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.

January 11th, 2015

Plastic Surgery Case Study: HTR Occipital Implant for Flat Back of the Head

 

Background: The flat back of the head is one of the common aesthetic skull deformities. It usually originates from either a genetic predisposition or a deformational effect of in utero or post birth head positioning. (occipital plagiocephaly) The flatness can be on just one side or both. (bilateral) When it occurs bilaterally there are aesthetic issues of skull disproportion that often bothers the person enough that they may great efforts at camouflaged by various hairstyles and hat wear.

Cosmetic correction of the flat back of the head is done using a variety of onlay implant materials. The contour of the bone is expanded through subperiosteal augmentation whose amount is controlled by the ability of the overlying scalp to expand.Those materials that are applied and shaped intraoperatively are several types of bone cements. (PMMA and hydroxyapatite cement) Preformed custom occipital implant materials include silicone, Medpor, HTR and PEEK. Of these custom shaped materials, only silicone is soft and flexible while the other polymers are quite rigid.

HTR Cranial Implants Dr Barry Eppley IndianpolisHTR (Hard Tissue Replacement) is a well known cranioplasty material. It has been used as a custom made implant for cranial defects for over 25 years. It is a unique polymer material because it is both porous and hydrophilic. These material characteristics allow it to become well vascularized throughout its thickness after implantation. It has a very successful history of inlay reconstructive use for skull bone defects but has been very rarely used as an onlay material for aesthetic augmentation.

Case Study: This 38 year-old male had a very flat back of the head for which he had prior attempts at occipital augmentation. He had a prior occipital implant (material unknown) placed through a long coronal scalp incision which ultimately became infected and had to be removed. This left the back of his scalp scarred and more rigid than normal. He thoughtfully considered all the implant materials and chose HTR because of its potential to become vascularized throughout the material. A 3D CT scan was used to create an occipital implant design of 18mm thick at its central portion.

HTR Occipital Implant Scalp Flap Elevation Dr Barry Eppley IndianapolisIn the prone position under general anesthesia, his original high occipital scar was completely cut out down to the bone. An occipital scalp flap was developed down to below the nuchal ridge at the base of the occipital bone. While the scalp flap raised easily it was very thick and inflexible. Extensive cross cuts in a grid pattern were done through the scar to create a full occipital flap release to create enough tissue looseness to close over an implant augmentation.

HTR Occipital Implant positioned Dr Barry Eppley IndianapolisThe HTR occipital implant was soaked in antibiotic solution and placed in its proper position on the position. It was secured with small plates and screws in a triangular pattern. Because the edge of the HTR material can not be made paper thin, a layer of PMMA bone cement was used to create a smooth transition from the implant to the bone.

HTR Occipital Implant Augmentation result intraop top view Dr Barry Eppley IndianapolisHTR Occipital Implant Augmentation for Flat Back of the Head Dr Barry Eppley IndianapolisWith an 18mm expansion in a previously operated and scarred flap, even with using a full coronal incision, the wound closure was tight over the implant. Fortunately no wound separation developed when the staples were removed. He went on to heal uneventfully, has developed no infection or fluid collections and is satisfied with his results.

Rigid implant materials like HTR can be successfully used in aesthetic skull augmentations. But the material characteristics makes for the need to use a long scalp incision for placement and some experience on knowing how to properly secure it without fracture or palpable implant edges.

Case Highlights:

1) Occipital augmentation skull reshaping surgery can be done by custom implant materials like HTR which is also porous.

2) Because HTR is a hard inflexible material it must be placed through a full coronal scalp incision.

3) Fine edging of HTR as an onlay material may need to be supplemented with a bone cement material to create perfectly smooth edge transitions.

Dr. Barry Eppley

Indianapolis, Indiana

January 10th, 2015

Female Nipple Reduction Surgery

 

Nipple concealers Dr Barry Eppley IndianapolisProtruding nipples can occur because of they naturally develop, induced to grow by pregnancy and breastfeeding, or inadvertently become more obvious by the placement of breast implants. Nipple hypertrophy can be managed by a variety of  products to help flatten and hide their prominence. These are usually circular silicone shields which, when applied to your skin, stay in place and help conceal your nipple in clothes. They are relatively inexpensive and go by such interesting names as ‘low beams’ and ‘top hats’.

But having to be constantly on guard about nipples that appear through clothes can be solved by a simple operation. Nipple reduction is a procedure which surprisingly some women are unaware. The procedure removes a portion of the nipple to make it smaller and is usually done under local anesthesia. The main goal is to reduce its length which makes it less prominent. In shortening the nipple it may also become more narrow in width.

Nipple Reduction Wedge Technique Dr Barry Eppley IndianapolisNipple reduction is done by two basic techniques. Removal of a pie-shaped wedge of nipple tissue is the most common method and can produce the most dramatic change in nipple length. Because it removes a portion of the actual nipple, some sensation may be lost. The other nipple reduction technique is to remove a circular ring of nipple from its sides. This technique is best used for this women who are concerned about any loss of nipple sensation.

Besides the risk of loss of nipple sensation, nipple reduction may make it harder to breast feed. Depending on the technique used you may not be able to breast feed if the terminal openings of the breast ducts become scarred. (like from a pie-shaped wedge of nipple reduction technique) This nipple reduction surgery should be deferred until after having children for women who are interested in breast feeding in the future.

Female Nipple Reduction intraop result Dr Barry Eppley IndianapolisNipple reduction surgery can be performed concurrently during any other breast procedure from having implants to undergoing a breast reduction. But of there is any doubt about whether nipple reduction needs to be done, deferring it to later does not cause a problem. It can always be done in the office later under local anesthesia.

The need for nipple reduction is a subjective one. Nipples that are easily detectable in thinner bras or under clothing without a bra can be a source of embarrassment. The good news is that this is a problem which can be simply solved in less than thirty minutes.

Dr. Barry Eppley

Indianapolis, Indiana

January 8th, 2015

PRP (Platelet Rich Plasma) Therapy for Hair Regeneration

 

Hair loss is incredibly common for both men and women. The use of non-surgical topical Minoxidil and oral Propecia as well as surgical hair tranplantation are well known and offer hair maintenance and hair restoration benefits to many. But between these two type of treatmets lies an intermediate hair therapy that has been historically lacking…a form of injectable therapy. That role is now beginnning to be filled with PRP therapy. PRP injections are a non-surgical method of hair stimulation that can be used for both men and women.

Platelet Rich Plasma Injections Indianapolis Dr Barry EppleyWhat is PRP? PRP (platelet rich plasma) is an extract of human blood that is an isolated concentration of platelets which contain high levels of specific growth factors that are well known to induce tissue regeneration and healing. When injected into the scalp, a growing body of medical evidence indicates that it is promising treatment option to promote hair growth. It is important to understand that PRP is derived directly from the patient so it is a completely natural blood product. While PRP has been around for years it has largely been a technology relegated to the hospital and use in major surgery. With today’s technologic advancements, PRP is now available to be used in an office setting for numerous aesthetic treatments such as hair regeneration.

How does PRP for hair growth work? It is postulated that PRP can cause the growth of hair through stimulation of the stem cells located in the dermal papilla of the hair follicle.(bulb) It is very likely that it may stimulate other structures in the hair follicle as well. PRP may induce a hair follicle to change from the resting staten (telogen) to the growth phase.(anagen) This may ‘wake up’ dormant hair follicle and/or may cause active ones to grow faster or develop slightly thicker hair shafts.

How is PRP done? A small amount of blood is drawn in the office, mixed with an antocoagulant and spun in a centrifuge for around 10 minutes. This process separates the blood into various fractions, one of which is the platelet layer or platelet rich plasma fraction. The pure PRP can then be injected into the scalp using small needles directly below the skin (hair follicles are below the skin not in it) or the microneedling can be done onto which it is applied topically. Treatments can be repeated every four months if needed to see optimal results. (hair follicle take months to grow out and see a visible shaft)

PRP Hair Regeneration Men Dr Barry Eppley IndianapolisPRP Hair Regeneration for Women Dr Barry Eppley IndianapolisWho is a good candidate for PRP hair regeneration? While individual results vary and no guarantee can be given that hair will grow, PRP works best in thinning hair. It will not take a ‘desert’ and turn it into a lush garden. It is not a magic potion that can make hair appear that has been completely absent for decades. Rather it requires some follicles to be present for its stimulatory effects to be seen. This is why it works just as well for women (maybe even better than men) because they may have more active follicles initially anyway. PRP is a good adjunctive therapy to be used both before and after hair transplantation. It is also an excellent treatment for those patients who have lost their hair from chemotherapy. (follicles induced into telogen by chemical poisons)

PRP is an emerging non surgical based therapy for natural stimulation for thinning hair. PRP is completely safe and natural because it contains the patient’s own blood product. The scientific evaluation of the effectiveness of PRP therapy for hair regeneration is currently under clinical trial investigation and its efficacy is currently based on anectodal and case report evidence only. Thus it should not be considered FDA approved or view as a ‘baldness cure’.

