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OLOGY spas and the plastic surgery practice of Dr. Barry Eplpey of Indianapolis is proud to announce the arrival of Dr. James Cook, Anti-Aging and Regenerative Medicine to our facilities!
Are you ready to change the way you live – for the better? From hormonal management to nutrition, exercise and sleep issues, Anti-Aging Therapy focuses on a long-term medical program to help you be at your best, and live a healthier, more vibrant life.
Join Dr. Cook on Thursday, May 22 at Clarian North Medical Center to begin your journey and learn more about this fascinating new area of medicine. Feel better now and into the future!
Thursday, May 22, 20086pm – 8:30pm
Clarian North Medical Center
116th & Meridian Streets
Carmel, Indiana 46032
http://www.clariannorth.com
317-814-4100 Call now to reserve seating!

Eyelid surgery, known as blepharoplasty, is one of the most common aging facial surgeries. This is not only because every person has four eyelids (4 surgeries per patient) but because it is often the first plastic surgery procedure (not an office-based procedure such as Botox) one may go through to deal with the effects of aging. Because the eyes are seen by everyone (every human conversation is based on heavy eye contact), we are all too aware of when we appear tired even if we aren’t. The eyes may be the window to the soul but they are also the shades to the eyeball whbich do weather with age.
Aging of the eyelids is a result of three things; 1) The constant muscle movement around the eye causes the skin to wrinkle and create folds (lower eyelid) and hooding (upper eyelid), 2) eyelid skin starts to sag due to gravity, and 3) fat starts to protrude out from under the eye (lower eyelid bags) much like a hernia. All three aging conditions cause the eyelids to look heavy, saggy and swollen creating a very tired appearance. The eyelids can be made to look worse if one’s brow also starts to sag, making the skin on the upper eyelid look even worse.
Surgical correction of these aging eyelid problems is to remove the ‘extra’ skin’, remove or push back the herniated fat (lower eyelid), and sometimes even tighten the corners of the eye. On the upper eyelid, a large amount of skin can be removed leaving a very fine scar along the natural upper eyelid crease. Sometimes fat is removed in the upper eyelid but it is not as big of a problem as it is in the lower eyelid. A surprising large amount of skin can be removed in the upper eyelid without causing any problems with eyelid closure. In the lower eyelid, however, the reverse is true. Managing the herniated fat is a very important part of lower eyelid surgery. Whether the fat that protrudes is removed or, in a newer technique, tucked back up under the eye like a hernia repair, getting rid of excess lower eyelid fat is key to a good result for most patients. Removal of skin in the lower eyelid, however, must be done very carefully and much less can be removed than one would think. If just a little too much is removed, the risk of the lower eyelid pulling down after surgery is a real possibility. For this reason, particularly in the older patient, the lower eyelid which is often loose anyway is tightened like a clothesline at the side of the eyelid where it attaches to the bone.
When all four eyelids are done at the same time (which is most common), the overall effect can be quite dramatic. And since everyone looks at our eyes in conversation, the more youthful and refreshed appearance is appreciated by all even though most do not know it is from plastic surgery.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Beginning in May 2008, Anti-Aging and Regenerative Medicine consults and treatments with Dr James Cook will be available at my northside practice location in Clarian North Medical Center in Carmel, Indiana. Dr Cook is a board-certified neurologist with nearly 20 years of private practice experience. He recently completed an Anti-Aging Fellowship and completed taking his board-certification examination. He is the only physician in Indiana who is fully fellowship-trained in Anti-Aging Medicine. Dr Cook brings an expertise and array of services that completes the Ology triad of services including spa, plastic surgery, and anti-aging therapies. Anti-Aging and Regenerative Medicine is about the diagnosis, treatment and prevention of age-related conditions such as male and female menopause, need for weight loss, sleep disorders, and chronic fatigue through hormonal balancing and nutritional supplementation.
With the introduction of anti-aging, Ology is truly about….the science of feeling, looking, and living better.
Dr Barry Eppley
http://www.eppleyoplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

