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.

August 30th, 2015

Case Study – Extreme Skull Augmentation with Scalp Tissue Expansion

 

Background: The size and shape of the skull can be safely increased for a variety of aesthetic reasons by onlay materials. Regardless of the material used to create the skull augmentation serious consideration must be given to how well the overlying scalp can accommodate it. If the scalp incision used to place it can not be closed or is closed under extreme tension, the complications that will ensue are obvious. Based on my skull reshaping/augmentation experience, I have learned that about 10 to 15 millimeters is the most amount a scalp can safely stretch…and that will also be influenced by the scope of the skull surface area covered.

The most common skull area that is requested to be augmented is the back of the head. Women request occipital augmentation for two reasons, to either build out a very flat back of the head (just like some men) or to build out the upper occipital/vertex region. (not a male request) While both achieve an occipital skull increase, the location of the area of skull augmentation and its outward effects are different. The woman who desires more of a combined occipital-vertex augmentation seeks to create a higher hairline level or ‘bump it’ effect from both the frontal and side views.

For large amounts of vertex skull augmentation or for ‘failed’ prior occipital augmentation procedures, a first stage scalp expansion procedure is needed. The scalp expansion amount does not need to be significant as what one sees with many scalp expansions that are done for other procedures. There is a big difference between expanding the scalp to cover a large scalp tissue loss versus what is needed to stretch out the scalp a bit to cover a larger skull augmentation.

Case Study: This 28 year old female had a prior occipital implant placed in another country to give her more skull height in the vertex and upper occipital region. It did not produce the desired effect and created vey little augmentation effect at all. It was done through a long zig zag scalp incision pattern which left her with a very wide scar line as the sequelae. To get her the skull augmentation result she desired as well as create enough scalp to do a total scar excision, a two-stage skull augmnetation procedure was planned.

Scalp Tissue Expander Dr Barry Eppley IndianapolisA first stage scalp expander was initially placed over the existing scalp implant area. Over the next six weeks a total volume of 150ccs of fluid was instilled into the expander.

Extreme Occipital Augmentation intraop top view Dr Barry Eppley IndianapolisExtreme Occipital Augmentation result intraop oblique viewDuring the second stage procedure the tissue expander was removed. The previously placed implant could be seen to be woefully inadequate and provided only a 4mm increase in skill height despite being custom made. The old implant was covered with 180 grams of PMMA bone cement placed to build up the desired skull areas which covered a much larger surface area. This created a near 3cm height increase over the central vertex skull area. Enough scalp tissue was present  from the expansion that permitted a comfortable scalp closure even with the old scar completely excised.

Extreme Occipital Augmentation result side viewExtreme Occipital Augmentation result front view Dr Barry Eppley IndianapolisHer results showed a dramatic impact in creating her desired  skull ‘bump it’ effect. Such large or extreme skull augmentation results are not possible without a first stage scalp expansion. The expander volume only needs to be enough to create the desired skull augmentation effect which is usually around 100cc to 150cc at most.

Highlights:

1) The amount of skull augmentation that can be obtained is the limit of how much the overlying scalp can safely expand.

2) Extreme or large amounts of skull augmentation require a first-stage scalp tissue expander procedure.

3) With a first-stage scalp tissue expansion the skull can be augmented as much as 2.5 to 3 cms in many places.

Dr. Barry Eppley

Indianapolis, Indiana

August 30th, 2015

Case Study – Permalip Implant Lip Augmentation

 

Background: Lip augmentation is the historic location for injectable fillers since the early 1980s and remains as one of the top injectable filler sites even today. There are a wide variety of injectable fillers and manufacturers but the use of hyaluronic-acid (HA) based fillers is primarily used in the lips as they have the lowest risk of potential complications.  HA injectable fillers flow in the smoothest and the easiest and this makes them ideal for lip augmentation.

While injectable fillers for lip augmentation is highly effective and safe, it is not permanent. (I am excluding the use of silicone oil from this discussion since it is not FDA-approved for this use) This lack of permanency poses a long-term issue in terms of cost. Few women are going to spend $500 to $1,000 per year over their lifetime to maintain a lip augmentation result. It simply is too costly to do so for most women.

The concept of lip implants has been around for a long time and numerous types of lip implants have been tried. While effective in increasing the size of the lips they have posed numerous problems including hardness, irregularities, scar tissue, lip numbness, extrusion and difficulty with removal. This has given lip implants an historic poor reputation.

Permalip Implants Indianapolis Dr Barry EppleyWhile no permanent lip implant can be perfect as the lip is a very soft and distensible structure, the problem with past implants is that the materials used were too firm. No matter how it is engineered and designed polytetrafluroethylene (Gore-tex) is too firm for the lips. A newer lip implant, Permalip, offers an improved material that is of a very soft flexible solid silicone material. Just by feel it seems more like a soft lip structure.

Case Study: This 42 year old female had various HA injectable filler materials placed into her lips for the past six years. While she liked her lip augmentation results, the cost of repeated treatments was becoming prohibitive. She sought a permanent lip augmentation result with implants.

Lip Implants result side view Dr Barry Eppley IndianapolisLip Implants result front view Dr Barry Eppley IndianapolisUnder local anesthesia in the office using infraorbital and mental nerve blocks with direct infiltration into the lips, Permalip implants were placed. A 4mm implant was placed in the  upper lip and a 3mm implant placed in the lower lip through small incisions placed just inside the corner of the mouth.

Indianapolis Permalip Implants Dr Barry EppleyPermalip implants offer the only permanent method of lip augmentation. Of all lip implants ever manufactured, their soft silicone composition is the best material and design offered to date. They are easy to place and, just as importantly, easy to remove should that be necessary. Because they have a smooth surface it is very important that the chosen length of the implant is at least as long as a measurement taken across the lip from one mouth corner to the other. If the implant is short of this distance it will become displaced with asymmetry of the implant between the two lip halfs.

Permalip Implant Size Options Dr Barry Eppley IndianapolisCurrently the largest Permalip implant is 5mms in size. This produces a very noticeable lip augmentation change but will not create dramatically large lips. The use of larger lip implants, even if they were available, would not be advised. When the ratio of the implant size to that of the natural lip exceeds more than 50% the rate of complication is bound to exponentially increase.

While lip implants offer a permanent method of lip augmentation, it is important that patients realize that they have the potential for complications like implants placed anywhere else in the body. The most common complications are palpability and implant asymmetry being at different tissue levels between the two lip halfs.

Highlights:

1) The only permanent FDA-approved method for lip augmnetation are silicone implants. (Permalip)

2) Permalip implant are generally used in qualified patients who have tried other injectable methods and now seek a permanent lip augmentation solution.

3) It is important to remember that Permalip implants are implants that are placed in a flexible and sensitive body part with exposes them to certain risks.

Dr. Barry Eppley

Indianapolis, Indiana

August 30th, 2015

Case Study – PEKK Skull Implants In Pediatric Skull Defect Reconstruction

Background: Cranial or skull reconstruction has been done for over half a century with a wide variety of different materials. Whether its is done using the patient’s own bone, bone substitutes or synthetic materials, successful skull reconstruction can be accomplished with all of them if skillfully done. But because of the availability limitations of using the patient’s own bone and the structural limitations of bone substitute materials, the use of synthetic materials remains the mainstay of major skull reconstruction today.

The use of polymethylmethacrylate (PMMA) bone cement, intraoperatively mixed and applied, has been the mainstay of skull reeconstruction for decades. It is relatively inexpensive, highly resistant to fracture, and can be loaded with antibiotics for postoperative release. But it does require skill in shaping it and it does not permit tissues to adhere/stick to it.

While still effective PMMA has been replaced over the past two decades by computer design technology and different types of synthetic materials. The standard of computer designed skull reconstruction has been HTR-PMI. This is a porous PMMA-based material that is formed by combining HTR beads (which are coated in calcium phosphate) into a solid composite based on the patient’s 3D CT scan of the defect. Due to its porosity and hydrophilic material quality, it has functioned very well as an implant reconstruction method for large skull defects. But it is not perfect as its edges must be thicker to prevent material fracture and it is actually made by hand from a negative impression of the patient’s skull model.

Congenital Occipital Skull Defects Dr Barry Eppley IndianapolisCase Study: A seven year-old female child presented with two soft spots on her head that had been present since birth. A 3D CT scan revealed two full-thickness skull defects in the back of her head that were separated by thin strip of midline bone. The reasons these congenital skull defects were there is unknown. A skull model was made from the scan to provide a hand-held study of her skull.

PEKK Cranial Implant Designs Dr Barry Eppley IndianapolisFrom the 3D CT scan implant designs were made to precisely cover the skull defects that were perfectly flush with the surrounding skull bone. These implant designs were turned into actual skull implants made of PolyEtherKetoneKetone. (PEKK)

Pekk Cranial Implant Reconstruction Dr Barry Eppley IndianapolisUnder general anesthesia, a hemi-coronal incision was made on the back of her head to expose the skull defects. The dura was easily elevated from the defect edges and the PEKK skull implants placed with a precision almost snap-like fit. Small titanium plates and screws were used to secure it into place. She was discharged the next day and had a completely uneventful recovery with beautiful healing of her scalp incision.

Custom designed (3D printed) skull implants made from a PEKK (PolyEtherKetoneKetone) material has become the new premier standard for large skull defect reconstruction. It has its origins from Polyether ether ketone (PEEK) which is a colorless organic thermoplastic polymer used in numerous engineering applications due to its robustness and resistance to wear. PEKK has very similar properties to PEEK but it has some superior properties including superior wear resistance, improved compressive strength and a lower water absorption capability.

Highlights:

  1. Custom designed 3D printed skull implants made from PEKK material offers a precision fit skull reconstruction method.
  2. Being able to be made thin with stronger mechanical properties is a significant advantage in a skull reconstructive material.
  3. PEKK skull implants require a 3D CT scan from which they are made.

Dr. Barry Eppley

Indianapolis, Indiana

August 30th, 2015

Safety of Cosmetic Surgery in the Elderly

 

Cosmetic Surgery in Octogenarians Dr Barry Eppley IndianapolisThe popularity of all forms of cosmetic surgery is growing and it spans all ages from teenagers to senior citizens for a wide variety of procedures. Age knows no limits when it comes to self-improvement and the desire to look as good as physically possible. While younger patients do inquire as to the safety of certain cosmetic surgery procedures, that very question becomes much more relevant in older patients who may more ailments and medical problems. Even when very healthy older patients naturally ask if their age places them at greater risk for complications.

In the September 2015 issue of the Aesthetic Surgery Journal an article on this topic appeared entitled ‘Safety of Cosmetic Procedures in Elderly and Octogenarian Patients’. To evaluate the incidence of complications from elective aesthetic surgery in patients over age 65 (so called ‘elderly’), the authors looked at a data base of over 180,000 patients from the company CosmetAssure’s data base. Postoperative complications in elderly and younger patient groups were compared with a separate. analysis of postoperative complications in patients over 80 years old. From this database just over 6,700 patients over 65 years old were identified with an average age of 69 years old and with a higher number of men with higher body mass indexs.

They found that the postoperative complication rates was not higher than that of younger patients.When looking at the type of cosmetic procedure, only a tummy tuck had greater complication rates in older patients.The most common postoperative complications in older patients were infection and bleeding. (hematoma) Also the octogenarian patients had a complication rate of around 2% which was not different than that of any other age group.

Cosmetic Surgery in the Elderly Indianapolis Dr Barry EppleyAs the U.S. population grows an older number of cosmetic surgery patients have come forth more than ever before. The first question that both plastic surgeon and patient alike ask at older ages is…is having this operation safe? Is the patient at increased risk because the patient is older? It is the plastic surgeon’s perception and experience that this is not so. This study supports that belief using data from a company that knows complications from having to insure against them and pay for them if they should occur.

Dr. Barry Eppley

Indianapolis, Indiana

August 29th, 2015

Burn Ear Reconstruction Options

 

Ear reconstruction is challenging and is put to the test when portions of the ear are lost from a burn injury. Burned ears present with a unique situation due to the pattern of ear loss. Almost always the external auditory canal and the cartilaginous tragus and portions of the antihelix may remain. But the outer helix and earlobe are often lost due to the greater exposure of the outer framework of the ear to the heat source.

Maintenance of the external auditory canal and the surrounding cartilage is always beneficial in ear reconstruction as these ear areas can be the hardest structures to surgically recreate. But the burnt tissue around the remaining stump of the ear, which has usually been skin grafted, poses a dilemma for outer ear framework reconstruction. The skin is not pliable and can not be used/elevated to provide any skin coverage over a helical cartilage reconstruction.

Burned Ear Reconstruction with Rib Graft result Dr Barry Eppley IndianapolisThere are two methods to create the necessary skin coverage for burn ear reconstruction. The most common is the use of a tissue expander as a first stage procedure. The surrounding skin grafted/burned skin can be slowly expanded directly over where the recreated helix will be. Once adequately expanded a cartilage graft can be used to make the helix and placed under the expanded. The key here is slow tissue expansion to prevent breakdown of the scarred skin.

Burn Ear Reconstruction 2  result Dr Barry Eppley IndianapolisThe second approach is to use the scarred skin around the ear stump as a pedicled skin flap. The raised skin is rolled onto itself and cartilage grafted underneath it. This will require that a skin graft be done to cover the area left raw from where the skin flap was raised.

There is also a third approach where an ear cartilage framework is covered by a pedicled temporal fascial flap. This requires of course an intact temporal artery pedicle which may or may not be present. The fascial flap covers the framework and is then skin grafted.

The burn ear deformity presents a different reconstructive challenge than that of congenital microtia for example. It suffers from poor quality surrounding skin cover and thus requires a different strategy for providing soft tissue coverage over a cartilage framework reconstruction.

Dr. Barry Eppley

Indianapolis, Indiana

August 29th, 2015

Incisional Techniques for Buttock Implants

 

Buttock augmentation has become a procedure today that almost rivals that in public interest and in procedures performed like that of breast augmentation. By far the most common method of buttock augmentation uses the patient’s own fat as an injectable technique known as the Brazilian Butt Lift. (BBL) But not everyone is a candidate for a BBL due to either lack of fat for adequate injectable volume or has been through a BBL procedure where the fat has not adequately survived.

Buttock implants offers a method of buttock augmentation that exerts its effect by the placement of a non-degradable solid silicone implant. While it is a far more invasive procedure and has a longer recovery, it offers a permanent buttock size increase.

The biggest ‘controversy’ in buttock implants is the pocket location as to whether it is on top of the muscle (subfascial) or inside the gluteus muscle. (intramuscular) This decision has great relevance for options in implant size  and the risk of long-term complications. Intramuscular buttock implants permit only smaller implant sizes but have a better long-term prognosis and lifespan. Subfascial buttock implants permit much larger sizes but has a potentially higher rate complications. (e.g.,s seroma, implant visibility)

One controversy of buttock implants that is less written about or addressed is that of the incision used to place them. All buttock implants are placed through an intergluteal incision that should stay below the superior end of the crease to remain hidden. When one considers that the most common complication of buttock implants, regardless of pocket location, is wound dehiscence or incisional separation, how the incision is made and closed has considerable merit.  While usually a self-healing problem, an intergluteal incision can take a long time to heal and potentially exposes the implants to contamination and risk of infection.

The intergluteal incision for buttock implants can be placed as a single midline technique or a double parallel off midline incisional technique. Each has their own advantages and disadvantages.

Single Incision Buttock Implant Approach Dr Barry Eppley IndianapolisThe most commonly used intergluteal incision is the single midline technique. This has the advantage of a more limited single scar of usually 6 to 7 cms length and both right and left buttock implants can be placed through it. But it does expose both sides of the implant pockets to each other (less significant if the implants are placed intramuscular) should incision breakdonw occur. The incision is also located at the greatest site of wound tension and shearing and, as a result, has a 20% to 30% incidence of some degree of wound separation.

Double Incision Buttock Implant Approach Dr Barry Eppley IndianapolisThe double intergluteal incision technique uses two separate parallel incision 6cm to 7 cm in length that are off the midine by about one centimeter on each side. While requiring double the time to close the incisions, it keeps the two implant pockets separate by a healthy bridge of tissue. The incisions are also located in intergluteal buttock skin that is more pliable and elastic and less prone to separation by shearing forces.

Both the single and double intergluteal incision techniques can be used very successfully in buttock implants. Both seem to scar well and neither in my experience has necessitated scar revision due to their healed appearances. But I tend to favor the double incision technique as it has less risk of postoperative wound dehiscence problems which makea a patient’s recovery quicker and less problematic.

Dr. Barry Eppley

Indianapolis, Indiana

August 27th, 2015

L-Shaped Inner Thigh Lift

 

One of the common body contouring procedures for the bariatric or extreme weight loss patient is the need for thigh lifts. While not usually part of the first stage body contouring efforts, it often is part of a second or third stage makeover effort. The problem with the thigh lift is that the traditional medial or inner thigh lift as a fairly high rate of complications.

The inner thigh lift scar frequently drifts downward due to gravity and the pull of the thigh tissues on it. This frequently exposes the scar below the inner thigh crease making it fairly visible. If the thigh lift scar is placed too high or under too much tension the downward drift of the scar can cause distortions of the vulva or scrotum. Extensive undermining of the thigh tissues also runs the risk of disrupting the groin lymphatics resulting in chronic lymphedema of the leg.

In the September 2015 issue of the Annals of Plastic Surgery an article was published entitled ‘L-Shaped Lipothighplasty’. Over a six year period the authors treated 16 bariatric surgery patients with inner thigh laxity. The majority of them (80%) healed.Two patients developed hypertrophic scarring and 1 patient had a wound infection. There results showed that he medial lifting technique defined as L-shaped lipothighplasty is a safe and effective technique and can reduce early and late postoperative complications in what is a known troublesome area in body contouring.

This paper provides additional documentation as to the validity of a liposuction-assisted medial thighplasty. As has been published in previous papers this is a procedure that is done using four basic steps. First an L-shaped medial thigh lift pattern is marked out. Secondly the area is infiltrated with a tumescent solution. Thirdly the thigh area is treated power-assisted liposuction. Lastly the skin and fat inside the marks are excised with care to preserve the underlying lymphatics and the saphenous vein.

Like all operations the inner thigh lift is different for certain types of patients. It is not one operation done the same way for everyone. The mini- or limited inner thigh lift uses just a horizontal incision in the groin crease with a horizontal ellipse of tissue. This limited form of an inner thigh lift works best for those people who have only loose tissue at the upper thigh area. The L-shaped or short scar inner thighplasty uses an L-shaped excision pattern close to the groin crease for more moderate excesses of inner thigh skin. The full vertical inner thighplasty uses a vertical ellipse of tissue down the center of the inner thigh to remove tissue along its entire length from the groin to the knee.

In most cases, however, the L-shaped inner thigh lift offers a good outcome with a low rate of complications. The L-shaped tissue excision pattern avoids the temptation to take too much tissue horizontally, The liposuction helps reduce the tension on the wound closure through debulking  and provides tissue mobilization with the skin undermining.

