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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘body implants’

Physiologic Tissue Adaptation to Face and Body Implants

Saturday, January 24th, 2015


Synthetic implants  are involved in some of the most common procedures performed in plastic surgery. From the skull down to the calfs, implants allow an instantaneous augmentation effect to be achieved of a variety of sizes and shapes. While rivaled more recently in some procedures by fat injection grafting, implants offers a permanent volume/augmentation effect that is simpler to achieve. (out of a box so to speak)

While implants offer many benefits, they also have their own set of potential complications. Infections, malposition and size issues are amongst the most common no matter where in the face and body an implant may be placed. These are obvious complications that occur in the short-term, within weeks or months after surgery.

But longer term changes which sometimes lead to complications with implants come about from a less obvious source. When a synthetic implant is placed in the body, the implant itself can never change as they are made of materials that do not degrade or change. (e.g., silicone) Rather the body must adapt to it and respond based on the pressure caused by the implant’s volume. Thus tissues change around the implant and these changes are almost always that atrophy. Surrounding tissues thin to varying degrees based on implant size and body location.

Chin Implant Settling Dr Barry Eppley IndianapolisOne of the classic examples of this response is that of the chin implant. Often erroneously referred to as ‘erosion’ (which suggests an inflammatory reaction which it is not) some chin implants can be seen on x-rays of being partially inside the bone. This is a benign but natural process of implant settling. As a response to the pressure of the chin implant, which causes its aesthetic effect by pushing off the underly bone on the soft tissues of the chin, the bone responds to this pressure over time by resorbing under the implant. This allows the chin implant to imprint into the bone. Once a ‘pressure release’ is obtained no further settling into the bone occurs. Interestingly it does not occur in all chin implants and rarely if ever occurs in any other type of facial implant.

Breast Implant Chest Wall Deformity Dr Barry Eppley IndianapolisAn often recognized example but one that is far more common is that of breast implants. The pressure release phenomenon occurs through the dual effect of overlying breast tissue thinning and underlying rib deformation. Every plastic surgeon has seen it in some women who undergo breast implant replacements. When the existing breast implant is removed, the remaining breast mound will look sunken in and deformed. This is one reason some women over time feel that their breast implants no longer look as big. The breast implant has never changed in volume but the surrounding breast tissue has become less and the implant may have settled down into the ribs more.

While this tissue response to chin and breast implants rarely causes any problems, such a response on the nose can be very problematic. Rhinoplasty that uses large implants for nasal augmentation is well known to cause thinning of the overlying soft tissues which is very thin. This can lead to implant exposure and infection.

Tissue atrophy and thinning occurs to some degree around every augmentative implant placed in the body. It usually does not cause any long-term problems but is one compelling reason to avoid very large implants at any face or body location.

Dr. Barry Eppley

Indianapolis, Indiana

The Biocompatibility of Silicone Polymer Implants in Plastic Surgery

Thursday, May 1st, 2014


Short of metal implants used for fixation and repair in bone surgery, most implants used  in plastic surgery are composed of a silicone-based material. It may have varying states of being a solid, (soft to more firm) but silicone-containing implants have long been recognized as one of, if not the most, biocompatible synthetic material in existence. The breast implant fiasco in the early 1990s created a vast patient scare and its negative connotations still reverberate today. This is despite the fact that silicone breast implants received complete vindication as being harmful and were re-introduced for clinical use again in 2006.

Periodic Table of Elements Dr Barry Eppley IndianapolisBecause of its prevalence in implant surgery and various and often diverse opinions about its safety, it is time to review the basic science of silicone materials. To do so requires going to the periodic table and looking at the element called Silicon.

Silicon elementSilicon sits as a chemical element five vertical rows from the left and three horizontal rows from the top. It has the symbol Si and has an atomic weight of 14. It is what is called a tetravalent metalloid, which sounds like it is really a metal, although the term means that it has properties of both metals and non-metals. Joining Silicon as a metalloid are some familiar names from the very friendly Carbon (the basis of all organic life) to the very poisonous Arsenic. It is the second most common element available in the earth’s crust after oxygen, appearing in dust and sands usually in the form of silicon dioxide. (silica) It does not exist much in its purest form, but its use in that regard impacts all modern technologies as it serves as the basis of semiconductor electronics and integrated circuits.

Silicone Polymers in Plastic Surgery Dr Barry Eppley IndianapolisSilicon has long served as the backbone for silicon-based polymers known as silicones. One should not confuse, however, Silicon and Silicone. The polymer Silicone does contain Silicon but it is put together with other elements such as oxygen and hydrogen which give it very different physical and chemical properties than elemental Silicon.  These formulations create common products with a wide range of physical forms (soft to hard) such as silicone oils, rubber, caulk and a diverse number of medical implants. Silicone polymers have a large number of very favorable properties as an implanted material including remarkable stability (does not change over a temperature range of -100 to 250 degrees C), does not absorb water or other fluids, has little chemical reactivity, little known toxicity and does not support bacterial growth. Thus it is a structurally stable polymeric material that is not likely to degrade in any way over a patient’s lifetime.

The biocompatibility of a long-term implantable medical device refers to its ability to perform its intended function without creating any undesirable local or generalized effects. A silicone polymer fulfills that role well and, when combined with the wide availability and low cost of its base material, it is no wonder that most non-metal medical implants are made of some or all of it. Its easy moldability makes it able to be molded into almost any shape or size such as silicone gel breast implant, a soft solid pectoral or buttock implant and a soft but more firm facial implant.

But besides its unique physical properties when made into a polymer, is there anything else that makes it so biocompatible? It probably does not hurt that its closest vertical neighbor is Carbon. By its electronic composition, Carbon and Silicon are closely related event though they are distinct elements that form distinct compounds. But being next to the element that is responsible for all life on earth probably does not hurt how that life sees it.

Dr. Barry Eppley

Indianapolis, Indiana

Implants for Quadricep/Thigh Augmentation

Tuesday, December 31st, 2013


Quadriceps Muscle WastingMuscle wasting of the upper thigh can be the result of a number of different medical problems. Thigh muscle shrinking can occur from lack of use, severe weight loss and malnutrition or can be the result of a nerve injury from trauma or other neurologic  disorders. One cause of thigh muscle wasting can be from HIV infection and the development of a full blown presentation of AIDS. The pharmacologic treatment of AIDS through retroviral therapy can create a series of well known body wasting and lipodystrophic problems. One such effect of the AIDS-related cachexia is muscle loss or thinning of the lower extremities. While the contemporary treatment of muscle loss may be fat injection grafting, that is not an option in most AIDS patients. The alternative would be muscle implants. While numerous body implants exist for muscular enhancement, none exist for augmentation of the quadriceps or thigh region.

In the December 2013 issue of the Journal of Cosmetic Surgery an article was published entitled Quadriceps Implant: Cosmetic Improvement to the Anterior Thigh Region in a Patient Suffering From HIV Muscle Wasting.  In this case report the authors describe a single patient with HIV induced muscle wasting who underwent quadriceps augmentation with a solid silicone implant. A custom-designed silicone thigh implant was placed through an incision in the anterior thigh beneath the fascia of the quadriceps muscle. outcome was reported as excellent at three months after surgery.

Because of HIV and the medications used to treat it, a patient may suffer from wasting in the legs and placement of a soft solid silicone implant can help improve the cosmetic appearance of the anterior thigh/quadriceps region. Putting the implant beneath the fascia of the muscle is common practice for any body implant and the thigh muscles woud be no exception. While this is just a single case report (one patient) and the follow-up is short, the use of implants in the anterior thigh for cosmetic augmentation could have application beyond HIV thigh muscle wasting.

Dr. Barry Eppley

Indianapolis, Indiana

Contemporary Body Implant Augmentation Surgery

Sunday, May 26th, 2013


Muscular enhancement of certain body parts can be done through the use of synthetic implants. Everyone knows about breast implant augmentation although this is not a true muscular enhancement but a breast tissue enlargement. Historically the most recognized body implants were for the chest, buttocks and calfs. The number of such implants combined pale in comparison to the number of breast implants that are placed but that makes them no less useful.

The number of body implant surgeries that are performed have continued to increase over the past decade. Greater awareness and acceptance of body augmentations has fueled demand as well as improvement in  implant materials and surgical techniques. Body implants, unlike breast implants, are made of a solid but very soft and compressible silicone elastomer material. This makes them capable of being inserted through small incisions and to have a feel that is similar to what they intended to enhance…muscle. Because they are a completely polymerized non-liquid material they will never rupture, degrade or need to be replaced.With these better materials has come an expansion of body implants to new and innovative areas of augmentation. These have included such areas as the arms, shoulders and even the hips to create muscle prominences and increased curves.

