One concept that is important to understand is the difference between non-surgical vs surgical fat removal. Without question, the definitive way to lose spot areas of fat is liposuction. Liposuction is a proven surgical method to reduce spot areas of fat and trim down specific body areas, but it is an operation and involves expense and recovery.  Non-surgical fat removal, no matter what the method, will never be as effective for spot reduction. One pursues that approach in the hope that enough fat may be lost to not need or desire the surgical solution. In short, non-surgical vs surgical fat reduction are not comparable methods. They have different outcomes.

Now enters one of the newest non-surgical fat treatments known as Zerona. Touted as a painless body slimming method that is proven to remove fat and inches without surgery with zero pain and downtime.  Could such a thing be really true? Is this hype or hope?

Zerona works by using a low frequency ‘cold’ laser that passes through the skin without injury and targets the fat cells. The laser energy targets the fat cells through a photochemical process. Not to be confused with a photothermal (heat) or photoacoustic (vibration) method, this non-heat generating process makes the fat cells ‘leaky’. The fat cells shed their liquid fat content, now known as free-fatty acids,  which is then absorbed through your lymphatic system. The lymphatic system transports it to the liver where it is processed and broken down, and most importantly, not re-circulated and stored again as fat.

Zerona is more than just a machine, it is a process. Treatment sessions number six to nine and have been shown to be able to take off three to five inches in the hips, waist and thigh in two to three weeks. But to aid the lymphatic clearing process, one must significantly increase their water intake and take a twice-daily niacin supplement during the treatment process. The treatment sessions require a commitment and must be done every two to three days to really be effective. Once the fat cells get leaky, you can’t let them heal themselves by missing treatments or having them too far apart. Each treatment session takes just under an hour and is painless. You literally get up and go afterwards. Daily exercise (such as brisk walking, light running, or other cardio training) can increase the final results by aiding in lymphatic clearance and an increased metabolism.

Is Zerona fat reduction too good to be true? It is if you think it is a replacement for liposuction or  a significant weight loss method. But if  you are looking for a safe and no risk method to lose some fat areas, Zerona may be a good option. For some, it is an alternative approach to try before submitting to liposuction and may eliminate the need for that experience and expense altogether. For others it is a commitment and a jump start to a healthier lifestyle…and along the way you may find a few things in your wardrobe that fit again.

Dr. Barry Eppley

Indianapolis, Indiana

This can best be explained by my response to a recent request for a free breast augmentation with a heart-felt plea for an improved perception of herself.

‘I have great empathy for the concerns you have about your breasts, and wish that providing you with a free procedure were an easy choice.  Given the number of women who come into my office with similar concerns about their bodies, I can understand how connected self-esteem and a positive self-image are.   Providing surgery for free may seem like a simple and straightforward thing to do,  but there are many factors involved that make the concept of ‘donated’ surgery not exactly free. While any plastic surgeon can give away his time to perform the operation, a surgeon’s fee represents just a fraction of the total costs of surgery. The cost of the breast implants, use of the operating room, and the fee for the anesthesiologist expertise are other cost factors that must be accounted for and paid. The surgery center or hospital, implant company and anesthesiologist are under no obligation, and usually are unwilling, to provide services and materials at their expense for an elective procedure. Often times, these costs make up more than that of the plastic surgeon’s normal fee.’

One of the hidden costs of any donated surgery in this country is the potential medical-legal responsibility. Unfortunately, donating surgery does not waive any responsibility on the plastic surgeon for the outcome. Should any untoward events happen, such as a rare but possible complication,  the surgeon is still liable and responsible.  The possibility also exists for the need for revisional surgery after the initial procedure should the result not be ‘perfect’ and the question then arises is the surgeon again expected to waive his or her fees?   While many patients say they will sign anything to get the procedure for free, the legal reality is that there are no forms or waivers that a patient can sign that will legally hold harmless the physician for the services that he or she has provided.

One may wonder then how do they do these free makeover surgery contests, either done locally or even on TV? The answer is whoever is doing it most likely is not a board-certified plastic surgeon. The American Society of Plastic Surgery strictly forbids providing any free surgery as a result of a contest, promotion, or any other method of inducement which encourages a patient to undergo surgery based on an economic incentive. Doing so is an ethical violation of its membership and could be grounds for dismissal from the Society. Those non-plastic surgeons who do offer such free surgery are not bound by these ethical guidelines and merely see the risk as a marketing expense.

