EXPLORE
Plastic Surgery
Dr. Barry Eppley

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

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

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

September 30th, 2014

Case Study: Removal and Reconstruction of a Large Forehead Osteoma

 

Background: Bony raised bumps on the forehead are not rare and are known as osteomas. They occur due to the development of normal bone under the periosteum of the non-hair bearing forehead. They are benign overgrowths of bone that are non-mobile. They are thought to usually be initially associated with a perforating vein through the bone which may serve as a nidus for their growth. They can occur from trauma due to bleeding, no obvious reason at all or as a hereditary trait.

The vast majority of forehead osteomas are small and benign and involve only the most outer aspect of the skull bone. They usually can be simply ‘popped off’ or easily separated from the outer forehead bone for removal. It is important, however, to initially obtain a skull film or CT scan beforehand to make sure the bone lesion does not extend down past the outer cortex of the skull bone.

Large frontal osteomas that are more than just a bump on the forehead are rare. But they present differently due to their size and their association with other symptoms such as pain. A CT scan will show that the osteoma is more aggressive as it extends deeper into the skull bone and is a truly expansile bone lesion. Simply removing the outer aspect of the osteoma will not be curative with these bone tumors.

Forehead Osteoma closeup Dr Barry Eppley IndianapolisForehead Osteoma Dr Barry Eppley IndianapolisCase Study: This 34 year-old female had developed a low growing bump on her left upper forehead over the past three years. As it had been larger she began to develop sensitivity when pressing on it and more recent onset headaches.  A CT scan showed an invasive osteoma that had penetrated beyond the outer cortex of the forehead bone but also down into the inner cortex with expansion on the intracranial surface.

Forehead Osteoma Excision Dr Barry Eppley IndianapolisForehead Osteoma Bone Reconstruction Dr Barry Eppley IndianapolisUnder general anesthesia a bicoronal scalp incision was made to expose the entire forehead. A large frontal bone flap was cut and removed that incorporated the entire osteoma. The osteoma portion was removed and the remainder of the normal bone saved. This cranial bone segment was split into two pieces and was used to reconstruct a portion of the outer cortex of the forehead with plates and screws. To ensure optimal smoothness, the remaining bone defect not covered by bone with hydroxyapatite cement.

Forehead Osteoma Reconstruction result front view Dr Barry Eppley IndianapolisForehead Osteoma Reconstruction result left oblique view Dr Barry Eppley IndianapolisThree months after surgery she maintained a smooth and symmetric forehead contour. Most of the numbness of the forehead had resolved and she no longer had any headaches.

The vast majority of forehead osteomas as small, benign and easily removed by separating them from the surrounding bone. Large and more infiltrating osteomas are rare  and can cause significant symptoms by their expansion of the persiosteum and even pressing on the dura. They require a full thickness bone flap to safely remove them from the underlying dura. Reconstruction can be done by a variety of skull restoration methods using bone grafts, alloplastic materials or a combination of both.

Case Highlights:

1) Large osteomas of the skull are uncommon but can be particularly deforming in the forehead and are often associated with pain. (headaches)

2) Full thickness resection of forehead osteomas requires a craniotomy flap for access.

3) Reconstruction of the resultant full-thickness forehead defect can be done by autologous bone grafts combined with contouring bone cement.

Dr. Barry Eppley

Indianapolis, Indiana

September 28th, 2014

Techniques and Outcomes inForehead and Brow Feminization

 

Forehead feminization Surgery Dr Barry Eppley IndianapolisFacial feminization surgery is a relatively recent plastic surgery procedure that has only been done since the late 1980s. It has been developed to address the need to modify masculine facial features for those with gender dysphoria who need to change their facial identity. As a result it is a well known need for the transgender patient. Certain facial features can have very specific male and female characteristics. Specifically the forehead and the jawline are especially important in facial gender identification.

