Your Questions

Q: Dr. Eppley, I am having abdominal etching liposuction next week. How defined do you think you can get for me as well as removing my love handles? I know this guy is 28 and I’m 52 but I really want to get some definition with the abdominal etching. 

A: I believe your answer comes from what you have stated after your initial question. Your observation that the model is 28 while you are age 52 speaks volumes in terms of result expectations….that is not an achievable goal. Three factors come into play in any type of body contouring that will define the result…1) How toned and defined are the underlying muscles, 2) how thick is the fat layer between the muscle and the outer skin and, of equal if not greater importance, 3) how much elasticity of the skin exists to shrink down around the reduced fat areas. The older one gets the loss of skin elasticity plays a major limiting factor. I have seen goal pictures like the one you have provided many times and I have yet to see any patient get that type of abdominal etching result no matter how much fat is removed.

In short I think we should temper our expectations to an abdominal result that has some definition but never as defined as we would like.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a question about mentalis resuspension and v-y inner lip plasty. I had a sliding genioplasty and no plate was used during my sliding genioplasty, just two screws which seem to have been placed quite low. Could this be part of why the mentalis muscle is not as high as it was? Thank you.

A: One of the methods in sliding genioplasty bone fixation is that of lag screws as opposed to a step fixation plate and screws. This is undoubtably the two low placed screws that you see. Placing lag screws does require more muscle and soft tissue stripped off of the chin to place them. But I do not think, based on this description alone, as to why you think the mentalis muscle is not as high as it once was. You are likely referring to the depth of the labiodental fold of which the mentalis muscle makes little contribution to it. The labiodental fold is a fixed structure that is an external indicator as to the depth of the vestibular sulcus intraorally. When the chin bone is advanced the depth of the labiomental fold will often appear deeper since its position did not change but the chin projection became greater. This is not usually a reflection of loss of mentalis muscle attachment, it is the natural deepening of the labiomental fold area which will occur despite having the mentalis muscle attached back into its original position. This deepening of the labiomental fold is a natural occurrence in many sliding genioplasty outcomes.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I’m considering getting facial feminization surgery but I want to know the cost, recovery time and the amount of pain to be expected. I want to get the most change of my face that I can but am not sure how much I can really achieve. You are the facial feminization surgery expert so I would need your guidance as to what would be best for me.

A: Facial feminization surgery is a broad collection of hard and soft tissue procedures that are individually selected for each patient based on what has the best value to help change the shape of their face. There is no standard FFS surgery where everyone gets exactly the same procedures. I would need to see pictures of your face to make an assessment with computer imaging to see what works best for you before any cost quote can be given. Regardless of the exact procedures, FFS is always a compilation of numerous procedures that will cause a lot of swelling and takes about three weeks until one looks fairly normal and non-surgical…but really complete recovery from this type of facial reshaping surgery takes up to three months for everything to completely normalize.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, What is the average age for breast augmentation? I am 50 years old. Do you have many patients in that age range?

A: Over the years I have performed breast augmentation on women from ages 17 to 76. Today a women having breast augmentation.reshaping at age 50 is very common while twenty years ago it was much more uncommon. While the mean age for women having breast augmentation is in the age  range of 35 to 40, age 50 is not very far from the mean age for breast augmentation patients today. Certainly age has very little with anything to do with the ability to have successful breast augmentation surgery.

The only real fundamental difference between younger and ‘older’ breast augmentation patients is age and pregnancy related changes in their breasts. Older women usually have more sagging and therefore often have to have some form of a lift for optimal breast reshaping results. Younger women, without having had children yet, usually do not have this lifting need. But I have certainly see an equal number of women age 50 and older who have merely lost volume without sagging and implants have an immediate and often remarkable breast rejuvenative effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I need a sinus setback procedure. I think it is called the brow bone. but my brow bone is a bit asymmetric. Will a browlift be needed after this surgery? Is in the quoted price also the hospital care and everything? How many days should I stay in your town all together? Also is it possible to make some sort of insurance arrangement in case something goes wrong so that I am fully covered in this case? Finally have you not seen or have you also not heard of anybone resorption with this procedure? Long term consequences really scare the XXX out of me.

A: In answer to your questions:

1) Generally, a browlift is not needed after a brow bone reduction. It does not usually cause the brow bone to fall.

2) Any price estimates given to you is all-inclusive of the surgeon’s fee, OR and anesthesia costs. A formal price quote can be given based on reviewing pictures of the patient. Most patients return home 48 to 72 hours after the procedure.

3) I can not think of anything that could go wrong with this type of surgery that would require hospitalizations. But most insurances will cover medical problems, regardless of the origin of the problem.

4) I have not seen or heard of any bone resorption afterwards with this operation.When properly done with good surgical technique, brow bone reduction should not result in any long-term bone resorption problems.

Dr. Barry Eppley

Indianapolis, Indiana