Your Questions
Your Questions
Q: Dr. Eppley, I am unhappy with the shape of my breasts after breastfeeding two children and then losing 35lbs after the delivery of my last child. I do not like how loose and droopy my breasts are. I am happy with the size and I would like to avoid implants. I also would like to know how to get rid of the stretch marks on my breasts. Can you tell me if a breast lift without implants will be enough to remedy those issues? Also, after research I’m expecting to need an anchor lift, is that what you would recommend? I have attached a front and side picture of my breasts for you to see how droopy they are.
A: I think much of your assumption about the need for an anchor or full breast lift is correct. That is certainly what your pictures show with the nipple being positioned just below the inframammary fold in the side picture. While this will lift the nipple above the fold and will tighten the skin and lift the breast tissue higher up on the chest wall, a lift alone will not be able to create any persistent upper breast pole fullness. But if that is not a necessity then you could get by without an implant. The sole purpose for an implant in a breast lift for many patients is to create upper pole fullness that will persist after the breast lift/tissues relax and settle downward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to have liposuction done on my stomach and waistline but don’t know the best kind to get. There are many different types out there and they all seem to suggest that each one is the best. I went to two different plastic surgeons, one using Smartlipo and the other Vaser, and they both said the way they do it is the best way. This has left me confused. What do you think is best?
A: When you see many different methods of doing the same thing being advertised or touted, this likely means that there is not one single best way to do it. For if there were, we would all know about it and it would be the only way to do it. It is easy to get caught up in technology and machines, particularly when it comes to performing liposuction. The reality is that the results of liposuction is most influenced by the skill and experience of the person performing it, not the specific device, machine or technique. No one type of liposuction is better than another, but there are better doctors than others that do it. Some do it well with great artistic flair and get very good results with minimal skin irregularities and others have less refined outcomes. Unfortunately, this is the aspect of liposuction that is impossible for you to evaluate clearly. You have to rely on your gut feeling of the doctor, their posted results and any reviews of satisfied patients that are unsolicited.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had breast implants in place now for over 24 years. They were originally placed in 1987 above the muscle and are silicone implants. I am scheduled to have a mammogram at the end of the month and am afraid the the mammogram might rupture my implants because they are so old. Do you think I should get a mammogram or is an ultrasound just as good?
A: The premise of your question is a little concerning. It suggests that either you have never had a mammogram or have not had one for many years. It would be very important that you get breast cancer screening and, no, an ultrasound is not a good substitute for a mammogram. It is not nearly as sensitive for breast cancer detection. If you don’t want to get a mammogram, then you need to get an MRI. I would have no concerns, however, about getting a mammogram as there is no evidence that they increase the risk of breast implant rupture. With the age of your implants, there is a very good chance that you have silent rupture in one or both of them already. The time is on hand to consider replacing your breast implants anyway so getting a mammogram will help answer the dual concerns about implant rupture and for breast cancer detection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a breast augmentation done in November last year. Initially I was very satisfied with the results but now they are starting to sag and I need a breast lift. I remember that I had a discussion with my plastic surgeon before the surgery about doing a lift at the same time as my implants but I decided against it because of the scars that would result. Now that I am ready for a breast lift will I have to have the implants removed, have the breast lift performed, and come back at a later date for new implants? Or can the lift be done with the breast implants in place that I have now?
A: Many times modestly sagging breasts get by initially with implants alone. But when the breast tissues relax after being pushed outward, they slide off the implant creating ptosis off of the edge of the implant. If you are happy with the size of your implants and they are in good position, I see no reason why you can’t proceed forward with the lift with the implants you already have in place. Most likely, you will need a vertical breast lift to get the breast tissues up in proper position over the implants. While it is never a pleasing revelation that you will need a second surgery to get the breast result you want, take solace in the fact that a breast lift is much easier to go through than the initial breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need to have a pannciuectomy. I had weight loss surgery in November 2010. I was originally 375lbs and I lost over a hundred pounds. I have had this overhang since I was in my teens and it now hangs to touch my upper legs. Will my insurance pay for it? My out of pocket expense is met for this year so surgery should be paid in full. Please please can you help me?
A: Many overweight people have a large abdominal overhang initially that is then aggravated by their weight loss. As the weight comes off and the ‘balloon deflates’ so to speak, this skin overhangs worsens and sags lower as it has lost volume. This creates complete obliteration of the groin creases and their pubic and genital regions creating the well known hygiene and skin irritation issues. As you have described, your abdominal pannus now hangs down completely into your thighs. By definition, this is one of the criteria that insurance uses to determine coverage.
