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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘facial reshaping’

Plastic Surgery Case Study: Facial Reshaping by Buccal Lipectomies and Perioral Mound Liposuction

Wednesday, December 31st, 2014


Background: The shape of the face is controlled by a variety of anatomic structures. Its foundation is influenced by the size and contour of the deeper facial bones, the thickness of the muscle and fat that lies above it and the amount and tightness of the overlying skin which envelopes it all. While everyone’s facial shape is unique, there are general types of facial shapes that are well known from oval, oblong, round, rectangular, square, triangular (inverted and heart-shaped) and diamond shape.

While the beauty of any of these facial shapes can be debated, many people find that a more inverted triangular or heart-shaped face is the most aesthetically pleasing. Having cheeks that are more prominent n width and projection that the portions of the face that lie below it is the hallmark of this facial shape. For those with a round face that desire such a facial change, one looks to fat removal to help with this transition.

Facial Fat (Cheek) Compartments Dr Barry Eppley IndianapolisFat removal of the face is not like the rest of the body. It is more localized into various compartments and has multiple motor nerves to consider when doing it. It is also not a high volume or voluminous source of fat that is capable of making by itself dramatic facial shape changes. Historically facial fat removal was associated with the buccal lipectomy procedure which is large volume by facial standards but does not require liposuction to remove. Other more superficial and lower volume facial fat areas exist, such as the perioral mounds, which can only be treated by small cannula liposuction.

Case Study: This 28 year-old female wanted to create a thinner more v-shaped facial shape. While she already had more of an inverted triangular facial shape, she did not like the fullness below her cheeks and by the sides of her mouth.

Buccal Lipectomy and Perioral Mound Liposuction result front view Dr Barry Eppley IndianapolisUnder general anesthesia, high maxillary vestibular incisions of 1 cm length were made below the parotid ducts. Splitting the buccinator muscles exposed the buccal fat pads which were teased out and removed. Through small incisions (3mms) inside the corners of her mouth, after having been initially infiltrated with a lidocaine and epinephrine solution, small cannula liposuction was used to remove fat from the nasolabial fold down to the jowl area. Each side produced about 2 to 2.5 cms of fat from each side.

Buccal Lipectomy and Perioral Mound Liposuction result submental view Dr Barry Eppley IndianapolisIt usually takes about 6 weeks until the full results from these fat removal procedures were seen. The final results of any facial liposuction/fat removal procedure are seen when the treated tissues feel soft with no hard areas, it feels completely normal to smile without stiffness and the overlying skin sensation feels completely normal. (not numb)

Facial fat removal can be effective at reshaping a somewhat fuller face but it can not really take a round full face and make it substantially thinner. It works best in moderately full to thinner faces where small fat reduction volumes make a more noticeable difference.

Case Highlights:

1) Reshaping or thinning a rounder face can be successfully done by specific site fat removal in properly selected patients.

2) A buccal lipectomy removes upper cheek fat while perioral mound liposuction removes lower cheek/jowl fat.

3) These procedures can make a round face less round and a thinner face more defined based on the limited amount of fat that can be removed.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery and Creating the Attractive Face

Monday, June 16th, 2014


Every elective cosmetic facial procedure that a plastic surgeon does is to create a more beautiful or attractive face. Many patients that undergo aesthetic facial plastic surgery today have a very clear idea in their mind as to what deficiency they have and what procedures they think will give them the improvement they are seeking. Some may ask if what they are seeking will create a more attractive face and others may ask what else or what the plastic surgeon may suggest.

Between discussions and computer imaging, most of the proposed facial procedures can be determined. But there is no doubt that facial attractiveness is highly subjective and personal factors of age, race and ethnicity influence how attractiveness is perceived. There are large numbers of facial measurements that can be done from anthropometric studies, but in the end the phrase ‘Beauty In The Eye Of The Beholder’ trumps any objective assessment.

While the determination of an attractive face may be subjective, there are well known guidelines that can be assessed and measured to help guide a surgical plan. They include symmetry, proportion and gender specificity.

While no face is perfectly symmetric, the closer the two sides of the face match the more attractive it will seem to be. Most observers, even close friends, do not usually notice many facial asymmetries. But each individual does as they spend a lot more time looking at themselves everyday and many asymmetries can be glaringly apparent in pictures due to their static nature. In my experience creating symmetry, even if never perfectly achieved, is a key feature in improving facial attractiveness.

The concept of facial proportion comes directly from anthropometric work that dates back to DaVinci. The horizontal assessment of facial thirds is the simplest and the most useful facial proportional measurement. Numerous forehead and lower facial procedures (jawline, chin) can be done to affect these facial ratios. The vertical fifths apportionment of the face is equally valid but less easily changed by surgery. There are also lots of facial angle measurements which are helpful to individual features but few are rigidly tied to an absolute attractiveness effect.

Gender association refers to facial features that are clearly male vs female. Overall, a man’s face is simply bigger with larger overall measurements.  But many of these important gender features that create attractiveness are not based on pure numbers but underlying skeletal features that have developed due to hormonal influences. For example, the male forehead angles back more, is less convex and has a brow prominence with a visible brow break. Conversely, the female forehead has a minimal brow protrusion, no brow break and a greater convexity that is more vertically inclined. The male nose is higher with a straight dorsal line and a tip that creates nasolabial angle of around 90 degrees.  Conversely, a more feminine nose can have a slightly concave dorsal line with a higher tip position and a more open nasolabial angle. The most obvious gender feature between men and women is the jawline where the differences in chin and jawline shapes are well known.

In the end, changing a face with the intent of enhancing attractiveness is a balance between striving for better symmetry, proportion and gender accentuation. How to put these three facial components together in a surgical plan is a mixture of objective and subjective assessments and the procedures needed to achieve them. This gestalt approach to facial reshaping is critical for success and requires a lot of experience to ever develop the amalgamated thinking to optimize facial  outcomes.

Dr. Barry Eppley

Indianapolis, Indiana

Facial Reshaping Techniques for Improving The Round Face

Thursday, July 10th, 2008

Not infrequently I get requests from patients for the desire to transform a round face into a more shapelier one. One cause of a round face is that the patient is overweight. A full neck, round cheeks, and a lot of subcutaneous fat throughout the face creates a generalized fullness that creates a fat and round face. These patients know full well that they are overweight and some liposuction of the neck and buccal lipectomies may make some difference. But weight loss will probably make the most difference in these cases. And these procedures should not be performed until some weight loss has been achieved.
But the overweight patient is not what usually makes up the ’round face’ patient. Most commonly these are younger patients that are not significantly overweight and are usually closer to being more height and weight porportionate. They may have some mild fullness in the cheeks and neck but often their bony prominences (cheeks, chin, or jaw angles) may be somewhat deficient. The approach to these patients must deal with both hard and soft tissues issues to be effective at improving the face’s angularity and definition.
In addition to the fullness of the cheeks and neck, the next most important consideration in facial shape improvement should look at the chin. Often it may only be midly short in the horizontal dimension but the width of the chin is also important, particularly in the male patient. Chin implants today can provide more projection as well as width in many different sizes. Placed through a small incision under the chin bone, a chin implant can lend more definition and squareness to the lower face from subtle to dramatic results.
Upper facial fullness, more specifically midfacial fullness, can be achieved through cheek implants. Placed into position by incisions inside the mouth under the upper lip, cheek implants can provide good highlights through three-dimensional enhancement of the bone as it wraps around the area below the eye. An amazing aray of cheek and midface implants is available to provide a lot of enhancements around this important facial landmark. When paired cheek implants are combined with a chin implant, an upside down triangle of change is created that directly opposes a more round or oval facial shape.
Jaw angle implants are always a possibility but these are rarely needed in most really round faces. They can produce some lateral facial fullness but this is not usually helpful in ‘de-rounding’ the face.
The procedures of buccal lipectomies, neck and jowl liposuction, chin and cheek implants make up the usual plastic surgery tools for facial rehaping. Which one or combination of procedures is most helpful for improving facial definition is best determined by careful computer imaging study between the patient and their plastic surgeon.

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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