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.

July 9th, 2014

Case Study: Custom Occipital Implant For Flat Back Of The Head Deformity

 

Background: Skull shape deformities are not typically perceived as an aesthetic problem. But just because they are not common does not mean they are not just as significant to someone who has it nor that they can not be improved satisfactorily. There are a wide range of aesthetic skull deformities that affect its entire length from the forehead back to where the neck muscles attach to the bottom end of the skull.

Flat Back of the Head Dr Barry Eppley IndianapolisOne of the most common aesthetic skull deformities is that of the flat back of the head. Occurring from either in utero or neonatal positioning the back of the head can suffer a non-neurologic deformation, ending up with a variety of flattened shapes. This flattening may or may not be associated with compensatory widening of the parietal bones creating flaring or widening in the back with the flat spot in between the two sides. (known as brachycephaly) While this can occur in anyone under the right circumstances, the Asian population is particularly prone to occipital flattening. This may be due to inherent development patterns in which front to back skull growth is naturally shorter.

While to the uninformed, flatness on the back of the head may be perceived as trivial and easily covered by hair. Nothing is further from the truth to someone who has it. I have heard many stories from patients abut the time and effort they put into styling their hair to camouflage it or from men who constantly wear hats to keep it covered. For some men what was once something they could feel, losing their hair begins a process of exposure of their flat back of the head and can serve as tbe the stimulus to seek a surgical solution.

Custom Back of Head Implant design Dr Barry Eppley IndianapolisCase Study: This 42 year-old Asian male had always been bothered by the flat spot on the back of his head. He routinuely spent time with gel products making his hair stand up in the back for camouflage. The flatness of the back of his head could be seen in a 3D CT scan with a severe drop-off from the top of the skull down. From this scan, a custom silicone implant was designed to cover the flat area with a central thickness of 8mms. He also had occipital asymmetry with the right side having a greater degree of flatness in which the design compensated by more material on that side.

Custom Occipital Implant Perforations Dr Barry Eppley IndianapolisCustom Occipital Implant Placement Dr Barry Eppley IndianapolisUnder general anesthesia, he was turned into the padded prone position. A horizontal 4.5cm incision was made low in the occipital hairline just below the nuchal ridge. Dissection was done down to the bone and wide subperiosteal undermining was done with long curved dissectors beyond where the implant edges would be in a 270 degree radius from the incision. The implant was prepared by making multiple ‘perfusion holes’ through it with a 3mm dermal punch. It was then folded for insertion, unfolded once inside, positioned and then secured with a single 1.5mm self-tapping screw at its lower edge.

Custom Occipital Implant results side viewThe effects of the implant were immediate and no edge-transitions could be felt. The incision was closed in two layers with small resorbable sutures for the skin. He had some mild pain the first night but took no narcotic medications after the first 24 hours. He looked very ‘non-surgical’ the next day.

Having performed occipital augmentation with various materials, there is no question that using a custom silicone implant is the simplest approach. By its prefabricated design and the smooth silicone material, it is also the most assured way to avoid any palpable edge transitions of the implant to the bone. The placement of perforating perfusion holes allows for multiple points of fibrous fixation that will ensure that the implant will never move or migrate despite its smooth surface. Such holes also prevent any flexing of the implant in an area like the back of the head where it encounters frequent pressure when laying. (although this is more likely to happen in a non-custom implant that does not have a perfect fit.

Case Highlights:

1) Augmentation for the flat back of the head can provide a significant aesthetic improvement.

2) A custom occipital implant made from the patient’s 3D CT provides the most accurate fit for the flat back of the head.

3) A custom implant can be placed through a low horizontal skin incision at the base of the neck, which may be particularly advantageous in men,

Dr. Barry Eppley

Indianapolis, Indiana

July 6th, 2014

Case Study: Male Chest Reshaping After Weight Loss

 

Background: Significant or extreme weight loss is defined as any amount over 75 lbs. or more. Such amounts of weight loss are most commonly caused by bariatric bypass, sleeve and gastric stapling procedures. Although there are some patients who do lose such large amounts of weight by their own diet and exercise efforts.

One of the well known effects of extreme amounts of weight loss is generalized tissue deflation and sagging skin. Depending on how much weight loss, gender and body location, there can be variable amounts of tissue thinning and loose skin. In general more sagging skin often occurs in women from the arms to the thighs than occurs in men. Part of this is due to better skin retractibility in men and having tissues that have never been previously stretched from pregnancies.

One body area where this gender difference in weight loss effects can be seen is the female breast and the male chest. In the female breast, which has an initial mound of tissue, volume deflation results in variable degrees of breast sagging over the inframammary fold. In the male chest, however, which may not have started out with a significant breast mound (although some men do have a large amount of breast tissue before the weight loss) the sagging of skin is usually less severe or may not be present at all.

Case Study: This 35 year-old male lost almost 90lbs through his own diet and exercise efforts. He had become so focused through this process that he became extremely fit and focused on optimal body shape and contour. While he was at a very good weight and was as lean as he wanted, he was not able to build up his chest as much as he liked. He also had some extra skin under his armpits that created an unaesthetic bulge.

Pectoral Implants after Weight Loss result front view Dr Barry Eppley IndianapolisPectoral Implants after Weight Loss result oblique view Dr Barry Eppely IndianapolisUnder general anesthesia, a transaxillary approach was initially done to place oval shaped 330cc silicone elastomer pectoral implants. They were placed without violating the lateral attachments of the pectoralis muscle. (unlike what is done in breast implants). The lateral pectoral triangle from the edge of the pectoralis muscle to the lateral chest wall was furthered defined by liposuction. Lastly, the skin roll by the armpits was excised and lifted using the same incision for the pectoral implants.

Pectoral Implants after Weight Loss Dr Barry Eppley IndianapolisRecovery for pectoral implants is very similar as that for breast augmentation. It is a muscular recovery with the biggest issue being a delay to return to working out for ten to fourteen days.

Chest reshaping in men who have lost a lot of weight requires a combination of muscle augmentation, the creation of muscular outlines by liposuction and the removal of any redundant axillary skin folds. While the residual tissue effects from weight loss do not affect the male chest as much as the female breast, a pectoral implant alone can not create a complete chest reshaping.

Case Highlights:

1) Significant weight loss can cause a generalized chest ‘deflation’ with loose skin

2) Pectoral implants can serve as the foundation for chest reshaping efforts after weight loss.

3) Soft tissue contouring around pectoral implants is needed in the weight patient to optimize the improvement in muscle definition.

Dr. Barry Eppley

Indianapolis, Indiana

July 4th, 2014

Silicone Breast Implants: Past, Present and Future

 

silicone breast implant history dr barry eppley indianapolisSilicone breast implants have been around since 1962, encompassing a complicated and  interesting history of device development that now spans over five decades. Between three U.S. manufacturers, a wide array of commercially available breast implant devices exist today. Saline-filled devices have not really changed over these years but silicone-based implants have undergone a significant evolution that has been described as having gone through five generations.

First generation silicone implants spanned the time period of 1962 to 1970. They had a very dense and viscous gel that was encased in a thick two-piece silicone elastomer shell held together with a seam. They were of a teardrop shape (not round) and had a patch on its back to try and hold it into place.The main complaints with their use was that they were too stiff and unnatural feeling and had high capsular contracture rates.

Second generation silicone implants spanned the time period of 1970 to 1982. The silicone gel was less viscous to produce a more natural feel. The outer implant shell was thinner, slightly permeable and had no seam. It also was round in shape and not tear drop. The thinner shells and less viscous silicone gels, however, lead to diffusion or bleeding of the gel outside of the implant shell leading to high rupture and capsular contracture rates.

Third generation silicone implants spanned the time from 1982 to 1992. A return to a more viscous gel with thicker multilayered shells was done to reduce the problem of silicone gel bleed and the device shell rupture rates. This also was the generation where the textured implant shell was introduced to help reduce the high rate of capsular contractures.

silicone breast implant ripplingWith a moratorium on breast implants imposed by the FDA in 1992, fourth generation silicone implants spanned the time period of 1993 to 2006. During this period, rigorous clinical studies and follow-up were done to produce a more cohesive silicone gel with an improved manufacturing and quality control process. This is what was finally approved by the FDA for the return of silicone gel breast implants to all plastic surgeons and any women older then 22 years of age.

Sientra Ultra Strong Cohesive Gel Breast Implants Dr Barry Eppley IndianapolisFifth generation silicone implants spanned the time period of 2006 to present day. The implant shells are essentially the same as before but the cohesive gel has a greater cohesiveness that retains it shape better in different positions. Such implants have become known as form stable and the urban term ‘gummy bear’ breast implant. Also, new textured anatomically shaped implants have become available to be used in a wider array of breast forms and chest dimensions. (2012)

Silicone breast implants have undergone consideration evolution over fifty years of clinical use. Today’s implant options are undoubtably the best they have ever been with more options the ever before. The concerns about the induction of autoimmune diseases by breast implants has been largely quelled by numerous studies that have demonstrated their safety. Outside of the U.S., no other industrialized country even uses saline breast implants and use silicone gel implants exclusively for breast augmentation.

Are today’s breast implants the best they will ever be? Undoubtably not if history is any indicator of how progress is made. A decade from now I would anticipate a whole new generation of silicone breast implants that offer new features and improved durability.

Dr. Barry Eppley

Indianapolis, Indiana

July 4th, 2014

Plastic Surgery Wisdom: Predictability of Operative Outcomes

Plastic Surgery Wisdom Dr Barry Eppley IndianapolisFor many plastic surgery procedures from facial reshaping to breast augmentation, it is often a numbers game. Sizes and dimensional measurements are a key part of numerous face and body procedures, particularly those that involve the use of an implant in particular. But even in those operations that do not involve an implant, measurements are often taken and drawings done on photographs or the patient themselves before surgery. All of this implies a certain predictability of the procedure.

The use of computer imaging magnifies the perception of predictability as it shows results of what may happen. The name predictive imaging signifies that there may be some certainty to the future result. Even though computer imaging is really meant to be a communication tool to determine the patient’s goals, the imagery that it creates naturally elevates a patient’s expectations.

For some patients, it is understood that the outcome of surgery is not like Photoshop and the results obtained are influenced by numerous factors not all in the plastic surgeon’s control. But other patients approach plastic surgery in a precise analytical manner and will focus on subtle nuances of alteration that may come down to a few millimeters.

What is important for any patient considering plastic surgery is that results are not always predictive. The body does not react to surgery like a mathematical model, engineering drawing or an architectural design. While it is important to have a pre-surgical plan, the living dynamics of the human body and its reaction to surgical trauma and healing often defies absolute measured predictability.’

Or to put it more simply…

‘Plastic Surgery Is Still As Much An Art Form As A Perfected Science For Many Problems’

Dr. Barry Eppley

Indianapolis, Indiana

July 4th, 2014

Facial Volume Enhancement By Injectable Fillers

 

Facial Fat Loss with Aging Dr Barry Eppley IndianapolisLoss of facial fat is a common occurrence as many people age. With loss of this fat volume comes tissue sagging, some of which would not have occurred if it was held up better by retained tissue support. One of today’s new uses for injectable fillers is in the treatment of this facial pseudoptosis. Using injectable materials to replace lost fat volume and restore contours to a variety of bony and soft tissue facial contours is now best known as filler rejuvenation.

Much of filler rejuvenation is focused on the temples, orbital hollowing and the submalar region, classic facial areas affected by fat volume loss/atrophy. Injecting into these areas can help plump back fat lost and soften a face that may have become gaunt and hard due to a skeletonization effect. While the volume of filler needed can often be substantial, 2ccs or more, the facial rejuvenation effect can be quite significant.

Choosing the right injectable filler, however, is critical as not all fillers create the same effect at the same injected volume. In addition, each filler has a different duration of effect. What one would use for superficial lines and wrinkles is different than what should be used for facial folds. The amount of ‘push’ of the filler needed is quite different. But what works for facial folds is similar to the type of fillers needed to create a facial volumization effect.

Voluma Injectable Filler Indianapolis Dr Barry EppleyThe four injectable fillers today that are most appropriate for filler rejuvenation are Juvederm Voluma, Radiesse, Sculptra and Perlane. The latter three are well known, having been around for awhile. Juvederm Voluma is the newest filler and is the only hyaluronic acid-based filler that is FDA-approved for cheek augmentation, a specific facial volume effect. What creates the lifting effect of Juvederm Voluma is the cross-linking of the hyaluron molecules so they have more viscosity. This greater stiffness allows for a better push on the surrounding and overlying soft tissues.

While there are proponents for each of these voluminizing fillers, they have various advantages and disadvantages. Voluma, Radiesse and Perlane work very similarly and are injected through slightly larger needles than their thinner more superficial wrinkle counterparts. What separates Sculptra from the others is that it is better suited for an overall treatment of a thinning face even beyond the fat pads into all subcutaneous facial planes. Its more liquid composition allows for larger volumes of material to be delivered.

Filler rejuvenation provides a variety of temporary but helpful effects. They can pick up a sagging midface to lighten a heavier lower face. This allows the focus to be redirected back to the eyes. Restoring lost temple volume makes one look healthier and helps balance out the face.

If one likes these filler rejuvenation effects, injection treatments can be repeated or the consideration given to fat injections for a hopefully a greater long-term effect.

Dr. Barry Eppley

Indianapolis, Indiana

June 29th, 2014

A Facial Implant Approach To Volume Restoration in Facial Wasting (Severe Lipoatrophy)

 

Fat loss in the face is referred to as facial lipoatrophy. While some people have it occur naturally with aging or weight loss, for others it is a medication side effect. While retroviral drugs have extended the lives of patients with human immunodeficiency virus (HIV), one of its well know side effects is the loss of the facial fat compartments. This has become known as facial wasting since it is an abnormal and active process. In facial lipoatrophy terms, there are various degrees of it classified as I through V. Many HIV positive patients have advanced type IV and V facial lipoatrophy appearances.

While facial wasting affects all fat layers in the face, its biggest impact is on the buccal fat pad. With its numerous fingers of fat that extend throughout the face and up into the temple region, loss of the buccal fat pad creates a skeletonized and hollow facial appearance. In its fullest extent, it makes one look ill and unhealthy and carries the social stigmata of someone who has the disease.

It has been shown that thymidine analogue drugs are the cause of this facial lipoatrophy effect. Recovery of some of the lost fat can be achieved with a switch to nucleoside reverse transcriptase inhibitor-sparing therapies but it is slow and never complete.Various forms of plastic surgery are needed to create a more dramatic and immediate facial change.

Facial rejuvenation procedures for facial wasting is focused on volume restoration around  the periorbital region (eyes), specifically that of the cheeks and temple regions. The temple hollowing is a pure soft tissue deficit while that of the cheek area is a combined bone and soft tissue deficit. This is not to say that the cheek has lost bone but that it has become very skeletonized adn looks withered, thus cheek (malar = bone) and the area below the cheek (submalar = soft tissue) needs building back up.

While there are injectable treatments available to treat facial wasting, synthetic (Sculptra) and natural (fat), they have favorable degrees of effectiveness. Sculptra injections are for those patients who are definitely opposed to surgery and have the patience to wait until their fill effect is seen…and then have it repeated 18 to 24 months later. Fat injections are problematic both in harvest and persistence. Many facial wasting have little fat to harvest and its ability to survive in tissue beds with very little subcutaneous fat is precarious at best.

Temple Implants in Facial Wasting result front view Dr Barry Eppley Indianapolis_edited-1A facial implant approach can be very successful and create an immediate volume restoration with long-term stability. The temple hollowing is treated with new soft silicone elastomer temple implants that are placed below the fascia but on top of the muscle. This camouflages the implant edges and is a remarkably simple procedure to insert them with no postoperative pain, little swelling and a very quick recovery. They are far superior to any injectable filler because they are so effective. They key in using them is to not pout in a size that is too big which is very easy to do in a very skeletonized temporal region.

Cheek Implants for Facial Wasting Dr Barry Eppley IndianapolisThe cheek area requires a very broad-based implant, part of which is placed below the cheek bone on the masseter muscle. Proper implant placement actually puts at least half if not more of the implant below the bone. While once submalar cheek implants were exclusively used, I have found that larger combined malar-submalar shell implants do a better job of midface volume restoration. Because these type of cheek implants are substantative in size, screw fixation is useful to keep them in the desired location as they heal.

One area that is left out with temple and malar-submalar shell implants is the intervening area over the zygomatic arch and immediately beneath it into the lower face. A complete facial wasting surgery includes implantation of this area as well but has to be done with either fat injections or preferably a dermal-fat graft placed through a limited facelift approach. Without filling in this area there can be a step-off in the face behind where the malar-submalar shell implant ends.

Facial wasting treatment is one specialized form of facial reshaping surgery. These procedures allowing for volume restoration of the face hopefully to a level that is close to what they looked like before starting their anti-viral drugs. With a more ‘plump’ face, one self-confidence is improved, they look healthier and they will be encouraged to stick with their long-term drug therapy.

Dr. Barry Eppley

Indianapolis, Indiana

June 28th, 2014

Cautionary Use of Injectable Fillers in the Nose (Non-Surgical Rhinoplasty)

 

The search for a less invasive way to change the shape of one’s nose has only more recently been possible through the use of injectable fillers. Their use in the nose has been labeled as an injectable rhinoplasty or a non-surgical rhinoplasty. Using injectable fillers for certain nasal shape problems  or to correct secondary rhinoplasty deformities has its merits. It is quick to do, has a low cost and avoids any type of recovery associated with a more invasive rhinoplasty.

An injectable rhinoplasty can be very successfully done but the question is what filler material is best to do it. With over a dozen filler materials currently available, the most commonly used have been silicone, numerous hyaluronic acid (HA) formulations and calcium hydroxyapatite gel. (CaHA) While all of these have successful histories of general facial soft tissue augmentation, their use in the nose should be approached with a heightened sense of caution.

Silicone (Silikon 1000) is the least commonly used injectable filler and is not FDA-approved for any soft tissue augmentation procedure. But there are more than a handful of practitioners who use it for those patients who seek permanent injectable filler results. While there is no question that silicone injections can work, they are also known to cause significant granulomatous reactions which can be difficult to treat and impossible to ever completely remove the material from the tissues. While silicone filler advocates point to injector technique as the cause of any problems with its use, it is best avoided in the nose.

Calcium hydroxyapatite gel (CaHA, Radiesse) is a thicker more viscous material due to its microspherical content. It is not associated with any significant granulomatous reactions and can safely be put into the nose. But it requires a bigger needle to insert and this can be more uncomfortable to the patient. (not that any nasal injection is pain-free) But its long-lasting effects may justify that trade-off if one has a compassionate injector.

