Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘nipple reduction’

Mini-Mommy Makeover Procedures

Sunday, May 19th, 2013

The concept of a Mommy Makeover plastic surgery procedure is about combining abdominal and breast reshaping in one operation. The breast and abdominal components are not new and include many well known procedures such as tummy tucks, breast implants, liposuction and breast lifts in whatever combination each individual women needs. While the effects of a Mommy Makeover can be dramatic, breast and abdominal procedures are major surgery with significant recovery as well.

But there are numerous other procedures of lesser magnitude that could also be lumped into the Mommy Makeover category and consist of a variety of ‘nips, tucks and sticks’ that create effects that mothers would also like. Here are some of the most noteworthy.

BOTOX  For reduction of those facial expression lines that come from the stress of balancing mother and wife roles, Botox injections are probably the most common injectable Mommy procedure.

Vi/PERFECT PEELS With only a few days of redness and flaking, these medium-depth facial peels are essentially painless to go through and provide a real boost to one’s complexion. A few of these a year will keep a mother’s skin radiant and glowing.

C-SECTION SCAR REVISION For those women that don’t need a tummy tuck and have a noticeable c-section scar with just a little pooch above it, widely cutting out the scar can produce a flatter upper pubic area. This scar revision can be combined with some lower abdominal liposuction for an additional and wider flattening effect.

UPPER LIP PLUMPING Some well placed Restylane or Juvederm injections into the upper lip has an instant youthful volumizing effect. This is particularly evident if the cupid’s bow and philtral columns are accentuated.

NIPPLE REDUCTION Breast feeding can elongate the nipple which can be a source of embarrassment and out of proportion to the size of the areola. Under local anesthesia, the nipple length can be reduced by half or more.

EARLOBE REPAIR Fixing stretched out ear ring holes or complete tears through the lobe can allow old or new ear rings to be comfortably worn again.

BELLY BUTTON REPAIR (Umbilicoplasty) Pregnancies can change an innie belly button to an outie due to a small hernia through the umbilical stalk attachment. Tucking the peritoneal fat back through the hole and reattaching the stalk of the belly button back down to the abdominal wall will recreate that an old inne look again.

EXILIS For those stubborn fat areas that just won’t go away despite some diet and exercise, this non-surgical fat treatment can easily fit into a busy mom’s schedule. It takes a series of treatments to see the effects but there is no downtime with 30 minute in-office treatment sessions.

These mini-Mommy Makeovers provide changes that do not require major surgery or recovery and can fit into anyone’s hectic schedule.

Dr. Barry Eppley

Indianapolis, Indiana

Contemporary Male Plastic Surgery Procedures

Sunday, May 5th, 2013


While plastic surgery always has and always will be dominated by female patients, more and more men are taking advantage of the changes that it has to offer. This is a reflection of a multitude of factors coming together including refined surgical techniques, new products and a fashion trend towards more masculinizing appearances of the face and body.

For the face, I have seen a strong trend towards the desire for more defined and strong jawlines. Men want not only a more pronounced chin but a jawline that goes with it. This includes more angular and defined jaw angles and a more straight jawline that connects it with the chin. To create this effect, more men are having a three-piece jaw implant approach of one chin and two jaw angle implants…as opposed to just an isolated chin augmentation procedure.

Men are also seeking stronger more ethnic noses as well. Men do not want smaller, dainty or upturned noses. They prefer noses that have a high, but straight, dorsal line. Even a small hump on the bridge may be acceptable if it is just a slight bump. They want a more narrow nasal tip but not an over rotated one. A straight and not too long of a nose is more important than a perfectly straight dorsal line for some men. I have done a few noses recently where the men prefered to leave just a little bump on the nasal bridge…to look better but still like their original nose somewhat.

While Botox and injectable fillers will always play a very small role in male facial rejuvenation, other slightly more invasive procedures are of more interest. A little liposuction under the chinj or along the neckline can help clean up the jawline in relatively short order. Fat reducing skin tightening devices, like Exilis, are also popular when a guy sees some neck or jowl line skin laxity developing. While the results are more subtle not the magnitude of surgery, the lack of downtime is very appealing.

