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.

May 27th, 2015

Facial Asymmetry in Deviated Nose Rhinoplasty

 

Patients that seek rhinoplasty have many reasons for doing so. One of the most common and often at the near top of the list is that of the deviated nose. Since the nose is a prominent midline facial structure, its straightness or lack thereof, is fairly easily discernible. While nasal deviation is a common problem and is addressed during may rhinoplasties, it is well known to be challenging to end up with a perfectly straight nose.

septal deviation preop dr barry eppley indianapolisseptoplasty postop dr barry eppley indianapolisStraightening the deviated nose is almost never one simple maneuver as it is rare that only one anatomic structure of the nose is at fault. It is a common perception that a deviated septum is the cause of a deviated nose and a septoplasty alone will make for its correction. The reality is that most deviated noses often have a deviated septum as well but its correction alone will not make for a straight nose. The major role that a septoplasty plays in the deviated nose is to serve as the site of cartilage graft harvest which will then be used in multiple locations to add structural support to help make the overall correction.

In the May/June 2015 Online First issue of the JAMA Facial Plastic Surgery journal, the article entitled ‘Frequency and Characteristics of Facial Asymmetry in Patients With Deviated Noses’. The authors goal was to analyze the characteristics of facial asymmetry in patients with deviated noses. Over 150 patients who had rhinoplasty for a deviated nose over a four year period were compared to 60 rhinoplasty patients who were treated with no nasal deviation. Facial asymmetry was categorized into 4 types based on the subunit of the face involved and nasal deviations into 5 types. They found that facial asymmetry was more common in those patients who had a deviated nose versus those who didn’t. (55% vs 32%) This facial asymmetry was marked by different anthropometic measurements in distances between the midpoint of the interpupil line to the most prominent malar point, lateral canthal angle, lateral alar angle, lip margin angle, and tilted chin angle.

This paper demonstrates why deviated noses are harder to correct than one would think. People who have crooked noses are more likely to have a face whose two sides don’t quite match up either. So while the patient thinks that only their deviated nose is the issue they actually may have associated facial asymmetry as well. The nose deviation is a microform of the overall more complex facial asymmetry. Such facial asymmetry can ultimately lead to unhappiness with their rhinoplasty result because they will interpret how the nose looks in the context of the overall face appearance.

Dr. Barry Eppley

Indianapolis, Indiana

May 27th, 2015

Botox vs. Xeomin for Upper Facial Wrinkles

 

Aesthetic facial neuromodulation, aka ‘Botoxing one’s face’, is a long proven method for reducing the development of certain facial wrinkles and unwanted facial expressions. It has been done for so long and with such success that the original facial neurotoxin and still the most popular, Botox, has worked its way into the cosmetic procedure lexicon as a verb.

Botox Facial Wrinkle Injections Dr Barry Eppley IndianapolisBut Botox is not the only player in the injectable neurotoxin market as two ‘younger’ products have appeared in the scene in the last five years, that being Xeomin and Dysport. While all three advertise, promote whatever subtle differences that may exist between them and physicians have their preferences between them for their own reasons, but it is not really clear whether one is more or less effective than the other.

In the May 2015 issue of Plastic and Reconstructive Surgery journal, the article entitled ‘A Prospective Split-Face, Randomized, Double-Blind Study Comparing OnubotulinumtoxinA to IncobotulinumtoxinA for Upper Facial Wrinkles’ was published . In this paper a clinical study was published on 45 patients (41 women and 5 men) who had three types of facial wrinkles treated  using a 1:1 dose ratio of Botox and Xeomin. A total of 50 units of each drug was administered to the upper face in three areas. (glabella, forehead and crow’s feet) and evaluated over a four month period. The effect on the wrinkles was assessed by a scale amongst blinded physicians. For toxin comparison, the researchers calculated differences in the degree of wrinkle scale at each period compared with pre-treatment and performed statistical analyses. They analyzed wrinkle types both individually and combined.

Xeomin Indianapolis Dr Barry Eppley IndianapolisTheir results showed that at identical doses, both Botox and Xeomin are safe and effective in the treatment of upper facial wrinkles. However, Botox  had statistically greater effectiveness in dynamic wrinkle reduction at each point in the study out to four months. This would suggest. although does not prove, that Xeomin may need higher doses to be equally effective.

Dr. Barry Eppley

Indianapolis, Indiana

May 25th, 2015

Case Study – Stretch Marks and Breast Augmentation Surgery

 

Background: Breast implant surgery works by the simple principle of placing a device under the breast tissues that pushes outward and creates a larger breast mound. Regardless of whether the implant is placed under the glandular tissue (subglandular) or partially or completely submuscular the outward result of a larger breast remains the same. Since the implant merely pushes the overlying breast tissue whatever outward breast characteristics that exist (e.g., nipple-areolar size/asymmetry, skin features) will remain the same or may get bigger as the breast mound enlarges.

breast stretch marksOne of the undesired features of breast skin is that of stretch marks. These skin deformities represent a dermal injury where the skin has thinned in a linear fashion due to expansion of the tissues. Breast stretch marks always appear in a radiating pattern extending outward from the central nipple-areolar complex and running directly perpendicular to the relaxed skin tension lines of the breast mound. (which are circular or concentric) They develop most commonly from pregnancy due to the skin stretch created by breast tissue engorgement. The collagen fibers in the skin’s dermis may also be weakened by the change in hormonal levels. Large amounts of weight gain or naturally very large breasts may also challenge the integrity of the dermis.

Since breast augmentation causes an immediate and large increase of the breast mound, through the placement of an implant and the resultant development of swelling, breast skin may theoretically develop stretch marks. In breasts that already have stretch marks could breast implants make them worse either by appearance or even making them bigger. These would be understandable concerns from any women considering breast augmentation.

Case Study: This 34 year-old female wanted breast augmentation as she had lost some of her breast volume after multiple pregnancies and they had lost any perkiness they once had. She had existing white-colored stretch marks on both breasts that radiated outward from the nipples.

Stretch Marks in Breast Augmentation Results front view Dr Barry Eppley IndianapolisStretch Marks in Breast Augmentation Results oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, she had 375cc silicone gel implants placed in a partial submuscular position (dual plane) through lower breast fold incisions. With the immediate enlargement of her breasts her stretch marks did get wider but never turned pink or red. Looking at her six weeks after surgery, when all swelling was gone, the appearance of her stretch marks was not proportionally bigger or looked worse.

Stretch Marks in Breast Augmentation results side view Dr Barry Eppley IndianapolisThere is little question that breast implants can potentially cause stretch marks or make existing ones bigger. The chance of developing stretch marks from the skin stretch caused by the implants is, however, extremely low and should be considered a rare occurrence. Even if they do occur they will not be severe and will fade within a few months after surgery. The risk factors for these occurring are in large breast augmentations, in implants that are placed above the muscle and in women that already have some amount of stretch marks. In the vast majority of women that already have stretch marks, the appearance of them does not worsen even though they make become wider as the breast mound size increases. (stretch of the stretch marks)

Highlights:

  1. Pregnancy and extreme weight gain/loss are the most common causes of stretch marks on the breasts.
  2. Breast augmentation surgery does not cause stretch marks on the breasts if they are not already present.
  3. Breast augmentation surgery does not usually make the appearance of existing stretch marks worse. (other than temporary redness)

Dr. Barry Eppley

Indianapolis, Indiana

May 24th, 2015

Case Study – Power-Assisted Liposuction for Male Gynecomastia Reduction

 

Background: Gynecomastia, or male breast enlargement, occurs in a wide variety of forms and ages. While typically perceived as a condition that occurs in teens and young men as a reaction to elevated hormonal levels from puberty, gynecomastia occurs equally in older men as well. ‘Man boobs’ as they are often called can be an aesthetic affliction to any man at any age.

older male gynecomastiaOlder men can develop gynecomastia for a variety of reasons from weight gain, dropping testosterone levels (and elevated estrogen levels) and various medications. (e.g., propecia or testosterone supplements) Often the cause is multifactorial and weight gain is a common denominator. Many older men as their abdomens become bigger and rounder will develop a similar but smaller enlargement of their breasts as well.

The surgical treatment of gynecomastia consists of only two basic approaches, liposuction or open excision. In many gynecomastia reductions surgeries of all ages, a combination of open excision and liposuction is usually needed. But softer gynecomastias and those thayt have little evidence of any lumps or masses under the nipple will do well with liposuction alone. Many different types of liposuction can be used for gynecomastia surgery and will work equally well based on the practitioner’s skill and experience.

Case Study: This 54 year-old male came for liposuction of the chest, abdomen and flanks…the three classic liposuction areas for men. He had lost as much weight as he could through diet and exercise and had ‘hit the wall’. He needed a surgical boost to make a more significant change than we he could accomplish. His chest had a softer type of breast enlargement that had no hard lu

Power-Assisted Liposuction Indianapolis Dr Barry EppleyUnder general anesthesia, liposuction was performed on his abdomen and flanks as well as both sides of his chest using a 3mm cannula on a power-assisted device. (PAL, power assisted liposuction) A total of 700ccs was removed from both sides of his chest. After surgery he wore a circumferential chest compression garment for three weeks.

Male GYnecomastia Liposuction Reduction result front viewMale Gynecomastia Liposuction Reduction side view 2His six month postoperative results showed a much improved chest contour with no residual signs of his ‘man boobs’. He also had no nipple protrusion or residual puffy nipples.

For many older men with gradual onset gynecomastia, liposuction alone can be a very effective treatment. It is often combined with other body areas such as the abdomen and flanks which many men have problems with as well. Power-assisted liposuction aids in fat and/or breast tissue removal through its oscillating tip, lessening the workload on the surgeon.

Case Highlights:

1) Liposuction is the most common surgical method used for gynecomastia reduction.

2) Men that develop gynecomastia as they age or gain weight are more likely to have a softer less fibrous type of breast tissue.

3) Power-assisted liposuction is an effective method to treat older softer male gynecomastias.

Dr. Barry Eppley

Indianapolis, Indiana

May 24th, 2015

Technical Strategies – Hydroxyapatite Block Grafting in Sliding Genioplasty

 

A sliding genioplasty is the autologous alternative to using a chin implant. It is done far less frequently than using implants for chin augmentation, and it should be, but it does have a defined role for lower facial augmentation. It is indicated for large chin movements which standard implants can not achieve, for young patients who need large amounts of chin augmentation and for existing chin implants that have developed complications.

Labiomental Fold Dr Barry EppleyA sliding genioplasty involves a bone cut below the anterior tooth roots and mental foramen which is done at various angles depending on the type of dimensional bone movement needed. As the bone moves forward it is important to appreciate that the labiomental fold will not move with it. The labiomental fold or groove, which is situated about 1/3 the distance from the lower lip to the bottom of the chin, is a fixed structure that is reflective of the attachment of the mentalis muscle to the chin bone over the incisor tooth roots. Its deepest part correlates to the depth of the vestibule on the inside of the lower lip.

Hydroxyapatite Block in Maxillofacial Surgery Dr Barry Eppley IndianapolisHydroxyapatite Prorosity Dr Barry Eppley IndianapolisAs the chin bone comes forward with a sliding genioplasty, the labiomental fold ‘stays behind’. Thus it will get deeper with horizontal chin bone movements. This is due to the now ‘step’ shape of the chin which allows the lower part of the labiomental fold to stay where it is but the chin tissue beneath moves forward.  One historic effort to deal with the deepening labiomental fold effect in a sliding genioplasty is to graft the step of the osteotomy. Many materials have been advocated and used but the hydroxyapatite block graft is one of the most historic. They have long been used in maxillofacial surgery as an interpositional or onlay graft which offers excellent biocompatibility due to its inorganic mineral content and interconnected material porosity.

Hydroxyapatite Block Sliding Genioplasty intraoperative view Dr Barry Eppley IndianapolisHYdroxyapatite Onlay Block in Large Sliding Genioplasty Dr Barry Eppley IndianapolisA carved hydroxyapatite block to fill the step of a sliding genioplasty is an excellent graft choice. Its benefits are when the sliding genioplasty movement is significant, usually 10mms or greater where a large bone step is created. Part of the bone is covered in the midline by the fixation plate but the hydroxyapatite block is placed on top of it regardless. Bone will grow around the fixation plate and into the block.

Grafting the bone step of the sliding genioplasty is not the complete cure for preventing the deepening or for the treatment of the deep labiomental fold. It does, however, have some benefit and is a simple and uncomplicated adjunct to the procedure.

Dr. Barry Eppley

Indianapolis, Indiana

May 23rd, 2015

Case Study – Knee and Calf Liposuction

 

Background: Liposuction is performed over many areas of the body, most commonly in the trunk region. (abdomen, chest and flanks) Its success is largely dependent on how well the overlying skin can retract after the underlying fat is removed. There are numerous types of liposuction that claim superior results if used. But the key to liposuction success is proper patient selection and the skill of the practitioner using the liposuction device.

Liposuction is also be performed in the extremities (arms and legs) although with less frequency than that of the trunk.  The principles by which liposuction works in the extremities is the same as anywhere else. But the legs pose unique challenges for good liposuction results. Skin retraction is often not as good due to the circumferential nature of the tissues and prolonged edema may result from increased venous pressures below the knees with delayed lymphatic outflow. Longer recovery times and prolonged use of compression garments is essential to get good skin retraction around the reduced fat areas.

Some women are afflicted with thicker lower legs, which they may refer to as ‘tree trunks’. This description is somewhat applicable as it refers to a lower leg that has no shape and is more of a straight line from the knees down to the ankles. The knees are thick, often with an inner bulge and the underlying calfs have no discernible shape. This is often a source of embarrassment and may even prevent them from wearing anything other than pants to hide them.

Case Study: This 33 year-old female had always had thick and unshapely legs. They did not match the rest of her body and made her look ‘fat’. She never wore shorts and did not really like warm weather because of her clothing limitations. Liposuction was offered to her as the only treatment option with the understanding it could give her lower legs more shape although not necessarily make them a lot smaller.

Knee and Calf Liposuction result front viewKnee and Calf Liposuction result back viewUnder general anesthesia, liposuction was performed on her inner knees and circumferentially on her entire calfs. Particular emphasis was focused on creating a superior and inferior concavity on the inner aspect of her calfs. A total of 1,750ccs was aspirated. She wore compression garments after surgery for six weeks.

Her three month postoperative results showed more shapely lower legs. The inner knees had less of a bulge, a medial infrapatellar indentation was evident as was a lower calf  contour that turned inward towards the ankles.

Case Highlights:

1) Liposuction of the knees and calfs can help create lower legs that are more shapely and look less like ‘tree trunks’.

2) Liposuction of the lower legs is about creating a more shapely outline than overall size reduction.

3) Liposuction of the lower legs takes up to three months after surgery for all swelling to finally subside and see the final shape.

Dr. Barry Eppley

Indianapolis, Indiana

May 22nd, 2015

Male Nipple Reduction

 

While men have nipples just like women, they serve no functional purpose. Men do not get pregnant nor do they have to breast feed so the role of the nipple-areolar complex is essentially decorative. While men may look peculiar if they did not have nipples, because we are used to seeing all humans with them, they are present in men as a result of pure genetics. The XY chromosome that men have does not start emitting testosterone until over a month into pregnancy. But up until that point the embyro acts like a female, creating nipples which persist even after the male develops more masculine features such as testicles and a scrotum.

While the make nipple serves no purpose it can be a source of irritation. Protruding nipples can be a source of embarrassment both in and out of shirts and can also end up irritated and sore due to abrasion on clothing. I recently watched the end of the Indianapolis marathon and saw several men who had actual blood on their shirts from chronic nipple irritation that eventually caused them to bleed. I would imagine it would take days for such nipple ‘sores’ to eventually heal and become non-tender.

Male Nipple Reduction Surgery Dr Barry Eppley IndianapolisMale Nipple Reduction Surgery Results Dr Barry Eppley IndianapolisThe good news is that protruding male nipples can be very effectively and simply reduced to provide a permanent resolution to these concerns. Under local anesthesia the nipple can be reduced through a vertical wedge excision at its base. This is actually closer to a ‘nipplectomy’ or complete nipple removal so that only the surrounding areolar base is left. For most men this is a very acceptable trade-off since they want the flattest nipple profile as possible. Since the nipple is usually a lighter color than the surrounding areola, close inspection may be able to detect that there is actually little to no nipple present. But this minor aesthetic alteration is irrelevant to those men affected by the symptoms of enlarged nipples.

Indianapolis Male Nipple Reduction Dr Barry EppleyMale nipple reduction provides an immediate and permanent solution to an anatomic structure whose presence is a mere quirk of a brief genetic window in utero. In less than an hour the procedure can be completed. Dissolveable sutures are placed so no followup for suture removal is needed. One wears bandaids for a few days, can shower the next day, and does not need any after surgery restrictions of activities.

Dr. Barry Eppley

Indianapolis, Indiana

May 21st, 2015

Technical Strategies – Postauricular Approach for Head Widening Implants

 

Augmentation of the face through a variety of implants has been around for along time. Implant augmentation above the face on the skull bones is almost unheard of. Skull augmentations are much less commonly done, not only because they are less frequently requested, but because they are no implants made for them and surgical techniques taught to do them.

Some people have abnornally narrow skull shapes with the temporal region above the ears (what I call the posterior temporal zone) being non-convex. The typical aesthetics of the posterior temporal zone is to have some convexity due to the shape of the bone and the thickness of the muscle. When the temporalis muscle is thin or the shape of the posterior temporal bone is more linear than convex, the side of the head can look very narrow. This becomes most manifest in men with short cropped hair or who shave their heads. Although I have seen patients who have substantial hair cover who are equally bothered by it.

A head widening or posterior temporal implant is a very effective implant augmentation of this area. The implant can be placed either in the subfascial or submuscular location depending upon the incisional access. A vertical incision directly in the side of the head provides direct and easy access to subfascial placement of the implant. However such an incisional approach introduces potential scar concerns particularly with little to no hair color.

Head Widenng Implant Surgical Technique Dr Barry Eppley IndianapolisHead Widening (Temporal) Implants Surgical Technique Incision and Pocket Dissection Dr Barry Eppley IndianapolisA postauricular approach is the ‘scarless‘ method for a head widening implant. With an incision in the crease of the back of the ear a submuscular pocket can be easily created. The pocket can be made from the very back of the posterior temporal region anteriorly to the front edge of the hair bearing temporal scalp. (anterior temporal zone) A posterior temporal implant can seem too large to fit through this small incision but the flexibility of a low durometer silicone implant makes it possible.

Head Widening (Temporal) Implants Surgical Technique Implant Placement Dr Barry Eppley IndianapolisThe posterior temporal implant must be folded onto itself, inserted and then unfolded once in the submuscular pocket. The pocket is fairly tight and the size of the implant makes it very unlikely that implant migration or displacement can occur. But I usually still place a single small titanium screw into the bottom of the implant for absolute security. It is critically important the closure of the postauricular approach re-estsblishes the muscle and fascia layers so the ear do not become protruding due to loss of its posterior attachments.

Posterior or head widening temporal implants can be placed through a postauricular incision into a submuscuar pocket. The implant usually does not need to be greater than 5mm to 7mms to great a substantial head width change when done on both sides of the head.

Dr. Barry Eppley

Indianapolis, Indiana

May 18th, 2015

The Success of the Brazilian Butt Lift

 

Buttock Fat Injections Dr Barry Eppley IndianapolisButtock augmentation is most commonly done today using fat injections. (aka Brazilian Butt Lift or BBL) It is popular because it not only offers a natural method of buttock enlargement but has a concomitant benefit of body contouring through the liposuction fat harvesting. Many good buttock augmentation results from this procedure are the result of the combination of both effects and no just the fat grafting itself. Waistline narrowing and buttock enlargement together can create a powerful change in the lower trunk/pelvic region.

This combination of waist and hip change has long been regarded as attractive in many cultures around the world. A waist-hip ratio of 0.7 in females is the aesthetic ideal and may be achievable with a BBL surgical approach. The question is how effective is this procedure in reaching this aesthetic ideal and how successful is the fat that is injected maintained.

In the May 2015 issue of the journal Plastic and Reconstructive Surgery, the article entitled ‘Gluteoplasty with Autologous Fat Tissue: Experience with 106 Consecutive Cases’. In this paper the authors looked at 106 consecutive female patients who underwent a BBL procedure over a three year period. One key inclusion factor is that they could not have a weight change greater than 10% during the follow-up period. The degree of satisfaction (patient and surgeon) was assessed on a scale of 1 to 4  with four being the highest rating. The average age of the patients was 33 years old and the average amount of fat injected into the buttocks was 505ccs. No patients experienced any medical complications. Five patients (4%) developed a seroma in the liposuction harvest area. The vast majority of the patients (103 out of 106, 97%) has high satisfaction ratings of 3 and 4. Only one patient (1%) reported aesthetically troubling fat volume loss months after the procedure. Two patients (2%)  had revision procedures for excessive gluteal fullness at the sides of the buttocks.

As can be seen in this study, BBL surgery has a high satisfaction rate with a very low incidence of any major problems. The autologous nature of the procedure is undoubtably the reason for few complications. Their experience shows that such fact injections are sustainable and not prone to a high rate of resorption after surgery. The one aesthetic problem that they did encounter infrequently was too much lateral fullness. This can be avoided by drawing a line laterally between the anterior and posterior hip area and not injecting in front of this line.

Buttock Augmentation results left side view. DR Barry Eppley IndianapolisThe authors point out that removal of excessive fat from the lumbosacral region is an important factor in obtaining a good buttock shape and must be done in every patient. This is the importance of performing the procedure in the prone position prior to the fat grafting.

Fat grafting to the buttocks is known to have a lower rate of resorption than that which occurs in the face. The exact reason is not known but may be a function of a larger muscle mass and higher volumes of fat injected. As a result, BBL surgery usually has better results and higher patient satisfaction than facial fat grafting. The fat redistribution effect is also more likely to achieve a pronounced recontouring than just fat grafting alone.

It is important to point out that no patients in this study was injected with mega volumes of fat (1,000ccs or greater) nor ws there an attempt to balloon out the buttocks to very large proportions. The success in this study’s patients may not translate to high volume buttock fat injections.

Dr. Barry Eppley

Indianapolis, Indiana

May 17th, 2015

The Infraorbital Rim Implant

 

Tear troughs and deep grooves under the eyes are often the result of underdeveloped or a weak skeletal structure. Specifically these would be the inferior orbital rims and the anterior cheek bones which sit at the bottom of the lower eyelid and supports the upper cheek soft tissues. Treatment of undereye hollows and grooves is most commonly done by injection techniques using either synthetic fillers or the patient’s own fat. While successful for some patients, not all experience the type of result they want or gets a result that is sustained.

Permanent and assured augmentation results in the face are achieved with preformed synthetic implants for select bony areas. While many styles and sizes exist for the commonly implanted areas of the chin, cheeks and nose, there are no implants that are commercially available for the inferior orbital rim. Given the new demand for augmentative treatments of this area, there exists a need for a preformed infraorbital rim implant for those patients who desire a permanent treatment method.

Infraorbital Rim Implant Designs Dr Barry Eppley IndianapolisAn infraorbital rim implant should provide superior and anterior projection along the bony rim from the naso-orbital junction out to the cheek. It only needs to be a few millimeters thick (2 to 4 mms) to make a noticeable difference. The naso-orbital junction is important as this represents the tear trough area which is a frequent aesthetic concern. How far out onto the cheek the implant should go can be debated but most infraorbital rim deficiences also involve a portion of the zygoma as well. However its lateral extent should be limited to the anterior aspect of the cheek.  (zygoma) If it extends out further a ‘bump’ will often appear in the side of the cheek.

Infraorbital Rim Implant Design Dr Barry Eppley IndianapolisInfraorbital Rim Implant Screw Fixation Dr Barry Eppley IndianapolisThe infraorbital implant is best placed through a lower blepharoplasty (eyelid) incision. While it can be placed through an intraoral approach, getting around the large infraorbital nerve is difficult and will create a postoperative period of lip and cheek numbness which hopefully is self-resolving. A lower eyelid skin-muscle flap provides direct access to the infraorbital rim and permits precise implant positioning and small screw fixation. This creates no more trauma than a lower blepharoplasty surgery. Like a lower blepharoplasty it is important to resuspend/reattach the orbicularis muscle  over the lateral orbital rim during closure, and use a lateral canthopexy if necessary, to prevent any postoperative lower eyelid contraction deformities. (ectropion)

The need for an infraorbital facial implant has been driven by the popularity of injection treatments for lower eyelid hollows and tear troughs. It offers a permanent treatment option for those who do not want injections or have failed previous injection treatments.

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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