Any of the hyaluronic-acid (HA) fillers offer the easiest and smoothest injection into the thinner tissues of the nose due their smooth linear flow capabililties. Even long lasting HA fillers inject fairly easily. They probably offer the least risk of adverse tissue reactions due to their hyaluron composition and push on the tissues, but this is certainly volume dependent. Many of the HA fillers today have the local anesthetic lidocaine in them, which will not really helping with reducing injection discomfort on the first pass, can make subsequent injections more comfortable and will eliminate any early postinjection discomfort.

Injectable Cosmetic Complications Dr Barry Eppley IndianapolisWhile different injectable fillers can be used safely in the nose, how and where they are placed is critical to minimize complications. The injection should be placed deep (sub-SMAS) to eliminate visible lumping of the material. The safest nose areas to inject are the dorsum/radix and bony side walls where the tissues are more elastic and have a resplendid blood supply. Larger volumes of fillers can be easily placed here. While injections can be done in the tip and nostril area, this is where the most complications are seen including tissue necrosis. Very judicious small amount of fillers should be used in these areas if one  must do so.

Injectable Rhinoplasty with Radiesse Dr Barry Eppley IndianapolisWhile the injectable and non-surgical rhinoplasty is ‘easy’ to do and offers a quick fix for select nasal problems, it is not complication-free. (nor is it permanent) Caution should be used when injecting into the nose including the choice of filler and the injection location. Injectable fillers work well for camouflaging small to moderate dorsal humps, to correct nasal bones that have been collapsed or have asymmetry and ‘top off’ a rhinoplasty where there remains a slight residual hump.

Dr. Barry Eppley

Indianapolis, Indiana

June 28th, 2014

Plastic Surgery Products: SERI Silk Scaffold for Soft Tissue Support

 

SERI Silk Scaffold in Plastic Surgery Dr Barry Eppley IndianapolisSERI silk surgical scaffold is a knitted, multifilament bioresorbable  bioprotein-based scaffold. It is derived from silk that has been purified to yield very pure fibroin. It is tear resistant, holds sutures well and can be cut to any shape. It provides immediate mechanical stability across a tissue defect due to its inherent strength and scaffold construction. It is designed to gradually resorb as new tissue grows into it. It is to be used as a temporary scaffold for tissue support and defect repair of soft tissues in plastic surgery.

This silk-derived biological material has favorable biocompatibility and causes minimal inflammation. Ordinary silk sutures are not traditionally thought as of very biocompatible because contain sericin which causes a profound inflammatory reaction. Commercial silk suture is made of fibrous proteins that are first processed into strands, then braided, and may be dyed and coated with wax or silicone. These silk sutures typically can become encapsulated and do not integrate into the native tissue. SERI surgical scaffold undergoes a proprietary purified engineering process which removes sericin and other impurities for a very pure sterile product. Tissue response to SERI Surgical Scaffold exhibits minimal inflammation that is confined to the silk-derived scaffold. This helps promote favorable integration and neovascularization as the scaffold is replaced over time with natural collagen. Studies have shown that this silk-based product is resorbed at slower rates than other types of synthetic polymers.

SERI Silk Surgical Scaffold Indianapolis Dr Barry EppleyThe SERI silk scaffold received FDA approval in 2009 and is distributed through Allergan for soft tissue repair. It has had its biggest application in various breast augmentation and reconstruction deformities, most notably for secondary breast procedures.  It has been primarily used as a supporting scaffold or sling to correct breast implant bottoming out, rippling and holds promise to treat breast implant capsular contracture. It shows promise for other plastic surgery procedures that need additional soft tissue support such as tummy tucks, breast lifts and facelifts.

Dr. Barry Eppley

Indianapolis, Indiana

June 28th, 2014

Fat Injections for Lower Eyelid Retraction

 

The use of fat for soft tissue augmentation and in various reconstructive problems is now widely used. While it may not always survive as well as often as would be desired, and occasionally survives and grows too well, its easy accessibility and introduction into tissues lends itself to broad applications.

