EXPLORE
Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

September 23rd, 2014

Celebrity Plastic Surgery – The Good and the Bad

 

One of the most common statements, comments or ‘requests’ from many patients considering plastic surgery is that they do not want to have a result like a certain celebrity(s). Every plastic surgeon has heard this endless times and the roll call of celebrities who are known for their strikingly obvious surgical changes is well known. It is understandable why a prospective patient would question why celebrities, who usually can afford the ‘best’ doctor, can end up with such undesireable results. Who is to be blamed…the plastic surgeon, patient or both?

One important factor to consider is the uniqueness of the patient. Celebrities, whose career often depends on looking youthful and vibrant, want to hang onto it sometimes at all costs. They may be more pressed because of their status to pursue treatments and surgeries that promise to achieve that goal. ..even if they are new and unproven. The celebrity patient, who had been identified as a cosmetic surgery disaster, may never have known exactly what they wanted. They may have just left it up to the surgeon, had unrealistic goals and even intimidated the surgeon into doing what they wanted by their status or economic resources. Thus they may have been doomed by these issues to having an unnatural result or even after surgery complications.

The average patient tends to approach plastic surgery much more cautiously as they fear looking unnatural or having been ‘done’. They also have more financial constraints and may have to choose fewer procedures to fit within their budgets. This proves that having the money to do anything you want does not necessarily lead one to make better decisions or choices. It also illustrates sometimes in plastic surgery that ‘less is more’. A few well chosen procedures will often produce a more natural result than the commando approach of doing everything that can be done. While these results may often not be as dramatic, they may largely go undetected and look more natural.

As every patient result is a direct reflection of the plastic surgeon doing it, the surgeons themselves must take some of the credit for what one sees in celebrities. I would be quick to point out that there are far more celebrities that have very good and natural results that are complete undetectable than the few who don’t. The celebrity examples of bad plastic surgery are a relatively small number but their societal prominence makes it seem like it happens regularly. But some plastic surgeons do perform bad operations and have suboptimal results as they are just human. The lure of fame and fortune can make it hard for a plastic surgeon to say no to a demanding celebrity. They may fear if they say no they risk losing the patient. Having a celebrity for a patient can be a great boon to a practice.

It is also important to realize that the beauty standards and aesthetic desires of someone in Beverly Hills can be very different from that of Des Moines Iowa or Burlington Vermont. This is a very different world from many people’s every day lives as TV shows and magazines on the rack demonstrate. As a a result, what may look good in one part of the country (or in other countries) may be seen as undesirable in another.

Dr. Barry Eppley

Indianapolis, Indiana

September 22nd, 2014

Technical Strategies in Plastic Surgery: A Modified Suture Technique in Chin Dimple Creation Surgery

 

chin dimpleCheek dimples are indentations in the central area of the chin soft tissue pad of varying degrees of depth. They are caused by a defect in the mentalis muscle and thickness of the overlying fat that causes the skin to be drawn inward. It is a genetically-inherited trait and has been associated with chromosome 5. It should be differentiated from a chin cleft which is a larger soft tissue indentation that is vertical in orientation and usually sits lower on the chin pad.

While a chin dimple is simple in anatomy, that does not make it easy to create one in a chin pad that does not have one. Few techniques for creating a chin dimple have been described and they are often portrayed as simply suturing down the skin from inside the mouth behind the chin pad. The reality is that it is not quite that simple as the chin pad has thick soft tissue and a suture alone can not reliably create a permanent soft tissue indentation.

Chin Dimple Surgery Technique Dr Barry Eppley IndianapolisThe success of chin dimple creation surgery can be variable and the dimple may not hold after it is initially done. I have found greater success using a modified suture technique. From an intraoral approach a central core of tissue (muscle and fat is removed) up to the underside of the skin. Using a resorbable suture on a straight needle, it is passed through the skin at the intended dimple site and then back though again through a separate hole just 1 to 2mms away from the previous exit site. This suture is then tied down to either the muscle or bone to create the indentation.

Chin Dimple Surgery result front view Dr Barry Eppley IndianapolisThis chin dimple creation technique creates an immediate effect that should be a little deeper than one desires allowing for some relaxation as it heals. The resorbable suture lasts long enough to allow the indentation to heal down and will be absorbed weeks later after the small amount of swelling has subsided.

Dr. Barry Eppley

Indianapolis, Indiana

September 21st, 2014

Case Study: Solid Silicone Testicle Implants

 

Background: The scrotal sac normally contains two testicles. Loss of one of the testicles can occur from a variety of medical conditions from an undescended testes, infection and cancer removal to name a few. Generally, having only one testicle does not affect one’s testosterone levels or the ability to have children. But it does affect the appearance of the scrotal sac and one’s self-esteem.

A lost testicle can be replaced by an implant and have been done so for over seventy years. Initially implants were composed metal, glass, plastic and even foam materials. But the first really successful testicle implants were placed in the 1970s and were composed of silicone gel-filled prosthesis not unlike that of breast implants. But with the breast implant fiasco that was initiated in 1991, silicone gel-filled testicular implants became unavailable. This led to the development and eventual FDA approval of a saline-filled testicular implant (with an outer silicone shell) that is widely used today.

Silicone Testicle Implants Dr Barry Eppley IndianapolisLike is now known with breast implants, the use of silicone testicular implants has never been associated with the development of autoimmune or any other disorders. Unlike breast implants, however, todays solid silicone devices that can be used for testicular implants are not gel-filled but are a soft solid elastomer. Thus they can not leak or rupture and will never break down or need to be replaced because of material failure.

Case Study: This 30 year-old male had an undescended testicle removed as a child. He desired an implant so that he would once again have two testicles and better scrotal sac asymmetry.

testicular implant sizing indianapolis dr barry eppleyTesticular Implant Surgery Indianapolis Dr Barry EppleyPrior to surgery, testicular sizing was done using soft solid silicone oblong implants. An implant size of 3 x 3.8 cms was chosen as a good match to the existing testicle. Under sedation anesthesia, a high lateral scrotal incision was made. After passing through Dartos muscle, an implant pocket was made by finger dissection. The implant was soaked in an antibiotic solution and then inserted into the freshly made pocket. The scrotum was stretched out to determine good implant positioning and size. The incision was closed in several layers with dissolveable sutures under the skin. A skin glue was applied for dressing.

Testicular Implant results Dr Barry Eppley IndianapolisHe reported no pain after surgery and only some moderate scrotal swelling. He had good testicular symmetry and a fuller appearance to his scrotum. He reported his recovery as being better than he anticipated.

Testicular restoration by implants can be done successfully using FDA-approved saline-filled or off label solid silicone devices. Solid silicone has the advantage of being more economical and will not ever need to be replaced due to material failure by leakage or los of shell integrity.

Case Highlights:

1) Loss of a testicle creates scrotal asymmetry and may adversely affect a man’s self-image.

2) Testicular implant surgery is a simple and effective procedure that helps restore the scrotal appearance and feels natural.

3) Testicle implants are available in either saline-filled or soft silicone elastomer types.

Dr. Barry Eppley

Indianapolis, Indiana

September 19th, 2014

Case Study: Healing and Scars From Breast Reduction Surgery

 

Background: The treatment of large breasts has been done for almost one hundred years with a variety of surgical techniques. Despite the many techniques that have been used to create a smaller breast, the one that has stood the test of time is the inferior pedicle method. Also known as the Wise pattern (as the skin excision pattern looks like a W), this method provides a real three-dimensional skin and breast tissue reduction with a significant breast lift.

Wise Pattern Breast Reduction Dr Barry Eppley IndianapolisWhile effective, it is not a perfect operation as it results in substantial scars. Fortunately most of these scars lie in favorable breast locations such as around the areola and across the inframammary fold. Only the vertical limb between the areola and the lower fold is in an unnatural skin location when it comes to resisting the forces of tension on it. But it does lie on the lower pole of the breast which is not a highly visible location from a woman’s perspective of her own breasts.

Case Study: This 35 year-old female had DD cup breasts that were problematic from both a clothes and musculoskeletal standpoint. She had back, shoulder and neck pain with shoulder grooving. She had always wanted smaller breasts since she was a teenager but waited until she was done with having children.

Breast Reduction early result front view Dr Barry Eppley IndianapolisBreast Reduction early result oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, an inferior pedicle breast reduction was performed removing 655 grams of tissue from each breast. All sutures were placed under the skin and no drains were used. This was a three hour operation done as an outpatient.

Breast Reduction early result side view Dr Barry Eppley IndianapolisHer recovery took about ten days to remove to work but her incisions took much longer to heal. She developed about three weeks after surgery small opening at the inverted T areas (junction of vertical and horizontal incisions) that spread open to about the size of a dime on one breast and a nickel on the other. These openings took almost one month thereafter to granulate in and heal.

There are two expected events that occur in breast reduction, extensive scars and time to heal them. One has to certain that the benefits of making breasts smaller are worth the scar trade-off to do so. There is also the time needed to reach optimal scar appearance which is at least six months and could be as long as a year after surgery. Also such extensive incisions will result in wound healing problems, albeit often minor, that will take longer to completely heal than most women anticipate.

Case Highlights:

1) Breast reduction is a highly effective breast reshaping procedure but does so at the expense of scars.

2) Significant breast reduction requires the classic anchor or invert T pattern scars that enables a complete three-dimensional beast change.

3) The scars from breast reduction will often take up to 8 weeks after surgery to completely heal and up to one year for complete scar maturation.

Dr. Barry Eppley

Indianapolis, Indiana

September 17th, 2014

Technical Strategies in Plastic Surgery – Exparel for Rapid Recovery Breast Augmentation

 

Breast Augmentation in Hispanic Women Dr Barry Eppley IndianapolisBreast augmentation remains one of the most popular and commonly performed elective body contouring procedures. The most frequent location for breast implants is under the pectoralis major muscle, technically a partial submuscular location known as the dual plane pocket. While this implant pocket location has numerous advantages long-term, the elevation of the muscle does not the short-term drawback immediate discomfort and some restriction of arm movement.

To counter this temporary chest muscle discomfort, rapid recovery breast augmentation protocols have been advocated for over a decade. These protocols largely rely on non-steroidal medications and immediate use of the muscle through early physical therapy. (arm range of motion) While complete muscle recovery does occur fairly quickly, there remains the immediate discomfort due to muscle injury and the pressure of the implant underneath it.

Exparel in Plastic Surgery Dr Barry Eppley IndianapolisOne tremendously effective management technique is to inject the portion of the pectoralis muscle over the implant and its sternal attachments with Exparel. This is the only local anesthetic that works for up to three days (72 hours) after tissue placement by injection. This newer local anesthetic combines bupivacaine (Marcaine) with a lipid-like delivery method known as DepoFoam. A single intraoperativhe injection at the source of the pain with either eliminate the pain completely or result in a decreased need for narcotic medications for up to 72 hours after surgery. This injection can eliminate the need for any other method of adjunctive pain relief like catheters or pumps.

Exparel has been around now for several years and has a significant history of both safety and effectiveness. It has been evaluated in over 21 clinical trials of various surgical procedures consistently demonstrating prolonged pain reduction or elimination for days after the procedure. It is thus no surprise that it works equally well in breast augmentation. It does add a few hundred dollars to the cost of the surgery but the allure of minimal pain on awakening and a return to most activities of daily life al almost immediately after raises the concept of a Rapid Recovery After Breast Augmentation protocol to a whole new level.

Dr. Barry Eppley

Indianapolis, Indiana

September 17th, 2014

Healing and Wound Complications in Supersize Abdominal Panniculectomy Surgery

 

The abdominal pannus is a stomach deformity where any amount of tissue hangs over the waistline. The term, pannus, is derived from a latin word for apron so it is fitting that any overhang is referred to as such. In days before bariatric surgery, abdominal panniculectomy surgery was very common and it was almost always associated with morbid obesity. Because of bariatric surgery, the most common abdominal panniculectomy today is much smaller and is done after large amounts of weight loss. These pannuses are largely skin and the overall health of the patient is generally good since they are more weight appropriate for their height.

Abdominal Panniculectomy Indianapolis Dr Barry EppleyBut despite the popularity and widespread availability of bariatric surgery, not every obese patient undergoes it or is eligible to do so. This still leaves certain patients who are overweight that suffer from a large pannus with all of its associated symptoms. There has been some understandable reluctance to operate on such overweight patients due to the increased risk of complications that is known to occur .

In the October 2014 issue of the Annals of Plastic Surgery, an article was published entitled “Supersize” Abdominal Panniculectomy: Indications, Technique, and Results’. In this paper, the authors reviewed a series of 26 patients over a six year period that had abdominal panniculectomies performed that weighed over 10 kgs. (22 lbs), hence the term supersized pannus. The indications for surgery were typical including a large amount of overhanging abdominal skin and fat (hangs down to mid-thigh level) that was associated with underlying chronic skin infections, history of panniculitis, and the presence of a hernia. Of the 26 patients, the mean pannus weight removed was over 15 kgs with a followup period of over a year. The overall wound complication rate for the “supersize” panniculectomy over 40%. (11/26 patients). The rate of major complications, defined as those complications requiring a return to the operating room, was just over 10%. (3/26 patients).

Abdominal Pannus Removal Indianapolis Dr Barry EppleyThe relevance of this paper is that it demonstrates that larger abdominal panniculectomies can be done and offer a dramatic improvement in mobility and function of the patient. However, it creates a large abdominal incision and has a lot of ‘dead space’ inside to heal. As a result, wound complications are common (and to be largely expected) and  revisits to the operating room for their management are not rare. This type of abdominal surgery should be confused in this regard with the more common tummy tuck. A CT scan done before surgery can help discover a hernia which can be very difficult if not impossible to pick up on a physical examination of a large pannus.

This paper of larger abdominal panniculectomies supports what I tell my patients…the operation will be highly successful and can be life-changing but there is a very high incidence of wound complications and the need for further surgery/hospitalization is not rare. In the long run it will be very much worth it but expect a healing period of two to three months for a full recovery.

Dr. Barry Eppley

Indianapolis, Indiana

September 13th, 2014

A Study in Incisionless Otoplasty

 

Otoplasty for Protruding Ears Indianapolis Dr Barry EppleyThe surgical correction of protruding ears has been successfully done for over a century. It has long been recognized that the problem in the ear that sticks out too far lies in its cartilage framework, either lacking an adequate antihelical fold or having a too prominent concha. A postauricular open approach with the placement of horizontal mattress sutures has been the backbone of otoplasty surgery almost since its first description. While originally described with a strip of skin excision on the back of the ear, it is now recognized that skin removal is not necessary for a good result.

While highly successful, otoplasty is an open procedure requiring extensive postauricular dissection. This results in swelling, discomfort and the possibility of incisional related problems. As a result, like in many other areas of surgery, less invasive approaches have been developed. Known as the ‘incisionless otoplasty’, a technique exists for performing the procedure without making an incision to do so.

In the July/August 2014 Online First issue of the JAMA Facial Plastic Surgery journal, an article was published entitled ‘Incisionless Otoplasty – A Reliable and Replicable Technique for the Correction of Prominauris’. This study evaluated the results of 72 patients (children and adults) who underwent corrected of prominent ears by a single surgeon over a seven year period with an average follow-up of over two and a half years. Ears averaged a total of 2 to 3 sutures per ear. No infections occurred. Complications were seen in ten patients (14%) and included suture failure, suture exposure, and granuloma formation. Nine patients (13%) needed a revision to obtain an optimal aesthetic result. The authors conclude that incisionless otoplasty was well tolerated and effective with minimal complications.

Incisionless Otoplasty technique Dr Barry EppleyThe incisionless otoplasty differs from a traditional otpplasty in several ways. The technique requires good lidocaine and epinephrine solution infiltration. One basic principle of the procedure is to break the spring of the cartilage along the length of the antihelical fold using a needle. The needle acts like a small knife slicing through the anterior surface of the cartilage structurally weakening it. This is a little bit like what is done in liposuction, creating criss-crossing tunnels. Sutures are placed in a percutaneous fashion in a horizontal mattress fashion to create the desired cartilage bend. This requires that the needle re-enter the skin through exactly the same puncture site and needle tract as it exited. The horizontal mattress pattern of the suture is created by using the curve of the needle. When tied down, the knots remain on the outside of the skin on the back of the ear and become buried by pulling them through the needle hole with a skin hook.

The incisionless technique definitely has a role in otoplasty surgery. But it does require good patient selection as not every protruding ear patient’s anatomic problem lies exclusively with the antihelical fold. Despite not having an incision, it is not complication free as this paper demonstrates. If you had up the complications and the number of revisions, it has a postoperative problem rate of around 20%. This number is certainly no better than that of traditional open otoplasty surgery. But no doubt when it provides the desired aesthetic result and has no after surgery complication or need for revision, it is an improvement over an open method.

Dr. Barry Eppley

Indianapolis, Indiana

September 13th, 2014

Case Study – Natural Blepharoplasty Results

 

Background: Aging is an inevitable consequence of living and its most recognizable effects are on the face. The first place affected on the face by aging is around and on the eyes. The near constant motion of the eyelids and its thin overlying skin are a set up for wrinkles, loose skin and bags and puffiness caused by extruding fat from under the eye. Given that the eyes more than any other facial feature reveal one’s ‘character’ and are a reported ‘mirror of the soul’,  aging changes of them reflect what most would not want others to see.

Beginning in the late 30s and early 40s, the signs of periorbital (around the eye) aging begins. Botox and other neuromuscular modulator injections do a good job of slowing down this process by decreasing the formation of crow’s feet, but it can not prevent the development of loose skin on the eyelids and the herniation of fat on the lower eyelids. These aging eye effects can be quite variable with some people more genetically prone to developing them sooner and more extensively than others. But inevitably everyone will have more of these eye aging signs than they want.

Eyelid (blepharoplasty) surgery is well known and has been around for almost a century in various forms and techniques. Most patient’s biggest fear about blepharoplasty surgery is that they will look like a different person or will look unusual or very obvious that they have had plastic surgery. They can even point to numerous celebrity examples who show exactly what they fear. How is such a result avoided? Will everyone look like they have had surgery? After all, the eyes are seen by everyone and won’t all changes be seen?

Case Study: This 58 year-old female was tired of her tired looking eyes. She wanted to look less fatigued but was afraid that she might look ‘surgical’. She had a large amount of upper eyelid skin with significant hooding. (skin laying on or near the eyelashes) Her lower eyelids show multiple redundant skin rolls and bags. Here eyebrows were not especially ptotic or has any significant sagging.

Upper and Lower Blepharoplasty result front view Dr Barry Eppley IndianapolisUnder general anesthesia, upper blepharoplasties was performed removing 12mms of skin centrally and sparing the underlying orbicularis muscle. Medial fat pockets were also removed.  Lower blepharoplasties were done using a skin-muscle flap technique. A three pocket fat removal, 5mms of tapered skin removal at the lateral canthus and a lateral orbicularis muscle suspension was done.

Upper and Lower Blepharoplasty result oblique view Dr Barry Eppley IndianapolisHer recovery took about ten days to look ‘non-surgical’ and three weeks to fairly normal. Many blepharoplasties will look a little tight for a period of time but by six weeks after surgery this has usually passed. Her results at six months show significant improvement but a result that retained her natural look.

An overdone or unnatural result from periorbital rejuvenation surgery is caused by numerous factors including aggressive tissue removal and an over elevated or exaggerated browlift. It is the browlift that is often at fault for a perceived abnormal eye look after plastic surgery. The effects of aggressive tissue removal, particularly that of fat, are often not seen until much later when the eye may look skeletonized or more hollow. The key to a natural blepharoplasty result is to not try and work out every excess bit of tissue or get rid of all wrinkles. While patients want the best result possible, they also d not want an over operated look either.

Case Highlights:

1) Aging of the eyes is the first facial area affected and is commonly treated by blepharoplasty surgery.

2) Four lid blepharoplasty (upper and lower eyelid surgery) is the most effective method of partially reversing the effects of aging on the eyes.

3) Natural blepharoplasty results occur when the amount of skin and fat removal is not overdone and lid function is not affected.

Dr. Barry Eppley

Indianapolis, Indiana

September 11th, 2014

Joan Rivers – A Comedian’s Legacy to Plastic Surgery

 

Joan Rivers and Plastic Surgery Dr Barry Eppley IndianapolisJoan Rivers, comedian and and, in many ways, a champion of plastic surgery, died last week…ironically, having a minor surgical procedure. (however, not a plastic surgery procedure). She is the second such famous female comedian (Phyllis Diller in 2012) that has been tied to plastic surgery that has died in the past few years; both of them pioneering female comedians and both more than willing to make endless jabs at their own adventures in surgical self-improvement.

No one knows exactly how many plastic surgery procedures Joan Rivers had. Most likely her jokes about them far exceeded what she had done. (minus Botox Cosmetic which does not count as actual surgery). Some of her most well known quotes on plastic surgery include:

‘I’ve had so much plastic surgery, when I die they will donate my body to Tupperware.’

‘I wish I had a twin, so I could know what I’d look like without plastic surgery.’

‘I have flabby thighs, but fortunately my stomach covers them.’

‘I’m never without a bandage.’

‘I’ve had so much Botox Betty White’s bowels move more than my face.’

‘I saw what’s going on under my chin. I don’t want to be the one the president has to pardon on Thanksgiving.’

‘The only way I can get a man to touch me at this age is plastic surgery.’

‘Every weekend I just go in and I do something….You get a tenth one free. It’s like coffee so you just keep going’

‘I was so ugly that they sent my picture to Ripley’s Believe It or Not and he sent it back and said ‘I don’t believe it’.’

‘Better a new face coming out of an old car than an old face coming out of a new car’.

What Joan Rivers (and Phyllis Diller) are most famous for about their plastic surgery is not their quotes but how they were perceived as classic examples of everything that is ‘wrong’ about having plastic surgery. She was commonly referred to as what patients would say they did not want to look like…over done and unnatural. But such criticism is a bit harsh since at age 81 she looked awfully good and much better than what the natural aging process had to offer.

Dr. Barry Eppley

Indianapolis, Indiana

September 9th, 2014

Forehead Widening Implants

 

Facial implants are commonly used to augment various areas of the face. While historically this had been relegated to the cheeks and chin, their use has been widely extended to many other facial areas as well. One of the newer areas of facial implant use has been the temporal region for correction of excessive temporal hollowing or concavity.

Zone 1 temporal implant results Dr Barry Eppley IndianapolisTemporal implants are uniquely different from almost all other facial implants because they do not augment bone. Rather they are soft tissue implants that augment the amount of muscle volume that exists in the temporal region. What causes temporal hollowing is loss of fat volume and/or muscle, not a change in bone volume. While augmenting the anterior aspect of the temporal bone can be done, it would require a large implant placed very deep under the muscle to create that effect. It is far simpler and more effective to place a smaller implant right under the fascia on top of the muscle which is how newer temporal implants are done today.

High Temporal; Implant Design for Forehead Widening Dr Barry Eppley IndianapolisTraditional temporal hollowing involves the lower half of non-hair bearing aspect of the temporal region just to the side of the eye. (lateral orbit) This is referred to as the Zone 1 temporal region. But other temporal areas can be augmented as well for different aesthetic effects. One of these is the Zone 2 temporal region. This is the upper half of the non-hair bearing area (above Zone 1) which is more to the side of the forehead than it is the eye. It abuts right up against the anterior temporal line of the forehead. Thus augmenting the temporal zone 2 creates a forehead widening effect.

high temporal implant Dr Barry Eppley IndianapolisZone 2 temporal implants, like Zone 1, are placed under the fascia from a small incision in the temporal scalp area. While they are subfascial, the temporalis muscle gets very thin as it approaches the forehead. In addition, the underlying temporal bone no longer is concave but starts to become almost convex as it merges into the forehead. Thus a Zone 2 temporal implant is closer to being a bony augmentation technique rather than a purely muscle implant like Zone 1.

Widening the forehead has been traditionally very difficult. Extending bone cements from a forehead augmentation onto the temporalis fascia can result in a visible line of the material and discomfort. Fat injections can be done but their survival and smoothness if far from assured. Custom silicone implants can be made for forehead augmentation that extends onto the temporalis fascia to both augment projection and width of the forehead. But for those patients that just want a little more forehead widening only, there have been no options to date.

Forehead Widening Implant result Dr Barry Eppley IndianapolisForehead Widening Implant result 2 Dr Barry Eppley IndianapolisZone 2 temporal or forehead widening implants offer s a simple and effective solution to those patients that would like to see just a slight increase in their horizontal forehead width. By placing an implant just to the side of the anterior temporal line under the fascia,  the forehead can be made wider in appearance. This procedure, like Zone 1 temporal implants, has a very rapid recovery with little swelling and discomfort afterwards.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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