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.

April 30th, 2016

Case Study – Vertical Breast Lifts with Implants

 

Background: Sagging of the breasts is a common result from pregnancies and weight loss. The loss of breast volume withdraws the support of the overlying breast skin leading to collapse of the breast mound. The breast mound then falls over the fixed inframammary fold creating a sagging breast appearance.

Breast Sagging classification Dr Barry Eppley IndianapolisThe classification of breast sagging is well known and is based on the location of the nipple relative to the inframammary fold. The relevance of this classification is in how it directs how the sagging breast is best treated and what type of breast lift is used to get the nipple back up above the inframammary fold.

In Grade II breast ptosis where the nipple sits just below the fold, the best correction is that of a vertical breast lift. Known as the lollipop lift because of its scar pattern, It moves the nipple vertically upward leaving a vertical scar between the nipple’s new position and its former location. In some cases, surgeons may try and make the periareolar or donut lift      work to avoid the vertical scar but the lifting effect will not be the same.

Case Study: This 35 year-old female had two children and lost much of her original breast volume. She wanted her breasts lifted and large breast implants placed at the same time.

Vertical Breast Lift and Implants result front view Dr Barry Eppley IndianapolisUnder general anesthesia, a vertical breast lift was performed raising the nipples 7 cms in the process. Silicone breast implants of 650cc high profile were after the lift was completed. The push of the large breast implants had its own lifting effect as well.

Vertical Breast Lift and Implants result oblique view Dr Barry Eppley IndianapolisVertical Breast Lift and Implants result side view Dr Barry Eppley IndianapolisHer one year result shows a major change in breast shape and size. Her vertical breast lit scars were remarkably imperceptible. The areolas were wider and the nipples ‘flatter’ as often happens after breast lift with a large implant push behind it.

The vertical breast lift is a very effective tool in the management of the sagging breast. While many women fear the resultant scars, in the right patient even large implants placed at the same time do not cause excessive widening or prolonged redness of the scars.

Highlights:

1) Vertical breast lifts and implants is a common combination breast enhancement procedure when ptosis occurs after pregnancy.

2) Vertical breast lifts are useful when the degree of breast sagging is modest with the nipple at or just below the inframammary fold.

3) The size of the breast implant placed partially controls how much breast lifting effect can be achieved.

Dr. Barry Eppley

Indianapolis, Indiana

April 26th, 2016

Large Breast Implants

 

While there many important issues to consider in breast augmentation, the size of the implant is one that women spent the greatest amount of time pondering before surgery. There are a variety of implant sizing methods and they all have their merits, but the reality is that breast implant sizing is not an exact science. No patient can really know for sure how they like the implant size selection until they swelling goes down and they have ‘worn’ it for awhile.

Women for breast augmentation usually want an implant size that looks natural, fits their body frame and does not stand out as their most notable feature. What that implant size may be is open to interpretation and highly subjective. But there are women who do want to have large breast implants and their goal clearly is not to be subtle in the result and a natural look is not their goal.

Breast implants come in a wide range of sizes from 150cc to 800cc. Because silicone implants are prefilled, their maximize size is 800cc volume. Saline implants, however, are alway overfilled and their volume can well exceed 1000ccs if desired. Considering these options in breast implant sizes, a large breast augmentation is going to be in the range of 600cc to 800ccs. For some women the volume may be much more.

For a variety of reasons, many plastic surgeons are opposed to larger breast implants. Such opposition is based on two basic and understandable reasons. Large breast implants are associated with a higher rate of complications such as loss of tissue support (bottoming out), implant asymmetries and deflations. (saline implants) The fundamental teaching in plastic surgery is to not place implants that exceed the ability of the tissues to support them long-term. The second reason for objection is the long-term consequences of the stretched out breast tissue. Large implants do deform the breast tissue irreversibly and their removal or reduction in size in the future will necessitate major breast lift surgery and its associated scars.

But breast implant size is a very personal decision and as long as the patient has been educated as to its potential consequences, large breast implants are a patient’s choice. The most common women who seeks large breast implants in my experience is the one who already has breast implants. They may have had them for years and now desire a much larger size. They may have had children or lost weight and their overall breast size has gotten smaller and a lot more volume is needed to fill out the loose skin. In these cases it can take a lot of implant volume to adequately expand the stretched out breast skin. In many ways these women are much more ‘qualified’ for large breast implants because they have a better frame of reference.

Some first time breast augmentation patients do seek large breast implants but they are far less common. Big for them might be up to 500ccs or so in small frames and 600cc to 700ccs in larger framed women. This is big for them given where they started but are not that big compared to women who are changing their existing breast implants.

The concept of large breast implants is open to interpretation but would be anatomically one where the implant width exceeds that of the the natural breast base width. While this may contribute to better cleavage it equally means that the side of the implant will protrude out beyond that of the chest wall.

Dr. Barry Eppley

Indianapolis, Indiana

April 25th, 2016

Arnica Montana in Rhinoplasty

 

Bruising after certain elective facial procedures is very common and expected. While well tolerated by patients, given that they have no choice, any reduction of its extent and duration would be appreciated. Rhinoplasty is one of those facial procedures that is well known to cause considerable bruising when osteotomies (breaking of the nasal bones) are done as part of the nasal reshaping. It creates the classic ‘raccoon eyes’ as the blood released by the cut nasal bones tracks along the lower eyelids/cheek tissue junction.

In the May 2016 issue of the Annals of Plastic Surgery, a paper was published entitled ‘Perioperative Arnica Montana for Reduction of Ecchymosis in Rhinoplasty Surgery’. In this paper thirteen patients who had rhinoplasty surgery with nasal bone osteotomies were prospectively randomized to receive either oral perioperative Arnica Montana or a placebo in a double-blinded fashion. Ecchymosis (bruising) was measured in digital photographs at three after surgery time points as well as its extent based on color assessment. Nine patients taking Arnica Montana had less bruising on days 2, 7 and 10 by 16%, 33% and 20% respectively compared to the control patients.

The authors conclude that Arnica Montana seems to accelerate postoperative healing, with quicker resolution of the extent and the intensity of ecchymosis after osteotomies in rhinoplasty surgery, which may dramatically affect patient satisfaction.

Arnica Montana Dr Barry Eppley IndianapolisArnica Montana, a homeopathic remedy as an extract of a flower, is given routinuely before and after many types of plastic surgery. It is particularly used in facial surgery where the very visible appearance and prolongation of facial bruising is the most distressing to patients. Arnica Montana is widely used because it has no known adverse effects and that it is believed to create reduced bruising. But there is limited clinical evidence of its effectiveness. This study adds support to its continued clinical use.

How does Arnica Montana potentially work in reducing and clearing bruising? The active ingredients of Arnica are sesquiterpene lactones, such as helenalin and 11,13- dihydrohelenaline and chamissonolid. These two sesquiterpene lactones have been shown to inhibit collagen-induced platelet aggregation and thromboxane formation. By having an effect on platelet aggregation, less bruising theoretcically occurs and clot/bruisinhg may be cleared faster.

Dr. Barry Eppley

Indianapolis, Indiana

April 24th, 2016

Case Study – Rib Graft Cleft Rhinoplasty

 

Background: Cleft lip and palate is one of the most common congenital facial deformities. While much focus is on the lip, alveolus and palate, the nose is equally affected as well. While the nose may not be ‘clefted’, deformity underneath it causes a variety of septal, turbinate and nasal cartilage and bone structural alterations.

Management of the nasal portion of a unilateral cleft lip and palate deformity is done at various stages of development. During the primary cleft lip repair, the base of the nose is realigned and in some techniques the nasal tip cartilages are manipulated as well. Prior to or during the early years of school a second effort on the cleft nose is often done. This is done through an open rhinoplasty with emphasis on the reshaping of the deranged nasal tip and cleft sided nostril.

The third opportunity to treat the cleft nose is in the teenage years. Patients are most motivated to have their nose reshaped during these important psychosocial development years. It can be debated as to whether this is done during the early or late teenage years and some plastic surgeons will await until near complete facial growth at age 17 or 18 years old.

Case Study: This 15 year-old hispanic teenager was borne with a unilateral (right) cleft lip and palate. She had prior effort on her nose both at the first few months after birth at the time of cleft lip repair as well as at age 7. By the time she was a teenager, her nose had developed the appearance of a nasal hump as well as the tip showing ipsilateral alar rim collapse and nostril widening.

Teenage Cleft Rhinoplasty result front view Dr Barry Eppley IndianapolisUnder general anesthesia, a small rib graft (#9) was harvested through a small (3 cm) subcostal cartilage graft. Then an open rhinoplasty was used to access the nasal cartilages and the septal deviation corrected.The nasal tip was lifted using a combination of a strong columellar strut and suture plication to the septum. An alar batten cartilage graft was attached to the dome and columellar strut to give the nostril better support. The remaining rib graft was used to create paranasal augmentation under the base of the cleft-sided nostril.

Teenage Cleft Rhinoplasty result side view Dr Barry Eppley IndianapolisTeenasge Cleft Rhinoplasty result submental viewTeenage Cleft Rhinoplasty result left oblique view Dr Barry Eppley IndianapolisHer six month result shows substantial improvement in the shape of her nose at the tip and nostrils. Lifting of the nasal tip eliminated what appeared to be a prominent nasal hump.Nostril shape and width was improved.

One of the keys to getting improved results in a cleft rhinoplasty is to provide the tip with a strong structural support. The limiting factor is often the size and strength of the cartilage graft. No other graft donor site works as well as that of the rib. It provides a virtually unlimited amount of donor material to be shaped and used as needed. Using the free floating end of rib #9 provides a donor site that can be harvested with a very small incision and minimal recovery.

Highlights:

1) Congenital cleft lip and palate causes a well known set of nasal deformities that affects both sides of the nose.

2) A full open septorhinoplasty is needed to address all the deformities of the cleft nose.

3) Thick nasal skin and a congenital absence of tissue on the cleft side in unilateral cleft lip and palate always limits how much nasal shape improvement can be obtained.

Dr. Barry Eppley

Indianapolis, Indiana

April 24th, 2016

Facial Scar Revision Study

 

Scar revision is an important technique and part of plastic surgery. Many traumatic and sometimes surgical scars do not heal as desired and may benefit from a scar revision procedure. While much ado is made of laser resurfacing of scars for improvement, the reality is that many poorly formed scars will benefit by actual excision and not just superficial laser treatments.

Z plasty scar revisionIn performing surgical scar revision, there are numerous basic concepts that are used to result in an improved appearance. One of these is the interruption of a straight scar line into a non-linear closure. The most historic method to do is that of a Z-plasty. A Z-plasty scar revision breaks up a straight line scar into a Z pattern. This is most commonly used to break up a scar that has a contracture component of it, crosses a joint line or runs perpendicular to the relaxed skin tension line.

In the April 2016 edition of the JAMA Facial Plastic Surgery journal, an article entitled ‘Perceptions of Aesthetic Outcome of Linear vs Multiple Z-plasty Scars in a National Survey’ was published. In this study the perception of the cosmetic appearance of linear scars vs zigzag scars by the general public. A computer-generated image of a mature scar was created in both straight line and a Z configuration and overlaid on photographs of Caucasian faces. Side-by-side comparisons were on an Internet-based survey to be rated on a10 point assessment scale. (1 = best appearance, 10 = worst appearance)

Over 800 participant ratings were gathered with significantly lower scores and better appearances for linear scars compared with zigzag scars in every assessed group of images. The authors conclude that the lay public has a significantly better perception of the appearance of linear scars compared with zigzag scars in 3 facial locations. (temple, cheek, and forehead)

Neck Z Plasty Scar Revision Dr Barry Eppley IndianapolisWhile this study is interesting, it needs to be out into clinical context. A Z-plasty is the least commonly performed non-linear scar revision that I perform. Most facial scar revisions are done using a broken line or irregular closure pattern. By contrast a Z-plasty often creates a a more pronounced change in the scar line that I often find aesthetically objectionable. A Z-plasty has its role in scar revision but should be used in very specific scar problems such as obvious contracture problems or scar deformities around moving facial structures such as the mouth or eyes.

Dr. Barry Eppley

Indianapolis, Indiana

April 21st, 2016

Buccal Lipectomy Misconceptions

 

One of the techniques to help create a thinner face is that of a buccal lipectomy procedure. Because it is the largest collection of encapsulated fat on the face and its extraction is a straightforward and uncomplicated procedure, it is an easy target when it comes to facial slimming efforts.