While a plastic surgeon may choose to donate his or her skill and experience for free, the rest of the costs of surgery remain, and are usually out of the surgeon’s control. The legal and ethical issues, that are completing unaware to most patients, makes donating an invasive operative procedure not quite the same as giving away a more traditional retail product.

Dr. Barry Eppley

Indianapolis, Indiana

Liposuction is a proven surgical method to reduce spot areas of fat and trim down specific body areas, but it is surgery and involves expense and recovery. Lipodissolve injections are a non-surgical method of spot fat reduction but it is a slow and somewhat uncomfortable process that really works for the smallest areas of fat.

Along now comes ZERONA. Imagine a painless body slimming method that is medically proven to remove fat and inches without surgery with zero pain and downtime.  Seem too good to be true? As a weight loss method…yes. As an effective body slimming method that can shrink your tummy, hips and thighs without surgery…no.

ZERONA is uniquely different from liposuction and other body slimming methods. How does it work? Using a low frequency ‘cold’ laser that uses the 635nm wavelength, the energy passes through the skin without injury and penetrates up to 5 centimeters.  The laser energy causes the fat to emulsify through a photochemical process. Not to be confused with a photothermal (heat) or photoacoustic (vibration) method, this non-heat generating process makes the fat cells ‘leaky’. The fat cells shed their liquid fat content, now known as free-fatty acids,  which is subsequently absorbed through your lymphatic system. The lymphatic system transports it to the liver where it is processed and broken down, and most importantly, not re-circulated and stored again as fat.

ZERONA is more than just a machine, it is a process. Through a typical series of 9 treatments, up to 5  inches off of the hips, waist and thigh in two to three weeks can be achieved. But, to aid the lymphatic process, the patient must significantly increase their water intake,  and take a twice-daily niacin supplement during the treatment process. The treatment sessions require a commitment and must be done every two to three days to really be effective. Once the fat cells get leaky, you can’t let them heal themselves by missing treatments or having them too far apart. Each treatment session takes just under an hour, and is painless. Some have described them as almost ‘zen-like’ which I interpret as relaxing and non-stressful. Equally important, the patient can get up,  go and return to all regular activities without any restrictions. There is no pain, bruising, or need for restrictions,  but daily exercise (such as brisk walking, light running, or other cardio training) can increase the final results by aiding in lymph mobility.

If  you are looking for a quick, safe, and affordable way to lose some fat areas, ZERONA may be a good option. For some people, it will be an effective alternative to liposuction and may eliminate the need for liposuction procedures altogether.  For others it may not be a magic pill, but does offer a jump start to a healthier lifestyle…and along the way you may be able get back into that favorite pair of jeans.

Dr. Barry Eppley

Indianapolis, Indiana

As a way to feel better about themselves again, or searching for a fresh start in a newly single world, opting for plastic surgery after divorce occurs more and more frequently. The benefits of plastic surgery after divorce are far greater than what occurs on the outside. It can have a profound emotional and psychological uplifting effect. From my perspective as a plastic surgeon, I believe this is its most significant benefit. Patients can feel almost reborn after surgery, generating a fresh start to another chapter in their personal life.

Many patients, particularly women, have spent a significant part of their adult lives  looking after others. Whether it’s for their children, husband or their own parents, their needs are often subrogated to everyone else around them. As a result, their own self-value and worth may have become diminished. Combined that with the effects of time on the face, and the stress of childbirth on the body, it’s not hard to understand why the self-esteem suffers. It can reach rock bottom when presented with the prospect of divorce.

The impact of childbirth on the female body is well recognized. When those changes occur in the company of the man who helped create these kiddos, sagging breasts and loose belly skin are just part of the child-rearing experience. But when it comes to having a new set of eyes view those changes, it is perfectly normal to be apprehensive that forgiveness and understanding may not be part of the equation. This makes some of the most popular and effective procedures women undergo is from the collection of Mommy Makeover options. These include breast implants and lifts, tummy tucks and thigh liposuction or some combinations thereof to get back to that once smaller and more firm body that existed before childbirth. For some women, their bodies actually end up looking better and more shapely than they ever were.

While the body can be disguised by clothing, the face can not be so obscure. Lines, wrinkles, and sagging jowl and neck lines are the hard-earned result of life’s experiences, but a refreshed countenance can go far toward turning back the proverbial clock. Some women test the plastic surgery waters with in-office Botox, injectable fillers and skin resurfacing procedures. Others go for more significant rejuvenation through eyelid tucks and lifestyle versions of face and necklifts which produce change without a lot of recovery.
 
