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Posts Tagged ‘plastic surgery’

Safety of Cosmetic Surgery in the Elderly

Sunday, August 30th, 2015

 

Cosmetic Surgery in Octogenarians Dr Barry Eppley IndianapolisThe popularity of all forms of cosmetic surgery is growing and it spans all ages from teenagers to senior citizens for a wide variety of procedures. Age knows no limits when it comes to self-improvement and the desire to look as good as physically possible. While younger patients do inquire as to the safety of certain cosmetic surgery procedures, that very question becomes much more relevant in older patients who may more ailments and medical problems. Even when very healthy older patients naturally ask if their age places them at greater risk for complications.

In the September 2015 issue of the Aesthetic Surgery Journal an article on this topic appeared entitled ‘Safety of Cosmetic Procedures in Elderly and Octogenarian Patients’. To evaluate the incidence of complications from elective aesthetic surgery in patients over age 65 (so called ‘elderly’), the authors looked at a data base of over 180,000 patients from the company CosmetAssure’s data base. Postoperative complications in elderly and younger patient groups were compared with a separate. analysis of postoperative complications in patients over 80 years old. From this database just over 6,700 patients over 65 years old were identified with an average age of 69 years old and with a higher number of men with higher body mass indexs.

They found that the postoperative complication rates was not higher than that of younger patients.When looking at the type of cosmetic procedure, only a tummy tuck had greater complication rates in older patients.The most common postoperative complications in older patients were infection and bleeding. (hematoma) Also the octogenarian patients had a complication rate of around 2% which was not different than that of any other age group.

Cosmetic Surgery in the Elderly Indianapolis Dr Barry EppleyAs the U.S. population grows an older number of cosmetic surgery patients have come forth more than ever before. The first question that both plastic surgeon and patient alike ask at older ages is…is having this operation safe? Is the patient at increased risk because the patient is older? It is the plastic surgeon’s perception and experience that this is not so. This study supports that belief using data from a company that knows complications from having to insure against them and pay for them if they should occur.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Pectoral Implant in Poland’s Syndrome

Thursday, July 2nd, 2015

 

Background: The male chest is largely defined by the size and shape of the pectoralis muscle as well as the nipple-areolar complex. While chest asymmetry to some degree is common in many men, significant asymmetry is most commonluy caused by abnormal development. A variety of congenital male chest conditions exist including pectus excavatum and pectus carinatum as the most common occurring 1 to 400 to 1500 births.

Poland's SyndromePoland’s syndrome was described more than a hundred years ago is fairly rare occurring in more than 1 to 20,000 births. It really describes a spectrum of anterior chest wall deformities that can include the pectoralis major, pectoralis minor, serratus muscles as well as that of the ribs and even potentially extending to involve the arm and hand., ribs, and soft tissue. Deformities of the arm and hand may also be observed. It is far more common in men with a high ride sided occurrence. Poland’s syndrome presents in a wide ranging degree of expression from ver mild chest asymmetry with no arm involvement to the extreme of a flail chest and a short dysfunctional arm.

Reconstruction of many male Poland’s patients involves restoring/recreating the deficient pectoralis major muscle. This has been done historically by implants, muscle flaps and, more recently, fat injections. Each method has their own advantages and disadvantages as well as their own advocates. For smaller pectoral muscle deficiencies the choice of implants vs fat grafting are the logical (benefit vs risk) choices.

Case Study: This 30 year-old male was born with a mild manifestation of Poland’s syndrome that involved the left side of his chest. It was most evident by the loss of a well defined lower pectoralis major muscle border and smaller chest contour. A custom designed implant was made using a silicone elastomer molding technique and send for fabrication into a solid but flexible implant.

custom pectoral implant Dr Barry Eppley IndianapolisUnder general anesthesia, the custom designed pectoral implant was placed through a transaxillary incision. After multiple trial fits it was determined that it was slightly too big. It was reduced down in size using scissors. Using a copy of the location of the lower border of the pectoralis major muscle the implant was inserted into a carefully made pocket using a long dingman dissecting instrument. The limits of the pocket defined the final implant’s location so that it could not migrate either inferiorly or superiorly.

Left Custom Pectoral Implant Poland's Syndrome Dr Barry Eppley IndianapolisWhen seen six months after surgery he had much improved chest asymmetry and no detection that there was any implant in place. It looked perfectly natural . The lower border of the pectoralis major muscle has been restored.

Custom designed pectoral implants can provide a good method of Poland’s chest reconstruction but they must be designed properly and placed into a carefully made pocket. There are multiple ways to create a custom designed pectoral implant but the simplest, and probably most effective, is to make a silicone elastomer mold on the actual patient. The muscle deficiency must be carefully determined through arm motion with an understanding that it is very easy to oversize it.

Highlights:

1) Male chest asymmetry is not that common and one of the origins of it is Poland’s syndrome.

2) Reconstruction of the male Poland’s chest is to create pectoralis muscle volume and a defined lower muscular border.

3) A custom designed pectoral implant is a useful reconstructive method in the male Poland’s chest and often needs to be smaller than one would initially think.

Dr. Barry Eppley

Indianapolis, Indiana

Need Plastic Surgery Help For A Physical Deformity?

Thursday, April 30th, 2015

 

Are you, a loved one or a family member suffering from a physical deformity that is seriously affecting the quality of your life? Such physical deformities can occur from birth defects, traumatic injuries (e.g., burns, motor vehicle accidents, domestic violence, work-related injuries) or surgery for different types of tumor removals. These events can have severe and devastating effects on one’s appearance and certain body functions.

Plastic surgery at reduced cost may be available for select patients to treat such physical deformities. Please e-mail your summarized story in 3 to 5 sentences with pictures of your physical deformities to see if you qualify for plastic surgery help. Such submissions will be reviewed and determined if you qualify for this special program. We are looking for patients with physical deformities where their improvement/correction through reconstructive plastic surgery could literally change their lives.

Dr. Barry Eppley

Indianapolis, Indiana

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

Product Review – Emend in Plastic Surgery for Nausea and Vomiting Prevention

Sunday, April 19th, 2015

 

While patients have many different fears about having surgery, one of the most common is postop nausea and vomiting afterwards. (PONV) While this is a concern regardless of the type of surgery, it is of paramount importance in cosmetic surgery because it is completely elective. For some this concern may even make them think more than twice about having surgery at all.

The patients that are at greatest risk of nausea and vomiting after plastic surgery are those patients that have a prior history of it. Also the risks are increased in those patients that are having longer operations, such as a facelift or Mommy Makeover for example. While anesthesiologists use a much more aggressive anti-emetic approach today, including the use of perioperative IV medications such as phenergan, zofran and steroids, it is not fool proof. Some patients will still have breakthrough PONV. Besides its uncomfortability, episodes of PONV cause elevated blood pressure which can induce bleeding and even hematoma formation.

Emend in Plastic Surgery for Nausea and Vomiting Prevention Dr Barry Eppley IndianapolisA newer medication, Emend (aprepitant), can provide an improved preventative approach to PONV. This drug has been approved in the U.S. since 2003 for the treatment of nausea and vomiting from chemotherapy in cancer patients. It works by an entirely different mechanism that other anti-emetic drugs being a Neurokinin 1 antagonist which blocks the neurokinin 1 receptor. Emend is also different in that it will not work if you are already suffering from nausea and vomiting. It is a preventative drug not a therapeutic one. It must be taken 6 hours prior to surgery to have an anti-emetic effect. In plastic surgeons that prophylactically provide it to their high risk patients along with conventional drugs, there is a near 100% prevention of PONV.

The only downside to the use of Emend is its relatively high cost, of around $50 per pill. But to those patients who have had PONV before, this is no doubt they would say it is well worth it.

Dr. Barry Eppley

Indianapolis, Indiana

DVT Prevention in Elective Plastic Surgery

Sunday, February 15th, 2015

 

Deep Vein Thrombosis in Plastic Surgery Dr Barry Eppley IndianapolisWhile any plastic surgery procedure has it own unique set of potential risks and complications, the overwhelming similarility of them is that they are aesthetic in nature. Rarely does undergoing plastic surgery expose one to significant risks of major medical complications. The one exception is that of venous thromboembolism. (DVT) Known as blood clots that originate most commonly in the calfs and behind the knees, that can lead to pulmonary embolism (PE) which can be deadly. At the least a period of anticoagulation therapy is needed that usually must be continued for six months after the event.

The relevance of this medical issue is that as many as 2 million cases of DVT occur per year in the United States (not from plastic surgery) with roughly 15% to 25% of them leading to a PE. When a PE occurs almost a 1/3 of them result in death. So it is easy to why this medical concern has attracted of attention and preventative strategies.

The risk of DVT and PE amongst all collective surgery patients has  been stated to be in the 1% range and has led to a number of intra- and postoperative strategies to reduce its risk. These include use risk of sequential compression devices (SEDs), patient positioning and adequate IV hydration during surgery. After surgery early walking and moving about as well as compression stockings in selected patients are encouraged. A preoperative assessment tool (Caprini scale) has also been developed to determine who is at greatest risk for developing a DVT where the addition of drug therapies may be given to reduce their risk.

Certain surgical procedures are well known to have an increased risk of DVT of which hip replacement surgery is at the top of the list. It is easy to see that this procedure is major surgery about the pelvic region, usually involves older patients and places them to a period of time after surgery where their mobility may be limited. There is no exact corollary to this procedure in elective plastic surgery but the closest would be tummy tuck surgery. That risk from ambulatory center data shows an occurrence of less than 0.1% or about once in every 1500 tummy tuck cases. This does not mean it can not occur in other aesthetic plastic surgery procedures but the risk factors are less in facial or breast surgery for example.

Lovenox Injections Indianapolis Dr Barry EppleyPrevention in higher risk patients for DVT has become a major focus in the past few years. The use of 5000 IU of heparin given twice daily subcutaneously after surgery is the historic recommendation. In the highest risk patients, dosing is even done before surgery. Newer lower molecular weight heparin (e.g., Lovenox) is given by a measured pen at a dose of 40mg subcutaneously daily and has become the popular method of DVT chemoprophylaxis.

The hardest question is in determining which elective aesthetic surgery patients should have DVT prevention medication. The following procedures have been identified in plastic surgery…tummy tucks, extensive body contouring operations in which the patient has a high BMI or may have prolonged inactivity afterwards and anyone with a known clotting disorder. (e.g., factor V Leiden) While the use of DVT prevention drugs may increase the risk of bleeding and hematomas after surgery, multiple studies have failed to demonstrate this theoretical concern with their use.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? – Valentine’s Day

Sunday, February 15th, 2015

 

Valentine’s Day or St. Valentine’s is a sort of holiday that is celebrated in many countries around the world. Its occurrence is certainly not just limited to the United States. It has its origin in the Feast of Saint Valentine based on an early Christian Saint named Valentinus. Like some holidays and traditions, its actual history is mired in legend and embellishments but it dates as far back as ancient Rome…at least the name of the Saint does.

St Valentine's Day SaintAccording to consistent historical tales, Emperor Claudius II executed two men, both named Valentine, on Feb. 14 of different years in the 3rd century A.D. Their martyrdom was honored by the Catholic Church with the celebration of St. Valentine’s Day. Legend has it that they were imprisoned and ultimately executed for performing weddings for soldiers and for preaching to the persecuted Christians. The romantic twist to Valentine’s Day did not emerge until the late Middle Ages, thanks to writers such as Shakespeare, where it became a day for lovers to express their affections with flowers, sweets and cards. (known as valentines)

Early 20th Century Valentine's Day cardWith the settling of the New World by the English, the tradition naturally followed. The eventual Industrial Revolution made the manufacture of cards more widely available and Valentine’s Day (and other holidays as well) were changed forever with the mass production of valentines by the early 20th century by the Hallmark company. The extension to include other gifts of flowers, candy and diamonds as well as the image of Cupid are marketing extensions of the romance theme.

From a plastic surgery perspective, Valentine’s Day has become a focal point for procedural promotions. Any procedures that can enhance a woman’s attractiveness, from Botox to breast implants, is advertised and discounted if done before or on this day. This is no different than in many other retail industries. At least the ‘gift’ of plastic surgery, given by someone else or to themselves, will last a lot longer than most other traditional Valentine’s Day indulgements.

Dr. Barry Eppley

Indianapolis, Indiana

E-Cigarettes and Plastic Surgery

Monday, June 23rd, 2014

 

Electronic cigarettes (e-cigs) have increased dramatically in awareness and use over the past few years. In plastic surgery, just like in the rest of the society, we are seeing an increasing number of patients presenting in consultations or for surgery who use them. The number still pales in comparison to patients who use tobacco-based cigarettes but the incidence is sure to increase over the next decade.

E Cigarettes and Plastic Surgery Dr Barry Eppley IndianapolisThe fundamental concept of e-cigarettes is that it simulates tobacco smoking but without many of the smoke-related dangers. It essentially uses a battery-powered vaporizer that uses a heating element to turn a liquid solution into water vapor. (hence the term ‘vaping’)  The liquid solutions are glycerin and propylene glycol-based with flavorings. Many of the liquid solutions contain nicotine but nicotine-free liquids are also available. Users get the psychological pleasure of smoking by the hand-held device and the creation of a vapor and the taste of the flavorings.

The health benefits of vaping have been touted as being safer than tobacco products due to isolating inhalation down to just nicotine or even no nicotine at all. While logic would suggest that this is very likely, the medical community and the government have yet to weigh in on this issue with clinical studies. But that issue aside, with an estimated 3% of the U.S. population using them, what risk do they pose for a user undergoing plastic surgery?

Vaping and Plastic Surgery Dr Barry Eppley IndianapolisFor those who vape with liquids that contain nicotine, the postsurgical risks are the same as other nicotine replacement therapies such as gum and patches. Nicotine is a potent vasoconstrictor so procedures that raise extended skin flaps that rely on dermal perfusion for viability (e.g., facelifts, tummy tucks, breast reduction/lifts) are at risk. Patients who vape need to switch to non-nicotine containing liquids for their liquid solutions two weeks before and after surgery use. These would be the same recommendations that have been given for tobacco products for years.

Besides counseling our regular smoking patients about the necessity to cease smoking before and after plastic surgery, an alternative suggestion can be to have them switch to e-cigarettes during this period. As long as they use a non-nicotine solution, vaping can be a substitutional habit as a bridging therapy during the perioperative period.

Dr. Barry Eppley

Indianapolis, Indiana

Real Self 100 – Dr. Barry Eppley

Friday, June 20th, 2014

Real Self Indianapolis Dr Barry EppleyReal Self is one of the internet’s top sites for patient information on cosmetic and plastic surgery procedures. If you are looking to have any face or body cosmetic surgery, Real Self is a great consumer website that is very much a social network for those who want have a procedure done or are looking to connect with those that already have. This website concept was created in 2006 by Tom Leary, who also helped create Expedia for travelers. It is an online community for learning and sharing information and experiences about cosmetic surgery. It is sort of a Facebook for cosmetic surgery but with input by professionals who have a lot of experience with the topics. Many people write in questions for the doctors who participate in Real Self to answer and one can receive just a few answers or up to a dozen from doctors across the country. Patients and doctors post before and after pictures and some patients share their cosmetic surgery experiences.

Real Self Dr Barry Eppley Indianapolis Plastic SurgeryFor 2013, Indianapolis plastic surgeon Dr. Barry Eppley was selected as one of Real Self’s top 100 doctors.As a Real Self 100 honoree, Dr. Eppley was recognized as a leading social media influencer in cosmetic surgery. This award is a testimony to his commitment and contributions throughout the 2013 year on the Real Self website. Contributions used to determine Real Self’s 100 include posted answers and photos as well as feedback shared by patients through reviews and stories. The recipient of this award were amongst the top 2% of the 6,000 doctors who are part of the Real Self doctor community.

In 2013, the 100 doctors on the list collectively impacted tens of millions of patients, with nearly 20% of our total site views centered on helpful answers and information posted by a relatively small group of doctors.

Plastic Surgery Children’s Book – Ellie Hears An Elephant

Saturday, March 29th, 2014

 

Children and teenagers can be afflicted by numerous types of physical birth defects, some of which cause medical problems and others which are more about looking different and being less than ‘perfect’.  With a developing and sometimes fragile self-image, prominent appearance differences can be a potential source of embarrassment. Plastic surgeons see children and young teens for several basic types of aesthetic surgery. One of the most well known is that of protruding or prominent ears. Caused by the lack of development of one the ear folds or overgrowth of some of the cartilage at its base, the ears can stick out quite distinctly from the side of the head. Such ears are evident right after birth and do not change or become less obvious as the child grows. They frequently can become a source of ridicule, which does not usually occur until they have begun formal schooling

Plastic Surgery Children's Book Ellie Hears An Elephant Dr Barry Eppley IndianapolisIn a new children’s book ‘Ellie Hears An Elephant’ written by Indianapolis plastic surgeon Dr. Barry Eppley and his daughter Hannah, the story of a young girl and her experience with elephants is told. What starts out as an innocuous trip to the circus to see her favorite zoo animal eventually turns into a source of teasing and embarrassment. Grappling with the decision as to whether to change her natural self requires input from those closest to her…her parents and her sister.

So what is Ellie to do? Her parents take him to a local plastic surgeon to find out what can be done. Should she make a change or not? That is the decision that only she can ultimately make.

Elective plastic surgery in children and teenagers has always been a sensitive subject. Whether one should change how they look for a prominent physical feature touches on the issue of a developing self-image and their psychosocial development. Should plastic surgery be done and is it necessary for one’s ‘health’? Like Ellie and her ears, such decisions are personal ones but fitting in and being accepted as normal can have a profound influence on that choice.


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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