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Archive for the ‘Clinic Snapshots’ Category

Clinic Snapshots – Rib Removal Waistline Narrowing

Thursday, February 9th, 2017

 

Rib removal is an aesthetic body contouring procedure that has an impact on narrowing the anatomic waistline. It is most commonly performed in my experience on already lean women that are trying to achieve an ultra narrow waistline or on male to female transgender patients to get some semblence of a waistline shape. While historically portrayed as an urban myth, rib removal surgery is very real and effective in the properly selected patient.

Rib Removal results front view Dr Barry Eppley IndianapolisTo create a waistline narrowing effect, the free floating (11th and 12th) ribs are shortened in their length. The concept of rib removal does not mean the entire ribs are removed back to their vertebral facets. Rather they are shortened back to the lateral border of the erector spinae muscle. This removes some support from the overlying soft tissues but does so without risk to any internal organs. This collapse inward of the soft tissues creates the waistline narrowing effect.

The debate in each patient is whether a portion of rib #10 should also be removed in addition to ribs #11 and #12. Rib #10 is not a free floater and has a more horizontal orientation. Its removal has less of an effect on the waistline than the lower two but a portion is often removed as well.

Rib Removal result back view. Dr Barry Eppley IndianapolisTraditional rib removal by chest surgeons is done through long incisions. But that is not acceptable in the cosmetic patient. Aesthetic rib removal is done through a 4 to 4.5 cm long incision placed in an oblique skin fold seen when the patient turns at the waist. This produces a far more acceptable incisional tradeoff. This patient picture shows the result seen just two days after rib removal surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Clinic Snapshots – Posterior Zygomatic Arch Osteotomy Incision

Thursday, January 26th, 2017

 

Cheekbone reduction surgery requires an understanding of the complete bony anatomy of the zygomatic bone. When most people think of the cheekbone ti is perceived as one solid block of bone just underneath the eye. While this area is a major part of the cheekbone, it overlooks the posterior extension of the cheekbone known as the zygomatic arch.

The zygomatic arch connects the main body of the cheekbone (zygoma) to the temporal bone above the ear. It is a thin bridge of bone between these two areas because underneath it passes the large temporalis muscle on its ways to attach to the lower jaw. The zygomatic arch is almost always bowed outward or has a convex shape. This gives width to the side of the midface.

In cheekbone reduction it is rarely a matter of shaving down the bone. Rather the cheekbone is cut and moved inward, this is what make the side of the face more narrow. The bone cuts are done in the front through the main body of the zygoma from an intraoral incision. Conversely the back cut is done where the zygomatic arch meets the temporal bone through an external incision.

Posterior Zygomatic ASrch Incision Healing Dr Barry Eppley IndianapolisThe external incision for the zygomatic arch osteotomy is done through the sideburn hair. It is usually about 1 cm in length and is placed at the junction of the sideburn hair and skin just in front of the ear. Because it is an external incision patients understandably are concerned about how it heals an whether it heals in an inconspicuous manner. Here is a picture of a patient with a posterior zygomatic arch osteotomy incision that was done just over one year ago.

Dr. Barry Eppley

Indianapolis, Indiana

Clinic Snapshots – Good Riddance Abdominal Panniculectomy

Thursday, December 29th, 2016

Cosmetic surgery of the abdomen and waistline is one the most common body contouring surgeries for either women or men. Women in particular are inclined to undergo these surgeries as they are victims of a lot of body changes from pregnancy and/or weight gain/loss. Liposuction and tummy tucks make up the bulk of these surgeries as they fall into the norm of the type of body changes that need to be treated.

But amongst tummy tuck surgeries there is a ‘supersize’ version due to the magnitude of the tissues that need to be removed. This enlarged version of a tummy tuck is known as an abdominal panniculectomy. The abdominal panniculectomy differs from all forms of a  tummy tuck as it removes a large segment of overhanging tissues known as a panniculus. Also known as an abdominal apron, this is a large amount of abdominal tissue that overhangs the waistline down on the thighs. In large abdominal pannuses it can even hang down as low as the knees!

abdominal-panniculectomy-indianapolis-dr-barry-eppleyThe abdominal pannus and its weight causes a constellation of problems for the person from chronic skin infections and moisture underneath it to the strain of its weight on the back and knees. This is not to mention the limitations imposed on clothing options to hold it in or try and hide it. It is no surprise then that when the day comes for their abdominal panniculectomy surgery there are no regrets in losing a bit of oneself!

While an abdominal panniculectomy may not be as eloquent as an operation as many smaller tummy tucks, patients are usually even more grateful.

Dr. Barry Eppley

Indianapolis, Indiana

Clinic Snapshots – Pectoral Implants with Abdominal Etching

Monday, December 26th, 2016

 

The principal method to augment the male chest is with the use of pectoral implants. Like in the female breast, the placement of a pectoral implant creates an immediate chest enlargement. The fundamental difference between a female and make chest implant is that one is a fluid-filled device while the other one is solid. The male pectoral implant is designed to completely replicate muscle and therefore can be more firm. Conversely a breast implant is designed create a breast mound that is softer and more supple.

Pectoral implants come in a variety of sizes with several shape choices. With standard volumes sizes now up to over 600ccs significant chest enhancement cab be achieved in just about any male regardless of their size. As a solid implant they have a low durometer which not only makes the feel much like muscle but also allows them to be introduced through a high axillary incision as well.

pectoral-implants-and-abdominal-etching-result-front-view-dr-barry-eppley-indianapolisA good complement for the male chest enhancement patient is that of abdominal liposuction or abdominal etching. Since they can both be performed in the supine position it is a good opportunity for a ‘male maleover’ with combined chest and abdominal reshaping.

The creation of a ‘six-pack’ is a form of liposculpture using focused fat removal along specific lines. Designed to replicate the appearance of the abdominal inscriptions, etching mimics those lines by creating a dermal-fascial adhesion. Abdominal etching works best in the thin patient. But it can be done at the same time as overall liposuction in men with thicker subcutaneous abdominal wall layers albeit with not the same abdominal etch line definition as in thinner men.

Dr. Barry Eppley

Indianapolis, Indiana

Clinic Snapshots – Jaw Angle Augmentation Fillers vs Implant

Monday, December 26th, 2016

 

Augmentation of the facial skeleton has historically been done through the placement of preformed implants. The past decade has seen the emergence of a variety of injectable materials to create soft tissue volume augmentation. These have included a large number of synthetic fillers as well as autologous fat. As their use has become more common and pervasive throughout aesthetic surgery, the injectable approach has been applied to every conceivable aesthetic facial need including augmentation of the bony cheeks, chin and jaw angles.

An injectable filler can be used for jaw angle augmentation. It does not usually produce the same result as a well selected jaw angle implant as it can not create angularity and sharper definition with the push of a soft material like fillers or fat. Thus injectable fillers for jaw angle augmentation is often done as a test or trial or are sometimes performed as a convenient opportunity at the time of other facial surgery using fat injections.

jaw-angle-implants-vs-injectable-fillers-dr-barry-eppley-indianapolisBut beyond that of a trial, the use of injectable fillers as a long-term method of jaw angle augmentation is compromised by economic issues. When one compares the volume of an injectable filler to an actual jaw angle implant (in this picture 1.5cc of Radiesse to a medium vertical lengthening jaw angle implant) the tremendous discrepancy in its volume/size can be seen. By comparing weights alone it can be seen that it would take more than 5cc to 7cc of a filler to match the volume created by an implant.

Because of their long-term cost issues, injectable fillers are a short-term approach to jaw angle augmentation. This is not only because they are not permanent but the sheer cost of trying to replicate an initial jaw angle implant effect.

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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