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Dr. Barry Eppley

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Archive for the ‘Did You Know’ Category

Plastic Surgery’s Did You Know? Rhytiphobia and Botox

Tuesday, September 24th, 2013


As we age the development of wrinkles on our faces is inevitable. The motion of the muscles of facial expression eventually cause permanent creases or wrinkles to develop in the skin. For some people wrinkles represent a positive reflecting signs of knowledge and experience. For others they are a sign of losing one’s youth and getting older. While no one really wants to develop wrinkles on their face, and many people fight it by a variety of anti-aging treatments, for some it is a real phobia. The morbid fear of developing facial wrinkles is known as rhytiphobia. People with rhytiphobia have an extreme fear of getting wrinkles  and will go to great lengths to avoid them. It is the lengths that people go to in avoiding their fears that define it as a phobia. Thus does getting Botox injections constitute treatment of a phobia? It is extreme to undergo facial injections to avoid or lessen facial wrinkles. Perhaps in the past the concept of having one’s face stuck with needles may have seemed extreme for something as innocuous as a few facial lines and creases. But today Botox is such a common and everyday occurrence that no one would think of it as a phobia treatment. Some people get Botox a few times to see if they like it, others get it with great regularity (every 3 or 4 months) to avoid any new wrinkles developing. To the most regular Botox users perhaps it is a form of phobia treatment, but at least it is a very effective one.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Anatomy of the Protruding Ear

Saturday, August 31st, 2013


The ears on the side of the head are relatively inconspicuous unless they stick out too far. A good looking ear is one that goes unnoticed, only bad looking ears catch our attention. But despite the small size of the ear, it has a compact anatomy that is filled with ridges and valleys. By description they comprise a dozen specific parts that collectively form what is recognized as a normal ear. When the ear sticks out too far, its most common cosmetic deformity, it is the result of a fold deformity (lack of the fold) of the antihelix or excessive development of the underlying concha. (the bowl of the ear) In some protruding ears it is a combination of both. Surgical correction involves making the antihelix fold by placing sutures on the backside of the ear to bring the outer helical rim closer to the side of the head. For the overgrown or too big concha, it may be pulled back by sutures to the mastoid bone or weakened by cartilage removal and then sutured back. Either cosmetic otoplasty is about ear reshaping by folding and bending.

Plastic Surgery’s Did You Know? Breast Implant Serial Numbers

Wednesday, July 17th, 2013


Right out of the files of ‘CSI Plastic Surgery’, a recent case out of China reported on the solving of a missing person’s case by their breast implants. A young murdered female was identified using an exposed silicone breast implant. Through the coding on the silicone breast implant, the police tracked the product back to where the breast augmentation procedure was performed and she was subsequently identified.

While this case was from China, such a similar event could well happen here in the U.S. Breast implants are manufactured in large numbers of sizes and styles and then shipped out to various hospitals and doctor’s office. To ensure tracking of the implants as is required by the FDA and for long-term patient safety, they all have lot and serial numbers. Lot numbers represent the batch from which a certain number of implant shells and fillers are made. Serial numbers are unique to each implant. These numbers are clearly evident on the box and on tracking labels inside the sealed implant boxes. After surgery, forms are submitted to the manufacturer with the patient’s name and other identifying information with the lot and serial numbers of the implants placed. Thus the manufacturer maintains a registry of every patient and the implants they have received.

But some manufacturers place the lot and serial numbers on the implant themselves. For those patients that received breast implants from those manufacturers that place the serial numbers on each implant (e.g., Sientra), the breast augmentation and breast reconstruction patient could always be positively identified…much like an internal ID card.

Dr. Barry Eppley

Plastic Surgery’s Did You Know? Fat Atrophy after Trauma

Thursday, July 4th, 2013


A common observation in blunt traumatic injuries of the face and body that have resulted in large bruises or hematomas (blood collections) is that soft tissue or contour depressions may appear many months later. This is confusing to patients as they do not know why it occurs since they did not have a laceration or obvious deep tissue injury. What has happened is that the blunt injury has caused fat underneath the skin to atrophy or wither away. But how did a ‘big bruise’ cause fat loss? One mechanism is that the trauma has damaged fat cells by compression. Some fat cells may have been crushed or broken apart by the external force, causing permanent loss of volume. This certainly is one injury mechanism but it probably not the only one. When large bruises develop that are associated with a blunt traumatic injury, the released red blood cells are eventually broken down as part of the bruise clearing process. When red blood cells are broken or are being broken down, the hemoglobin they contain can release their heme prosthetic groups.  As the heme decomposes, the non-protein bound heme can become highly cytotoxic due to the iron (Fe+) atom contained within its porphyrin ring.  The iron’s ability to donate and accept eIectrons enables it to convert hydrogen peroxide into free radicals. Free radicals are well known to cause damage to cellular structures of which adipocytes (fat cells) would be very susceptible. Localized ‘iron toxicity’ may add to the development of subcutaneous fat atrophy in traumatic injuries.

Dr. Barry Eppley

Plastic Surgery’s Did You Know? Pectoralis Muscle Atrophy after Breast Augmentation

Monday, July 1st, 2013


The most common location for placing the implants in breast augmentation is under the muscle. What this means is that a pocket is made between the thicker outer pectoralis major muscle and the thinner underlying pectoralis minor muscle. When it comes to nerves in breast augmentation the most common concern is about nipple sensation and one of its major sensory contributing nerves coming in from the side of the chest wall which is at some risk of injury as the outer pocket dissection is done. But there is another nerve, known as the medial pectoral nerve, that almost always get injured in the pocket dissection between the two pectoralis muscles. The medial pectoral nerve either comes up from the pectoralis minor muscle to innervate the major muscle from below or does so around the lateral aspect of the minor muscle. When placing a breast implant below the muscle, the pectoralis muscle is therefore partially deinnervated. This causes some muscle atrophy which is actually believed to be advantageous as it allows the breast to project better. As the thicker pectoralis muscle gets a little thinner over the implant, this allows the breast to acquire a more natural shape on the lower pole of the breast. In female bodybuilders, this pectoralis muscle atrophy may cause some weakness in the muscle which can be overcome by weight training.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Original Nosejob

Sunday, June 23rd, 2013


The desire to change or make up a new nose has been around for a long time. The first recorded nose job is written in the ancient Indian Sanskrit texts around 600 BC. Doctor would reconstruct noses by taking a strip of skin from the forehead or cheeks, twisting the skin side over a leaf of the appropriate size, and then sewing the skin into place. Two polished wooden tubes would be inserted into the nostrils to keep the air passages open during healing. Such drastic rhinoplasty surgery was often necessary as the punishment at that time for adultery was to have one’s nose removed. Today’s rhinoplasty surgery and the desire for one has come a long way from its origin thousands of years ago. But this original rhinoplasty surgery still exists today in nose reconstruction which may be needed after skin cancer resection or traumatic injuries. Known as forehead flaps, they are still the main method of major nasal reconstruction when substantial portions of the nose are missing. And the basic concepts of the forehead flap remain the same as was performed long ago in ancient India.

Plastic Surgery’s Did You Know: The Need for Strong Male Jawlines

Tuesday, June 18th, 2013



A strong jawline has been deemed as both a desireable and attractive male facial feature for millenia. A strong male jawline is not a passing fad or temporary fashion statement. It has been and always will be an important feature of a male face. Everyone knows that a strong jawline implies increased masculinity and increased attractiveness. But where does this impression come from and why? Face shape and structure has long been considered a good indicator of dominance. A rounded chin is viewed as more feminine than a more square stronger chin. Recent research has shown that during ovulation women seek out masculine-appearing men whose features suggest high testosterone levels which would indicate a high fertility and well as good quality genes that can be passed on to their offspring. Strong jawlines also imply dominance over other males which may be most important when a woman is at or near their peak fertility. Like so many desireable physical features of men and women, its basis lies deep in history with the need to secure a mate, procreate, and pass along good genes.


Plastic Surgery’s Did You Know? Sunscreens and Skin Aging

Monday, June 10th, 2013


Everyone by now knows the value of using sunscreens in lowering the risk of getting skin cancer. By decreasing the amount and duration of ultraviolet light skin exposure, the skin cells have more time to repair themselves and less chance of permanently damaging the natural healing mechanisms of the cell’s structure. In addition, it has now been proven that sunscreens also result in less skin aging and less skin wrinkles over time. In the June issue of the Annals of Internal Medicine, a study out of Australia (a country that really knows about sun exposure) reported on the effects of the use of sunscreen in over 900 fair-skinned people under age 55. They either used SPF15 sunscreen daily or only as they desired. The group that used daily sunscreen showed little increase in skin aging after nearly five years compared to the group that used it on a more discretionary basis. These findings are really no surprise in that skin aging and wrinkle development is known to be the result of irreversible cellular damage of the elastin fibers and decreased collagen production from ultraviolet irradiation. Decreasing the risk of skin cancer and slowing down the visible signs of skin aging are the direct result of blocking UV rays. This is why many modern skin moisturizers and even makeups contain UVA and UVB protection.

Plastic Surgery’s Did You Know? The Muscles of Facial Aging

Sunday, June 9th, 2013


A facelift, despite being a well known procedure, is frequently misunderstood. The most common misconception is of the actual facial area that is treated. Rather than the whole face, it treats only the lower third of the face, the neck and jowl areas. But the second misconception is what lies under the skin or, more pertinently, what is changed under the facial skin as it is lifted. It is commonly believed and often stated that the facial muscles fall with aging, carrying with it the overlying skin. But this is only partly true at best. The only facial muscle that really changes as we age is the platysma muscle which is a neck muscle not a true facial muscle. Running between the clavicles and the jawline, the platyma muscle splits or separates in the middle as we age. This creates the classic neck bands seen running down the middle of the neck. What one sees is the inner edges of the platysma muscle which makes up the paired neck cords running vertically. It is this muscle that is put back together during a facelift and accounts for the small incision right under the chin for access to do it. There are no facial muscles on the side of the face that can fall. There lies the very big masseter muscle, responsible for chewing, that is densely adhered to the bone. It can never fall with aging or become loose from the bone. Skin and the underlying subcutaneous tissues, known as the SMS, can sag with aging but not the muscles.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Lower Eyelid Bags

Saturday, June 8th, 2013


Undereye bags are a well recognized facial entity. Everybody has seen lots of people who have them and eventually many people will see them on themselves as they age. For some few people they will have them even when they are quite young before they have any significant aging. Lower eyelid bags in the aging face are made up of several tissue components including loose skin and muscle as well as protruding fat. In the younger patient who just has bags or puffy lower eyelids the issue is one just of protruding fat. But in either the young or old, where does the fat in lower eyelid bags come from and why is it there? This is known as herniated lower eyelid fat that wss originally under the eyeball. Fat under the eye acts as a cushion, which is why you can push back on your eye and it gives in a little. The fat around and under the eye cushions it from impact. This fat is normally contained to the under the eyeball due to a ligament in the lower eyelid known as the septum. But as we age this ligament weakens, allowing the fat to come spilling out creating the puffiness or bags.  In the younger patient with bags, this ligament is naturally or congenitally weak allowing the fat to prematurely bulge out. In essence bulging lower eyelid fat is the result of a weakness or hernia in the lower eyelid ligaments. This heriated lower eyelid fat has three distinct pockets of fat known as temporal,central and medial or nasal fat pockets. Interestingly, while fat is well known to have a yellow color the nasal fat pocket is white and no one knows why.  Herniated lower eyelid fat can be removed exclusively in a transconjunctival lower blepharoplasty or as part of a more complete open lower blepharoplasty.

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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