I often call a tummy tuck, medically known as an abdominoplasty, as the ‘facelift’ of the body. It is a dramatically effective procedure that makes a change in the mid-section of the body that no amount of exercise or weight loss can ever do. While it is not a simple and quick recovery, the long-term benefits are enormous for most patients. The analogy of a tummy tuck to a facelift is a good one, because the surgery is all about layers. Removing and moving different layers of the abdominal wall to get the desired effect.
Whatever you don’t like about your stomach and waistline area, what you are seeing is a function of the three layers; skin, fat, and muscle. Each patient’s problem’s is composed of different contributions (excess or looseness) of these three layers. Knowing the contributions of each goes a long way in picking the right tummy/waistline solution.
If ones stomach area or waistline is full but the overlying skin is not loose, for example, then this problem is better treated by liposuction and you probably don’t need a tummy tuck. If, however, the stomach skin is loose, has stretch marks, sticks out, if you have had children, then some variation of a tummy tuck is probably in order. A tummy tuck deals with all three layers of the problem; removing loose skin, excess fat (even in areas where skin is not removed), and tightens the muscle. This three-layer approach produces the best result as all problem layers are adjusted.
Tummy tucks come essentially in two varieties; a mini- or limited tummy tuck and a maxi- or full tummy tuck. The fundamental difference between the two is in the amount of skin removed. If the cut-out of skin and fat is done below the belly button, this falls into the mini-tummy tuck variety. In this more limited operation, a new belly button does not have to be created, at the price of cutting out less skin. In the full tummy tuck, the cut-out of skin and fat goes above the belly button. A new belly button hole is needed to bring out the original stalk of the belly button. In either case and for most patients, liposuction is done around the waistline and into the back removing fat from areas that the cut-out does not reach. This is an extremely valuable companion procedure as you need to think of this operation as a 270 degree result, not just a 180 degree (or frontal only) effect.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
http://www.eppleytummytuck.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

A facelift is one of the most recognized procedures in aesthetic plastic surgery…..but also one of the most misunderstood. The general public’s perception of a facelift….based on TV shows and the internet…is someone after such surgery being bruised from their eyes to their neck and their face wrapped up in a big dressing…like they had been involved in a major accident. And that it will take weeks to even look good enough to go out in public. In reality, this perception is flawed at best and even grossly inaccurate at worst.
The name of the operation, facelift, is misleading. It does not really describe what the surgery actually does or what the objectives of the procedure are. More accurately, a facelift should be called a neck-jowl lift, for this is what it actually helps. It is a great procedure for tightening the neck, getting rid of the that neck waddle, and lifting those sagging jowls. The medical name for a facelift, rhytidectomy (old plastic surgery meaning cutting out wrinkles), should be described as a cervicoplasty. (reshaping of the neck) However, the name facelift persists and always will as it is embedded in our plastic surgery nomenclature.
Therefore, when you realize that only the neck and jowl are affected by the procedure, many of its misconceptions fade away. In isolation as a stand-alone procedure (which half of my ‘facelift’ patients only have), a facelift causes no bruising or swelling from the nose up. While many facelift patients get their eyes, forehead, nose and other facial procedures done at the same time, this is not a requirement and is only done if one wants the ‘total face’ rejuvenated. I find that after an isolated facelift, one can look pretty good in about a week and can easily be out in public in a few days with a little make-up in the neck area.
Remember, the eyes are not swollen at all!
One of the great misconceptions about a facelift is what is actually done in the operation. A facelift operation is all about tissue layers and vectors of lifting. The lifting off of the skin from the underlying tissues over the side of the face (to the cheek area) and across the neck through incisions placed in and around the ears is obvious in any diagram of a facelift operation. And movement of loose skin pulled back and over the ears at about a 45 degree angle to the face probably accounts for about 80% - 90% of the result created by a facelift. And often this is the only tissue moved in a facelift. This is the safest and easiest approach with the least likelihood of complications. Deeper layers have also been raised up and moved in more recent versions of facelift surgery. These deep layer that can be moved independent of the skin, is a special layer of tissue over the muscle. This tissue, known as SMAS, is raised and sutured up in a more vertical direction compared to the direction of the skin pull, closer to 60 degrees usually. The public erroneously believes that it is muscle that is moved which is not possible. The SMAS sits on top of the muscle. There is considerable debate as to whether the ‘deeper’ versions of the facelift produce better long-term results than skin movement only.
The neck-jowl lift, known historically as a facelift, can lift two different layers of sagging facial tissues in two slightly different up and backward directions.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.eppleyfacelift.com
http://www.ologymd.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Rhinoplasty (nose surgery) is one of the top ten requested cosmetic procedures for both men and women in plastic surgery. The prominence of the nose and its significance to the appearance of the face makes the need for any rhinoplasty surgery to be very precise. Good results in rhinoplasty are dependent upon an understanding of the complex framework of bone and cartilage that make up the nose. Rhinoplasty surgery changes the shape of this framework which is revealed through the overlying skin.

Think of your nose as a house. The shingles are the overlying skin, the framework and timbers are the cartilage and bone, and the drywall the nasal lining. The support that lies underneath the highest roof angle is the septum. (cartilage) What makes anyone’s nose look the way it does, like a house, is a reflection of how the framework is structured and the roof (skin) that drapes over this framework. As plastic surgeons we think of the nose as 4 areas, the upper 1/3 which is bone, the middle 1/3 known as the middle vault which is all cartilage which is straight, and the lower 1/3 or the tip of the nose which is a combination of scroll-shaped cartilages that come together over the septum and is what gives everyone their unique tip shape. (which is the most different between any two people) The fourth area is the skin, which dependent upon its thickness, can show the underlying framework well if it is thin but can hide much of it if it is thick.

When we alter the nose we are changing the way the framework (bone and cartilage) is joined together and is shaped. This could be taking down the height of the roof in one area (that bump on your upper nose), reshaping the tip of the nose (by changing the shape of the scrolled cartilages, breaking the bone along the bridge to narrow the nose (collapsing the walls), or in some cases adding to the roof line with implants or cartilage to raise the height of the roof line.

Due to the complexity of how all of these framework structures come together, most rhinoplasties today are done ‘open’. While this used to be a controversial area (what was known as the most contested 6 millimeters of skin on the body), it is now accepted to produce the best results in most nose surgeries. All that this means is the skin is lifted off of the tip of the nose so all the framework structures can be seen. To no surprise, you can shape better what you can see better. This only leaves a nearly imperceptible scar at the middle of the skin between your nostrils. (known as the columella) This is a very small price to pay for a better rhinoplasty result!
Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.eppleyrhinoplasty.com
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Liposuction, after 25 years since its introduction in the United States in 1981, remains one of the most popular plastic surgeries for both men and women. How it works seems simple enough…’stick a tube and suck it out’ to paraphrase what many patients say. And while it is conceptually simple mechanical process, there is more to it than meets the eye.

At its most basic level, liposuction is a simple two-stage process for removing fat. A hollow tube (cannula) is put under the skin, the tube is moved back and forth until the fat is dislodged, and the attached vacuum source draws the fat back through the cannula into the tubing and finally into the plastic bottle.

Despite this apparent simplicity, there is more science to it than that. There are three interesting components about liposuction, all of which contribute to its safety and effectiveness. These include tumescent fluid infiltration, vacuum pressure, and cannula size and design.

The placing of fluid during the liposuction operation before doing the suctioning is an integral part of the operation. I frequently get asked by patients if I do tumescent liposuction. Patients think that this is a special method of liposuction, when in fact, it is used in every liposuction procedure. Putting large amounts of fluid into the fat areas to be suctioned beforehand is known as tumescent infiltration. This achieves two fundamental things, substantially reduces bleeding (from the fat being broken up by the liposuction tube and it distends the fat compartments which make the tube easier to pass through the fat being suctioned. Without tumescent infiltration, liposuction would quite bloody, give patients more pain, and have them bruised for a month, if not longer.

The amount of suction generated by the liposuction machine, in short, makes liposuction possible. At the accepted amount of suction needed for liposuction (-20 cms of water or -1 atmosphere of pressure), the pulling of fat through the tubing certainly occurs. But it also causes the vaporization of water. If you have ever witnessed an actual liposuction procedure, you may have seen bubbles in the fat or bubbling in the plastic cannister. To some degree, this is actually water boiling….or the pressure in the system falling to the vapor pressure of the water in the fat being removed. It is this vaporization that makes the viscosity (how thick it is) of fat, which is actually a combination of fat, blood, and infiltration fluid, less to improve its ease of flow through the tubing. From a flow standpoint, water that is vaporized ( a gas) flows 100 times faster than liquid water. This is also why liposuction done at higher altitudes, where the water vapor of pressure is less, is somewhat easier to do. (takes less suction from the machine)

The tube (cannula) that is actually used under the skin differs in diameter and the holes at the tip. In days gone by, the cannulas were quite large but left a lot of depressions in the overlying skin after due to removing too much fat too fast and in large pieces. Today, small cannulas are used which removes fat more carefully and in smaller pieces, decreasing the problem of skin irregularities after surgery. The tip of the cannula is rounded so that it travels through the fat easier with less chance of penetrating something you shouldn’t. The holes at the tip are where fat sticks to and then gets sucked into the cannula. The more holes there are at the tip achieves two effects; increases the shearing effect (like a blade) on fat and makes more cross-sectional area through which fat can be suctioned.

Currently, there are newer methods of liposuction or to be accurate, methods of loosening up the fat. These include ultrasonic and laser-assisted. While they sound quite advanced (and they are), there is no convincing evidence at this time that they are actually better than traditional liposuction. Better meaning….you get more fat removed, smoother results, and recover faster with less bruising and pain. They are marketed by the manufactures as such but there is no solid science to prove it. And they still require suction to pull out much of the loosened or liquefied fat.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.eppleyliposuction.com
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

How is a Chin Implant done?
Short chins (both in height and in length) are good indications for what we call alloplastic mentoplasty, otherwise known as a chin augmentation using a synthetic implant. Chin implants are by far and away the most common method for enlarging one’s chin. Its principal advantage is that it is simple and quick to do, allows for a rapid recovery, and the result is very predictable with a high patient satisfaction rate.
A wide variety of synthetic materials have been used in the chin but the standard over time continues to be solid silicone. It is well tolerated, flexible, easy to insert and remove, can be easily manufactured in an endless number of configurations and sizes, and is inexpensive. Its flexibility allows even large extended implants to be placed through small incisions. As of this writing, porous polyethylene (Medpor) is the lone alternative and good results can be achieved with its use although it is more expensive, requires greater intraoperative time and effort for fashioning and placement, and is more difficult to remove should that ever be necessary.
The chin implant is almost always put in through a small incision on the underside of the chin in the submental crease. This provides a direct approach for placement of the implant (shortest distance to the bone) and allows liposuction and neck tightening procedures to be done through the same incision. The chin implant is slide into position on the bone after a pocket has been made that will accomodate its size. Once in place, it is either sewn or screwed into place and the tissue closed over it. While a chin implant can also be placed through the mouth (a common approach done by many oral surgeons), placing it this way disrupts the main chin muscle and the risk of having the implant riding too high on the chin bone after surgery unless the implant is secured by screws to the bone.
The chin implants used today are quite different from those used in the past. Today’s chin implants are better by having ‘wings’ that extend out further to make a smoother transition to the bone on the side of the chin out on the jaw. This allows for the creation of increased width to the chin and improved blending into the lateral body of the mandible without irregular transition zones. The size and style of chin implant chosen is done by pre-surgical imaging of the face and chin and looking at how the different sizes change one’s profile.
Chin implants are a very safe procedure that has few complications if done well. Infection after surgery is rare but the implant could be salvaged by antibiotics alone if it occurs in the early postoperative period. Thereafter, implant removal is usually required for resolution. Some temporary lower lip numbness can occur but this resolves quite quickly after surgery.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Breast reduction surgery, also known as reduction mammoplasty, was performed on over 175,000 patients in 2006 (over 20,000 were in men but that is a very different topic that breast reduction in a female and will not be covered here) It is a frequently sought-out procedure by many large-breasted women, young and old, for one very good reason…it is tremendously effective at reducing or eliminating the back, shoulder, and neck pain that comes from carrying such weight around on their chests and upper stomachs. This explains why the scars that result from the surgery, while not always ideal from a plastic surgeon’s viewpoint, seem to be a good trade-off for the vastg majority of patients who undergo the procedure.

Breast reduction is one of the few plastic surgery procedures that can still get consistently covered by medical insurance….if the patient qualifies. Qualifications include large breasts given one’s height and weight, evidence of problems with the breasts such as shoulder grooves and skin rashes under the breasts, and evidence that conservative treatment methods such as physical therapy, chiropractic treatments, or pain medications have not worked.

So if you qualify, how does a breast reduction operation work? A breast reduction is done by a precise cut-out pattern that is based on one single concept…….remove breast tissue, tighten skin, and…..keep the nipple alive! If it weren’t for the nipple, a breast reductiuon operation could be done twice as fast and could be reduced to any size, no matter how small. But that circle of pinkish-colored tissue changes how the whole procedure must be done.

The nipple is keep alive by making sure that enough blood supply gets to it from below both during and after surgery.. This means the nipple is never removed (there is a variation of a breast reduction procedure known as breast reduction with free nipple grafting…but that is not what we are talking about…and is rarely sued today) This means that a central core or central pedicle of breast tissue undeneath the nipple must be maintained for the blood supply to get through. So, as the breast tissue is being removed, the central pedicle gets smaller and smaller but canc only be reduced so much. How much can never be precisely known during surgery so it is an art to know how far to push the limited of breast tissue removal from the central pedicle. My rule of thumb is….I would rather leave a little too much and have a live nipple after surgery….than remove too much and have a smaller breast with with a dead nipple. While we as plastic surgeons do well at reconstructing nipples, a reconstructed nipple is never as good as your original one! Therefore, I tell patients I will not likely go less than 2 cup sizes smaller than where we start for safety’s sake of the nipple. This often is disconcerting to hear for some patients but the improvement that one gets ina breast reduction, in my opinion, is as much due to the skin tightening and lifting the breast back up on the chest wall as it is due to the actual amount of breast tissue removed. (All breast reductions…..are a breast lift too!)

The skin cut-out pattern is the precise design part of the operation. The skin cut-out is based on a simple principle that most grade-school children know……how to make a cone out of a piece of paper! By simply cutting a wedge out of paper and bringing the edges of the paper together….you have a cone! While this conceptual image is not precisely accurate (it is more like a keyhole rather than a simple wedge), you get the picture.

So, breast reduction surgery is……locate the new position of the nipple and mark the skin cut-out pattern (prior to surgery), make the skin cut-out, keep the nipple attached to the breast tissue, remove breast tissue from all sides getting closer to the nipple, and bring the keyhole together. Finally, pick your new spot for the nipple on the cone and bring it through.

Doesn’t sound simple…and it isn’t. The breast reduction operation is a mixture of precise design, art of shaping, and a lot of sewing. And to make matters more difficult…..there are two breasts and you have to match them. It is a lot of work, but very rewarding as those women who undergo it have almost instantaneous relief of much of their pain…and get to go out and finally buy new bras!

Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Joint Plastic and Hand Surgery at Clarian North - Dr. Barry Eppley and Dr. Mark Greenberg

Over the past twenty-five years, I have had the opportunity to operate on hundreds of facial trauma patients and repair thousands of facial fractures. I have done so many over the years that I was a co-author on a major 1000 page textbook on facial trauma entitled, Maxillofacial Trauma and Esthetic Facial Reconstruction. Despite this extensive experience, I have never had the opportunity to do a facial fracture repair like I did last week at Clarian North Medical Center in Carmel, Indiana.

I was asked to see a patient who fell at home while working and sustained fractures of his wrist and his face. When I saw the patient, his right side of his face was terribly swollen and his hand and wrist were in a cast. Working with Dr. Mark Greenberg of the Indiana Hand Center, we coordinated a surgery for later that week in which we could repair both problems during the same surgery at the same time. Normally, surgeons may do their procedures during the same operation but rarely are surgeries performed concurrently at the same time. (we surgeons are territorial and like our space!) In an one and half-hour operation, this patient had his wrist and four facial bones repaired, not only saving him from having to undergo two separate surgeries on different days but cutting the normal time in surgery for these problems in half!

This joint effort provided a great service to the patient from which he was deeply appreciative. I applaud Dr. Greenberg, the operating room and nursing staff at Clarian North, and our very accomodating anesthesiologist. While many complain about the inefficiency of modern medicine, this surgery cas reminds me of its many benefits as well.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis