I regularly get contacted from people out of town and out of the country in regards to their plastic surgery concerns and problems. This is not a surprise as the internet has made the accessibility of information available at the click of a mouse. Since information on the internet spans the globe in a matter of seconds, it is no surprise that patients will seek and travel to a plastic surgeon whom they feel offers expertise in what they desire.Traveling a long distance for plastic surgery can make sense and be a good experience if it is a well organized process and thoroughly planned out in advance.

The first step in the process, which everyone initially does, is to send me your initial inquiry either through my consult form on my website (www.eppleyplasticsurgery.com) or e-mail me at info@eppleyplasticsurgery.com. You will receive an initial response back within 24 hours, answering your basic question(s). If you desire to go further, it will be necessary for you to send more detailed information on yourself, your plastic surgery concerns, and photographs directly to me. Based on a review of this information, my concierge Cindy will contact you and arrange for a phone consultation where we can extensively review your needs. Once a thorough discussion has occurred and we are both satisfied, plans can be made to visit me in Indianapolis. Most commonly, this may be in one trip for consultation and surgery at the same time, or it may be split into two visits based on your level of comfort.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

My office often gets asked if we perform the ‘LifeStyle Lift’, ‘S-Lift’, and a variety of other names that end in -lift. The callers and patients don’t know, of course, that all these names really refer to the same procedure, otherwise known as a limited facelift. Their interest is peaked by the allure of improvement in sagging jowls or loose neck skin but without the downtime of a full facelift.

 
The confusion about this procedure stems from general misconceptions about what an actual facelift is. Most patients envision a facelift as a procedure that starts at the top of the head and ends somewhere below the neck. Visions of weeks of seclusion, obscene facial swelling and bruising, and ruinous financial strain make many patients feel that they definitely don’t want a facelift. They don’t understand that a facelift is really a misnamed procedure. A better name which more accurately describes what it is….is a necklift or a jowl-necklift.

A facelift, in isolation, does very little above the jawline or for most of the face. It is a procedure that changes the neck and jowl line only. Many patients will have other facial procedures done in conjunction with a facelift, such as the brow, eyes, nose, cheeks, or lips (often referred to as total facial rejuvenation) but these do not constitute a facelift. As a stand-alone procedure, a facelift is really about the neck and jowls and creating a sharper neck angle and a clean jowl line again.

 
Therefore, a limited facelift is a scaled down version of the full facelift. It has gotten, for a variety of marketing purposes, many catchy names as previously mentioned. Some plastic surgeons even put their own name on it. But, in the end, there are all the same procedure. A limited facelift is…..limited. Meaning the length of the incisions used (in front of the ear), how much skin is undermined and removed, and the amount of subsequent after surgery care and recovery is much less than a full facelift.

An important concept to grasp here is….the result is also less than that of a full facelift. For this reason, the best candidates for a limited facelift is someone younger who has minimal jowling and loose neck skin or someone older, who really needs a full facelift, but prefers a smaller procedure for any number of reasons.

 
I have found that one-half of the facelifts I do today are of the limited variety. They are very popular due to their quick recovery, lack of pain, and minimal swelling and bruising. They are a great stopgap measure that will substantially delay the need for a facelift is some patients and may, in others, potentiallhy eliminate the long-term need for a full facelift. Whe combined with other small face procedures, such as eye tucks and peels, they really make a nice change with no chance of getting that ‘operated look.’

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

One of the most important things we do as plastic surgeons or any surgeon for that matter…is to match the solution to the problem. Large operations for small problems run the risk of creating complications that exceed the scope of the original problem. Small operations for big problems simply will not work and are destined for failure and more surgery. Learning this judgment skill can only be done through experience…otherwise known as mistakes.

 
I have learned to carefully match the magnitude of the operation to the size of the problem. Small problems need small operations. Big problems require big operations. You cannot make a big problem better by a small operation…no matter how much the patient would prefer it. The allure and excitement of a big operation (to the plastic surgeon) is doomed to likely create a problem for the patient which is just as significant, if not more so, than the original problem.

