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Posts Tagged ‘plastic surgery of the face’

Roger Ebert and Prosthetic Facial Reconstruction

Thursday, January 27th, 2011

Later this week, renowned movie critic Roger Ebert is returning to television for two new debuts. One is something of which he is very familiar, a new show entitled “Ebert Presents at the Movies”.Since his original Sneak Previews show started some 35 years ago, and I remember it well as a regular viewer in my youth, his new show will be old hat even being taped where his original show was done. His second debut, however, has a more recent history.

Ebert was diagnosed with thyroid cancer in 2002 which subsequently spread to his lower jaw despite the cancerous gland being removed. This required the front part of his lower jaw to be removed as well as to needing radiation to the cancer that surgery couldn’t. He suffered complications after this surgery that landed him back in the hospital to next get a tracheostomy tube for breathing. All of these procedures combined left him with no chin and a total loss of his voice by 2006.

This is a devastating facial deformity that plastic surgeons have seen for decades after cancer removals. Known historically as an ‘Andy Gump’ facial deformity, it poses a major reconstructive challenge which defied a really satisfactory solution until the 1990s. Prior to that time, skin and muscle from the chest (pectoralis myocutaneous flap) was brought up as a pedicled flap and wrapped around a metal bar made in the shape of the front part of the lower jaw. While this was often successful, it left patients with far from a really satisfactory reconstruction. That all changed with the development and refinement of microvascular tissue transfer. Such problems today are much better done with a free fibular bone and skin flap to make the front part of the upper jaw and skin for the new chin. This would usually be done at the time of the chin removal so the patient would not go through an ‘Andy Gump’ facial phase.

But having had so many complications and a long difficult course of cancer treatments, Ebert is understandably hesitant about undergoing a long and stressful operation on his body. As a result, he has opted for prosthetic reconstruction which will be debuted on his upcoming new show.

Maxillofacial prosthetics is an often unheard of field of dentistry of which its practitioners are masters of making facial prostheses of all kinds. Their abilities can rival anything seen in Hollywood. Most facial prostheses today are attached to the remaining facial bones with dental implants so they can be more reliably held in place. Presumably due to inadequate bone that has been exposed to radiation, Ebert’s new chin prosthesis will be externally supported as it will rest on his shoulders like a collar. This will enable him to have a facial appearance that, while not being normal, will be something more comfortable for the viewer to see. Because of his voice loss, a laptop computer will serve to make his voice.

While the technology to make a prosthetic chin and to have his voice emanate from a computer are modern day marvels, the real miracle is the fortitude and strength for him to press forward in a public forum with such a difficult set of facial problems. If he were a movie, I would give him two thumbs up and urge you to rush and get your ticket. You will be inspired by this script.

Dr. Barry Eppley

Indianapolis Indiana

The Use of Makeup and Concealers after Facial Plastic Surgery

Monday, January 3rd, 2011

One of the most common questions that a female patient may ask after any form of facial cosmetic surgery is…how soon can I apply makeup? While that time period will vary based on the type of facial procedure you have had, a general rule is that cosmetics may be applied as soon as the incisions have healed. This is usually about a week after surgery. The one exception to that is if you have had a facial laser skin resurfacing procedure. The skin takes longer to re-epithelize so any cosmetic application should wait at least ten days to fourteen days. As a quick aside, coloring your hair (after a facelift or browlift) should wait for about three weeks after surgery.

Camouflaging cosmetics may be used to hide bruising and scars so one can get out the house quicker. Bruising will go through a classic phase of color changes for weeks after surgery. Initially bruising appears as black and blue. But as the blood breaks down and is absorbed, the color spectrum will change as it transitions into yellow and then eventually a light green color. (this is the spectrum of colors as hemoglobin breaks down) In the face, gravity will pull these bruising colors downward. So what was once on the face can find itself in the neck. Once was once in the neck will find its way onto the sternum and chest. To counteract these colors, apply a small amount of neutralizer on the opposite side of the color wheel to the color of the bruising…green to counter redness, yellow to hide purple bruises and purple to cover yellow discoloration. Mineral-based makeup can make cover-up even more effective due to their more uniform application and light reflective ability.

Keep your makeup routinue simple. Don’t use bold colors that will draw attention to your scars and face. Use a more muted natural look. If bruising and discoloration is present, use a neutralizing toner as suggested before your foundation. Then sponge on mineral makeup or your regular foundation that matches your natural skin tone and blend carefully. A translucent powder helps set the foundation and gives a soft natural look.

When it comes to washing your face, use a gentle cleanser that does not contain alcohol and is non-foamy. It is important to get off one’s daily make-up application each night. Since surgery can make dry skin more dry and oily skin more oily, gentle moisturizers and astringents may be needed.

Dr. Barry Eppley

Indianapolis, Indiana

Frequently Asked Questions on Plastic Surgery of the Face on Indianapolis Doc Chat Radio Show

Sunday, January 10th, 2010

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from noon – 1:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of Frequently Asked Questions about Plastic Surgery of the Face was aired. Using questions that Dr. Eppley receives from his practice on facelifts, rhinoplasty, eyelid tucks, brow lifts, otoplasty, chin augmentation, Botox and injectable fillers, the show answered these questions in detail for the listeners. The following questions answered were:

Would a “Lifestyle Lift” keep me looking young?  I’m in my forties.

Will a face lift help my acne scars?

What causes the dark circles under my eyes?

How do I tell if I need upper eyelid surgery or a brow lift?

What is the best method for lip augmentation?

Do facial exercises keep the face looking young?

Will permanent makeup look natural?

What’s the difference between plastic surgery and cosmetic surgery?

What kind of anesthesia should I have for facial surgery?

I want to improve my looks, but will it look like I had something done?

Do you ever actually use plastic for facial cosmetic surgery?

Can plastic surgery make my face look like someone else?

What is the difference between an “open” rhinoplasty and a “closed” rhinoplasty?

How old do I have to be to get a rhinoplasty?

What do you use to build up the bridge of a nose?

What can you do about the size and shape of my nostrils?

My nose gets too long or too wide when I smile.  What can be done about that?  

Why is a revision rhinoplasty so much more difficult than a first-time rhinoplasty?

When can I have my nose redone after a previous unsatisfactory operation?

How does Botox work?

How long does Botox last?

What is the difference between Botox and injectable fillers?

How do I know if chin augmentation is right for me?

How do you pin ears back?

Free plastic surgery consultations can be done with Dr. Eppley by calling his IU Health North or IU Health West Hospital offices at 317-706-4444 or by sending an email inquiry to: info@eppleyplasticsurgery.com.

Facial Analysis Before Plastic Surgery

Thursday, February 19th, 2009

As a plastic surgeon, analyzing a patient’s face before surgery is obviously important. For anti-aging facial plastic surgery, a great detailed analysis of a patient’s face is not usually necessary as you are ‘nipping and tucking’ loose sagging skin…essentially trying to restore their look of years ago. For plastic surgery involving actual changes in the foundation of the face (moving bone or adding implants), however, a detailed analysis is much more important.

Analyzing facial asymmetries or how the face may look after implant augmentation has much greater significance than a typical facelift patient for example. In this type of facial patient, you are really changing the way they look. While that may be what the patient desires, some patients may find the change different or troubling after surgery. I have found this issue to be particularly relevant in the patient who receives multiple facial implants or other foundational facial changes. Over the years, I have had more than one patient who required revisions of facial implants because of changes that they could not accept even though I and others may have found them to be a good improvement.

Any form of facial analysis before plastic surgery that helps the surgeon and patient have a better understanding of potential outcomes is always welcome. I have come across recently a novel website service that provides facial analysis at a very low cost. At That’s My face website, they offer free online facial analysis and facial statues. Based on a frontal and profile view that you upload into their server, they will generate a facial profile which includes your face aged 10, 20 or 40 years, your face in different ethnicities and sexes, your caricature, identify facial asymmetries, give you an attractiveness rating, and compare yourself to others that may look like you. In addition, you can have customized 3-D statues made. All for very reasonable costs of $29 and up.

I find this website service to be potentially very useful for a small subset of my facial patients. Rather than using black and white photographs with hand-drawn grids on them or other methods of tabletop analysis, this form of facial profile analysis is more detailed and accurate with a quick turnaround time. I or the patients can do it themselves.

While no form of preoperative assessment or computer imaging can guarantee any surgical outcome, any method that allows better presurgical analysis or improve surgeon-patient communication and understanding is valuable.

Dr. Barry Eppley

Indianapolis, Indiana

Multiple Procedure Facial Plastic Surgery

Monday, October 6th, 2008

While patients usually come in for a specific facial concern, it is hard to see the face as a single part. Aesthetic facial surgery is all about creating facial balance and proportion. Sometimes, the correction of a single facial feature does put it into good balance…but other times it requires adjustment of multiple features to get the best result. This can be a difficult and awkward situation as the patient may have come in for just one concern, but how do you tell them about other issues that they have not brought up without offending them? I have found that being direct is always best and most patients usually express appreciation as they are coming to me as the expert…and want an expert opinion. I like to discuss facial features and potential procedures in the spirit of obtaining the best facial balance…..not necessarily to improve one’s looks or make one more handsome or prettier.

 A good way to think about aesthetic facial surgery is to relate it to a symphony. Like a pleasing musical piece, it usually takes the coordination of multiple instruments or elements to create a good composition that is pleasing to the ears. Sometimes a solo is adequate and acceptable, but most of the time the playing of the symphony is preferred. Similarly, changing the aesthetics of the face oftens needs to be an orchestrated event, changing several features during a single procedure to get the best result.

While there are specific facial measurements and angles to go by in deciding what to do, many plastic surgeons by experience have developed a feel for coordinating facial movements. For a potential patient to understand these proposed changes, however,  they must see how such manuevers affect the look of the face. This is where computer imaging is so valuable…as a forum for communicating potential results. I make it a point that every patient has a visual understanding of what their outcome may be. This is particularly important  in combination facial surgery where the option of one or several procedures are possible. A common example of this would be rhinoplasty with or without chin augmentation.

 

Dr. Barry Eppley

Indianapolis, Indiana

The Popularity of Facial Implants

Tuesday, September 23rd, 2008

The use of implantable synthetic materials plays a critical role in a number of cosmetic strategies for  improving the shape of the face. Significant advances in materials science and facial implant designs during the past two decades have made certain types of synthetic implants critical for the esthetic augmentation of facial landmarks and contours. Their  popularity today and their increasing frequency of use is a direct result of increased patient demand for facial improvement, the limitations and complications of trying to do the same thing with bone grafts and the remarkable tolerance of  the face to any implanted material due to its excellent blood supply.

     Regardless of their chemical  composition and structure, synthetic  implants assure the plastic surgeon of two very appealing things. First, it makes the operation fairly simple as an ‘off-the-shelf’  solution to change the face in the desired way. Secondly, synthetic implants are predictable in size and shape which will not change over time. These two features are particularly attractive to any patient seeking elective esthetic facial surgery where a low number of potential risks, how much time it takes to recover, and the reliability of the outcome are major factors in the decision to undergo surgery. In short, facial implants are relatively simple operations that work well and have few complications when done well.

 

There are some patients, of course, who are adverse to the concept of a foreign material being put in their face. But once the procedure is explained and they can actually see and feel a real facial implant, these fears are usually washed away. Particularly when the alternative (moving the bone or trying to build the area up with bone) treatment strategies are far less appealing and not nearly as reliable….and cost a whole lot more!

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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