Fat Injections Cheeks Dr Barry Eppley IndianapolisOne of the now very common aesthetic uses of fat injections is in the treatment of tear troughs and cheek augmentation. While synthetic injectable fillers are done more commonly for these periorbital areas, using one’s own fat allows for larger volumes of material to be added that has the potential for a much longer lasting effect. It is often a convenient time to undergo fat injections when one is already having other aesthetic surgical procedures as fat harvesting and injection is not as simple as off-the-shelf injectable fillers.

Augmenting the soft tissue volume of the lower eyelid and cheeks certainly seems to provide support or a push upward on the lower eyelid if enough volume is placed. While that effect seems intuitive and sometimes obvious during surgery, does it really create a noticeable effect on the lower eyelid position and is it maintained long term?

In the May 2014 issue of the Journal of Ophthalmic Plastic and Reconstructive Surgery, an article appeared entitled ‘Effect of Autologous Fat Injection on Lower Eyelid Position’. In this paper, seventy (70) patients over a four year period underwent fat injections to the cheek and lower eyelid tear trough for aesthetic augmentation. Its effect on lower eyelid position was measured by marginal reflex distance and inferior scleral show on before and after treatment pictures. A mean decrease in marginal reflex distance and a mean change (lessening) in scleral show of 0.5mms was found in both eyes with an average follow-up of just over four months. Only some temporary after treatment induration of the eyelid skin was seen in a few patients. (7%) The authors conclude that fat injections appear to augment support to the lower eyelid and may be useful in the treatment of lower eyelid retraction.

Fat Injection Grafting Dr Barry Eppley IndianapolisWhile the use of fat injections will continue to be used for tear trough and cheek augmentation due its simplicity compared to implants, its effective has been primarily judged by volume retention. Increased lower eyelid support suggests that it may have a role in the treatment of lower eyelid ectropion/retraction as well. Downward positioning of the lower eyelid has long been known to be caused by a relative tissue loss aggravated by the pull of cicatricial forces if present after lower eyelid surgery. Injecting fat adds tissue volume as well as helps break up and loosen scar tissue. Injecting fat as a preparatory step before lower eyelid suspension or lateral canthoplasty, or in some cases as a stand alone procedure, may be a useful technique for challenging cases of lower eyelid positional problems.

Dr. Barry Eppley

Indianapolis, Indiana

June 25th, 2014

Plastic Surgery Wisdom – Assessing ‘Small’ Aesthetic Surgery Results

 

Plastic Surgery Wisdom Dr Barry Eppley IndianapolisAssessment of after surgery results is understandably a big focus for plastic surgery patients. They are often quick after surgery to begin observing the details of their results, comparing sides and noting any differences from what they may have expected before surgery. A big part of presurgical counseling/education before plastic surgery is controlling the speed of expectations, describing the effects of swelling/bruising and tissue distortions and how long all that takes to go away. Despite the best presurgical education, it is hard for patient to appreciate that many of the fine details of their surgical changes will take three to six months to settle and see the final results. (some procedures can take up to a year)

Patients frequently misinterpret the magnitude of the surgery to how long it takes to see the final outcome. In bigger surgeries patients frequently assume and understand that recovery will be longer and buy into the being patient approach. In smaller surgeries for smaller problems, however, they often assume that the recovery will be very short and they will see their final results sooner. While in some cases this may be true, it often isn’t.

Often smaller aesthetic surgeries take just as long to see the final outcomes as more extensive surgery. This is not because the swelling and bruising are so significant although it is at least proportionate to the size of the problem. It is primarily due to what brought the patient to surgery (or back to surgery in the case of a revision) in the first place. The drive to have surgery for a relatively small aesthetic concern speaks to the patient’s concern about it and how carefully they look at it. With this close and frequent inspection after surgery comes impatience and the desire to see a ‘quick fix’. But the reality is even small aesthetic problems take time to heal and settle and they often are not faster than more extensive surgery.

‘When The Aesthetic Concern Being Treated Is Small, It Takes A Disproportionately Long Time To See The Final Result’

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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