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.
There are many considerations that patients must consider after any form of major plastic surgery. Whether it is when to shower or going back to work, swelling, pain and how one’s face and body looks will have some impact on all of life’s everyday activities during the recovery period. Understandably patients are anxious to resume much of their routinue and often as soon as possible.
In the past it was not an infrequent question, usually posed by a female patient, that wanted to know when they could resume sexual activity after surgery. Often asked almost embarrassingly and in a sheepish manner, they would say they were asking at their husband’s bequest. More rarely it would be a man asking and they, coincident or not, were usually divorced or single. Today, that question still comes up but it is a far less frequent one compared to work and other exercise concerns.
The obvious variables in how soon can one have sex after surgery is what type of plastic surgery did one have and what type of sexual activity is one referring to. While I would submit that the concept of sex to most patients in the weeks or first month after any form of major plastic surgery is likely to be incredibly low to non-existant on anyone’s priority list, the question nonetheless bears addressing.
Sex, like any form of exercise, increases blood flow and places potential stress on bodily tissues particularly the skin. Temporary increases in circulation can cause discomfort and may exacerbate swelling. Physical motion places sheering forces on incisions and may risk some skin wound separation. The concerns therefore become issues of comfort vs. actual harm to the surgery result. In the vast majority of procedures the issue is really one of comfort. I can think of only a single patient (lower buttock lift) where early sexual activity did cause partial separation of the incisions. I think the historic adage of ‘if it hurts don’t do it’, just like in any form of exercise, is a safe approach.
Interesting and perhaps not surprisingly, the when can I have sex after surgery question is more closely linked to body contouring surgery. In aesthetic facial surgery, one may look a bit rough but the body is unaffected and works just fine. But in common body procedures such as tummy tucks, breast augmentation and liposuction, one feels anything but fine for some time after surgery. In addition incision sites are in closer proximity and patients may be particularly concerned about pulling apart their incision and infection as well. I would have no concern about infection risk but one does need to be careful with incisions for up to six weeks after surgery. Incisions may appear well healed but their tensile strength (ability to be pulled apart) remains low.
The consideration of sex after surgery is an old one and predates any type of plastic surgery procedure. Childbirthing, c-sections and episotomies have raised this question long before and in a much more direct fashion. A little bit of common sense and comfort are good guidelines for knowing when and how to resume sex after your plastic surgery operation. One simple analogy that most patients can relate to is walking or running on treadmill. If you are ready and comfortable with that activity, then you are ready for sex.
Dr. Barry Eppley
Indianapolis, Indiana
Background: Aging of the eyes is both an unavoidable eventuality for everyone and the first and most noticeable place on the face that it occurs. The classic findings are heavy or extra skin on the upper eyelids and bags on the lower eyelids. This combination makes for a tired or older appearance that is recognized by everyone since most of how people see and remember our face is in the eye area.
While these findings are typical periorbital signs of aging, why do they occur? Since most of eyelid closure comes from movement of the upper eyelid, its thin skin is prone to become lax and wrinkled. It eventually falls down into the eyelashes obliterating the supratarsal fold and making the upper eyelid heavy. The bags on the lower eyelids come from herniated fat. As the lower support structures between the tarsus and the lower eye socket edge weaken, fat that is normally under the eye as a supportive cushion protrudes forward. As it bulges past the vertical plane of the infraorbital rim, it appears a bag-like protrusion. This combined with the development of wrinkled and sagging skin give the lower eyelid its baggy and sagging appearance.
Case Study: This 55 year-old female from Indianapolis Indiana wanted to make her facial appearance fresher and less tired. She felt her eyes were her biggest problem and wanted to get rid of her loose skin and bags. She had an eye history of having had Lasik surgery two years previously and had some mild dry eyes since. On examination her lower eyelid was lax with a delayed snapback test.
Under general anesthesia, she underwent upper and lower blepharoplasty. On her upper eyelids, excess skin and a small strip of orbicularis muscle was removed along her existing supratarsal crease line. No fat was removed. On the lower eyelids the three fat pockets were removed and a small strip of skin excised. (3mms) A canthopexy procedure was performed because of her lax canthal tendon. The skin was closed using an orbicularis muscle suspension technique prior to a superolateral sweep for the skin closure.
Her skin sutures in the lateral canthal area were removed one week later. It took her a full three weeks for all swelling and bruising to completely resolve. She did return to work ten days later and felt comfortable enough to do so with a little make-up. She had no problems with tearing or dryness of her eyes in her recovery.
While blepharoplasty surgery can make a big difference in the appearance of one’s eyes, it is important to recognize that eyelid function must not be disrupted. Management of the lower eyelid is usually the key to preventing postoperative problems. Not removing too much skin and providing tendinous and muscular support on the lower eyelid will minimize the risk of ectropion or lower eyelid retraction.
Case Highlights:
1) Aging eyes have extra upper eyelid skin and lower eyelids bags which bother the owner the most.
2) The emphasis of blepharoplasty surgery is removal of skin in the upper eyelid and fat removal in the lower eyelid.
3) Successful and uncomplicated blepharoplasty surgery is based on judicious skin and fat removal with management of a lax lower eyelid if necessary.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
Buttock augmentation has become a part of mainstream body contouring plastic surgery. Creating a larger buttock has become desirous of those who have a normal size and just want to become bigger (ethnic buttock enhancement) to those who simply have never had one or ‘lost’ it at some point. Its popularity is largely due to the use of fat injections which offers a safe and natural method of increasing one’s buttock size even if fat survival is unpredictable and not everyone has enough fat to do the procedure.
But in increasing the buttock size with fat, we are only adding volume to the smallest component of what makes up a buttock. The greatest contributor is not fat but muscle, specifically the trio of the gluteus maximus, minimus and medius muscles. The gluteus maximus, as the name suggests, is by far the biggest of the three and occupies the lower 2/3s of the buttock. The medius is a pork chop-shaped muscle that is near the top of the hips and the minimus is sandwiched between the medius and the maximus. This composite large muscle mass is what keeps us upright as we walk, the bipedal feature which separates us from our primate ancestors.
The shape of the buttocks is largely a function of genetics which determines the size of the muscle and the amount and distribution of the overlying subcutaneous fat. Women almost always have more buttock tissue than men, regardless of race. One’s buttocks will also change with time as fat loss occurs with aging due to hormonal changes and a shift of where fat is preferentially stored. While exercise can certainly help shape and even slightly enlarge the gluteal muscles (up to a ½ to 1 inch), it can not simulate the size effect of a surgical buttock enlargement.
Despite what shape and size the gluteus muscles contribute to the buttock contour, it is fat that makes up the round or fuller buttock. Specifically this is a form of fibrofatty tissue and not the typical more gelatinuous fat that one finds in the stomach for example. The fibrous component is needed to keep the fat suspended over the buttocks not unlike that of the breasts.
With buttock augmentation by fat, most of the injectate goes into this subcutaneous fat layer. While the gluteus maximus muscle is a vascularized bed which more ideally supports fat survival, it is not possible to put all the injected fat into it. Most of the time the bulk of it goes into the fatty layer under the skin. The thicker the fat layer, the more fat that can be injected into it. This is why a really flat buttock has less of a chance for successful enlargement than a more full one. Without a certain amount of subcutaneous buttock fat, one may be better off considering a buttock implant as opposed to fat injections that does not have a sufficient reservoir in which to be placed.
Dr. Barry Eppley
Indianapolis, Indiana
Combined Fractional Laser and Topical Steriods Hold Promise For Wide Hypertrophic Scar Improvement
Author: barryeppleyScar therapy consists of a wide variety of possible treatments from injections, lasers and light devices and surgical excision. There is no one type of scar treatment which is uniformly effective for all scars. There are simply too many types of scars and differing skin types and body locations for any uniform approach to improving the appearance of scars.
While scar revision by excision still remains a mainstay for many scar patients that I see, it is not effective for scars that involve large surface areas. Broad hypertrophic scars, particularly from burns and other forms of trauma, pose unique challenges for improvement. While in some cases complete excision and skin grafting may be useful, patients may either not want that approach or want to try non-surgical methods first.
One non-excisional treatment approach, and the only that I find effective for established scars, is that of combined laser resurfacing and topical steroids. When referring to laser resurfacing, I am not talking about a uniform ablative approach but specifically that of fractional CO2 ablation. This ablative CO2 laser creates channels from 400 to 600 microns or more deep into the dermis/scar. Such channels provide many points of entry for topical agents such as steroids. The early introduction of intradermal steroids helps to control the inflammation that the laser causes as well as suppresses collagen synthesis to reduce scar thickness
This scar treatment approach can be done under either topical or local anesthetic. Usually topical is better because wide hypertrophic scars are typically hard to inject under and get good pain relief. Numerous topical anesthetic creams are available but ones that contain a combination of benzocaine, lidocaine and tetracaine penetrate and work the best. Once adequately anesthetized, the broad scar is treated by the fractional CO2 laser to create intradermal pores. Thereafter, the steroid triamcinolone acetonide suspension (kenalog) is applied over the laser-treated area. Different concentrations of the steroid can be used from prepared concentrates of 10, 20 and 40mg/cc. In some cases, intralesional steroid injections may be given as well if the scar is very thick. The topical steroid suspension is held into place over the scar treated area by a clear adhesive dressing for 24 hours.
Few wide hypertrophic scars respond well to a single treatment and a series of fractional laser resurfacing and topical steroids is needed to get the best result. Typically it requires three or four sessions spaced four to six weeks apart.
This combined laser and steroid treatment is fairly novel but makes biologic sense with its multimodality approach. The synergism of these two treatments strives to create a flatter scar that is more supple, not necessarily complete scar removal. Breaking down existing scar tissue, without creating a lot more, is the only realistic goal for this type of hypertrophic scar.
Dr. Barry Eppley
Indianapolis, Indiana
A consultation with a plastic surgeon is usually the third step in one’s evolution towards having actual surgery. The first is the recognition of the need or desire and the next is the acquisition of basic information with some research. While the most detailed information and a definitive surgical plan can only be assured by an actual in-patient evaluation, there is much for patients to learn from internet searching, whether it is evaluating plastic surgeons to visit to what will be the recovery process of their desired procedure. While the internet provides an extraordinary amount of information on just about every single procedure in plastic surgery, much of it is understandably fairly basic and often highly promotional.
Qualified information on plastic surgery procedures comes from talking to the expert, an actual plastic surgeon. The historic venue for this is the office consultation. But talking to a plastic surgeon today has and should parallel the development of online and electronic technology. Through internet forums like Real Self or plastic surgeons using Skype for a face-to-face discussion, the concept of much better information from the comfort of your own home is becoming a main stream method for talking to expert plastic surgeons all over the world.
While the use of Skype for plastic surgery restricts one to a home-based computer, smartphones and portable tablets have now made it possible to take such consultations anywhere one might be. FaceTime for Mac makes it possible to talk to anyone that has an iPhone 4, iPad 2 or iPod Touch. While cell phones have long made it possible to hear a voice from anywhere, it is even better to see a face with that voice. From the tiny camera on these devices, you can see everything on the other end with unbelieveable clarity. With picture-in-picture view, you can see clearly (frankly better than Skype) the person you are talking to. Using either the front or rear camera, or rotating from portrait to landscape, FaceTime for Mac smoothly adjusts the view. FaceTime calls are also in HD, being able to support video calls up to 720p.
Using FaceTime for plastic surgery consultations is just as easy as that for Skype. You must first get an Apple ID and an e-mail address. Once a consultation time has been arranged, the plastic surgeon finds your name in the contacts list and starts the video call. I can call your iPad, iPod Touch or Mac using your email address. An invitation will appear on your screen. All you have to do is to accept it and the video call begins.
While presently the number of devices that support FaceTime is small in comparison to the total number of computers and cell phones, those numbers will continue to grow. The video technology in iPhone 4s and iMacs is a harbinger that in a few years the majority of people will have access to it. This assures that the capability to have a plastic surgery video consultation from just about anywhere will be commonplace.
Dr. Barry Eppley
Indianapolis, Indiana
Background: A bump or hump on a nose is a common reason a patient will seek rhinoplasty surgery. A smooth or straight dorsal line is one of the more important aspects of a pleasing nasal appearance. While some small bump reductions can be achieved by a simple shaving of the bone edge, this is the exception and is not what will work for most hump reductions.What makes up most humps is a combination of bone and cartilage as the hump occurs where the bone of the nose stops and the cartilage of the nose begins. Successful and sustained nasal hump reduction is usually a combination of both bone and cartilage removal.
While many rhinoplasty patients have small humps, there are some that have really large and prominent humps. These are usually associated with many types of ethnic noses. These large humps create a hooked nose appearance. The dorsal line of the nose has a very convex or almost mountaneous peak appearance in profile. The size of the hump is a sign of septal overgrowth and the nasal tip may be pushed down due to the amount of septal push on the nasal tip cartilages.
While some small hump reductions can be done by shaving or rasping and do not require breaking the bones of the nose, most larger hump reductions do. Taking off the cartilage and bone of the hump will leave a flat open-roof deformity. To change that open roof back to an inverted-V shape of a pleasing nasal bridge appearance, the sides of the roof or bone must move inward. This is what breaking or cutting the nose bones does. It is also the rhinoplasty maneuver that causes bruising and black eyes afterward. The nasal bones are cut down low and then pushed in to close the open roof. This will also make the upper part of the nose more narrow and less thick after a significant hump reduction.