While I would agree that it sounds like your panniculectomy would be covered by insurance, my opinion is irrelevant and is meaningless from the insurance coverage perspective. This is why we always file a predetermination so the insurance company has enough information for them to make a decision. It is their decision not mine. As a plastic surgeon, I am merely a vehicle by which I can help the patient be put in a position so their insurance company can make an accurate review and determination. This predetermination involves a written letter by me describing your condition, the problems that it is causing and photographs which show the size of the abdominal pannus. That is mailed to them and then you await a written response as to their decision about coverage for your abdominal panniculectomy.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had breast augmentation about six months ago. I went from a 34B to a 34D and they are under the muscle. While the size is satisfactory, they still feel and look fake. They still feel hard, although not as hard as right after surgery. One breast is also higher than the other one and they have not dropped like my surgeon said they would. What do you recommend I do now?
A: While it is true that breast implants can initially be high due an immediate skin expansion effect, some settling or dropping of them can usually be expected as the lower breast skin relaxes. This is an effect that will occur within the first few months after surgery. I usually like to see it happen by no later than six weeks after surgery. While some settling can still occur up to several months later, you are at a point in time where no change will be seen. Besides a high position, your breast implants feel tight because the tissue pocket that contains them is somewhat too small. A small pocket around a bigger implant will feel tight or hard. What you need now is revisional surgery. The breast implant pockets need to be opened up on the lower pole, one side more than the other. This will drop down and even out the implants and, with larger pockets, make them feel softer. Breast augmentation revision is your next step.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 38 years old and have had very noticeable nasolabial folds for the past several years. I have had injectable fillers, specifically Juvederm Ultra XC, placed into them with some improvement. I also had my cheeks injected also. Now, less than 6 months after the injections, my nasolabial folds are just about back again. I would like to something that is more permanent and may even have a greater effect. Do you think a cheek lift will work? Or should I just wait until I am older?
A: Deep nasolabial folds at a young age can be a very difficult problem. Some facial shapes and skin types are simply more prone to them and, if this is an issue at the young age of 38, it is going to continue to be a long-term facial issue. Injectable fillers for the nasolabial folds offer both advantages and disadvantages. Their advantage is that they work when properly placed. There is great debate of the many fillers as to which one is better but none has ever been shown to be really be ‘better’, they all work. Some simply last longer at a greater price. They work instantaneously and generally have no significant problems. Their disadvantage is that they are not permanent. No injectable filler is permanent, no matter what is said by some. However, a cheek lift is not the solution either…for now. You are too young to justify such surgery and it is not a permanent solution either. You would be best served to continue with injectable fillers at this point even though they have limited duration. The effectiveness of cheek or midface lifts depends on mobility of the cheek tissue across the zygoma or cheekbone. I doubt if you have much of at your age. This is why such cheek lifts are years away for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting fairly large breast implants. I am only 5′ 2” and 107lbs. I’m currently a 32A. I have been told that I would need multiple surgeries to get my desired size of 650cc. One plastic surgeon I consulted with suggested that I start with a 400cc implant and then have a second implant later to get to my size. My breast width is about 13cm. What is the largest implant (style and cc)that I can get based on my breast width?
A: There are some issues that you may be aware of when you place large implants in women with small breasts, primarily which is the stretching out of tissue support. This can cause some long-term problems such as tissue thinning, bottoming out and an increased risk of the need for revisional surgery. But I will assume you know these so I will answer your specific question.
Depending upon whether you are choosing a saline or silicone gel implant, there are different size consideration either of which would be a high profile style implant. I only use Mentor breast implants so I can only speak of those sizes. A 560cc high profile saline implant has a base width of 13.4 cms which can be maximally filled to 650cc. At maximal fill this will narrow its base to 13.1cm. For silicone Memory gel implants, a 650cc implant has a base width of 14.4cm.
As can be seen by these numbers, I do not know why you can not reach your desired breast implant size in a single breast augmentation surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Cosmetic plastic surgery is now more than a $10 billion a year industry in the United States that has seen increases in number of procedures across all age groups. The largest growing population of patients, however, are those in their later years. Due to Americans being healthier, living longer and being more active later in life, millions of them want their looks to keep pace with how they feel. As a result, many are turning to cosmetic surgery to help them look younger and feel better about themselves.
In 2010, over 600,000 Americans age 65 or older choose to undergo some form of cosmetic surgery. Compared to ten years ago, that is a five times increase in number of procedures done. However a significant of these procedures, and a big reason for the large surge in numbers being done, is not actual surgery. In the interest of of wanting to look younger and fresher, many are going the injectable route choosing such popular products as Botox and Juvederm. While not as effective as surgery, they do help give one an extra edge in their appearance by decreasing frowning and plumping up certain wrinkles and folds.
Such injectable procedures involve only a minimal amount of discomfort by being placed right under the skin. Between wrinkle reduction and tissue plumping, these injections help give the face a smoother more youthful appearance. These are all procedures that can be done fairly quickly with a limited recovery time and are more economical options compared to surgery. When combined with a variety of available skin refreshening procedures such as chemical peels and light laser resurfacing, one can really take off a few years with next to no recovery or downtime.
While injectable treatments have lead the way in number of procedures for older Americans, ironically they are not the most effective given the amount of aging changes that are usually present. Injectables are more effective in younger patients simply because they have less wrinkles, lines and sagging skin. This is why surgery is also growing in numbers for the Baby Boomer generation with popular procedures being eyelid tucks, browlifts, and face and neck lifts. These anti-aging facial plastic surgery procedures can be done alone or, ideally in combination with surgery, to remove loose and sagging skin that creeps its way across our faces as we age.
We all look for that extra something to look and feel better as we age. My older and more mature patients clients are traveling, playing sports, exercising and doing all of the right things in life to look, feel and stay young. But, unfortunately as we age, all of the activity and exercise won’t make your face look any better. Looking better requires a effort, just of a different kind than that of feeling better.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if you performed jaw augmentation using bone grafts.What do you think about using bone grafts to increase the mandibular angle? Would you recommend it? And if you prefer other materials, why is that? I was browsing the web for some before and after photos of jaw augmentation using bone grafts, but to no avail. If you perform this procedure, and have done so in the past, would it be possible to see some of your work? Thank you!
A: There is a good reason why you can not find jaw angle augmentation using bone grafts…it is not done. It would be a very poor procedure for cosmetic jawline augmentation for the following reasons. First, onlay bone grafts to the face undergo partial or complete resorption. For the purposes of volume augmentation, much of the grafts would likely be lost or they would lose shape. Secondly, the amount of bone graft material that could be obtained and its thickness is very limited. Even using skull, hip or rib bones, it would be difficult to get enough material to adequately do both sides. This is not to mention the pain, discomfort and scars that would result from their harvest. Thirdly, most jaw angle augmentations require vertical lengthening which would mean placing part of the bone graft out into space. This would completely resorb.
For these three major reasons, and a few minor ones that I didn’t mention, synthetic implants are far superior to bone grafts for jaw angle augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
The pursuit of the perfect or idealized female appearance is not a realistic goal for any woman, regardless of what plastic surgery has to offer. Improving your own body through diet and exercise, and perhaps a little plastic surgery if desired, is a more common sense approach. Women should only want to have a pleasing face and good body proportions that fall within what their natural genetics will allow.
The Barbie doll, introduced in 1959 and celebrating her 50th birthday in 2009, has always been a controversial figure when it comes to body image. One of the most common criticisms of the doll is that it promotes an unrealistic or unattainable body image for young women to try and emulate. Based on her 1/6 scale at a height of just under 12 inches, she would be the equivalent of 5’ 9” with a weight of 110 lbs with measurements of 36-18-33. Technically at these dimensions she would have a body mass index of around 16 which would classify her as anorexic.
While the Barbie look is not one young women should really admire, it is perhaps interesting to know what plastic surgery procedures one would have to go through to achieve it. In the October issue of O magazine, former model Katie Halchishick served herself up as a example of what she would have to do to achieve Barbie proportions. Posing for a photographer, she used her body to diagram out what she would surgically have to do to change her features to achieve the equivalent of Barbie’s proportions and shape.
Based on this photographic diagraming, it was shown that she would need facial plastic surgery consisting of a browlift, jawline reduction and thinning, nose reshaping, neck contouring and a chin augmentation. For her body she would need a breast lift, upper arm thinning by liposuction and a tummy tuck…and that is for just above the waist. And it was not like this former model didn’t have an attractive face and body to start with.
