Q: Dr. Eppley, I am interested in learning more about SmartLipo and laser body sculpting. I workout regularly and have a small amount of belly fat that I cannot seem to get rid of. I am 5’ 4” and weigh 127 lbs so I am anything but fat. But this small amount of stubborn belly fat will not budge no matter what I do.
A: Someone of your lean body frame is actually the ideal liposuction patient…the person who has made a reasonable effort and can just not change the genetics of their fat distribution. Liposuction was originally developed to treat spot fatty areas that are resistant to diet and exercise although its use has widely expanded today for the more convenient removal of larger amounts of fat. Removal of localized abdominal fat can be one of the most rewarding areas for liposuction.
When it comes to liposuction, the the techniques have evolved into a variety of energy-driven methods to initally loosen the fat to help make the vacuum extraction process easier and more efficient. Laser is one of those technologies and the name Smartlipo is a tradename from the manufacturer who developed the initial laser liposuction devices. The heat energy generated with its use can help liquify fat fofr improved results if done properly. The key issue with Smartlipo is to realize that it still is invasive surgery and is not something done magically from the outside, a common public misconception about it.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a chin implant revision. I had a chin implant about six months ago and the doctor said it would look just like I wanted. Well it hasn’t and he appears to have chosen the wrong implant. What I wanted was a much wider and more square chin look and it doesn’t look that way at all. I have done some imaging on my picture to show you what chin look I am after. What is the best type of chin implant to achieve my desired look?
A: The imaged change that you desire in the width of your chin can not be made by almost any off-the-shelf preformed chin implant. Even square chin implants do not add that much width. If you look carefully, the widest part of the chin goes past a vertical line dropped down from the corners of the mouth. That is beyond the widths of most existing chin implants.
There is however a way to do it with one and only one preformed implant, the Medpor RZ extended square chin implant. It is possible to exceed its natural width because of its central connector. It is actually inserted in two separate pieces and then attached once in place. You can increase the width of the chin by a full centimeter by not snapping it together but by leaving the two pieces spaced apart and made ‘one-piece’ by only the thin bridge of the connector.
The other option is to make a one-piece design out of silicone that contains all the desired dimensions and is placed as a single piece implant. (aka custom chin implant)
Dr. Barry Eppley
Q: I am interested in getting a rhinoplasty done. I want a more streamlined look to my nose. It needs to be straighter with less of a downward slope or dip in the bridge area. I think the dip is the result of a barbell bar that I dropped on my nose when I was about 12 yrs old. I have attached some pictures of my nose for you to see. What are your rhinoplasty recommendations?
A: Your pictures and your history show a classic saddle nose deformity. Your nasal bones and middle vault (upper and middle third of your nose) are collapsed and your internal septum is underdeveloped. This also results in a low and broad nasal tip, short columella and flared nostrils. The key to a successful result in the saddle nose deformity is building up of the entire dorsal line from the bridge down to the nasal tip. Without question the best material for this is your own cartilage. Your septum, however, would not provide adequate donor material. Ideally a rib graft should be used. This provides the best amount and shape that this buildup requires. One could use a synthetic implant, which is easier, but there is a definite risk of long-term problems with foreign materials in the nose. Otherwise, your rhinoplasty would be done through an open approach with dorsal graft and columellar grafting, nasal tip refinement and nostril narrowing. This would provide a more streamlined and straighter look to your nose as the attached computer imaging illustrates.
Dr. Barry Eppley
The development of a droopy neck and saggy jowls is loved by few…and is the bane of many women and some older men. Much can be found that promises to improve it from creams, exercises, laser and light therapies, and even the occasional clothespin approach. But we all know deep down inside that such hope only benefits the manufacturers and sellers of these products…and the only lifting that gets done is usually from your wallet.
While surgery is the only effective option for that loose neck and jowl skin, everyone would like to have as little surgery as possible and avoid hearing that dreaded word…facelift. While the fears surrounding a facelift are largely unfounded, people would certainly like to avoid that consideration if possible. This facelift phobia has led to the emergence of the concept of the branded selling of facelift surgery.
The most well-known current example is that of the Lifestyle Lift. Through their national magazine and television ads, this is a franchise approach to getting a facelift…or some version of it. Promising to turn the clock back at least ten years and look recovered in just a few days, its snazzy name seeks to assure patients that it will fit into their ‘lifestyle’. Interestingly, nowhere in their advertising does the company suggest it is actual surgery. Somehow the concepts of surgery and lifestyle are incongruous. I have seen numerous patients who have visited their facilities and were surprised to learn that it was actually an operation that requires some recovery and a temporary change in their lifestyle.
In reality, the Lifestyle Lift is an operation that is decades old and is practiced by most plastic surgeons. This ‘mini-facelift’ operation has now cloned many spinoffs including the Swiftlift and Weekend Lift to name just a few. Often touted as being innovative and original by the advertising surgeon, the names suggest that getting a fresh, younger look is really easy…or at least is quick for the surgeon to do.
Like many things that are heavily marketed, the Lifestyle Lift has its share of proponents and critics. An internet search will quickly bare that out. As an operation, however, limited types of facelifts do have a valuable role in facial rejuvenation. Not every patient needs or wants a fuller or more complete type of facelift.
Facelifting is not, nor should be, an operation that is performed the same on everyone. ‘Mini-facelifts’ are best reserved for patients with earlier signs of aging, not advanced problems such as turkey necks. A catchy name does not necessarily make the procedure novel or unique. Many plastic surgeons offer similar type facelift procedures that just don’t have a branded name, but that doesn’t make them any less effective or useful.
Dr. Barry Eppley
Q : I have a weak chin that has bothered me my whole life. I am so self-conscious that I turn away so people can not see me in profile. I also think my entire jawline is weak, it overall looks too small for the rest of my face. Can my jawline be improved with different types of implants?
A: Historically, most people think of jaw enhancement as that of the chin only. Chin implants have been around for over fifty years and have evolved today to include a wide variety of different chin styles and sizes. For horizontal jaw shortness, a chin implant can provide a simple, quick and permanent method of significant profile improvement.
Today, jaw enhancement has progressed to consider changes along the entire jawline from back to front. Besides chin implants, the use of implants to accentuate the jaw angle have become popular. Designed to increase the width of the jaw (and some designs will lower the jaw angle as well), they increase bigonial width and create a stronger and more masculine.
Chin implants are most commonly done as a stand alone facial augmentation procedure. Jaw angle implants can also be done by themselves if an adequately projecting chin already exists. For cases of an overall weak lower jaw, the combination of chin and jaw angle implants together can make for a more dramatic change in jawline appearance. This combination (the ‘jawline trifecta’) is increasingly popular for those men who have a congenitally shorter jaw or for those want to make a stronger jawline out of an otherwise normal sized one.
Dr. Barry Eppley