EXPLORE
Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

April 17th, 2016

The Transpalpebral Browlift Explained

 

Correction/repositioning of sagging brows is done by well known browlift procedures. The vast majority of browlift surgeries are done in women with access to do the procedure coming from above in and behind the frontal hairline. The three different female browlift techniques (coronal, pretrichial and endoscopic) are chosen based on forehead skin length and the position of the frontal hairline.

Browlifts in men, however, are more challenging because of the typical lack of a stable hairline, poor hair density or no hairline at all. Thus, most men can not have a superior scalp approach due to concerns of visible scarring or disturbed hairline concerns. Browlifts in many men have more limited options and include either a mid-forehead, direct (superior eyebrow hairline) or a transpalpebral incisional approaches.

endotine browlift devices dr barry eppley indianapolisThe transpalpebral browlift technique is used almost exclusively in men and relies upon a device (Endotine) to achieve the browlifting effect. In addition it has a browlifting effect that is largely limited to the outer half of the brow (temporal brow) and creates a more modest lifting effect. This location of the browlift is what makes it most useful in men as inner browlifting creates an unnatural appearance for most men.

Transpalpebral Browlift brow bone exposure Dr Barry Eppley IndianapolisThe transpalpebral browlift is done from an upper blepharoplasty incision and is often done in conjunction with removal of upper eyelid skin. After the upper eyelid skin is removed, the outer brow bone is accessed in a subperiosteal fashion. Dissection is carried above the lower edge of the outer brow bone in excess of 15mms to allow the Endotine device to fit.

Transpalpebral Browlift drill hole and endotine device Dr Barry Eppley IndianapolisAt 15mms above the lower edge of the brow bone an outer cortical bone is drilled. This allows the Endotine device to be inserted into the hole and oriented in an upright triangular position. This allows the prongs on the device to be angled upward.

Transpalpebral Browlift endotine device [placement Dr Barry Eppley IndianapolisOnce the Endotine device is inserted, the outer brow tissues are lifted and suspended on the device’s prongs. The soft tissue are then closed over the device and the upper blepharoplasty incision closed.

The transpalpebral browlift is essentially a ‘push’ browlift from below. This is stark contrast to the more traditional browlift methods which are ‘pull’ procedures from above.  The Endotine device makes this possible. It is composed of a resorbable polymer material which breaks down and is absorbed completely within 6 to 9 months after it is inserted. This should be enough time to allows the brow lift tissues to scar down and heal to the bone in a slightly more elevated position.

Patients will feel the device under the skin for a few months after the procedure although it is not visible on the outside. For men the transpalpebral approach, while having a modest result, avoids scar concerns at the eyebrow or on the forehead which can take a long time to mature and their imperceptibility is not always assured.

Dr. Barry Eppley

Indianapolis, Indiana

April 16th, 2016

Case Study – Webbed Neck Surgery

 

Background: A webbed neck, medically known as pterygium colli deformity, is a well known but rare congenital neck condition. Skin folds are present along the sides of the neck from the back of the head behind the ears down to the shoulders. The hairline often follows the skin folds in their upper part. It is most commonly seen in Turner’s syndrome but occurs on congenital syndromes as well. The skin folds occur in varying presentations but can be quite pronounced in many cases.

The surgical correction of the webbed neck has evolved from original descriptions of z-plasties done directly along the skin folds. While successfully breaking up the skin folds, such a direct approach leaves unsightly scars that are rarely worth the trade-off.

The posterior approach to the webbed neck is the preferred technique today. This involves removing tissue from the midline of the posterior neck and wide skin undemining out to the skin folds. Closing the posterior neck defect then pulls the skin folds inward. (more posteriorly) A variety of posterior neck excisional patterns have been described from butterfly, M and Z-plasty patterns. While providing definite improvement in the appearance of the skin folds and keeping the scar fairly hidden (with long hair), partial relapse is common with the secondary skin relaxation.

Case Study: This 35 year-old Asian female had a congenital webbed neck from birth. She did not have Turner’s or any other known congenital condition. Her necks webs would be described as mild to moderate. She was teased a lot for her neck webs when she was growing up. Prior to surgery, she shaved the lower portion of her occipital hairline to aid the subsequent surgery.

Webbed Neck Surgery Markings Dr Barry Eppley IndianapolisUnder general anesthesia, the posterior neck was marked with red dots to mark the most tolerated lower extent of the tissue excision and midline closure and a modified T-shaped excisional pattern. The neck webs were vertically marked.

Webbed Neck Surgery tissue excision Dr Barry Eppley IndianapolisWebbed Neck Surgery fascial plication Dr Barry Eppley IndianapolisThe posterior neck skin and fat was excised down to fascia. The skin edges were widely undermined out to the skin folds. The fascia edges could be grasped and mobilized considerably to the midline.

Webbed Neck Surgery fascial plication completed Dr Barry Eppley IndianapolisThe posterior neck fascia was plicated in the midline with large resorbable sutures. This could be seen to bring in the skin folds at the side of the neck significantly.

Webbed Neck Surgery skin closure Dr Barry Eppley IndianapolisThe skin edges were then brought in to the midline and closed in a T-shaped pattern. Prior to the skin closure, multiple quilting sutures were placed from the skin down to the fascia to both eliminate deep space as well as take tension off the skin closure suture line.  Marcaine injections were done along the fascia as well as the greater and lesser occipital nerves to manage immediate postoperative discomfort. The posterior neck incisions were covered only with with tapes.

Webbed Neck Surgery before and after during surgery Dr Barry Eppley IndianapolisThe skin folds were completely eliminated with this webbed neck surgery technique. The neck was changed from wide neck ‘wings’ to an hourglass neck appearance.

Webbed Neck Surgery results Dr Barry Eppley IndianapolisWebbed Neck Surgery left side result Dr Barry Eppley IndianapolisWhen seen the next day after surgery before returning home, her webbed neck condition was completely eliminated. The combination of posterior neck tissue excision and midline fascial plication creates an improved and sustained result in webbed neck surgery.

Highlights:

1) Webbed neck correction requires a posterior neck approach with tissue excision and midline closure to prevent visible scars on the sides of the neck.

2) Midline fascial plication is critical to bring in the sides of the neck (webs) and relieve tension on the posterior midline neck closure.

3) This form of webbed neck surgery uses the same principles as midline platysmal plication in facelift or direct anterior necklift surgery.

Dr. Barry Eppley

Indianapolis, Indiana

April 14th, 2016

Lip Fat Injections using Buccal Fat

 

Lip augmentation is a popular facial filling procedure that has been done by a wide variety of materials. Synthetic fillers, fat injection and implants have all be done with well known advantages and disadvantages. The perfect lip augmentation material, however, remains elusive

Of all the known injectable fillers, fat has a high appeal but is the most vexing. Fat is a natural material that is unique to each patient and everyone has enough to harvest to do lip augmentation. But even in small volume placements like the lips, its retention and survival is far from assured. In fact, substantial clinical experience has shown that the lips actually have one of the lower rates of fat grafting success on the face. Whether that is due to high motion activity of the lips or their lack of much native fat tissue is unknown.

The donor site for lip fat injections has been harvested from just about every body donor site imaginable. No one knows if the donor source of fat grafting affects how well the fat graft takes although it is hard to imagine that it does not play some role albeit even if it is a minor one.

Buccal Lipectomy intraop Dr Barry Eppley IndianapolisOne donor source for injectable fat grafting that has not been previously described is that of the buccal fat pad. There is more than enough fat in the buccal fat pads for transfer into the lips. But buccal fat pad harvesting should not be routinuely done due to potential undesired aesthetic tradeoffs of facial hollowing that could occur in many patients. But for those patients with rounder faces that desire facial slimming, a buccal lipectomy can be aesthetically beneficial.

Buccal Fat Injections to Lips Dr Barry Eppley IndianapolisHarvested buccal fat pads can be pass back and forth to create an injectate that can easily be injected through a small blunt-tipped cannula. And for the buccal lipectomy patient who also desires lip augmentation this can be a superb method of fat recycling/redistribution.

Buccal Fat Lip Injections result Dr Barry Eppley IndianapolisDoes fat from the buccal fat pads survive better than other donor sites. The fat is clearly different in being encapsulated and with much larger globules. It is tempting to hypothesize that it survives better than subcutaneous fat, and I suspect that it does, but it remains to be scientifically proven.

Dr. Barry Eppley

Indianapolis, Indiana

April 12th, 2016

Technical Strategies – Diced Rib Graft Injection in Rhinoplasty

 

Primary or secondary correction of nasal bridge deformities is now well known to be corrected by injectable fillers. The use of hyaluronic acid-based (HA) injectable fillers provides a quick and very directed approach to a wide variety of nasal contour deformities. While effective, no HA filler to the nose provides a permanent contour correction in the vast majority of patients.

I have run across a handful of patients that stated they had gotten one HA injection to the nose years ago and the result was sustained. But it is hard to know whether this is merely cosmetic accommodation or was indeed a ‘permanent’ result. I suspect that of the nasal contour issue was significant, such a permanent result would not have been seen. I know from injecting a lot of dorsal hump patients with HA fillers to camouflage it (placing filler above the hump to create a straight dorsal line) that such filler volumes are not sustained in the nose.

Diced Rib Graft Injection Preparation Dr Barry Eppley IndianapolisAn alternative and permanent options for larger primary or secondary dorsal line defects is that of a diced cartilage graft injection. This is a concept that, while injected, must be differentiated from that of HA filler injections. This is where cartilage grafts from either the septum, ear or rib are processed to make them injectable. This is done by cutting (dicing) them into small 1 x 1mm cubes (or smaller) and placing them into an open barrel 1ml syringe.

Diced Rib Graft Injection Preparation 2 Dr Barry Eppley IndianapolisThrough an intranasal (intercartilaginous) incision, a tunnel is made on the dorsum up onto the upper dorsal defect area. (frontonasal junction, radix, nasal sidewall) The syringe is introduced and the compressed cartilage grafts are injected in the desired amount and shaped externally. The grafted area is taped to hold the desired shape for 7 to 10 days.

While many diced cartilage are traditionally wrapped in surgical or fascia, there is a role in smaller nasal dorsal defects for direct injection of the cartilage. The small nasal tunnel and confinement of the syringe allow the cartilage particles to be precisely delivered.

Dr. Barry Eppley

Indianapolis, Indiana

April 11th, 2016

X-Ray Planning in Submental Chin Reduction

 

Chin reduction surgery is sought for those patinets afflicted with a chin that is too strong or protrusive. A large chin can exist in numerous dimensions, albeit being vertically too long, too horizontally forward or too wide. In many cases the chin protrusion is caused by at least two and sometimes all three dimensional excesses.

Intraoral chin reduction is reserved for  a minority of large chin patients. A chin that is too vertically long can be reduced by a wedge reduction bony genioplasty. But chins that are too far forward should not be reduced by shaving or setback genioplasties. This will lead to soft tissue chin problems of redundancies and/or chin ptosis. (sagging)

A submental chin reduction is the most effective technique  for a chin that needs multiple dimensional changes. It is preferred because it can deal with the resultant soft tissue excess that results from loss of bone support. It also provides direct access for reducing the jawline behind the chin along the inferior border.

Submental Chin Reduction PlanningThe best and simplest method for estimating and planning the bone removal in a submental chin reduction is a panorex x-ray. This x-rays provides visualization of the important mental nerve as it courses through the bone.

Submental Vertical Chin Reduction Dr Barry EppleyWith x-ray planning as a precise guide, the measurements can be transferred to the bone during the chin reduction surgery. This will allow the maximum amount of bone removal while protecting the integrity of the mental nerve as it courses through the jawbone.

Submental Chin Reduction before and after radiographic resultsSubmental Chin Reduction radiographic result predictgion planning vs actual resultAn after surgery x-ray shows the execution of the exact bone removal plan and how close the path of the nerve is to the underlying bone cut. Comparison of the preoperative planning panorex to the result seen in the after surgery panoex shows how well the surgical bone removal was done.

The use of a panorex x-ray in submental chin reduction is a valuable presurgical tool which is of  greatest importance when bone needs to be removed along the jawline behind the chin.

Dr. Barry Eppley

Indianapolis, Indiana

April 10th, 2016

Extended Cheek Implants for High Cheekbone Look

 

High Cheekbone Look Indianapolis Dr Barry EppleyHjgh cheekbones, whether it is in women or men, is an often desired facial feature. Careful inspection of what constitutes the ‘high’ or ‘strong’ cheekbone look reveals that it has several anatomic components. The main portion of the cheekbone is indeed high but the prominence extends back along the zygomatic arch, stopping just short of the temporal region. A prominent zygomatic arch creates both a strong cheek line but also contributes to a submalar hollow or concavity.

Cheek implants are commonly used to try and achieve it but often are inadequate due to the implant’s shape. No cheek implant provides any zygomatic arch extension which is critical in helping to achieve this type of cheekbone augmentation result.  (extended cheek implants) Fabricating  custom cheek implants from the patient’s 3D CT scan is the ideal method to achieve this implant design and look but adds a significant amount to the cost of surgery.

Facial Implant silicone carving blocks Dr Barry Eppley IndianapolisCustom Carved Extended Cheek Zygomatic Arch Implants Shape Dr Barry Eppley IndianapolisAngel Wings Extended Cheek Zygomatic Arch Implants block carving Dr Barry Eppley IndianapolisAn alternative method to fabricate extended cheek implants is to make them during surgery by hand carving. This is done using a silicone carving block. These are available as rectangular carving blocks of the dimensions of 12 cms x 7 cms and being 1.5cm thick.  They are available in three durometers (hardness) which I prefer the medium or 20 durometer. Measurements and a paper template are made from the patient and then transferred to the block where their outlines are traced onto it. A large scalpel blade is used to cut out the design from the blocks  and it is finished with small scissors. The image left behind in the carving block resembles that of ‘angel wings’.

Extended Cheek Zygomatic Arch Implants intraop placement Dr Barry Eppley IndianapolisThe extended cheek implants are fashioned so that the portion over the zygomatic prominence is curved downward to add anterior cheek fullness. Wedges are taken on the underside to allow it to make the bend down onto the maxilla. Perfusion holes with 3mm punches are made to allow tissue ingrowth over the maxillary portion of the implant.

Extended cheek implants provide a zygomatic arch extension that is critical to create the elongated midfacial line for the high cheekbone look. Such a facial implant design can be handmade during surgery from silicone carving blocks.

Dr. Barry Eppley

Indianapolis, Indiana

April 10th, 2016

Case Study – Custom Jaw Angle Implants

 

Jaw Angle Reduction Surgery Dr Barry Eppley IndianapolisBackground: Jaw angle reduction is a well known surgery that is most commonly performed in Asian patients to narrow a wide lower face.  The historic approach for this operation, and still one that is commonly performed, is that of an amputation technique of the jaw angle bone. By cutting off the jaw angle, the lower facial protrusion is eliminated and the lower face narrowed.

But jaw angle reduction surgery is not without its complications. Adverse aesthetic effects may develop such as overcorrection, asymmetry and loss of support of the jawline soft tissues. Patients may also develop surgical regret and wish to return to the original jaw angle shape.

Jaw angle implants would be the logical method to restore the bony anatomy from prior jaw angle reduction surgery. But standard jaw angle implants do not provide vertical jaw angle lengthening, a critical element in jaw angle restoration.

Jaw Angle Reductions with Medpor Impplant Reconstruction Dr Barry Eppley IndiianapolisCustom Jaw Angle Implants for Jaw Angle Restoration right side Dr Barry Eppley IndianapolisCustom Jaw Angle Implants for Jaw Angle Restoration left side Dr Barry Eppley IndianapolisCustom Jaw Angle Implants for Jaw Angle Restoration front view Dr Barry Eppley IndianapolisCase Study: This 40 year-old Asian male  had his jaw angles removed over ten years ago. He tried to reverse the surgery six years later with standard Medpor jaw angle implants. They failed to create the effect he desired leaving his jaw angle still vertically and horiontally defiicient. Custom jaw angle implants  were designed off of an original presurgical panorex x-ray where the jaw angle reduction surgeon had marked the lines of bone resection. A 3D CT scan was used to create the implant designs. The 3D CT scan can not visualize the Medpor material although the three metal screws used to secure the implant could be seen.

Remove and Replace Jaw Angle Imkplants intraop implants Dr Barry Eppley IndianapolisUnder general anesthesia, his original intraoral incisions were reopened and his jaw angle implants exposed. The Medpor jaw angle implants were removed in pieces and the screws were chiseled out of the bone. The custom jaw angle implants were inserted after lower border capsulotomies to release the scar tissue. The new implants were secured with two 1.5 x 5mm screws placed with a percutaneous technique.

Jaw angle restoration from prior jaw angle reduction surgery is usually best done with custom made implants. This case illustrates that inadequate results are usually obtained using standard jaw angle implants. Vertical lengthening of the surgically altered jaw angles is the key to an adequate jaw angle restoration. New vertical jaw angle implants that will soon be available may work for some patients but it is hard to beat what custom jaw angle implants can do.

Highlights:

1) Jaw angle reduction surgery often amputates the jaw angles creating a vertical shortening and loss of soft tissue support.

2) Jaw angle restoration is frequently inadequate using standard jaw angle implants.

3) Custom jaw angle implants is the ideal method for jaw angle restoration after jaw angle reduction surgery.

Dr. Barry Eppley

Indianapolis, Indiana

April 10th, 2016

Case Study – Sagittal Ridge Reduction with Parasagittal Augmentation

 

sagittal skull sutureBackground: The shape of the top of the head is highly influenced by the sagittal suture. The sagittal suture is a connective tissue joint between the two parietal bones of the skull. The sagittal suture in an adult connects the bregma (the intersection of the sagittal and coronal sutures above the forehead) back to the vertex. (highest point on the skull) In adults the sagittal suture does not close completely until around thirty years of age.

At birth the sagittal suture is open. But if it closes in utero, a classic skull deformity develops at birth known as scaphocephaly. (sagittal craniosynostosis) This creates a very long and narrow head due to the restriction of the growing brain to push out on the skull bones now restricted by the fused suture.

But deformities of the sagittal suture can occur in less dramatic presentations. Slight disturbances of sutural fusion can cause ‘micro’ forms of sagittal growth disturbances known as a sagittal ridge or sagittal crest. This appears as a prominent ridge of bone that is higher than the rest of the top of the skull and can be seen clearly as a ridge running down the middle of the top of the skull. It can some or all of the sagittal line and is usually most prominent at the vertex of the skull.

Case Study: This 35 year-old male was bothered by the shape of the top of his head. He felt it was too tall in the middle and did not have a nice round normal skull shape. It was shaped more like a roof with a peaked middle and sides that angled downward.

Sagitttal Reduction Parasagittal Augmentation intraop Dr Barry Eppley IndianapolisUnder general anesthesia, a zig zap scalp incision was made across the top of his head in between his braided hair style. Through this incision the sagittal ridge was reduced by burring. The area between the reduced sagittal ridge and the temporal lines on the side was augmented with a thin layer of PMMA bone cement.

Sagittal Ridge Reduction Parasagittal Augmentation result front view Dr Barry Eppley IndianapolisA Sagittal Ridge Skull Reduction result side view Dr Barry Eppley IndianapolisSkull Reshaping Scalp Scar Dr Barry Eppley IndianapolisHis after surgery results showed the change in the shape of the top of his skull. The height of the sagittal ridge was reduced and the sides of the skull were raised to create an overall smooth convex shape. The scalp incision healed well and blended in with his hairstyle pattern.

More prominent sagittal ridge deformities can not be satisfactorily lowered by bone burring due to the thickness of the bone. Adding height to the sides of the reduced sagittal ridge (parasagittal augmentation) aids in making a more pleasing shape to the top of the skull.

Highlights:

1) Certain sagittal ridge skull deformities have an associated parasagittal deficiency creating more of a peaked or triangular head shape.

2) Sagittal ridge skull reduction can be combined with parasagittal augmentation using bone cements to create a more natural shape to the top of the head.

3) A limited coronal scalp incision can be used for top of the head skull reshaping.

Dr. Barry Eppley

Indianapolis, Indiana

April 9th, 2016

Case Study – Fat Injection Breast Augmentation

 

Background: The consistent success of breast augmentation over the past five decades has been because of the stable volume provided by an implant. But breast implants are not perfect, are prone to failure and need to be replaced over one’s lifetime, For these reasons some women understandably would prefer a more natural breast augmentation method.

Increasing soft tissue volume by fat injection is now widely used for many face and body areas. The breast has not been excluded in the growing world of fat transplantation and, in conjunction with the buttocks, is the commonly fat injected area of the trunk for both aesthetic and reconstructive purposes.

While the appeal of fat graft augmentation is high for the breast, very few women actually qualify for it. Between limited or inadequate fat donor sites and the desire for breast augmentation size increases beyond what fat grafting can achieve, the number of women who undergo fat injection breast augmentation by fat injection is 1% or less of all women who undergo breast augmentation surgery.

Case Study: This 19 year-old female was bothered by some modest fullness of her abdomen and flanks and the small size of her breasts. While she did not want breast implants, she was interested in whatever breast size increase she could get by recycling her undesired fat from the abdomen and flanks to the breasts.

Fat Injection Breast Augmentation Indianapolis Plastic Surgeon Dr Barry EppleyFat INnjection Breast Augmentation Dr Barry Eppley Indianapolis_edited-1Under general anesthesia, her abdomen and flanks was harvested of 925cc of fat using a power-assisted liposuction device. The fat was processed by filtering and washing for a total concentrate of 360ccs. The breasts were injected with 180ccs per side.

Fat Injection Breast Augmentation result front view Dr Barry Eppley IndianapolisFat INjection Breast Augmentationk result oblique view Dr Barry Eppley IndianapolisFat Injection Breast Augmentation result side view Dr Barry Eppley IndianapolisWhen seen at three months after surgery, her breasts showed a very modest sustained size increase of about a 1/2 cup per breast. Her result is not equivalent to a 180cc breast implant due to some partial fat absorption.

Fat injection breast augmentation (FIBA) is always a gamble as the result is limited by both donor site availability and fat survival/retention. It is a procedure for those women whose greatest priority is on fat reduction body contouring and any secondary gain they can get in breast size increase.

Highlights:

1) Fat injection breast augmentation (FIBA) can produce a visible but modest increase in breast size.

2) The amount of fat that can be successfully added to the breasts is a function of how much fat one has to harvest and how much fat survives the transfer process.

3) The final breast volume obtained by fat transfer will be far less than what is extracted by liposuction.

Dr. Barry Eppley

Indianapolis, Indiana

April 9th, 2016

Case Study – Occipital Skull Reduction

 

Background: The skull is prone to numerous aesthetic deformities and the back of head is a common area that is affected. The most common deformity of the back of the head is excessive flatness or asymmetry. The least common aesthetic deformity is an excessive projection or development of the bone.

An occipital protrusion or excessive projection of the back of the head is most commonly caused by any number of expressions of a congenital sagittal craniosynostosis deformity. The entire skull is long and narrow from front to back and an excessive back of the head protrusion is part of it. But there are patients with otherwise acceptable heads shapes that just have an isolated and excessive occipital projection.

Treatment of an occipital protrusion is done by a bone burring method. The amount of projection reduction is a function of the thickness of the outer table of the skull. This thickness can vary, being anywhere from 5 to 8mms in most patients. That amount of bone may not sound significant but can produce noticeable aesthetic improvements as the following case illustrates.

Case Study: This 40 year-old male was bothered by the protrusion on the back of his head. The upper portion of the occiput had a noticeable fullness that made the back of his head look long.

Under general anesthesia and in the prone position, a 9 cm long incision was made to expose the entire back of his head. A rotary handpiece and burr was used to reduce the thickness of the bone 6.5mms at its most prominent area. The bone reduction was taken down to the dipolic space where the bleeding becomes more excessive. A drain was used and removed the following day.

Occipital Skull Reduction result left side view Dr Barry Eppley IndianapolisOccipital Skull Reduction result right side view Dr Barry Eppley IndianapolisOccipital Skull Reduction scar Dr Barry Eppley IndianapolisHis long-term results (2 years) showed a significant reduction in the amount of the occipital protrusion. The scalp had healed so well that it could barely be found even under very close inspection.

Occipital skull reduction is not a procedure that is associated with dramatic amounts of bone reduction. The results are always limited due to being able to safely remove only about 1/3 of the thickness of the skull bone. But aesthetic improvements in the protrusion of the back of the head in properly selected patients can be achieved within these limits.

Highlights:

1) Protrusions of the back of the head can be reduced based on the thickness of the out7er layer of the skull.

2) Occipital skull reduction is done by a bone burring method.

3) A small horizontal scalp incision on the back of the head is used to perform occipital skull reduction.

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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