Dr. Barry Eppley

Indianapolis, Indiana

August 26th, 2015

Case Study – Custom Parasagittal Skull Implants

Background: The top of the skull has the best aesthetic shape when it is a smooth convex curve from one temporal line to the other. This shape can be altered and is influenced by the original sagittal suture line which runs down the middle of the skull between the two original anterior and posterior fontanelles. While it should be smooth and unraised sagittal crest deformities can occur which can be argued are very minor variants of the well known sagittal craniosynostosis condition.

A sagittal crest can develop which appears as a prominent bony ridge down the middle. This can make the bony area between the temporal lines at the side and the midline of the skull (parasagittal area) appear depressed or too shallow. It is also possible that the height of the midline of the skull is normal but that the bony problem is that the parasagittal region is underdeveloped. Either way the top of the head does not have a convex shape and appears irregular in contour.

To create a more convex shape to the top of the head, it is necessary to determine whether sagittal crest reduction needs to be done or parasagittal augmentation is more appropriate.  Computer imaging from the frontal view is very helpful in this regard although there are limitations to it based on the length and density of one’s hair.

Case Study: This 24 year old male wanted to improve the shape of the top of his head. He felt that he had two grooves on each side of the middle of the skull running from front to back. While they were not big or severe they were bothersome to him. He felt that the height of the middle of his skull was fine and it was the sides along it that were too deep.

Parasagittal Skull Implant Designs Dr Barry Eppley IndianapolisParasagittal Skull Implant Thicknesses Dr Barry Eppley IndianapolisUsing a 3D CT scan custom parasagittal skull implants were designed to fill in the grooves. They were long and slender and spanned the traverse from the midline to the temporal region on both sides. With the aid of computer design the parasagittal depressions were filled up just to the level of making the temporal lines curve upward to the midline and nothing more.

parasagittal skull implantsPerforated Skull Implants Dr Barry Eppley IndianapolisScrew Fixation of Parasagittal Skull Implants Dr Barry Eppley IndianapolisUnder general anesthesia two small (3 cm) incisions were made at the posterior end of the parasagittal region near the back of the head. Subperiosteal tunnels were made and the implants inserted. Once positioned they were secured with a single 1.5mm self-tapping titanium screw.

Parasagittal grooves or depressions can be augmented to help create a more convex head shape across the top. Given their small size in many cases and the need for perfectly smooth edges that lay flush to the surrounding skull bone, a custom computer-designed implant approach is needed. This also allows the skull implants to be inserted through the smallest possible scalp incisions with assurance that they will create the best possible contour result.

Highlights:

1) Parasagittal skull deficiencies can occur due to either a high sagittal crest, low parasagittal areas or both.

2) Correction of low parasagittal areas of the skull is done by augmnetation to bring them closer to the level of the sagittal crest.

3) Custom parasagittal skull implants are the most accurate and least invasive method to augment long slender skull deficiencies.

Dr. Barry Eppley

Indianapolis, Indiana

August 26th, 2015

Chin Implant Imprinting

 

The use of a chin implant for an increase in lower facial projection is often combined with other procedures (e.g., rhinoplasty) as well as done as an isolated chin augmentation. It has a long history of use in aesthetic facial surgery dating back over fifty years and nearly every available biomaterial has been tried as some form of a chin implant. But the use of silicone chin implants today constitutes the majority of chin augmentation devices used.

One phenomenon of placing a silicone chin implant (it also occurs with other biomaterials as well) is that of ‘chin implant erosion’. This is an erroneous term that implies that a chin implant is actively eating into or destroying the chin bone underneath it. (aka an active inflammatory process occurring as a a result of a bone reaction in response to a leaking of silicone molecules from the implant) That perception and propagated term is far from what actually occurs.

Chin Implant Imprinting 3 Dr Barry Eppley IndianapolisThe chin is a unique facial area for augmentation because it is a projecting bony structure with tight tissue attachments that wrap around it. Thus when an implant is placed between the chin bone and the overlying soft tissues it will exert some forces (pressure) on the underlying and overlying soft tissues. The body will relieve this pressure with passive adaptation to it. Since the chin implant can not change due to its synthetic inert structure, the surrounding tissue must. As a result, the chin implant will often (although not always) settle a millimeter or two into the bone as a form of pressure relief. This can be seen in great detail as the serial number, size indicator or any grooves or markings on the implant can be seen on the bone surface as the implant is removed.

Chin Implant Imprinting Dr Barry Eppley IndianapolisThis passive bony remodeling phenomenon to a chin implant is benign and self-limiting. It has little to no impact on the external aesthetic chin augmentation result and does not affect the quality of the underlying bone. Because most chin implants are placed in the subperiosteal plane this settling will also allow some bony growth to often extend up along the sides of the implant. Such bony overgrowth can be seen clearly intraoperatively as well as on CT scans. This bony overgrowth further implies that the implant is not causing a destructive bony process.

There are very rare cases where chin implant settling has placed the mandibular incisor tooth roots at risk or has caused some dental sensitivity. This is a direct result of a chin implant being placed far too high over the much thinner cortical bone near the tooth roots. As a result, passive implant settling may occur deeper into the bone and appear very close radiographically to the tooth roots. This is the direct result of an incorrect chin implant placement.

It is time to eliminate the term ‘chin implant erosion’ due to its biologic inaccuracy and replace it with a term that correctly identifies it with the passive bony remodeling process that it is. The better descriptor would be ‘chin implant imprinting’.

Dr. Barry Eppley

Indianapolis, Indiana

August 26th, 2015

Case Study – Large Nose Female Rhinoplasty

 

Background: Rhinoplasty can achieve many different types of nasal changes. The classic requested changes would be reduction of a prominent hump or bump and making the tip smaller, more refined and usually shorter. Straightening of a crooked nose is also a common request and is done as part of any other nasal shape change. These type of rhinoplasty changes are the same whether one is male or female.

Women may have rhinoplasty surgery to achieve a number of specific changes including a smaller and more upturned nose, hump removal and thinner straighter nose. Often times they require a more subtle reshaping or reduction than that seen in men for an improved nasal appearance. Small hump and hook removals can have a big impact on a teenager’s or young woman’s self-image.

But some women have larger noses with thick skin that make them not unlike that of men. Their reductions and nasal reshaping is not subtle and requires more drastic cartilage and bone changes to achieve a more feminine type nose.

Case Study: This 44 year old women wanted to reshape her nose and have it become more proportionate. She hated her large nasal hump and her thick tip which plunged downward. She felt her nose was very masculine and did not match the rest of her face.

Large Nose Female Rhinoplasty result side viewUnder general anesthesia an open rhinoplasty was performed. A large hump eduction was done creating an open roof which required medial and lateral osteotomies to close. The caudal septum was shortened and the tip lifted and narrowed. Her septum was also straightened and her inferior turbinates reduced.

Large Nose Female Rhinoplasty result oblique view Dr Barry Eppley IndianapolisLarge Nose Female Rhinoplasty result front viewWhile she had some immediate improvements in the shape of her nose right when the tapes and splint were removed, it really took a full nine months to see the final shape. The real indicator of when the nose has completely healed and assumed its final shape is when the entire nose (including the tip) feels soft and all the feeling has returned to the skin over the tip. A soft supple tip is the best indicator of the final rhinoplasty.

With the right type of rhinoplasty and even time to heal, even large nose in many women can be given much better shapes that appear more feminine.

Highlights:

1) Rhinoplasty can effectively reduced a prominent dorsal hump and achieve improved tip shape.

2) The controlling factor in many rhinoplasties, including women, is how well the overlying skin can shrink down to the reshaped osteocartilaginous framework.

3) The female rhinoplasty with thicker skin and a larger nose can take many months to achieve its final shape.

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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