Your Questions

Q: Dr. Eppley, which has the most effect on your buttock size, implants or fat injections?Which has the better results because I do have some fat from having a baby. 

A: The choice between fat injections or implants for buttock augmentation depends on numerous factors. The most significant are how much fat you have to donate and how much buttock size increase you desire. Whether ‘some fat’ is enough to achieve a visible change depends on what your body looks like now. The largest donor source of fat is the stomach area although it can be taken from many other places as well such as the flanks and thighs. The minimum amount of fat one should have should be at least 1.5 liters to be able to put reduce it down to 400cc to 500cc per buttock. I wold consider this to be the minimum to justify the surgical effort. For some women, much more may be needed. If fat is inadequate then the only option is going to be implants.

If you could send a picture of your body and your height and weight that would be helpful in providing a more specific answer.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wanting some more information about the Smart Lipo and discounts under the Patriot Program. 

A: Thank you for your inquiry. I would need to know what body areas you desire for liposuction and what they look like before a cost quote could be provided. You may feel free to do that by description or sending pictures, whichever conveys what you need. I would also point out that although I use Smartlipo technology for liopsuction it is done under general anesthesia and not local anesthesia to achieve the best results possible.

The Patriot Program is a discount program for plastic surgery for active military and their families. The amount of discounts from regular surgery fees are determined on a per patient basis. As a general rule, we make a 25% reduction from the normal surgeon’s fee for the procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Do you use stem cell therapy to fix atrophic rhinitis…to regenerate nasal bone, tissue and mucosa, particularly, nasal mucosa? I have a bad dry nose which is primarily atrophic rhinitis three years after the partial removal of nasal turbinate. All the medication from doctors does not help much. So I can’t wait to find out how stem cell therapy and tissue engineering are going on for help with atrophic rhinitis.  I read on other webpages that one plastic surgeon says you are the only doctor in the states doing this. Is that true? Thank you very much for your time. I’d really appreciate if when you kindly answer my question.

A: The treatment of atrophic rhinitis is a difficult problem for which there are no known therapies that are universally effective. The use of injectable autologous therapies offer promise for a lot of difficult clinical conditions in which some regeneration of function or regeneration of actual tissues would be therapeutic. Current autologous injection therapies include PRP (platelet-rich plasma) fat and stem cells. PRP is an extract of one’s own blood that contains platelet concentrates which have numerous potent growth factors in them. Fat concentrates are centrifuged or filtered aliquots of fat and stem cells. Stem cells can be isolated from fat but must be done concurrently as a direct isolate from the patient’s fat and immediately re-injected. The FDA currently bans the growth of stem cells from the patient as an isolated step in cell culture as a delayed reimplantation procedure.

The best approach currently for treating non-healing wounds and dysfunctional tissue elements, in my opinion, is the combination of PRP with a fat/stem cell concentrate. The entire nasal lining, septum and middle turbinates could be injected with up to 5ccs of this combined autologous therapy with the goal of reducing the degree of atrophic rhinitis. Understand that this is not exclusively stem cells but is a mixture of autologous elements that does partially include some stem cells. Whether this would be effective for atrophic rhinitis is not known as the primary problem is that the main producer of the moisturization of air (inferior turbinate) is missing. But whether the middle turbinate and other areas of nasal lining can compensate for it but being stimulated is the theoretical basis of the injections. Because it is an autologous therapy, there is no harm…it is just a question of how much benefit, if any, can be achieved.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I have a 16 yr. old son who was diagnosed with plagiocephaly at a year old.  He wore a helmet for several months and I’ve tried various therapies over the years but at 16 his head is still a little flat on the back right side of his head.  It’s really only noticeable from a bird’s eye view and not straight on.  He never talks to me about it and it is slight but I would like to offer him an alternative if it becomes bothersome to him.  I’ve read about the injectable kryptonite and want to learn more about this.  My son is a soccer player so I wanted to ask you if heading the ball would be an issue with this if he were to ever have the procedure done.  Thanks so much!

A: The surgery that I have evolved to today with a unilateral occipital plagiocephaly is a minimal incision cranioplasty using PMMA.  (acrylic bone cement) The kryptonite material is no longer available. This is the same technique only using a different material. Through a 1.5 inch incision in the scalp, the material is placed into position using a funnel technique and then shaped externally as it sets. Most patients need somewhere between 30 and 60 grams of material to provide better skull symmetry between the two sides. This material is actually stronger than bone so it is more resistant to blunt head trauma than your native skull bone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I reviewed some of your work and like what I see. Does breast augmentation affect nipple sensitivity or the ability to be erect? Where are the scars located? What is average cost of the procedure?

A: The potential influence of breast augmentation on nipple sensation and erection is always a possibility in this surgery but the incidence of it occurring is very low. Various studies have shown that the incidence is around 1% to 3% regardless of the differing incisions used for implant insertion. (under the breast, the nipple or the armpit) The choice of incision location is somewhat dependent on what type of breast implant is chosen. (saline vs. silicone) Silicone implants can now be placed through the armpit using a funnel insertion device but there are size limitations which are usually less than 400cc to 450ccs in implant volume. Any size saline implant can be placed through the armpit since they are inflated after they are put in place. The cost of breast augmentation is affected by the implant type with saline breast augmentation being less costly than that of silicone breast augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, At the moment, I am at a complete loss of what to do about my profile. I have had so many consultations now and have advice ranging from ‘do nothing’ to ‘have a neck lift, fat removal and chin implant at the same time’. I need to do something as it’s making me very self conscious and I hate seeing photos of myself from the side.

My problem is that I am only 27 and am apparently not a candidate for neck liposuction alone because of my bone structure. It has to be explained to me that I have a low hyoid bone that is creating a blunted neck angle so that my neck blends into my chin. My teeth do align so it is not a problem with my bite but I do also have a weak chin. 

From my own research it seems like a chin implant might provide me with the illusion of an improved neck angle but my concern is how it will impact my face front on and my smile- lots of reviews seem to say their jaw looks to masculine after a chin implant or that they can no longer show their bottom teeth when smiling. At the moment when I smile I show my bottom teeth, which I like, and my chin points slightly in feminine way. I also have a small indent in my chin when I smile and am unsure if a chin implant would make this worse. 

Do you have a recommended approach to this sort of problem? Given my age, I don’t want to risk ruining my face with anything too drastic! I do need to do something though as it’s making me really self conscious. 

Thanks in advance for your help. I do wish I was a more straightforward case!

A: Quite frankly you are a very straightforward case. The combination of chin augmentation and neck liposuction is the correct approach. The key to a successful chin augmentation in you is to understand that in the profile view there needs to be both a horizontal and vertical dimensional change and in the front view the chin shape needs to stay a triangular shape and not become too round or full which is more masculine. There are two ways to achieve these chin changes. An implant needs to have some vertical elongation and must be more of a central buton style that has no significant lateral wings to it. The other option is a sliding genioplasty which can be brought forward as well as down. (vertical lengthening) Sliding genioplasties will always keep a narrow chin or make one more narrow as it comes forward because it is a U-shaped that is being brought forward. The indent in your chin, whether the augmentation is done by an implant or an osteotomy, will not change.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The shortened version is that I first got lipo on the backs of my thighs 15 years ago about age 20. The surgeon took too much fat out under my buttocks creating banana rolls. I had several corrective lipo surgeries and subsequent three fat transfers. The fat transfers seemed to transfer the fat too low (not in the crease under the buttocks) creating a more pronounced banana roll and more rolls beneath. No exercise will help and I just don’t want to go through life with these legs. It’s hard to even wear pants without the rolls showing. I found you beause I saw a surgery you did removing skin, (more on the lower buttocks I think) and because it seems like you do a lot of body implants. I’m afraid to cut the rolls out because of the scar and particularly because the scar could spread due to my active lifestyle.  I would consider it however. I’m wondering if you think a combination of lipo and some implants in my legs would be a possibility. I don’t care if it makes my thighs bigger I just want them to look even. I have a one year old and am hoping to get pregnant within the next year. 

1. Would thigh implants be possible or would skin need to be removed?

2 . Should I wait until I have recovered from my next child? I only want to have two.

A: Thank you for sharing your story and pictures. You now have a double roll lower buttock deformity. There is a defined roll both above and below the infragluteal crease. Without knowing your history one would say to just try liposuction…but that is of course how you got here in the first place. The only way you are going to eliminate those rolls is to treat the problem which is too much skin and fat through excision. (lower buttock tuck/lift) This is not a problem that is amenable to implant augmentation or further liposuction. By removing a horizontal wedge of skin and fat both above and below your existing crease line the rolls can be eliminated and a more defined infragluteal crease can be obtained. While this does create a scar, I have not found it to be problematic for any patient. Significant scar spreading has been seen even in active patients. One does have to avoid strenuous exercise that pulls the gluteal crease apart for about 6 weeks after surgery. Whether this is something that is done before or after your next pregnancy is a personal issue. I don’t think pregnancy has any affect on the scar or the long-term outcome.

I hope this is helpful,

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I currently have separate Medpor chin and jaw angle implants. I also understand that you do custom facial implants using a person’s CT scans. My question is, assuming that I would like them replaced with a custom one-piece total jawline implant further down the road, would I have to remove the current implants before proper modeling can be done, or will you still be able to customize the jawline implant with the current implants still in place? Also, would the removal of these Medpor implants be possible? I’ve been to your blog and I understand that you’ve always stated that Medpor removal is possible, but hearing many other surgeons claim that it is impossible makes me a little afraid. Anyway, my preference would be to have the removal of the existing implants and placement of the new implants done together, as it would mean one surgery only. Regardless. kindly let me know what my options are.

A: The answers to your questions are as follows:

1) You can have CT imaging done with your Medpor implants in place. Medpor implants are not picked up especially well by CT scans and they do not appear in the images.

2) Your Medpor implants can be successfully removed, I have done it many times. They are not nearly as easy as silicone to remove but far from impossible to do so.

3) Removal of your existing jaw implants and their replacement would be done during the same surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, is there a way to reduce my forehead size or flatten my forehead? I have some substainal bumps from being tripped when I was 11 years old and they haven’t ever reduced or went down in size. The bumps are not too large on the front part of my forehead. Is that possible?

A: Bony forehead reduction can be done to some degree based on the size of the bone bumps and the thickness of the outer table of the frontal bone. Raised bumps can easily be reduced down to the level of the surrounding forehead. Beyond that about 4 to 5mms of forehead bone can generally be reduced before the diploic space between the outer and inner cranial tables is breached. Depending upon the exact nature of your forehead irregularities it can be very effective or at least offer some contour improvement. Burring reduction of the forehead area can be done through a pretrichial or hairline incision.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had Medpor chin and paranasal implants placed close to 3 weeks ago. The implants were both placed intraorally.However, I still have issues with stiffness and a little difficulty with lip closure. Can I just check whether these issues are normal at this stage of recovery, or is it something I should be worried about? The stiffness in movement is one that concerns me the most, as it does affect my speech a little. Lastly, if this isn’t typical, would removal of these implants be possible? 

A: What you are experiencing for these types of facial implants is extremely typical. My experience and what I counsel my patients on before surgery is that to expect the following recovery as it relates to swelling, function and aesthetics…50% by three weeks, 75% by 6 weeks and 100% by three months. Thus you are being way premature to even consider implant removal as you have not gotten yet to see what the final result will be. Your perception of what you thought your recovery would be is undoubtably much less than that and this accounts for your concern at this early recovery point. Patients understandably do not appreciate that this is, in essence, very similar to bone surgery even though it is done for aesthetic purposes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to learn of the options available to repair elongated earlobes following a facelift in 2011.

A: Elongation of the earlobe after a facelift is the result of either too much tension placed on the earlobe when the facelift is closed or too much skin at the earlobe. The natural release of tension (skin relaxation) and gravity to gradually pull the earlobe down making it longer. This is a well known adverse facelift sequelae and has even been given a specific name, pixie ear deformity. There are two techniques for correcting these elongated earlobes. The simplest is a direct V-Y skin closure technique that can be done under local anesthesia in the office. The only negative to this approach is that there will be a visible vertical scar from the shortened position of the earlobe down to where it was maximally elongated. The other approach is to re-do a portion of the facelift in front of the ear using the same incisions, known as a mini-, limited, or short scar facelift. This lifts up and tightens the skin back up shortening the earlobe in the process. While this does require a one hour procedure in the operating room under sedation anesthesia, it does not leave any visible scar below the new earlobe position.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am having trouble deciding whether I need a breast lift alone or should have implants with it. I am 35 years old, had 2 kids and am a fairly full 34C. I do struggle to keep them in a C bra however. While I am happy with the size of my breasts I am not so with their shape. I just want back my fbreasts back up where they used to be and were nice and perky. I know I need a lift but am uncertain about whether an implant is necessary? I have several plastic surgery consutations and have been given different opinions, one says I definitely need it the other I cn have it or not. Neither doctor seems to be able to explain why in terms that I can understand and, quite frankly, they both seemed a little uncertain themselves. 

A: The breast issue that you have is a common one, once full breasts have fallen even though they have not necessarily gotten smaller. This has happened because of two breast tissue changes, there is now more skin and less internal breast tissue. That combination makes the change from a perky to a saggy breast. While you are happy with your breast size now know that they appear the same size because of the extra skin. When they are lifted, the breasts may appear smaller because a lot of extra skin has been removed. While breast lifts do not remove volume, this is why some women will have the perception that their breasts are a little smaller after a lift. There is also the longer term issue in that most breast lifts will lose the initial upper breast fullness that exists right after surgery as they settle with tissue relaxation. The role that a small breast implant may play for you then is in maintaining upper pole fullness and avoiding the fear that you may look a little smaller after a lift alone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 47yrs old and I have had four children and over the years I have tried to lose the belly fat and the fat in my thighs. Question can you use the belly fat to enlarge my breast and not saline or silicone implants. I am a 36B and would just like to stay that way just want them to look fuller and firm.

A: While the appeal of breast augmentation with fat is undeniable, it has significant limitations compared to the use of traditional saline or silicone implants. It is different in the following ways:

1) It will cost 2x to 3x more

2) It will only increase the size of the breasts a 1/2 cup in most cases

3) It requires an adequate amount of donor fat

4) How well the fat takes is unpredictable, 100% almost never occurs

5) It may require more than one fat grafting session/surgery

6) Breast lumps and irregularities may occur

7) If you need a breast lift also, this must be done first and wait three months before doing the fat grafting

8) It requires one month before and one month after surgery of using the Brava breast suction device 8 to 12 hours per day

In short, breast augmentation with your own fat is not a comparable operation to doing it with synthetic implants. As we know it today, it is more expensive, less effective and not as efficient. It is best done on patients that have the proper motivation, expectations and breast and body anatomy. This will likely change in the future but for now it is only a good option for a very select few breast augmentation patients.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a sagging buttocks problem that started when I had liposuction done many years ago. No matter how much I diet and exercise the lower buttocks will not  tighten up. I have seen some pictutes of your buttock lift results and they show MAJOR improvement and the scarring seems minimal. Based on my pictures, would you anticipate my having similar results?  Do you have any concerns with my age (47) or the fact I have had previous lipo done?  What is the recovery like? As you can see, I have volume, I work out like crazy.  I want a symmetrical lifted butt.   Please tell me there is hope.

A: This is precisely the improvement I would expect. When you cut out the buttock overhang and tuck it, that is always the result one will get. It is an operation that just works. As long as one keeps the side part of the scar no further than the lateral edge of the lower gluteal crease, the scar is not visible. The fact that you have had liposuction previously is probably what may have contributed to the problem and, if anything, is more helpful than harmful as it enables the tuck to be done more effectively due to the loose skin that it has created. I have seen women have this procedure from age 30 to 72, but I don’t think age as anything to do with the success of the procedure. It is all about the anatomy of the problem. If there is overhang, it can be removed and tucked at any age. The recovery from a lower buttock lift is fairly easy. It is not a painful procedure afterwards, just a feeling of tightness in the lower buttocks. (which, of course, one should have if the procedure is done adequately) The only destruction in the first month after surgery is that one has to be careful about bending over which pulls on the incision line…but one is well aware of that because of its tightness. The biggest restriction of that is that one will not be doing any significant exercise that involves the legs.

Otherwise, this is a one hour procedure done under general anesthesia

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been suffering from extremely dry lips for several years.  They are painful, inflamed, and become red throughout the day. My dermatologist prescribed several topical medications, but they did not work. I have consulted with him about a lip procedure called vermillionectomy using lasers that may provide the results I need to increase moisture to my lips. I have attached a picture of my lips for you to see my problem.

A: Thank you for sending your picture. In looking at it it appears the entire vermilion (red part of the lip may be involved….the picture is a little grainy) Then procedure of a vermilionectomy basically removes the dry part of the vermilion and moves out the wet part of the vermilion to the skin edges. This type of lip procedure is normally reserved for patients (usually older) in whom lip cancer involves the dry vermilion and it must be removed and reconstructed. It would work for the very dry lips because it is being replaced with vermilion which has salivary glands in it. It would make your lips, however, usually a little smaller and probably with a little less pout. (fullness) It could be regarded as an ‘extreme’ treatment for dry lips but, if the condition is severe enough, this may justify that surgical effort.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 66 years old. I have had breast implants for approximately 30 years and would like to have them removed.   I have Medicare / Anthem insurance, but I don’t know if they will cover this.  I would like to know how much this procedure would cost if I paid for it (without insurance). 

A: Congratulations on the longevity of your breast implants. Although at the time they were placed you probably thought they would last a lifetime, few patients ever do and one could predict a 10 to 20 year lifespan until the devices fail and have to be replaced. Thus you have done well. You did not state why you wanted your breast implants replaced. Is there a particular problem with them or is this just an aesthetic issue? Replacing them with new silicone implants will have total costs in the range of $5800. Issues to be considered are new size and style of the silicone gel breast implants and whether they should stay in their existing anatomic location (above or below the muscle) or be changed.

Your assumption is correct about insurance coverage. Breast implants are only a covered medical procedure if they are being done as part of a breast reconstruction after cancer or part of a revision of a prior breast reconstruction procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I currently have butt implants and I love the look of them, but I hate how they feel because I can feel the hard edges of the implants. I want to have them replaced using the softer silicone implants that are approved in other countries. If I purchase the soft implants online would you be able to perform the replacement surgery? Thanks. 

A: Do you know the manufacturer of the implants that you now have? I use Implantech very soft gel buttock implants that virtually feel like gummy bear candies (without any hard edges) so it is hard to imagine anything that would be any softer. But they can also be made in a very low durometer that can feel just like jello. Thus I am not sure any implant used elsewhere in the world would be any softer.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am going to have jaw angle implants in the next few weeks. I had a couple of questions for you for after the procedures.  I was wondering what my limitations will be in terms of food. I’m assuming chewing will be difficult so I wanted to prepare things to eat in advance for the first week or so after surgery. I don’t know if I will be on an all liquid diet for a while or if Iwill be able to eat soft foods (mashed potatoes, soup, jello, etc). I also have 2 big boxes of Boost just in case. Please let me know.

A: Your questions about eating are good ones as the jaw angle implants will cause some initial limitation in mouth opening due to masseter muscle trismus. That will take about 2 to 3 weeks before returning to normal. You can really eat anything you want as I don’t place any patient on restrictions, but realistically it will not be a normal diet initially. Soft foods and protein supplements like Boost are good suggestions.  You will find out quickly that cutting up solid foods into smaller bites will bypass the need for any substantial amount of chewing. Fortunately this phase is fairly short and the worst is over in 7 to 10 days after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My problem is quite complex. I had a dimpleplasty last December and I was told it would take about 2 months for the dimple to flatten. I have waited 4 months so I had the Dr remove the retention stitch which he said would flatten my cheek. After 2 months it didn’t happen so I had a a buccal muscle closure…. It’s been 5 weeksnd no improvement. My surgeon says he’s out of ideas and there nothing more he can do..I am devastated with these two horrible indentations and would do anything to have my face back. I hope I can hear from you with great news.

A: I am assuming by your description that you have a cheek dimpleplasty to try and reduce/eliminate your cheek dimples as opposed to a dimpleplasty to create them. Both surgical efforts appears by your description to be done close the soft tissue defect/herniation below the dimple and nothing else was added. If this is an accurate interpretation on my part, my suggestion at this point is to add volume either through fat injections or a dermal-fat graft. Given the scar that is there now and the refractory nature of your cheek indentations, I would have more confidence in dermal-fat grafts at this point.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was curious if it is possible to receive these exact results from forehead reduction if I decided to go with the sinus removal and reshape instead of the tool to burr them down. Also I have what I feel to be extra bone above and on the sides of my eyes that are pretty prominent, thus making my eyes look a little sunk in. Can that be reduced as well? Lastly how far down do you think my hairline have to be reduced and does it look as though I need a tissue expander to achieve the results I’m aiming for or just a stage one?

A: Maximal brow bone reduction is always achieved with brow bone removal and reshaping. It is a far more effective procedure than just burring alone. By doing so I would be also be able to burr down the bone outside of the frontal sinuses (above the brow bone and on the side of the eyes) This bone is thick enough that burring alone would suffice. This would help open up the eyes.

In looking at where you are now and where you would like our hairline to be, that appears to be about a 3cm movement lower. That would require a first stage tissue expander for about three weeks prior to the second stage at which time the hairline can be advanced and the brow bones and eyes reshaped at the asme time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking for someone who can give me realistic advice on how to reduce the size of my chin (mentalis) I heard botox is an option but probably wont have much affect. Are there any other options I could explore? I think there is fat in that area so would laser liposuction be an option? Any help would be great.

A: Thank you for your inquiry. I am not sure what you mean by realistic advice but here are the facts on chin reduction. A large chin is due to too much bone, too much soft tissue or both. Its reduction therefore must involve surgical reduction of either bone, the soft tissue cover or both. If the bone problem is one of too much vertical length, then an intraoral vertical reduction bony genioplasty is needed. If the bone problem is too much horizontal with or without vertical bone excess, then a submental bine burring reductyion needs to be done. All excessive soft tissues problems need a submental excision and tuck unless it is just a mild amount of laxity then an intraoral soft tissue suspension must be done.

I don’t know where the concept of Botox comes from since that is a temporary muscle paralyzer not a soft tissue reduction method anywhere it is applied on the face. No form of liposuction should ever be done on the chin as all it will do is dimple the chin and make it look irregular. The amount of fat in anyone’s chin no matter how big it is is very small and the chin needs it to keep an outer smooth skin contour.

The only way to reduce a large chin is surgery, removing either bone, soft tissue or both.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, can you tell based on your extensive experience as a plastic surgeon what is the deal with the Lifestyle Lift? I see their commercials all the time and it just sounds too good to be true. They say nothing about that it is surgery but no cream or laser can produce those kind of results. Is it legitimate or a scam?

A: The Lifestyle Lift is both a tradename and a company that sells a form of a facelift surgery. It is a company that spends a lot of money every year to generate business for its franchisees so to speak. Its most popular TV ad is the one that features Debbie Boone who is the daughter of Pat Boone, a teen idol of many years ago and is still alive. (I just saw him on an infomercial for a whirlpool tub for seniors just this morning)

Like anything that is highly marketed, it is going to attract its share of detractors. While I haven’t done an official poll, I feel confident to say the whole Lifestyle Lift concept is probably not thought of highly by many board-certified plastic surgeons…at the very least for competitive reasons. And there is no question the company has had its share of legal entanglements brought on by a history of aggressive marketing practices.

But all the political and emotional issues aside, the company promotes its facial rejuvenation techniques through licensed physicians who enroll to be a provider in a certain geographic territory. It is surgery and it is a form of a limited facelift. Many of the patients seen in ads clearly have had other procedures done than just the Lifestyle Lift as many facelift patients are prone to need and do.

What turns off most board-certified plastic surgeons is that the Lifestyle Lift is marketed as a new and innovative procedure (I believe ‘break through medical procedure’ is what the ads say) which it is not by any plastic surgery standards. The most novel feature of it is the name as such facelift techniques date back decades in time. Doing the procedure awake and having it done in ‘just over an hour’ is obviously very appealing to patients but that does not necessarily convey that it is a superior surgical result or one that any sustained longevity. Since no scientific study has ever been published on the Lifestyle Lift  in terms of its technique or patient outcomes in any professional plastic surgery journal or presented at any plastic surgery meeting, it is easy to understand why many board-certified plastic surgeons are taken back by its claims in its ads.

A prospective patient should view the Lifestyle Lift like having any other consultation from a plastic surgeon. Take in the information, do your research and make your own educated decision about whether it is right for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 42 year-old male whose hair is thinning. I am on Propecia and Rogaine and it seems to have slowed it down but is not causing any regrowth. I have read about PRP blood treatments for hair loss and wondered what your thoughts were on how effective it might be. I know you have a lot of experience with PRP so your insight would be very valuable.

A: PRP, an acronym for platelet-rich plasma, is a concentrate of platelets derived from a patient’s own blood. Because platelets are packed with growth factors, small peptides that help modulate wound healing when injured, they have been used and shown to be effective in many medical applications. Their success in wound healing and many reconstructive surgery applications and their lack of any known adverse effects  has naturally led for PRP to be extended into numerous cosmetic applications. It has been used as an adjunct in facelifts, injectable filler and fat grafting. It is presumed that the platelet concentrate has a tissue stimulating effect for regenerating lost or aging tissues such as fat and skin elasticity. The medical evidence for such effects is weak at best but the idea is so logical that its current use can best be described as a ‘what can it hurt’ approach. PRP use in hair loss treatments or in combination with Neograft follicular unit hair transplantation is another PRP application that has not been scientifically evaluated but numerous practitioners report favorable results with its use. The question of exactly how effective PRP is on stimulating the follicles of hair whether they are in their natural location or after transplantation is not yet known. I am optimistic about the effects of PRP on hair regeneration but no one yet knows how many injection sessions or how often or how many treatments need to be done for maximal benefit. Its use with other hair loss/regeneration treatments therefore is up the patient and their hair restoration physician.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My temples bulge out too much and I know it is the muscle because it gets worse when I clench my teeth together. Is it true that the less your muscle expands and contracts when chewing, the thinner it is? If I use my mouth less will the muscle shrink? Is surgery the only method to reduce the size of the temporalis muscles? How much would the surgery cost please, and would the muscles be taken off by excision? What risks are involved?

A:  Like all muscles, size is somewhat dependent on use. But one would have never open their mouth again to have the temporalis muscle shrink in size.

The non-surgical approach to temporalis msucle reduction is Botox injections. It would require a series of Botox injections done 4 months apart up to a year to get teh muscle to shrink. Presumably this would be permanent but that is not assured.

The temporalis muscle is released from behind the ear and at the top of the skull,  4 to 5 cms removed and then retacked done through a vertical incision in the hairline above the ear. The only real risk to the procedure is in how much correction (reduction in convex profile) can be achieved. It does not affect mouth opening or movement. Its total cost for both sides is in the range of $6500.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I find that my jaw slants downwards and my chin appears too long for my face. My chin is also weak as it does not protrude as far as my lower lip. If possible, I have attached photos and some crude imaging to get your opinion on what you would recommend for me. Thank you.

A: Thank you for sending your pictures. What you are describing and have is the classic steep mandibular plane angle problem. With a short chin many times the jaw angles are high, all which reflect some degree of underdevelopment of the mandible.  I can see from your attempts at imaging that you need a sliding genioplasty to move the chin forward but to vertically shorten it (an implant will keep it just as long if not longer) and vertical lengthening jaw angle implants that adds zero width. You are correct by that imaging in that the best way to change a steep mandibular plane angle is to lower the jaw angle and shorten the chin as it comes forward.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had cheek impants and a chin implant to attain a more asethetic facial balance as I had very little cheekbone prominence. But I also have benign parotid hypertrophy for about six years now which I now think attributes greatly to my facial imbalance.  I would like to entrust someone to use their best judgment as to what i might need to make it more harmonious.  Do you a parotidectomies will help?  I also model so its really important that my face is in balance and looks good.  I want a more sculpted face. I also was interested in a lateral canthoxpexy to elongate my eye shape…a more almond shaped eye? I’m attaching photos…thanks!

A: While I think there is no question the lateral face reduction by superficial parotiodectomies would be aesthetically beneficial, you have to balance that with the risks of visible scars, facial nerve injury and salivary gland leaks. This would be particularly relevant for anyone but particularly someone who models. That is a question up for further discussion. Lateral canthopexy can be effective for moving the corner of the eye out more to the side, thus elongating the eye shape. This is a much easier decision to consider.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley I was just wondering the cost of gummy bear breast implants. I would like a D cup and was also wondering if that makes a price difference. Really I just need to know how much all together it would cost me? Also do you offer financing? Thank you

A: The total costs for gummy bear (highly cohesive silicone gel) breast implants is right around $5800. It does not matter what size breast implants you would get (150cc to 800cc) the costs are the same regardless of the size chosen. All financing is done through Care Credit, the largest cosmetic surgery financing company in the U.S. Gummy bear breast implants use a high cohesive gel which is more like a firm jello or like the gummy bear candies as the name suggests. Even if the outer shell of the breast implant gets disrupted, the gel is not going to extrude and the external breast will show no signs of deflation or loss of volume. (because there is no loss of volume)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 46 year old female who is interested in getting breast implants. I am currently weight training and looking to compete in bodybuilding contests next year. I am not a heavy body builder, my physique is more feminine but I do have to acquire a certain amount of muscle. I want to know how augmentation can improve my physique naturally. My questions about breast augmentation are should the implants be over or under the muscle? Can I still train after augmentation? How long do I have to wait to return to training after augmentation? Can I still run after augmentation? I have attached one of my training videos so you can see what kind of body that I have?

A: Congratulations on taking up a focused and goal directed workout program. It appears your goal is more towards figure competition rather than heavy muscular body building. Your body frame appear fairly small and petite so you would need proportionate breast implant size. (although that is a matter of one’s interpretation)

Since most breast implants are placed under the pectoralis muscle for less long-term risks (capsular contracture), this is very relevant given your exercise regimen. While disrupting the pectoralis muscle is always a concern in the avid exercise person, I have done breast augmentation in several true female body builders over the years and it has not turned out to pose any long-term disruptions in their regimens. There should be no problem returning to running and body building within two to three weeks after surgery. It may take you a month to get back to speed in regards to chest strength and arm range of motion.

There is always the option of placing the implants above the muscle (subglandular). But the only benefit that provides is quicker recovery.

The other consideration of above or below the muscle would be what shape of augmented breast one desires. (round vs tear drop) The location of the implant can influence that look although shaped breast implants today make that issue less relevant than it once was.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 21 years old and I bit unhappy about my profile…I was thinking about doing something on my chin,nose and ears what would you recommend me. I have sent you some recent pictures of me.

A: In answer to your questions, You would benefit by any three of the procedures that you described.

1) Your ears do stick out the left more than the right. A setback otoplasty would be very effective.

2) Your nose is very ‘juvenile’ in shape with a low dorsum and a soft amorphous round tip. An augmentative rhinoplasty to build up the bridge, give the tip more projection but also narrow it would give your nose a more defined structure.

3) Your chin is short both horizontally and vertically. A sliding genioplasty or a combined horizontal/vertical lengthening chin implant would make your profile more balanced and proportionate for a male.

I have attached some imaging which reflects these proposed changes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have rather convex temples that I’d like to be thinned please. My widest points appear to be at the upper squamous temporal parts, between the hairline and the ear (beyond hairline but visible still), and on the latitude 1mm above the brow.

1) If you know roughly which point in the temporal area I’m talking about, is convexity in that area governed by temporalis muscle thickness or convexity of the squamous temporal bone itself. 

2) If it is due to the muscle, then from your experience, is the muscle in that area thick at all? Is 4mm a realistic amount that can be taken off at that very point on either side of my head?

3) If it’s a possible procedure, is it an internationally recognized cosmetic surgery procedure?

A: To answer your questions in regards to temporal reduction surgery:

1) The temporal area to which you refer is exclusively controlled by muscle thickness. The temporal bone is naturally concave in that area and has a little significance on the external shape of the temporal area.

2) The temporalis muscle is an exquisitely thick muscle, easily approximating 10 to 12 mms thickness in that area.

3) Temporal reduction is not a common aesthetic procedure and is probably performed by very few doctors in the world.

Dr. Barry Eppley

Indianapolis, Indiana