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

Cosmetic plastic surgery is very unique from traditional medicine in one significant way….it is elective. The ‘problems’ treated do not absolutely need to be treated, operating on them is elective. Therefore, one of the contributing factors used in deciding whether to go with one treatment or another is the concept of value. What result am I going to get for what I am paying? That is a key question. 

While not talked about in most other areas of traditional medicine (if you break your leg, you don’t debate with your doctor about the economics of one treatment option versus another), the issue of value and outcome is actually of great significance in cosmetic treatments/surgery. While it is rarely talked about, I find it to be a very significant issue in most patient’s minds and I discuss it with patients frequently in my Indianapolis plastic surgery practice.
In discussing various treatment options for any particular problem in cosmetic plastic surgery, I always compare the various treatment options in terms of outcome and cost. I have learned over the years that one of the issues that makes a contribution to a patient’s interpretation of a satisfactory result is their assessment of….did I get a good result based on what I paid? Did I get good value for my economic efforts? Patients can live with less than a perfect result if they think they got a good value. Patients tend to get unhappy, even with a reasonable result, if they feel that they ‘overpaid’.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

I have noticed over the years an occasional relationship between the economics of a patient, affordability if you will, and the potential satisfaction from a procedure.The less likely a patient can really afford the procedure, the less likely they will be completely satisfied with it.
To give a good example, I had a lady last week that wanted injectable filler placed into her nasolabial folds but all she had to spend was $425. At the current time, I usually placed Radiesse, a particulated filler which lasts longer than many other fillers. In my experience, it usually takes a full syringe at the price of $850 to really do a good job of filling it out. Since she could only afford half a syringe, that is what I placed and I indicated to her that that amount would help but it would not be an ideal amount to do the job well. I did the procedure and sure enough……one month later she came back and felt that it didn’t work well and wanted it fixed. What I had said at her initial consult had long been forgotten.
Morale of this story….sometimes it is just better to tell patients that the amount of plastic surgery they can afford will not produce enough of a result to make it a worthwhile investment. Saying no to patients is always tough, but you can’t make a small investment turn into a big result.
Dr Barry Eppley

http://www.eppleypalsticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

One of the most frequently asked questions to me by patients, and undoubtably looked for on websites and the internet, are photographic results of plastic surgery. Specifically, plastic surgery pictures from the specific plastic surgeon that they are evaluating. Given that everything we do in plastic surgery is visible and capable of being photographed, most plastic surgeons will have a good library of before and after pictures to peruse. I always send my patients to my website collection at http://www.eppleyplasticsurgery.com/cosmetic.html. From there, they can choose any of the twenty-one cosmetic categories, click on the category, and then click on results to see before and after pictures.

When viewing photographs of plastic surgery results I advise my patients that, first and foremost, these are representative examples and do not imply that they will get the same result. They are posted so patients can see what is possible in some patients, but are not a guarantee of what result they may get. Secondly, I try to put up what I consider typical or average results, not just the best results for any procedure that I have. All results can be critiqued in some fashion and that is one of their main points…no patient gets a perfect result. Every surgical result has flaws. It is about getting significant improvement but with as few complications as possible. Lastly, pictures can be deceiving. Lighting, angles, and how far after surgery the picture was taken all contribute to how the result looks.

In conclusion, before and after pictures of plastic surgery are posted to help you think about your proposed surgery and get a visual understanding of what may happen. They are a significant part of each patient’s education process. They are not, however, a guarantee of surgical results.

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Like all businesses, I get many accolades for services provided as well as a lesser number of complaints about services or results. That is the nature of plastic surgery where everything we do is visible. All results can be easily judged.

But I got a very kind note from a parent about a conversation that I had with her son while he was in the office. I was seeing him for long-term follow-up from repair of facial scars sustained as a child. He happened to ask me about my feelings on marijuana as a medical professional. I interpreted this as a serious question from a young man who was obviously trying to sort the issue out in his own mind. As I expressed my views (which were not negative from a medical viewpoint), I left him to ponder this question. Will partaking of marijuana take you closer to…or further from… your objectives and goals in life? That is the real question of any habit. You do become the end product of what you do, think, and whom you associate with. I hope it gives him serious pause.
Dr Barry Eppley

A very frequent request for potential breast augmentation patients is that they would like to see breast augmentation photos/pictures of my results. I find patients reviewing before and after breast augmentation photos to be extremely educational for them and I insist that they do so. I refer to them to either by practice website, http://www.eppleyplasticsurgery.com or Mentor’s excellent website Love Your Look at http://www.loveyourlook.com/doctors/doctor-profile.aspx?id=14771&query=Indianapolis%2c+IN&s=253&tab=10&primary=True&type=augmentation where a sampling of my patient gallery is availble for review. While no patient result seen can be exactly reproduced on another patient, it does give some estimation of breast size and what is possible. It also clearly shows, if the breast augmentation photos are examined carefully, that breast implants do a great job of adding volume and size but are limited in changing other breast variables such as nipple size and position and the amount of spacing between the breasts.

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

One of the more interesting observations in plastic surgery is the change in patient’s expectations before and then after a plastic surgery procedure. Often it occurs in the most unlikely of patients.

 
What I am referring to is how some patients, who before surgery state that they would find any improvement in their problem acceptable, become after surgery much more critical. In plastic surgery we have long recognized that patients will very small problems are quite intolerant of less than a perfect result. This we know and quite frankly we accept this issue if we choose to operate on these type of patients. In more major problems, such as missing a breast from cancer or total body contouring after massive weight loss for example, less than perfect results are usually quite tolerated given the severity of the initial problem.
This being said, I have observed that some patients with major problems can get quite picky or critical of the result. This is a phenomenon of what I call patients ‘changing their targets’. In these patients, once one level of result is obtained, they then forget from whence they came. And their standards then became higher or, from a plastic surgeons perspective, they get much pickier. Minor issues that did not bother them before surgery now become more significant issues. You might consider this phenomenon ‘accomplishment feedback”, to put a positive spin on it.
Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

I read earlier this week of another Botox ‘concern’ this week on the internet which reported ‘Botox moves from the face to the brain’. This news story was based on a recently published paper in the Journal of Neuroscience. The concern is that Botox apparently can migrate from where it is injected to somewhere in the brain, suggesting that this may be potentially harmful. At the least, it sounds harmful anyway.
Doing my due diligence, I decided to read the article for myself as undoubtably patients will ask me about it. The article is officially titled ‘Long-Distance Retrograde Effects of Botulinum Neurotoxin A’ authored by an team of scientists at the Neuroscience Institute in Padova, Italy. It was published in the Journal of Neuroscience on April 2, 2008. In this study, botulinum toxin A was injected into rats either into various areas of the brain or into its whisker facial muscles. The most potentially relevant injection site for cosmetic purposes is the facial muscle site. They found that some of the botulinum enzyme remnants were later found at the facial nucleus site in the brain. Thus, confirming the novel finding that botulinum toxin has the ability to move ffrom the nerve endings in the face to the brain…..at least in rats.
What does this mean to the cosmetic patient who regularly gets botox injections? Not much in my opinion. First, this was a study performed in rats, so it does not mean it works the same way in humans. Secondly, the study did not show any harmful effects to the rat despite this finding. Third, the type of botulinum A and the dose used were different than what is used for cosmetic purposes in humans. As billions of cosmetic Botox injections have now been done in humans with no significant problems ever reported to date, this is a very interesting study but the correlation to human applications has not been made.
Or as one of my patients said after asking me about this news story this week……too bad for the rats but I will not stop getting my Botox!
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis