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.

February 18th, 2014

Plastic Surgery’s Did You Know? Bichat’s Fat Pad and Buccal Lipectomy Surgery


The buccal lipectomy is a well known procedure that is done in certain patients for a cheek slimming effect. It is unique amongst most fat removal procedures in plastic surgery because it involves removal of fat within a surrounding capsule. (the only other procedure is the removal of the fad pads in blepharoplasty surgery) The buccal fat is a deep pad that is located between the buccinator muscle and the more superficial muscles including the zygomaticus and masseter muscles in the, appropriately named, buccal space. What is actual function is, large as it is, is not really known. It has been described the functions of aiding sucking in infants to facilitating the movement of the muscles it lies between. None of these explanations, however, are particularly satisfying.

Bichat Buccal Fat pad Dr Barry Eppley IndianapolisWhile buccal fat pad removal is controversial today due to the potential long-term risks of excessive thinning and the creation of a gaunt face, the buccal fat pad has an interesting history. It is also often called Bichat’s fat pad and is so named after the famous French anatomist and physiologist Marie Francois Xavier Bichat. While he lived only a short thirty years (1771-1802), he is remembered as the father of modern histology and descriptive anatomy. While he never used a microscope (interestingly he did not trust them) he was able to describe tissues as distinct entities. (muscle, fat etc) Hence the ‘discovery’ of the large buccal fat pad and its four main extensions. (parotid, temporal, buccal and malar) While one could argue some anatomist somewhere would have found it eventually anyway (it is hard to miss when doing facial dissections), in the context of its day over 200 hundred years ago, such anatomic finds were revolutionary.

Dr. Barry Eppley

Indianapolis, Indiana

February 17th, 2014

Case Study: Custom Vertical Lengthening Jawline Implant


Background: One of the original facial implants ever made was for a short chin. Chin implants are the oldest facial implant used and can do a job of lengthening a wide variety of horizontal chin/jaw deficiences. Other jaw deficiences in the angle area on the back end of the jaw can also be augmented by differing jaw angle implant styles as well.

But the one type of jaw deficiency that can not be treated by any type of off-the-shelf preformed implant is that in the vertical dimension. The vertically short jaw is characterized by a lower third of the face that looks small and disproportionate. The chin may or may not be horizontally short and one may or may not have a large amount of overbite dental relationship. A vertically short lower jaw violates the classic canons of the facial thirds for a well proportioned face.

Correcting the vertically short jaw requires an unusual type of implant. It must be one that mostly sits on the lower edge of the bone and wraps around the entire jawline from angle to angle. This can only be obtained by making a custom implant from the patient’s own anatomy using a high resolution 3D CT scan.

Case Study: This 26 year-old young man wanted to have a stronger lower face/jaw appearance. He had always felt his jaw was short and, out of habit, he always held his jaw lower with an open bite relationship to make it look bigger. He had done this jaw repositioning habit almost all of his life. In obtaining his best jaw posiiton, the distance between his central upper and lower central incisors was 8mms.

Vertical Lengthening Jawline Implant Design Dr Barry Eppley IndianapolisA 3-D CT scan was obtained of his face and a custom vertical lengthening jawline implant designed. Based on experience with other jaw lengthening implants, the implant added 8mms of length at the chin which tapered back to 3mms at the jaw angle to keep a mandibular plane angle. A more square chin width was designed but only 3mms of width was added at the jaw angles. It was made as a single piece implant of firm durometer.

Under general anesthesia, a curved submental and bilateral ascending ramus incisions were made to create a subperiosteal tunnel around the jawline. The implant was sectioned in the midline and inserted from the submental position and properly seated on the bone. Screw fixation (2.0mms) was used on each side of the split chin implant for stabilization. Through the intraoral incisions, the correct position of the implants was confirmed and were stabilized by 1.5mm screws through a percutaneous technique.

Vertical Lengthenng Jawline Implant result oblique viewVertical Lengthening Jawline Implant result front viewHis early postoperative course showed a large amount of swelling as anticipated. By ten days after surgery enough swelling went down to be passable and at three weeks the majority of the swelling had resolved. However, the final result of the surgery is not judged until three months later when one can be assured all of the swelling was gone.

Vertical Lengthening Jawline Implant result side viewThe vertically lengthening wrap around jaw implant can effectively increase the height of the lower face to make it either proportionate to the upper two-thirds or even stronger. Its fabrication from a 3D CT scan assures the most symmetrical shape and other desired features of the jawline/chin area are incorporated into it. This new type of custom facial implant design is reflective of a what modern imaging and computer design processes can achieve.

Case Highlights:

1) The vertically short lower jaw is a completely different and more challenging problem than one that is horizontally short.

2) A wrap-around custom vertically lengthening implant made from a patient’s 3D CT scan equalize the height of the lower face to the upper two-thirds of the face.

3) While large, a wrap-around jaw implant can be inserted through a combined submental and intraoral approaches.

Dr. Barry Eppley

Indianapolis, Indiana

February 16th, 2014

Depressor Septi Muscle Surgery To Prevent Smiling Nose and Lip Deformities


The nose is often perceived as a static structure on the face. But this is really only true for the upper part of the nose which is solid fixed bone. The bottom third, or the tip, is unfixed cartilage that can be easily moved. One of the ways it can move is through muscle action.

Depressor Septi Nasi Muscle in Rhinoplasty Dr Barry Eppley IndianapolisThe depressor septi muscle is the one muscle that pulls on the tip of the nose. It is a paired very small muscle which is found one either side of the septum. It arises from the incisive fossa of the maxilla and ascends to insert into the nasal septum and the back part of the nasalis muscle. When it contracts it pulls the tip of the nose down and pulls upon the upper lip shortening it.

When the depressor septi nasi muscle is overactive, it creates the classic smiling deformity. This is seen as the nasal tip being pulled down, the upper lip shortening and, in some cases, a upper lip horizontal lip crease/wrinkle when one smiles. The smiling deformity is often treated concurrently during rhinoplasty to augment any tip changes after surgery or can be treated as an isolated procedure.

The surgical techniques for resecting an overactive depressor septi nasi muscle vary. In the February 2014 issue of Plastic and Reconstructive Surgery a study appeared entitled ‘Smile Analysis in Rhinoplasty: A Randomized Study for Comparing Resection and Transposition of the Depressor Septi Nasi Muscle’. In this paper two techniques (intranasal resection and intraoral transposition) of depressor septi nasi muscle treatment were performed randomly in rhinoplasty surgery in in 100 consecutive cases. Before and after surgery smile analysis and nasal measurements were done. Before surgery, tip projection and and upper lip height were decreased with smiling. After surgery, these muscular effects on smiling were significantly decreased. The intranasal and intraoral techniques for muscle resection did not differ in how much they decreased the effects of smiling on the length of the nose, tip projection or upper lip height.

The traction effects of the depressor septi nasi muscle on the tip of the nose when smiling is well known and has been treated by a variety of techniques for decades. The intranasal approach is historically more common due to the anatomic location of the muscle when doing a closed rhinoplasty. It has a side benefit of decreasing the interalar distance. The intraoral approach has been more recently described undoubtably due to the now widespread use of open rhinoplasty. Coming from below (inside the mouth) allows  an actual release and transposition of the paired muscles. This results in an increased fullness to the upper lip afterwards.

With either method, however, hyperactive depressor septi muscle surgery can be effective if a decrease in tip projection, upper lip height or a horizontal upper lip line occurs when smiling that creates an unattractive effect.

Dr. Barry Eppley

Indianapolis, Indiana

February 15th, 2014

Six-Pack Abdominal Etching Liposuction


When it comes to the ‘abs’ most people think of having a six-pack. And many work hard to try and get it. But not many can for a variety of reasons…not working hard enough, too much abdominal fat from poor diet and not the right body type. Getting six-pack abs really comes down to genetics and hard work.

Abdominal Muscle Anatomy Dr Barry EppleyActually everyone already has a built-in six-pack, known as the abdominal inscriptions, which are part of the rectus abdominus muscles. The rectus abdominus muscles are a set of paired vertically oriented muscles that extend between the bottom of the rib cage and extend down into the pubic area. Throughout their vertical course, they are crossed by three fibrous bands called the tendinous inscriptions. They are usually three such horizontal crossings, one at the level of the belly button, one up high near the bottom of the rib cage below its central xiphoid process and a third one about halfway between the two.

These inscriptions cause indentations or lines across the muscle to appear as they extend about halfway into it. Regardless of your weight and abdominal size, everyone has these inscriptions. The trick is having a thin enough fat layer between them and the overlying skin for them to be seen on the outside.

Abdominal Etching Six Pack Surgery intraop Dr Barry Eppley IndianapolisFor those who diet correctly, exercises regularly, and do a lot of abdominal work but can’t get the cut abdominal look they desire or others who just want to take a shortcut, there is a way. A plastic surgery procedure known as ‘abdominal etching’ or ‘six-pack’ surgery can create it. While often described as ultra-sophisticated liposuction, it is really a form of linear liposuction. Rather than removing fat over a broad surface, fat is removed along a very specific linear lines where the tendinous inscriptions lie. One vertical line is made down the center representing the linea alba between the rectus abdominus muscles through an incision inside the bellybutton. Then the horizontal lines are made from small tiny incisions placed in the middle from which the lines can be made out to the sides.

As much fat as possible is removed between the skin and the tendinous inscriptions to create permanent indentations in a six-pack fashion. While there is an artistic side to how much fat to remove and the location of the lines, it is a relatively simple technique of small cannula liposuction done along straight lines.

Abdominal Etching result oblique view Dr Barry Eppley IndianapolisLike all liposuction, it takes months after surgery to see the final result as the underside of the skin contracts down to the muscle. Such lines will likely be permanent since the fat cells will not return to the indentation lines. However, the number of fat cells outside of the lines are greater in number and will get bigger should one gain weight. Thus abdominal weight gain may create an unnatural look after etching, creating the ‘waffle look’ with fat ballooning up between the lines. It behooves one to maintain a healthy lifestyle and exercise program afterwards.

The best candidates of abdominal etching are those men and women who are already fairly fit and lean. The thinner the abdominal fat layer the more the inscription lines will show.

Dr. Barry Eppley

Indianapolis, Indiana

February 11th, 2014

Case Study: Vertical Ear Reduction (Macrotia Surgery)


Background: Otoplasty is a common aesthetic surgery for ear reshaping which very successfully corrects a protruding ear problem. From incisions behind the ear,  a cartilage fold is created by sutures that pulls the helical rim backward reducing its outer prominence and lessening the aurioculomastoid angle. While ears that stick out often look big, they usually only appear that way due to their protrusion.

While protruding ears are very common, a truly large ear or macrotia is very rare. Macrotia would be defined by an ear height that exceeds the normative height of which numerous studies show a mean height of around 60 to 63mms from the apex of the superior helix down to the inferior extension of the lobule. These same studies show that the lobule comprises under 2 cms or less than 1/3 of the total ear height. Morphometric measurements aside, there is also the patient’s perception of whether they think their ear is too long regardless of the actual measurement.

Macrotia reduction surgery is quite different than a traditional setback otoplasty. True vertical ear reduction requires a shortening or removal of skin and cartilage to create that effect. While there are many wedge resection techniques that will create substantial vertical reduction, which are borrowed from skin cancer resection and ear reconstruction technique, they result in a substantial risk of a prominent scar across the central aspect of the ear. While staggering the incisions across the concave and convex surfaces of the ear can help with the scarring substantially, it is still a high risk manuever in the aesthetic ear patient.

Case Study: This 25 year-old young male wanted to decrease the size of his ears. He felt they were too long and disproportionate to the rest of his face. The vertical length of his  ears were 71mms. Most of the excessive ear height was in the upper 1/3 of the ear with a large scaphal fossa.

Vertical Ear Reduction Technique (Scapha Reduction) Dr Barry Eppley IndianapolisUnder a field block of local anesthesia at the base of the ear and then directly into the ear, a  bidirectional reduction approach was done. A 5mm helical rim reduction was done on the lobule. Then a 7mm resection of skin and cartilage was done of the scapha fossa, placing the closure just inside the helical rim. To get the reduction, a transverse full thickness incision was needed across the helical rim so that the top of the ear would rotate downward. Dissolveable sutures were used throughout all incisions.

Vertical Ear Reduction Dr Barry Eppley IndianapolisThis superior and inferior vertical reduction reduced the ear height down to 60mms. (reduction of 11mms). The scarring was very minmal and the only long-tern concern with healing would be a potential small notch deformity at the helical rim. This could be created by a small scar revision if necessary.

Vertical ear reduction (macrotia reduction) can be successfully done with judicious excisional locations and meticulous surgical technique. Macrotia surgery can be done under local anesthesia with no real recovery other than some ear swelling and mild ear discomfort.

Case Highlights:

1) The large ear, known as macrotia, is most commonly one of increased vertical height.

2) In macrotia reduction surgery, the goal is to place scars at inconspicuous locations as possible. The central wedge reduction method usually results in prominent scarring.

3) Superior scaphal and inferior helical rim reductions can create up to a cm. of vertical height ear shortening with very acceptable scarring.

Dr. Barry Eppley

Indianapolis, Indiana

February 10th, 2014

Case Study: Eyelid Lifts (Blepharoplasty) in the Older Male


Background: Aging begins around the eyes early in life and continues unabated up through one’s senior years. This periorbital aging is manifested by the creation of extra eyelid skin which is caused by the stretching of the thin eyelid skin due to frequent movement. As the redundant eyelid skin becomes excessive it weighs down the upper eyelid. Known as hooding it essentially creates folds of skin that lie on the eyelashes pushing the lid margin downward.

Older Male Eyelid hooding Dr Barry Eppley IndianapolisBetween of the weight of the eyelid skin and its folding over the lashline, an obstruction of the upper visual field results. This is often not even noticed by the individual because the visual field loss is so gradual. Getting lower and lower over the years, the loss of incoming light from a gradually smaller visual field is just credited to a naturally weakening vision with age.

With this upper eyelid hooding and visual field obstruction comes accompanying forehead wrinkles. While some of these horizontal forehead wrinkles are due to lifelong facial expressions, some of them are due to a constant holding of the eyebrows upward to lift some of the skin off of the eyelids, making one able to see better. Such browlifting is often inadvertent and unnoticed by the individual.

Case Study: This 76 year-old male wanted to improve the appearance of his eyes. He said he was frequently told he looked like he was squinting all the time. He felt he looked old and that some eyelid surgery may be beneficial. He wore glasses and had no symptoms of dry eyes.

Older Male Eyelid Lift Results front view Dr Barry Eppley IndianapolisUnder general anesthesia, a large excisional skin-only upper blepharoplasty was done. No orbicularis muscle was taken. The lower eyelids were treated by the raising of skin-muscle flaps, excision of protruding fat pockets, lateral canthopexies, conservative skin removal and orbicularis muscle suspension suturing.

Older Male Eyelid Lift results oblique view Dr Barry EppleyAfter surgery he had excellent improvement in appearance of both upper and lower eyelids. He felt he could ‘see’ better and that there was more light wherever he went. He did have a minor complication of some lower eyelid irritation and lower eyelid sag at the corners which took about two months after surgery to completely resolve.

Older Male Eyelid Lift results side view Dr Barry Eppley IndianapolisBlepharoplasty (eyelid lifts) in older patients can offer great improvement in appearance and even function. But the lower eyelid must be handled very carefully as it is at high risk for after surgery lid malpositioning. (ectropion) Even when handled well (limited skin removal, tendon tighening and muscle suspension), many older patients will experience  temporary period of lower eyelid lag symptoms.

Case Highlights:

1) Advanced aging around the eyes creates severe upper eyelid hooding, upper visual field obstruction and redundant lower eyelid skin with sagging.

2) When the amount of excessive eyelid skin is considerable, the eyes can look small and one can appear to be continuously ‘squinting’.

3) Upper and lower eyelid lifts (blepharoplasties) can create considerable improvement, opening up the eyes and making them feel less heavy.

Dr. Barry Eppley

Indianapolis, Indiana

February 9th, 2014

Treatment of Greater Auricular Nerve Injuries from Facelift Surgery


Facelifts are common facial rejuvenation surgeries that are associated with relatively few minor after surgery problems. (e.g., tightness and banding) Many of these issues are self solving with time as tissues heal and relax. One issue that may not improve with time is a nerve injury. While the greatest fear of nerve injury from a facelift is that of a branch of the facial nerve resulting in localized facial muscle weakness, the reality is that this is fairly rare and almost always recovers with time.

Greater Auricular Nerve in Facelifts Dr Barry Eppley IndianapolisThe most commonly injured nerve in a facelift is actually the greater auricular nerve. This is a sensory nerve derived from the second and third cervical roots that supplies feeling to parts of the ear primarily. It can be easily injured in a facelift because of its superficial location, coursing over the top of the sternocleidomastoid muscle right in the path of the skin flap dissection into the neck from behind the ear. It is reported to have a 6% risk of injury in facelift surgery.

Injury to the greater auricular nerve can present in various ways depending upon the mechanism of injury. Stretch or traction injuries result in short-term numbness and tingling. Should the nerve be cut or entrapped by suture, the symptoms will be like a neuroma with a trigger point and radiating pain when touched or compressed. (tinel’s sign)

In the February issue of Plastic and Reconstructive Surgery, an article appeared entitled ‘ Surgical Decompression of the Great Auricular Nerve: A Therapeutic Option for Neuropraxia following Rhytidectomy’.  In this paper the authors reviewed their treatment of four patients who had greater auricular nerve injuries from short-scar facelift procedures. With a positive Tinel’s sign, they underwent decompression of the nerve by stitch removal and an overlay of allogeneic dermis to prevent recurrent scarring to the skin. This led to universal improvement and near resolution of symptoms by six months after the procedure in all patients. This approach was even effective when the time of the original facelift to the nerve surgery was a year apart.

This paper describes a treatment approach for greater auricular nerve injuries that is straightforward and expected. Suture compression was the universal culprit although actual nerve transection and neuroma formation could also be a mechanism of injury. With neuromas, they need to be excised and the proximal end of the nerve buried into the muscle.

What is equally interesting is that all patients in this report had short-scar facelift techniques done with inadvertent suture placement presumably due to limited visibility. (although it could equally be due to a surgeon’s unawareness of the pathway of the greater auricular nerve) While suture entrapment can also occur in more open facelifts, the limited dissection of a shorter scar facelift leaves fewer options for suture placement. In this case, no SMAS suture at all would be better when in doubt as to where the nerve is.

Dr. Barry Eppley

Indianapolis, Indiana

February 9th, 2014

Plastic Surgery in the Trenches


While plastic surgery today is associated with images of rejuvenated faces and enhanced breasts and buttocks, its origins and history is associated with a bit more nobler objective. From the trenches of World War I came the need to reconstruct faces torn and shattered from warfare wounds. It was the absolute horrors of war that provided the stimulus for many of the modern-day aspects of plastic surgery.

World War I Plastic Surgery Dr Barry Eppley IndianapolisThe most famous name associated with World War I facial reconstruction is that of an Armenian-American dentist and oral surgeon, Dr. Varazstad Kazajian. He was stationed at the Harvard Unit at Base Hospital No. 22 in France. During the war, Dr. Kazanjian demonstrated his skill at facial surgery, using his knowledge of dentistry to repair wounds, and rose to become head of Maxillofacial Surgery at the hospital. When the war was over, he continued to work as a surgeon back in Boston becoming the first Professor of Plastic Surgery at Harvard University. From the end of the war until he retired he developed new techniques for treating facial wounds and facial birth defects.

This year is the centenary of World War I and is the basis for an exhibition from the National Museum of American History. This online exhibition looks at American’s entry into the war in 1917 and Military Hospital Life. Beginning in 1917, the National Library of Medicine will open an exhibit featuring patient and practitioner experiences at the military hospitals in World War I. This exhibition and website features the National Library of Medicine’s collection of magazines produced by soldiers stationed in military hospitals in the United States during World War I. Over Here explores the work, lives, and recovery of personnel and patients at Army hospitals during and after the war. The exhibition centers on the experiences of the wounded and those stationed at US Army General Hospital No. 3, in Rahway, New Jersey.

While plastic surgery today encompassses a wide range of congenital, traumatic and cancer-related reconstructions, it is perhaps somewhat unfortunate that it is often perceived as only servicing the needs of those seeking cosmetic surgery. Thus it is easy to forget that much of the foundation of plastic surgery occurred behind the battlelines with efforts to aid those disfigured by war.

Dr. Barry Eppley

Indianapolis, Indiana

February 7th, 2014

Five Things You Did Not Know About Brow Bone Reduction


Brow bone reduction is often aesthetically necessitated when the frontal sinus air cavities become too large. This is almost exclusively a male problem since the development of the frontal sinuses is highly related to levels of circulating testosterone and growth hormone during development. As a result, it is often associated with other strong facial bone features in men as well. Very strong brow bones due to frontal sinus pneumatization is almost never seen in women.

Brow Bone Reduction - Bone Flap Technique Dr Barry Eppley IndianapolisWhile brow bone reduction can occasionally be done by a burring technique, the thin cortex of the overlying brow bone does not allow for more than a few millimeters of reduction with that approach. More substantial brow bone reduction requires an osteoplastic flap technique whereby the bulging bone cover of the frontal sinus is removed, reshaped and then replaced. This can increase the amount of brow bone reduction by three or four times than of just burring the bone.

When it comes to brow bone reduction surgery, here are five things you may not have known about it.

Brow Bone Reduction and Browlift Surgery Are Related. The osteoplastic technique for making the brow bone less prominent requires an open incision and forehead flap turndown for exposure. Several types of browlifts also require an identical surgical approach through either a hairline or scalp incision. This also means that a browlift can be done with brow bone reduction if needed, which often is the case in Facial Feminization Surgery.

Brow Bone Reduction and Migraine Surgery Can Be Done At The Same Time. For those individuals that suffer from frontal migraines caused by supraorbital nerve compression, decompression of the nerve by stripping off the surrounding muscle and opening up the bony foramen can reduce symptom frequency and intensity. Working on the brow bones requires coincidental exposure of the supraorbital nerve, thus potentially solving an aesthetic and pain problem during the same operation.

Frontal Sinusitis Is Not Caused By Brow Bone Reduction. While the osteoplastic technique does expose the frontal sinus cavity, often not leaving the underlying mucosal lining completely intact. such exposure does not place one at increased for subsequent sinus infections. Almost every frontal sinus cavity that i have ever seen is completely healthy and no patient has ever reported a frontal sinusitis problem later.

Air Leaks Are Uncommon Sequelae from Brow Bone Reduction Surgery. By taking off the overlying bone and some mucosal lining with it, broad frontal sinus exposure does occur. But putting back the reshaped bone provides a near complete seal on most cases. When small openings around the replaced bone are seen, which is common, patching of them are done. This is accomplished by a variety of materials from temporalis fascia, bone cement or even bone wax. Despite these efforts, it is possible that extreme sinus air pressure (usually from blowing one’s nose) can open up a small hole (‘blow hole’) right after surgery. This is seen by the filling up of the forehead with air. Time and avoiding blowing one’s nose usually makes this a self resolving problem as the tissues eventually scar down.

Upper Forehead Augmentation May Be Needed When The Brow Bones Are Reduced. Some prominent brow bone patients have the opposite problem in the upper forehead. While the lower forehead may be too prominent, the upper forehead may be too recessed or sloped backwards. This can be simultaneously treated by building up the forehead above the brow bones with bone cement after the brows are reduced. The angulation of the forehead in profile should be assessed before surgery to avoid missing this aesthetic problem and the opportunity to simultaneously correct it. (the ying and yang of forehead reshaping)

Dr. Barry Eppley

Indianapolis, Indiana

February 6th, 2014

Combining Liposuction and Arm Lifts – The Brachiolipoplasty Procedure


Arm Reshaping Surgery Indianapolis Dr Barry EppleyArm lift or brachioplasty surgery had become very popular in the past decade, largely due to the preponderence of bariatric and weight loss surgery. While many women would like to have smaller and more shapely arms, liposuction remains the only surgical technique of arm reshaping in most non-weight loss patients due to the scar from arm lift surgery.

Arm lifts fundamentally involve a simple excision of skin and fat with the only nuance of how to orient the excision and the final placement of the arm scar. While plastic surgeons have various locations of the final scar (medial arm, posterior arm and posteromedial arm), one scar location over the other has never been proven to offer a superior scar result or less wound healing complications.

In the February 2014 issue of Plastic and Reconstructive Surgery, an article was published entitled ‘Avulsion Brachioplasty: Technique Overview and 5-Year Experience’. In this paper, 44 consecutive armlift patients over five years were reviewed based on a treatment combination of liposuction combined with skin resection. The average amount of liposuction aspirate was 340ml per arm and a skin resection average weight of 90 grams. Their results showed no after surgery complications of hematomas or infection. Only one patient had a seroma. Half of the patients needed dressing care for wound dehiscences. Nine (20%) of the patients had a scar revision within the first year after surgery.

Arm Lift Dr Barry Eppley IndianapolisThis article highlights to specific and distinct points about this arm lift technique. First, it demonstrates the value of doing liposuction to aid arm lift surgery. Besides helping to debulk the arm and making for a better reduction in its circumference, it also helps to better preserve the lymphatics and decrease after surgery swelling. With a lot of skin removal in the upper arm, a tight closure due to thick skin flaps can increase the risk of wound dehiscences.

The second important point is that armlift surgery is associated with a fairly high risk of minor wound dehiscences and scars that are unpredictable in their quality. This is due to the very thin skin of the upper arm which is unlike most other areas of trunk and extremity surgery. While all go on to heal without the need for surgical intervention, it it a process that can take up to 6 to 8 weeks after surgery to have complete incisional healing and the cessation of any suture extrusion. (spitters)

The location of the incision and the resultant scar in arm lifts, as this article as discussed, is best done in the posteromedial upper arm location. I have evolved to this location over the years as it offers the best aesthetic location between when one raises their arms or has them down at their sides. Being halfway between the side and the back of the upper arm, it offers the greatest amount of concealment in a location where the concept of a completely hidden scar is not realistic.

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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