Despite that the buccal lipectomy procedure has been around for a long time, the effects if its removal are frequently misunderstood. The first misconception is what effect it has on slimming the face. The main portion of the buccal fat pad adds volume primarily to the submalar region of the face. This lies right under the cheekbone where one would put their thumb under the cheekbone prominence. It should not be confused with the malar fat pad, which is directly below the skin of the cheek. It also does not extend all the way down to the side of the mouth or even down to the jowls.

 

Facial Effects of Buccal Lipectomy Dr Barry Eppley IndianapolisGiven its anatomy, this is why a buccal lipectomy will NOT slim the face from the cheeks down to the jawline. By itself it can not make a round face into more of a V-shape. It simply is not that powerful. This is why a buccal lipectomy is often combined with perioral liposuction to extend its effect further down on the face.

Another more recent misconception is that a buccal lipectomy will eventually lead to gauntness of the face or a prematurely aged look. While this belief does have some partial truth to it, such a facial effect depends on what type of face on which it is performed. Thinner faces that are genetically prone to eventual facial lipoatrophy would be prematurely and adversely affected by removing the buccal fat pads. But in fuller and more round faces (aka heavy face) there is no reason to believe that excessive facial thinning will eventually occur.

Buccal Lipetomy Fat Pad AnatomyThe last misconception is that the buccal lipectomy is an all or none procedure. While large amounts of the buccal fat pad can be removed, that does not mean it has to be. A subtotal or incomplete buccal lipectomy can be done when there are concerns about too much fat removal. There are three lobes or extensions of the buccal fat pad and in a subtotal technique only a portion or just the anterior lobe can be removed.

Dr. Barry Eppley

Indianapolis, Indiana

April 20th, 2016

Case Study – Jumping Genioplasty

Background: A sliding genioplasty is the most well known of all the facial osteotomies and also the most commonly performed. It is done for various chin augmentation and reshaping purposes. It if often compared to a chin implant and doctors often tout one versus the other for aesthetic chin augmentation. But the reality is that both have their place and their benefits vs liabilities must be evaluated on an individual basis.

Sliding Genioplasty Indianapolis Dr EppleyThe advantage of a sliding genioplasty is that it is very versatile in terms of dimensional changes of the chin. The bone cuts can be devised to bring the chin forward, make it vertically longer, widen or narrow it or almost any combination thereof. With the use of today’s plate and screw designs, the genioplasty no longer just as to ‘slide’ forward to make for a stable dimensional change to the chin.

In a sliding genioplasty the amount of forward movement of the chin is limited to the anteroposterior thickness of the mandibular symphysis. In order to maintain bone contact between the upper and lower chin segments, the back edge of the downfractured and mobilized chin segment should stay in contact with the front edge of the stable upper bone segment. In doing so, the amount of horizontal advancement as well as the ability to vertically shorten the chin has its limitations.

Case Study: This 15 year-old petite female was born with a congenital condition that caused her lower jaw to be severely underdeveloped. Even though she was a teenager her dental condition did not permit her lower jaw to be brought forward as would be the ideal surgical treatment.

Teenage Jumping Slidinmg Genioplasty result side view Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral approach was made to the chin. A low level horizontal bone cut as made below the mental foramens. In bringing the chin bone forward in a traditional sliding genioplasty, the small size of the chin did not make as much horizontal advancement as desired nor did it shorten the chin enough. The downfractured chin bone was then brought forward and ‘jumped’ in front of the upper chin segment and sat on top of it like a chin implant. The pedicled chin segment was secured to the bone by  two lag screws.

Teenage Jumping Sliding Genioplasty result front view Dr Barry Eppley IndianapolisJumping Sliding Genioplasty result oblique view Dr Barry Eppley IndianapolisHer six month result showed a noticeable horizontal advancement as well as a vertical shortening. The amount of horizontal chin advancement is still less than desired btu an improvement nonetheless. Hopefully she will be able to undergo a mandibular advancement in the future.

A jumping genioplasty is an older form of the traditional sliding genioplasty. It is rarely used today since the introduction of rigid plate and screw fixation. But in very small chins that need significant horizontal advancement and vertical shortening it can still be used.

Highlights:

1) A sliding genioplasty is a well known chin augmentation procedure that cuts and moves the symphysis of the mandible forward.

2) A jumping genioplasty maximizes the horizontal advancement of the chin bone while simultaneously shortening its vertical height.

3) In chins that are short because of significant jaw underdevelopment, they are often too long vertically as well.

Dr. Barry Eppley

Indianapolis, Indiana

April 18th, 2016

Nasal Lift for Tip Elevation

 

Aging affects all facial tissues to some degree including the nose. The effects of time on the nose occurs at the nasal tip where the cartilages are help up by ligaments to the cartilage structures of the middle value. The effects of age on the nasal tip are that some increased droop can occur as the ligaments weaken or stretch. This makes the tip go down slightly and the nasolabial angle lessens.

The typical treatment for a drooping nasal tip, at any age, is to lift and support the lower alar cartilages in a more upward position. This could involve trimming of the upper edge of the cartilage, suture suspension or a combination of both. This us usually done from below through an open rhinoplasty approach.

Nasal Lift Excision Pattern Dr Barry Eppley IndianapolisIn older patients with nasal tips that droop or in older patients that have been through a rhinoplasty and do not want any further open rhinoplasty surgery, an alternative approach would be a ‘nasal lift’. Like anti-aging procedures on the face this involves the use of skin excision at a distant location to create its effect. No cartilage manipulation is done.

Nasal Lift result Dr Barry Eppley IndianapolisUsing a horizontal skin excision at the bridge of the nose (frontonasal angle), the tip of the nose is lifted from the upper nasal tissue closure. Because the tip is at some distance from where the lift is created, the amount of nasal tip elevation would be slight. (1 to 2mms)

While the removal of nasal skin and the creation of a fine line scar in the upper nose may seem ‘radical’, it really is not. The location of a fine line scar is at the frontonasal junction which is a natural skin line when one lifts their  nose or squints. Many older patients already have a fine line skin wrinkle there already.

A nasal lift is a very uncommon procedure that would only be for a very specific type of nose patient. One must be older, have an established frontonasal crease and desire only a minor amount of nasal tip rotation.

Dr. Barry Eppley

Indianapolis, Indiana

April 17th, 2016

The Transpalpebral Browlift Explained

 

Correction/repositioning of sagging brows is done by well known browlift procedures. The vast majority of browlift surgeries are done in women with access to do the procedure coming from above in and behind the frontal hairline. The three different female browlift techniques (coronal, pretrichial and endoscopic) are chosen based on forehead skin length and the position of the frontal hairline.

Browlifts in men, however, are more challenging because of the typical lack of a stable hairline, poor hair density or no hairline at all. Thus, most men can not have a superior scalp approach due to concerns of visible scarring or disturbed hairline concerns. Browlifts in many men have more limited options and include either a mid-forehead, direct (superior eyebrow hairline) or a transpalpebral incisional approaches.

endotine browlift devices dr barry eppley indianapolisThe transpalpebral browlift technique is used almost exclusively in men and relies upon a device (Endotine) to achieve the browlifting effect. In addition it has a browlifting effect that is largely limited to the outer half of the brow (temporal brow) and creates a more modest lifting effect. This location of the browlift is what makes it most useful in men as inner browlifting creates an unnatural appearance for most men.

Transpalpebral Browlift brow bone exposure Dr Barry Eppley IndianapolisThe transpalpebral browlift is done from an upper blepharoplasty incision and is often done in conjunction with removal of upper eyelid skin. After the upper eyelid skin is removed, the outer brow bone is accessed in a subperiosteal fashion. Dissection is carried above the lower edge of the outer brow bone in excess of 15mms to allow the Endotine device to fit.

Transpalpebral Browlift drill hole and endotine device Dr Barry Eppley IndianapolisAt 15mms above the lower edge of the brow bone an outer cortical bone is drilled. This allows the Endotine device to be inserted into the hole and oriented in an upright triangular position. This allows the prongs on the device to be angled upward.

Transpalpebral Browlift endotine device [placement Dr Barry Eppley IndianapolisOnce the Endotine device is inserted, the outer brow tissues are lifted and suspended on the device’s prongs. The soft tissue are then closed over the device and the upper blepharoplasty incision closed.

The transpalpebral browlift is essentially a ‘push’ browlift from below. This is stark contrast to the more traditional browlift methods which are ‘pull’ procedures from above.  The Endotine device makes this possible. It is composed of a resorbable polymer material which breaks down and is absorbed completely within 6 to 9 months after it is inserted. This should be enough time to allows the brow lift tissues to scar down and heal to the bone in a slightly more elevated position.

Patients will feel the device under the skin for a few months after the procedure although it is not visible on the outside. For men the transpalpebral approach, while having a modest result, avoids scar concerns at the eyebrow or on the forehead which can take a long time to mature and their imperceptibility is not always assured.

Dr. Barry Eppley

Indianapolis, Indiana

April 16th, 2016

Case Study – Webbed Neck Surgery

 

Background: A webbed neck, medically known as pterygium colli deformity, is a well known but rare congenital neck condition. Skin folds are present along the sides of the neck from the back of the head behind the ears down to the shoulders. The hairline often follows the skin folds in their upper part. It is most commonly seen in Turner’s syndrome but occurs on congenital syndromes as well. The skin folds occur in varying presentations but can be quite pronounced in many cases.

The surgical correction of the webbed neck has evolved from original descriptions of z-plasties done directly along the skin folds. While successfully breaking up the skin folds, such a direct approach leaves unsightly scars that are rarely worth the trade-off.

The posterior approach to the webbed neck is the preferred technique today. This involves removing tissue from the midline of the posterior neck and wide skin undemining out to the skin folds. Closing the posterior neck defect then pulls the skin folds inward. (more posteriorly) A variety of posterior neck excisional patterns have been described from butterfly, M and Z-plasty patterns. While providing definite improvement in the appearance of the skin folds and keeping the scar fairly hidden (with long hair), partial relapse is common with the secondary skin relaxation.

Case Study: This 35 year-old Asian female had a congenital webbed neck from birth. She did not have Turner’s or any other known congenital condition. Her necks webs would be described as mild to moderate. She was teased a lot for her neck webs when she was growing up. Prior to surgery, she shaved the lower portion of her occipital hairline to aid the subsequent surgery.

Webbed Neck Surgery Markings Dr Barry Eppley IndianapolisUnder general anesthesia, the posterior neck was marked with red dots to mark the most tolerated lower extent of the tissue excision and midline closure and a modified T-shaped excisional pattern. The neck webs were vertically marked.

Webbed Neck Surgery tissue excision Dr Barry Eppley IndianapolisWebbed Neck Surgery fascial plication Dr Barry Eppley IndianapolisThe posterior neck skin and fat was excised down to fascia. The skin edges were widely undermined out to the skin folds. The fascia edges could be grasped and mobilized considerably to the midline.

Webbed Neck Surgery fascial plication completed Dr Barry Eppley IndianapolisThe posterior neck fascia was plicated in the midline with large resorbable sutures. This could be seen to bring in the skin folds at the side of the neck significantly.

Webbed Neck Surgery skin closure Dr Barry Eppley IndianapolisThe skin edges were then brought in to the midline and closed in a T-shaped pattern. Prior to the skin closure, multiple quilting sutures were placed from the skin down to the fascia to both eliminate deep space as well as take tension off the skin closure suture line.  Marcaine injections were done along the fascia as well as the greater and lesser occipital nerves to manage immediate postoperative discomfort. The posterior neck incisions were covered only with with tapes.

Webbed Neck Surgery before and after during surgery Dr Barry Eppley IndianapolisThe skin folds were completely eliminated with this webbed neck surgery technique. The neck was changed from wide neck ‘wings’ to an hourglass neck appearance.

Webbed Neck Surgery results Dr Barry Eppley IndianapolisWebbed Neck Surgery left side result Dr Barry Eppley IndianapolisWhen seen the next day after surgery before returning home, her webbed neck condition was completely eliminated. The combination of posterior neck tissue excision and midline fascial plication creates an improved and sustained result in webbed neck surgery.

Highlights:

1) Webbed neck correction requires a posterior neck approach with tissue excision and midline closure to prevent visible scars on the sides of the neck.

2) Midline fascial plication is critical to bring in the sides of the neck (webs) and relieve tension on the posterior midline neck closure.

3) This form of webbed neck surgery uses the same principles as midline platysmal plication in facelift or direct anterior necklift surgery.

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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