Case Study: This 35 year-old Hispanic man from Indianapolis Indiana wanted to get rid of his large nasal hump. He had a large and very prominent hump in an otherwise thin and narrow nose. His tip was a little wide but did not have much downward rotation. Computer imaging was done to see how much lowering of the dorsal line he desired. Two options were given as to the amount of lowering of the dorsal line, the more significant lowering involved burring down of the radix (upper nasal bone) as well.
Under general anesthesia, an open rhinoplasty approach was done exposing the entire osteocartilaginous structures. The upper part of the septum from the tip to the bone was removed with scissors after separating away the upper lateral cartilages. The exposed roof of the nasal bones was revealed and this was reduced with an osteotome creating an open roof. Medial and low lateral osteotomies were done with a small osteotome to close the open roof. Some rasping of the roof edges was also done. The upper lateral cartilages were rolled onto themselves and sewn down to the septum to create ‘auto spreader grafts’. The tip was then trimmed and narrowed by sutures.
After one week, the nasal splint and tapes were removed. Some swelling of the nose was present as expected but a big change could already be seen. By six weeks after surgery most of the significant swelling was gone and most of the overall new shape of the nose was appreciated.
Large nasal humps are part of many ethnic rhinoplasties and require significant cartilage and bone removal. Osteotomies are almost always needed due to the created open roof. Attention needs to be paid to potential narrowing of the middle vault when such large humps are reduced. Rather than discarding the upper edges of the upper lateral cartilages with the septal reduction, they can be preserved and used to keep width to the middle vault to keep/preserve straight dorsal lines from the frontal view.
Case Highlights:
1) Large nasal humps require bone and cartilage reduction/reshaping through an open rhinoplasty approach.
2) The amount of nasal hump reduction that a patient wants should be determined prior to surgery with computer imaging.
3) Dorsal hump reduction in men should achieve a straight line between the radix and the tip. In women more reduction may be desired in the upper third of the nose to create a more feminine appearance.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
Device-based energy therapies for skin tightening and fat reduction have been around now for about a decade. Like computer and all electronic devices, their effectiveness improves with technologic advances. One of the recent device advances in heating fat and tightening skin is Exilis technology. This uses a well known energy technology, radiofrequency, to create its effect. But its advantages are based on modifications to radiofrequency in how it is delivered.
Exilis uses radiofrequency which is basically sound waves that are delivered into and through the skin. Traditionally radiofrequency is delivered in a bipolar fashion which penetrates little further than the thickness of the skin. But Exilis’s uniqueness is that it is monopolar radiofrequency which allows the waves to penetrate deeper and deliver more energy to dissolve fat cells. By using a grounding pad on the patient, the radiofrequency is applied deeply and it does a return circuit back to the machine. The skin temperature is also monitored to make sure it never gets too hot (above 45 degrees C) to prevent skin damage and make it comfortable for the patient. In addition, Exilis has a proprietary technology called Energy Flow Control (EFC) which monitors the energy level to prevent burns and any energy arching if skin contact is not ideal.
While many non-invasive energy therapies have left physicians skeptical, Exilis is FDA-approved for tightening skin and reducing wrinkles. The heat generated in the dermis of the skin causes collagen production, generation of collagen networks and tightening of skin. Fat reduction has also been reported by both doctors and patients alike. The deeper penetrating heat can cause fat cells to break down (lipolysis), release their free lipids and shrink in size. This results in an external change in the size of the body part.
The application head of Exilis and its built-in cooling device make it possible and safe to treat loose skin and excess fat anywhere on the body. This could be as diverse as the neck and jowls, back of the arms, bra rolls, stomach and all the way down to the knees. The ability to ‘spot treat’ is a major advantage over other more cumbersome devices. Each treatment is not only safe but is not painful. Most patients equate an Exilis treatment similar to a hot stone massage due to precise temperature monitoring. It can be used to treat all skin types which is another advantage of the device.
Because the temperature and the duration of generated heat to any part body is controlled for safety, multiple treatments are needed and results gradually achieved. Exilis treatments are done in a series of 4 to 6 treatments spaced one to two weeks apart to get the best result. Treatments are done in 30 to 45 minute sessions with no pain during and no downtime afterwards. One can go right back to their regular activities without any change in routinue.
For those patients receiving treatments for fat reduction, we advise drinking lots of water after the treatments to flush out fat through enhanced lymphatic flow. Combined with regular exercise and a niacin-based supplement known as Curva, optimal fat reduction can be achieved.
Results from Exilis are gradual although most see some immediate results. But maximum results takes months to see, up to three months after the last treatment. Studies have shown that the results are long-lasting.
Dr. Barry Eppley
Indianapolis, Indiana
Background: When a man presents for facial rejuvenation it frequently is driven by someone (or many) telling them they look tired. With enough repeated comments and in looking in the mirror, it eventually becomes evident that they in fact are looking tired. This most commonly is due to changes in the eye area.
A man’s eyelids begin to sag and excess skin and fat develop in both of them. The upper eyelid skin hangs down onto the lashes making them feel heavy and obliterating any evidence of a supratarsal fold. The lower eyelid becomes very puffy and develops a sagging appearance. Dark circles often develop under the eyes which draws extra attention to their changed and aging appearance. Also, the eyebrows may begin to sag and hang below the browbone, creating a ‘hangdog’ or an angry expression. Crow’s feet and other wrinkles develop outside of the actual eyelids.
Blepharoplasty or eyelid surgery is the well known antidote to a man’s aging eyes.While eyelid surgery may seem similar between men and women, there are some subtle and important differences. Men often seek a less obvious and an absolutely natural look compared to women. Eyelid scars are also a major concern, particularly in the lower eyelid as men do not have the option of scar camouflage with cosmetics. (they can use them but usually don’t want to) Men also desire to avoid any periorbital change that would make them look in any way feminine. These include such concerns about too high of an upper eyelid crease/scar, an upward flare to the eyebrow or too tight of a sweep to the tail of the lower eyelid or alteration of the corner of the eye. It is also important to realize that men are not usually interested in getting rid of every single wrinkle around \their eyes, they just want to less less tired and more refreshed.
Case Study: This 52 year-old man from Indianapolis Indiana was tired of being told he looked tired. He was bothered by skin that hung down onto his upper eyelids and eyelashes and the bags under his eyes. His lower eyelid bags were usually fairly swollen in the morning and it took all day until some of the puffiness went down. It took him several years to come to the realization that surgery was the answer.
Under general anesthesia, he had both upper and lower eyelids treated. The excess skin of the upper eyelid was removed creating a visible supratarsal fold and upper eyelid crease. A skin-muscle flap lower blepahroplasty technique was used removing a significant amount of herniated fat. Minimal lower eyelid skin was removed and the corner of the eye was tightened with the skin closure.
He had the usual amount of swelling and bruising after surgery that took about ten days to look ‘passable’. By three weeks after surgery, he looked non-surgical and was clearly in the benefits phase of the procedure. He did have some mild tearing issues of the left eye which took six weeks to completely resolve due to a slight amount of temporary lower eyelid retraction in the corner. He ended up with a less tired look around his eyes but with an unchanged appearance.
Case Highlights:
1) Facial aging in men disproportionately affects the eye area with extra skin, protruding fat, wrinkles and brow sagging.
2) Blepharoplasty surgery in men must avoid overresection and tightening of eyelid tissues that can look unnatural and more feminine.
3) Eyelid surgery in men creates a refreshed look but an overall unchanged facial appearance.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
The adornment of ears has been around since the dawn of civilization. Women and men have been putting all sorts of jewelry on ears from the top of the helix down to the earlobe. In what some may consider out of the ordinary or more extreme, the non-cartilaginous portion of the ear (earlobe) has even been split, severed or expanded in the interest of aesthetic enhancement.
When one thinks of changing the size of the earlobe, thoughts are given to people from some remote island or tribes from more distant lands. But the trend of earlobe expansion that has been seen in the past ten years, that of gauging or inserts into the earlobes, is now commonplace right here in the U.S. While everyone is entitled to their own sense of beauty and body modification, expanded earlobes with large central holes with or without inserts is usually not going to be a lifelong expression for most people.
As a plastic surgeon I am seeing more young men present for surgical correction of the stretched earlobes. The most common reasons are either for employment or job promotion, entering the military service or they simply are tired of them. The first two are forced upon the person by having to mold into the conformity of the organization. The last reason is one in which one wants to undo a generational fashion statement that now makes one self-conscious with a lot of saggy earlobes. Such an appearance, as unfair as it might be, creates an impression amongst some that they know who and what you are.
Whatever the motivation for change, plastic surgery correction of stretched earlobes is an easy problem to fix. Stretching the earlobes creates too much earlobe tissue, even if the outer rim of it can be quite thin. It is always better to have too much tissue in which to do a reconstruction than too little. This is a basic axiom in plastic surgery. While the large amount of floppy earlobe tissue and its central oblong hole may look like an impossibility from which to create a unified smaller earlobe, it is actually straightforward to do. It can be done in the office under local anesthesia in less than an hour for both earlobes. So what may have taken a year or so to create by steadily increasing the gauge of the disc inserts can be undone in one hour of precision reconstruction to make the earlobe look normal again.
Recovery from such earlobe reconstruction is very minimal if at all. I use dissolveable sutures on both sides the earlobe which require no removal. No dressings are used and one only applies antibiotic ointment for the first week after the procedure. Showering, washing one’s hair and all normal activities can be done without interruption. Patients report no pain, bruising and minimal swelling. The earlobe looks normal immediately. Patients interestingly do report the feeling of ‘phantom lobes’, much like that of phantom limb syndrome after amputations. But there seems to be no problem adjusting back to what looks very similar to their original earlobes, albeit with a tiny vertical scar in the earlobe close to its attachment to the face.
Dr. Barry Eppley
Indianapolis, Indiana
Case Study: Breast Augmentation and Its Effects On Stretch Marks
Author: barryeppley
Background: Breast augmentation works because it is a synthetic implant that makes the breasts bigger. While it is true that the role of the plastic surgeon is critical to get good implant placement in the proper position and as symmetrically as possible, but in the end the implant itself plays a major role in the final breast appearance. To a large degree, and often not appreciated by patients, is that implants merely magnify what the breasts initially looked like.
Stretch marks are usually the result of rapid stretching of the skin. They occur because the underside of the skin, known as the dermis, can not take the pressure from the rapid stretching and it tears. Stretch marks are, therefore, a form of scarring in the skin. But because they are located on the underside of the skin, they are generally resistant to improvement by any form of known treatment. While initially appearing as red or purple, they often fade in color to white.
When stretch marks occur on the breasts, usually from pregnancy, they occur in a radiating pattern from the areolas. This is reflective of the circular expansion of the breast mound against the natural lines of skin tension (Langer’s lines) of the breast skin. How fast the breast mound expands and the natural thickness of the skin will determine whether and how severe stretch marks may develop.
Because pregnancy causes some degree of loss of breast tissue, many women after they are finished having children desire breast augmentation. Pregnancies have left them with smaller deflated breast mounds that often have stretch marks as well. A very relevant question from them is what will happen to their stretch marks after getting breast implants. Will the stretch marks look worse?
Case Study: This 23 year-old female from Columbus Indiana wanted breast implants to improve the size and shape of her breasts. She had been through two pregnancies in the past four years and had lost most of her natural breast tissue. She also had very severe stretch marks that radiated widely out from her nipple-areolar complexes, were wide and many in number and were white in color. While she wanted larger breasts regardless of how the stretch marks would appear afterward, her question about what would happen to them after surgery was common.
Under general anesthesia, she had saline breast implants placed through a transaxillary approach. She was very small in size (5’ 1”, 102 lbs) and the implants were inflated to 375cc which stayed within the dimensions of her natural breast base diameter. During surgery it could be seen that her breast stretch marks did get wider from the expansion of the implants but they did not look worse in appearance.
When seen at one month after surgery, her breast implants were symmetrically placed and of acceptable size to her. Her stretch marks were still very apparent and actually a bit more red than before surgery. When comparing before and after photos, it could be stated her breast augmentation neither improved or made worse her pre-existing stretch marks.
This breast augmentation case shows a woman with very significant stretch marks on her breasts. Few women will present with a more severe case of breast stretch marks. While breast augmentation did not improve their appearance, nor would it be expected to, the procedure did not make them look worse. For some women whose breast stretch marks are relatively new (in the past few years) the rapid expansion of the breast skin from implants may make them initially more red. But this red color will fade as the breast skin relaxes after surgery. So while augmentation does make the stretch marks somewhat bigger, it does not necessarily make them look worse in the long run.
Case Highlights:
1) Stretch marks from pregnancy are common findings on many women considering breast augmentation. There is usually the concern that their appearance may be worse after surgery.
2) The expansion of the breast skin from implants does widen stretch marks but does not usually make them look worse in appearance.
3) Some stretch marks may initially get more red right after breast augmentation but this fades with time and skin relaxation.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana