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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.

August 3rd, 2015

Correction of Tuberous Breasts

 

Tuberous breasts are a well known congenital breast problem that presents in varying degrees of deformity. It has its greatest impact with the patient who presents for breast augmentation and often adjunctive strategies must be done at the time of implant placement to get a good breast shape result. Women often recognize that their breast(s) are misshapen but don’t know the exact name of the deformity.

Tuberous breasts are characterized by a breast base constriction (narrow diameter), small breast development, a high inframammary fold and inferior pole skin shortage and the classic areolar herniation presentation. Since it presents as a spectrum of deformity several classification systems have been devised which can be used to help with matching the deformity with the type of corrective breast procedure needed.

In the January 2015 issue of the journal Plastic and Reconstructive Surgery the article entitled ‘Tuberous Breast Deformity: Classification and Treatment Strategy for Improving Consistency in Aesthetic Correction’ was published. Using 26 patients (51 breasts) a three-tiered classification system was used based on the degree of base constriction, level of the inframammary fold, breast volume, amount of skin envelope, degree of ptosis and amount of areolar herniation. What differentiates their classification system are the added descriptors of ptosis and areolar herniation. The surgical technique included periareolar incisions, glandular dissection down to the level of the new inframammary fold, radial scoring of the inferior dermoglandular flap, submuscular release and dual plane tissue expander or implant placements. Circumareolar lifts are performed lastly to correct ant ptosis and enlarged areolas.

Of the tuberous breasts treated, 12 type 1, 26 type 2 and 13 type 3s were treated. MOst patients (92%) had a one-stage correction while a two-stage approach using a tissue expander was needed in the remaining 8%. A periareolar mastopexy was used in almost every patient (96%) with the addition of a vertical mastopexy in a limited few. (8%) Few complications occurred (8%) which were capsular contractures or implant malposition.

Tuberous Breast Augmentation result Dr Barry Eppley IndianapolisSurgical treatment of the tuberous breast is a challenging problem that often defies consistent and reliable correction. In very minor cases, a breast implant alone with or without areolar reduction may be all that is needed. But this represents the exception and not the rule. One of the keys in the correction of the tuberous breast is using the periareolar incisional approach. This provides access to a variety of the anatomic problems that the tuberous breast presents, not the least of which is the glandular dissection and release. While it has been historically taught that a subglandular breast implant should be used to help expand the lower breast pole this need is obviated by the glandular dissection and release technique. Dual plane breast implant placement can then be used and the long-term higher risks of subglandular breast implants are avoided.

This article provides a logical and thoughtful approach to the treatment of  tuberous breasts that can be done as a single stage correction in most cases.

Dr. Barry Eppley

Indianapolis, Indiana

August 2nd, 2015

Case Study – Custom Skull Implant for Sagittal Crest Deformity

 

Background: The skull is partially created and composed of numerous sutures. During development the skull is composed of six separate cranial bones which are held together by sutures which are made up of fibrous and elastic tissue. These sutures keep the skull bones separate for up to 18 months after birth to allow for brain growth at which point they grew together and remain so through adulthood.

sagittal skull sutureOne of these cranial sutures and the only one located directly in the midline is the sagittal suture. It is the suture that connects the two parietal bones. It is the cranial suture that takes the longest to close often not completely so until around thirty years of age. Early closure of this suture in infancy creates the classic scaphocephaly craniosynostosis with severe head shape aberration. But much less severe forms of scaphcephaly do occur and are noted by a prominent sagittal ridge or sagittal crest = from the bregma anteriorly back to the vertex posteriorly. This can be accompanied by a relative parasagittal deficiency which can magnify the appearance of the sagittal crest.

While the sagittal crest can be burred down there are limits as to how much it can be reduced. The thickness of the sagittal crest is often not greater than 6 or 7mms thick before the inner bony table is encountered or breached. In some patients the sagittal crest may be thicker but it is not assured. Thus maximal sagittal crest reduction may not make the top of the head acquire a convex shape, only blunting of sagittal point.

Skull Implant for Sagittal Ridge Deformity design Dr Barry Eppley IndianapolisSkull Implant design for Sagittal Ridge Deformity side view Dr Barry Eppley IndianapolisCase Study: This 35 year-old male wanted to change the shape of the top of his head. It had a very triangular shape, almost to the point of an inverted V shape. There was a prominent sagittal crest but also a relative parasagittal deficiency. It was felt that sagittal crest reduction alone would not provide much improvement. Instead, recontouring of the top of the skull was elected to be done with a custom designed skull cap implant made from the patient’s 3D CT scan.

perforated skull cap implant dr barry eppley indianapolisUnder general anesthesia a 9cm scalp incision was made perpendicular to the sagittal crest just anterior to the vertex. Wide subperiosteal undermining was done to develop the implant pocket. Prior to insertion the skull cap implant had multiple perforation holes placed through its thickness with a 3mm dermal punch. The implant was inserted and secured down to the bone with a single 1.5mm titanium screw. A drain was placed to be removed the next day.

Skull Implant for Sagiittal Ridge Deformity Dr Barry Eppley IndianapolisSkull Implant fo Sagittal Ridge Deformity result back view Dr Barry Eppley IndianapolisThe change in the shape of the skull was both immediate and significant. The upper head shape was convex and no longer pointed as can be seen from both the front and back views. It should be noted that this was just one day after surgery so swelling may make the height of the head higher than it may eventually be. But clearly the head shape reflets what the shape of the designed implant was. It will take months to eventually determine how smooth and indiscernible the transition from the implant edges to the bone. (which should be smooth and non-visible)

The custom skull implant provides a very effective solution for the sagittal crest skull deformity that has associated parasagittal deficiencies. The thickness of the implant over the sagittal crest only needs to be very thin (1mm) while the parasagittal area is much thicker as it blends to a fine edge into the upper temporal region.

Highlights:

1) The sagittal ridge skull deformity is the result of sagittal suture overgrowth, parasagittal deficiency or a combination of both.

2) Parasagittal augmentation can recontour the top of the head to make it more convex rather than triangular in shape.

3) A custom skull implant offers the most assured method of top of the head reshaping with the smallest incision to do so.

Dr. Barry Eppley

Indianapolis, Indiana

August 2nd, 2015

Technical Strategies – Asian Love Band Surgery

 

The Asian eyelid is very different from that of Caucasians both in anatomy and in aesthetic appearance. For the upper eyelid the ‘double eyelid’ blepharoplasty procedure is well known to create a crease which does not naturally exist. But for the lower eyelid aesthetic enhancements are less well known or requested.

Asian love band surgery indianapolisOne newer lower blepharoplasty aesthetic enhancement procedure is that known as Asian Love Band surgery. In this procedure a fullness is added to the lower eyelid just below the lashes. This is intended to enhance the underlying orbicularis muscle which in youth is fuller and more developed. (orbicularis roll) With aging the orbicularis muscle stretched and thins losing its fullness. To illustrate cultural differences in facial aesthetics,   an orbicularis roll in Caucasians would be considered undesireable and often requested to be removed. The Love Band operation is also perceived to make the eye look larger and more open, an optical illusion created by dividing the lower eyelid into two visible parts which is similar to what  “double eyelid” surgery does for the upper eyelids.

The Love Band lower eyelid surgery is done by placing small strips of grafts or implants under the skin through two small incisions at the inner and outer edges of the lid just below the lash line. Traditional materials used include allogeneic dermis (Alloderm) or Gore-Tex. The procedure can also be done non-surgically (albeit temporarily) by using hyaluronic-based injectable fillers.

Lower Eyelid Love Bands Surgical Technique 1 Dr Barry Eppley IndianapolisLower Eyelid Love Bands Surgical Technique 2 Dr Barry Eppley IndianapolisLower Eyelid Love Bands Surgical Technique 3 Dr Barry Eppley IndianapolisThe surgical technique that I have developed for Asian Love Band surgery uses temporalis fascia. This is a natural material that is harvested from small incisions in the temporal area. (although Alloderm can also be used) A small fat injection cannula is passed from one side of the eyelid to the other. The strips of temporalis fascia have a suture pass through them of which the ends are passed into the length of the cannula. The cannula is then removed leaving the suture on the other side of the eyelid. The suture is then used to pull the fascial graft through the lower eyelid tunnel, trimmed and closed with a tiny dissolveable suture.

The Asian Love Band procedure requires a method to pass a graft or implant right under the lash line through the tiniest of incisions. This cannula passing method provides a simple and effective method to do so.

Dr. Barry Eppley

Indianapolis, Indiana

August 1st, 2015

Case Study – Small Rib Graft Dorsal Augmentation Rhinoplasty

 

Nose Job Indianapolis Dr Barry EppleyBackground: One of the main features of the nose is the dorsal line or the nasal dorsum. It is more commonly called the “bridge” of the nose as it connects the forehead to the tip of the protruding nasal tip. It is made up of bone (upper half or upper third) and cartilage. (upper lateral cartilages) In the profile or side view the nasal dorsum should be a relatively smooth continuous line from the forehead to the tip. When looking at the nose from straight on, the dorsum should form straight appearing lines down its sides (dorsal aesthetic lines) that connect the eyebrows to the tip of the nose.

The most frequently encountered aesthetic deformity of the nasal dorsum is that of a hump. (convexity)A dorsal hump is incredibly common and its reduction is done in many a primary rhinoplasty procedure. It results from an overgrowth of the osteocartilaginous junction of the nose and is thus a natural feature. A dorsal depression or saddle nose (concavity) is more times than not an unnatural feature caused by either trauma or iatrogenic causes. (over reduction of a dorsal hump from a rhinoplasty) But it can occur naturally is smaller more upturned noses and is a result of relative undergrowth of the nasal septum during development.

While the dorsal hump requires osteocartilaginous reduction, the dorsal depression requires augmentation. There are multiple methods of nasal dorsal augmentation from implants to cartilage and bone grafts, each with their own advantages and disadvantages.

Case Study: This 24 year-old male wanted to have the dip in his nasal bridge augmented to the point where it was straight. This was a natural dorsal line concavity which he had always had. He had a prior nasal dorsal augmentation with layered septal cartilage, which provided some modest improvement, but not to the level of it being straight. While he realized a dorsal nasal implant could be used, he preferred the use of his own cartilage.

Rib Graft Shaping for Rhinoplasty Dr Barry Eppley IndianapolisDorsal Rib Graft Rhinoplasty Dr Barry Eppley IndianapolisUnder general anesthesia a small rib graft was harvested in situ from the 8th rib through a  small 2.5 cm incision. The rib segment was carved to the desired shape and length as measured on the patient’s nose over the area of the depression. Through an intercartilaginous intranasal incision a narrow pocket was developed over the cartilage and bone of the dorsal depression onto which the fashioned cartilage graft was inserted and placed.

The nasal dorsum can be augmented with a variety of implants and natural tissue grafts. Small nasal dorsal deperssions can be easily and simply built up with implants of various materials. Small silicone dorsal implants are one example and they all offer the assurance of a dorsal augmentation that will not warp later. (although asymmetry can exist if careful  pocket development and placement is not done) This small nasal implant also has a very low rate of complications given that it is putting little pressure on the overlying soft tissues.

Despite the simplicity of implants some patients may feel more comfortable with a cartilage graft. While the usual source of harvest is the nasal septum, it is suitable for very limited amounts of dorsal augmentation. Once partially harvested the septum can no longer be considered a donor source. Ear cartilage is curved and the risks of asymmetries and irregularities is high unless it is diced and wrapped in fascia. Small cartilage grafts can be harvested from the rib without having to remove a larger segment by an in situ harvest method.

Highlights:

1) Dorsal augmentation of the nose can be done by either implants or cartilage grafts.

2) A dorsal nasal implant that is modest in size has a very low risk of long-term problems.

3) A single en bloc carved piece of rib can provide a cartilaginous option for dorsal nasal augmentation in rhinoplasty.

Dr. Barry Eppley

Indianapolis, Indiana

July 30th, 2015

Simultaneous Stahl’s Ear and Constricted Ear Corrections

There are numerous types of congenital ear deformities. The constricted ear represents a tightness of the ear like a cinch around the outer helix of the ear which makes it smaller and often folded somewhat onto itself. The Stahl’s ear deformity, also known as a Vulcan or Spock ear, has a cartilage fold that can cause a pointed malformation in the upper part of the ear. Both types of ear deformities are uncommon but are even more rare when they occur together.

In the July 2015 issue of the International Journal of Plastic Reconstructive and Aesthetic Surgery, an article appeared in print entitled ‘ Surgical Correction of Constricted Ear combined with Stahl’s Ear’. Over a seven year period, the authors had 19 patients with constricted ear with Stahl’s ear, most of whom had it on just one side. They were surgically treated by a technique that consisted of an initial double Z-shaped skin incision made on the back side of the ear with the entire layer of cartilage cut parallel to the helix traversing the third crus to form a fan-shaped cartilage flap. The superior crus of the antihelix were shaped by folding the cartilage rim. The cartilage of the abnormal third crus was made part of the new superior crus of the antihelix and the third crus was eliminated.

Postoperative assessment of the ear reconstructions based on symmetry, helical stretch, successful elimination of the third crus, the auriculo-cephalic angle, and the substructure of the reshaped ears. All reconstructions were rated as excellent to good without any complications seen. This study shows that even the rarest of congenital ear deformities can be successfully treated with the proper surgical technique.

In the human ear the bifurcated Y-shaped superior and inferior crus is a major component of its upper half. In Stahl’s ear deformity an aberrant crus usually replaces the superior crus, crossing the scaphoid fossa from the site of the normal bifurcation of the antihelix posteriorly towards the helix which gives it an abnormal J-shape. A surgical technique to correct Stahl’s ear deformity can be done by a Z-plasty to the incision to lengthen the skin on the posterior surface, together with making use of the aberrant crus to reconstruct the superior crus without reducing the ear size using horizontal mattress sutures. This is achieved by posterior scoring and suturing without any cartilage excisions which converts the J antihelix into a Y antihelix.

Adding the constricted ear problem to the Stahl’s ear raises the stakes in terms of reconstructive difficulty. The tightness of the skin and shortage of cartilage necessitates the need to release the constricted cartilage into a fan shape and use Z patterned incisions on the back of the ear.

Dr. Barry Eppley

Indianapolis, Indiana

July 29th, 2015

Five Facts About Pectoral Implants

Unlike facial implants, the use of body implants (excluding breast implants) has a much shorter surgical history. While the use of facial implants dates back more than five decades in plastic surgery, body implants have been done for less than two decades and in numbers that are just a fraction of that of face or breast implants.

One type of body implant is that used for pectoral or chest enhancement. Pectoral implants are used for a variety of chest shape concerns such as aesthetic muscle enhancement or in the correction of congenital deformities such as Poland’s syndrome. They have a very successful history in plastic surgery of favorable patient outcomes with a low risk of complications. But there are numerous misconceptions about pectoral implants so let me dispel a few of them.

A Pectoral Implant Is Not The Same As A Breast Implant. A breast implant is a two part medical device that has an outer silicone shell (bag) which contains either saline or a silicone gel. They have a limited span and will not last forever in any patient. One day the bag will develop a tear and the failed implant will need replaced. Conversely, pectoral implants are made of a solid silicone material that can not fail, rupture or break apart. Thus pectoral implants are permanent medical devices that will never need to be replaced due to structural implant problems.

There have been a few cases across the U.S. where surgeons have made the inexplainable decision to use breast implants for male pectoral augmentation. While that would be appropriate for transgender (male to female) breast augmentation, only solid pectoral implants should be used for male chest enhancement.

Pectoral Muscle ImplantsA Pectoral Implant Is A Muscle Implant. What is unique about most body implants is that they are designed to do muscle augmentation and are really ‘muscle implants.’ They are usually shaped like the muscle they are designed to enhance. Although they are solid implants they are very soft and flexible and will essentially feel similar to the muscle they are designed to enhance. They are made of a low durometer silicone material which allows for tremendous flexibility without tearing or fracturing the implant.

Pectoral Implant results front view Dr Barry Eppley IndianapolisPectoral Implants result oblique view Dr Barry Eppley IndianapolisPectoral Implants Are Not Just For Body Builders. Many people have the misconception that a man gets pectoral implants because they want to look like a body builder. That is a very uncommon use for pectoral implants. They are far more frequently used in men who can not adequately develop sufficient pectoral size through exercise or who have chest deficiences/asymmetries due to a congenital or developmental anomaly. In other words they are used for men who are seeking to look more normal…not ‘supernormal’.

pectoral implant styles Dr Barry Eppley IndianapolisPectoral Implants Are Available In A Variety Of Shapes and Sizes. Since the shape and size of men’s chests can be very different, it is no surprise that pectoral implants are not just ‘one size fits all’. The main shapes of pectoral implants are either oval or more rectangular based on the areas of desired chest enhancement. Sizes are a combination of length, width and height measurements and the volume in ccs of solid silicone contained therein. (somewhat similar to breast implants) Matching the implant size and shape to each individual man’s chest shape is one of the keys to a successful pectoral augmentation outcome.

Pectoral Implants Are Placed Through High Axillary Incisions. As part of a successful pectoral implant surgery, the incision to place the implant should be hidden. The only place to insert a pectoral implant is through an incision way up in the armpit or axillary region. While the incision will be slightly longer than that used for placing breast implants, incisions in the armpit usually heal very heal to the hair follicles and sweat glands that are present in the skin.

Dr. Barry Eppley

Indianapolis, Indiana

July 29th, 2015

The Role of The Buccal Lipectomy in Facial Reshaping

The buccal fat pad is most commonly known because of the aesthetic buccal lipectomy procedure. Its historic significance is in what it creates when it is removed…a facial thinning effect. It is the one facial defatting procedure that is easy to do, effective and permanent. It is not a facial liposuction procedure, as is commonly perceived, but rather an excisional procedure where the fat is teased out and directly cut off and removed.

Despite its historic use more recent concepts of facial aging have cast doubt on the validity of the procedure. Losing facial volume by fat atrophy is one of the sequelae of aging and its toll on the face is that of a devoluminizing effect leading to a gaunt and more aged facial look in many people. This has let to contemporary efforts to maintain or even add fat volume to the face as a restorative procedure. This has led to many plastic surgeons spurning the buccal lipectomy as a procedure that should be avoided and abandoned.

The reality is that the buccal lipectomy is neither a completely good or bad aesthetic procedure. It all depends on the patient’s facial anatomy, shape and desired effect. Understanding the anatomy of the buccal fat pad will shed light on whether it could be beneficial to any patient’s facial reshaping goal.

Buccal Fat Pad AnatomyWhile the merits of the buccal lipectomy can be debated, its anatomy can not. It is a large encapsulated fat pad that has a distinct vascular pedicle that sits right below the cheekbone in the appropriately named buccal space. There is no other such fat collection with this specific anatomy in the face. Besides its size and exact anatomic location it is also not appreciated that it has numerous extensions (fingers) that extend outward and beyond its ‘home’ submalar located buccal space. Its biggest extension heads northward where it can be found around the temporalis muscle. Its location here speaks to what is believed to be its role as an interpositional material between the masseter and temporalis muscles. This allows them to have functional movement without interfering with each other or allowing scar adhesions to develop between the two muscles. What is also clear in the anatomy of the buccal fad pad is that it does not extend downward below about the level of the occlusal plane.

This anatomy has several implications as to the merits and potential deleterious effects of the buccal lipectomy procedure. First, its removal results in a very discrete facial thinning location or indentation which sits below below the cheekbone and is about the size of a thumbprint. It does not have a larger facial thinning effect. It will not create any lower cheek thinning effect like down around the side of the mouth as is commonly believed. Secondly, an aggressive removal of the buccal fat pad (which is easy to do) will result in an adverse thinning effect up into the temporal region. This will result in temporal hollows as the remaining fat pad is pulled down and atrophied from the loss of the ‘mother ship’ so to speak. Lastly loss of the buccal fat pad is permanent and is one of the only facial fat collections that can not be restored by secondary weight gain by fat cell uptake of excess lipids. (although fat injections can be a corrective procedure)

The conclusion based on anatomy is that the buccal lipectomy procedure should be reserved for very specific types of facial shapes and should often be performed in a subtotal or incomplete manner. Only in the fullest and roundest of facial shapes should a more complete buccal lipectomy be done. In less round faces who have a very specific fullness isolated to just below the cheekbone, a subtotal buccal lipectomy can be safely performed. For a more complete facial derounding effect, a buccal lipectomy will need to be combined with other procedures to achieve a maximal facial reshaping effect.

Dr. Barry Eppley

Indianapolis, Indiana

July 29th, 2015

Case Study: Breast Implants with Periareolar Lift

Background: Loss of breast volume is very common amongst women usually caused by pregnancies or weight loss. As the breast deflates sagging of the breast mound often occurs. As long as the nipple remains positioned at or above the inframammary fold (lower breast crease) augmentation with breast implants will adequately fill up and out the deflated breast creating a more pleasing breast size and shape.
But with increased degrees of breast sagging (nipple at or below the inframammary fold), an inplant alone will not be satisfactory solution. While it will expand the breast volume the nipple will likely be driven downward not upward creating a breast look that few would desire or accept as an improved breast shape outcome.
The need for a breast lift at the time of breast augmentation is very common. While no woman wants a breast lift and the skin scars that result they may have little choice. The options for true breast lifting are three fold. The most common and effective are the vertical breast lift (lollipop lift) and the combined vertical and horizontal breast lift. (anchor lift) But the breast lift that creates the least scar and also has the least lifting benefit is that of the periareolar or donut pattern breast lift.
Case Study: This 42 year-old female presented for breast augmentation. She had lost some weight, and between that and having had children, had a bit of a breast sag. Her nipples were exactly at the level of the inframammary fold. The dilemma was whether just getting breast implants would create a nipple positioning problem on the enlarged mound or whether she should just have a breast lift at the time of her implants. She was adamantly opposed to any type of breast skin scar on the mound itself.
MM Bam results front viewUnder general anesthesia she had silicone gel breast implants (475cc) placed in a dual plane position through a small inframammary incision. At the same time she had an eccentric ring of skin removed from around her areolas. (donut breast lift)
MM Bam results oblique viewMM BAM result side viewAt three months after surgery, her breasts show an acceptable breast mound enlargement and nipples that were in good orientation on the breast mound. There was no appreciable sag of the breasts although her breast mounds remained in the same overall position as that before surgery. Her areolar diameters were increased.
Of all the types of breast lifts, the donut lift is the ‘weakest’ of the group. It really has a very limited breast lifting effect and this could be seen if it was ever just done on its own. It does provide a bit of a lift when combined with implants although the implants really do the heavy lifting in the final result. But the donut lift does have a role to play in the woman who is questionable if she really needs a lift or not. It may be just enough in some women to allow them to get by without having to get scars on the skin portion of the breast mound. It is hard to say whether the increase in areolar diameter seen is due to the natural stretch of it from the underlying implant expansion or from the combined tension of the periareolar skin reduction.
Highlights:
1) Minimal to modest amounts of breast sagging can be improved with a perirareolar or donut style breast lift procedure.
2) A periareolar breast lift works best when combined with breast implants.
3) A periareolar breast lift almost always enlarges the diameter of the areola, particularly when used in combination with breast implants.
Dr. Barry Eppley
Indianapolis, Indiana

July 21st, 2015

Case Study – Sagittal Ridge Skull Reshaping

Background: While the skull is often perceived as just a large round homogenous surface, it is actually made up of various regions or aesthetic units. These units arise from the various plates and suture lines from which the skull is embryologically and developmentally formed. Each of these skull areas can be prone to surface contour irregularities based on how they development and merge to form the intact skull.

One aesthetic skull region is that of the sagittal ridge or sagittal crest. This is the midline region of the skull that extends from the top of the forehead all the way to the back of the head at the bottom. Most of it does correspond to the location of the original sagittal suture seen in utero and the anterior and posterior fontanelles (soft spots) seen for a short period of time after birth. Sagittal suture line abnormalities can present as high ridges, indentations, a triangular-shaped skull and dimples or lumps over the original fontanelle areas.

Sagittal line abnormalities can become particularly apparent in men more than women due to hair issues. In men with thinning hair, are bald or who shave their head the prominence of the sagittal region of the skull becomes unmistakeable.

Case Study: This 40 year-old male was bothered by two large humps along the midline of his skull in the anteroposterior direction. There was a central dip between the two high spots. He wanted to being the high spots down to the level of the central dip or valley. In addition he had an occipital knob deformity, which is also a midline skull abnormality, although not known to be connected developmentally to the sagittal suture.

Sagittal  Crest Skull Reshaping Operative Plan Dr Barry Eppley IndianapolisUnder general anesthesia and in the prone position, the occipital knob was reduced by burring through a small horizontal incision over it. Then using a horizontal incision placed transversely between the two sagittal humps the height of the bony humps was burred down as much as possible into the diploic space.

Sagittal Crest Reduction results side viewSagittal Ridge Reshaping Dr Barry Eppley IndianapolisAt six months after surgery, he had a marked improvement in his skull shape. The sagittal profile was nearly completely smooth and the occipital prominence was gone. The scalp scar had healed in a near conspicuous fashion.

Sagittal skull reshaping can be done by bone reduction or augmentation of any low areas. Most commonly bone reduction is needed due to sutural overgrowth. Burring reduction will usually suffice as long as the thickness of bone will permit the reduction.

Highlights:

1) The sagittal line of the skull can be affected by a variety of raised or depressed areas along its midline course.

2) Sagittal ridge or sagittal crest skull contouring can be done by burring reduction and is limited by the thickness of the skull bone.

3) Aesthetic sagittal skull contouring requires small incisions to limit visible scarring.

Dr. Barry Eppley

Indianapolis, Indiana

July 20th, 2015

Exils and Vanquish Combination Treatments for Skin Tightening and Fat Reduction

 

There are numerous non-invasive no downtime body contouring procedures for skin tightening and fat reduction specifically. One of these technological approaches is that offered by BTL Aesthetics. They offer plastic surgeons two-energy driven devices that work together to produce the best outcome without patient discomfort or recovery. These two devices include the Exilis and Vanquish.

Both BTL devices used monipolar radiofrequency energy to create their effects. Exilis is primarily used for skin tightening and a superficial fat reduction that lies right under the dermis of the skin. Conversely Vanquish directs radiofrequency energy much deeper to reach larger fat areas much further past the skin. By creating cellular apoptosis fat layers are reduced in thickness. It is easy to see when both Exilis and Vanquish are done together they create the best non-surgical contouring effect possible.

Exilis Dr Barry Eppley IndianapolisExilis is able to tighten skin at high energy levels due to its sophisticated cooling system in a small handpiece. Vanquish creates a safe effect by spreading its radiofrequency energy over a much larger area using external panel applicators. With these panel applicators Vanquish can treat the abdomen, flanks, thighs and arms.

Vanquish Fat Reduction Dr Barry Eppley IndianapolisThe usual sequence of treatment is to use Vanquish first for bulk fat treatment/reduction. To treat the abdomen and flanks fir example it takes a 45 minute treatment session. Four treatments spaced one week apart will produce a noticeable change. Vanquish does have some skin tightening effect but Exilis is even more effective. Using Exilis right after Vanquish increases the skin tightening effect which is usually needed when the fat loss ensues.

Despite their body contouring benefits it is important to realize that the Exilis-Vanquish combo treatment are no weight loss devices. They work best on those patients who need focal areas of body contouring, need to lose just a few inches and understands that it will not create a ‘liposuction’ result. A healthy lifestyle, some exercise and good hydration are patient contributions that are needed for optimal results.

The pursuit of fat reduction and skin tone improvement in the 30 to 50 year old range through non-surgical means is highly sought after. The BTL Vanquish and Exilis combo performs as well as any other non-invasive devices and does so with no discomfort or downtime. They also work well after other surgical body contouring procedures like liposuction and tummy tucks.

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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