Muscle implants are used to surgically build-out an underdeveloped area of muscle in the body. These muscle deficiences can be caused by a birth defect, a traumatic injury, or an aesthetic desire for body shape improvement. Aesthetic desires for body implants (pectoral, calf, arm implants) comes from an inability to build up the muscle adequately from exercise. There are also recent fashion and body image trends for an increased gluteal size. (buttock implants) Birth defects can also drive the need for implants and include club foot and Spina Bifida for calf implants, chest wall deformities from Pectus and Poland’s syndrome for pectoral implants and Sprengel’s deformity for deltoid implants.

An overview of old and new body implants includes the following.

PECTORAL IMPLANTS Male chest enhancement is done by transaxillary implant placement under the pectoralis major muscle but staying within the outline of the muscle. (unlike breast implants) They are available in different oval and more square shape forms.

BUTTOCK IMPLANTS Intramuscular or subfascial pocket placement in regards to the gluteus maximus muscle is used for implant location. I prefer the intramuscular location to reduce the risk of potential complications even if it poses size limitations (< 400ccs implant volume) and a longer recovery.

CALF IMPLANTS Being the smallest of all body implants, they have a cigar-type shape that are available in different lengths, widths and thickness. They may be used to build up the inside of the leg (medial head gastrocnemius muscle) or combined with outside of the calf augmentation as well. (lateral head gastrocnemius muscle)

ARM IMPLANTS The top (biceps) and bottom (triceps) of the arm can be build up for those men that either can’t get enough muscle bulk by exercise alone or want to maintain a more muscular arm shape with less long-term exercise maintenance.

DELTOID IMPLANTS While there are no true shoulder implants, they can be made by either modifying existing body implants used for other areas or hand making the implants from performed silicone blocks.

HIP IMPLANTS Placing implants placed below the muscular fascia below the prominence of the greater trochanter of the hip can build out an otherwise straight leg line.

Body implant surgery is both safe and effective when done by a surgeon who has good experience with these  materials and has anatomical knowledge of the different and varied parts of the body where these implants go. While fat injection augmentation has a valuable role in the enhancement of certain body areas also, synthetic implants offer a permanent and assured solution to body augmentation that has the trade-off of an implanted material and a longer recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Common Questions about Body Implant Surgery

Tuesday, January 26th, 2010

1. What is body implant surgery?

While everyone has heard of breast implants, few are aware that there are other locations for the placement of implants to enhance the contours of one’s body. All of these body implants are for the purposes of enhancing certain muscles. Think of body implants as muscle contouring surgery. These include traditional areas of the chest, buttocks, and calfs as well as newer implants for the arm (biceps and triceps), hip and deltoid areas. The majority of body implant patients are male.

Some may think that the use of these implants is cheating, as opposed to muscle growth through working out, but many of these procedures are used for reconstructive purposes as well. Some  patients may use them to help with genetic or injury-related body deformities caused by such conditions as pectus excavatum, spina bifida, and clubfoot. These cause deformities marked by muscle atrophy, underdevelopment or asymmetry.

2. Aren’t pectoral implants in men a lot like breast implants in women?

Yes and no. Pectoral implants, commonly referred to as breast implants for men or male chest implants, is done to  enhance the appearance, size and outlines of the pectoral muscles. Like breast implants, they are very effective at creating that change and are associated with no greater amount of risks or complications. From the standpoint of location under the existing pectoralis muscle, they are very similar to breast implants in that regard.

They do differ in that the end goals are not the same. Breast implants are trying to make a rounded or tear-drop mound that sits up and away from the chest wall and has some compressibility. Pectoral implants are only trying to push out the existing muscle and, as a result, need less volume to do so. A muscle also has more of a firm feel to it rather than displacement to the touch like a breast. Therefore,  pectoral implants are smaller in size and are composed of a soft but solid silicone elastomer. They are not fluid or gel-filled like breast implants.

3. What is the best way to achieve a larger and rounder buttocks?

There has been a significant increase in the number of buttock enlargement/enhancement requests. Fueled by increasing multiracial population growth and popular figures like Jennifer Lopez, more women are pursing an increased curvature to the buttocks through different forms of augmentation.

The debate in buttock augmentation is whether to do it through the use of an implant or with fat injections. There are surgeon advocates for both procedures and, when done well, satisfying results can be achieved either way. This is why it is important to look at each one’s advantages and disadvantages.

Buttock or gluteal implants have the advantages of a bigger and immediate result that will not change after surgery. Its downside is that it is a more invasive procedure, takes a lot longer to recover, and runs the risk of infection and implant displacement.

Fat injections have the advantage of a more ‘natural’ procedure that is not associated with any of the potential complications related to a foreign body. It also gives one the extra benefit of fat reduction from the donor site. Its disadvantages are that it can not usually achieve the same buttock size as that of an implant (at least in one fat grafting session) and the take of the fat graft is not completely predictable.

4. Can an implant make my calf bigger?

Calf augmentation creates fullness in the gastrocnemius muscle of the  lower leg by placing implants in subfascial pockets overlying the muscle. It can help those men and women who can’t achieve the size of the calf muscle they desire. The calf muscle is one of the more difficult muscles in the body to enlarge due to its very compact muscle fibers. This form of lower leg  sculpting can also correct muscle imbalance as a result of such congenital defects as disproportionate calf development, clubfoot, bowleggedness, and just plain skinny calfs. (aka ‘chicken legs’)

The calf muscle is a two-headed muscle in which one or two implants which may be used in each leg. A person may desire to have only the inner head of the muscle enlarged, the outer head, or both. They are inserted through a small incision in the skin crease behind the knee.

The biggest issue with calf implants is the recovery period. Because they are in the lower part of the legs, some significant swelling can occur. And it usually takes up to three weeks before one can walk more normally. Working out and other unrestricted activities will take at least a month or two following surgery.

Recent reports have seen the use of fat injections for calf augmentation. But this approach is just in its infancy and consistent long-term outcomes remain to be seen.

5. I have heard there are implants for the arms. Is this true?

Bicep and tricep implants will create muscular definition and perceived enlargement of the muscles in both the front and back of the upper arms. This procedure is done exclusively for those who can’t achieve the upper arm size they want even after significant efforts at muscular exercise. Generally, two implants are placed in each arm to give the greatest overall change.

6. Are there any new areas where body implants are being used?

The newest uses of body implants are for the hip and deltoid areas. Deltoid implants are used to rebuild or augment deficiencies of the deltoid muscle group caused by  congenital deformities (Sprengel’s deformity or scapular hypoplasia) or traumatic injuries. (motor vehicle accidents) Hip implants are exclusively done for cosmetic augmentation. For those women who feel that their hips are too narrow and want more of an hourglass figure, hip implants can give them more curvature.

7. What complications can occur with body implants?

Placing an implant always has the standard medical risks of infection, displacement, and chronic pain as well as the cosmetic risks of over- or undercorrection. Unlike the face, body implants are always placed in areas exposed to constant motion and stress and are much larger in size. As a result, they have a higher incidence of fluid collections and displacement.

Dr. Barry Eppley

Indianapolis, Indiana

Macrolane Injections for Body Shaping

Sunday, May 10th, 2009

There are a large number of injectable fillers today (nine at present) that are used exclusively for aesthetic facial purposes. Many of these are composed of hyaluronan with well known brand names such as Restylane, Juvaderm, and Perlane to name a few. The popularity of these injectable products is that hyaluronan is naturally found in many tissues of the body, such as skin, cartilage, and the vitreous humor of the eye. It is therefore extremely well tolerated when placed into the body.

Hyaluronans fundamentally differ in their concentrations and size of the molecules with longer-lasting products having bigger molecules and higher concentrations. The longest lasting and largest molecule of hyaluronan that is available as an injectable filler is not available here in the U.S.  Macrolane (the manufacturer of Restylane and Perlane) is available in many countries around the world and is used for non-surgical body shaping treatments.

The concept of Macrolane is that it can naturally regenerate body contours. That is a technical way of saying it can be used in lieu of any body procedure which uses an implant. It is touted for use as a substitute of breast and pectoral implants as well as buttock and calf implants. Macrolane can also be used even out discrepancies in the skin surface, most notably liposuction irregularities or depressions. The large size of the molecule allows it to persist for longer than a year and it is very thick and viscous. (very much like injecting jello)  Because the body naturally breaks down hyaluronan, any shaping will only last for 12-18 months and top-ups would be required to retain its contouring effects.

How effective is an injectable material compared to an implant? Having looked at the companies website and their before and after photos, I would have to that its effects are visible but fare poorly compared to an implant. In my Indianapolis plastic surgery practice, almost all of my patients would not have been happy with any of these results.

This does not mean that it has no role to play in body shaping. But it would take very careful selection of patients who only need more minor changes to be satisfied. While the injection procedure would not require a general anesthetic and could be done in the office, its limited improvement and lack of a permanent result make its use more narrow than one would think.

While fat injections are currently filling much of the role that Macrolane might play in the U.S., I suspect we will eventually see this injectable product available here provided its safety profile is acceptable. The problem that I see with its use in the U.S. is that it may quickly find its way into the hands of those who are not adequately trained in the scope of body contouring because of its ease of use and lower costs than a surgical implant.

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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