EXPLORE
Plastic Surgery
Dr. Barry Eppley

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

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

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

July 4th, 2014

Facial Volume Enhancement By Injectable Fillers

 

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

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

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

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

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

June 29th, 2014

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

 

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

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

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

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

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

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

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

June 28th, 2014

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

 

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

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

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

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

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

June 28th, 2014

Plastic Surgery Products: SERI Silk Scaffold for Soft Tissue Support

 

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

June 28th, 2014

Fat Injections for Lower Eyelid Retraction

 

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

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

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

June 25th, 2014

Plastic Surgery Wisdom – Assessing ‘Small’ Aesthetic Surgery Results

 

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

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

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

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

Dr. Barry Eppley

Indianapolis, Indiana

June 23rd, 2014

E-Cigarettes and Plastic Surgery

 

Electronic cigarettes (e-cigs) have increased dramatically in awareness and use over the past few years. In plastic surgery, just like in the rest of the society, we are seeing an increasing number of patients presenting in consultations or for surgery who use them. The number still pales in comparison to patients who use tobacco-based cigarettes but the incidence is sure to increase over the next decade.

E Cigarettes and Plastic Surgery Dr Barry Eppley IndianapolisThe fundamental concept of e-cigarettes is that it simulates tobacco smoking but without many of the smoke-related dangers. It essentially uses a battery-powered vaporizer that uses a heating element to turn a liquid solution into water vapor. (hence the term ‘vaping’)  The liquid solutions are glycerin and propylene glycol-based with flavorings. Many of the liquid solutions contain nicotine but nicotine-free liquids are also available. Users get the psychological pleasure of smoking by the hand-held device and the creation of a vapor and the taste of the flavorings.

The health benefits of vaping have been touted as being safer than tobacco products due to isolating inhalation down to just nicotine or even no nicotine at all. While logic would suggest that this is very likely, the medical community and the government have yet to weigh in on this issue with clinical studies. But that issue aside, with an estimated 3% of the U.S. population using them, what risk do they pose for a user undergoing plastic surgery?

Vaping and Plastic Surgery Dr Barry Eppley IndianapolisFor those who vape with liquids that contain nicotine, the postsurgical risks are the same as other nicotine replacement therapies such as gum and patches. Nicotine is a potent vasoconstrictor so procedures that raise extended skin flaps that rely on dermal perfusion for viability (e.g., facelifts, tummy tucks, breast reduction/lifts) are at risk. Patients who vape need to switch to non-nicotine containing liquids for their liquid solutions two weeks before and after surgery use. These would be the same recommendations that have been given for tobacco products for years.

Besides counseling our regular smoking patients about the necessity to cease smoking before and after plastic surgery, an alternative suggestion can be to have them switch to e-cigarettes during this period. As long as they use a non-nicotine solution, vaping can be a substitutional habit as a bridging therapy during the perioperative period.

Dr. Barry Eppley

Indianapolis, Indiana

June 22nd, 2014

Plastic Surgery Case Study: Teen Rhinoplasty

 

Background: Rhinoplasty is one of the most popular cosmetic surgery operations in teenagers. While the basics techniques of nasal reshaping in teen rhinoplasty are no different than that in adults, there are numerous unique aspects to it that influence its timing and potential interpretation of the results.

Teen Rhinoplasty Dr Barry Eppley Indianapolis copyTeen rhinoplasty is usually very seasonal, with teenagers presenting for surgery during school breaks and particularly during the summer. They often present in a transitional time, like between high school and college, as they go into a new social environment that will not interpret that they have had surgery. While a teen may want a noticeable change in their face, they often are particularly private about it being done.

A common question is when can a teen have a rhinoplasty? While there are no absolute anatomic or growth guidelines, the more important question is the psychological stability and expectations of the teen requesting it. This is where the role of the parents has a great insight and influence. But as a general guideline, girls can have it done as early as 13 or 14 while boys should wait just a little longer and have the surgery closer to age 15 or 16 years olds. There are exceptions of course and this depends on the magnitude of the nasal deformity.

In today’s internet and Facebook world, the expectations of a teen rhinoplasty are of critical importance. Teenagers often email or come in with pictures of models and celebrities for what they want their nose to look like. They not infrequently ask if they can have their nose just like a certain famous person. It is important to point out to them that such a change is not only not possible and they should strive to have nose changes that fit their face and can be surgically achieved. This is where the role of computer imaging plays an invaluable role, even if it is not always what the teens wants to hear or see.

Besides cosmetic changes, a teen may seek rhinoplasty for functional reasons as well. Breathing difficulties from trauma or a sports injury or congenital or developmental abnormalities such as cleft lip and palate all commonly cause breathing difficulties or an obviously crooked nose. These situations are where a combined functional and aesthetic procedure is done known as a septorhinoplasty.

Case Study: This 16 year-old female had wanted a rhinoplasty ever since she went through puberty. She wanted it done in the summer between her junior and senior high school years. She felt her upper nose was too flat and broad and the tip of her nose was too long and downturned. She wanted a more refined ‘cuter’ nose that had a more narrow bridge and shorter and less wide tip. She had no breathing problems.

Teenage Rhinoplasty result front view Dr Barry Eppley IndianapolisUnder general anesthesia, an open rhinoplasty approach was used and septal grafts harvested. The bridge was augmented with a two-layer stacked septal grafts and low lateral nasal bone osteotomies done to narrow the shape of the upper nose. A cephalic trim was performed on the lower alar cartilage with turnover batten grafts, the tip shortened by a dome division technique, the caudal septum trimmed, a columella strut graft placed and a double dome suture technique used to shorten, narrow and slightly upturn the tip.

Teenage Rhinoplasty result side view Dr Barry Eppley IndianapolisRecovery was typical for a rhinoplasty with tapes and splint removed one week later. By three weeks after surgery, her bruising and obvious swelling was gone. She went to cheerleading camp at six weeks later and returned to school nine weeks after surgery. While her nose was still not completely settled and further refinement and shaping will take place over the school year, the shape of her nose was more pleasing to her even at the start of the school year.

One of the biggest challenges after a teen rhinoplasty is the realization that complete rhinoplasty healing is a process and could take up to a year to see the final result. Expectations from many teens is that rhinoplasty is like ‘instant oatmeal’ or as simple to get the result as what they saw on Photoshop. This is where having the parents on board initially to provide a support system after surgery can be very important. Teens do have a recovery advantage in that they tend to heal quickly and their nasal skin often has good elasticity so it may shrink down faster.

Case Highlights:

1) Teen rhinoplasty is unique from adults in its timing and expectations from the surgery.

2) Computer imaging before any rhinoplasty, particularly in teens, should be done to prevent any unrealistic expectations.

3) Parental support is crucial in teen rhinoplasty to support the patient through the recovery period.

Dr. Barry Eppley

June 21st, 2014

New Paranasal Implant Design for Midface Augmentation

 

Of all the commercially available facial implants, one of the most obscure and least commonly used is that of the paranasal implant. Augmenting the base of the nose is historically associated with rhinoplasty surgery in an effort to add overall projection to the base of the nose. It was initially seen as a nose augmentation procedure not necessarily a facial skeletal implant to improve midface projection of the pyriform aperture region

paranasal implant anatomy pyriform aperture dr barry eppley indianapolisAnatomically the pyriform aperture refers to the anterior nasal aperture. This is a vertically oriented opening in the face with a wider base under the nostrils and a more narrow end superiorly just below a line between the eyes. From a bony standpoint it is bordered by the nasal bones superiorly and on the sides by the maxilla. At its lower end the maxillary bone curves centrally to join in the midline to create the anterior nasal spine prominence.

thAugmenting the paranasal region is currently done by using the well known peri- pyriform aperture silicone implant. While this design seems logical, its use in my experience has been plagued by too much fullness to the side of the nose creating an unaesthetic and uncomfortable ‘bump’. Patients often interpret this as misplacement/displacement of the implant from its desired location.Its shape does not really permit it to lie very close to the rim of the pyriform aperture and it frequently must be trimmed to do so. While the pyriform aperture area of the midface is not big, its proximity to the sensitive lips and base of the nose does not permit much forgiveness in terms of implant size and location.

Paranasal Implant Designs Dr Barry Eppley Indianapolissilicone paranasal implant designTo overcome the problems with current implant shapes, a new paranasal implant design has been developed. It has more of a triangular shape with a more tapered shape at its lateral and inferior edges. This allows its point of maximal projection (5mms) to lie directly under the nostrils and allows it to flow smoothly into the surrounding concave maxillary bone. This avoids any noticeable or palpable bump to the side of the nose and makes it undetectable from the outside. It is surprising the influence that a small amount of projection (5ms) has in just the right location.

silicone paranasal implant surgical placementThe paranasal implant is placed through a small 1 cm incision in the depth of the maxillary vestibule, just medial to a vertical line drawn up from the canine. A short dissection upward locates the lateral aspect of the pyriform aperture just under the base of the nose. Only a small pocket is needed. The paranasal implant is easily inserted and positioned. Because it is a small and tight pocket, no fixation is really needed. (although I almost always use it as I do with just about every facial implant but it can be argued it is not absolutely needed for this implant) A two-layer closure (muscle and mucosa) is done over the implants.

Paranasal implants add projection to the lower central third of the midface. They are used to augment a more flat midface profile with a sunken nasal base. This new design is more anatomically based, adds projection in the right location and can be easily placed without postoperative palpability. Its effectiveness and procedural simplicity should extend facial augmentation benefits to more patients.

Dr. Barry Eppley

Indianapolis, Indiana

June 20th, 2014

Real Self 100 – Dr. Barry Eppley

Real Self Indianapolis Dr Barry EppleyReal Self is one of the internet’s top sites for patient information on cosmetic and plastic surgery procedures. If you are looking to have any face or body cosmetic surgery, Real Self is a great consumer website that is very much a social network for those who want have a procedure done or are looking to connect with those that already have. This website concept was created in 2006 by Tom Leary, who also helped create Expedia for travelers. It is an online community for learning and sharing information and experiences about cosmetic surgery. It is sort of a Facebook for cosmetic surgery but with input by professionals who have a lot of experience with the topics. Many people write in questions for the doctors who participate in Real Self to answer and one can receive just a few answers or up to a dozen from doctors across the country. Patients and doctors post before and after pictures and some patients share their cosmetic surgery experiences.

Real Self Dr Barry Eppley Indianapolis Plastic SurgeryFor 2013, Indianapolis plastic surgeon Dr. Barry Eppley was selected as one of Real Self’s top 100 doctors.As a Real Self 100 honoree, Dr. Eppley was recognized as a leading social media influencer in cosmetic surgery. This award is a testimony to his commitment and contributions throughout the 2013 year on the Real Self website. Contributions used to determine Real Self’s 100 include posted answers and photos as well as feedback shared by patients through reviews and stories. The recipient of this award were amongst the top 2% of the 6,000 doctors who are part of the Real Self doctor community.

In 2013, the 100 doctors on the list collectively impacted tens of millions of patients, with nearly 20% of our total site views centered on helpful answers and information posted by a relatively small group of doctors.


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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