Body procedures in men are becoming increasingly dominated by chest reshaping efforts. At the smallest level, the protruding nipple is a problem for men of all ages and nipple reductions are a simple and quick reduction procedure done in the office. Gynecomastia problems are often much smaller today than in the past. ‘Puffy nipples’ problems have become more common than the larger breast mound gynecomastia issues from years ago. Men simply don’t like any protrusions from their chest other than a well-shaped pectoralis chest muscle profile. Using either small cannula liposuction to reshape the pectoral outlines or creating increased muscle size by the placement of pectoral implants, men are making changes to their chest that diet and exercise can not create.

Men are becoming more familiar and comfortable with what plastic surgery has to offer. But their desires and needs are somewhat different than that of women and it is important that they seek improvements through plastic surgeons who are in tune with these more contemporary male aesthetic procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Male Nipple Disorders and Their Surgical Correction

Monday, July 16th, 2012

The size and shape of a man’s chest can be a source of pride or embarrassment. Much emphasis on the aesthetics of a masculine chest is based on the pectoralis muscular anatomy. While this muscle provides support for the overlying skin, and clearly its size and border outlines are important, the lone remaining aesthetic feature is that of the nipple. While a man’s nipple is usually much smaller than a woman’s, it can have numerous aesthetic deformities which are both bothersome and embarrassing.

The male nipple has the same anatomic features as that of a female, a centrally elevated nipple and a surrounding areola. Men typically have much less nipple projection, even when stimulated, and a thin width to the surrounding areolar circle. This is no surprise given that it has no lactation function and has no purpose in being any larger. But despite its small size, it can have a series of aesthetic problems that men would like improved.

Nipple protrusion, or the overly projecting nipple, is a frequent source of male embarrassment. For some men, the nipple sticks out all the time. For other affected men, the protrusion is only bothersome as it occurs with stimulation, particularly when one is cold. Sticking out through shirts is the common complaint which brings men in for a nipple reduction procedure. Men want a completely flat nipple that does not become erect at all. A nipple reduction is a simple procedure that is performed in the office under local anesthesia. To be more accurate, it should be called a nipple amputation or nipplectomy. While a nub of nipple can be retained, most men want it completely gone and flat. Removing the nipple through a wedge excision to include the ducts and bringing the areolar edges together is the surgical technique.

A different form of nipple protrusion is that of the puffy nipple. The puffy nipple is not protrusion of the nipple but that of the entire nipple-areolar complex. This is caused by breast tissue pushing out from behind. This is known as areolar gynecomastia, a small form of breast tissue enlargement that causes visible projection of the overlying nipple. This is commonly seen in young men who desire a completely flat chest profile. This is treated by an open excisional approach through a lower areolar incision. The breast tissue is directly excised and feathered into the remaining breast tissues beyond the areolar margins. This is the smallest form of gynecomastia that is treated. Care must be taken during the procedure to not over-resect the breast tissue, causing a nipple inversion problem later.

The sagging or ptotic nipple is a problem of older males. As the chest tissues lose volume and sag, the nipple sits much lower on the chest wall. This is caused not by the nipple sagging per se, but by the entire chest skin on which it sists falling off of the muscle and ribs so to speak. This can be improved through a nipple lift procedure. By removing a crescent of skin above the nipple, the nipple is lifted upwards into a higher position. There is a limit to how much movement can be done, often being no more than 10 to 15mms upward. While greater upward nipple movement is possible trough different patterns of skin excision, this results in scars that extend downward from the nipple. This is usually not an acceptable trade-off for most men.

Nipple asymmetry can also occur due to either congenital deformities or some more natural amounts of chest asymmetry. Nipple asymmetries can occur in either horizontal or vertical dimensions. Most commonly, it is the difference in their horizontal positions that is disturbing. It can involve just one nipple or both. Based on the movements needed to move the nipples to more symmetric positions determines where on the nipple circle the crescent skin excision is oriented. Often moving both nipples, splitting the difference in the asymmetry, is the best way to get the most symmetric result.

Male nipple deformities can be easily treated and improved, many of which can be treated  under local anesthesia with virtually no recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Nipple Reduction and Areolar Gynecomastia Treatment in Men

Tuesday, July 7th, 2009

Gynecomastia (male breast enlargement) comes in many forms, from a large almost female looking breast to just a scant amount of excessive nipple or areolar projection. In my Indianapolis plastic surgery practice, I have seen more ‘minor’ cases of gynecomastia in the past few years. In these minor expressions of gynecomastia, there is a special subset in which the main aesthetic problem is that of excessive nipple projection.



Excessive nipple projection can occur in the teenage years as well as in the older male as well. The prevalence in the younger teenage and young male patient has a lot to do with cultural influences to which we are exposed today. The current appearance of the male models that are used in advertising show a chest that is both hairless but very smooth including a flat nipple. I call this the ‘Abercrombie Fitch’ look which helps drive a young males perception of attractiveness. As young male are often shirtless given their activities, this look can be very influential. Older male, conversely, are primarily bothered by the protrusion of the  nipple that can be seen through shirts.



In many cases, this nipple and areolar protrusion may or may not be part of an underlying mild gynecomastia. Some men merely have hyperactive nipples or more promiment nipples than others. In other cases, there may be a small or areolar gynecomastia that pushes the nipple forward by volume displacement.



Correction of these nipple and areolar protrusions are quite simple and uncomplicated. If the areolar is flat, but the nipple is undesiringly protrusive, a simple nipple reduction can be done. This is done by taking a wedge from the center of the nipple and closing it, making the nipple flat and permanently disrupting its ability to stick out any further. Some nipple sensation will be lost but this is usually irrelevant in a male. If the  areola is protrusive, then breast tissue must be taken out from underneath it. Through a semi-circular incision on the bottom part of the areola, the nipple and areola is lifted up and a wedge of tissue is removed. The amount of tissue removed should be sufficient enough that there is a slight indentation at the time of closure.



Both nipple reduction and areolar gynecomastia are simple outpatient procedures that have virtually no recovery and only a short limitation from strenuous activities after. Both heal with virtually no detectable scarring and consistent aesthetic improvement.



Dr. Barry Eppley

Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana





Nipple Reduction Surgery for Women and Men

Sunday, February 22nd, 2009

Large nipples may be long and protruding or merely have a very wide diameter. In either case, such prominent nipples are bothersome to women or men because they can be seen through clothes. Whatever the cause, correction is done for cosmetic reasons and to look a chest or breast look that does not stand out in clothes. Enlarged nipples rarely cause pain or any nipple discharge issues.


Nipple reduction can be done by several different simple methods, depending upon the shape and length of the nipple and to what degree of reduction that the patient wants. One method involves removal of the top of the nipple in a v-shaped wedge and then closing it with small dissolveable sutures. Another method involves removal of a strip of skin around the neck of the nipple which when sutured closed, reduces the height of the nipple by pushing a portion of the nipple back into the breast tissue. With either method, feeling in the nipple is not usually changed and the ability to breast feed is possible. The top reduction method can reduce the length of the nipple the most while the strip reduction method is designed to have the least potential for any effect on nipple function. Once reduced, the shortened nipple length will be preserved forever.


Nipple reduction surgery is a simple procedure that can be done under local anesthesia in the office. Once injected, the procedure is painless and done in less than one hour. Small incisions are made right on the nipple and the excess nipple tissue removed. Dissolveable sutures are used so there is no need for suture removal later. Band-aids are used for dressings. While easily done alone in the office, nipple reductions can also be done with other breast procedures such as breast augmentation, breast reduction, or breast lifts. When combined with these procedures, they are done in the operating room with the main breast procedure.


There really is no recovery with nipple reduction. One can return to work or any other physical activity the same day. Showering and getting the nipples wet can be done the next day. Other than some mild nipple sensitivity, there is no swelling or bruising of any consequence.

Nipple reduction produces a very natural appearing nipple that causes less protrusion in clothes while maintaining feeling.


Dr. Barry Eppley

Indianapolis, Indiana

Different and Unusual Procedures in Plastic Surgery

Thursday, July 3rd, 2008

As plastic surgery has worked its way into the mainstream of American society, it is no surprise that procedures are being done today that were not imaginable a mere ten years ago. And I am not referring here to surgery wonders of technology and scientific advancement (although that exists also), I am talking about what patients desire to have done. This is a reflection and commentary on contemporary American culture, not necessarily how far the science of plastic surgery has come.
As I talk with friends and colleagues about some of the plastic surgery procedures that I do today, I have come to realize that some of them may be considered ‘unusual’ . Certainly, some of them are different than traditional perceptions of plastic surgery. Many are relatively minor procedures that can be performed in the office and probably reflect the trend toward treating smaller concerns. They are the opposite of bariatric plastic surgery, for example, where a new subspecialty of plastic surgery has developed to treat the sequelae of gastric bypass and massive weight loss patients. The emergence of larger plastic surgeries and big procedures doesn’t occur very often but every few decades. But the emergence of more minor plastic surgery procedures occurs much more frequently. Here is a list of my unusual plastic surgery procedures that have emerged and become popular in the past decade.
Buttock Implants/Fat Injections – The appeal of a larger, more rounded buttocks is certainly a body image of recent note. Whether done by transferring fat from one body part to another or by an implant placed through an incision near the tailbone, the desire for buttock enhancement could not have been envisioned ten or twenty years ago. There is actually a great number of patients who would like buttock reduction but no single good procedure exists for that problem.
Labial Reduction – Whether due to discomfort from rubbing on clothes or during inetrcourse or simply to ‘look better’, reducing the size of a woman’s labia is now a common procedure. One would never have thought that such a concealed part of the anatomy would create a demand for treatment. A very simple and effective procedure, labial reduction restores the outer appearance of the vagina to a more youthful appearance.
Earlobe Reduction/Enhancement – As woman age and with the lifelong use of ear rings, the ear lobes will frequently get longer. The size of the ear lobe can easily be reduced (earlobe reduction) in the office and it is a procedure that I often do at the same time of a facelift. Aging may also make one’s earlobes get quite thin and almost shriveled in appearance in very thin females. Injectable fillers, such as Juvaderm or Radiesse, can give an immediate rejuvenation effect to the earlobes that may last as long as a year.
Eyebrow/Eyelash Hair Transplants – The science of hair transplantation has evolved to the point that single hair (follicle) transplants are now routinuely done in scalp hair restoration. It is quite logical that single follicular transplantation be applied to very small areas such as the eyebrow and even the eye lashes. The alternatives of permanent makeup, colored pencils, and false eyelashes made opting for actual hair tranplants a difficult decision. But some few patients do.
Umbilicoplasty – While every full tummy tuck patient gets a new bellybutton (umbilicus), some non-tummy tuck patients want one also. Most commonly, it is to change an outie to an inne belly button.
Nipple Reduction/Nipple Enlargement – I have seen it both ways. The concern of large nipples is that they can be very visible through clothes…and at all times. Reducing the size of the nipple is a simple procedure and some women may lose a little sensation. Most recently, I have started to some men that want their nipples reduced also! Conversely, nipple enlargement or enhancement is about changing an inverted nippled (which is turned inward) to one that has some outward projection. While not quite as predictable (long-term result) as nipple reduction, the nipple can be released and brought more outward.
Corner of Mouth Lift – The downturning of the corners of one’s mouth with age gives a sad or angry appearance. A simple procedure in which a small amount of skin is removed and the corners lifted up and the mouth line leveled gives a nice and subtle improvement. Such a procedure is a simple office operation or is often done as part of a facelift. This is actually an old procedure that has now been ‘reinvented’ or rediscovered.

One wonders what this list will be in another ten years!

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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