Your Questions
Your Questions
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
Q: Dr. Eppley, I am really interested in getting Brow Bone Augmentation surgery done.I am a 21 year old girl with big eyes. But my problem is that my eyeballs stick out from my upper eyelids making me look really ugly and scary to people. Now I want to get this surgery done but I have very important questions that I would like you to answer for me. Will brow bone augmentation surgery help hide my eyeballs that stick out? I have a perfect nose and i like my nose just the way it is, but i’ve been told that having my full brow bone augmented could lead to changing the shape of the nose. Is this true? I would like to know the price range for a full Brow Bone Augmentation (BBA) surgery. I know this answer has to do with the type of material used, but out of an estimation I would like to know a range of price for both HA and PMMA. Lastly are the results of the BBA surgery permanent,meaning my eyeballs will be hidden for the rest of my life without worrying about any bad affect on my eyes in the long run. THANK YOU.
A: What you asking about brow bone augmentation is true. It can help deepen the look of the eyeball. It is just a question of how much. It has no effect on the appearance of the nose or the function of the eyes. The results would be permanent since the materials used are non-resorbable. The total cost of the procedure is in the range of $ 9500.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am seeking revisional rhinoplasty. I have had two prior procedures in 2001 and 2007. I am seeking to make the following changes to my nose. First I want to eliminate the ethnicity of my Middle Eastern nose. I am seeking a more European looking nasal appearance with significant improvement in the nasal tip and narrowing of the nostrils with less nostril show. Second, my septum as a result of my last rhinoplasty is slightly off midline with a deviation to the left. This will need correction. Cartilage from the right ear was used to support my tip in the past. My left ear is intact and can be uaed for further reconstruction. Lastly, my columella requires shortening without flattening my nose. Thank you for your kind assistance.
A: Thank you for sending your pictures. Based on your two prior surgeries (which appear to have been done via closed rhinoplasty ??) and the thickness of your nasal skin, any tertiary rhinoplasty is challenging in terms of achieving your goals. Your skin thickness makes it impossible to truly have a classic European nose which is more thin-skinned. As you experienced, removing cartilaginous structure underneath is not a guarantee that it will be well reflected on the outside. While you have room for some improvement, I am not optimistic that it can ever achieve the degree of tip narrowing and refinement that you desire. The purpose of your ear cartilage graft used in the past is mysterious to me as such tip grafting will only cause it to become thicker not thinner. Columellar shortening is not possible without causing a downward tip pull and is almost never done anyway except in cases of large projecting nose reductions.
While I think certain features of your nose can be improved (septal straightening, some limited tip narrowing) I have concerns about achieving your goals in a nose that is already scarred and grafted.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in laser resurfacing to help reduce the growing number of wrinkles on my face. I don’t know much about laser surgery and how it works. I have seen some very good results and then read some bad stories about it. I know to get a really good result it is not s one day recovery. Do you think the results will be noticeable or rather worth the ordeal?
A: In laser resurfacing the historic rule is…the deeper you go, the better the results. Simplistically, the more bad skin you remove the new skin that heals over it will look better. But laser skin resurfacing is not all one tool and there are different ways to do it. By far today’s use of fractional laser resurfacing is superior to what has been done in the past. What makes fractional laser different is that it only treats a fraction of the skin’s surface. (as the name implies) But each penetration of the beam goes deeper, creating a better effect but with less recovery. These laser treatments can be done at all levels from light to deep and is based on the severity of the problem and how much time one has fofr recovery. Even a lighter fractional laser resurfacing treatment does really produce a noticeable result with very tolerable recovery. It can look pretty bad the first day or two (by your standards) but by five to seven days be completely healed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a gummy smile that I don’t like. I would like to achieve four things: 1) straighten gum line 2) reduce amount of gums shown when smiling 3) improve lip seal at rest and 4) reduce horizontal protrusion of upper lip area in profile. (least important) I have attached some pictures. Do you think my gummy smile is caused by vertical maxillary excess, or short upper lip, or hyperactive upper lip muscle or some combination? Will jaw surgery for vertical maxillary excess reduce my face length too much?
A: In looking at your pictures, I do think your gummy smile is a result of a combination of a short upper lip and some degree of vertical maxillary excess. The short upper lip is the bigger component of the problem however. The first step you need to do is consult with an orthodontist to find out if you are even a candidate for a maxillary shortening. This is going to require a model and x-ray analysis. It is impossible to anyone to say, based on these pictures alone, that you have a significant VME and whether it merits surgical shortening. If it is determined that a maxillary osteotomy is not an option, then you may consider soft tissue management of the gummy smile through various upper lip techniques such as levator muscle release and mucosal V-Y lengthening.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant inserted 8 months ago, which turned out to be too big. I was very unsatisfied with the result and it was removed 2 months after the initial surgery, which is 6 months ago from now. The problem is that chin ptosis has developed. I am suspecting that adequate mentalis reattachment was not performed after the implant removal. Moreover, the central part of my lower lip would not move downwards, even when I smile widely, always covering my lower incisors totally. This seems different from typical lower lip incompetence caused by mentalis muscle ptosis, since I believe that ptosis of mentalis muscle causes lower lip to drop downward with inability to close mouth properly. This lower lip issue is not a newly developed problem, since it was present immediately after the initial implant insertion surgery and never went back to normal. Also, my lower lip seems to have become shorter in vertical length. My labiomental sulcus area looks like the soft tissue is fixed to the bone making it look unnatural when i speak or smile. I am thinking a mentalis resuspension would help my problems but my question is why would my lower lip not move downwards? This sometimes interfere with my pronunciation when I speak which bothers me a lot. One more question is would sliding genioplasty combined with mentalis resuspension give a better result than mentalis resuspension alone? I want to know the best solution to correct my problems. I am looking forward to your answer. Thank you.
A: You are correct in that the lower lip may sag with chin ptosis in some cases, but not always. Many chin ptosis patients have a normal lower lip position and function. Rarely you will have a patient like you who has the opposite lower lip problem in which the lip will not evert. This can occur if the implant was inserted from below (submental incision) and the implant pocket was made up close to the mandibular vestibule. This disrupts the attachments of the labiomental sulcus and blocks lower lip eversion. Even when the implant is subsequently removed, the muscle fibers remain disrupted.
Since there was a reason you had the chin implant in the first place, it would make the most sense to consider a sliding genioplasty. In that way all three problems can be simultaneously treated. (chin deficiency, chin ptosis, labiomental sulcus muscle repair)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 5’6” and weigh 125lbs. I am fairly thin for my height but my thighs are just to big for my body. My lower half doesn’t fit my upper half and no amount of exercise or weight will change that. I now know that fir sure as I have tried for years. I am a size 6/8 in jeans and that just drives me crazy . I know that liposuction removes fat and helps contour areas of the body. But does that mean it can give the appearance of thinner legs and make me able to fit into smaller jeans?
A: Your question is both a good and a common one. I have seen many people who are disproportionate in various body areas. They are not overweight but one area of their body doesn’t fit the rest. This is very common in the thighs or saddlebag areas. Liposuction can effectively reduce prominent saddle bags and, when combined with inner thigh and knee liposuction, can give the leg a much improved silhouette. For some patients this will make their leg thinner and they may be able to fit into smaller jeans. For other patients, despite the improved look, they make not end up with truly thinner legs and may only feel more loose in their current jean size. I think it is always best to think of liposuction as contouring or spot reduction. Making any body area truly thinner may be expecting more than the procedure can do in many cases.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi I am 18 yrs old and I have been insecure about my body for quite some time now. At the time I was born to the present I have been very depressed because I have a huge navel. (outie). I really find it hard to wear clothes without thinking about my navel. For example, If they are going to see it, what will their reaction be, etc. I am tired of being unable to wear bathing suites and clothes and I need a solution. Today was the first time i heard that there was a surgery called Umbilicoplasty that can change an outie into an inne. I need help. I am wanting to know what can be done.
A: The belly button or umbilicus is really nothing but a scar that extends from the skin down to the abdominal wall. Originally it was where the umbilical cord extended through the abdominal wall. Thus it really represents a small hole or defect in the abdominal wall. In most people, that scar is inverted or v-shaped and is an inne. In the minority of people it can be an outie because a small amount of peritoneal fat protrudes through the abdominal wall pushing the scar outward making an outie. In essence being a small abdominal wall hernia. Some outies are just everted scar but bigger ones are actual small hernias. Either way, an outie can be fixed by changing the scar to attach directly down to the abdominal wall or fixing the hernia. This is known as an umbilicoplasty and changing an outie to an innie is the most common non-tummy tuck form of it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have severe breast asymmetry. Left is a D cup and right is an A cup. I also have very large areolas and my breasts are pendulous. Because they are so uneven I have had upper back soreness and other aches and pains. Would insurance cover me at all? It is just as disfiguring as other birth defects and even cancer. I am not at all exaggerating.
A: Whether your medical insurance would cover the reduction of your larger D cup breast is a determination of the insurance company. No physician can say with any certainty whether they will or won’t. This requires a written letter with photographs by a plastic surgeon to your insurance company. This is known as a pre-determination process. Once they have this information, they will then make either an approval or denial in a written response. They will definitely not cover any form of a breast lift such as may be needed on the smaller right breast and this would not even be submitted, lest it jeopardize any potential approval of the left breast reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, because of an accident at an early age I had some weak chin and facial asymmetry on the right side. Four years ago I had a chin implant whichi resulted in horrible deep hollows on the side of the chin. My chin implant was a button type. So I’ve had three fat grafting surgeries to correc the hollows and also using fat to lessen the asymmetry. (underdeveloped right side of my face) The results are not bad but still lots ofasymmetry and the fat is starting to melt unevenly so I am looking for a more radical solution. I want to remove the button type implant and replace with an extended anatomical chin implant as well as jaw angle implants to look more solid. What is yourt suggestion about this? Thanks a lot.
A: I would agree that changing the chin implant to an extended style is much better for a male than a central button style. The jaw angle area could be permanently enhanced by lateral extension jaw angle implants. The only area that will not be filled in as well is the area between the two. But I don’t think in your case that would justify custom implants to be made. Fat has been a good intermediary step to see if the changes are favorable but it is definitely not a permanent solution. The combination of chin and jaw angle implants provides a permanent volume solution to jawline enhancement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I planned for long time to get calf augmentation and feel that now is the time. I am 170 cm tall and weigh about 72 kg and am very athletic. But I have skinny calves and they haven’t grown like the rest of me. My calves are 34 cm around. I am ready for this mentally and financially. I want to know which type of method is best for me and about the price and how much bigger will they be?
A: The most reliable method for calf augmentation is using soft very flexible solid silicone implants placed through a popliteal incision. The amount of calf size increase that can be obtained is based upon whether one (medial) or two (medial and lateral) calf implants are used and how tight or soft the calf skin is. Calf augmentation can also be done by fat injections but that method is limited by how much of the fat will survive and whether one has enough fat to harvest for the procedure. At your height and weight, I do not envision that you have any significant fat to use.I will need to see some pictures of your lower legs to see what may best for you. The price of surgery is based on how many implants are used so seeing the pictures first is important.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 33 year old male who has a very prominent brow which over hangs my eyes by at least a cm especially from the bridge of the nose to brow. This severely affects my looks. I have already had surgery where the surgeon shaved the area down after peeling the skin over my face which did slightly improve my appearance but nowhere near enough. The only answer I can see as someone obviously without any knowledge of a medical procedure to facilitate this is that if the brow bone was trimmed from the sides and the brow and presumably nose ‘pulled back’ and recessed. After googling cosmetic surgeons you appear to be one of the few doctors that may be able to help me with this. I don’t consider myself a vain person but just wish to have a relatively normal life. Do you think my brow bones can be further reduced? If so what potential risks are involved. As a cosmetic surgeon I am sure you are more than aware of the psychological damage that looking unusual can be and I am placing hope that maybe this can be changed. Thank you in advance.
A: Brow bone reduction by shaving rarely produces a satisfactory result. It may be a simpler procedure but it can only reduce the brow prominence by a few millimeters. Any further reduction will enter the frontal sinus cavity. Men in particular require an osteotomy technique for brow bone reduction as the amount of reduction can easily be 5mm to 7mms, if not more.
Please send me a few pictures of your forehead for my assessment. You have already been exposed to the greatest risk of the procedure, that of a scalp scar
Dr. Barry Eppley
Indianapolis, Indiana