In the October 2014 issue of the journal Plastic and Reconstructive Surgery, an article appeared entitled ‘Facial Feminization Surgery: The Forehead. Surgical Technique and Analysis of Results’. Over a four year period, the authors performed 172 forehead reshaping procedures. The results were assessed by cephalometric x-rays and a six month after surgery survey. The specific techniques discussed were incisional access and how the bone areas are specifically reshaped. Incisional access was done through either a hairline (pretrichial) or modified coronal based on the vertical length of the forehead and whether hairline lowering was simultaneously needed. The bone was reshaped through sequencing of frontonasal-orbital reconstruction/recontouring with osteotomy and setback of the anterior wall of the frontal sinus.

No serious complications were observed in this forehead feminization patient series. No hematomas, seromas or infections occurred. There were no complications related to osteotomizing the anterior wall of the frontal sinus such as sinus dysfunction, sinusitis, mucoceles, or air leaks. One patient did develop a cerebrospinal fluid leak from the posterior wall of the frontal sinus that resolved spontaneously within days after surgery by posture measures. Most patients had some degree of forehead numbness with complete recovery starting three months after surgery. No permanent injury to the frontal branch of the facial nerve occurred although some patients  had some weakness which fully recovered weeks after surgery. The average level of patient satisfaction by the after surgery survey was between satisfied and completely satisfied.

Brow Bone Reduction - Bone Flap Technique Dr Barry Eppley IndianapolisThis article highlights several technical aspects of the procedure that one learns by doing this type of surgery over the years. Where to place the incision and how to access the brow area must be initially considered. Whether to place the incision at or behind the hairline depends on how long the forehead is and the natural shape of the frontal hairline. Brow bone reshaping almost always requires removing the anterior wall of the frontal sinus, reshaping it and repositioning it further back into the frontal sinus. (burring reduction is inadequate and the anterior wall of the frontal sinus permits little reduction to be achieved) With the anterior wall of the frontal sinus removed, the nasal root and glabellar region must be reduced to create a more feminine frontnasal junction. Reduction/rehaping of the superolateral brow bone down along the lateral orbital wall must not be forgotten as a more comprehensive approach to the fronto-orbital recontouring.

Despite the rather invasive nature of this type of forehead surgery, complications are remarkably few and significant improvement is always seen. There can be issues that may require secondary revision such as the smoothness of the brow region. This article does not address whether any revisions were required but some low percent can be expected. (3% to 5%)

Brow bone reshaping and associated hairline modifications can effectively alter masculine facial features in the transgender patient with a very low incidence of negative side effects. To really change the forehead/brow area a comprehensive bone and soft tissue approach is needed.

Dr. Barry Eppley

Indianapolis, Indiana

September 27th, 2014

Tummy Tucks May Improve Urinary Incontinence

 

One of the most common body contouring operations after pregnancies and significant weight loss is the abdominoplasty or tummy tuck. The known benefits of tummy tucks lie in the change they bring to the shape of the abdomen and waistline. If the abdominal tissue cut out is big enough, patients may also see improvement in back pain and skin hygiene in the groin creases. One of the other potential benefits for some patients that has been reported in several small studies is an improvement in urinary incontinence.

Urinary Incontinence IndianapolisIn the September issue of the Aesthetic Surgery Journal a study was published entitled ‘Improvement in Stress Urinary Incontinence after Abdominoplasty’. In this paper 250 women who underwent tummy tuck surgery were evaluated after surgery for urinary incontinence (UI) symptoms by survey. Only 100 patients (40%) completed the survey. Of these 100 patients, 60% reported an improvement in their UI symptoms while the other 40% did not. Lack of having had a prior c-section was the one factor identified that was a good predictor of improvement in UI symptoms after tummy tuck surgery.

Urinary Incontinence and Tummy Tuck Surgery Dr Barry Eppley InianapolisHow a tummy tuck may improve UI is speculative but it could be surmised that the relief of the pressure of excess abdominal tissue pressing down on the bladder is a contributing factor.  It could also be that elevation of the pubic mound as result of the tummy tuck affects the urethral sphincter favorably. There is very scant discussion in the medical literature about any correlation between UI and abdominal contouring surgery so the exact mechanism of how the improvement occurs is not yet known.

This study, while not proving a decisive link between abdominoplasty and UI improvement, is strongly suggestive. A 60% stated improvement by patients indicates that it is more than just an infrequent occurrence. Since not all patients who had UI symptoms before surgery got improvement, it would be important to figure out whom is most likely to do so. This would be beneficial for UI patients who may avoid the need for other treatments if a tummy tuck is done first.

