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.

March 20th, 2016

Scalp Tissue Expansion in Large Skull Implants

 

In skull implant surgery, the limiting factor in terms of the amount of augmentation obtained is the stretch of the scalp. With the use of 3D CT scans and computer designing, any size and shape of skull implant can be made. But just because it can be made does not mean that it can be safely inserted or avoid long-term complications. The key is adequate scalp tissue to accommodate the size of the implant and not over stretch the scalp tissue over time.

The exact size and dimensions of a skull implant that the scalp tissues can tolerate will vary amongst different patients. There is no absolute thickness number in millimeters that is the maximum for any patient. But I use a general rule that any skull implant thicker than about 10 to 12mms may make the scalp closure tight or raise concerns about tissue thinning long term.

For those patients that would like larger amounts of skull augmentation, the concept of increasing the amount of scalp tissue to accommodate the implant must be done. This is achieved through the historic and well known use a scalp tissue expander. But unlike how scalp tissue expanders are used for more typical cases of scalp reconstruction, there are some differences when used as a first stage preparation for larger skull implants.

First Stage Scalp Tissue Expander for Large Skull Implant Dr Barry Eppley IndianapolisThe amount of scalp expansion for skull implants is more limited and only needs to be enough to look just slightly beyond the amount of skull height that the patient aesthetically wants. This is usually no more than 125cc to 150cc for most patients. I prefer a long rectangular shaped tissue expander as it can be inserted through a small scalp incision.

Scalp Incision for Scalp Tissue Expander Placement Dr Barry Eppley IndianapolisThe scalp incision to insert the tissue expander show lie along the future location of the longer incision needed for the second stage skull implant insertion. This is placed on the side of the head in the posterior temporal area and no hair is removed in making and closing the incision. The incision length needs to be no greater than 4 to 5 cms. This keeps the incision way from the location of the overlying scalp expansion.

Port Location for Scalp Tissue Expander Dr Barry Eppley IndianapolisPatients will do their own at home scalp tissue expander inflations. The port of the expander is placed on the deep temporalis fascia just above the ear. This location makes it easy for the patient to locate it and see it to insert the needle for the saline inflations.

Usually the needed scalp tissue expander inflations are completed in four to six weeks after the expander placement. Because the amount of scalp expansion is not great, its detection is very minimal in women who wear their hair long.

Dr. Barry Eppley

Indianapolis, Indiana

March 20th, 2016

Outcome Study of Asian Facial Implants

 

facial implants dr barry eppley indianapolisFacial implants are having a resurgence in popularity and use over the past decade. This is due to a variety of reasons including the widespread use of injectable fillers, new facial implant styles and patient demand for permanent facial volume enhancement methods. With increased use large volume facial implant clinical studies that describe the outcomes is helpful to both surgeons and patient alike.

In the advanced online edition of the March 2015 issue of the Aesthetic Surgery Journal, an article appeared entitled ‘Alloplastic Augmentation of the Asian face: A Review of 215  Patients’. This was a retrospective review of Asian patients over a four year period that underwent facial implant augmentation of the forehead, nose, midface and chin. Complications consisting of infection, malposition, extrusion and revision for aesthetic reasons were evaluated. This included 243 implants of which 141 were done in the nose. (58%) In the nose the infection rate was 1.5%, extrusion 1%, malpositions almost 10% and aesthetic revision of 11%. This makes for an overall nasal implant complication rate of 18%. Chin implants (40) had a 2.5% incidence of malposition and 15% rate of aesthetic revisions. Midface (31) and forehead (31) implants were associated with the lowest rates of revisional surgery with just one patient. (3%) Overall infection and extrusion rates were less than 1% each.

Based on their experience with facial implants in Asian patients, the authors conclude that when used properly, facial implants have a low complication rates and satisfying aesthetic outcomes.