PRP therapy is a natural alternative for improving hair growth for those patients who do not want surgical hair transplantation. Conversely it is also an adjunctive therapy for those that have already undergone hair transplants. Although results will vary from patient to patient, PRP injections offer improvement in hair caliber and thickness for natural thinning and miniaturization or as a stimulus for newly implanted follicles.

Dr. Barry Eppley

Indianapolis, Indiana

January 8th, 2015

Complication Rates of Inner Thigh Lifts

 

There are may women who are not happy with the appearance of their inner thighs. But when significant weight loss has occurred after dieting or bariatric surgery, the inner thigh can develop considerable loose skin which is maximally unaesthetic in its appearance. This is the most common patient in which an inner thigh lift (medial thighplasty) is done.

The inner thigh lift can treat varying amounts of loose tissue and there are a variety of patterns of skin and fat excisions that can be done. These patterns include horizontal, short vertical and long vertical inner thigh lifts. The pattern of excision chosen is based on the location and extent of the loose tissues and how much of the length of the inner thigh is involved. Despite inner thighs being now more than ever before, it is the one body contouring procedure which is probably written about and critiques the least.

Thigh Lift Scars Dr Barry Eppley IndianapolisIn the January 2015 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘Medial Thigh Lift in the Massive Weight Loss Population: Outcomes and Complications’. In this paper, 106 patients (90 women, 16 men) over a nine year period who had various types of inner thigh lifts performed were assessed. Horizontal thigh lifts had a 43% complication rate, short scar inner thigh lifts had a 67% complication rate, full length vertical inner thigh lifts had a 74% complication rate. Complications included wound dehiscence (50%), seroma (25%), infection (16%)  and hematoma. (6%) Chronic leg edema occurred in 25% of the patients which in a few patients took up to one year to resolve. Liposuction outside the scope of the excision was associated with increased complication rates.

For those plastic surgeons that have performed more than just a few inner thigh lifts, this study really rings true. Inner thigh lifts are associated with a high rate of complications and some degree of suture line dehiscence is the norm and not the exception. It is only a question of how big the separation will be and how long it will take to heal. To no surprise, the more extensive the inner thigh lift is (the longer the scar) the higher the rate of potential complications. It is a bit surprising that liposuction also increases the rate of wound dehiscences. But probably not surprising when thought about biologically since it traumatizes the skin flaps and disrupts lymphatic outflow.

Why do thigh lifts have such a rate of wound problems compared to other body contouring procedures? It simply is the location of the incisions are in an area of the body that is exposed to a lot of stress and shearing on the wound closure. It is also over an area of a density of lymph nodes (inguinal lymph node basin) which make sit prone to seroma formation.

Fortunately most of the wound complications associated with inner thigh lifts are not major and do go on to heal on their own without significant scarring complications. But what this study suggests is that over aggressive inner thigh lifts are doomed for problems and a more conservative inner thigh lift, while falling somewhat short of patient expectations in some cases, will more likely have a smoother and shorter recovery period.

Dr. Barry Eppley

Indianapolis, Indiana

January 6th, 2015

Technical Strategies – Pretrichial Approach to Forehead Craniotomy Defect Reconstruction

 

Craniotomies that involve the frontal and/or frontotemporal bones are commonly done for a variety of intracranial problems such as bleeding from trauma or for access to tumors. While the bone flap is put back into position using low profile plates and screws and the detached temporalis muscle resuspended, residual skull deformities are common.

Frontal skull deformities can occur if the bone flap settles to any degree as it heals or the craniotomy line does not heal by bony union. This can leave a palpable edge or visible ridge across the forehead along the original craniotomy line. A portion of the forehead may also be flatter or more recessed. The temporal region can also develop a visible concavity due to temporalis muscle atrophy from its initial detachment.

Forehead Hydreoxyapatite Cement Augmentation with Pretrichjal Incision Dr Barry Eppley IndianapolisThese after craniotomy contour defects of the forehead and temple region can be built back up by bone cement augmentation very successfully. But it is not always necessary to completely reopen part or all of the original scalp incision. This incision (now scar) is often way far back from the forehead region and may be well healed with regrowth of hair around it. A more direct and simpler approach to the forehead defects can be done through a pretrichial or hairline approach. Bone cement can be introduced through this closer and more limited incisional access.

The pretrichial incision is a standard approach for a cosmetic browlift so it usually heals in an inconspicuous manner. Using an irregular or zigzag incision pattern that parallels the frontal hairline ensures that it will heal with a scar that is hidden along its edge. The pretrichial approach to craniotomy defects of the forehead in selected patients can simplify the secondary correction of their residual contour problems.

Dr. Barry Eppley

Indianapolis, Indiana

January 4th, 2015

Platelet-Rich Plasma (PRP) Use In Facial Laser Resurfacing

 

Fractional Laser Resurfacing Face Dr Barry Eppley IndianapolisLaser resurfacing is a long-standing treatment that can have a profound rejuvenative effect on wrinkled and sun damaged facial skin. By burning off the top layer of skin and allowing it heal, a fresh skin surface is created with fewer surface imperfections.While effective, it is associated with a significant healing time, discomfort and  temporary facial redness. This has been improved by changing from a fully ablative laser treatment, which treats the entire skin surface, to a fractional approach.

Fractional laser resurfacing treats a portion or fraction of the skin surface’s  (usually 5% to 22%) but with deeper channels cut down into the thickness of the skin. This has the dual effect of shortening healing time due to less injured skin surface and causing greater collagen regeneration and tightening. But despite the advantages and reduced recovery time of the fractional laser, adjuvant treatments are still sought to reduce healing time and facilitate a faster recovery. One such treatment is that of platelet-rich plasma. (PRP)

Platelet Rich Plasma PRP Therapy Dr Barry Eppley IndianapolisPlatelet-rich plasma (PRP) has been used for many applications in various surgical fields for its ability to improve wound healing, hemostasis, and graft survival. It is a blood concentrate that is full of platelets. Platelets contain many different growth factors and cytokines in high concentrations which serve as the theoretical basis for the use of PRP in tissue repair. Studies are mixed as to its true effectiveness across a broad spectrum of applications. But the superficial nature of laser resurfaced skin seems like a good application for it.

In the Online First edition of the November/December 2014 issue of JAMA Facial Plastic Surgery, a study was pubished entitled ‘Evaluation of the Effect of Platelet-Rich Plasma on Recovery After Ablative Fractional Photothermolysis’. This was a blinded study using small human forearm test sites that were treated with fractional laser treatments at consistent depths in both arms. The treated sites were immediately treated with either topical PRP or saline. (control) Significant improvement was seen in PRP-treated arms compared to controls in all 15 treated patients. Improvement was defined as the erythema rating of the untreated arm minus the erythema rating of the PRP-treated arm. Patients noticed a reduction in the amount of redness, swelling, itching and pain in the PRP-treated sites.

These study results suggest that PRP can improve the healing rate of facial laser resurfacing sites. It presumably does so by creating a faster rate of skin cells growing across the injured skin surface through earlier induction of cell turnover. It is interesting that such positive results were seen with just one application immediately after the laser resurfacing. Given the reduced cost to acquire a single concentrate of PRP today, it should enjoy broader useage.

Dr. Barry Eppley

Indianapolis, Indiana

January 4th, 2015

Plastic Surgery 2015

 

Plastic Surgery 2015 Dr Barry Eppley IndianapolisAs 2014 has now passed, we look forward to 2015 and wonder what plastic trends will be forthcoming. But looking forward requires looking back at the most common and written about plastic surgery procedures.

The internet and the multicultural diversity in the U.S. has led to a strong demand for buttock augmentation procedures. While by far most commonly done through fat injections (aka the Brazilian Butt Lift (BBL)), buttock implants have increased by a draft effect as well. (thin women are not candidates for a BBL) While buttock enlargement is most popular in the sun and coastal states, their is strong demand in the Midwest as well.

The Mommy Makeover continues to be popular as more women want to try and get back to their pre-pregnancy bodies. While the name is relatively new and catchy, it is a combination of well known body contouring procedures of a tummy tuck and some form of breast reshaping. (implants alone or combined with a lift)

Neck rejuvenation through fat removal and skin tightening applies to the young and old. Sharper neck angles are desired. While multiple non-invasive devices exist that promote neck tightening, nothing compares to what liposuction, necklifts and lower facelifts can create. However external energy treatments like ultrasound and radiofrequency can be a good initial treatment for the surgery wary.

