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Archive for the ‘Did You Know’ Category

Plastic Surgery’s Did You Know – Mondor’s Cord

Sunday, January 3rd, 2016


A Mondor’s cord is a painful and hardened ridge which  may appear weeks after breast augmentation surgery emanating downward from the lower breast crease. (if an inframammary incision was used) It may also develop in the upper arm if a transaxillary breast augmentation technique was used. This is not a complication of breast augmentation surgery but an infrequent temporary annoyance that occurs in some women.

Mondor's Cord after Breast Augmentation Dr Barry Eppley IndianapolisMondor’s cord is is caused by an inflammation of the draining veins from around the incision, more commonly known as superficial thrombophlebitis. Trauma to the veins from the procedure is the cause very much like the same condition that can develop in the hands and forearm after having an IV inserted. It usually does not develop for several weeks after surgery and becomes most apparent when one is stretching or reaching with their arms which makes the restriction of the cord most apparent. In some cases more than one vein may be involved giving rise to more than one cord.

Because it is a hard cord it can cause some discomfort. It is a self-resolving condition but can be treated by anti-inflammatory medications and warm compresses. It will take several weeks to go away. One is not a risk for any blood clots or the throwing an emboli.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Golden Ratio

Monday, April 20th, 2015


The search for what makes a face beautiful or attractive goes back hundreds if not thousands of years. Long before the possibilities of plastic surgery were even remotely envisioned, painters and sculptors used mathematical numbers and rations to create their works. Numerous contemporary studies have both qualified and quantified ‘beauty’ and have been able to apply some basic principles to it. (e.g., symmetry)

Golden Ratio in Plastic Surgery Dr Barry Eppley IndianapolisBut the most appealing numerical approach to beauty in the face and body as well as nature is that of the Golden Ratio. Much has been written to seemingly verify its use to show that its ration (1.618) represents the perfect shape from just about anything from natural to man made objects including the human body.

The Golden Ratio, represented by the Greek letter phi (?), is the relationship between two sides of a rectangle (1.61803) where the ratio of the larger side to the smaller side is equal to the ratio of both sides to the larger side. In mathematics, the Golden Ration occurs in the well known Fibonacci sequence where each subsequent number is the sum of the two previous ones. (:1, 1, 2, 3, 5, 8, 13, 21, 34, 55, 89 etc) If you divide each number besides the first one) by the previous number it is surprisingly close to 1.618 or the Golden Ratio.

Golden Ratio in Facial Plastic Surgery Dr Barry Eppley IndianapolisBut is the Golden Ratio useful in helping the plastic surgeon create a more beautiful face? Studies have shown that there are aesthetic correlations with many facial features relating to each other through this relationship. (e.g., the ratio of the length of a person’s face to its width is 1.6) It does seem to be a number that when assessing faces defies historical, racial and cultural differences.

However, a plastic surgeon’s ability to change one’s facial features is based on a knowledge of anatomy, surgical techniques and the desired end goal. While being an artist does not make one a good plastic surgeon (contrary to popular perception), there is a role for understanding aesthetic proportions and relationships.The Golden Ratio is as good a guideline as any other one might use.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? – Valentine’s Day

Sunday, February 15th, 2015


Valentine’s Day or St. Valentine’s is a sort of holiday that is celebrated in many countries around the world. Its occurrence is certainly not just limited to the United States. It has its origin in the Feast of Saint Valentine based on an early Christian Saint named Valentinus. Like some holidays and traditions, its actual history is mired in legend and embellishments but it dates as far back as ancient Rome…at least the name of the Saint does.

St Valentine's Day SaintAccording to consistent historical tales, Emperor Claudius II executed two men, both named Valentine, on Feb. 14 of different years in the 3rd century A.D. Their martyrdom was honored by the Catholic Church with the celebration of St. Valentine’s Day. Legend has it that they were imprisoned and ultimately executed for performing weddings for soldiers and for preaching to the persecuted Christians. The romantic twist to Valentine’s Day did not emerge until the late Middle Ages, thanks to writers such as Shakespeare, where it became a day for lovers to express their affections with flowers, sweets and cards. (known as valentines)

Early 20th Century Valentine's Day cardWith the settling of the New World by the English, the tradition naturally followed. The eventual Industrial Revolution made the manufacture of cards more widely available and Valentine’s Day (and other holidays as well) were changed forever with the mass production of valentines by the early 20th century by the Hallmark company. The extension to include other gifts of flowers, candy and diamonds as well as the image of Cupid are marketing extensions of the romance theme.

From a plastic surgery perspective, Valentine’s Day has become a focal point for procedural promotions. Any procedures that can enhance a woman’s attractiveness, from Botox to breast implants, is advertised and discounted if done before or on this day. This is no different than in many other retail industries. At least the ‘gift’ of plastic surgery, given by someone else or to themselves, will last a lot longer than most other traditional Valentine’s Day indulgements.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Gummy Bear Breast Implants

Sunday, November 9th, 2014


Gummy Bear Breast Augmentation Dr Barry Eppley IndianapolisJust about anyone considering silicone breast implants has heard the term ‘gummy bear’ breast implants. Some women even come in requesting this specific ‘type’ of breast implant. Besides the catchy name, what is the appeal of it?

Gummy bear implants are made of a highly cohesive silicone gel which does not act like a liquid. Rather it acts like a soft solid…just like the gummy bear candy. Compared with the previous types of liquid silicone gel implants, the silicone particles in the gummy bear implants are highly cross-linked so the gel is held more closely together. This creates a breast implant that has a more natural feel. It also creates a breast implant that when cut in half, the gel stays put. (as demonstrated in the video) This eliminates any concern about what happens when the implant shell ruptures which will inevitably occur in some patients over their lifetime. There would be no errant gel getting loose and running amuck in or beyond the breast implant pocket.

What most don’t realize is that today all silicone breast implants are of the gummy bear variety. The breast implant term, ‘gummy bear’, is really an urban and not a manufacturer’s term. While at one time unique to one specific manufacturer, all breast implant manufacturer’s have them.Three gummy bear implants are approved by the Food and Drug Administration (FDA) for use in the United States: Sientra’s Silimed implants, Allergan’s Natrelle 410 breast implant and Mentor’s MemoryShape™ Breast Implants, formerly known as the contour profile gel (CPG).

The only downside to a gummy bear breast implant is that its stiffer feel may necessitate a larger incision in which to insert it through. But this concern is overcome by the use of an insertion funnel which allows even large implants to be put in through relatively small incisions.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Function of Eyebrows

Monday, May 26th, 2014


Why do we have eyebrows? They initially seem to have no specific purpose. They are just a clump of short hairs coming our of the skin over the brow bones which create a wide variety of eyebrow shapes. While their biologic purpose may be perplexing, their aesthetic value can not be debated. They are plucked, shaved and tinted for aesthetic benefit and eyebrow hair transplants are done to augment sparse eyebrows or to replace those lost by injury.

Eyebrow Expressions Dr Barry Eppley IndianapolisThe evolutionary purpose of eyebrows has been debated for a long time. It has been historically believed that they played a functional role by keeping sweat or rain off the face. It can be appreciated that the shape of the eyebrows allows any water running down on the forehead to be diverted away from the eyes to the side of the face. Perhaps this may have helped primitive man but clearly this is of no functional benefit today. More recent theories have pointed to their role in facial expression. Many facial movements involve changes in the shape and position of the eyebrows which help communicate emotions. They also have been identified as being important in personal identification. Recent studies have shown that people were less likely to identify celebrities without their eyebrows than without their eyes. This suggests that eyebrows may persist because they are important for facial and emotional identification. Throughout the entire face, eyebrows appear to be as expressive as any other facial feature.

Dr. Barry Eppley

Plastic Surgery’s Did You Know? Fat Cell Biology

Saturday, May 24th, 2014


Other than skin, fat is the most commonly manipulated tissue by plastic surgeons. Most people think of fat removal by liposuction when they think of plastic surgery by fat transplantation by injection is becoming increasingly popular. But when fat cells are removed or transplanted the questions are whether they will come back or do they survive and grow? The basic science of fat cell biology helps answer these questions.

Injectable Fat Grafting Indianapolis Dr EppleyFat cells are created during the last three months of pregnancy and during puberty and are influenced by the estrogen and testosterone hormones. The development of fat cells and their distribution are the same in male and females until puberty when the surge in hormones changes their bodily distributions. After puberty, fat cells do not generally replicate or are created (fat cell hyperplasia) and their number remains fairly stable for the rest of one’s life. One may get heavier or get bigger in certain body areas because fat cells gets bigger taking on excess calories. (fat cell hypertrophy) This is best illustrated as to what happens in the bariatric surgery patient where extreme amounts of weight loss occur…their fat cells merely get smaller but not less in number.

Liposuction removes fat cells but leaves many fat cells behind. No liposuction treated area removes all the fat cells. If one gains weight after liposuction, those remaining fat cells can get bigger. Thus one cal potentially wipe out any body contouring benefits from the procedure. When fat cells are transplanted, those that survive have the same characteristics from whence they came which is usually the stomach area. With weight gain those transplanted fat cells can get bigger or with weight loss those same fat cells can get smaller. Thus fat injected areas can grow or get smaller after transplantation.

Dr. Barry Eppley

Plastic Surgery’s Did You Know? The Roman Nose and Rhinoplasty

Sunday, December 8th, 2013


Roman Nose Rhinoplasty Dr Barry Eppley IndianapolisA Roman nose, also called a hook nose or aquiline nose, is one with a prominent bridge which gives it the appearance of being curved or slightly bent. The very word, aquiline, comes from the latin word aquilinus which means eagle-like in reference to the curved beak of an eagle. It is characterized by an outwards curve in the central area that protrudes far off from the face. The nose appears as a hook due to this predominant bridge. In Roman times such a nose shape was associated with a sign of leadership. This undoubtably serves as the genesis for the historic perception that people with this nose shape are often great leaders. Abraham Lincoln is often referenced in this regard since he had a Roman nose. But modern day rhinoplasty views the Roman nose as an unaesthetic one.  A straight line bridge or dorsum is viewed as a basic goal of rhinoplasty surgery. Taking down a bump or hump on the nose is a very common patient request. Patients wants a smooth and straight dorsum and a nose without a hook today. Taking down a nasal hook requires shaving down the bone and cartilage that it is composed of, creating an open roof deformity. This is closed down by breaking the nasal bones to collapse the sides and make a smooth and lower bridge of the nose.

Dr. Barry Eppley

Plastic Surgery’s Did You Know? Body Dysmorphic Disorder

Sunday, November 17th, 2013


While cosmetic surgery is about improving one’s face or body appearance, whether one needs such surgery or not is open to personal interpretation or desires. How one sees themselves plays a major role in the ‘need’ for cosmetic surgery. It should be no surprise then that the use of antidepressant and other psychiatric medications has been reported to be twice as high in patients seeking cosmetic treatments over those that don’t. In addition, up to 15% of cosmetic surgery patients suffer from a well known psychologic problem known as BBD or body dysmorphic disorder. (compared to 1% in the overall population) Body dysmorphic disorder is when one is overly obsessive about some aspect of their appearance or have exaggerated concerns about their appearance. This drives them to not only have cosmetic surgery but frequently repeat or revisional surgeries to achieve an appearance goal that may not be achieveable. Sometimes this involves returning to the same plastic surgeon, but if turned away, they will find another surgeon to resume their change efforts. While one assumes that screening for the BDD patient is easy, there is no standardized screening tool for it. Often the plastic surgeon only makes the diagnosis after the surgery has been done and the patient is not happy with a result that may otherwise be acceptable to most patients.

Plastic Surgery’s Did You Know? Board Certification Matters

Tuesday, November 12th, 2013


Every prospective patient who seeks cosmetic enhancements knows to ask or look for ‘board certification’ of their surgeon or treatment provider. While this is a seemingly good question, a positive answer may still not be a reassuring one that guarantees your doctor has all the requisite training and experience to give you the best result. This is because board-certification today does not mean what it meant decades ago. Many ‘Boards’ have emerged that are relatively new and self-regulating and certifications in some of these boards is not the same as others. It thus becomes important to ask your doctor board-certified in what board and by whom as some board certifications really matter. The American Board of Plastic Surgery’s is one of the most rigorous of these boards and is the only certification for whole-body plastic surgery recognized by the American Board of Medical Specialties. (ABMS) The American Board of Medical Specialties runs a website, CertificationMatters.org, where prospective patients can see if their doctor is certified by this rigorous board. This is a great place for patients to see if their doctor is listed in this board registry.

Plastic Surgery’s Did You Know? The Missing Element in Jawline Enhancement

Monday, October 28th, 2013


A strong jawline is a well known perceived desirable facial feature. While an obvious aesthetic asset in men, it is even so in women as long as the chin does not protrude too much. What what makes up a nice and well defined jawline? The jawline comes from the mandible or lower jaw which is anatomically made up of five distinct components that is essentially a paired L-shape curvilinear structure that meets in the middle. Its anatomic components and their aesthetic corollaries are the symphysis (chin), parasymphysis (prejowl), body (middle of the jawline), ramus (angle) and the condyle. (jaw joint which has no aesthetic relevance) Chin implants increase the projection of the symphysis, jaw angle implants increase the width or length of the ramus and prejowl implants increase the fullness of the parasymphysis. But there is no off-the-shelf standard implant for the body of the mandible that would connect whatever is done at the opposite ends of the jawline. (chin and jaw angles) This is the missing piece of aesthetic jawline enhancement, the ability to make a smooth and stronger jawline along the sides. Currently, only custom made implants can do body jawline augmentation. or the wrap around jawline implant which includes all elements of making a well defined jawline.

Dr. Barry Eppley

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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