While this is an entertaining and even humorous bit of photographic morphing, it does actually have a serious message. Trying to have so called ideal body proportions, or even an unrealistic body shape like that of Barbie, is not a healthy pursuit…even if plastic surgery could make it possible. On a more common request, trying to look like a certain model or entertainer is equally unrealistic. Plastic surgery should be used to enhance the face and body shape that women already have rather than pursuing excessive surgery to try and achieve what one isn’t meant to be. This is a healthy and psychologically balanced approach to plastic surgery that many teenage and younger women would be advised to follow.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 35 year old man and I have always been heavy since I was a teenager. Last year I decided to do something about my weight and I worked out alot at the gym and started eating better and I lost 120 lbs. Doing this made me feel great while I am fully clothed. However when I am naked I look terrible and am not confident whatsoever. I have the classic excess skin around the tummy area and the back and the breast area. Also I have excess skin between my Scrotum and my Bottom cheeks between my legs. I would really appreciate some advice on what procedures I can have done for this excess skin. It is for me that I want to do this not for other people I want to be able to feel as good naked as I do fully clothed. What can I do? Any help you can give me would be gratefully appreciated.
A: The loss of a lot of weight, whether it be by bariatric surgery or non-surgical methods, creates a very classic pattern of excess skin. For men, the primary skin excesses are around the waistline, the chest and the inner thighs. These require a surgical approach which usually consists of a waistline tummy tuck with a low horizontal scar, chest lifts, and inner thigh lifts. These are the three primary targets of male body contouring after weight loss. They often can all be done at the same time. The key concept to grasp is that there are scar trade-offs for removal of this excess skin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants. I am fairly small framed, some call me petite, at ‘m 5’0” and 102lbs. I’m currently a 32A cup size. I have had one consultation and tried on sizers and it seems like 550cc implants seem to be the best fit for me for the size I am after. I have been told that this is a large implant for my type of body but this is the look I really want. My goal is a 34 DD. With implants of this size would it be possible for me to get a teardrop breast shape despites the large implant size on my small chest? Two other questions, will my areola stay the same size and what is the best implant and incision to use?
A: There is no doubt that you are interested in a very large implant for your frame. While it is every women’s right to choice any size implant they want, there are many plastic surgeons who will not accommodate an implant size that they feel may lead to loss of breast tissue support in the long run. That being said, whether it is a saline vs a silicone implant, you need a high profile implant to accommodate that volume with the most narrow implant base diameter so it does not end up too far to the side getting in the way of the swing of your arm. I would lean towards a saline high profile implant because it can be placed through a small armpit incision and gives the most projection with the narrowest implant width. As the skin expands to accommodate the breast implant underneath, your areolar size will get bigger.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My teenage daughter was born with a hairy giant nevus in her scalp. It required three procedures of subtotal removals before it was completely gone between the ages of two to four years of age. While the scars from the removal procedu Smart Sales Blueprint res are largely hidden in her scalp, it has resulted in one of her eyebrows being much higher than the other. She is now a teenager and her eyebrow asymmetry is of understandable source of concern and embarrassment for her. I am looking into seeing if some plastic surgery procedure can be done getting her left eyebrow lowered to match her right eyebrow. Do you have any suggestions for how this may be done?
A: Eyebrow over-elevation can be a common sequelae from nevus excision of the scalp or forehead. It is obviously the result of either the scalp resection or actual forehead skin removed as part of the nevus excision. Thus the eyebrow malposition is because there is a forehead tissue deficiency. It is unlikely therefore that the eyebrow can be lowered by a ‘simple’ forehead and scalp tissue loosening, a reverse endoscopic browlift so to speak. The most successful and likely only effective procedure is to create more forehead skin or loosening through tissue expansion, thus allowing the eyebrow to move downward. Unlike eyebrow elevation through standard browlift techniques, eyebrow lowering is a much bigger challenge.
I would need to see a picture of eyebrows and forehead to determine what may be possible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have some questions about chin augmentation for me.Here is a picture that I myself adjusted (I included the original). I actually like my front but as you can tell from my profile, my chin is weak. If you adjust my chin, it really doesn’t do anything to make me look better. My question is after a chin augmentation what can I do to achieve better symmetry in my profile and make me look better from the front (cheek reduction?). It’s quite odd because I look good from the front and correcting my chin doesn’t seem to make me any better looking. In before and afters online you can clearly see how it makes people look remarkably better. Perhaps this is as good as it will get for my chin. Do you think it will dramatically change the way I look from the front? I am interested to hear your professional opinion because I’m puzzled, I was thinking this procedure would make me better looking.
A: Thank you for sending your pictures. What you are perceiving is absolutely correct. While from a profile view, bringing your chin forward increases its prominence and is better by facial proportions measurements, it does not necessarily improve your overall appearance. The reason that more chin prominence does not fit in ‘better’ with the rest of the shape of your face is due your ethnicity in which your facial shape is broader, wider and flatter. You do not have an angular thinner face in which more chin prominence helps make the rest of the face look better as well. (balance) You have to be careful in your facial type that increasing your lower facial prominence does not make it look heavier and too prominent. The only way that chin augmentation would be a benefit is that from the frontal view the chin becomes more tapered rather than wider. This requires more of a central button implant and not the typical anatomic chin implant with long wrap-around wings.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had breast augmentation with saline implants filled to 450ccs. This gave me a 36 D bra size. I had it done five years ago and have been very happy until recently. I have noticed that my breasts seem to be getting lower and my neck and back is hurting more. I am wondering if you think this is because of their weight? I am considering having them replaced with smaller implants that would take me down to a C cup which I assume is around 3255cc to 350ccs. My question is if I do have them reduced will one cup size smaller help them sit higher and reduce my back pain?
A: Your question is an interesting one but I doubt if your breast implants are a primary culprit of your neck and back pain. Contrary to the perception of many, the most common reason why large breasts cause musculoskeletal pain is because of their severe sagging and not just their weight. In most women with breast implants, the implant makes up a large percent of their breast size and the ‘sagging’ they may get with time is more skin relaxation and not true breast tissue ptosis. While I don’t know what your breasts look like, you would have to have a lot of breast tissue sagging off of the implant to cause these problems. Therefore downsizing your implants, short of complete removal, does not seem like it would prove beneficial for pain relief.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant placed six months ago. The implant was fairly small (4mm) and didn’t seem to make much of a difference. I then had the implant replaced about a months ago for a larger one because I wanted to see an actual difference. Now my chin is huge! The surgeon who redid it didn’t show me my any pictures of what the result would look like or did he show me the size of implant that he would use. I was just told the measurements and didn’t see it. So needless to say I am not happy and am looking for a really good surgeon who would be able to go in and replace the implant for a more aesthetically pleasing one for a small petite female. I have a slender face but the new implant just makes it look longer and because of how large it now is, I can’t smile right, etc. Please let me know if this is something that could be considered. Thank you.
A: I can appreciate your dilemma. A 4mm implant is not really visible in just about anyone. But it is also easy to go too big and wide in a female. Too wide an implant in a female is a common problem that I see. Chin implants in women have to take into account different size and shape considerations. What you would use in a women can be different than that of a man. I would need to see some pictures of where you were when you started and what you look like now if that is possible. I am certain you can get a much better result than you have now just based on your description alone. I suspect it is the wings of the implant that are as much of a culprit as that of the actual horizontal projection.
Dr. Barry Eppley
Indianapolis, Indiana
The thought of eating turkey at the upcoming Thanksgiving holiday brings together two inseparable images. While history does not show that turkey was ever actually served at the first pilgrim’s festival, it has become the featured culinary dish since. While many will enjoy the tasteful bites from a turkey leg, breast or stuffing, few will aspire to have the turkey neck.
While few want to eat a turkey’s neck, even fewer want to have one on of their own. The turkey neck or neck wattle is that well known fleshy fold of hanging skin that is unavoidable for many as we age. The loss of a once smooth jaw line and a shapely neck shows the persistent effects of gravity and time.
While creams and other potions promise much, the turkey neck needs a surgical fix. Forget about non-surgical options and other ‘lunchtime’ type procedures. They simply do not work no matter how hopeful one is. For the fuller neck in a young person, fat removal by liposuction alone may be enough. But when the neck skin is loose and floppy, and you can pinch a wad of skin and fat between your fingers, some method of actual removal is needed.
The removal of a turkeyneck requires some form of a facelift. While often misunderstood, a facelift is really a neck and jowl operation and does not change the face much above the level of one’s mouth. It is a poorly named procedure and the term necklift would more accurately describe it. It is really less extensive and easier to go through than most people think.
When it comes to necklifts, there are numerous options.Which one is best for any particular person is determined by how much loose neck skin one has. Some jowling and a little loose neck skin may only need a limited facelift. If there is a lot of loose neck skin, then a fuller form of a facelift is really needed. This is a powerful neck changer and can produce some really dramatic results. For those that want the least invasive amount of surgery but with a dramatic change, the turkeyneck can also be directly cut out in a procedure appropriately called the direct necklift.
The turkeyneck is not a desired culinary item on the bird and many people don’t like it on themselves either. While year round turtlenecks are always an option, a little skillful carving may be a better solution.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, if eyebrow loss is due to disease process like alopecia and not to behavioral issues such as trichotillomania or over plucking, would it still be considered cosmetic or might insurance cover part of the procedure(s)? I realize cost may vary, but since I would be traveling a fair distance for a consultation, can you provide ballpark estimate of cost? Thank you.
A: Short of traumatic loss of part or all of the eyebrows due to trauma( burn, avulsions), insurance is not going to cover eyebrow hair transplants. Thin or thinning eyebrows are viewed by insurance as a cosmetic problem not a medical one. Generally speaking, most eyebrow hair transplants need about 150 to 200 hair on each side. (more may be needed) At $10 per each indivudal hair transplant that would bring the cost to about $ 4,000 for the procedure which is done in an office setting under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an horizontal scar split my eyebrow. from1mm in the middle of the eyebrow to 6 mm at the end of the eyebrow. I have 6 hairs growing in the scar and i wouldn’t like thm to be lost in a scar revision. I don’t want to lose even one eyebrow hair in a scar revision. It is possible?
A: The simple answer is I couldn’t tell you without seeing a picture of the scar. But by definition, a scar revision removes scarred skin and anything that lies within that scarred skin. When dealing with noticeable scars inside the eyebrow, what makes them visible is their lack of hair or very scant hair within them. This scar needs to be removed, and any free-standing hairs included, to bring the edges of the eyebrow skin that has good density of hair together to minimize the scar’s appearance. This concept of eyebrow scar revision is limited by the size of the scar and would not work well if the scar is very large. (greater than 1 cm.) In these cases to prevent eyebrow distortion, one would need to consider eyebrow hair transplants instead.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a better chin and jawline. I am a 28 year-old female and I have always thought my chin was too short. I am fairly tall (5’ 9”) and my short chin gives me somewhat of a short-faced look that becomes particularly apparent when I smile. I know chin augmentations in women are not that common but I think I really need it. I have attached some pictures for you to review and tell me what you think.
A: Thank you for sending your pictures. While the pictures you have sent show you smiling (which distorts the chin area somewhat), I can still see your concerns about a small chin. I have done imaging showing a 5 to 7mm horizontal advancement in side view and a central or button style chin implant in frontal view to give it more of a tapered look which is more aesthetically pleasing in a female’s chin. I think this size and style of chin implant gives your lower face better balance and shape.
Actually chin augmentation in women, while less common in numbers than in men, is not that rare in my experience. How chin augmentation in done in women, however, is different in the amounts and shape of the augmentations as what defines an attractive female chin is different than that of men. It is more than just a simple horizontal measurement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have underwent a lower jaw advancement plus a genioplasty few months ago. I think my chin could have been advanced a lot more and would appreciate feedback if such can be procedure can be performed once again. What would be a cost of such procedure given it would be a repeated genioplasty. Thank you.
A: Thank you for your inquiry and sending your pictures. Your chin certainly still appears short despite the recent combination of mandibular advancement and osseous genioplasty. Your chin needs to be brought forward at least 7mms if not more to bring your lower face into better balance. Whether that can or should be done by a repeat osteotomy or simply putting an implant in front of the osteotomy needs to be determined by a lateral cephalometric x-ray. That would show how far the chin as been brought forward by the first osteotomy and how thick the chin bone is to see how much further advancement can be done. It is not a problem technically to do the genioplasty again, you just want to know precisely how much advancement can be gained. It certainly appears that the original genioplasty was fairly conservative.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, The picture used on the December 28, 2008 article written by Dr. Eppley looks like my body. I have lost some weight but am still a large women. I am very curious about this procedure. Do I have to be at normal weight to have a pubic lift done? Does insurance ever cover this type of procedure. My Gyn says that she thinks I may have some sort of a “prolapse” and suggested I go see a plastic surgeon. I am so embarassed by how I look I haven’t done so. Your website gives me hope that I am not the only person who has this problem. I look forward to hearing from you. Thank you.
A: A large overhanging suprapubic mound is a common problem for men and women that either have a large abdominal pannus or who have lost a lot of weight. The difference between the two is in the amount of fat that either contains. Either way, this overhanging mound can interfere with urinary outflow, sexual function as well as pose hygiene issues. Its removal can be done through a procedure known as a suprapubic reduction/lift (mons reduction) which consists of liposuction debulking of its fat volume if needed and reduction and lifting of the excess skin that it contains. Based on the above or overlying abdominal anatomy, it may be necessary in some cases to remove any overhanging abdominal pannus or extra skin first before proceeding with a pubic lift procedure. (e.g., abdominal panniculectomy or extended tummy tuck) This is usually not a procedure that medical insurance will cover.
Dr. Barry Eppley
Indianapolis, Indiana
Stem cells have caught the imagination of medical specialists and researchers over the past decade. The idea that your body holds within it the ability to regenerate and heal itself through these wonder cells has an irresistible appeal. Stem cells show good promise for numerous d How Do You If Your Ex Boyfriend Wants You Back ifficult diseases for which modern medicine has few good answers. Clinical trials for some neurologic and degenerative disease therapies have been encouraging.