Facial aging is now well known to be associated with fat or volume loss. This is had to increased uses of injectable fillers as office procedures and the use of injected fat in surgery as part of other facial rejuvenation procedures. The cheeks are a key focus for this midface rejuvenation. Cheek implants are not passe but patients are often considering  injection methods before or as a replacement for them.

Increases in fat grafting has not been just limited to the face and buttocks. Fat grafting to the breasts has become an accepted procedure but requires more careful and limited patient selection. Fat is not a replacement for implants in most cases but for a small modest increase in breast size and to add a little shape, fat grafting is a viable option.

Breast reduction in men continues to increase in overall numbers. The interest spans from very young men who may have too much nipple-areolar protrusion to older men with overall chest deflation and sagging. While liposuction alone can be effective for a small number of gynecomastia reductions, it usually needs to be combined with open excision to avoid residual nipple protrusion. Chest sagging in older men usually needs some form of a lift as well to reposition the nipple and chest tissues back up on the chest wall.

All of these procedures will continue to be in strong demand throughout 2015. But the question will be what new ones will emerge and how will the ones we know be modified and improved.

Dr. Barry Eppley

Indianapolis, Indiana

January 3rd, 2015

The Importance of Skin Elasticity in Liposuction

 

Liposuction is the ‘largest’ cosmetic procedure performed around the world if it is rated based on surface area alone. It is certainly by sheer numbers one of the top five aesthetic body procedures performed every year as shown by annual statistics. But the extent of the surface area it treats is what really distinguishes liposuction from any other plastic surgery where tissues are excised (e.g., tummy tuck)

But because it does not remove loose skin, the body contouring effects of liposuction rely upon a phenomenon created by the often large underlying surface area that it treats…skin retraction. Once some of the underlying fat is removed, there is actual skin excess. It is important that this skin shrink down to create an optimal contour reduction result. The shrinkage of the skin is primarily important to reflect the volume of tissue that has been removed. But it is secondarily important to help make the skin surface smooth.

Smartlipo Abdominal Liposuction result front view Dr Barry Eppley IndianapolisIt is the skin’s retractive ability that is important to a satisfying liposuction result. And this is often a physical characteristic patients overlook or hope that it won’t have a big impact on their result. Many times patients, understandably, want to avoid an excisional procedure like a tummy tuck or an arm lift to achieve a contour change. But a smaller contour that has a lot of skin irregularities and unevenness may be less appealing that a fuller contour that has a very smooth skin surface.

Smartlpo Abdominal Liposuction result side view Dr Barry Eppley IndianapolisSkin that does not respond well to the effects of liposuction is either damaged or aged. Women that have a lot of stretch marks around the belly button and lower abdomen is the classic example of lost skin elasticity. Older women, usually around age 60 and older, have skin that is thinner with almost equally poor retractive capability even if no stretch marks are present. Conversely men usually not have the same skin retraction problems, not because they do not get pregnant which helps, but because their skin is thicker and often has hair. (which ensures a greater number of elastic fibers)

When liposuction is done on skin of poor retraction potential, it is important that patients understand the trade-offs. Deflated looking skin is often the result. And while many new energy-based liposuction technologies exist, none of them have a magical ability to create a substantially improved retraction of the skin…despite how they marketed and promoted.

Dr. Barry Eppley

Indianapolis, Indiana

January 3rd, 2015

The Use Of Aspirin and Coumadin in Facial Plastic Surgery

 

Aspirin and Facial Plastic Surgery Dr Barry Eppley IndianapolisIt is very common today for many people to be on some form of ‘blood thinning’ medication. Most commonly this is aspirin at 81mg per day as a preventative measure against cardiovascular disease and is used for its antiplatelet effect. Plavix (clopidogrel) also has an antiplatelet effect and is used to prevent heart attacks and strokes in high risk patients for these problems. The use of more potent forms of anticoagulation to treat deep vein thrombosis, atrial fibrillation and patients with heart valves has also become more prevalent with drugs such as Coumadin, Xarelto and Eleques.

It has been standard practice with patients on antiplatelet and antocoagulation therapies to cease these medications at least one week before elective surgery. This is a preventative measure to reduce the risk of adverse bleeding during surgery and the development of hematomas after surgery. This is understandable given that many plastic surgeries are elective and the timing of them can be changed around the use of certain medications.

In the Online First edition of the November/December 2014 issue of the JAMA Facial Plastic Surgery journal, an article entitled ‘Anticoagulant Complications in Facial Plastic and Reconstructive Surgery’ was published. In this paper, the authors sought to determine what the complication rates were for a variety of facial plastic surgery procedures who were on antiplatelet (aspirin) and/or anticoagulation (coumadin) therapies. From a pool of 640 patients (320 on one of these medications and 320 who were not), complications from their surgeries were evaluated. Forty two (42) patients (13%) who were on anticoagulant or antiplatelet medication during surgery had at least one complication compared with 52 (16%) of patients who were on no medications. Five patients in each group had a severe complication (1.6%).

Coumadin and Facial Plastic Surgery Dr Barry Eppley IndianapolisPatients on aspirin at the time of surgery were not more likely than those who were not to have a complication. Patients on aspirin and Plavix also didn’t have increased complication rates. In contrast, patients who were on Coumadin had increased bleeding during surgery and higher infection rates after. Other complications such as wound separation and skin flap viability were not increased with Coumadin use however.

The most relevant finding in this paper is that patients can safely undergo elective facial plastic surgery while on aspirin. Give that many patients are on aspirin for pure prophylactic purposes and would suffer no harm from being off of it, I would still advise patients to stop it before surgery. But if there is a medically compelling reason to be on it, then it appears to pose no increased risks for numerous facial procedures

The use of coumadin, however, is a different story. This study shows that the risk of bleeding and infection are higher, which is not surprising, and thus staying on this degree of anticoagulation for any elective facial plastic surgery seems like an unwarranted risk.

Dr. Barry Eppley

Indianapolis, Indiana

December 31st, 2014

Plastic Surgery Case Study: Facial Reshaping by Buccal Lipectomies and Perioral Mound Liposuction

 

Background: The shape of the face is controlled by a variety of anatomic structures. Its foundation is influenced by the size and contour of the deeper facial bones, the thickness of the muscle and fat that lies above it and the amount and tightness of the overlying skin which envelopes it all. While everyone’s facial shape is unique, there are general types of facial shapes that are well known from oval, oblong, round, rectangular, square, triangular (inverted and heart-shaped) and diamond shape.

While the beauty of any of these facial shapes can be debated, many people find that a more inverted triangular or heart-shaped face is the most aesthetically pleasing. Having cheeks that are more prominent n width and projection that the portions of the face that lie below it is the hallmark of this facial shape. For those with a round face that desire such a facial change, one looks to fat removal to help with this transition.

Facial Fat (Cheek) Compartments Dr Barry Eppley IndianapolisFat removal of the face is not like the rest of the body. It is more localized into various compartments and has multiple motor nerves to consider when doing it. It is also not a high volume or voluminous source of fat that is capable of making by itself dramatic facial shape changes. Historically facial fat removal was associated with the buccal lipectomy procedure which is large volume by facial standards but does not require liposuction to remove. Other more superficial and lower volume facial fat areas exist, such as the perioral mounds, which can only be treated by small cannula liposuction.

Case Study: This 28 year-old female wanted to create a thinner more v-shaped facial shape. While she already had more of an inverted triangular facial shape, she did not like the fullness below her cheeks and by the sides of her mouth.

Buccal Lipectomy and Perioral Mound Liposuction result front view Dr Barry Eppley IndianapolisUnder general anesthesia, high maxillary vestibular incisions of 1 cm length were made below the parotid ducts. Splitting the buccinator muscles exposed the buccal fat pads which were teased out and removed. Through small incisions (3mms) inside the corners of her mouth, after having been initially infiltrated with a lidocaine and epinephrine solution, small cannula liposuction was used to remove fat from the nasolabial fold down to the jowl area. Each side produced about 2 to 2.5 cms of fat from each side.

Buccal Lipectomy and Perioral Mound Liposuction result submental view Dr Barry Eppley IndianapolisIt usually takes about 6 weeks until the full results from these fat removal procedures were seen. The final results of any facial liposuction/fat removal procedure are seen when the treated tissues feel soft with no hard areas, it feels completely normal to smile without stiffness and the overlying skin sensation feels completely normal. (not numb)

Facial fat removal can be effective at reshaping a somewhat fuller face but it can not really take a round full face and make it substantially thinner. It works best in moderately full to thinner faces where small fat reduction volumes make a more noticeable difference.

Case Highlights:

1) Reshaping or thinning a rounder face can be successfully done by specific site fat removal in properly selected patients.

2) A buccal lipectomy removes upper cheek fat while perioral mound liposuction removes lower cheek/jowl fat.

3) These procedures can make a round face less round and a thinner face more defined based on the limited amount of fat that can be removed.

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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