Dr. Barry Eppley

Indianapolis, Indiana

September 26th, 2014

Temporary Injectable Saline Breast Augmentation

 

A recent article appeared in the New York Times entitled ‘What A Difference A Day Makes’. This catchy title was actually referring to a type of non-invasive plastic surgery…temporary breast enlargement. With over 300,000 women a year in the U.S. having breast enhancement with implants, the concept of temporary breast augmentation initially seems a bit strange. How can one enlarge their breasts by using an implant if it is only temporary?

Saline Breast Injections for Augmentatio Dr Barry Eppley IndianapolisThe ‘trick’ is that it is not done with implants but with injectable saline. Rather than surgery, a saline solution is injected into the breasts in the office which quickly and briefly expands them. Think of it as a saline implant without the surrounding containment bag. The saline solution fills the connective tissue spaces between the breast and fat cells and, as a result, pushes out the overlying breast mound. As saline is essentially salt water it is safely removed by being absorbed into the bloodstream by the next day.

What is the role of temporary saline breast augmentation? It is one way for women who think they want breast enhancement to ‘try out’ the procedure first and see if they like it. Many plastic surgeons would argue, appropriately so, that other non-invasive methods work just fine such as computer imaging and try on volumetric gel sizers. But an injectable augmentation allows one to wear it for a day and see how one likes it…an experience that no other method of breast augmentation sizing can offer. It would be easy to see that its use could extend to other very short-term needs such as social events and vacations as a breast pick me up.

A temporary injectable breast augmentation in the U.S. can only be done with saline. Injectable hyaluronic acid-based fillers that are used in the face can not really be used in the breast. Besides not being FDA-approved for breast use, the sheer volume of synthetic filler needed would make it economically impractical despite a much longer persistence of the injected material.

While injectable saline will make the beasts bigger, it should not be confused with what an actual implant may feel like. Injected saline creates a more diffuse feel to the breast while an implant feels different as its contents are constrained by the enveloping bag. An actual implant will also give the breast more projection and ‘push’ while injectable saline has less push and spreads out more.

Temporary injectable breast augmentation is not needed for many patients considering breast implants. But for a few women who want to have a 24 hour breast enhancement experience, injectable saline offer a safe approach to doing so.

Dr. Barry Eppley

Indianapolis, Indiana

September 23rd, 2014

Celebrity Plastic Surgery – The Good and the Bad

 

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

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

Celebrity Female Plastic SurgeryIt is also not a very fair assessment to compare what a celebrity looked like in their twenties with a picture twenty or thirty years later after they have had some surgery.  This is commonly seen on the internet and the differences are often drastic and unnatural which is somewhat inevitable. Comparing a changed aging picture to a youthful one by definition will make most people look peculiar and altered. What would be more useful is a more direct before and after pictures from their surgery where such dramatic transformations are less likely to be seen.

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

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

It is also important to realize that the beauty standards and aesthetic desires of someone in Beverly Hills can be very different from that of Des Moines Iowa or Burlington Vermont. This is a very different world from most people’s every day lives as TV shows and magazines are quick to detail. As a a result, what may look good in one part of the country (or in other countries) may be seen as undesirable in another. Someone in Big Fork Montana is unlikely to appreciate the ‘necessity’ of  having a larger and more shapely buttocks that someone in Miami Florida does. Having a taut face or big lips may be the norm in LA but not so much in Biloxi Mississippi.

Dr. Barry Eppley

Indianapolis, Indiana

September 22nd, 2014

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

 

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

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

September 21st, 2014

Case Study: Solid Silicone Testicle Implants

 

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

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

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

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

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

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

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

Case Highlights:

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

September 19th, 2014

Case Study: Healing and Scars From Breast Reduction Surgery

 

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

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

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

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

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

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

Case Highlights:

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

September 17th, 2014

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

 

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

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

September 17th, 2014

Healing and Wound Complications in Supersize Abdominal Panniculectomy Surgery

 

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

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

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana


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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