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Haveing spent a long time in plastic surgery at Riley Hospital in Indianapolis, I have performed a lot of cosmetic otoplasties for protrudung ears as well as ear reconstructions in children both with missing or partially missing ears. Parents frequently have a lot of questions about otoplasty in their child and many of these questions are fairly common. Here are the most typical ones.
AT WHAT AGE CAN AN OTOPLASTY BE DONE IN A CHILD?
Classic plastic surgery teaching is that an otoplasty should wait until the ears are nearly fully formed at around age 6. The theory is that scarring on the ear may not cause it to develop properly if done before that age. While this may be classic teaching, it has now been shown that otoplasty done as early age 2 does not result in any problems of ear growth. Therefore, I think age 2 and beyond is a safe time to do otoplasty from an ear development standpoint.
The more relevant question(s) in my mind in terms of otoplasty surgery timing is….when will the child be reasonably cooperative (they need to allow a head dressing to be on for a week after surgery) and when does it bother the child (from a social teasing standpoint). These are practical surgical issues and when these two question are put together, I find age 4 is reasonable. The child at age 4 is more cooperative than age 2 and I think you want to otoplasty surgery BEFORE they are teased to prevent any self-image issues. (i.e., before they formally go to school and are around a lot of other children)
IS RECOVERY AFTER AN OTOPLASTY DIFFICULT?
In general, no. The ears are somewhat tender but not acutely painful. Most bothersome (after 3 or 4 days) is the head dressings which gets itchy and does impede their hearing somewhat (they may have selective hearing anyway!) The head dressing is only there to prevent the ears being bent, twisted, or traumatized which may cause the sutures holding them back to come loose…with the ear ending up sticking out again.
HOW PERMANENT ARE THE RESULTS OF OTOPLASTY?
Once healed, an otoplasty result is fairly permament. Some studieds have shown that very long-term results of otoplasty shown some mild degree of relaxation but the improvememnt is so substantial thaty this minor ‘relapse’ is not even noticed.
Until an otoplasty heals, however, the ear is at risk of coming ‘undone’. For the first month or so, the new ear position is held there by the internal sutures. After that, the scar that forms takes over for the sutures which are no longer needed. Therefore, one must be careful during the first month to not disrupt the internal sutures which are temporarily playing a critical role.
Dr. Barry Eppley
http://www.eplpeyplasticsurgery.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. And 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.
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
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
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
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
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
I often get asked by patients if I think they are ready to have plastic surgery. My initial reponse is always the same….if you think you want or need it…then you are ready. Something as elective and personal as plastic surgery can’t really be decided by the doctor, I simply decide what the best treatment options are for you and help educate you to a decision on how to deal with your concern.
While that is an initial response, a more in-depth answer would include the following three very relevant issues. 1) Do your homework on treatment options for your concern first. While the internet is full of inaccurate and misleading information, there is also a wealth of accurate information on any plastic surgery topic. Review it and bring in your questions. 2) Make sure you can afford it. That is something that I as a plastic surgeon can not help you with. Only you know your finances and whether your plastic surgery desires fit into your budget and were it sits on the priority scale of your life. 3) Be prepared for the risk of potential complications. Not all plastic surgery procedures turn out perfect. While most ‘complications’ are minor, they can and do occur with some frequency. Allot time in your schedule for this possibility…and have have the psychological mindset that it can happen and its occurrence will not be devastating for you.
If you have thought through these significant issues with your plastic surgery procedure, then you are indeed ready in my opinion.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Eyelid surgery, known as blepharoplasty, is one of the most common aging facial surgeries. This is not only because every person has four eyelids (4 surgeries per patient) but because it is often the first plastic surgery procedure (not an office-based procedure such as Botox) one may go through to deal with the effects of aging. Because the eyes are seen by everyone (every human conversation is based on heavy eye contact), we are all too aware of when we appear tired even if we aren’t. The eyes may be the window to the soul but they are also the shades to the eyeball whbich do weather with age.
Aging of the eyelids is a result of three things; 1) The constant muscle movement around the eye causes the skin to wrinkle and create folds (lower eyelid) and hooding (upper eyelid), 2) eyelid skin starts to sag due to gravity, and 3) fat starts to protrude out from under the eye (lower eyelid bags) much like a hernia. All three aging conditions cause the eyelids to look heavy, saggy and swollen creating a very tired appearance. The eyelids can be made to look worse if one’s brow also starts to sag, making the skin on the upper eyelid look even worse.
Surgical correction of these aging eyelid problems is to remove the ‘extra’ skin’, remove or push back the herniated fat (lower eyelid), and sometimes even tighten the corners of the eye. On the upper eyelid, a large amount of skin can be removed leaving a very fine scar along the natural upper eyelid crease. Sometimes fat is removed in the upper eyelid but it is not as big of a problem as it is in the lower eyelid. A surprising large amount of skin can be removed in the upper eyelid without causing any problems with eyelid closure. In the lower eyelid, however, the reverse is true. Managing the herniated fat is a very important part of lower eyelid surgery. Whether the fat that protrudes is removed or, in a newer technique, tucked back up under the eye like a hernia repair, getting rid of excess lower eyelid fat is key to a good result for most patients. Removal of skin in the lower eyelid, however, must be done very carefully and much less can be removed than one would think. If just a little too much is removed, the risk of the lower eyelid pulling down after surgery is a real possibility. For this reason, particularly in the older patient, the lower eyelid which is often loose anyway is tightened like a clothesline at the side of the eyelid where it attaches to the bone.
When all four eyelids are done at the same time (which is most common), the overall effect can be quite dramatic. And since everyone looks at our eyes in conversation, the more youthful and refreshed appearance is appreciated by all even though most do not know it is from plastic surgery.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis