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Posts Tagged ‘Did You Know’

Plastic Surgery’s Did You Know? The Golden Ratio

Monday, April 20th, 2015


The search for what makes a face beautiful or attractive goes back hundreds if not thousands of years. Long before the possibilities of plastic surgery were even remotely envisioned, painters and sculptors used mathematical numbers and rations to create their works. Numerous contemporary studies have both qualified and quantified ‘beauty’ and have been able to apply some basic principles to it. (e.g., symmetry)

Golden Ratio in Plastic Surgery Dr Barry Eppley IndianapolisBut the most appealing numerical approach to beauty in the face and body as well as nature is that of the Golden Ratio. Much has been written to seemingly verify its use to show that its ration (1.618) represents the perfect shape from just about anything from natural to man made objects including the human body.

The Golden Ratio, represented by the Greek letter phi (?), is the relationship between two sides of a rectangle (1.61803) where the ratio of the larger side to the smaller side is equal to the ratio of both sides to the larger side. In mathematics, the Golden Ration occurs in the well known Fibonacci sequence where each subsequent number is the sum of the two previous ones. (:1, 1, 2, 3, 5, 8, 13, 21, 34, 55, 89 etc) If you divide each number besides the first one) by the previous number it is surprisingly close to 1.618 or the Golden Ratio.

Golden Ratio in Facial Plastic Surgery Dr Barry Eppley IndianapolisBut is the Golden Ratio useful in helping the plastic surgeon create a more beautiful face? Studies have shown that there are aesthetic correlations with many facial features relating to each other through this relationship. (e.g., the ratio of the length of a person’s face to its width is 1.6) It does seem to be a number that when assessing faces defies historical, racial and cultural differences.

However, a plastic surgeon’s ability to change one’s facial features is based on a knowledge of anatomy, surgical techniques and the desired end goal. While being an artist does not make one a good plastic surgeon (contrary to popular perception), there is a role for understanding aesthetic proportions and relationships.The Golden Ratio is as good a guideline as any other one might use.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Roman Nose and Rhinoplasty

Sunday, December 8th, 2013


Roman Nose Rhinoplasty Dr Barry Eppley IndianapolisA Roman nose, also called a hook nose or aquiline nose, is one with a prominent bridge which gives it the appearance of being curved or slightly bent. The very word, aquiline, comes from the latin word aquilinus which means eagle-like in reference to the curved beak of an eagle. It is characterized by an outwards curve in the central area that protrudes far off from the face. The nose appears as a hook due to this predominant bridge. In Roman times such a nose shape was associated with a sign of leadership. This undoubtably serves as the genesis for the historic perception that people with this nose shape are often great leaders. Abraham Lincoln is often referenced in this regard since he had a Roman nose. But modern day rhinoplasty views the Roman nose as an unaesthetic one.  A straight line bridge or dorsum is viewed as a basic goal of rhinoplasty surgery. Taking down a bump or hump on the nose is a very common patient request. Patients wants a smooth and straight dorsum and a nose without a hook today. Taking down a nasal hook requires shaving down the bone and cartilage that it is composed of, creating an open roof deformity. This is closed down by breaking the nasal bones to collapse the sides and make a smooth and lower bridge of the nose.

Dr. Barry Eppley

Plastic Surgery’s Did You Know? Rhytiphobia and Botox

Tuesday, September 24th, 2013


As we age the development of wrinkles on our faces is inevitable. The motion of the muscles of facial expression eventually cause permanent creases or wrinkles to develop in the skin. For some people wrinkles represent a positive reflecting signs of knowledge and experience. For others they are a sign of losing one’s youth and getting older. While no one really wants to develop wrinkles on their face, and many people fight it by a variety of anti-aging treatments, for some it is a real phobia. The morbid fear of developing facial wrinkles is known as rhytiphobia. People with rhytiphobia have an extreme fear of getting wrinkles  and will go to great lengths to avoid them. It is the lengths that people go to in avoiding their fears that define it as a phobia. Thus does getting Botox injections constitute treatment of a phobia? It is extreme to undergo facial injections to avoid or lessen facial wrinkles. Perhaps in the past the concept of having one’s face stuck with needles may have seemed extreme for something as innocuous as a few facial lines and creases. But today Botox is such a common and everyday occurrence that no one would think of it as a phobia treatment. Some people get Botox a few times to see if they like it, others get it with great regularity (every 3 or 4 months) to avoid any new wrinkles developing. To the most regular Botox users perhaps it is a form of phobia treatment, but at least it is a very effective one.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Fat Atrophy after Trauma

