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.

August 29th, 2014

Technical Strategies in Plastic Surgery – Eyebrow Fat Injections

Eyebrow Arch ShapeEyebrows are an important component of facial shape as they provide some  visible structure to it.  One of the important components of eyebrow shape for women is whether they have an eyebrow arch. A small arch in the middle of the eyebrow helps create a nice frame for the eye. But not everyone is fortunate enough to have an arch in their eyebrow. This has led to numerous ways to create it, most commonly done by plucking/threading/shaving but also can be created by pencil liner or even hair transplants.

An alternative surgical approach is to add or change the arch shape by structural enhancement using fat grafts. Through small cannulas, concentrated fat can be linearly placed along the eyebrows in an arched fashion. This very straightforward fat grafting method only requires about 2ccs of fat per brow which is placed through a small needle puncture in the middle of the brow.

Brow Fat Injections Dr Barry Eppley IndianapolisFat Injections Brows Dr Barry Eppley IndianapolisThe entrance site should be placed in the height of the arch of the brow. Finding where to place the arch of the eyebrow is well known. The peak of an eyebrow arch is not necessarily in the direct middle of it but usually just a bit more towards the tail of the brow.  It usually is just a bit more lateral than a vertical line drawn up from the iris. Thus, a good eyebrow arch shape does not have a perfectly symmetric rainbow shape.

Eyebrow Arch Fat Injections Dr Barry Eppley IndianapolisBeside helping with eyebrow shape with good placement, fat injections can also have a lifting effect. By adding volume directly beneath the eyebrows, an outward and upward push of the eyebrows can occur.

Small volume fat injections to the eyebrows done with a microdroplet (small aliquot) technique is associated with good survival. (volume retention rate) Given the small volume needed, a large number of donor site options are available for harvest.

Dr. Barry Eppley

Indianapolis, Indiana

August 28th, 2014

Case Study: Avoiding Breast Scars in Augmentation with A Superior Nipple Lift

 

Background: Women that want breast augmentation present with a wide array of breast shapes and sizes. The post-pregnancy breast that has become deflated (lost volume) and has some sagging is one of the common ‘abnormal’ breast types seen. But even within this type of breast shape there are subtypes or different variations within this general category. The lean bodied female with thin skin and stretch marks is one of these subtypes that has essentially a loose deflated sac of skin that just hangs over the lower breast fold.

What makes this type of breast augmentation challenging is how to avoid the need for a breast lift. No woman really wants a breast lift and in cases of significant breast sagging it would be unavoidable. But it is the mild breast sagging cases that can pose a dilemma. It is the size of implant chosen that can determine how to manage the breast sagging. If a small breast implant size is used, then a vertical breast lift will be needed. If a moderate implant is placed, a periareolar or donut lift could be adequate. If a larger implant is used, then a superior nipple lift may be all that is needed.

The definition of what constitutes a small, medium and large breast implant will be different for each patient and it is open to interpretation. But that can be determined based on the patient’s natural breast base width and how the implant’s dimensions compare to it. Larger breast implants in women with thin breast tissues may risk loss of support and bottoming out later but can potentially avoid scars on the breast.

Case Study: This 40 year-old female wanted to reshape her breasts with a much bigger size as well as correct her sagging. She had a very thin body frame with small deflated breasts with thin skin and a narrow breast base width. (12 cms) While the potential need for a lift was discussed with her, she did not want any breast scars and opted for an implant size that was at the perimeter of her breast base width. The potential lower nipple position was felt to be better than any scars.

Stacey Norman Breast Augmentation results front viewStacey Norman Breast Augmentation results oblique viewUnder general anesthesia, 450cc high profile silicone implants were placed through a lower breast fold incision. (the location of the incision was placed lower than her natural breast crease to accomodate the implant size and provide a bit of a ‘nipple lift’) After the placement of the implants, a superior crescent mastopexy (upper nipple lift) of 1 cm was done to help center the nipple on the new enlarged breast mounds.

Stacey Norman Breast Augmentation results side viewAvoiding  a breast lift in a sagging breast is always challenging and can really only be accomplished in one with minimal to moderate sag. The slightly sagging breast with thin skin and little volume does get a bit of a lift with larger implants. The volume addition is particularly enhanced when the inframammary crease is lowered. (although this maneuver does increase the risk of bottoming out and the creation of a lower pole double bubble) It is usually necessary to add a superior nipple lift as part of the breast reshaping procedure to help center the nipple on the breast as best as possible. Even with the combined implant and nipple lift technique, some women may still have to accept a breast that is slightly ‘tilted’. (nipple slightly off center/low on the mound) But this trade-off may still be better than breast skin scars from a more formal lift.

Case Highlights:

1) Deflated breasts that have thin skin and a moderate amount of sagging pose  a challenge in breast augmentation surgery.

2) Vertical breast lift scars can be avoided in some mildly sagging breasts if large enough implants are used with an upper nipple lift.

3) There is a balance between the implant size used and the ability of the breast tissue/skin to support it.

Dr. Barry Eppley

Indianapolis, Indiana

August 25th, 2014

Case Study: Custom Wrap Around Implant for Male Jawline Enhancement

 

Male Jawline Dr Barry Eppley IndianapolisBackground: The ideal male jawline is seen as strong and chiseled…at least by most men.  (some women may prefer a softer jawline which creates a more nurturing appeal) For those men that do not have it, implants can be used to create a stronger or more pronounced jawline. While once traditionally seen as simple chin augmentation, today’s facial implants now incorporate jaw angle implant designs to change the back part of the jaw as well for a more complete or total jawline enhancement.

For many men the use of standard chin and jaw angle implants, through a three-point augmentation approach, can create the desired jawline improvement. With a three implant approach, however, the sides of the jawline may remain deficient since there may not be a direct connection between the chin and jaw angle implants. Also three implants placed individually runs the risk of implant asymmetry since they are not connected and their position must be ‘eyeballed’ for placement as they relate to each other. There is also the limitations of jawline changes based on the sizes of existing chin and jaw angle implants.

All of the existing potential problems with standard jaw implants can be overcome by the use of a custom-designed jawline implant. By making a single piece wraparound implant, the entire jawline can be augmented in just about any dimensions that one wants and the overlying soft tissues can tolerate.

Custom Jawline Implant design Dr Barry Eppley IndianapolisCase Study: This 23 year old male wanted to have a more masculine jawline with a stronger chin and jaw angles. By using computer imaging, it could been seen that the look he wanted was more of a total wrap around effect that just augmentation of the chin and jaw angle areas. By using his 3D CT scan, a wrap around jawline implant design was done creating a more square chin, prominent jaw angle flare and a smooth connection between the front and back part of the jaw.

Custom Jawline Implant placement Dr Barry Eppley IndianapolisUnder general anesthesia, a small (2.5 cm) submental incision was made behind his existing skin crease. (accounting for a forward rollout of the incision which will always occur. Subperiosteal dissection was done over the entire chin and back along the jawline to the angle with special long-handed dissectors. This was combined with two posterior vestibular incisions to expose the jaw angle. The implant was folded and tunneled into position from the submental incision. The positioning of the jaw angle sections of the implants was checked through the intraoral incisions to ensure good seating over the jaw angles. A single microscrew was used anteriorly but the fit over the jaw angles was so good no screw fixation was felt necessary.

Custom Jawline Implant result front viewCustom Jawline Implant result oblique viewThis is his result just 10 days after surgery. While these is still some slight swelling and tissue ‘stiffness’, his face/jawline looks very acceptable at this early point that he could pass as not being obviously ‘surgical’. His jawline shows improved definition and now has more of a classic strong male jawline that has much more angularity to it without being too big or overdone.

Male jawline enhancement is optimally done by a custom wraparound implant if one wants a total change to the entire jawline that appears connected throughout the implant. It is also the only implant approach that will work if one has more extreme dimensional needs that standard implants can not achieve. While the cost of a custom jawline implant is more than that of standard implants, the difference is not as great as most would think. The custom aspect of the implant also lowers the risk of revisional surgery as the shape and location of it along the jaw is determined prior to to surgery in the computer designing process.

Case Highlights:

1) Complete jawline enhancement involves a total change to the entire horizontal portion of the lower jaw in a ‘wrap around’ fashion.

2)  A custom jawline implant is made from a patient’s 3D CT scan and incorporates changes to the chin, jaw angles and the jawline between them in the desired dimensional changes.

3) Due to the flexibility of even a large silicone one-piece jawline implant, it can be inserted through a small submental skin incision conbined with two intraoral mucosal incision to check for posterior positioning.

Dr. Barry Eppley

Indianapolis, Indiana

August 24th, 2014

Technical Strategies in Plastic Surgery – Fat Grafting the Labiomental Fold

 

Labiomental Fold Augmentation Dr Barry Eppley IndianapolisThe labiomental fold is the horizontal indentation below the lower lip that is located at about 1/3 the distance between the lip and the chin. It has various morphologies being quite deep in some while in others being barely noticeable at all. It exists anatomically because tt represents the junction between the horizontal orbicularis muscle and the vertical mentalis muscle attachment to the bone. For this reason it lies exactly opposite the depth of the anterior mandibular vestibule intraorally.

Besides the aesthetic consequences of its depth, the labiomental fold can be a source of tightness or stiffness after intraoral chin surgeries. Whether it is for a sliding genioplasty or a chin implant, the intraoral approach disrupts the attachment of the mentalis muscle that lies underneath the labiomental fold. With healing and scar tissue formation combined with increased projection of the chin, the labiomental fold area can feel tight and interfere with lower lip movement.

While healing and scar maturation will usually solve most labiomental fold problems, patients who have had multiple chin surgeries may not improve with time. Injections such as steroids and various types of hyaluronic acid-baed fillers can be tried and may be effective.

Labiomental Fold Fat Grafting Dr Barry Eppley IndianapolisBut a tight and restrictive labiomental fold may require surgical treatment. While the labiomental fold may be released of its scar contracture, that alone would be inadequate. For just releasing it along will result in recurrent scar contracture. The space that is created by its release must be filled with new healthy tissue. The logical choice for tissue replacement would be a fat graft. Dermal-fat or strip fat grafts can be harvested from many different locations but the abdomen is by far the most common donor site.

Labiomental Fold Release Dr Barry Eppley IndianapolisLabiomental Fold Fat Graft Dr Barry Eppley IndianapolisThe labiomental fold is released intraorally by separating the fat layer below the skin from the underlying mentalis muscle. This is released from one side of the labiomental fold to the other. Into this tissue defect a fat graft is laid into place. The tissue beneath the mucosal layer over the graft is closed with a final mucosal closure over it. This will create not only a scar release but will soften the depth of the labiomental fold as well.

Fat grafting the labiomental fold is an effective strategy for both releasing a scar contracture as well as reducing its depth for aesthetic benefit.

Dr. Barry Eppley

Indianapolis, Indiana

August 24th, 2014

Dermal-Fat Grafts For Buttock Augmentation

 

Buttock augmentation continues to grow in popularity, largely driven by the acronym BBL. The Brazilian Butt Lift is a moniker for the transfer of autologous fat into the buttocks though injection using the patient’s own fat harvested by liposuction. Besides being a natural procedure, the additional benefit of body contouring from the liposuction part of the procedure complements the changes to the buttocks as well.

Fat Injections Buttocks Brazilian Butt Lift Dr Barry Eppley IndianapolisWhile getting the fat for a BBL is done by liposuction, which provides the greatest diversity of donor options, it is not the only potential fat donor source. There are more than just a few BBL patients who ask for and get a tummy tuck at the same time as their buttock augmentation. There are more than just a few plastic surgeons who have looked at the tummy tuck discard tissue and wondered if this would make for a good autologous ‘implant’…but were not brave enough to do it.

In the August 2014 Online First edition of the Aesthetic Surgery Journal, an article entitled ‘Abdominoplasty-Derived Dermal-Fat Graft Augmentation Gluteoplasty’. In this paper, nine (9) patients that had lower abdominal dermal-fat grafts used for buttock augmentation were reviewed. These were patients that were undergoing abdominoplasties (tummy tucks)  in which two oval-shaped dermal-fat grafts were harvested from their tummy tuck excisions and transferred to their buttocks in a subfascial location. The mean size of the dermal-fat grafts was just under 200 cm2 with a mean weight of 288 grams. One of the eighteen grafts became infected (5.5%) and had to be removed six weeks after surgery. All other grafts survived and provided a lasting increase in buttock volume and projection.

This study shows that large dermal-fat grafts in the buttocks are safe and do not have a high risk of infection or complete fat necrosis. The history of dermal-fat grafts goes back almost 100 hundred years but most of that experience has been in smaller graft sizes that do not approximate that used for the buttocks. It would be interesting to see long-term results (one year) of how much volume was obtained as even large dermal-fat grafts undergo some volume loss based on my experience.

I can not help but speculate that a large dermal-fat graft may be better suited to be placed in an intramuscular position as opposed to a subfascial one. Similar to the placement of an intramuscular implant, the improved vascularity may aid in its survival and volume retention.

For those tummy tuck patients who are also interested in buttock augmentation (or vice versa), the excised tummy tuck segment can be successfully used to create small to moderate amounts of buttock augmentation. If it is placed in an intramuscular location, fat injections could also be done in the subcutaneous location as well for improved amounts of volume increase.

Dr. Barry Eppley

Indianapolis, Indiana

August 24th, 2014

Case Study: Male Hump Reduction Rhinoplasty

 

Background: Rhinoplasty surgery can create many changes to the shape of the nose from its union with the forehead up top down to the base of the nasal tip. One of the top three requested nasal changes is that of a hump or bump. A prominent nasal hump not only distracts from a pleasing nasal shape but it also draws attention away from one’s eyes. The nose should blend into the center of the face and allow the eyes to become a major focal point in both conversation and pictures.

Hump Reduction Rhinoplasty Dr Barry Eppley IndianapolisWhile everyone recognizes a nasal hump, there are misconceptions about what causes it. Most perceive that it is a completely bony structure but a hump is actually where the nasal bones and septal cartilage meet along the bridge of the nose. Its prominence is a function of genetics, ethnicity and how much the underlying septum has grown. Septal overgrowth from below will push up the nasal bones and create an uprising along the dorsal line. In essence, most nasal humps can be seen as half bone (top half) and half cartilage. (bottom half)

Hump reduction involves bone and cartilage removal and is often the first thing done in many rhinoplasty surgeries. While there are differing contributions of bone and cartilage makeup of the nasal hump, both components of it must be taken down to make the hump smaller or disappear. In men the hump must only be reduced enough to have a straight dorsal line propfile. (women can tolerate more of a reduction or lower dorsal line) In some patients, there is a desire to keep a small hump to preserve their ethnicity.

Case Study: This 30 year old hispanic male wanted to get rid of the large hump on his nose. He also wanted the tip of his nose to not droop down so much and to be a little bit thinner. He had some mild breathing difficulties but none that could be attributed specifically to either side of his nose consistently.

Male Hump Reduction Rhinoplasty result side view Dr Barry Eppley IndianapolisUnder general anesthesia, an open rhinoplasty approach was done. The upper lateral cartilages were separated from the top of the septum and the cartilage part of the dorsal line trimmed down. This exposed the end of the nasal bones which were reduced by an osteotome and rasping. The upper lateral cartilages were sewn back to the septum by folding them over onto themselves, creating a form of a spreader graft on each side. The caudal end of the septum and the lower alar cartilages reshaped and sutured together. Low lateral nasal bone osteotomies were done from an intranasal approach.

Male Hump Reduction Rhinoplasty results oblique view Dr Barry Eppley IndianapolisAt six weeks after surgery, enough swelling had gone down to reveal a much improved nasal shape. Further nasal tip changes could be expected to occur as further swelling and skin adaptation occurred over the cartilages in the ensuing months.

Male nasal hump reduction rhinoplasty must take into account how much to reduce its prominence and to prevent middle nasal vault collapse. Smoothness and prevention of over reduction of the bridge are keys in male rhinoplasty. But an overlooked component of dorsal line reduction is in the supratip area. This is the hardest are to judge how much reduction should be done and is frequently overlooked or under reduced in hump reduction. If inadequately reduced a polly beak deformity can result from a residual excess of cartilage height at the lower end of the septal height.

Case Highlights:

1) A nasal hump or bump is one of the most commonly requested reasons for rhinoplasty surgery.

2)  Taking down a nasal hump involves both cartilage and bone reduction which may require nasal osteotomies if a residual open roof deformity results.

3) In men, rhinoplasty for hump reduction should strive to attain a string straight dorsal line and avoid over rotation of the nasal tip.

Dr. Barry Eppley

Indianapolis, Indiana

August 24th, 2014

Fat Injection Facial Reconstruction Of Parry-Romberg Syndrome

 

Parry-Romberg syndrome, also known as progressive hemifacial atrophy is a very uncommon neurocutaneous disease. It is characterized by shrinkage of tissues (primarily fat although muscle bone and skin are affected as well) on one side of the face that usually follows the distribution of branches of the trigeminal nerve. It affects females more than males and often starts in childhood or early teens. Its cause is unknown although it is believed that it is autoimmune in nature similar to scleroderma.  The disease process eventually burns itself out with varying degrees of atrophic facial areas left behind.

The only treatment for the sequelae of Parry-Romberg syndrome is fat injections to try and restore lost soft tissue volume. Other treatments can be used, from synthetic bone implants to free tissue transfers, but fat injections currently remain as the primary treatment for most atrophic facial areas. The interesting question, however, is how well do fat injections work in tissues that are so atrophic and may or may not have underegone disease cessation.

In the September 2014 issue of the Annals of Plastic Surgery, am article appeared entitled ‘Parry-Romberg Reconstruction – Beneficial Results Despite Poorer Fat Take‘ In this paper, a study reported on the effectiveness of fat injections for the treatment of Parry-Romberg syndrome, specifically looking at volume retention and skin changes in the treated areas. Fat graft take was assessed by 3D photogrammetry and skin changes were determined by spectrophotometry. All patients treated had multiple fat grafting procedures from 1.8 to 5.2 procedures based in the severity of their syndrome. Total volume of fat injected averaged 48ml per treatment session. They reported that Parry-Romberg patients had less fat take than unaffected patients that had been grafted. Skin color and texture had a three-fold improvement after fat grafting as determined by melanin index and patient assessment surveys.

This is the first paper that has provided some assessment of how well fat injections work in rebuilding atrophic facial areas affected by Parry-Romberg syndrome. Despite poorer fat graft take within the diseased tissues, fat grafting resulted in long-term improvement in facial contour and skin hyperpigmentation. It is no real surprise that fat survival is less in atrophic tissues and that multiple fat injection sessions are needed to obtain the best result. Skin quality improvement has been observed in many other damaged tissues (e.g., irradiation) so it is also no surprise that similar improvement would be seen in Parry-Romberg patients as well.

Fat injection and dermal-fat grafts have a significant role to play in the reconstruction of Parry-Romberg patients. As long as one has enough fat to harvest, fat injections should be considered even when the disease is active since it may have a benefit on disease progression with no side effects.

Dr. Barry Eppley

Indianapolis, Indiana

August 23rd, 2014

Technical Strategies in Plastic Surgery – Submental Incision for Tracheal Shave

 

Reduction of a prominent Adam’s apple is a neck contouring procedure that is known as a tracheal shave or, technically, a chondrolaryngoplasty. It is a very effective procedure that is most commonly done through a small skin incision directly over the tracheal prominence. Through this approach the elevated ridges of the thyroid cartilages are literally shaved down using a scalpel and occasionally a rotary burr if the cartilage is very stiff or ossified.

The skin incision in the neck for a tracheal shave is positioned in a horizontal orientation. As a result it usually heals exceptionally well, often being virtually invisible. But in some patients who have concerns about the neck scar for a tracheal shave, there is an alternative incision location.

Submental Approach for Tracheal Shave Dr Barry Eppley IndianapolisSubmental Tracheal Shave Dr Barry Eppley IndianapolisA submental approach can be taken for the neck contouring procedure. Through an inch long incision in the submental skin crease, a skin flap can be raised down to and over the tracheal prominence. It is some distance away but the elevation of such a skin flap in the neck is common, frequently done as part of many facelift procedures. Using special retractors made for working under narrow skin tunnels, the trachea can be shaved down with a scalpel.

The submental tracheal shave produces offers a ‘scarless’ method to do the procedure. While it is effective, I have found that it can be difficult to get as much reduction as that which can be done through a direct skin incisional approach.  This is particularly so if a rotary burring technique may be needed for maximal reduction as the narrow skin tunnel limits instrument access. Thus the submental approach must be used selectively in the right tracheal shave patient.

Dr. Barry Eppley

Indianapolis, Indiana

August 21st, 2014

Case Study: Endoscopic Placement of Custom Brow Bone Implants

 

Background: The forehead occupies one-third of the face and has a significant role to play in overall facial aesthetics. One component of the forehead is the prominence of the supraorbital rims, also known as the brow bones. How prominent they are affects the shape of the forehead and the appearance of the eyes. The more prominent the brow bones, the more deep set one’s eyes will appear. The more prominent the brow bones, the more masculine one’s facial appearance will look..

For men who seek brow bone augmentation, the traditional treatment options have had their drawbacks. Access to the brow bone area has had to be done through a long open incision placed either at the hairline or further back in the scalp. This has some obvious limitations for many men given what their frontal hairline pattern and density may be. In addition, there are no preformed brow bone implant options available. As a result various types of bone cements have to be used, which can be done successfully, but still requires a wide open forehead exposure to do.

Custom Brow Bone Implant Design Dr Barry Eppley IndianapolisCase Study: This 23 year-old young man wanted to have a more prominent and masculine brow bone appearance. His forehead was not particularly recessed or retro-inclined but there was no distinct brow bone bulge or brow bone break up into the forehead. He was interested in a limited method of brow bone augmentation using implants rather than bone cement. A 3D CT scan was done from which a one-piece brow bone implant was designed.

Endoscopic Custom Brow Bone Implant Surgical Technique Dr Barry Eppley IndianapolisEndoscopic Brow Bone Implant in place Dr Barry Eppley IndianapolisUnder general anesthesia, two small (2.5 cms) irregular incisions were made at the edge of the hairline. Under endoscopic visualization subperiosteal elevation was done down to the lower edge of the brow bones where the periosteum was released from one frontozygomatic suture to the other. The supraorbital neurovascular bundles were dissected out and made sure that they were not at risk form compression by the implant. The custom brow bone implant was soaked in antibiotics and then inserted through one of the incisions. It easily slide into position and had a virtual ‘snap fit’ into place. The position of the implant was confirmed through the endoscope. No fixation of the implant was needed due to its custom fit.

Endoscopic Brow Bone Implant result side view Dr Barry Eppley IndianapolisEndoscopic Brow Bone Implant result oblique viewA custom implant offers a surgically straightforward and reliable method of brow bone augmentation. It avoids the historic need for a long open scalp incision, reducing morbidity and expediting recovery. Through a computer design process, thickness, symmetry and maximal point of projection of the implant can be assured.

The endoscopic approach provides good pocket dissection and visualization of the supraorbital nerves for implant insertion and placement. While this works extremely well for implants, it would equally so for preformed or standard sized brow bone implants if they were available.

Case Highlights:

1) Brow bone augmentation as an isolated procedure can be done through either preformed or custom implant designs.

2)  An endoscopic approach through two small scalp incisions can be used for brow bone implant placement with very minimal scarring.

3) An endoscopic implant placement technique now makes it more feasible for men or women who seek a higher profile to their brow bones.

Dr. Barry Eppley

Indianapolis, Indiana

August 19th, 2014

Technical Strategies in Plastic Surgery – MicroLiposuction of the Perioral Mounds

 

The removal of fat from the face by liposuction is historically seen as very limited in what it can accomplish. The large buccal fat pads can be removed by open excision but the remainder of facial fat is largely subcutaneous in location and small in volume over a large surface area. Liposuction of submental and neck fat is commonly done and very effective. Its ease of removal is largely because it is a relatively broad surface and an area that can collect substantial fat in some people. There is also little risk to any facial nerves as long as one stays below the jawline.

But above the jawline, subcutaneous fat removal by liposuction is not as generous. Fat pockets are small and often intertwined with more fibrous tissue. In addition the ability to hide small access incisions for cannula entrance is more limited. But these restrictions aside, there are facial areas where small amounts of fat can be removed.  A few ccs of fat removed may not be seem significant but on your face in the right location, its effect can be meaningful to create facial contouring/thinning effects.

Perioral Mound Liposuction Dr Barry Eppley IndianapolisOne such facial area that can have effective liposuction is the perioral region, specifically the perioral mounds. These small collections of fat beside the mouth and below the buccal pad fats create a puffiness or fullness. They are actually above the jowls although they can merge into them as well. By accessing this facial area through a small incision inside the mouth, the mound fat can be reduced and an outer convexity turned into a concavity if desired. It is important to stay in the subcutaneous space above the buccinator muscle to get the fat reduction effect.

Perioral Mound Liposuction cannula Dr Barry Eppley IndianapolisBecause this is a small area, it is necessary to use very small cannulas for perioral mound liposuction. Some may call these microcannulas or even nanocannulas depending upon what type of traditional liposuction cannula to which it is being compared. When the cannulas are this small, they will be only one hole located at the tip on one side. Multiple hole cannulas at this small size are difficult to manufacture and are prone to fracture. The area is thus treated by a double pass method, first down on the muscle and then secondly turned over and worked off the underside of the skin. (which is usually the most productive pass) A productive perioral mound liposuction may only pull out 1 to 1.5 ccs of fat at most.

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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