There are several of this paper’s conclusions of which I would agree. In properly selected patients facial implants can create aesthetic changes that can be very pleasing and relatively easily achieved. No other plastic surgery techniques can create facial augmentation results so directly and immediately. To keep complications rates low, facial implants should be placed in subperiosteal pockets right next to the bone with as much tissue thickness over the implants as possible. Facial implants should be placed as far away from the incision as can be done to avoid implant exposure should wound dehiscence occur.

While one of the main conclusions of this paper is that facial implants have a low complication rate, that is both a true but inaccurate statement. Major medical complication rates are indeed low as shown by a 1% or less occurrence of infection and extrusion. This proves that in the face implants are incredibly well tolerated when properly placed. But the aesthetic revision rate by comparison is high although normal in my experience. The nose and chin implant revision rates, which accounted for two-thirds of their patients, was 10% to 15%.  This may seem high to patients but compares very favorably to many other implants placed in the body. (actually body implant revision rates are usually higher than that of facial implants)

While this was a clinical study of Asian patients, its findings really apply to patients of all races. The only unique implant experience in this study is the high rate of nasal implants which is always highest in this patient population.

Dr. Barry Eppley

Indianapolis, Indiana

March 16th, 2016

Case Study – Breast Lifts with Implants

 

Background: Severe sagging of the breasts occurs for a variety of reasons but the most common is weight loss. Weight loss creates the unaesthetic combination of excessive stretched out breast skin and loss of breast volume. Occurring together this allows many breast mounds to fall over the inframammary fold carrying the nipple with it. The empty sack of breast skin creates a very deflated breast appearance. While its look may be masked when compressed upward in a bra, its lack of support is very apparent without it.

Breast Sagging classification Dr Barry Eppley IndianapolisSevere sagging or Grade III breast ptosis always requires a full breast lift to get the breast mound and nipple back up on the chest wall. A full breast lift is an anchor pattern procedure with the result scars appearing like its description. It is identical to the breast lift component used in a breast reduction procedure. An implant is always needed for some degree of volume restoration and to create support to hold the breast lift up.

The combination of a breast lift with an implant, the so called implant mastopexy, is always a difficult procedure to perform and get consistently pleasing results. This is because the two aesthetic breast procedures fight against each other. The breast lift tightens and make the enveloping breast skin smaller. While the role of the breast implants is to push out and expand the overlying breast tissues. These two opposing forces can make it challenging to get the right combination of implant size and degree of breast lift. When one factors in the issue of secondary tissue relaxation after any lift, the naturally ‘stretchy’ nature of the breast tissues in the weight loss patient, the normal risks and complications that come from breast implants and that every woman has two breasts that ideally should match, it should be no surprise that the revision rate on this type of aesthetic breast procedure is significant.

Case Study: This 47 year-old female was bothered by the very saggy appearance of her breasts. While once having much larger breasts significant personally-induced weight loss caused her breasts to deflate and severely sag. She passed the ‘pencil test’ with flying colors. (placing a pencil under her breasts and it stays in place) She had a full Grade III ptosis with the right breast hanging lower than the left.

weight loss BAM LIft results front view Dr Barry Eppley IndianapolisUnder general anesthesia and using preoperative markings made in the standing position, a full breast lift was performed. The bottom part of the lift was left open through which anatomic shaped silicone breast imlpants of 450cc size were placed in the partial submuscular plane.

weight loss BAM Lift results oblique view Dr Barry Eppley Indianapolisweight loss BAM Lift result side view Dr Barry Eppley IndianapolisHer three months postoperative results show dramatic improvement in her breast shape and size. While her breast mounds appear to be in good position at this point after surgery, I would not judge the final result until six to nine months when full tissue relaxation has occurred. I would anticipate some residual drop of the breast mounds to occur over the implants with further tissue settling.

While early combination breast lifts and implant result may be very acceptable, the poor quality of the breast skin/tissues will inevitably make for some secondary tissue sag off of the implants. Whether that will be enough to bother the patient is a personal decision. But it is wise in combination breast lifts with implant surgeries to anticipate the potential need for a revisional surgery.

Highlights:

1) Severe sagging of the breast always has the nipple located below the inframammary fold and is associated with significant breast tissue loss.

2) Full anchor style breast lifts are needed with Grade III ptosis and an implant to restore volume to the elevated breast mound.

3) The revision rate for combined full breast lifts with implants in Grade III ptosis is as high as 50% or more due to secondary tissue relaxation of the overlying breast mound.

Dr. Barry Eppley

Indianapolis, Indiana

March 16th, 2016

Foot Fat Grafting for Chronic Pain

 

Foot Fat Grafting for Chronic PainChronic foot pain of various causes is a not uncommon problem. Pain that emanates from the heel pad region of the foot is most frequently due to plantar fasciitis (bottom of the heel) and Achilles tendonitis. (back of the heel) While some heel pain problems resolve by conservative measures such as rest, shoe support, stretching and non-steroidal anti-inflammatory medications, others are unremitting and require more invasive treatment. The use of steroid injections and plantar fasciotomy surgery are traditional options when conservative therapies fail.

While the use of steroid injections and plantar fasciotomies are reported to have fairly high success rates, they are not complication free. Steroids are well known to cause soft tissue atrophy with repeated use or high dose injections. Plantar fasciotomies have the potential to cause flattening of the arch and heel numbness as well as rupture of the plantar fascia.

Fat pad atrophy is being recognized as a leading contributor to heel and ball of the foot chronic pain in some patients. The heel as well as the ball of the foot have specific fat pads that are separated and encased by fibrous bands. They help to absorb the shock on the foot bones that naturally occurs from walking and running. Thus the logic of good athletic foot wear with shock absorbing materials. But should the heel fad pad become thin or even mostly lost, pain will develop with the surface of the bones as well as the tendons and nerves now more exposed to being compressed between the bones and the surfaces that the bottom of the foot contacts. High levels of repetitive activity from running or cycling or overuse of steroid injections to treat chronic foot pain are common sources of fat pad atrophy. Diabetic, overweight and older patients are especially prone to fat pad atrophy

Centrifuged Fat Preparation for Fat Injections Dr Barry Eppley IndianapolisWith the widespread use of injection fat grafting today, it is no surprise that such transplantation into the foot to treat chronic pain from fat pad atrophy was inevitable. Like everywhere else in the body where it is used, the appeal of using your own tissues and the allure of its stem cells make foot fat grafting a logical treatment option. The placement of concentrated fat, usually harvested from the abdomen or thighs, using small blunt-tipped cannulas makes injecting into the foot incisionless and fairly risk free.

The heels and balls of the feet are unique places to inject fat, not only because of the tight tissue spaces, but because of the compressive forces that it will be exposed to after surgery.  Fat usually takes up to six weeks after surgery to determine how much survives. So avoiding athletic activities like running and cycling, high heels and long standing times should be avoided during the first month after surgery. Not all injected fat survives after any injection treatment but avoiding excessive trauma to the fat cells during the early transplantation period seems logical.

Fat Injections For Foot Rejuvenation Dr Barry Eppley IndianapolisFoot fat grafting is relatively new and has not been extensively studied or used to date. Whether the foot is a ‘favored’ or ‘disadvantaged’ for injected fat take is not precisely known. I know from personal experience that foot fat grafting into the toes web spaces works fairly well and is maintained. But whether the bottom of the`foot is equally favored remains unknown. Other important issues beyond survival with foot fat grafting is how well it works for pain reduction, how the fat may be distributed in the foot with chronic weight bearing and how well it sustains its volume over time These are other foot fat grafting issues are awaiting results from ongoing clinical and research studies.

Dr. Barry Eppley

Indianapolis, Indiana

March 15th, 2016

Case Study – Perioral Mound Liposuction

 

Background: Fat collections exist throughout the face interpersed amongst the various tissue planes. Large deeper pockets of fat exist with the well known buccal fat pad with its various fingers throughout the deeper face extending up into the temporal regions. Thinner more widespread fat exists under the facial skin as well as right under the intraoral mucosal lining.

Attempts to thin a fuller face or provide increased facial definition through soft tissue manipulation can be done with fat removal. But unlike fat removal in the body below the neck which uses exclusively liposuction, fat removal in the face is not quite as straightforward. Besides its much smaller volume removals, the techniques to do so can also be somewhat different.

Fat removal in the face is historically and still most commonly perceived as that of buccal lipectomies. While buccal lipectomies can create an impressive amount of large globular fat extraction, they are often the wrong facial slimming technique for what the patient wants to achieve. Such is the case with the more discrete perioral mounds, small subcutaneous fat collections by the side of the mouth that have nothing to do with te=he buccal fat pads.

Case Study: This 33 year-old female was bothered by small areas of facial fullness to the sides of her mouth. She was already a very lean person and these would not be affected by weight loss. She initially thought that buccal lipectomies would create a reduction in them with the result of a more inward/slimmer appearance to this part of her face.

Perioral Mound Liposuction result front view Dr Barfry Eppley IndianapolisUnder local anesthesia with IV sedation, perioral mound liposuction was performed using small micrcannulas. (techically these were 2mm fat injection cannulas) Small stab incision were made from just inside the corner of the mouth to access this facial area. Approximately 1cc of fat aspirate was obtained from each side.

Perioral Mound Liposuction result oblique view Dr Barry Eppley IndianapolisHer postoperative results show reduction in the size of the perioral mounds after a month or so of healing and swelling dissipation. While the change was small, so was her original   problem but the improvement was very noticeable to her. Microliposuction would be the appropriate treatment for a ‘micro‘ facial fat problem.

While many areas of the fat can not be safely or effectively treated by liposuction, the perioral region is not one of them. The safest liposuction zone on the face can be defined by a  straight line drawn from the corner of the mouth to the tragus of the ear, a vertical line from the corner of the mouth down to the jawline and a bottom line along the jawline connecting these two other lines. There are no facial motor nerves in this area of the face. This is exactly where perioral mound liposuction is performed.

Highlights:

1) The perioral mounds are small subcutaneous fat collections by the side of the mouth.

2) Perioral mound fat collections are often confused with the buccal fat pads.

3) Perioral mound liposuction is performed with the use of microcannulas from inside the corner of the mouth.

Dr. Barry Eppley

Indianapolis, Indiana

March 13th, 2016

Case Study – Custom Occipital Skull Implant for Asymmetry

 

Background: One of the most common of all aesthetic skull deformities is flattening of the back of the head. Commonly called plagiocephaly it causes a flatness on one side of the back of the head that is frequently associated with an overall craniofacial scoliosis. It can occur in mild to more severe manifestations  whose aesthetic significance often depends on the shortness of the patient’s hair. It is no surprise, therefore, that the aesthetic sequelae of unilateral occipital flatness affects men more than women.

The best method without question in adults for correcting occipital plagiocephaly is a custom made occipital skull implant. Designed and manufactured from the patient’s 3D CT scan, it can match the dimension’s of the opposite more normal side of the occipital skull. While it can be argued that in plagiocephaly the side of the occipital skull opposite to the flattened side may be overexpanded (although not always so), it is best to use it as a reference when trying to achieve symmetry on the back of the head.

Custom Occipital Implant dimensions Dr Barry Eppley IndianapolisCustom Occipital Implant design for asymmetry Dr Barry Eppley IndianapolisCase Study: This 42 year-old male had long been bothered by the flatness on the right side of his head. Even he did not have a close cropped hairstyle, he was very conscious of it. Using a 3D CT scan, a custom right occipital skull implant was designed to match his opposite normal occipital skull projection.

Custom Occipital Implant marker orientation intraop Dr Barry Eppley IndianapolisCustom Occipital Implant intraop Dr Barry Eppley IndianapolisUnder general anesthesia and in the prone position, a 7 cm low horizontal scalp incision was made without shaving any hair. Making an extended implant pocket with long curved instruments, the implant was inserted in a rolled fashion. It was then unrolled and properly positioned using a ‘compass’ marker embedded into the implant and the 3D image designs. The incision was closed with resorbable sutures placing them either in tissue planes below or above the hair follicles. No drain was used.

Occipital  Skull Implant intraop oblique result Dr Barry Eppley IndianapolisOccipital Skull Implant intraop side view result Dr Barry Eppley IndianapolisOccipital Skull Implant intraop top view result Dr Barry Eppley IndianapolisHis immediate intraoperative results showed the back of the head shape improvement that the implant design predicted. His head dressing was removed the next day and he could wash his hair the following day. He returned to work the following week.

A custom occipital skill implant offers a straightforward and predictable method of obtained improved back of the head shape and projection for unilateral asymmetry. Placement in the subperiosteal plane on top of the bone can be done through very small scalp incisions through unique insertion techniques and positioning markers embedded into the implant’s outer surface.

Highlights:

1) Asymmetry of the back of the head is the most common form of occipital skull deformity.

2) A custom made occipital skull implants is the best treatment method in an adult.

3) A custom occipital skull implant can be inserted through the smallest scalp incision.

Dr. Barry Eppley

Indianapolis, Indiana

March 13th, 2016

The Omnimax MMF System – Product Review

 

Jaw surgery has a long association with the need for maxillomandibular fixation. (MMF) Wiring the jaws together is an essential first step in many types of maxillofacial surgery. Whether it is in elective orthognathic procedures, the treatment of jaw fractures or in the reconstruction of the jaw after cancer reconstruction, the application of maxillomandibular fixation is essential. Putting the teeth together in the correct occlusion (bite) ensures that the jaw realignment/restoration surgery results in a satisfactory functional outcome.

The historic and standard approach to the application of maxillomandibular fixation is the application of arch bars to the teeth with multiple interdental wires. (usually 26 gauge) This ‘gold standard’ MMF technique has been used with various modifications for over 100 years with no real changes in the concept or technique. While unquestionably effective, it is tedious and time-consuming to apply and always involves some glove integrity violation and even skin penetration. It is by far the most despised maxillofacial techniques by all surgeons of any specialty. I have applied MMF on over 1,000 cases in my career and can do in an average 15 to 20 minutes. Those plastic surgeons with far less experience (e.g., residents and young surgeons) can easily take 45 minutes to an hour of operative time to get the bars and wires correctly applied.

In addition arch bars and interdental wires pose hygiene challenges for the patient after surgery and their high compressive forces on the teeth and gums results in significant occurrences of periodontal (gum) recession via papillary blood flow compromise.

Omnimax Maxillomandibular Fixation System Dr Barry Eppley Indianapolis Omnimax MMF System Indianapolis Dr Barry EppleyThe Omnimax MMF system (Zimmer Biomet) represents breakthrough technology and is a real game changer for getting the jaws and occlusion properly aligned. While other hybrid MMF systems have emerged in the past five years, I find that they have more limited uses with their own set of problems. (e.g., mucosal tissue overgrowth of the plates and screws and a high number of screws used per arch to name the top two)

Omnimax extended screw design Dr Barry Eppley IndianapolisThe Omnimax system overcomes these MMF issues by several design innovations. The plates have a better segmentalized design with extended screw slots and are composed of an anodized titanum, all factors which contribute to less soft tissue irritation. But the key breakthrough design feature is the EXTENDED SCREW INSERTION SLOTS. This permits the MMF plate to stand off of the soft tissues while still being stabilized to the bone. This is a brilliant innovation in screw design that is proprietary to the Omnimax MMF system. Not only does the plate no longer compress the soft tissues but the stand off feature allows intermaxillary wires to be applied without creating compressing and necrosing gingival tissues.

Omnimax MMF system in place Dr Barry Eppley IndianapolisThe Omnimax MMF system with the innovative plate standoff feature due to the screw design finally overcomes the traditional problems with hybrid plate and screw MMF approaches. It decreases the number of screws needed for application (from 14 in other systems to 8) and improves intraoral hygiene and tissue health for the patient after surgery. But of equal importance in terms of operating room efficiency it changes the application of MMF from an average 45 minutes to 15 minutes (or less) with a far less risk of glove puncture.

Omnimax MMF System kit Dr Barry Eppley IndianapolisIn my opinion the new gold standard for maxillomandibular fixation has finally arrived. The simplicity and innovative design of the Omnimax MMF system will change the perception of this basic maxillofacial technique from one of contempt to possibly even pleasure.

Dr. Barry Eppley

Indianapolis, Indiana

March 12th, 2016

Single Point Temporal Artery Ligation

 

Prominent temporal vessels can be a source of aesthetic concern. Looking like worms due to their serpiginous course on the sides of the forehead, they usually have an episodic appearance. When the temperature is warm, the person’s heart rate is elevated or when one bends over, the size of the vessels either become prominent or increasingly so. Prominent temporal vessels largely appear in men and only very rarely in women.

temporal artery anatomyWhile some think that these prominent temporal vessels are veins, they are in reality arteries. This is easily conformed by feeling the pulsations in them. They are always anterior branches of the superficial temporal artery system. While anatomic drawings usually show them as occurring in one consistent pattern, they present in many variations. The anterior branch may have a low takeoff from the main artery down at the sideburn level or can be much higher in the mid-temporal region.

Temporal Artery Ligation Dr Barry Eppley IndianapolisReduction of the prominent temporal artery is done by ligation. The key to a successful temporal artery ligation procedure is do clearly identify the anterograde course of the artery as well as any side branches that may flow retrograde into it afterwards. This is best done by close visual inspection and feel, pushing down on various parts of the arterial course and seeing how much it reduces its visibility.

Due to backflow from various seen and unseen branches off of the anterior branch of the temporal artery, multi-point ligation is usually needed. Placing ligation points close to whether the anterior branch comes off the superficial temporal artery as well as at its most distal point in the forehead is the best technique to prevent recurrent arterial prominence.

Temporal Arter Ligation incisions Dr Barry Eppley IndianapolisIt is uncommon to be able to do a single proximal point of ligation and reduce the prominent temporal artery completely. This single point approach has often been tried but rarely works due to backflow. But in some cases where compressing the identified proximal portion of the artery eliminates all palpable pulsations, it is reasonable to do. By placing a 5 to 7mm incision inside the temporal hairline a permanent ligation suture can be placed around it.

Dr. Barry Eppley

Indianapolis, Indiana

March 8th, 2016

The Cephalic Trim in Tip Rhinoplasty

 

There are many technical maneuvers in rhinoplasty that help change the shape of the nose. One of the most historic and commonly used techiniques for the nasal tip (tip rhinoplasty) is that of the cephalic trim. A cephalic trim is the removal of a portion of upper edge of the lower alar cartilages. It is designed to help narrow a broad nasal tip as well as shorten (deproject) and move upward (rotate) the nasal tip.

While a cephalic trim can be a very effective tip reshaping maneuver, it is not completely benign. Weakening of the lower alar cartilage from the cartilage removal can be associated with such postoperative problems such as alar retraction, a pinched tip and over rotation of the nasal tip. Thus it should not be viewed as just a ‘standard’ rhinoplasty technique to be used in all noses.

Cephalic Trim Rhinoplasty result front view Dr Barry Eppley IndianapolisIn the January 2016 issue of the journal Plastic and Reconstructive Surgery, an article appeared entitled ‘ Role of the Cephalic Trim in Modern Rhinoplasty’.  In this review article the authors review five types of cephalic border trim techniques. These include the scroll incision (separation of the upper and lower lateral cartilages), the limited cephalic trim (scroll area only), the standard cephalic trim, and the extended cephalic trim. The last and fifth type is where a lateral crural turnover flap is used. The choice of the type of cephalic trim is based on the extent of the wide and boxy tip shape, the strength and width of the cartilages and the thickness of the overlying nasal skin. By understanding that there are different types of cephalic trims and using an incremental approach, complications from this rhinoplasty maneuver can be avoided.

What makes the cephalic trim less than benign is that it weakens the structural support of the lower alar cartilages and removes attached supportive ligaments. Studies and lot of clinical experience has shown that at least 6mms of lower lateral cartilage width needs to be maintained to keep reasonable structural support. It is also important to realize that the structural support of the lower alar cartilages is going to challenged further when the overlying skin is placed back on top of it and healing and scar contracture occurs.

Wide Nasal Tip Rhinoplasty result Dr Barry Eppley IndianapolisTo be safe and structurally sound, any form of a cephalic trim should be reserved for the truly bulbous nasal tip. Increased domal width or a very convex lateral crural shape are good indications for a standard cephalic trim. If the cartilage is weak in any way either a limited cephalic trim should be done or a suture only technique used in tip rhinoplasty.

Dr. Barry Eppley

Indianapolis, Indiana

March 7th, 2016

Case Study – Calf Implants for Male Lower Leg Reshaping

 

Background: Increasing the size of the calf (gastrocnemius) muscles is very difficult. The tight and dense muscle fibers of this lower leg muscle take extreme muscle-building exercises to enlarge the overall muscle size. And unless one is willing to continue these exercises for the rest of one’s life, the size of the calf muscles will not persist.

Calf Implant Augmentation Indianapolis Dr Barry EppleyThe most immediate and permanent method of calf augmentation is the placement of calf implants. Inserted through small incisions on the back of the knee, they are placed in the subfascial location on top of the muscle. Because there are two separate bellies of the muscle, implants can be placed on either the inner or outer calf muscles or both.

Patients for calf augmentation generally hope to achieve one of two effects. Some patients simply want to have a more shapely lower leg by making the inner belly of the calf muscle bigger. This creates an outward bulge that changes a straight line leg profile. Less commonly are patients that want to have a much more muscular appearing calf and need both inner and outer calf implants to create a more profound effect.

Case Study: This 36 year-old male wanted to make his lower leg look more proportionate to his upper leg. He had very skinny lower legs with a straight line profile from the knee to the ankle.

Calf Implant Incisions Dr Barry Eppley IndianapolisCalf Implant Insertion Technique Dr Barry Eppley IndianapolisUnder general anesthesia and in the prone position, 3.5 cm skin incisions were made on the inner half of the popliteal fossa behind the knees. The fascia was incised and subfascial pockets developed. Medium size calf implants (Implantech) were inserted over the medial belly of the muscle and as anterior s possible. The incisions were closed with resorbable sutures.

Male Calf Implants result front view Dr Barry Eppley IndianapolisMale Calf Implants result front view raised Dr Barry Eppley IndianapolisMale Calf Implants result back view Dr Barry Eppley Indianapolis Male Calf Implants result back view up Dr Barry Eppley IndianapolisHis postoperative results showed an improved lower leg profile in the inner half. There is now a more pronounced bulge below the knee that makes the leg look more muscular and proportionate. The muscle is more evident which is seen when standing his toes.

Calf implants provide permanent muscle enlargement. The size of the calf implant chosen is subjective and the maximum size implant that will fit into the subfascial pocket should always be chosen as it very difficult, if not impossible, to make a calf look too big.

Highlights:

1) Calf implants provide increased gastrocnemius muscle size to improve the shape of the lower leg.

2) The most common location for calf implants is on the medial or inner half of the gastrocnemius muscle.

3) Calf implants improve only the upper half of the lower leg.

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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