Thursday, July 4th, 2013


A common observation in blunt traumatic injuries of the face and body that have resulted in large bruises or hematomas (blood collections) is that soft tissue or contour depressions may appear many months later. This is confusing to patients as they do not know why it occurs since they did not have a laceration or obvious deep tissue injury. What has happened is that the blunt injury has caused fat underneath the skin to atrophy or wither away. But how did a ‘big bruise’ cause fat loss? One mechanism is that the trauma has damaged fat cells by compression. Some fat cells may have been crushed or broken apart by the external force, causing permanent loss of volume. This certainly is one injury mechanism but it probably not the only one. When large bruises develop that are associated with a blunt traumatic injury, the released red blood cells are eventually broken down as part of the bruise clearing process. When red blood cells are broken or are being broken down, the hemoglobin they contain can release their heme prosthetic groups.  As the heme decomposes, the non-protein bound heme can become highly cytotoxic due to the iron (Fe+) atom contained within its porphyrin ring.  The iron’s ability to donate and accept eIectrons enables it to convert hydrogen peroxide into free radicals. Free radicals are well known to cause damage to cellular structures of which adipocytes (fat cells) would be very susceptible. Localized ‘iron toxicity’ may add to the development of subcutaneous fat atrophy in traumatic injuries.

Dr. Barry Eppley

Plastic Surgery’s Did You Know? Pectoralis Muscle Atrophy after Breast Augmentation

Monday, July 1st, 2013


The most common location for placing the implants in breast augmentation is under the muscle. What this means is that a pocket is made between the thicker outer pectoralis major muscle and the thinner underlying pectoralis minor muscle. When it comes to nerves in breast augmentation the most common concern is about nipple sensation and one of its major sensory contributing nerves coming in from the side of the chest wall which is at some risk of injury as the outer pocket dissection is done. But there is another nerve, known as the medial pectoral nerve, that almost always get injured in the pocket dissection between the two pectoralis muscles. The medial pectoral nerve either comes up from the pectoralis minor muscle to innervate the major muscle from below or does so around the lateral aspect of the minor muscle. When placing a breast implant below the muscle, the pectoralis muscle is therefore partially deinnervated. This causes some muscle atrophy which is actually believed to be advantageous as it allows the breast to project better. As the thicker pectoralis muscle gets a little thinner over the implant, this allows the breast to acquire a more natural shape on the lower pole of the breast. In female bodybuilders, this pectoralis muscle atrophy may cause some weakness in the muscle which can be overcome by weight training.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Original Nosejob

Sunday, June 23rd, 2013


The desire to change or make up a new nose has been around for a long time. The first recorded nose job is written in the ancient Indian Sanskrit texts around 600 BC. Doctor would reconstruct noses by taking a strip of skin from the forehead or cheeks, twisting the skin side over a leaf of the appropriate size, and then sewing the skin into place. Two polished wooden tubes would be inserted into the nostrils to keep the air passages open during healing. Such drastic rhinoplasty surgery was often necessary as the punishment at that time for adultery was to have one’s nose removed. Today’s rhinoplasty surgery and the desire for one has come a long way from its origin thousands of years ago. But this original rhinoplasty surgery still exists today in nose reconstruction which may be needed after skin cancer resection or traumatic injuries. Known as forehead flaps, they are still the main method of major nasal reconstruction when substantial portions of the nose are missing. And the basic concepts of the forehead flap remain the same as was performed long ago in ancient India.

Plastic Surgery’s Did You Know: The Need for Strong Male Jawlines

Tuesday, June 18th, 2013



A strong jawline has been deemed as both a desireable and attractive male facial feature for millenia. A strong male jawline is not a passing fad or temporary fashion statement. It has been and always will be an important feature of a male face. Everyone knows that a strong jawline implies increased masculinity and increased attractiveness. But where does this impression come from and why? Face shape and structure has long been considered a good indicator of dominance. A rounded chin is viewed as more feminine than a more square stronger chin. Recent research has shown that during ovulation women seek out masculine-appearing men whose features suggest high testosterone levels which would indicate a high fertility and well as good quality genes that can be passed on to their offspring. Strong jawlines also imply dominance over other males which may be most important when a woman is at or near their peak fertility. Like so many desireable physical features of men and women, its basis lies deep in history with the need to secure a mate, procreate, and pass along good genes.


Plastic Surgery’s Did You Know? Sunscreens and Skin Aging

Monday, June 10th, 2013


Everyone by now knows the value of using sunscreens in lowering the risk of getting skin cancer. By decreasing the amount and duration of ultraviolet light skin exposure, the skin cells have more time to repair themselves and less chance of permanently damaging the natural healing mechanisms of the cell’s structure. In addition, it has now been proven that sunscreens also result in less skin aging and less skin wrinkles over time. In the June issue of the Annals of Internal Medicine, a study out of Australia (a country that really knows about sun exposure) reported on the effects of the use of sunscreen in over 900 fair-skinned people under age 55. They either used SPF15 sunscreen daily or only as they desired. The group that used daily sunscreen showed little increase in skin aging after nearly five years compared to the group that used it on a more discretionary basis. These findings are really no surprise in that skin aging and wrinkle development is known to be the result of irreversible cellular damage of the elastin fibers and decreased collagen production from ultraviolet irradiation. Decreasing the risk of skin cancer and slowing down the visible signs of skin aging are the direct result of blocking UV rays. This is why many modern skin moisturizers and even makeups contain UVA and UVB protection.

Plastic Surgery’s Did You Know? The Muscles of Facial Aging

Sunday, June 9th, 2013


A facelift, despite being a well known procedure, is frequently misunderstood. The most common misconception is of the actual facial area that is treated. Rather than the whole face, it treats only the lower third of the face, the neck and jowl areas. But the second misconception is what lies under the skin or, more pertinently, what is changed under the facial skin as it is lifted. It is commonly believed and often stated that the facial muscles fall with aging, carrying with it the overlying skin. But this is only partly true at best. The only facial muscle that really changes as we age is the platysma muscle which is a neck muscle not a true facial muscle. Running between the clavicles and the jawline, the platyma muscle splits or separates in the middle as we age. This creates the classic neck bands seen running down the middle of the neck. What one sees is the inner edges of the platysma muscle which makes up the paired neck cords running vertically. It is this muscle that is put back together during a facelift and accounts for the small incision right under the chin for access to do it. There are no facial muscles on the side of the face that can fall. There lies the very big masseter muscle, responsible for chewing, that is densely adhered to the bone. It can never fall with aging or become loose from the bone. Skin and the underlying subcutaneous tissues, known as the SMS, can sag with aging but not the muscles.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Lower Eyelid Bags

Saturday, June 8th, 2013


Undereye bags are a well recognized facial entity. Everybody has seen lots of people who have them and eventually many people will see them on themselves as they age. For some few people they will have them even when they are quite young before they have any significant aging. Lower eyelid bags in the aging face are made up of several tissue components including loose skin and muscle as well as protruding fat. In the younger patient who just has bags or puffy lower eyelids the issue is one just of protruding fat. But in either the young or old, where does the fat in lower eyelid bags come from and why is it there? This is known as herniated lower eyelid fat that wss originally under the eyeball. Fat under the eye acts as a cushion, which is why you can push back on your eye and it gives in a little. The fat around and under the eye cushions it from impact. This fat is normally contained to the under the eyeball due to a ligament in the lower eyelid known as the septum. But as we age this ligament weakens, allowing the fat to come spilling out creating the puffiness or bags.  In the younger patient with bags, this ligament is naturally or congenitally weak allowing the fat to prematurely bulge out. In essence bulging lower eyelid fat is the result of a weakness or hernia in the lower eyelid ligaments. This heriated lower eyelid fat has three distinct pockets of fat known as temporal,central and medial or nasal fat pockets. Interestingly, while fat is well known to have a yellow color the nasal fat pocket is white and no one knows why.  Herniated lower eyelid fat can be removed exclusively in a transconjunctival lower blepharoplasty or as part of a more complete open lower blepharoplasty.

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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