Archive for the ‘Newspaper Articles’ Category
Monday, June 20th, 2011
Liposuction is a very effective procedure for removing unwanted fat. It is a well known procedure that many people want and some have concerns about its safety. There are stories every year around the U.S. about serious complications arising from liposuction so it is no wonder it can give one pause. If you dissect behind these stories, however, there is almost always a reason these liposuction complications have occurred. This recent story caught my attention…I will get into the reason after the story.
‘Earlier this month, an Arizona doctor was charged with murder after three patients died in 2006 and 2007 during liposuction procedures performed at his clinic. According to the prosecution, the doctor did not kill these patients with a gun, rather the murder weapon was arrogance and the motive was greed. Two of the patients overdosed on anesthesia during routine liposuction procedures and the third died of a fat embolism after undergoing buttock augmentation with fat injections. All three were improperly intubated during resuscitation, making it impossible to save them.
The doctor, who was trained in Internal Medicine and Dermatology, opened a cosmetic clinic in 2005. Initially he offered Botox, hair restoration and laser procedures before moving ‘up’ to do liposuction and breast augmentation. He employed medical assistants with little or no medical training. According to the Arizona Medical Board Review, his medical staff included a massage therapist, a former restaurant owner, two former pre-school teachers and his mother. And when he had to surrender his medical license after the first two deaths, he hired a homeopathic doctor to perform surgery that soon killed a third patient.’
While on the surface of the story liposuction receives the blame for these complications, even the medically uneducated would perceive that the real problem was not the procedure but the doctor. The average person reading this story would say…how could this happen? Aren’t there rules and regulations that govern what doctors are allowed to do?
The simple answer is…no. Once a doctor has a medical license, they can perform anything they want…in their office or their own clinic. The only regulations are when they try to perform procedures in a hospital where medical oversight exists. This has become a significant issue in cosmetic surgery where much can be done under local and IV sedation anesthesia. An office setting without general anesthesia is very appealing to many patients, particularly when it comes to liposuction, as they perceive a limited or virtually no recovery scenario. As this story illustrates, the office setting under local anesthesia may not be safer than an operating room under general anesthesia. Not to mention that the results between the two locations may not be remotely similar.
How could someone with no real training be allowed to perform these procedures you ask? Because in the office setting the only ‘regulations’ a doctor has is their own conscience. In today’s medical climate, whether it be for economics or ego, the appeal of an upfront fee as opposed to an insurance billable procedure is an invitation for doctors to step beyond what they are actually formally trained to do.
Prospective cosmetic surgery patients need to do their homework and look out for their own health and safety. That attractive low fee and the ‘simple’ office procedure can be a recipe for problems. Bargains are for the retail mall, not for medical procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, liposuction safety
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Monday, June 13th, 2011
If you ever consider having plastic surgery, qualifying the doctor is an important first step. Are they the right doctor for you and what you need? Many magazine articles and other sources will give you a list of good questions to ask when you have an in-office consultation such as (1) are they board-certified, (2) how many years have them been in practice, and (3) how many procedures of your interest have they done?
While these are certainly good questions and the answers are extremely relevant, such questions today can be answered long before you ever pull into the parking lot of the doctor’s office. If you walk in with these types of questions for your consultation, you must not have a computer in your house or have never done a Google search. It is hard to imagine that such a person exists today, except maybe my 95 year-old grandmother.
While these were once good questions for prospective patients to ask during an office visit, they have gone the way of the bag phone. Such answers are relatively easy to find at the click of a mouse from home. Whether we as plastic surgeon’s like it or not, our websites and the information that they provide is a lot more relevant to patients than any number of diplomas hanging on the wall. If a plastic surgeon doesn’t have an up-to-date website that easily provides this basic information, patients will quickly move on to another surgeon that does. Today’s internet-based society makes it essential that these once basic qualifying questions are easily answered with minimal research effort.
With today’s electronic informational access, photo and video acquisition, and numerous locations for postings, contemporary plastic surgery qualifiers are different and more meaningful. Today, the more relevant checklist in finding the right plastic surgeon for your needs is procedure education, photographic examples and patient testimonials.
Traditional office print pieces, such as brochures and flyers, are historic methods of education in every plastic surgery practice. While they are still useful, so many are tempate-derived that they provide generic and virtually useless information…other than to say this service is provided. You want to know what this specific plastic surgeon does, not what most plastic surgeons do. This has spilled over now into websites as well. They all look pretty but what about their content? Is it meaningly and relevant to your needs? Look for brochure and website information that provides current and updated procedure information. This also suggests an interest in ongoing patient education which is most manifest in some type of website blog.
We have image overload everyday. Whether it is on Facebook or on your cell phone, we are surrounded by pictures. Plastic surgeons are without question the most advanced and proficient of all medical specialities in taking pictures. Therefore, patients should expect a good demonstration of a plastic surgeon’s most valued asset, their before and after patient photographs. While it is true that the best results will be posted, at the least you need to see a handful of actual patient before and after photographs. The more, the better.
Patient testimonials carry a lot of weight. Who doesn’t want to hear about a happy patient when you are considering going to that plastic surgery practice. But don’t just rely on what is posted, ask to talk to at least one patient who has had your similar procedure. But a patient who had surgery a long time ago is not as useful as one who has had surgery in the past weeks to months. Fresh experiences are what you need as these patients have the best recall of what it was like right after surgery.. Having a recent patient also suggests that the procedure is performed more than just a few times a year.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery education
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Monday, June 13th, 2011
Liposuction is a very popular body contouring surgery largely because it works. It is an immediate method to remove certain areas of unwanted fat that you just haven’t been able to budge by your best efforts. With this fat removal method, may people expect to lose weight as well. It is no wonder many people think this when you see such advertisements such as ‘Lose 10 lbs In A Few Hours’ or ‘Get The Body You Always Wanted’. I have seen many such liposuction promotions in magazines and on the internet and it begs the question of aggressive advertising vs . medical fact.
Can you lose weight by liposuction? The simple answer is yes…in the short term. When advertisements promote how much weight is removed with liposuction, they are referring to what is suctioned out at the time of surgery. This is known as the fat aspirate and and is collected in a canister. It can be both measured in cubic centimeters or millimeters (always is) and weighed. (sometimes is) The weight of the aspirate can be closely approximated by its measured volume. Since a gallon of water weights 8 lbs and a gallon contains 2.2 liters (2200cc), then a liter (1000cc) of fat will approximately weigh 3 1/2lbs. Therefore if you have had liposuction surgery and had 2000ccs removed, for example, then you would have had a surgical weight loss of about 7lbs.
While this seems impressive, and one did have this 7lb weight loss in a hour or two, it is actually a bit misleading. The reason is that prior to the actual liposuction being done, a large amount of fluid is first put into the fat known as tumescent fluid. This is essential to liposuction to not only lessen the pain after surgery but, of equal importance, to reduce any bleeding that the procedure will cause. This fluid has both volume and weight and the actual fat aspirate will contain up to 1/3 of this by content. So the actual amount of fat removed and weight that has come off has to be toned down a bit. When you see large weight loss claims from liposuction, it is because large amounts of tumescent fluid have been initially placed….and then removed as well.
While liposuction may cause some weight loss immediately (surgical weight loss), a more significant drop may actually occur afterwards. In the healing phase for several weeks after surgery, most people are not motivated to eat normally. When combined with the increased caloric demands of healing, a metabolic weight loss often happens. This will usually equal the surgical weight loss by four to six weeks after surgery. So if 5lbs of fat aspirate has been removed during surgery, one can usually expect to be down 10lbs in another month or so. Whether one sustain this weight loss over time is affected by many factors, not the least of which is one’s lifestyle habits.
While liposuction and weight loss will be forever linked, one should view the association as incidental and a side benefit. Weight loss is not the reason to have liposuction…spot body contouring is. Some weight loss will happen for almost all patients. The amount varies on one’s body and how much fat was removed. Some view liposuction as a jump start method for their weight loss approach and, in the short term, that is what will happen.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, weight loss after liposuction
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Monday, June 6th, 2011
While women have always made up the majority of plastic surgery patients, the percentage of men is steadily increasing. More men today acknowledge what women have known all along…appearance does matter regardless of age.
While the goals are always the same, to look as good as one can, a man’s age influences why it matters. Younger men are motivated by optimal attractiveness or to correct features that they consider embarrassing. Older men are motivated by divorce, job competitiveness and countering the effects of time. The common procedures that men choose, not surprisingly, are also influenced by age. Droopy eyelid skin and neck wattles are the concerns of older men while the removal of excessive body fat and reshaping noses, ears and chins captivate younger men.
While age may make a difference in what plastic surgery procedures men desire, there is one characteristic that they all share. Men are less patient than women, particularly when it comes to appearance issues. This means that cosmetic treatments that require regular maintenance, like Botox and injectable fillers, are not that appealing. Men prefer more of an immediate fix like what surgery does. And men do not want a lot of recovery or downtime after surgery if possible. Discretion is paramount in male cosmetic surgery. While everyone knows that men having plastic surgery is not rare, the male patient does not really want to broadcast it.
One observation that has reverberated amongst plastic surgeons for decades is that men can be difficult to please and are less satisfied than women after surgery. They also are more prone to want revisional surgery. That has not been my experience…with the exception of the younger male patient. Facelifts and eyelid surgery in the middle to older-aged male gets good results and satisfaction is just as good as women. When it comes to structural changes in the face or body contouring surgery in the younger male patient, there is some definite truth to that belief. Younger men today grow up today playing with action figures, looking at men’s magazines and seeing great emphasis placed on exercise and sports which exposes them to more pressure to have a very masculine face and body. This makes managing the expectations from surgery in younger men extremely important.
One male quality that seems to be true…and most women will probably second it as well… is that many men are not very tolerant of pain. They are less comfortable with after surgery discomfort and that is to be expected as men have never endured pregnancy and child delivery. That gives women a decisive advantage in the early after effects of many plastic surgery procedures. This is not to say that men are not tough, just not as tough as women when it comes to appearance alteration.
Last year over one million men underwent some form of cosmetic alteration in the U.S. The stigma of men paying more attention to their appearance and grooming habits has changed alot in the past ten years. The beauty gap between men and women is closing to some degree as an increase in the desire of men to use their improved looks to remain competitive professionally and personally is on the rise.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, male cosmetic surgery, male plastic surgery
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Tuesday, May 31st, 2011
A common question that some women face today is…are they for real? With more women than ever undergoing breast augmentation, this is not a far-fetched question. It may be inappropriate to ask but the statistical reality is one may be more right than wrong many of the times. According to statistics from the American Society of Plastic Surgeons, the number of women who have had breast augmentation had risen nearly 40% over the past decade. In 2010, nearly 300,000 American women received cosmetic breast enhancement.
One other trend in breast augmentation is a noticeable size difference. Many plastic surgeons have commented that women are asking for bigger breasts than they were a decade ago. Historically women would usually ask to go a cup size bigger. Today it is not uncommon for a women to want two or three cups bigger, particularly the younger they are. Women state they want to get a good value for their investment and they want to make a noticeable difference in their clothed appearance.
What accounts for these trends in breast augmentation? By far I would say that it is simply more accepted than ever before. As we enter the upcoming decade of 2010 to 2020, this is the beginning of the third generation of women who have had access to breast implants for cosmetic enlargement. It is a normal part of society now and younger women’s mothers and soon grandmothers will have had the procedure.
Breast augmentation has a track history of safety as well as effectiveness. Despite the hullaboo of what transpired in the early 1990s, the procedure has been proven to cause no medical problems or makes people systemically sick.. While it is far from a perfect procedure, because after all it is an implant in the body, its complications are local in nature and often aesthetic in significance.
The social trends of today play a major role in its popularity as well. Just go through the checkout counter at the local grocery store and the magazines are full of articles about celebrities who have had or are assumed to have had some form of plastic surgery. Many of these are women actors and performers who have enhanced their top half. The influence of these magazine, TV shows and now the internet have made it seem that having breast enhancement is now the new norm.
There are more choices in breast implants today than ever before. Since 2006, both saline and silicone implants are available in not only differing sizes but projection and styles as well. With the potential for gummy bear breast implants to be available perhaps later this year, increasing implant options appeal to an even broader spectrum of women. Just like the many aisles in a drugstore, multiple options for a single product line result in more sales.
The rise in breast augmentation is a result of greater societal acceptance, safety of the devices, influence of famous people, and a wide variety of implant options. I suspect the upcoming decade will see the number of implanted women continue to rise.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, breast implants, dr barry eppley, indianapolis
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Tuesday, May 24th, 2011
Liposuction remains the most rapid way to lose unwanted fat albeit a surgical one. While it is ideally for those people who have made every effort to lose fat areas on their own through diet and exercise, not every fat area responds the same. Some fat areas are more difficult to lose than others and certain fat areas can not be reduced at all except in the face of extreme weight loss. It is these non-metabolically responsive fat areas that justify liposuction intervention.
One of the very good questions any prospective patient should ask about liposuction is will my fat return? Will I keep this fat off years from now or is this just a short-term fix? Economically does this procedure have a good ROI? (return on investment) There are many urban myths about whether fat can or can not return after liposuction. Where some of these purported claims come from I do not know, but science and a lot of patient experience provides the following insights.
Fat will not return after liposuction. This is patently false and perhaps was started and propogated by what one would hope will happen. The reality is fat can return. The results from liposuction are closely aligned with your weight. If your weight stays the same years from now then so should the result. Fat after liposuction can return just as easily as after weight loss…and then weight gain. Some body areas are more resistant to fat return than others (knees or arms vs stomach and waistline), but no body area or fat cell is completely immune to the allure of extra calories.
If fat comes back after liposuction it will go to other body areas. This is sort of true but not to the extent of what was originally removed. A recent published study showed that fat suctioned from the stomach and thighs from women had some slight increase in measurements in the arms and upper back a year after surgery. But not to the extent that the women noticed or was bothered by it…or that they regretted having the procedure. If fat returns it must go somewhere and it is logical that it may have more trouble going back to a treated area that is now embedded with scar tissue.
Fat cells are permanently destroyed by liposuction. This is not true. Those fat cells that have been suctioned out are permanently removed. But there are always lots of fat cells left behind as you can not or would you want to remove them all. (otherwise your skin would be stuck down to your muscles and wouldn’t move) While the fat cells that are left behind may be damaged, they have a great ability to heal and regrow. Since it has been discovered that fat sites have the highest amounts of stem cells in the body, and stem cells can be easily stimulated to grow and transform into fat cells, liposuctioned fat sites are not immune to recur. This may be different with the current use of Smartlipo (laser liposuction) where the heat from the laser energy can cause more fat and stem cell damage.
Despite the effectiveness of liposuction to reduce unwanted fat, the long-term success of the procedure is highly dependent on the lifestyle habits on whom it is performed.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, fat return after liposuction, indianapolis, smartlipo
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Monday, May 16th, 2011
If a picture is worth a thousand words, then a story is worth at least five hundred words. Many mothers may find this story of interest.
‘When 34 year-old Kathy opted to get breast implants and a lift one year after having her third child, she didn’t really think of herself as having any type of makeover. She just wanted back what she had before children and to regain the confidence and clothing options that she once had. Before three pregnancies, she was a nice full C cup. But between breastfeeding and the repeated stretching and shrinking that occurs from the pregnancy process, she was now done to nearly an A cup. She knew it was bad when her sister said she really need some plastic surgery.
Two years later, she returned for a tummy tuck. She wouldn’t be seen in a swimsuit or any tightly fitting clothes, lest her stomach bulge be seen complete with all of its stretch marks and an unusually-shaped belllybutton. Despite of years of steady dieting and numerous weekly workouts, no stomach cure had been achieved. She wasn’t fat but had a lot of loose skin of which no amount of exercise is magically going to burn off. She finally realized that she was trying to get rid of something over which she had no control. ‘
Between the two plastic surgery procedures she had undergone a Mommy Makeover, a popular term used for multiple plastic surgery procedures that restore, or improve, one’s post-pregnancy bodies. Unlike the extreme plastic surgery makeovers seen on TV, mommy makeovers are extremely common and the breast and stomach procedures are both done at the same time. Unlike the previous generation, mothers of today want to return to their old body and, in many cases, even have a better one than before the pregnancies.
One interesting thing about Mommy Makeovers is some psychology behind them. Many women feel guilty and little selfish about such ‘self-indulgence’. They may also be worried about taking time away from their children’s and husband’s hectic schedules to undergo surgery. Some may argue that how you feel as a mom is important to one’s family as well. It is not really all that self-centered to feel youthful and more confident. Having an improved body image may also improve one’s interactions with their own family. I am not a women nor have ever been pregnant so I can’t speak for whether this is psychological double talk or fact. But I do know what many women have told me… they may be a mommy but they are still their own person as well.
One very common Mommy Makeover questions I get asked is, how soon after my last pregnancy can I have surgery? How long to wait differs on whether it is the breasts or the stomach that is being addressed. Breast augmentation and/or lifts can be done as soon as six months afterwards as time never improves breast shape. One only awaits the completion of breast feeding or the maximal amount of breast deflation. Liposuction and/or tummy tucks should wait until you have put forth your best effort at diet and exercise or have come to the realization that the loose skin is the main problem. This may be six months for some and for other women it may be years later.
Tags: dr barry eppley, indianapolis, mommy makeover
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Monday, May 16th, 2011
Over 30 million people in the United States have some degree of migraine headaches. While there are drug therapies that are very effective, some patients either get little to no relief or have other problems related to side effects from taking the drugs. For a small number of migraine sufferers it is very disabling and little benefit is obtained despite the best neurologic care.
Plastic surgeons have developed new procedures to “deactivate” migraine headaches…and it was learned from results seen from cosmetic treatments. Usually cosmetic surgery benefits from what is learned in reconstructive surgery but this is one of the rare instances where the reverse has occurred. Based on Botox injections and browlift surgery, both which temporarily paralyze or remove certain brow muscles, significant improvements or actual cures occur in migraines that start in the forehead. This has led to understanding the cause of migraines in some patients known as the peripheral trigger.
The peripheral trigger theory of migraines is based on certain sensory nerves being squeezed or compressed by a surrounding muscle or contact point. Due to the nerve being irritated, this leads to a cascade of events that becomes a migraine. To date, four trigger areas have been identified. Three of these are where a nerve passes through a muscle and many with migraines can actually put their finger on these exact spots; the greater occipital nerve in the back of the head, the zygomaticotemporal nerve in the temple area, and the supraorbital nerve at the inner half of the eyebrows. The fourth trigger point has been identified in the nose where a significant septal deviation makes contact with an enlarged turbinate.
Surgical migraine deactivation is done by removing the source of irritation, the muscle from around the nerves or straightening the nasal septum. This is done through small incisions inside the scalp hair or from inside the nose. Studies have now been reported that such surgery produces good results that last, with nearly 90 percent of patients having at least partial relief at five years after surgery. Migraine attacks were less in number, not as severe, and lasted for a shorter period of time. In about one-third of patients studied their migraine headaches were completely eliminated.
While migraine surgery is for just a minority of sufferers, it is not a procedure that is associated with any significant complications or side effects. The procedures are comparatively minor surgery, have quick recovery, results are immediate and no patient yet has reported that they have gotten worse afterwards.
How does one know they may get improvement in their migraines with surgery? Before surgery, one needs to be tested with Botox injections to confirm the correct trigger site. If Botox works to temporarily improve migraine symptoms, then the peripheral trigger is confirmed and surgery will likely be successful. But before one considers Botox injections and even surgery, they should be initially evaluated and treated by a neurologist. Only after failure of traditional medical treatments should one consider this new plastic surgery treatment.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, migraine surgery
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Monday, May 16th, 2011
Breast augmentation continues to be one of the most popular and successful body contouring procedures in plastic surgery. While it may seem hard to make the association of breast enhancement with confections and desserts, they are more closely related than one would think. This is because of two recent technological advances in the type of breast implants that are available and how they are implanted at the time of surgery.
One important, but often overlooked, aspect of the surgical implantation of breast devices is getting them placed into the breast pocket. When only saline implants were available this was never a concern as they were inflated after they were placed. This meant that very small incisions could be used for their introduction that were not even on the breast. Rolled up like a burrito, a saline implant is inserted through a one inch incision and then inflated to the desired size. With the re-introduction of silicone breast implants in 2006, larger incisions are needed as they are pre-filled and must be inserted as such.
This makes the issue of larger scars with silicone breast implants a concern for some patients. Plastic surgeons will frequently push and cram the breast implant through a small incision because of this concern. Needless to say, this technique is not good for the implant and undoubtably weakens its shell and leads to premature rupture and the early need for replacement. That has all changed with the introduction of an improved delivery method.
Known as the funnel, and looking exactly like what is used to decorate a cake, the breast implant is now easily propeled into the implant pocket….all without ever touching the implant or squeezing it too hard in one place. This incredibly simple but highly effective delivery method now makes it possible to use very small incisions again and even do silicone gel breast augmentation from a remote armpit incision.
As silicone gel has returned as an implant option to saline, it has again become a sought after breast implant material. With no risk of ever spontaneously deflating like a saline implant can (and eventually will), its more natural feel makes it a very popular choice. While the health concerns from the early 1990s with silicone has long been dispelled, the concern about rupture and what happens to the material persist. This has lead to the development of advanced silicone materials that hold together more like a solid, resulting in what is known as the gummy bear breast implant.
The gummy bear breast implant is more than just a cute nickname. It is a reflection how the silicone filling looks and feels…soft and spongy. And just like those cute little red, green and yellow bears, you can push and pull on it and even cut the material and it won’t lose its shape. The physical similarity between this new implant and the candy are striking and it is no wonder how it got tagged with this name.
Breast augmentation continues to get better and more safe as the materials and techniques to deliver them improve. This gives women more options to choose what they feel best fits their bodies.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, funnel breast augmentation, gummy bear breast implants, indianapolis, silicone breast implants
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Monday, May 2nd, 2011
One of the most common reasons men appear for facial plastic surgery revolves around one issue…they are tired of looking tired. Even though they get 7 or 8 hours of sleep, every morning someone eventually asks if they had slept well. Most men over age 50 can relate. They want their face to look as good as they feel and can be frustrating when it is not.
The classic story that I often tell is one of the differences between being younger and older. In college you pull an all-nighter and the next day, looking like you had, proudly proclaim your accomplishment when asked. When you are older you get 8 hours of sleep, go into work and the first thing someone asks is…did you pull an all-nighter?
Eyelid lifts, or blepharoplasties, can clean up that tired look by removing extra skin and fat from around the eyes that has developed over the years. But blepharoplasty is just one of the growing number of cosmetic procedures that more men are having. Facelifts, hair transplants and stomach and love handle liposuction make up most of the age-fighting operations.
While men were once just a minute fraction of any plastic surgeon’s practice, those numbers have grown to represent 15% to 20% today. Men of all ages are growing more comfortable with the idea of getting help for their looks. It is simply more acceptable today, another example of the rapidly changing social attitudes sweeping our society. Most men are interested in improving their appearances but without taking too much time from work. It also doesn’t hurt that plastic surgery reality shows (do men really watch these?) and affordable financing have also promoted interest.
Another galvanizing drive for man having plastic surgery is job insecurity and staying competitive. While looking good and appearing energetic has always been important, in a tough job market it is important to look as best as one can. I just had a man come in last week who was between jobs and wanted to look good for interviews. The competitive nature of men can make them willing to try something they believe will give them an edge in an interview or a potential business transaction. The practical economics of men also has them saying such changes are an investment in their future.
The internet has also fueled this male cosmetic surgery interest, specifically internet dating. I have had more than one man who has told me he can’t post a current picture online of the way he looks now. One patient even told me a woman embarrassed him by commenting in an e-mail exchange about his eye bags. (he reposted his picture after his eyelid lifts)
Men fear more than women that undergoing plastic surgery will make them look too drastically changed or have a ‘surgical look’. While there are certainly some male celebrities and actors that have that look, they are the exception. In reality, getting rid of those sagging jowls and droopy eyelids can definitely make one look less tired and more alert but the change is almost always subtle and natural.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, male plastic surgery, plastic surgery for men
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