Because of the uncomitted nature of stem cells, it is no surprise that it has been touted for the most common of all human conditions…that of aging. As an anti-aging treatment, stem cells have become the magic pixie dust allegedly contained in numerous topical skin therapies and cosmetic surgeries. A topical potion that may contain stem cells is surely as close to the fountain of youth as we have ever been. Their use has spilled over into cosmetic surgeries which are now being advertised for such procedures as stem cell facelifts and stem-cell-enhanced fat injection breast augmentations. These are being promoted as not only cutting edge operations but promising results that are far better than traditional methods of plastic surgery used.
When you factor in that everyone has plenty of stem cells throughout their body, many of whom lie in great numbers in our fat, their benefits seem obvious. How could they not make any cosmetic surgery better?
While stem cells are a part of the future of some medical therapies, they currently represent a potential case of a ‘truism.’ Truisms are common beliefs in which something just seems to be so true that we assume that it is…only later on closer scrutiny to be proven to not be so. Currently stem cells, at least in anti-aging therapies and plastic surgery, has many of the makings of a truism.
Those that advertise and market them are making claims that are far ahead of proven science. There has yet to be a single piece of medical evidence or research that has shown that stem cells can make your skin younger or your facelift last longer or look better. While we would like it to be true, and it seems that it should be true, the reality is that stem cells and anti-aging effects are still courting but there is no signs yet that they are to be married.
Because fat is resplendid with stem cells and fat injections are a common part of many plastic surgery procedures today, it is tempting to call them ‘stem-cell enhanced’ or even a stem cell therapy. This is false advertising at the least and deceptive at the worst. While stem cells may be part of our fat, we don’t yet even know how to make them work or what they would do if they could be turned on.
If you drawn to some type of cosmetic stem cell treatment, whether it be a cream or surgery, remember that nothing sells better than hope.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have loose skin on elbows and I only want the elbows done, I have had a quote but unsure how and when I can drive, and I am not sure about visible scar will be which worries me. It’s just coming into summer and not sure if that would matter to have it done now or wait. Can you advise me Thanking you in advance.
A: The biggest issue with elbow lifts, very similar to armlifts, is that there will be a visible scar as the trade-off for the loose skin. Whether this is a good trade-off will differ for each patient. If you have a scar concern, then this may not be a good procedure for you. That aside, my patients can drive the very next day. This would not be a procedure that most people would want to do in the summertime due to early scar visibility due to short sleeves being worn.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello Dr. Eppley, I have reviewed your website qned found that you have run across silicone oil pockets and were able to induce drainage during a lift surgery. I have had buttock injections done. I do not have any lumps and I wanted to know that if found by MRI is there a way for a large pocket of silicone in my buttock to be drained? I really want to know if you can help me by performing this procedure, since you have seen and had experience with silicone oil. I really need your care. Thank you for emailing me in advance.
A: The traditional method by which silicone oil injections are done is supposed to be a small or ‘microdroplet’ approach for soft tissue augmentation. This is taught this way to avoid a large collection of isolated oil which can cause tissue reactions and fibrosis. While this may be the way it is done in the face, I suspect that most buttock augmentations with silicone oil involves much larger deposits than small drops. Since you have no lumps in your buttocks, you may not have any large oil collections that are capable of being drained. Certainly an MRI would reveal if such collections exist. If they do, drainage may certainly be possible. The one question I would ask then is, if you are having no problems, why do you want it removed? This is particularly relevant given that a surgery and an incision may be needed to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Shopping for discounts as an innately human characteristic. Most people like to negotiate or are attracted to sales as the need to feel like one has gotten the best deal is sometimes as important as the item of interest. At no time is this more evident than in economic downturns. While I think the Groupon concept may have been successful at any time in history, it has really taken off since our recent recession started.
While Groupon had its origin in retail items such as restaurants, spa services, and clothes, it has more recently spread to medical procedures such as cosmetic surgery. Groupon discounts now exist on a wide range of cosmetic procedures from Botox to breast implants. These elective medical procedures for some appear to fall into the mindset of any other retail purchase.
While cosmetic surgery today is commonplace, it begs the question why anyone would be willing to buy cosmetic surgery based on a doctor who only offers the lowest price. Choosing cosmetic surgery on price seems to be a poor health decision. Almost all of these cosmetic procedures can cause serious problems if done improperly…and may cause injuries that are hard to correct later.
