Your Questions

Q:  Dr. Eppley, I’m a 33 year-old  that doesn’t like how my nose and upper lip looks. At one time I was considering a lip lift but decided against it due to scarring. I am in orthodontic braces as I write this and have been told that I would need to postpone any nose surgery until my braces are off. But I wanted to get your recommendations for my nose as I would like to lessen the upturn of my nose and straighten it. I have no hump to be taken down. It is just the tip that needs to be refined. I have attached some pictures for you to see what my nose looks like.

A:  Based on your pictures, the upturn of your nose makes the upper lip look longer than what it really is. You were wise to pass on the lip lift. The tip of your nose is short or underprojected as we call it. This makes your nostrils appear bigger and gives you a lot of  columellar show. (strip of skin between the nostrils hangs down too much) The type of rhinoplasty you need is one that would lower your nostril rims and decrease your tense septal angle. (high supratip area) This will require some cartilage grafting from your nasal septum to bring the entire tip downward. This rhinoplasty approach will give your nose and lip a more pleasing appearance. It is not that your upper lip is too long, it is that the tip of your nose is too short.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I am a 32 year old female that is considering a breast lift. I actually have fairly large breasts being a 36D and with a bra on they look great. But when the bra comes off they look gross. They hang down like two old ladies. I had one Is It A Good Bad Sign If U See Ur Ex For The Past Week At The Same Time child ten years ago and nursed him and this appears to have put the whammy on their once nice shape. What I want is a more uplifted and better shape. I do not want them any smaller or larger They are the ideal size for my body shape in my opinion. Will a breast lift do what I want and is there bad scarring as a result?

A: Many women suffer from age and child-bearing a skin-breast tissue mismatch. As a result they have good size to their breasts but the stretched out skin gives them a low sagging appearance. While some breast sag is aesthetically acceptable, when the nipple sits below the lower breast fold it is rarely pleasing to anyone. This is exactly the condition where breast lifts work the best, removing excess skin and reshaping the breast so the nipple and the entire breast sits higher on the chest wall…many times back where it used to be. While there are some minimal incision breast lift procedures, they are only effective for the most minimal amounts of breast sagging. Most really effective breast lifts requires longer scars, much of which lies in the lower breast crease. Whether the part of the scar that goes around the nipple and vertically downward toward the lower crease is acceptable will vary amongst different patients. Seeing pictures of breast lift results with close inspection of the scars is critical for you to determine your level of scar tolerance.

Dr. Barry Eppley

Indianapolis, Indiana

Is It A Good Bad Sign If U See Ur Ex For The Past Week At The Same Time

Q:  Dr. Eppley, I have reviewed your rhinoplasty computer images of what my nose may look like after surgery. While I like the changes that have been done, what I would like to know is if my nose can get even a bit smaller than what you have showed in your imaged pictures?

A: When it comes to reducing the size of one’s nose, what limits the result is how much skin one has and its thickness. All of the maneuvers in rhinoplasty surgery are about changing the underlying cartilage framework. In reducing a large nose that framework is reshaped and made smaller. While the supportive framework of the nose can be changed, the final result seen will also reflect how well the skin shrinks as well. How well the skin contracts is key and the thicker the skin is the less likely it will contract as much as the cartilage has been reduced. The wild card in every rhinoplasty surgery is how the overlying skin will reshape to the new framework.

I try to show on computer imaging realistic results and often the most minimal changes that I think will happen. While anything can be done on Photoshop that does not mean it can be achieved by actual surgery. You should make a decision about whether surgery is worth it based on the least amount that can be achieved…not on the most that you hope can be accomplished. This is particularly true in reduction rhinoplasty.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to lift my breasts but I am completely opposed to getting implants and that is not even a consideration. So please don’t even try to convince me to get them whatever their purported benefits may be to how the breast may look by using them. However, I am undecided  as to whether it is worth the effort to undergo a breast lift. I would be happy if only my nipples were positioned higher as they sag down quite a bit now. I don’t have to have my breasts fuller after a lift and it wouldn’t bother me if they even end up a little smaller as a result of the lift. I just don’t know if the scarring and the cost would be worthwhile.

A: While implants are often used at the same time as a breast lift, they do not always have to be. If one is willing to accept a slightly smaller breast and no upper pole fullness afterwards, then one may do well with a breast lift as that is what it accomplish in most cases. The real question, and a hard one to answer for many women with sagging breasts, is whether the scars to lift them are a good trade-off. The best way to answer that important question is to look at numerous after surgery results of breast lifts and look carefully at the scars. Your reaction to those breast scars will answer the question of your acceptance of breast scars from a cosmetic reshaping operation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 36 year-old man who has lost 40 lbs within the last year and a half and can’t lose anymore. I work out vigourously three or four times a week, eat a sensible diet and cannot lose any more size in my abdomen. My legs and arms have little visible fat and good tone. I am looking to reduce my waistline, love handles and abdomen. I am not sure about what procedures that I need to achieve my objectives.

A: Many people in their weight loss efforts face the same circumstances that you find yourself in. You have put good effort in losing weight and getting your body in better shape and have lost some substantial weight. But now you have ‘hit the wall’ and are short of what you want your body to look like. For many, the remaining excess fat may be quite resistant or there may be rolls of skin that no diet and exercise will ameloriate. Regardless, this is where surgery can help one make the final step. For most men, it is the use of liposuction in the abdomen, flanks and waistline that is usually needed. In extreme weight loss, there may be a need for some stomach skin removal as well. For many women, liposuction combined with some form of a tummy tuck is what is needed to get a flatter stomach.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting breast augmentation and a tummy tuck. I have had a child and am not planning on any more. I have numerous tattoos across my rib cage. My concern is what will happen with my tattoos when my breasts get bigger and my stomach skin is pulled downward. I have attached pictures which show where my tattoos are and the location of where my stretchmarks are on my stomach. Will these tattoos be affected by these procedures and will my stretchmarks still be visible after surgery?

A: While it is true that breast implants do stretch out the overlying breast skin and a tummy tuck has a downward pull on the upper stomach skin, their distorting effects on the outer skin are limited to the local area. Given that your tattoos are located on the side of your rib cage, they will not be affected at all by either breast augmentation or a tummy tuck. The tattoos are simply too far away to be altered. In regards to your stomach stretch marks, however, these will be dramatically changed by the tummy tuck procedure. In a full tummy tuck, all stretch marks that lie between the belly button and the pubis will be permanently removed with the skin and fat that has been cut out. Those stretch marks that lie above the belly button will be pulled down lower with the skin closure of the tummy tuck. With the creation of a new belly button, many women will have no stretch marks or loose skin around this central indentation. Some stretch marks may remain but they will be below the belly button closer to the low horizontal scar.    

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 25 year-old man looking for a type of rhinoplasty that will change the appearance of an upturned nose. I have had this nose shape since I was born. It is not only upturned but it is concave across the bridge with excessive columellar show from the very profile view. I am very tall which really accentuates the problem as you can literally look straight up my nose. What type of rhinoplasty do I need to make my nose look more normal and would it make enough of a change to make the operation worthwhile. I can’t seem to find any pictures on the internet of this type of rhinoplasty correction.

A: What you have is a congenitally short nose that sometimes is also called a saddle nose although this is not completely accurate. In a short nose, the length of the nose is diminished from the radix to the tip and is due to an underdeveloped nasal septum. Your description of this nasal type is exactly what one sees from a saddle-shaped bridge to an upturned nasal tip. It actually is not rare and a short nose can also occur from traumatic injuries as well as natural development. The correction of the short nose depends primarily on the use of cartilage grafts along the dorsum and columella to extend its length and direct the tip downward. The end of the septum must be extended as well. This is done though an open rhinoplasty. While cartilage from the septum can serve as the donor source, it is frequently inadequate in the amount and dimensions needed. This is why rib cartilage is frequently used in the lengthening of the short nose.   

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting some minor plastic surgery work done. I had a kidney and pancreas transplant done over a year ago.. I am wonder if being on immunosuppression drugs would it be unsafe to have some minor facial work completed?

A: In answer to your question regarding the ability to do some minor plastic surgery work on immunosuppressed patients, the answer is maybe. It would depend on what type of immunosuppression you are on (how significant), what procedures you are considering and their risk of infection and ultimately what your transplant doctors feel is adviseable. I have done numerous plastic surgery procedures on transplant patients all without any problems. Almost all of these have been on kidney transplant patients only .I have not done any work on someone who has had a pancreas transplant or combined kidney and pancreas transplants.  However, as long as your transplant doctors know what you are considering and give it their blessing, then some facial plastic surgery work can be done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had brain surgery for a tumor over 10 years ago. This left me with a scar in my scalp which initially was not a problem. As I have gotton older and more hair has fallen out, the scar and some depressions along it has become more noticable. I thnk if the holes were filled in it would nto be so obvious.  I was trying to determine if I would be a candidate for using injectable fillers to fill holes and creases left by the surgery. I have attached some pictures for your review.

A: What you have, as you know, are the skull depressions from the craniotomy burr holes from your original surgery. They have sunken in due to lack of full-thickness skull bone support from underneath the scalp. These are quite common from craniotomy surgery. Leveling them out is very straightforward by building up the smoothness of the underlying skull bone. I would not use injectable Kryptonite in these cases because the scalp tissue is quite stuck down into the hole and needs to be released from the burr hole and then built up and leveled with bone cement. This is much easier to do and will create a smoother result by opening up a small portion of the scar directly over the depressions and placing hydroxyapatite bone cement directly into the underlying bone defects. This is a ‘spot’ form of cranioplasty. This is not much more invasive than an injection approach and is more likely to get rid of the scalp depressions with a smooth transition into the normal surrounding bone and scalp.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 24 year-old male seeking help and guidance about my head shape. I have caphocephaly which was untreated from childhood and now as an adult I find the appearance of my head very troubling. I am concerned in particular about the temporal hollowing and frontal bossing of my head shape. Is there something that can be done about this?

A: As you have well described, you have a classic case of mild to moderate scaphocephaly with bicranial narrowing from front to back with a midline ridge. While the bone can not be changed at this point, there is room for substantial cosmetic improvement through cranioplasty techniques. I envision a cranial reshaping procedure in which some of the midline ridge from the forehead is reduced but, more effective, would be augmentation in the parasagittal areas from the forehead to the top of the head. This would produce some greater width or roundness to your forehead and frontal skull. Due to the volume of material needed, I would use PMMA for cost purposes. This would need to be done through a bicoronal incision in the hairline. The temporal narrowing could be partially improved by either extending the cranioplasty into the upper temporal area or placing temporal implants in the subfascial plane.

While you can not completely correct the skull and forehead narrowness, substantial improvement can be done which would be enough to no longer be seen as having scaphocephaly.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a chin implant placed over a year ago that ended up with my chin being asymmetric. I had a Ct scan which showed that the implant was ‘cockeyed’ in position with the left side being much higher than the right. I then had a revision done on it and my surgeon placed a new implant but it still does not look right even though it is only one month after surgery. I am going to get another CT scan but if it shows that it is still not symmetrically placed what should I do now?

A: Chin implant displacement can occur because the implant wings are asymmetrical or the entire chin implant is positioned too high on the chin bone. Asymmetry of the implant wings has become more common today due to the widespread use of newer chin implant designs that have  extensions or wings with fine feather edges. While they are of great value in creating a more natural chin appearance, particularly in men, great care must be taken to get symmetric pocket developments that are long enough to accomodate the length of the implant. Too high of an implant position is quite commonly seen with the intraoral approach for insertion. In either case, secondary correction is straightforward with implant repositioning/pocket adjustment with secure fixation of the implant to its new bony position. To do that I prefer the use of screws to assure what I have obtained in surgery forever stays that way. Why chin implant  revision was not successful is most likely that a new more symmetric implant pocket was not created and the implant was securely fashioned to the bone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 57 years old and am interested in getting breast implants. I have always had small but nice and perky breasts even for my age. But due to a recent divorce, I would feel more confident if my breasts were fuller. Since I have gone through menopause when I was 50, I was wondering  if this hormonal change in any way causes long-term problems with having breast implants?

A: There are more ‘older’ women over the age of 50 having breast augmentation than ever before. Of equal relevance is that 50 plus year-old women are having their old implants replaced. They are part of the first group of women who had breast implant placed in the 1980s. They are now at the point where their implants have ruptured or deflated and are in need of replacement. The point being is that lots of women of this age group either have or are getting breast implants. There are no known adverse hormonal effects of a women receiving breast implants. The potential risks and complications of breast augmentation are the same, either before or after menopause.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is there a limit to what volume of cranial augmentation can be done in a single procedure ?  I imagine that the lack of loose skin in that area will restrict the amount of filler material that can be injected, because the skin would have to stretch to accommodate it.  Does this mean that the procedure must be staged over several visits ?  Or do you employ those subcutaneous balloon dilators to generate excess skin before you start ? Many thanks for your time.

A: You are correct in your assumption that the overlying skin can be a limiting factor in how much cranial augmentation can be achieved. If a significant amount of augmentation is needed, then the use of tissue expanders may be necessary. This is very rare due to the obvious staged nature of the process, but more extreme cases may necessitate it. 

Based on my experience, frontal augmentation cranioplasties can take up to 120 grams of material and still get a coronal incision closed. Conversely, an occipital augmentation due to the tighter scalp in the area can only accomodate 30 to 60 grams without compromising incisional closure. While these implant volumes will achieve the results most patients want, there are exceptions where less amounts of augmentation have to be accepted or the use of a first stage tissue expansion must be done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if you also fix torn ear lobes from heavy earrings. If so how long does it take to heal and what is the cost of this for just one ear? 

A: The repair of torn earlobes is a common procedure that I do all the time. This is done in the office under local anesthesia. Dissolveable sutures are used and there are no dressings other than some light antibiotic ointment. There is minimal swelling and no bruising. Complete healing, as judged by when you can re-pierce your ears or wear clipons, is six weeks after the procedure. Repair of just one earlobe costs $ 425.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a forehead reduction. I have attached two photos of my forehead for your review. I hope these are enough. As you can see my forehead is massive and it gets me down !! Can you help? Is it always successful? Is there much recovery?

A: Thank you for sending your pictures. What you refer to as a massive forehead is one that is very long. I would estimate that the measurement between your eyebrows and the edge of your frontal hairline is at least 7.5 cms. If the forehead length in females is greater than 6.5 cms it is considered too long. This can be improved with a frontal hairline advancement, also known as a forehead reduction. This is where an incision is placed along the edge of the frontal hairline, the scalp behind it is loosened, lifted and brought forward, and the forehead skin underneath then removed. The amount of forehead skin removed is the amount that the vertical length of the forehead is shortened. Generally, 1.0 to 1.5 cms can be reduced in the middle of the forehead. There is less so taken out from the sides where it tapers into the upper temporal area. This is a very effective and successful procedure. Forehead reduction is an outpatient procedure that takes 90 minutes to do under general anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in facial reshaping. I’d like to get a more feminine face. I would like to reshape my heavy jawline and brow, correct the weak chin, do liposuction under chin and I would also like to correct any small asymmetries that would improve the appearance of my face. I have attached a front and side for your assessment of what can be done.

A: Thank you for sending your pictures. In looking at our face what is most striking are two things. First, you have a very strong facial structure as seen in your prominent brow bones and cheekbones. This upper part of your craniofacial skeleton is also broad as reflected in the wide base of your nose and its wide tip. Secondly, and in contrast, your lower jaw (mandible) is actually short both in the horizontal and vertical dimensions. This gives you the impression that your jawline is heavy, when in fact, it is really short which makes it wider than it is tall. 

I have done some computer imaging projections based on what I think would make the most significant changes towards a more feminine face. These include brow bone reduction, rhinoplasty and chin augmentation. (both horizontally and vertically) One of the key components of this approach is that your lower face (jaw) needs to be vertically lengthened to change the shape of your face from square to more of an angular or triangular shape. Combined with reduction of the brows and thinning of the nose, your face will become softer and more feminine.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I had orthognathic surgery over a year ago where my upper jaw was shortened and my lower jaw was brought forward. Ever since my septum has somehow shifted off to the left side  and my nose is slanted that way as well. The left nostril  sags down and looks wider as well. The right side looks more normal. What can be done know to correct these nasal problems? I am certain they are the result of my jaw surgery since my nose didn’t look like this before my jaw surgery.

A: Septal and nasal deformities as a result of a LeFort (maxillary) osteotomy are not rare. A LeFort I osteotomy has three potential adverse effects on the nose if certain steps are not taken during the surgery to avoid them. The septum may become deviated afterwards as the floor of the nose is part of the upper jaw. When the maxilla is impacted (shortened, moved upward), the septum must be similarly shortened. If not, the impacting upper jaw will cause it to be bent or deviated as it impinges on it. The nostrils can become wider afterwards as the paranasal muscles are disinserted with the incision under the upper lip. If these muscles are not brought back together at the time of the intraoral mucosal closure with a V-Y advancement, then the sides of the nostrils will flare outwards. Lastly, the tip of the nose can change due to the altered position or shape of the anterior nasal spine on which the caudal end of the septum and columella resides. It appears that you now have some degree of all three of these nasal problems. All of these deformities can be corrected  during a secondary septorhinoplasty procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have lost 65 lbs over the past year through diet and exercise. At 5’4” and 180 lbs, my BMI still says I am obese. I would really like to go ahead and have my abdominal apron removed now because I am sick of it, it makes me look bad and gets in the way of me exercising. Should I lose more weight before having the surgery or just go ahead and have the apron removed now? I know doctors like to have your BMI below 30 before surgery so I am not sure what to do. I have attached some pictures of my gross stomach for you to see.

A: The timing of when to do an abdominal panniculectomy/tummy tuck in the course of one’s weight loss is a common one. There are no absolute guidelines other than the more weight loss the better. BMI is a useful measurement but it is still just a number. What counts is the size of your pannus, what the rest of your body looks like, and how your weight loss is progressing. Many patients with abdominal pannuses ‘hit the wall’ so to speak in their weight loss and the size and weight of the pannus becomes limiting at that point. Based on the pictures you have shown, I think you would be best served by moving ahead now with your abdominal panniculectomy procedure. Your body is not that big compared to the size of the pannus. You would look and feel so much better if it were removed. This would make it easier to function and exercise and you would be more likely to lose weight if you desire after its removal than with where you are currently.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in having multiple facial changes done by you and want to look as attractive as possible. I am a 22 year-old male whose face is a little out of balance and proportion. I have taken the golden ratio mask picture of which I am sure you are familiar and applied it to my face. It shows clearly where my facial imbalances and deficiences are. I know you would do what is best for one’s face but would you go for different results if you were masculine or feminine. The one I used was the female golden pic and there’s a male one as well. Of course I would much rather go for the male look. How close can you come with surgery to achieving these golden ratio mask results?

A: I am very familiar with the golden ratio masks and you are not the first person that has presented it to me. They are very interesting for assessing facial beauty and do provide at least a measureable target for which to aim. They can help surgical planning and, for those who may not be experienced in assessing faces and making the diagnosis by examination of where the deficiences are, they can provide a sort of blueprint to follow. What I do not like about them is that they can create unrealistic or artificial goals for patients as surgery is not like Photoshop nor can it create that degree of precision or change. Perhaps worse, those patients that use them before surgery are going to assess their after surgery results with them. This is a near certain setup for disappointment and an initiator of the need for revisional plastic surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been getting injectable fillers into my smile lines and lips for several years now. While I really like the effects that it creates, I do tire of having to be stuck by needles and the recurring expense of doing it once or twice a year. Is there any injectable treatment that would be permanent or at least last a lot longer?

A: While current off-the-shelf injectable fillers produce some wonderful facial changes, they are synthetic and will be eventually resorbed and the effect will be lost. While no truly permanent injectable filler can be definitely claimed, there are several promising options that are now being used. Most people have probably heard of using liposuction-derived fat for injection, and it has been used for some time, but its known problem is that its survival is unpredictable. While it does work well is many areas of the face, the smiles lines and lips are not amongst the most favored. Encouraging injectable cell treatments include fibroblasts and stem cells, both harvested and grown from the patient. Taking a skin biopsy from behind your ear allows fibroblasts which make collagen to be grown for later injection. Known as laViv, this is an FDA-approved treatment that allows the injection of millions of fibroblasts into any desired facial site. Comparatively, Cryo-lip (an Indianapolis biotech company) creates large numbers of stem cells for injection into any desired area. Whether any of these cell-based injectable fillers can create a long-term permanent effect is not yet known.      

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 54 year old female with an overlying abdominal apron. I have had three c-sections with some prominent scarring where they did this surgery. This c-section scar pulls in and the weight of the overhanging apron on it makes it chronically sore and irritated. I am also a diabetic and have high pressure. Do you think removing the fat with liposuction will help me. I am interested in something like Smartlipo since it appears to be the least invasive. Will my diabetes and high blood pressure get better after surgery?

A: When anyone describes having an abdominal apron, also known as a pannus, they are by definition talking about a large amount of skin that hangs over the waistline. In treating an abdominal apron the consideration of liposuction is immediately excluded. While it does remove fat, it will actually make the overhang of the apron worse. What you need is an abdominal panniculectomy, also known as a ‘simple’ tummy tuck. It is the cutoff of the abdominal apron without any manipulation of the underlying abdominal muscles. This will provide both an immediate and effective cure of your problem. Given your age and health conditions, you will need to get medical clearance from your doctor. It is very possible, although not assured, that this surgery may help reduce some of your medication requirements for your blood pressure and diabetes if the apron is big enough.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I have a fatty area on my very upper inner thighs that is always rubbing even though the rest of my legs are fairly muscular. I also have an area of fat between my breasts and armpits that I cannot stand. I exercise daily and these problem areas are never resolved. Do you think Lipodissolve would be beneficial? Thank you.

A:  Thank you for your inquiry. In answer to your question, I do not think that Lipodissolve would be the way to go for all of those fatty areas. Lipodissolve requires a series of injections, which cause swelling and discsomfort for a week afterwards. It would take three or four injection sessions spaced four to six weeks apart to see results. With multiple fat areas you would find that process slow and mildly unpleasant, in essence an inefficient fat reduction method whose results are uncertain. While it is a non-surgical treatment, it just won’t work well for what you want to achieve. It would be far better, achieving more efficient and effective fat reduction, to undergo a one hour Smartlipo procedure under anesthesia. This may be exactly what you want to avoid but you would also want whatever treatment is chosen to work as well. Interestingly, a one hour liposuction procedure will actually cost less and have a quicker recovery than a series of Lipodissolve injection sessions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting breast implants but am concerned about the time it may take to recover. I have a 7 year old daughter and need to take care of her daily needs so I can not be limited afterwards. How long will my recovery actually be after surgery?

A:  In regards to recovery after breast augmentation, I place all my patients on a rapid recovery program. This means that there are no physical restrictions after surgery and there is nothing you can not do if you feel comfortable. Patients start on arm exercises the first night of surgery to help recover quite quickly. Will you be sore…yes. But will you be limited from doing anything for your young daughter…no. In recovering from getting breast implants, the main source of discomfort from the submuscular dissection for the implant pocket, the lifting off of the pectoralis muscle from the chest wall. Therefore, recovering from breast augmentation is really about taking care of a big pulled muscle. What is the fastest way to recover from a pulled muscle? How do athletes recover quickly when they pull a muscle? Early range of motion and stretching is the key. This is why lifting the arms and stretching them, starting within hours after surgery, will get the discomfort to lessen quicker and range of motion of the arms come back quicker. Breast implants primarily affect lifting and moving of the arms as the insertion of the pectoralis muscle is on the upper humerus and not on the shoulder.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a tummy tuck done three weeks ago. I developed a problem within the first week after surgery. At the crossing zone of the inverted T incision, I developed necrosis and infection. Now it is just a big black patch around it. Is there anything that can be done to make it heal and heal faster?

A:  What you developed, as you have described, is a zone of tissue necrosis at the areas of a tummy tuck which has the least blood supply to the skin. It appears that you have had a combined vertical and horizontal tummy tuck and that junction where all the incisions come together  would be at the greatest risk for exactly that problem. While initially dark in the first few days after surgery, it turns black and becomes hard as the zone of demarcation between good and dead skin becomes quite clear. This dead skin and its underlying tissue is known as an eschar. It would be wise at this point to do nothing and allow this area it to heal on its own. Removing the black eschar now will likely reveal a full-thickness tissue defect right down to the abdominal fascia. It would be best to treat this eschar like a scab. Allow healing to take place to the point where it gets loose and is ready to come off. This will allow for a lot of healing to take under and around the eschar. There is nothing that can speed up this process and it will likely take six weeks or longer before the eschar will lift off to reveal if any full-thickness defect exists underneath.  The eschar should only be removed earlier if infection around the area develops.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I went in recently for a consultation from an Indianapolis rhinoplasty surgeon. During the consultation he recommended a chin implant with my rhinoplasty surgery. While he seemed very honest in this suggestion, I was completely floored as I never thought I had any chin problem. I certainly didn’t think that I had a weak chin. Having had the idea settle in for awhile, I am now more comfortable that maybe I do need one. I like the way my face looks in every way except for my profile which is why I want my nose done. What I am concerned about is that the combination of a rhinoplasty and chin implant will change my face too much. I have attached a profile picture of me for your thoughts. What would you do if you were me?

A:  It is not uncommon to perform a rhinoplasty and chin implant together and it can be a powerful changer of one’s profile. But whether it is aesthetically beneficial can actually be determined by you. Make sure that you have done a series of predictive computer imaging. Have shown to you how your profile would look both with and without a chin implant with your rhinoplasty prior to actually undergoing surgery. These images will answer your question better than anyone simply telling you one way or the other. One cautionary note, if you opt for chin augmentation your plastic surgeon needs to be careful about the style and size that is selected for implantation. You have a retruded but long chin. It would be easy to end up with too strong a chin appearance afterwards if the right chin implant is not chosen.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I am a 38 year old mother with 3 children. Needless to say, three pregnancies and breastfeeding them all has taken qute a toll on my body. It looks like the proverbial life has been sucked out of me. My breasts are flat and droopy, I have a small skin amount of belly skin that hangs over my waistline and I recently found out that I need a hysterectomy due to chronic bleeding. Other than these issues, I am actually in good health. Since I have to have a hysterectomy anyway, I thought that getting breast implants and a tummy tuck at the same time would be a good idea.  It would be great to get a while new body along with fixing my gyn issues. Do you think all of this can be done at one time and is it safe?

A: Combining breast augmentation and a tummy tuck with a hysterectomy procedure is  perfectly safe provided you are in good health and have no significant health risk factors such as smoking, diabetes, or high risk for blood clots. Tummy tucks and hysterectomies are very commonly done together as it provides unparalleled access for the Gyn doctor to do the hysterectomy and provides solutions to many body problems in one operation. Adding a breast augmentation to this combined abdominal procedure does not add significant operative time, risks, or recovery. This would be the ultimate ‘Mommy Makeover’, correcting all issues that are associated with one’s pregnancies. Your most challenging aspect in getting this done is to be able to coordinate a plastic surgeon and a gynecologist’s schedule as well as the economics of doing it in a hospital environment.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I had a rhinoplasty done to reduce the bump on my nose.. The doctor told me that he took it off using a rasp which shaved it down. What I am wondering is whether the bump can grow back again? I have read that some people who have had their nose hump removed have had it grow back again a few years after their surgery. Is this true?

A: There is really no such thing as a hump or bump (a dorsal hump in plastic surgery terms) that grows back after it has been treated by a rhinoplasty operation. Once the bone and cartilage have been removed, they do not have the ability to grow new bone or cartilage tissue. That is a regenerative capability that we as adults do not have. (and for many medical problems I wish we did!) The perception of a dorsal hump ‘growing back’ after s rhinoplasty most likely reflects a hump that was never sufficiently removed in the first place. While it may initially look like it was removed, it can ‘reappear’ when all of the surrounding tissue swelling goes away. If you add inj a little scar tissue on top of an inadequate reduction, some hump can once again be seen. Whatever amount of residual dorsal hump that is seen after a rhinoplasty is merely a reflection of what was originally there. Regrowth should not be confused with inadequate removal.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I have alot of scarring on my face. Mostly small scarring from acne and also some from adult acne which includes one very large pocket where a cyst once was, also another very large scar where I had to have a surgeon remove another cyst .There are also a few smaller scars where more cysts were removed and one ice pick also. I’d like to know if you can help to remove some of these in your office or at least help to minimize some of the issues. I am embarrassed to go out into any type setting outside my home wether it be work or any other. I use to be what most would consider a pretty attractive woman. I would like it so much to not feel so awkward about myself because of my complexion. I have been dealing with the the withdrawing from others for about 17 years or so where as I use to be an outgoing and confident person. If you can help me I would greatly appreciate it. Thanks so much.

A: One of the most challenging facial skin conditions to really improve is that of acne scarring. There is no magic solution to this devastating problem and it is compounded by the fact that there are many different types of acne scars by depth and shapes. Surgical methods of improvement can include excision, dermabrasion and fractional laser resurfacing. There is even an occasional role for fillers placed underneath certain types of acne scars. Usually some combination of several of these approaches are needed. Almost always some improvement in acne scarring can be obtained. It is just a question of how much and is it worth the effort involved to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I have a problem with sores on my breasts. My breasts are very small and extremely saggy having lost most of my breast tissue after breastfeeding four  children. I kid you not that they are literally two sacks of skin just hanging there. When I wear a bra they get all bunched up inside it and are folded unto themselves. This causes the skin and particularly my nipples to rub and get weepy,oozing painful areas. Due to these sores, is it possible that I would qualify through my insurance to have a breast lift with implants covered? It would seem that insurance should cover it since it is causing a medical problem. What do you think?

A: Medical insurance will never cover any breast procedure that involves a lift or implant, unless it is part of a breast reconstruction due to breast cancer. While it would seem logical that your skin problems would provide the reason for a surgical solution, that will not happen. Insurance will cover the medical treatments for your breast skin problems but not for breast lifts whether implants are used or not. This will be viewed as a cosmetic procedure, not a reconstructive one.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I am 24 years old and lead a very healthy life style. However, I still cannot get rid of some fat on my stomach. I am interested in the least intrusive means of getting rid of this fat. Smartlipo seams to be a good fit. I am researching it more to be sure it is right for me and that I can afford it. I was wondering what the average cost for Smartlipo on the abdominal region (including all the additional fees such as room and other personnel involved). If you could send me an email with an estimated average, that would be great. I appreciate it!

A:  By the tone of your inquiry, I can tell that you likely have a false assumption about Smartlipo. Smartlipo is a method of liposuction which means it is intrusive and it is surgery. There is no minimally invasive or non-surgical method of fat removal that is really effective in terms of what most people want and expect. Smartlipo, for a variety of reasons, is often perceived as if it is a substitute for liposuction surgery and that it is some ‘mild’ form of liposuction that is exclusively performed under local anesthesia with minimal to no recovery. This is unfortunate because Smartlipo is liposuction surgery and is often best done under general anesthesia to get the absolute best result…and there will be some typical recovery. The cost range of abdominal Smartlipo will be in the range of $3500 to $5000.

Dr. Barry Eppley

Indianapolis, Indiana