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.

February 21st, 2014

Case Study – Custom Temporal Implants for Head Widening

 

Background: The head has a wide variety of shapes and sizes. Like the face, there are  certain head shapes that are more pleasing than others. While one knows intuitively whether they like their head shape or not, there are certain measurements of height and width of the head that can help classify its beauty or conversely its degree of deformity.

Head Measurements Dr Barry Eppley IndianapolisHead and face measurements and their ratios have been studied for over 100 years in a field of scientific study known as anthropometry. Classic anthropometric measurements of the head are its length, width and cephalic index. The length of the head (front to back) is measured from the midpoint of the brow just above the nose back to maximal projecting point of the back of the head. The width of the head is from a point just above the ears from one side to the other. Taken together the cephalic index is derived which is obtained by taking dividing the width of the head by its length which creates a percent ratio. This number is almost always less than 1 since most normal human skulls are longer than they are wide. Based on their cephalic index, head shapes have been historically divided into three main types; long-headed (dolichocephalic, > 80%), medium-headed (mesocephalic, 75% to 80%) and round-headed (brachycephalic, < 80%)

The dolichocpehalic head is one that has a narrow head width. (which is compensated for by an increased head length) But there are certain head shapes that are narrow in their bitemporal width but do not have an increased cranial length. Their mid-temporal region slants inward as it ascends upward to the top of the skull rather than having a more aesthetically pleasing convex shape on the side of the head.

To date, there has not been any known method to safely and easily create aesthetic augmentation for increasing the width of one’s head should their bitemporal width be too narrow.

Case Study: This 35 year-old young man did not like the narrow width of his head. He felt his head was too narrow above the ears and it slanted inward rather than outward. This made his head ‘too small’ and disproportionate for the rest of his head and face shape. He wanted a wider head but did not want any visible scars in doing so given his close cropped hair.

Custom Temporal Implants for Head Widening Dr Barry Eppley IndianapolisWhile a 3D CT scan would have been ideal to make his custom temporal implants, he wanted to forego that extra expense. Using a standard male skull model, implant designs were done in silicone elastomer putty by hand with dimensions of 10 cms long, 8cms high and 7mms thick at its central location. The edges were made paper thin to have a smooth implant transition. The handmade temporal implants were converted into a medium durometer medical grade silicone implant and sterilized.

temporal implant size dr barry eppley indianapolisTemporal Widening Implants Surgical Placement Dr Barry Eppley IndianapolisUnder general anesthesia, skin incisions were made on the back of the ear in the depth of the postauricular sulcus. Dissection was carried down to the fascia and then superiorly under the lower edge of the temporalis muscle. Wide submuscular elevation was done over markings for the implant location that were made prior to surgery. The temporal implants were then rolled and inserted through the small incision and all edges unrolled once inside. The implants were then secured to the underlying bone at its lower edge with two 1.5mm titanium screws. The incision were closed in multiple layers, re-establishing the postauricular sulcus by dermal sutures to the fascia.

While he had some moderate temporal swelling after surgery, his pain was minimal. He had little recovery other than some swelling that resolved in a few weeks. His head width was instantly changed into a more convex shape which was very pleasing, adding 1.5 cms of bitemporal width. (Due to patient privacy, he did not want his before and after pictures published online. However he is willing to have them sent to anyone that wants to view them privately. You can request his before and afters by contacting me at info@eppleyplasticsurgery.com)

This type of temporal implants provide increased width and convexity for the narrow head. While custom temporal implants can be made from a  patient’s 3D CT scan, the relative flat bony surface of the mid- and posterior temporal region makes a semi-custom approach a good treatment option. This new type of skull implant design provides another option in skull reshaping/augmentation that provides a different type of temporal augmentation that smaller more anterior-based implants for the non-hair bearing temporal hollow.

Case Highlights:

1) A narrow head is usually due to a bitemporal width reduction of the skull and/or muscle.

2) Custom temporal implants can be made to increase the bitemporal width from 5mm to 7mms per side.

3) Large custom temporal implants can be discretely placed through incisions on the back of the ears.

Dr. Barry Eppley

Indianapolis, Indiana

February 20th, 2014

Recipient Site Behavior of Fat Grafting

 

Indianapolis Fat Grafting Dr Barry EppleyFat grafting has become a very popular method of soft tissue augmentation. While it is not always completely effective due to post-transplant absorption, it is always very safe given the natural composition of the graft. When effective the initial augmentation result can be quite good but its long-term effects are not really known given its widespread current clinical use for a large number of face and body procedures.

How the fat graft may behave when transplanted is an interesting and very relevant question. One naturally assumes that whatever fat survives will sit there in a stable fashion for the remainder of the patient’s life. But such a thought would be naive as fat is well known to be influenced by a variety of hormonal and diet factors. But like all transplanted tissues, does the graft maintain its natural donor site behavior or does it acquire the characteristics of the site into which it is transplanted.

In considering this issue, a paper appeared in the February 2014 issue of Plastic and Reconstructive Surgery entitled ‘Analysis of Fat Graft Metabolic Adaptation and Vascularization Using Positron Emission Tomography-Computed Tomographic Imaging’. In a mouse model, fat grafts were taken from the epididymal region and placed in the forehead with or without vascular endothelial growth factor. Fat graft volume and metabolic activity were assessed by PET-CT scans after transplantation. Their results showed that the transfer of the metabolically inactive fat changed its metabolic activity to resemble that of the recipient site. The addition of a growth factor improved both the revascularization and volume survival of the grafts.

While this paper has a long title, what it suggests about the basic biology of fat grafting is far more succinct and encouraging. If fat grafts truly lose their harvest site characteristics then it would not matter where the donor site for the fat is. This would mean that abdominal fat would behave more like breast tissue if placed into the breasts and knee fat would behave like facial fat when transferred there, for example.

While this experimental study suggests that fat grafts change their metabolic characteristics, there is a growing body of clinical evidence that this may not always be so. I have seen numerous grafted patients where the fat has grown disproportionately at the recipient site as a result of overall weight gain. In each case the donor site was the abdomen. Such cases have been seen in lip and cheek fat injections in women and a Poland’s chest augmentation in a man.

While this experimental study shows a desired conversion of the metabolic activity of fat grafts to their recipient site and most of the time fat grafts survive less than desired, fat graft overgrowth does occur and is a long-term risk. No one yet knows what type of patient and what fat graft donor or recipient site may be predisposed to this lack of conversion to the biologic behavior of the recipient site

Dr. Barry Eppley

Indianapolis, Indiana

February 20th, 2014

Plastic Surgery Product Review: Funnel 2 Device for Breast Augmentation

 

Breast augmentation requires the insertion of an implant through an almost always smaller incision than the size of the implant. This is not an issue with saline breast implants since they are inserted in a rolled fashion and inflated once in place. But silicone breast implants must be placed fully filled and their placement through small skin incisions stresses the implant shell and may lead to premature rupture and a shortened lifespan of the device.

Introduced in 2009, the use of a funnel device improved this aspect of silicone breast augmentation surgery. This unique device, shaped just like its name implies, allows a silicone implant to be ‘shot through’ small skin incisions easily and with far less stress placed on the implant shell. It also allows the implant to be go from package to breast pocket without ever being touched by human hands or touching any skin surface reducing  risk of bacterial contamination.The funnel’s shape is one reason why it works but its slippery inner lining is just if not more important than the device’s shape.

Funnel 2 Breast Augmentation Indianapolis Dr Barry EppleyNow the funnel device has been improved and is known as the Funnel 2. It is now clear as opposed to the  first generation opaque device which allows the breast implant to be easily visualized and oriented prior to insertion. This is not only helpful to keep the base of the round silicone implant downward against the chest wall but also critical when placing textured shaped breast implants. Turning a textured breast implant around in a breast pocket is not always easy and proper orientation is critical to the final shape of the breast after surgery.

The Funnel 2 has the same interior hydrophilic coating that creates a slick surface which allows the breast implant to glide easily into the pocket with the same no-touch technique. This improved device continues to be an essential component of contemporary breast augmentation surgery.

Dr. Barry Eppley

Indianapolis, Indiana

February 19th, 2014

Non-Invasive Body Contouring with the Vanquish Device

 

Non-invasive body contouring devices have been around for almost a hundred years and, historically, most were more gimmick than effective. But the past decade has seen a new generation of body contouring devices that actually have science behind them and do offer some fat reduction benefits. While all such current devices are different, they are similar is that they create their effects by driving some form of energy to the fat that lies beneath. This energy then breaks up the fat cell wall, allowing its lipid contents to leak out and be absorbed.

One of the more popular energies today is radiofrequency. Everybody knows radiofrequency energy as almost everyone owns or has operated a microwave oven. While it is not the same as cooking a food dish in a microwave, the energy that radiofrequency-based body contouring devices is similar. Just like that food dish that gets hot in the middle but is still cold or uncooked on the outside, so it is with the fat that lies underneath the skin.

Vanquish  Fat Reduction Dr Barry Eppley IndianapolisVanquish is a relatively new radiofrequency-based body contouring device that helps destroy fat cells without surgery. Studies have shown that many patients can lose up to two inches around their waist. It’s a noninvasive treatment and requires no downtime. The procedure takes about 30 minutes and requires around four to eight sessions spaced one week apart.

Vanquish Body Contouring Dr Barry Eppley IndianapolisA treatment session is as simple as laying on a comfortable spa bed and an aesthetician places a set of panels over the patient’s abdomen about one inch from the skin. The panels never touch the patient’s skin and does not need to. The device is then turned on and heats up the fat cells under the skin. A warm sensation is felt but never any pain. The depth of the devices’s is about one inch under the skin and is why multiple treatments are needed to work down through the thickness of the fat layer.

While many plastic surgeons are initially skeptical of the device in the beginning, the results quickly win them over. The best patients are those who are mildly overweight with a few problems areas that have not been lost with diet and exercise efforts. Women after menopause that have collected far right around the middle are great candidates as the stubbornness of this type of fat is well known.

Immediately afterwards the treated areas will have some mild redness and swelling but there are no activity restrictions. It is important for the patients afterwards to drink plenty of water and stay hydrated. This helps eliminate the lipids released from the dead fat cells.

The Vanquish device is not a substitute for what liposuction can do…but it can in the right patient prevent it from ever becoming a possibility.

Dr. Barry Eppley

Indianapolis, Indiana

February 18th, 2014

Ear Reduction Surgery for Macrotia

 

The most common aesthetic ear problem is that of the protruding ears. Caused by either the lack of a well defined ear fold or too big of an inner concha, a good ear shape can be obtained by a variety of traditional otoplasty techniques. While the protruding ear often appears to be too big, it only appears so because they stick out too far from the side of the head. Once brought back into a more pleasing relationship to the side of the head, the once protruding ear now appears normal in size.

Ear Height Measurements Dr Barry Eppley IndianapolisBut there are ears that are occasionally too big or oversized known as macrotia. In essence they are disproportionately large in height compared to the size of the head. Anthropometric measurements have shown that the normal vertical length of the ears are around 60mms in women (58 to 62mms) and somewhat larger in men, averaging closer to 65mm. (range of 62 to 66ms) The height of the ear has also been historically stated to be equal to the length of the nose although this is a far less reliable measure of an acceptable size. Ultimately, however, what appears is whether the patient thinks their ears are too big or not.

Just like for the protruding ear, there is an otoplasty surgery to make big ears smaller. (less tall) Unlike protruding ear surgery, however, skin and cartilage must be removed to reduce its vertical height. While one method is to take out a large central wedge from the middle of the ear, this produces more of a visible scar that crosses two two ear ridges as it goes from the concha to the outer helix. This is more of an ear reconstruction technique commonly used in skin cancer.

Vertical Ear Reduction Technique (Scapha Reduction) Dr Barry Eppley IndianapolisA more aesthetic ear reduction technique for macrotia is the ‘high’ and ‘low’ method. Taking some tissue from the top and the bottom of the ear creates a noticeable height reduction while placing scars in more inconspicuous locations. This ear reduction surgery is done by a ‘high’ excision by the taking of a crescent-shaped segment of skin and cartilage from the scapha fossa. Depending upon how much height needs to be reduced, this may or may not cross the helical rim at its lower end. The ‘low’ excision involves a helical rim wedge excision along the bottom part of the ear lobule. As much as 10 to 12mms of ear height can be reduced with this ear reduction method.

Unlike setback otoplasty, ear reduction otoplasty surgery actually involves less recovery and swelling of the ear as the actual extent of surface area of the ear traumatized is less.

Dr. Barry Eppley

Dr. Cris Ueno

Indianapolis, Indiana

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


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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