March 11th, 2010
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March 11th, 2010
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March 5th, 2010
When spring just around the corner, this is the time of year when many people start thinking about their body again. Warm weather and less clothing cause some women to think about their ‘curves’. Perhaps to the surprise of some, spring is the peak season when the greatest number of breast augmentation surgeries are done. This is a seasonal trend that is very unique to this type of cosmetic surgery.
When considering breast augmentation, most women today opt for silicone gel breast implants. Since they have become available again for human use in late 2006, they rapidly have become the preferred implant for many breast augmentations. Yet, despite FDA-approval, many patients understandably ask about their safety. Even if one was not old enough to even be aware of what transpired in the early 1990s with the previous generation of silicone breast implants, there remains some lingering concerns that are easy to find on the internet.
Since silicone gel breast implants are FDA-approved, and they would not be available if they were not, that speaks to their safety. But most do not know the extent of information that goes into that type of approval process. And because of their history, silicone gel breast implants have become the single most studied implantable device in the world. As a result, the most common questions that women may have about this type of breast implant has well known answers.
Can breast implants make me sick? In 1997, the Federal government (Department of Health and Human Services) appointed the National Academy of Science to study the likelihood of medical complications after breast implant surgery. After reviewing years of evidence and research concerning silicone gel-filled breast implants, they found that health problems such as connective tissue illnesses, cancer, and other diseases were no more common in women with breast implants than in women who had never had the surgery.
In the 1990s, thousands of women claimed that they had become ill from their implants. Some studies around that time suggested that these health symptoms of women with implants may improve when their implants are removed. We now know conclusively that this is not true. The relationship between autoimmune diseases and breast implants is coincidental…both largely occur in women between the ages of 20 to 50…but one does not lead to the other. The FDA has even gone so far as to conclude that there is link between fibromyalgia and breast implants either.
Will breast implants cause cancer? Reviews of research and medical studies on silicone breast implants show that breast cancer is no more common in women with silicone breast implants than in those without. In fact, for reasons different than one may think, women with breast implants actually have earlier breast cancer detection. This has nothing to do with the implant per se, it is a function of breast awareness. Women with breast implants are more likely to be ‘attuned’ to their breasts and how they feel.
Can I breast feed with breast implants? For the younger women, this is a frequent question. The issue is not whether one can physically do it, but will any harm come to the baby by doing so. The American Academy of Pediatrics concluded in 2001 that having silicone breast implants is not a contraindication to breastfeeding nor does it pose any health risks to the infant. Similarly, epidemiological investigations have not found any increased risk of health problems in children born to women with silicone breast implants.
Dr. Barry Eppley
Tags: breast augmentation, breast implants, dr barry eppley, indianapolis, plastic surgery, silicone gel braest implants, silicone gel breast augmentation
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March 5th, 2010
The mere mention of the word ‘facelift’ is to many people a frightening concept that is best avoided. Beyond implying surgery, images of ‘perpetual surprise’, ‘wind-tunnel’ and ‘unnatural’ come to mind. It is these very misconceptions and fears that have led to a surge of procedures that have become broadly known as non-surgical facelifts.
Cleverly marketed as appealing improvements known as ‘lunchtime facelifts’ and ‘liquid facelifts’ , these facial procedures are hopefully performed in a doctor’s office with a combination of Botox, injectable fillers (such as Juvaderm and Radiesse), and light and laser treatments. They are tremendously appealing precisely because they are not surgery, and involve no scarring or downtime. And they are based on a recently appreciated anatomic understanding of facial aging which is that of volume deflation (loss of fat) and not just sagging tissues alone. ‘Re-inflation’ of the face is the result of these treatments, even if it is only temporary (there are no permanent injectable fillers).
Under the guise and enthusiasm of anything that is pain and recovery-free being better than a real facelift, a patient inquired about the ‘new’ Y-facelift published this past weekend in New York Times Sunday Magazine. Buried in the center pages of this magazine was a story entitled ‘Houston, We Have Facelift’. Reading this story got me thinking about everything that is both good and bad about the non-surgical facelift ‘revolution’.
The concept: Developed by a dentist who claims to have taken four years to develop this approach, the Y-facelift involves filling the face with large volumes of injectable fillers, molding it around with one’s fingers, and then treating the skin with radiofrequency treatments to tighten it. I am not sure what the Y means but some filling out of the face is most certainly achieved, without surgery, for a subtle improvement.
The bad:. It may be shocking for some that everything in New York isn’t always better (although always twice as expensive) and the New York Times Style magazine does not carry the same scientific clout, for example, as the New England Journal of Medicine. Cosmetic procedures are fraught with a common problem- marketing that frequently gets way ahead of proven science. This practice is so prevalent that doctors and companies alike have learned that appearing in Allure, Cosmopolitan and other beauty magazines with exaggerated and unfounded claims drives business better than a scientific discourse in any medical peer-reviewed magazine. (and much easier to get published) Even the pharmaceutical industry has this figured out which is why almost one-third of television ads today are for some prescription drug. The bottom line is the ‘Y-Lift’, while based on a few known plastic surgery procedures, is an unproven amalgamation which most likely benefits the treatment provider more than the recipient.
What matters: The debate between non-surgical or surgical facelifts can be debated ad nausem. Both may be appropriate for any patient under the right circumstances. The practitioners of both will hotly contest each one’s merits. But the non-surgical boom of cosmetic procedures speaks to an important issue that is rarely discussed…value. What does one get for what one pays? The non-surgical Y-facelift retails between $4,000 and $8,000 for results that will last one year, maybe slightly more. The price of non-surgery, when looked at long-term, is frequently more than that of actual surgery…with results that are not nearly as long-lasting.
There are many factors that go into deciding what is the best facial rejuvenation procedure. Never forget that the concept of value in plastic surgery, like any other retail purchase, is extremely important. But the medical merits of such procedures should not be determined by what is written in a trendy magazine whose sole intent is newsstand and ad sales, not satisfied and happy patients.
Dr. Barry Eppley
Tags: dr barry eppley, facelift, indianapolis, injectable fillers, non-surgical facelift, plastic surgery
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February 23rd, 2010
With the winter Olympic games ongoing in Vancouver, it gives one pause to ponder about more than the traditional meaning of this event. Every two years, the Olympics and the media exposure that surrounds it provides athletes, known and unknown, with the rare opportunity to showcase their skills and personality on an international stage. As an audience we are glued at night (and sometimes during the day thanks to Tivo) to watch athletes perform in ways that we only fantasized about in our youth. For some of these athletes, their accomplishments will be a springbroad to fame and riches thereafter.
The ancient Olympics were held in Olympic Greece over a span of nearly 1300 years beginning in the 8th century BC. Revived 1400 years later in 1894, Baron Pierre de Coubertin resumed the games in Athens. To adapt the games to the ‘new’ world, a variety of modern inventions since their rebirth have included the Winter Games for ice and snow sports, the Paralympic Games for physically disabled athletes, and the Youth Olympic Games for teenage athletes. To support all these activities, the games have long shifted away from pure amateurism to complete corporate commercialization. Over half of the Olympic coverage seen in Vancouver on NBC were commercials.
The vast majority of Olympic competitors are under the age of 35. As a result, most athletes have much, if not all, of their youthful appearance. Some have had some form of plastic surgery, however, to look better under all this media exposure. Few have owned up to it however. In this young age group, Botox, injectable fillers, rhinoplasty and ear surgery would be the likely plastic surgery procedures. For obvious reasons, liposuction and other body contouring procedures would be unlikely given their state of physical conditioning.
Olympic gold medalist and four-time Word tennis champion Lindsay Davenport has freely spoken about her experience with Juvederm injectable filler. The years of sun damage from playing tennis led her to seek non-surgical facial rejuvenation. Concerned about her ‘parentheses’ (laugh lines), she had those injected to restore volume and had Botox in her forehead and around her eyes to decrease wrinkles as well. Her experience was so positive that she has been a spokesperson for Juvederm’s educational campaign.
Olympic hurdler Jana Rawlinson from Australia has opted to have her breast implants removed in preparation for the 2012 Olympics in London. Such a cosmetic move may be the first in the world of competitive athletics. She felt they were slowing her hurdling down. Having breast implants, adding just 1% to one’s total weight and causing some minor adjustment in balance, may make the fraction of a second difference between winning and losing. Interestingly, she cited a patriotic duty to do the best that she could for her country over her own vanity for the removal decision.
While most recognize the Olympic symbol of the five interlocking rings, fewer know that there is an accompanying motto as well. The Olympic motto is “Citius, Altius, and Fortius” which in Latin means “Faster, Higher and Stronger”. Given the evolution of the Olympics today, perhaps the motto should include Richer and Better Looking as well.
Dr. Barry Eppley
Tags: dr barry eppley, indianapolis, olympic games, olympics, plastic surgery
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February 20th, 2010
Facelift surgery is one of the top five requested procedures in plastic surgery. Despite its popularity, it remains as the most misunderstood of the known plastic surgery operations. Almost everyone thinks that a facelift is a total makeover of the face, from the scalp down to the neck. In reality, it only treats the lower third of the face, the jowls and the neck. Therefore, it is a much less extensive operation to go through than one thinks, with a smaller than anticipated recovery as well. Facelifts are often combined with other facial procedures as well such as blepharoplasty and browlift.
In this edition of the Doc Chat radio show, Dr. Barry Eppley discusses many aspects of facelift surgery, demystifying the operation and providing insight into what it can and cannot do. In discussion of facelift surgery, Dr. Eppley interviews a husband and wife, both of whom had different facelift operations. The wife underwent a traditional full facelift, the husband underwent a direct necklift. Hear what they have to say about their experiences and the learn from actual patient experiences what facelift surgery is all about!
Dr. Barry Eppley discusses Facelift Surgery
Tags: dr barry eppley, facelift, indianapolis, plastic surgery
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February 19th, 2010
The recent surprise decision by Senator Evan Bayh to not seek re-election is likely a strong reflection of his desire to flee an unpopular ship as it is with his frustration with the ways of Washington. The recent questionable efforts to ramrod through a monster of major health care reform is certainly one factor that drove him closer to the edge of this decision. Perhaps Bayh knew that as the details of the health care bill began to see the light of day, great public disdain for all those that voted for it was sure to occur.
As a plastic surgeon, I was happy to see that the unsavory ‘Botax’(a 5% tax on all cosmetic procedures, surgery or otherwise) was cut from the final version of the Senate health care reform bill. The ‘Botax’ was eventually eliminated when it was quite rightly pointed out that it was not only a discriminatory tax on women but it was punishing those who sought self-improvement…the equivalent of taxing healthy behavior given the efforts of most patients to take good care of their investment in themselves.
As a replacement for taxing cosmetic surgery, the Senate desperately searched for ways to redistribute more of your money. They turned their focus to… indoor tanning of all things. Known as the ‘Tan Plan’, a 10% federal tax on indoor tanning was quietly included in the revised bill. Optimistically, it is expected to generate close to 3 billion dollars to help pay for the uninsured. Tanning is a more palatable target because it is a debatedly unhealthy behavior that in the very least, doesn’t improve your skin’s condition from the experience.
While I don’t want to be an endorser of any behavior that exposes people to more ultraviolet radiation and thereby increases their risk of developing skin cancer, this new federal tax is just as reprehensible as the Botax and may even be more discriminatory. Though the tanning industry and tanning advocates have put forth their concerns, I have yet to hear anyone mention the very biased nature of this tax. I am most definitely not a tanning expert, but I am certain that the vast majority of the population that patronizes tanning salons are light skinned individuals seeking to darken their natural skin tone. The number of non-Caucasian users of tanning salons must surely be very low, at best just a few percent of the total client base. The Tan Plan is really a racially-biased tax, likely unintentionally but true nonetheless.
What the Botax and the Tax Plan demonstrate is that it is virtually impossible to pick and chose what type of human behavior you want to tax (penalize), and not raise a lot of concerns. If you really want to generate a lot of tax revenue and maybe even change societal health behaviors in the process, there should be a Fat Food Tax. Taxing food purchases with a certain percentage of fat content and the industry that makes them would make these other tax proposals as insignificant as the antioxidants in a soda.
Must we really be deluged with food choices that have such high fat or sugar contents? They taste great and we all love them, but most are a nutritional desert and have led us to be one of the most overweight countries per capita in the world. Obesity and all of the problems that it causes is a far greater health problem that cancer, AIDS and many other medical diseases combined. Such a food tax would, however, cause such a societal clamor that the mere mention of it makes one reach for that bag of Doritos. Taxing personal lifestyle behaviors is risky and will never be a politically popular way to try and fund some levels of health care reform.
Dr. Barry Eppley
Tags: botox, cosmetic surgery, evan bayh, health care reform, health care tax
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February 12th, 2010
As if Michael Jackson’s stunning death this past summer was not tragic enough, last week his personal physician was formally charged with manslaughter . Dr. Conrad Murray, a cardiologist who was with Jackson at the time of his death, is accused of medical behavior that led to his demise. Murray is claimed to have administered the sedative propofol to help Jackson sleep. Shortly thereafter Jackson was found unresponsive, and was declared dead after arriving at the hospital. These charges against Dr.Murray are sure to be the prelude to another sensational celebrity courtroom drama set to play out later this year.
Until this event occurred, most people had never heard of the drug propofol. Known as the ‘milk of amnesia’ amongst anesthesiologists, this white-colored liquid sedative has undoubtedly performed perfectly during millions of surgical procedures – certainly for many surgical patients who are reading this very column. Propofol is intended to be administered only by an anesthesia professional in a medical setting, because it depresses breathing and heart rate while lowering blood pressure. Propofol is absolutely not an insomnia medication . How then did the ‘milk of amnesia’ come to be in use at a private residence?
It’s my belief that the thing that killed Michael Jackson is the very same thing that led to his facial disfigurement from multiple plastic surgeries. The ‘fame’ monter and the opportunity to rub shoulders with a pop star is capable of making anyone, let alone a physician, cross the line between appropriate behavior and irresponsibility. Dr. Murray will ultimately pay a steep price for his short time as a celebrity’s physician but the deceased is not a guilt-free victim. A lifetime of privilege and asking for the ‘extraordinary’ created a pattern of behavior that ultimately proved fatal. It is one thing to demand the best room in the hotel or to make special accommodations for your private plane at the airport…but pushing the envelope in medical treatments can have different consequences.
Ultimately, the doctor should have used better judgment. The use of propofol at home can not be defended at any level. We are certain to hear in court testimony, however, a fantastic story that will justify his actions. It probably will be as equally convincing as the glove that did not fit O.J.’s hand.
Even in a small, Midwestern practice, our best judgment as physicians is tested. When a friend or family member asks for a Vicodin prescription for a ‘bad back’, or a patient expects us to write off her co-payment, or when a local celebrity asks for pain medication that is waaaaaay more than what is necessary for a simple elective surgery, we’re expected to uphold our professional standards and do the right thing. We’re supposed to say no. Because when you don’t refuse, and when you do write that ‘questionable’ prescription because you feel obligated, you’ve opened the door to further indescretions. And before you know it, you’re saying ‘yes’ more often than not, and over time you allow the patient to dictate the course of treatment. And sooner or later you wind up like Dr. Murray.
Dr. Barry Eppley
Tags: dr barry eppley, dr conrad murray, indianapolis, michael jackson, plastic surgery
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February 9th, 2010
One of the first signs of aging is what happens around one’s eyes. We are so expressive with our eyes and forehead that they bear the brunt of much of the early and visible signs of the aging process. How many times has someone said to you…are you tired?…have you been working late?…when in fact you just had eight hours of sleep. The development of extra eyelid skin, lower eye bags, and wrinkles around the eyes can be telling.
This makes the blepharoplasty (eyelid tucks) a vital plastic surgery procedure in making one look more refreshed. Many patients fear, however, that such an eyelid procedure will change their appearance rather than just making it more youthful or rejuvenated. This fear is promoted by just looking at today’s over-operated celebrities who have had too much surgery, or overly aggressive surgery, and look very unnatural. Such changes do make one look different, but not better.
Modern blepharoplasty surgery avoid these problems using a more conservative approach based on a better understanding of how the eyelid and face changes with age. Greater emphasis is placed on not disturbing the eyelid’s complex system of support and removing just the right amount of extra skin. This leads to a more natural looking result that does not alter one’s appearance.Baggy upper and puffy lower lids can now be treated with less tissue disruption and scarring for a safer and more natural long-term result. The goal is to look like yourself…just better!
When considering an upper eyelid procedure, the position of the eyebrow must be considered. A low hanging eyebrow can make it look like there is more skin in the upper eyelid than really exists. A browlift procedure is occasionally done with a blepharoplasty when it is determined that a higher brow is aesthetically beneficial. How do you know if your eyebrow is too low? That would depend on where one’s brow was when they were young. I would submit that most people do not remember where it was in their younger days. You simply have to play with it in the mirror to decide if higher is better.
Browlifts are primarily a procedure for women, they are rarely done in men. When browlifts are done, emphasis should be on more lateral brow elevation and less inner brow elevation. A woman’s eyebrow usually has an upward and outward sweep to it towards one’s temple area. Bringing up the inner part of the eye brow is what creates an unnatural overelevated look.
Today’s in-office ‘needle’ treatments can also provide some around the eye area improvement. Botox (and Dysport), not injectable fillers, is what is used. It is a great treatment for reducing the frowning look between the eyebrows, horizontal forehead lines, and crow’s feet wrinkles at the side of the eyes which can be particularly evident when one smiles. As an early treatment before significant eye aging changes occur or as a complement after blepharoplasty surgery, Botox is a simple and cost-effective non-surgical treatment.
One no longer has to be told that they look tired or are seeing their eyeball slowly disappear in a sea of loose and hanging eyelid skin. Between the three Bs (blepharoplasty, browlift and Botox), a more rested and refreshed you awaits!
Dr. Barry Eppley
Tags: blepharoplasty, botox, browlift, dr barry eppley, eyelid tuck, indianapolis, plastic surgery
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February 5th, 2010
The trail of plastic surgery devotees in Hollywood is growing faster than sequels to the movie Saw. From aging musicians and film makers to young actresses on the rise, Tinseltown is awash with everyone getting nips and tucks. While an occasional tweak or two may be the norm, some ‘ stars’ are becoming more mannequin than human in their quest to turn back the hands of time.
Most recently, Heidi Montag of ‘The Hills’ fame, underwent a second round of extensive plastic surgery procedures. The 23-year-old reality TV star, who had a rhinoplasty and breast augmentation in 2007, confessed to having ten plastic surgery procedures in one day according to People magazine. By her own admission, she admits to being addicted to plastic surgery. In her quest to be “the best of me”, she had liposuction on her neck, waist, hips, and thighs, a buttocks augmentation, revision of a prior breast augmentation, an ear pinning, a “mini” brow lift, chin reduction, Botox in her forehead as well as fat injections in her cheeks and around her mouth.
Ms. Montag represents the ‘extreme’ plastic surgery patient. Low self-esteem, combined with easy access and large amounts of disposable income and an insatiable need for attention, can create this perfect storm with the end result what we now see on the cover of People magazine.
Heidi Montag’s situation is definitely the exception. But real addiction can and does occur outside of reality TV and mainly affects those that suffer from Body Dysmorphic Disorder. (BDD) In this condition, there is a never-ending unhappiness with changes that keeps the person affected with it coming back for more. Most repeat plastic surgery patients, however, are not ill and are motivated by what I call ‘accomplishment feedback’, a normal psychological response that creates a desire for further benefits after a previous positive experience. Every retail business thrives to create that outcome. That is a far cry from a BDD illness or a ‘plastic surgery addiction’. The sheer reality of economics prevents most people from ever crossing the line into either of these behaviors.
Ms. Montag’s plastic surgeon has also been the target of criticism. When should plastic surgeons tell patients no? How much is ‘enough’? While many people are appalled by what Heidi Montag did and felt she did more than she should have been ‘allowed’, the answer is not so straightforward. Should McDonald’s be selling those 80 grams of fat in a burger and fries meal to anyone overweight or should home mortgages or debt consolidation services be tendered to people whose finances knowingly don’t support them?
Elective plastic surgery is medicine mixed with a good dose of business and marketing. While the safety of the patient is the number one limiting factor to the number of procedures that should be performed at a given time, it’s impossible to remove the component of ‘personal responsibility’ from the equation. Defining what is reasonable for someone to want is akin to you telling me what I should like. While beauty may be in the eye of the beholder…what is needed to get there is most certainly in the mind of the beholden.
Dr. Barry Eppley
Tags: beauty, body dysmorphic disorder, dr barry eppley, indianapolis, plastic surgery, plastic surgery addiction, reality tv
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