Your Questions

Q: Dr. Eppley, I lost a chunk of my nose — right on the bridge. It was not a cut — a chunk of skin is missing – down past epidermis and dermis into subQ.  It has a nice granular base. I know it will have to scar — is there any way to help it heal while keeping scarring minimal?A certain wound gel or something?  I usually fill in missing skin with redder tissue that is hyperpigmented. Thanks for any advice. 

A: As to your nose, I don;t think there is really any magic about what makes skin heal. Given that you have a full-thickness skin loss that is now granulated, what you need is something that will help in re-epithelize faster. The topical agent that i recommend to my patients in this situation, believe it or not, is A & D ointment. (as in Vitamin A and D) While it is most commonly know for use in diaper rash ( a very superficial de-epithelization problem), vitamins A and D are well known agents that skin cells need to grow. I have found this very simple and inexpensive topical cream very helpful in such cases. It has a bit of an unusual odor because the vitamins are derived from cod liver oil which is also why the cream is a little dark or brown-colored. Just keeping the area a little moist with it should help it heal quickly over the next 7 to 10 days.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a SMAS facelift two weeks ago. I have swelling and numbness alongside stitches and jawline. Although the swelling is even on both sides the swelling feels dense, thick and kind of hardish. Is this normal? Also, I have these slight dents under my cheek bones that I believe is caused by where majority of swelling begins. Is this normal? I have good things to report about my recovery, bruising is gone, symmetry is good,  no pain and it looks like I am going to get the result I am after.

A:  Recovery from a facelift procedure is rarely as fast as any patient would like. The skin will be numb for weeks to months where the skin flaps were raised and along the suture lines. The swelling will go away much quicker but it is perfectly normal for the face to feel firm and still a bit swollen at just two weeks after surgery. Expect all swelling to be gone by six weeks after surgery. Some of the facial features that are outside the zone of the facelift, such as the cheeks, may appear different because of the swelling around it. Your facelift recovery sounds perfectly normal and you appear to even be a bit ahead of schedule for what many patients experience.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 45 year-old man that would like to improve my body. I am a little overweight and I seem to carry all of it in my belly. My chest and arms have no muscular definition and I would like implants to pumo them up. I have attached some pictures. Tell me if you think I am a good candidates for these procedures.

A: Thank you for your inquiry and sending your pictures. In considering your request, the first issue is that of your belly. (abdomen) Given that you are a male with a round firm belly, it is important to realize that a significant part of the abdominal fat you are seeing is intra-abdominal (around the organs) and not extra-abdominal (between the muscles and the skin) where it can be reached by liposuction.  That is a unique feature of most men that have large bellies. While there is some fat that can be suctioned, the critical question is whether it is enough to justify the surgical effort. If I examined you I would know by feel. But in just looking at your pictures, I am concerned that the result obtained may not meet your expectations. Liposuction will help but it is not magical and it will not make your abdomen flat. The only way to get closer to what you desire is a combination of liposuction and weight loss. Liposuction will likely only get you halfway there.

When it comes to body contouring implants, like pectoral and arm implants, it would first be appropriate to get your abdomen in better condition. Given your abdomen the way it is now, pectoral implants would merely get lost in the shape of your body and may not make enough of a visual difference to justify the effort. At the very least, you are not now a candidate for arm implants. Body implants in general work and look best in men who are at a good body weight and are lean enough that the profiles of the implants can be seen.

In conclusion, the only option I would consider at this point is abdominal and flank liposuction and possibly pectoral implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have an weird forehead. It has that I mainly have a brow as a man and it also has horns (exotosis) I was wondering if you do such surgery to fix this/shave down my skull to get me a desired smooth forehead as a female should have. I also have a high hairline so I’m wondering if you can pull it down. How old do you have to be? I know 18+ but the skull doesn’t finish developing until what age? I am 20 so I don’t know if I am old enough yet. Also, can both surgeries be performed at the same time?

A: The skull is largely finished developing by one’s early teens, it is the facial bones below it that continue to develop until the late teens with the mandible finishing complete growth around age 21. Therefore, at age 20 you can have frontal/brow bone reduction without any concerns about growth implications. The only issue is how much the brow bones can be reduced given the frontal sinus which lies underneath it. That could be determined before surgery by a simple lateral skull film. The hairline advancement/vertical forehead skin reduction is done through a pretrichial incision. This also provides the exposure needed for the forehead and brow reduction so, by necessity, these two procedures would be performed at the same time.

Dr. Barry Eppley

Indianapolis, Indiana