Archive for January, 2010
Sunday, January 31st, 2010
With the summer season nearly here, spending time outdoors and ditching those layers of cold-weather clothes has many of us worrying about how our bodies fared over the winter!. For some people, the ‘getting in shape’ process seems to never end, and for others there seem to be problematic areas that just won’t improve no matter how much they diet and exercise. Whether it be a small stomach pooch, love handles, or a little fullness on the thighs, improving these areas would not simply offer a better look, but would provide more self-confidence in shorts and at the pool.
Enter the consideration of liposuction. While most people know what liposuction is, today’s Smart liposuction is a huge step forward from the traditional standard of the last twenty years. Liposuction is no longer a brutal beating that you may have seen on TV or the internet. The latest advance in liposuction is known as Smartlipo or laser liposuction. SmartLipo is a cutting-edge, highly effective method to significantly improve the safety and effectiveness of traditional liposuction. Routinely used in dental procedures, lasik eye surgery, and other fields of surgical reconstruction, laser technology is what sets SmartLipo apart from all other methods of liposuction.
Traditional liposuction uses a vacuum with a metal tube attached, which the plastic surgeon moves back and forth manually. Because the human hand is not that precise, patients can sometimes get a lot of bleeding, swelling and trauma to the tissues. SmartLipo is different in that it uses a carefully calibrated laser to liquefy fat deposits in the top layers of the skin. The laser actually ruptures the fat cells, like a hot knife going through butter, and the resulting oily, liquid substance is then suctioned out through a tiny incision in the skin. The small laser can also seal blood vessels as it zaps fat, so there is less swelling, bleeding and bruising than with traditional liposuction….and less pain! Research has shown that little, if any, fat is reabsorbed back into the body. The more gentle technique of the SmartLipo procedure allows patients to recover faster and see the results they are looking for more quickly.
The heat from the laser also has another very valuable contribution to the final result – it helps tighten loose skin. The historical problem in traditional liposuction is that it relies on the patient having good, taut skin to begin with. Otherwise, removing fat will simply make skin looser and to sometimes ‘sag’ after the procedure . By heating the underside of the skin to temperatures of 45 degrees C (approximately 112 degrees F), the skin is made to shrink to some degree. This makes it possible for some people to successfully undergo liposuction today who may not have gotten good results in the past.
SmartLipo also makes it possible for many patients with smaller problem areas to require only a local anesthetic for the procedure. Traditional liposuction often requires general anesthesia. This makes it more practical for some people, as they can drive to and from the procedure, eliminating the transportation and care needs of a typical surgical operation.
Liposuction has a long history in plastic surgery of being a very good body contouring method for the right patient who is willing to undergo the recovery. Like most everything in life, liposuction has now gotten better….smarter if you will. SmartLipo is a technological advance for certain – but it is not a miracle. One still needs to have realistic expectations about what the procedure can and cannot do. But for smaller fatty deposits, or for someone who is fairly fit to being with, Smartlipo may be the simplest solution to regaining confidence with their body.
Dr. Barry Eppley
Tags: dr barry eppley, indianapolis, laser assisted liposuction, liposuction, plastic surgery, smartlipo
Posted in Newspaper Articles | No Comments »
Saturday, January 30th, 2010
Enhancing one’s bust size through breast implants today is easier than ever before!….That is certainly the marketing hype and there is a lot of truth to it. But to call the recovery after breast augmentation as….no recovery….or painless… as some advertisements suggest does not quite convey an accurate picture. All surgery induces some pain, swelling, and bruising. Breast augmentation is no different.
Breast augmentation is most commonly done today by placing the implant under your big chest muscle known as the pectoralis. (although there is a recent trend back to above the muscle for some plastic surgeons as silicone gel implants have become available again) By putting the breast implant under the muscle, it is stretched, bruised, and even some fibers are cut. This makes the muscle sore, swollen and difficult to stretch. This also makes the upper arm hard to lift up very far. In essence, breast augmentation makes the muscle stiff and sore. It is not the incision that causes any discomfort, it is the muscle.
While breast augmentation can not be completely pain and recovery free, rebounding from the surgery and getting back to normal activities definitely can be accelerated. This is made possible by doing something to the muscle after surgery…early and aggressive physical therapy. Breast augmentation physical therapy starts the night of surgery and consists of range of motion exercises of the arm. By early stretching of the arm in circles and by raising the arm from one’s side to the level of the shoulder and above, the pectoralis muscle is mobilized. Stretching helps loosen up the injured muscle fibers and prevent restrictive scar formation. The more you move, the quicker you will recover. Just like pulling a leg muscle, the earlier you begin to stretch and use it the quicker you will get over it.
This form of pectoralis physical therapy, combined with anti-inflammatory drugs such as Alleve and Ibuprofen, allows one to get moving very early. While swelling, a little bruising, and some pain can be expected, early physical therapy can lessen its effects to just a few days. Even in the worst-case scenario, one should have a significant recovery by one week after surgery.
One other helpful recovery aid I use in my Indianapolis plastic surgery practice is the ActiPatch anti-inflammtory device. This is a small battery-operated battery device that emits pulsed electromagnetic fields that penetrate the breast tissue and help reduce swelling and inflammation. I have started my patients wearing it for the first 36 hours after surgery. It is easy to wear it inside one’s bra as the loop fits over much of the breast mound.
Rapid recovery breast augmentation is a reality through a combination of early physical therapy, anyi-inflammatory medications, and the ActiPatch device. Significant recovery should now be a matter of days not weeks.
Dr. Barry Eppley
Tags: breast augmentation, breast implants, dr barry eppley, indianapolis, plastic surgery, rapid recovery after breast augmentation
Posted in Newspaper Articles | No Comments »
Saturday, January 30th, 2010
I have heard many patients say “Can you fill up my lips with Botox’ or ‘I need a filler between my eyes to stop me from frowning’. This confusion comes from the fact that all these in-office anti-aging treatments come out of a needle. But the reality is not all that comes out of a needle is the same. While such confusion is understandable due to the relative newness and apparent similarity of these injectable treatments, that is a little like saying that one scalpel can do all the same surgeries. Injectable agents are treatments which have different mechanisms of action, even if the end result is often times similar. (facial wrinkle or fold reduction)
To clear up the confusion, I often explain to patients the difference between static wrinkles and dynamic wrinkles that appear on one’s face. Dynamic wrinkles are those wrinkles and lines that appear when your face is moving or expressing yourself such as smiling or frowning. When we were younger, the only lines and wrinkles we had were dynamic. Our face was otherwise wrinkle-free when we weren’t expressing ourselves. Static wrinkles are those facial lines that are evident even when our face is not moving. All dynamic wrinkles, with time, will eventually lead to static wrinkles. When we are older, those static lines look even worse when they become dynamic. What looks cute on a child’s face when they laugh, decades later, will someday be viewed quite differently.
These two types of wrinkles are what separates Botox and any of the injectable fillers. (e.g., Restylane, Juvaderm and eight other brands) Botox is for dynamic wrinkling. It is a muscle-paralyzing or muscle weakening agent so it will soften the wrinkles and lines that occur from a dynamic facial movement, such as between the brows with frowning….or the crow’s feet around the eyes from smiling. Injectable fillers are for static wrinkling. They soften lines and larger wrinkles by plumping them out so they look less evident at rest. In some cases, the combination of Botox and fillers are used at the same when the line or wrinkle is very deep and weakening the muscle action will help preserve the longevity of the filler material but not being ‘beaten on’ by continuouosmuscle movement. This dual combination is almost exclusively in the furrows between the eyebrows from frowning. (also known as the ’11 sign’)
One other important difference between Botox and injectable fillers is where they are used. Botox is primarily a ‘northern’ facial procedure used on the forehead and around the eyes. Injectable fillers are a ‘southern’ facial procedure, used mainly around the mouth.
Feel free to contact me and get a free copy of my book on this subject entitled ‘INJECTING YOUTH’.
Dr. Barry Eppley
Tags: botox, dr barry eppley, indianapolis, injectable fillers, injecting youth, plastic surgery
Posted in Newspaper Articles | No Comments »
Saturday, January 30th, 2010
The plastic surgery treatment of the aging face often involves a facelifting surgery. A facelift is one of the top ten cosmetic procedures performed in the United States. Despite its frequent performance and its recognition by the public, it is a procedure that is usually misunderstood.
The most common misconception of a facelift is that it does very little for much of the face. It is a procedure that has its impact on the neck and jowl areas. The rest of the face is untouched by the operation. While other procedures are often done with it, such as eyes and brows, these procedures are not part of the a traditional facelift operation. A facelift should more properly be called a necklift or a neck-jowl lift.
Another misconception about facelifts is what is actually lifted. Everyone understands that face and neck skin is lifted and moved back, but what goes on underneath the skin layer is a frequent point of misinterpretation. Patients often ask me if I am going to lift and tighten the ‘muscles’. From an anatomic standpoint, lifting the facial muscles is an impossibility. Most facial muscles are attached tightly to the underlying bone and moving them would not only be very difficult but would not have any postive benefit. There is only one muscle that is often tightened in a facelift and that is the platysma muscle in the neck, which is often separated due to aging. It is never lifted per se but it is tightened in the middle, from the chin down to the adam’s apple, to help sharpen the neck angle.
The layer underneath the skin that patients misinterpret as muscle being moved is actually a different tissue altogether. Between the skin and the muscles is a layer of tissue known as the SMAS. This is an acronym for a more anatomic name but for simplicity of understanding think of the SMAS as another layer of skin underneath. This layer can be raised up off the muscles and resuspended up higher on the face. The combination of SMAS and skin tightening together generally makes for a better facelift result that may last somewhat longer.
There is great controversy in plastic surgery about how to most effectively deal with the SMAS during the facelift operation. Many facelift surgeons tout their own techniques and may even have their own names for their ‘type’ of facelift based on their version of SMAS manipulation. While SMAS management in any form of a facelift is a plus, there is no proven superior method of what to do with it. If one single SMAS facelift technique was genuinely best, we all would be using it.
In a facelift, the underlying tissues that are manipulated is the SMAS layer not muscles. SMAS tightening does usually make for a better facelift result that is more durable. However, time and aging will eventually outlast any facelift result no matter how it is done. And the overall goal for most patients is to ultimately outlive their facelift result….or at least I would think so.
Dr. Barry Eppley
Tags: dr barry eppley, facelift, indianapolis, jowl lift, necklift, plastic surgery
Posted in Newspaper Articles | No Comments »
Saturday, January 30th, 2010
Breast reduction is one of the most common plastic surgery procedures in the United States. Reduction of large breasts provides immediate and long-term improvement in back, shoulder, and neck pains that come from a woman having to carry around the equivalent of a rope around their neck with several pound bags hanging from them. Despite the common performance of the breast reduction operation, there are numerous misconceptions and misinformation that surround the procedure. Here are the top five breast reduction myths.
Breast reduction causes a lot of pain after surgery. Despite what many paients fear, breast reduction is not associated with much pain after surgery. There certainly is some soreness and discomfort, but acute and unbearable pain just does not occur. Since breast reduction is about the removal of skin and breast tissue, not muscle or bone, pain is far less than what many women fear.
My breasts will still sag after surgery even though they will weigh less. Breast reduction is a combination of a reduction AND a breast lift procedure. The surgical technique o f breast reduction involves an entire reshaping of the breast, upward nipple repositioning along with breast tissue removal. Beast lift procedures are essentially the same operation but without any breast tissue removal.
My nipples are removed during the operation and are put back in place at the end. In general, this is rarely done. In the most commonly performed method of breast reduction, known as the inferior pedicle technique, the nipples are left attached to a central mound of breast tissue. Breast tissue and skin is removed around it. Keeping the nipples attached keeps them alive and preserves feeling in them. In a less common breast reduction method, known as free nipple grafting, the nipples are in fact removed and put back later. But this method is only done in very large breasts in which the nipples are in danger of survival with the traditional inferior pedicle method of breast reduction.
I won’t be able to breast feed or feel my nipples after a breast reduction. In the inferior pedicle technique, the nipples (and their underlying glands and nerves) remain attached. Thus, the nerve supply to the nipple is maintained allowing for sensation, the ability of the nipple to get erect, and to be able to breast feed. There is always the risk that even with the nipples remaining attached, the nerve supply to the nipple will be injured from removing breast tissue from other areas, but this is not common. (although a possible risk)
My insurance won’t cover my breast reduction. No one, patient or plastic surgeon, can predict with any accuracy what any insurance company may do. This is why the submission of a pre-determination letter from the plastic surgeon in absolutely necessary in all cases. Your insurance company has very specific criteria for what qualifies someone for breast reduction (they all do) and the pre-determination letter must have all your information (breast size, symptoms, amount of breast tissue to be removed) to see if you qualify. My experience has been that over 80% of patients get approved on the first submission.
Dr. Barry Eppley
Tags: breast reduction, dr barry eppley, indianapolis, plastic surgery, reduction of large breast
Posted in Newspaper Articles | No Comments »
Saturday, January 30th, 2010
The greatest misconception about facelift surgery is that it does very little for what most people think of as their face. A facelift is really a neck and jowl lift, changing only the lower third of the face or the neck. Facelift surgery is also not a ‘one size fits all’ operation. Facelifts come in a variety of variances that are customized to the each patient’s specific problems. Subtle differences in each facelift do make each one a little unique.
Despite many nuances in each patient’s facelift surgery, they are done in fundamentally two ways or types, limited and full. The differences lie in how much work is done in the neck area.
Limited facelifts affect mainly the loose skin in the jowls with some minor effect on the neck. Often neck liposuction is done as part of the procedure. This type of facelift has become popularized by different surgeons and companies that implies its simplicity and ease of recovery. Despite these name differences, they are are essentially the same operation. It is a good procedure for those who have early to moderate signs of face (neck and jowl) aging. The recovery is quick, one week or so, and in my Indianapolis plastic surgery practice the limited facelift makes up about one-half of all facelifts that I do.
A full or traditional facelift is an extension of the full facelift. More skin is undermined in the neck and the platysmal muscle is often sewn together as well. It is reasonable to think of a full facelift as about twice that of a limited facelift. The surgery is twice as long, the amount of work done is about double. This is a better procedure when one is older and the facial (neck and jowl) aging process is more advanced. If you have significant loose skin in the neck, then a full facelift is probably needed.
One of the fears that many patients have is that a facelift involves a lot of pain, swelling, and an extended recovery. In reality, this is simply not true. One of the main reasons people think this goes back to a basic misunderstanding of what a facelift really is. (it does not involve any operations above the mouth…..while many other facial procedures can be done with a facelift, they do not count as a facelift) Isolated facelifts are much easier to go through than most imagine. Even a full facelift takes only slightly longer than a limited one.
Unfortunately, the fear of what a facelift may entail after surgery prevents some people from even considering this very effective procedure. Once I explain in detail the type of facelift a patient may need and what is really involved to go through it, these fears subside and the process to get what one wants is no longer so daunting.
Dr. Barry Eppley
Tags: dr barry eppley, facelift, indianapolis, limited facelift, plastic surgery
Posted in Newspaper Articles | No Comments »
Saturday, January 30th, 2010
Rhinoplasty or getting a ‘nosejob’ continues to be a popular facial procedure and is one operation that is almost synonymous with plastic surgery. The central position of the nose on the face makes the need for any rhinoplasty surgery to be very precise. Good results in rhinoplasty are largely dependent upon a detailed understanding of the anatomy of the nose. Whether it is a small area of nasal change or an entire nose restructuring, how the anatomy of the nose is altered will eventually be seen through the overlying skin.
What makes your nose look like it does? Think of the shape of your nose like a single level house. The roof covering is the overlying skin, the framework of the roof is the nasal bones and upper and lower alar cartilages, the central support beam is the septum, and the walls are the nasal lining. The look of one’s nose, like the shape of the roof on the house, is directly influenced by how the framework of the roof is shaped. A hump or bump on the nose occurs, for example, because the central beam is arched (too long), raising up a normally smooth roof line. The tip of the nose is too long, for example, because the legs of the tripod support on the roof edges is too long. Deviated noses occur because the central support beam is deviated or the tripod edge supports are longer or shorter on one side.
I think of changing the nose in terms of four areas, three outer framework and one inner framework support. The upper outer one-third is the nasal bones, the middle third (also known as the middle vault) is the upper cartilages, and the lower one-third is known as the lower cartilages or the tip of the nose. The septum is the central internal support. One important nose area is the thickness of the outer skin which, although we can not change, definitely influences how what is done underneath will be eventually seen.
Rhinoplasty surgery is about changing the way these framework parts are joined and in how they are shaped and connect. Taking down a hump on the nose, for example, is a matter of lowering the roof line by reducing the nasal bones and septal height and usually allowing the roof sides to fall back in together once shortened. Reshaping the tip of the nose is by changing how the sides of the lower cartilages come together in the middle and changing their unified angulation to the underlying septum. Building up the nose is by adding some form of graft to the top of the roofline along its entire length. The variations of what can be done to change the structure of the nose are numerous and an artistic appreciation and experience is needed to know what will work well for any person’s nose.
One question that is often asked about rhinoplasty surgery is…will my insurance cover the costs? The answer is yes and no. If the procedure is being done to improve your breathing, then it likely will. If any part of the procedure is done to change the external appearance of the nose, then it won’t cover that part. Often nasal breathing problems, however, serve as an opportunity to have a cosmetic rhinoplasty as well. This is common and about three-fourths of my nose patients are having both done at the same time.
Dr. Barry Eppley
Tags: indianapolis, nasal anatomy dr barry eppley, nasal surgery, nosejob, plastic surgery, rhinoplasty
Posted in Newspaper Articles | No Comments »
Saturday, January 30th, 2010
With spring now in the foreseeable future, many people will be thinking about getting ready for the summer. As part of some get ready lists, removing unwanted body and facial hair works its way up that list. With the method of laser hair removal widely available, many will seek out these treatments. While laser hair removal is a good treatment method for many, the marketing and advertising claims frequently do not give an accurate reflection of the facts and the science behind it.
Laser hair removal should be best thought of as a hair reduction method. While some patients do get a high percentage of permanent hair reduction, the concept of permanent and complete elimination of hair is not accurate. The biology of hair growth and the way the laser light works makes this very difficult to achieve. When laser hair removal first came onto the scene in the early 2000s, this was naively widely touted. We now know better. If you can live with 50% to 90% reduction in hair, then laser hair removal may be for you.
Not all hair responds well to the laser. Like a black colored car that attracts sunlight and gets very hot, it is all about driving heat down to the growing hair bulb. For this reason, dark colored hair with fair colored skin always works the best. Blonde, gray, white, and red colored hair is not reduced as much because it is a ‘poor’ target. Expect less hair reduction if this is your hair color. Conversely, dark colored skin picks off some of the laser light before it can get to the hair bulb. (which actually is below the skin) Because higher energies of laser light is needed to get past the pigment in the skin, there is a slightly higher risk of skin burns and irritation.
Laser hair reduction requires a series of treatments to be effective. Because the laser will only knock out hairs in an area that are actually growing (less than 10% of your hair in any area is actually active at any one time), a series of treatments over time is needed. A general rule is that it will take 5 or 6 treatments over a 6 month period to get the best result. So while spring may bring hair removal to mind, you ideally should have started last fall!
Long-term maintenance treatments may be needed in many cases. Hair that was initially suppressed by laser treatments can get activated later in life with hormonal changes or medications that one may be taking. While this seems to be contradictary to the way most people think lasers on hair works (frying the hair bulb so that it is ‘killed’), the reality is that the laser changes the hair growth cycle and teaches it to grow differently. Often times, it changes a thick dark hair to a fine and clear baby hair. But certain changes in life can reactivate its original growth cycle making you see hair ‘coming back’.
Laser hair treatment is commonly done for both women and men. (men and back hair make up about half of the patients that we see) While it can be very effective for the right person, proper knowledge and education will determine if laser hair treatments are a good or better value over traditional waxing methods.
Dr. Barry Eppley
Tags: dr barry eppley, indianapolis, laser hair reduction, laser hair removal
Posted in Newspaper Articles | No Comments »
Saturday, January 30th, 2010
Due to the marketing and appeal of a facial rejuvenation procedure called the Lifestyle Lift, many people have at least heard of it. A scaled-down version of a facelift, the Lifestyle Lift is not unique or new but is actually a common procedure performed by many plastic surgeons. Todays trend toward less invasive plastic surgery and beginning facial rejuvenation earlier has led to the marketing of an otherwise routinue facial procedure.
Unknown to most, the Lifestyle Lift is a branded name and is a blended marketing and service approach to delivering minimally invasive facelift surgery. In essence, it is a franchise approach to selling surgery with office locations in 22 states. (the closest office to Indy is in Cincinnati)
While there is nothing wrong with that concept, the Lifestyle Lift company was recently fined $500,000 in New York where its corporate headquarters is located.. The attorney general there has settled complaints against the company as it has admitted that it used its employees to pose as satisfied customers in online ads. Apparently the company ordered employees to write positive reviews of the Lifestyle Lift on message boards and other internet forums to appear as unsolicited testimonials and endorsements, thus violating consumer protection laws. (proving once again that www. really means the wild wild west…believe at your own risk!)
While the company and the way it operates may have some deceptive marketing practices, the actual operation however is still a sound one. The limited facelift or short scar facelift (a.k.a Lifestyle Lift) is very popular and highly successful. It is a scaled down version of a more extended facelift into which many other smaller facial procedures can be added as well.
Younger patients today want to treat jowl and neck sagging early rather than wait until it looks worse. Therefore, their facial concerns are less severe and they do not need a full facelift operation. The limited facelift is often combined with other smaller procedures (e.g., Botox, injectable fillers, laser resurfacing, neck liposuction, eyelid tucks) to create an even better overall result without extending one’s recovery. Older patients (who really do need a bigger operation but do not want it) can still get a simpler and less invasive operation that will provide some real improvement. (although less than that from a full facelift) This usually fits their financial situation and allows them to have surgery that they can afford with a recovery that fits into their work or leisure schedule.
Dr. Barry Eppley
Tags: dr barry eppley, facelift, indianapolis, lifestyle lift, limited facelift, plastic surgery, short scar facelift
Posted in Newspaper Articles | No Comments »
Saturday, January 30th, 2010
In researching a plastic surgery topic this week, I came across an entertainment article in which the writer presented an opinion on the top ten plastic surgery disasters in men. Using photographs, they compared the ‘before’ and ‘after’s of several well known male celebrities- of which there is no doubt that these men have had facial work done. And I am not referring to in-office procedures such as Botox and injectable fillers. All had obvious surgical manipulation of aging facial features.
Those listed are well chronicled and include often cited celebrities such as Kenny Rogers, Gary Shandling, Carrot Top, Sylvester Stallone, Bruce Jenner, Burt Reynolds and Gary Busey to name a few. While I am certain that they don’t feel unusual looking, most women would disagree. This begs the question of what is it that makes them look unnatural? Is there a common problem that they now all share?
In reviewing these pictures it appears the problem lies for many of them in the work around the eyes and cheeks. On the whole, the appearance of these men has changed to more of a feminine look. This is the result of a variety of changes that include over-elevation of the brows, a ‘pulled too tight’ appearance around the eyes, and unnatural cheek bone augmentation giving an ‘apple-cheeked’ effect. The neck and jowl lines, while no longer sagging, have changed them. In an effort to rejuvenate the aging and sagging face, they have been overlifted and plumped up too much.
This may make the skin much smoother and eliminate a lot of skin wrinkles and folds, but the end result is anything but ‘natural’ in appearance, and is a red flag that screams ‘facelift!’ to even the least discerning eye. Certainly, men care about their appearance as they age, and want to look as young as they feel. With regard to celebrities, it’s a usually a foregone conclusion that plastic surgery is a necessity in order to keep pace with the up and coming younger entertainers. However, great work – and natural looking results are never a guarantee in Hollywood surgical circles, and paying top dollar to a well-known or famous surgeon really has nothing to do with the final outcome.
To get a natural looking result in men, facial rejuvenation really has to be ‘underdone’ in comparison to that of a woman. Women can aesthetically tolerate more significant facial changes.. The goal of very smooth skin and sleek facial features simply looks better on women. Even when women have gone too far, they rarely look as bad as what can happen in men. Nips and tucks are very helpful to slow the aging process down in men, but dramatic sweeping changes simply trade-off one problem for another. Facial rejuvenation in men illustrates the age-old concept that less is often more.
Dr. Barry Eppley
Tags: dr barry eppley, indianapolis, male plastic surgery, plastic surgery, plastic surgery in men
Posted in Newspaper Articles | No Comments »
|
|
|
|