But beyond this concern, there are other issues that underpin serious problems with the Groupon cosmetic surgery concept. One of these is that not every patient who buys such a discount may be a good candidate for surgery. While Groupon does make a footnote that services are dependent on being qualified, making an online purchase creates a level of provider obligation that may be difficult to reverse. In this discount coupon approach, eligibility is not done before one purchases the procedure. This is the exact opposite of what occurs in common medical practice.
Unlike a meal which you don’t like or a purse whose clasp falls off weeks after you have purchased it, what happens when you don’t like your cosmetic surgery result that requires a revision or a complication that requires further surgery or medical care? Who is going to pay for it? Who is financially responsible? I can assure you that it isn’t Groupon even though they took a hefty profit on the transaction. Having cosmetic surgery because you could afford it due to the discount unintentionally exposes the enthusiastic shopper to a financial risk that they are completely overlooking.
Equally relevant, why would any cosmetic surgery provider offer an expensive surgery at half price? Would a well qualified plastic surgeon with lots of experience offer cheap cosmetic surgery? More times than not such, cosmetic surgery Groupon offers come from doctors of dubious backgrounds and training for the procedures that are touting. The Groupon concept makes it easy for such providers to find new patients who don’t look past the dollar signs.
Cheap cosmetic surgery may sound attractive…but the consequences later may be anything but cheap.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a flat spot on the back of my head that I would like corrected. It is at the back of the crown of my head and it gives me a funny looking head. I have attached pictures and have drawn on them the shape that I would like to have. Can you tell me I how this can be corrected? What material and how would it be placed? What is the recovery after this type of operation?
A: Having done quite a few occipital cranioplasty procedures for skull flattening that looks just like yours, I would recommend PMMA. This is because it will take about 40 to 60 grams of material to create the desired effect. PMMA offers the most cost effective material when it comes to this amount of cranioplasty augmentation. Other material options include HA (hydroxyapatite) and Kryptonite but they will cost anywhere from 3x to 5X more in terms of material cost, that can add thousands of dollars to operative costs. The procedure would be done through an open approach through a low horizontal incision on the back of the head, where hair loss is not likely to ever occur. This is done as an outpatient procedure done under general anesthesia with an operating time of approximately 90 minutes. There is actually very minimal recovery afterwards other than some non-visible swelling on the back of the head. Occipital cranioplasty is a much simpler procedure to go through than most people envision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what can you tell me about this new procedure of making cheek dimples?
A: There have been media reports recently that talk about a ‘new’ plastic surgery procedure known as dimpleplasty. While this has been touted as being new, it really is not. The actual procedure of making dimples dates back several decades.
Cheek dimples are actually anatomic defects in the zygomatic muscles which run between the lips and the cheeks. This is an important muscle for smiling as it helps lift up and out the upper lip. In someone with cheek dimples, this muscle has a split in it. When someone smiles and the zygomatic muscle contracts, the split in the muscle separates which allows the skin overlying the split to be pulled inward. Thus a cheek dimple is really a hernia in the muscle. How big and where it is located determines the location and the size of the dimple.
In cheek dimpleplasty, a small incision is made inside the cheek where a split in the muscle is created. This allows the underside of the cheek skin at the desired dimple location to be sewn or attached to the inside of the cheek lining. This creates a scar or attachment that will lead to dimples when one smiles. This is a simple outpatient procedure done under local anesthesia so the dynamics of smiling and the dimple effect can be seen. There really is not recovery other than some mild cheek swelling. The biggest risk of the surgery is that the cheek dimples may be less or even more noticeable than desired. (depth of the dimple)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in using PRP for lip augmentation. I am looking for something more natural and longer-lasting other than the typical injectable fillers. Can PRP be put into the lips and how well does it work?
A: PRP can be injected into the lips just like anywhere else. It is not a question as to whether it can be done but whether it should be done. Will it create a lasting augmentative effect beyond that of a short-term fluid distention is the question. There is no medical evidence that it would nor would I biologically understand why it would. PRP is not a filler material per se but rather an adjunctive healing agent. It has no primary effect on its own such as creating more collagen than would normally exist in an otherwise healthy tissue site. The PRP I have put into the lips has been combined with fat to offer a higher probability of a sustained effect. It is the fat that is the filler and the PRP is added for its theoretical benefit on helping fat cells to survive or in helping stem cells to convert to fat cells. This is the most natural lip augmentation injection treatment but it is unproven as to how sustained or permanent the lip enhancement effect is.
Dr. Barry Eppley
Indianapolis, Indiana
