Cankle Lipo

Liposuction can be performed almost anywhere there is some thickness of subcutaneous fat. The thick leg, between the knee and the ankle, represents differing thicknesses of subcutaneous fat which yield an amorphous lower leg that has a straight line shape. Creating an improved shape comes by creating a thinner profile, or inward indentation, from the lower end of the calf down to just above the ankle bone. (particularly above the inside of the ankle) Discrete small-cannula liposuction can be safely done to reduce the appearance of a chubby ankle.

The key is to not overdo the liposuction area and focus on a limited treatment area that will make the most difference. Because of the elevated venous and lymphatic pressures, the ankle swelling after surgery is more prolonged than liposuction does in almost any other area of the body. But the results can be very visible later and a modest shape improvement is definitely achievable.

Earlobe Lift

Even though the earlobe is small, it is extremely visible. Its appearance can definitely create an impression as to one’s age. (much like one’s hands) An abnormal earlobe, like the ‘pixie earlobe’ deformity after a facelift, is particularly unflattering and a well-known sign of a ‘bad facelift.’

As we age, the earlobe for some people actually deflates losing some of its fat volume.  It may also get elongated, particularly in women, due to decades of ear ring wear. The deflated or stretched out earlobe can be rejuvenated. Injectable fillers are an easy and immediate fix to the wrinkled and delated earlobe. A few tenths of a cc of Juvaderm (or amost any filler) provides an instant plumping. Fillers in the earlobe seem to last longer than almost anywhere else in the face, perhaps due to its slow lymphatic clearance. This is a not uncommon request after someone has had a facelift. The floppy thin earlobe looks out of place after.

In the elongated earlobe, a simple earlobe lift can be done by removing a full-thickness wedge of tissue. Done under local anesthesia, a shorter and fuller earlobe is the result.

Dimpled Chin

Neuromuscular injections have found a low of uses but no matter where it is placed on the face it is for muscle weakening or paralysis of an area of hyperactivity. One of the uncommon but very effective uses for this treatment is in the softening of chin fasciculations. Some patients will experience excessive muscle activity of the mentalis muscle. This is a small but thick muscle that envelopes the bony chin with attachments into the overlying skin. When this muscle becomes stressed, through habit or from straining in a short chin, the chin skin will develop irregular dimples and assume an almost golfball shape. In the extreme, it can be quite noticeable and peculiar-looking.

Muscle weakening injections, like Botox and Dysport, can lessen these chin skin irregularities. While not permanent, repeat injections over time make allow for some expression re-education.

Knee Liposuction

When looking at the legs, it is important to look at the entire legline particularly its inner aspect. The inside of the knee is one small area that can stick out and breakup a smooth transition from the inner thigh down to the calf. It is one of the most bothersome leg areas for many women. It is an easy area in which to do liposuction from a small incision located in the backside of the knee. A surprising amount of fat can be quickly removed and it is important to blend the fat removal down into the upper calf and upward into the knee and lower inner thigh so a smooth flow of the inner leg line is obtained.

It is uncommon to just do knee liposuction alone. It is almost always done as part of inner and outer thigh reshaping. One important patient consideration is that the knee will be sore for some time, often longer than any other liposuction area. Because the knee is a moveable joint, there is a lot of continuous motion across the area leading to prolonged swelling and discomfort. I advise my patient to wear an elastic athletic knee strap afterwards for several weeks. Not only does it stay on but the contiunous support helps reduce discomfort.

Neckline Botox

Even after a good facelift, low neck lines (necklace lines) may still be present. No form of  a necklift can produce  as much improvement way down in the neck below the adam’s apple as it does above it. These low horizontal lines across your neck are a telltale sign of aging. One of the only methods to treat it are Botox or Dysport injections.

While claimed to produce a bit of a neck lift, some go as far as calling it a “Nefertiti lift.”  While there are no other options to treat these neck lines, I have never been impressed that a true neck elongation actually occurs. But a slight softening effect can be seen and it is quick and easy to do.  Whether injections into this neck area is beneficial is ultimately based on whether one feels that the cost is worth its temporary effect.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Earlobes, like the rest of the face, undergoes changes with aging. The natural aging process involves a relaxation of the collagen fibers that make up its skin and atrophy of tissue volume, allowing the earlobe to get longer and thinner. When combined with the use of earrings, their weight will accentuate the sagginess of the earlobe that often develops.  Given that the earlobe has no cartilage like the rest of the ear, it has no support to resist these aging forces.

Measurements of earlobes over time will show that it does elongate, even in men, of at least several millemeters or more. As the earlobe elongates and makes up a more significant part of total ear length (the majority of the ear that has a cartilage framework does not change in size), it can be another facial feature that contributes to an aging appearance.

The concept of earlobe rejuvenation, sometimes called an ear lobe lift, can combat this aging ear feature. There are two fundamental approaches to achieve this effect, a ‘nip and tuck’ of the earlobe or the use of injectable fillers to plump it up.

The earlobe lift involves shortening the elongated earlobe. Through an incision at the junction of the face and earlobe, a wedge of tissue is removed. The wedge can be taken either horizontally or vertically depending upon which creates the better effect. When done vertically, the final scar is at the junction of face and ear, just where a facelift incision would go thus making it virtually undetectable. When taken horizontally through the earlobe, a fine line scar will exist through the center of the earlobe. In either case, small sutures are placed which are removed a week later. No dressings are needed and one can get it wet immediately without a concern. The earlobe lift makes it appear smaller, rounded, and more full. This is a simple procedure which can easily be done in the office under local anesthesia in less than an hour. There is very little swelling afterwards so it is not easily seen.

For earlobes that are not that long but have gotten thin, injectable fillers are a better solution. By addingvolume, the earlobe becomes plumper and the skin smoothes, helping decrease or eliminate any wrinkles or folds. A plump earlobe equals a younger looking one. As the earlobe gets fuller with an injection, any earlobe holes will get smaller and tighter. There are nearly a dozen injectable filler types and any of them will work. In my Indianapolis plastic surgery practice, I prefer either Juvaderm, Evolence, or Radiesse. All of these will last around 9 to 12 months. But when placed in the earlobe, they may last even longer. In just a few minutes, both earlobes can be injected. There is usually a little bit of swelling but this goes away in a few days.

Improvement of the aging earlobe is one of the easiest and quickest facial rejuvenation procedures. Whether by a lift or a fill, a younger looking earlobe is but a few minutes away.

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

As plastic surgery has worked its way into the mainstream of American society, it is no surprise that procedures are being done today that were not imaginable a mere ten years ago. And I am not referring here to surgery wonders of technology and scientific advancement (although that exists also), I am talking about what patients desire to have done. This is a reflection and commentary on contemporary American culture, not necessarily how far the science of plastic surgery has come.

 
As I talk with friends and colleagues about some of the plastic surgery procedures that I do today, I have come to realize that some of them may be considered ‘unusual’ . Certainly, some of them are different than traditional perceptions of plastic surgery. Many are relatively minor procedures that can be performed in the office and probably reflect the trend toward treating smaller concerns. They are the opposite of bariatric plastic surgery, for example, where a new subspecialty of plastic surgery has developed to treat the sequelae of gastric bypass and massive weight loss patients. The emergence of larger plastic surgeries and big procedures doesn’t occur very often but every few decades. But the emergence of more minor plastic surgery procedures occurs much more frequently. Here is a list of my unusual plastic surgery procedures that have emerged and become popular in the past decade.

 
Buttock Implants/Fat Injections - The appeal of a larger, more rounded buttocks is certainly a body image of recent note. Whether done by transferring fat from one body part to another or by an implant placed through an incision near the tailbone, the desire for buttock enhancement could not have been envisioned ten or twenty years ago. There is actually a great number of patients who would like buttock reduction but no single good procedure exists for that problem.

 
Labial Reduction - Whether due to discomfort from rubbing on clothes or during inetrcourse or simply to ‘look better’, reducing the size of a woman’s labia is now a common procedure. One would never have thought that such a concealed part of the anatomy would create a demand for treatment. A very simple and effective procedure, labial reduction restores the outer appearance of the vagina to a more youthful appearance.

 
Earlobe Reduction/Enhancement - As woman age and with the lifelong use of ear rings, the ear lobes will frequently get longer. The size of the ar lobe can easily8 be reduced in the office and it is a procedure that I often do at the same time of a facelift. Aging may also make one’s earlobes get quite thin and almost shriveled in appearance in very thin females. Injectable fillers, such as Juvaderm or Radiesse, can give an immediate rejuvenation effect to the earlobes that may last as long as a year.

 
Eyebrow/Eyelash Transplants - The science of hair transplantation has evolved to the point that single hair (follicle) transplants are now routinuely done in scalp hair restoration. It is quite logical that single follicular transplantation be applied to very small areas such as the eyebrow and even the eye lashes. The alternatives of permanent makeup, colored pencils, and false eyelashes made opting for actual hair tranplants a difficult decision. But some few patients do.

 
Umbilioplasty - While every full tummy tuck patient gets a new bellybutton (umbilicus), some non-tummy tuck patients want one also. Most commonly, it is to change an outie to an inne belly button.

 
Nipple Reduction/Nipple Enlargement - I have seen it both ways. The concern of large nipples is that they can be very visible through clothes…and at all times. Reducing the size of the nipple is a simple procedure and some women may lose a little sensation. Most recently, I have started to some men that want their nipples reduced also! Conversely, nipple enlargement or enhancement is about changing an inverted nippled (which is turned inward) to one that has some outward projection. While not quite as predictable (long-term result) as nipple reduction, the nipple can be released and brought more outward.

 
Corner of Mouth Lift - The downturning of the corners of one’s mouth with age gives a sad or angry appearance. A simple procedure in which a small amount of skin is removed and the corners lifted up and the mouth line leveled gives a nice and subtle improvement. Such a procedure is a simple office operation or is often done as part of a facelift. This is actually an old procedure that has now been ‘reinvented’ or rediscovered.

One wonders what this list will be in another ten years!

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