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Dr. Barry Eppley

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Archive for the ‘plastic surgery wisdom’ Category

Plastic Surgery Wisdom – The Revisional Surgery Patient (The Cautious Consumer)

Saturday, November 1st, 2014


Plastic Surgery Wisdom Dr Barry Eppley IndianapolisThe need for revisional procedures in aesthetic plastic surgery is not rare. The exact number or percentage of time this need arises can not be precisely determined as each cosmetic procedure and patient are unique. But if one had to choose an average number, all factors considered, the number that would be around 15%. Understand this is an average number but what I like about this number is that it catches a patient’s attention. It lets one know that it is not common but on the other hand it is not rare.

Most of the time these revisions are relatively minor and are often adjustments or tweaks  to improve some small area of an otherwise successful procedure. But less commonly the original procedure has ‘failed’. This may be due to loss of an implant, for example, or an operation that simply did not do what one thought it would do. Or in the worse case scenario, the operation resulted in a complication that has now caused a worse problem than the original aesthetic concern they were trying to improve.

When ‘bad things happen’, patients seeking revisions become understandably much more cautious. They do more research, ask more questions, get different opinions, and overall put a lot more thought into the next surgery before proceeding with it. This makes one a much more educated patient which usually leads to an improved outcome. For the plastic surgeon, the revisional surgery patient requires a greater investment of time and education.

‘After An Unsuccessful Aesthetic Surgery, A Patient Will Become A Cautious Consumer’ 

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Wisdom – Assessing ‘Small’ Aesthetic Surgery Results

Wednesday, June 25th, 2014


Plastic Surgery Wisdom Dr Barry Eppley IndianapolisAssessment of after surgery results is understandably a big focus for plastic surgery patients. They are often quick after surgery to begin observing the details of their results, comparing sides and noting any differences from what they may have expected before surgery. A big part of presurgical counseling/education before plastic surgery is controlling the speed of expectations, describing the effects of swelling/bruising and tissue distortions and how long all that takes to go away. Despite the best presurgical education, it is hard for patient to appreciate that many of the fine details of their surgical changes will take three to six months to settle and see the final results. (some procedures can take up to a year)

Patients frequently misinterpret the magnitude of the surgery to how long it takes to see the final outcome. In bigger surgeries patients frequently assume and understand that recovery will be longer and buy into the being patient approach. In smaller surgeries for smaller problems, however, they often assume that the recovery will be very short and they will see their final results sooner. While in some cases this may be true, it often isn’t.

Often smaller aesthetic surgeries take just as long to see the final outcomes as more extensive surgery. This is not because the swelling and bruising are so significant although it is at least proportionate to the size of the problem. It is primarily due to what brought the patient to surgery (or back to surgery in the case of a revision) in the first place. The drive to have surgery for a relatively small aesthetic concern speaks to the patient’s concern about it and how carefully they look at it. With this close and frequent inspection after surgery comes impatience and the desire to see a ‘quick fix’. But the reality is even small aesthetic problems take time to heal and settle and they often are not faster than more extensive surgery.

‘When The Aesthetic Concern Being Treated Is Small, It Takes A Disproportionately Long Time To See The Final Result’

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Wisdom – The Making Of An Expert

Saturday, May 10th, 2014


Plastic Surgery Wisdom Dr Barry Eppley IndianapolisAn expert is defined as someone who has skills and techniques in a particular field that is widely acknowledged as being an authority by their peers. One becomes an expert by acquiring extensive knowledge or abilities through education, training and experience that places them above that of an average practitioner in the same domain of endeavor. In essence, an expert has to acquire unique knowledge and then be recognized by others for having it.

While some can today circumvent the traditional process of becoming an expert by using marketing and the internet to become a self-proclaimed one, education and training is recognized as being key parts of earning that moniker. Knowledge alone, however, is not enough to make someone an expert. It is a good start and one can not become an expert without it, but the key factor that tips the balance to being an expert in any field is experience.

Experience always comes with age and the repetitive nature of doing a certain task. What experience ultimately provides is judgment…knowing when to apply one’s skills and then how to do it both efficiently  and effectively. As the old adage goes…‘good judgement is learned by initially making a lot of bad judgments’. In plastic surgery this means that one has generally had and seen most complications of any operation or in the treatment of any particular problem.

While many patients think they want a plastic surgeon who has had few complications or problems, that may only mean they have done too few operations.

‘An Expert In Plastic Surgery Means That Enough Operations Have Been Done to Have Encountered Most Of the Possible Complications’

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Wisdom: Achieving Natural Results

Sunday, April 20th, 2014


Plastic Surgery Wisdom Dr Barry Eppley IndianapolisMost everyone that considers some cosmetic plastic surgery procedure is interested in a natural result. While the concept of a natural looking result is open to wide interpretation, it usually refers to a procedure that is not overdone. Being overdone in plastic surgery often refers to cosmetic operations(s) that may have been performed in an aggressive manner. This could refer to the facelift that was pulled too tight, the breast implants that were too big or the browlift that was elevated too high, to name a few examples. While every patient wants the most ‘bang for their buck’, more of a physical change may not always be better. It becomes critical, therefore, for every patient to relay in as much detail as possible to their plastic surgeon as to the exact type of change they are seeking. Since so many patients use the term ‘natural’ to describe what they want, one had better be sure what the plastic surgeon sees as natural and how an unnatural outcome is going to be prevented. Don’t assume a natural looking result occurs ‘naturally’.

Natural Results in Plastic Surgery Needs To Be Defined Before The Operation

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Wisdom: The Importance of Presurgical Markings

Friday, December 27th, 2013


Presurgical Marking in Plastic Surgery Dr Barry Eppley IndianapolisOf all the surgical specialities, plastic surgeons are well known for drawing on their patients before surgery. While some may equate that with being an ‘artist’, the reality is that such drawings can be incredibly useful for guiding certain aspects of how some procedures are done. Since patients are often asleep during surgery and are almost always in a near or completely horizontal position, the facial or body structures may be altered from what they naturally are in a more vertical natural position. Thus knowing where things are or how much tissue to remove should not be left to ‘winging it’ in a patient who is laying in an unnatural position where tissues have shifted. Most plastic surgeons will take the time before surgery to make a variety of presurgical markings using devices such as calipers, rulers, tape measures and various colors of marking pens. While careful presurgical markings does not always ensure a perfect result, but a lack of precision or a definitive roadmap for the surgery will have a much less of a chance to be close to the desired goal. As the old motto goes…

‘You Can Not Hit A Target You Do Not Have’

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Wisdom – Trade-offs and Complications from Plastic Surgery

Monday, December 9th, 2013


Plastic Surgery Wisdom Dr Barry Eppley IndianapolisWhile plastic surgery can offer great improvements in innumerable aesthetic and reconstructive concerns, all do so with certain after surgery issues. In some operations these after surgery issues are so slight by comparison to the initial problem that they may of little consequence. In other operations, their consideration may be of such significance that they may make the difference of whether one should undergo surgery at all. While many patients do not always appreciate that there are trade-offs and the risks of complications with every plastic surgery procedure, a well-informed and thorough preoperative consultation should educate one that it is so.

There is a difference in the after surgery issues of  trade-offs and complications. A trade-off is an assured event that is inevitable. It may be a visible scar or the implantation of a medical device that makes the operation possible. A complication is a potential event of variable occurrence that one hopes never happens. It may be a hypertrophic scar or an infected medical device and often leads to additional surgery. It is equally important that one knows both of these after surgery events for any plastic surgery operation they are considering. If the result of any plastic surgery procedure is successful and aesthetically pleasing, a trade-off is a minor consideration and well worth it. If a trade-off becomes a complication, it may still work out favorably but often may not.

‘Trade-offs for Plastic Surgery Are Always Worth It If They Do Not Become Complications’

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Wisdom: 3D Custom Facial Implants

Wednesday, November 27th, 2013


Plastic Surgery Wisdom Dr Barry Eppley IndianapolisFacial implants are an invaluable aid in aesthetic facial rejuvenation and structural changes as well as less frequently in facial reconstruction. Facial implants are most commonly perceived as preformed implants of various styles and sizes to augment areas like the cheeks, chin, jaw angles and nose. (off-the-shelf implants) Less commonly, blocks or sheets of various implant materials are available to carve or shape during surgery to make the desired implant. (semi-custom implants) The use of true custom-designed facial implants done from a patient’s 3D CT scan before surgery has emerged today as another viable and reasonably economic implant method. While once rarely done due to imaging and software design limitations as well as cost, it is now emerged as a much easier and economic implant method to do.

The custom design method for facial implants is truly amazing when visualized on a computer screen. The ability to create any shape and thickness of an implant and match the symmetry between facial sides, if needed, is impressive. But one limitation of computer designing implants is that it is done on an inanimate facial skeletal computer image that does not take into account the soft tissue cover…nor how such designed implants may be capable of being placed. Given that placing facial implants must be done in an inconspicuous and visible scar-free manner, being able to get a custom designed implant through the limitations of intraoral or discrete external facial incisions can be problematic.

Custom designing facial implants often allows larger and more encompassing implants to be created. But part of their design must take into consideration how they can be inserted and whether the overlying soft tissue cover will be adequate and still get the incision closed in a tension-free manner over it.

‘Any Size and Dimension of Facial Implants Cane Be Computer Designed, But That Does Not Always Mean It Will Be Made To Surgically Fit’

This issue is an important one where the input from the plastic surgeon based on their experience can help modify a custom designed facial implant to ensure it can be successful.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Wisdom – Non-Surgical Cosmetic Procedures

Thursday, November 21st, 2013


One of the great evolutions that has occurred in plastic surgery over the past two decades is the emergence and widespread popularity of minimally invasive to non-invasive cosmetic procedures. From Botox and injectable fillers to fractional laser resurfacing and innumerable externally applied body contouring devices, there are a range of options for reducing wrinkles, tightening loose skin, getting rid of fat and improving the appearance of cellulite.

While invasive plastic surgery procedures are not being replaced by these innovations, they do offer alternative choices to real surgery that may at least delay the need. While non-invasive cosmetic procedures are perceived as safer, patients still need to have realistic expectations. Understandably every patient is looking for no down time, low cost and maximal results…what I would call the holy grail of plastic surgery.

But the reality is that one can not get major improvement from minor procedures. To some degree, ‘no pain, no gain’ does really apply. Almost all non-invasive procedures require several treatment sessions to achieve their effects and the change is never going to be as dramatic as a facelift or liposuction.

But the most interesting, and often unappreciated, aspect of non-surgical procedures is that they actually help those who need it the least. The smaller one’s physical problem or concern is, the more effective these procedures become. They are about maintenance or delay, they do not work best for reversal or major changes in aging appearance. The reverse of this then means…


Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Wisdom – Choosing Breast and Facial Implant Size

Saturday, September 21st, 2013


Aesthetic augmentation using implants is an important part of many cosmetic plastic surgery procedures. Whether it is the breast or different areas of the face, implants are used to make these areas bigger. While there are numerous factors that go into selecting the right implant for the need, the consideration of implant size is one of the most important. Plastic surgeons use numerous methods to try and determine implant sizing beyond just experience. Sizers exist for breast implants and various measurements can be made for the face. But in the end there is no guarantee that no matter how much thought goes into the implant selection that it will be exactly what the patient desires. Often during surgery, in which intraoperative sizers are initially placed, there may be a debate about one size versus the other. (smaller vs. bigger)  Since  breast augmentation is about large volumetric enhancement on the body and facial implants is about smaller changes measured in millimeters, I have learned to make that choice based on the margin for ‘error’ and which choice is most likely to lessen the potential need for revisional surgery due to unhappiness with the amount of aesthetic augmentation.

‘When In Doubt Choose The Larger Size in Breast Implants and The Smaller Size in Facial Implants’

This is said because more women who are unhappy with their breast augmentation size is because the implant was not big enough. Conversely facial implant surgery revision is much more likely to occur because the implant was too big.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Wisdom – Choosing Surgery For the Least Possible Result

Wednesday, September 18th, 2013


There are many factors that go into why any patient opts to undergo cosmetic plastic surgery. A perceived and persistent problem, hope for the best result, cost, reputation of the plastic surgeon, timing in their life, recovery opportunity, significance of the involved risks and a host of more minor considerations all pours into a big bowl to create the ingredients for a decision to undergo surgery. One of the important balances that every patient weighs heavily in this decision is what is to be gained at what cost? While everyone wants the lowest cost for their surgery, they also want the most gain that they can.

While patients understandably perceive their surgery hoping that the most ideal result is achieved, that is not actually how it should be viewed at that side of the benefits vs cost ratio. I will illustrate this point by a patient that I just saw today. A young man came in after losing 150 lbs of weight. While this helped much of his overall body the one area that it did not improve was the amount of penile show that he had. Buried within a suprapubic mound of fat was some of his penile shaft, showing a length of 4 1/2 inches when fully erect. What he wanted was suprapubic mound liposuction to gain more visible penile length. His goal was to add an additional 1 1/2 inches by the fat reduction. My feeling was that the most assured result was a 1/2 inch in increased penile show, maybe more would happen but this was what I felt was the less likely amount of improvement that would be seen. With a round figure of $2,500 to do the procedure he felt that was not enough improvement to justify the cost. Out of curiousity I asked him if the cost was only $500 would it be worth it and he said yes. I also asked him if it was assured that he would absolutely gain 1 1/2 or even 2 inches would he pay $5,000…and he said absolutely yes.

Cosmetic plastic surgery is unique because of this delicate and variable benefit vs cost consideration. Much disappointment and unhappiness can result when one’s preoperative expectations of the result are not met.

One Should Choose To Undergo Elective Plastic Surgery Based OnThe Least Improvement That One Feels Justifies The Cost’

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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