounts of breast sagging, a breast implant alone may not provide enough of a lift and the nipple lift is insurance that a more centrally positioned nipple on the breast mound may occur. Secondly, in women who really need a more formal breast lift with their implants (such as a vertical breast lift) but are very apprehensive about the scars, they may initially try a nipple lift and see how much improvement they get. One can always proceed with a fuller breast lift later if enough improvement is not obtained. A nipple lift is not the same and should never be thought of as a form of a breast lift although many call it such. It is nothing more than raising up the level of the nipple on the breast mound, it does not change the shape of the breast mound.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 24 years old and I have scaphocephaly that I would very much like to have corrected. Frontal bossing is apparent, and I also display temporal hollowing, as well as depressions along a prominent saggital ridge (as long as I have hair on my head, these features are not a significant concern for me). What is a significant concern for me — something that I would sacrifice a lot for in the hopes of even a modest correction in appearance — would be the protruding occipital bone. In my case, the premature fusion of the saggital suture caused the occipital bone to form something of a pointed cap, which extends from the base to the top of the skull; as such, the posterior fontanel is located high on the skull, and from a top down view, it mirrors the anterior fontanel. Are there procedures available to address this? Perhaps the occipital bone could be reshaped (shaved?), or would it be possible to perform a craniectomy in order to correct the appearance with a prosthetic? Thank you very much for your time, Dr.
A: The protruding occipital and posterior sagittal skull areas could be modified by burring reduction (shaving) not a craniectomy. Craniectomies are not going to be performed in adults for cosmetic concerns. But significant skull burring and reshaping often can be accomplished. How much reduction could be obtained would ultimately be determined before surgery by a few simple plain x-rays. But it is likely that the protruding occipital bone, particularly in the midline, is fairly thick and thus capable of being significantly reduced.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, if a patient seeks to duplicate a jawline of an existing person via the use of custom implants, assuming their current structure and soft tissue allow for that look, how closely do you work with the patient to design the implant? What sort of process do you use to make the implant provide a look as close to the desired person as possible?
A: When it comes to designing custom facial implants, I have done it from numerous different approaches. Many patients do not want to participate in the details of their implant design, but some patients do. I do not profess to have an exclusive skill or knowledge in how to predict how any implant shape and size may affect the way the face will look once it is implanted, so I am always open to input. I have even done a few cases where I let the patients completely design their own implants out of clay, only providing input as to details that may make a certain design or size difficult to surgically place. Obviously I have tremendous experience in seeing how different implant shapes and sizes affect the face. But I appreciate that a patient providing input about their implants does empower and invest them in the process. On the flip side of that investment also comes partial responsibility in the outcome of the facial implant procedure, particularly if the results are less than desired.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to get brow or maybe forehead augmentation. My eyes pop out too much and I would like to have deeper looking eyes. Do you think this will help?
A: I would need to see some pictures of your face to determine by imaging whether this would be a good procedure for you. A side view of your face would be particularly useful. By definition, increasing the prominence of the brow bones and forehead will make the eyes appear more deep set and less ‘protrusive’. Brow bone augmentation makes the superolateral orbital rim bigger and, in some cases, patients may also benefit by infraorbital rim augmentation as well to get a circumferential deeper look to their eyes.
Dr. Barry Eppley
Indianapolis, Indiana