While plastic surgery can drastically boost self-image and confidence, it is not a fix for most of life’s problems. When done for the wrong reasons of expectation for some secondary gain, short-term euphoria can soon be met with disappointment. It can’t make someone else like you better or get you a better job or promotion. It is really about making you feel better…about you.
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One of the benefits of a more firm face and body is that it can be combined with the wisdom of life’s experiences and lessons. That combination can only bode well for moving on to new opportunities and challenges.

Dr. Barry Eppley

Indianapolis, Indiana

But more men are finding their way into the plastic surgeon’s office in the past few years. Besides a steady increase in male numbers, what is noteworthy is the change in what what men are requesting. While there remains some traditional procedures that have always been of interest, technology, societal trends, and younger men have opened up new areas of the face and body for change and improvement. Here are four of the most popular younger male (teenage to early 40s) procedures today.

Liposuction still remains the most requested male procedure.  The culprits are always the same, the stomach and love handle areas. But most men that want liposuction are not fat and many are not even overweight. To the contrary, they are lean but have fat collections at the side of the waist and flanks. Even in men that work out regularly, those love handles can be impossible to work off. Today’s liposuction techniques can even give that ‘six-pack’ look for those leaner men that are not opposed to a little surgical cheating.

Chest recontouring is the one male plastic surgery procedure that is really on the rise. Male breast enlargement, known as gynecomastia, has always been an issue. But with increasing teenage weights and the present young male aesthetic for a completely flat and smooth chest, improvement in the male chest is sought out like never before. Even small nipple protrusions can be bothersome for the teenage male. Obvious man boobs are not desireable at any age.

Nose reshaping (rhinoplasty) has always been a popular male operation and that has not changed. It is the one procedure of the face that young men are not afraid to change. Noses that are big with prominent humps and wide nasal tips are bothersome and distracting to an otherwise balanced face. Sports and recreational activities make the young male nose a good target for injury causing twisted and deviated noses that often pose problems for breathing as well.

One set of procedures that is really new and undoubtably influenced by movies and models is structural facial reshaping. Creating that chiseled and angular face is what some young men aspire to achieve. A good jawline in particular is associated with enhanced masculinity. While one perceived just as making a strong chin with an  implant, modern plastic surgery implants can be extended all the way to the back of the jaw. With the development of jaw angle implants, the jaw line can become more defined than just with a chin implant alone.  

A new generation is redefining male plastic surgery. Have a lean body, flat chest, and a nose and jaw line that creates a well defined face has probably never been out of style. But modern surgical developments make them more attainable than ever before.

Dr. Barry Eppley

Indianapolis, Indiana

What separates men from women in plastic surgery is two-fold. First and perhaps surprising to many, most men require extreme discretion and privacy. Men are much more sensitive to how they might be perceived by others for having plastic surgery. Secondly and not surprisingly, the type of procedures that men undergo in plastic surgery are different from women. The top male cosmetic procedures in my Indianapolis plastic surgery practice are nose reshaping (rhinoplasty), eyelid tucks (blepharoplasty), facelifts, gynecomastia reduction and liposuction.

Liposuction still remains the most requested procedure for men. Unlike women, however, male liposuction is done in the abdomen, love handle, and neck areas. Even in relatively lean individuals, fat collections at the side of the waist and flanks are common as one ages.  Even in men that work out regularly, those love handles can be impossible to work off. Today’s liposuction techniques have been refined to produce better results with less risk of skin irregularities and etching procedures are now available for the leaner male who want an easy way to the ’six-pack’ abdominal look.

In younger males and teenagers, nose reshaping (rhinoplasty) remains a popular operation. Putting the nose into better balance with the rest of the face can make a significant aesthetic change. It is not commonly done in men over forty who have come to accept the shape of their nose. Changing the nose in mid-life may make one feel ‘not like themselves’. Rhinoplasty may frequently be performed with chin augmentation for an overall better facial profile. Computer imaging is used before surgery to determine what changes to make on the nose and whether chin augmentation would be beneficial.

Gynecomastia reduction is the one male plastic surgery procedure that is really on the rise. Whether it be a small protrusion of the nipple in a teenager, to a more traditional larger gynecomastia in adolescents, to the sagging and deflated appearance in the middle-aged and older male, improvement in the male chest is sought out like never before. Liposuction, nipple lifting and reduction, and pectoral implants are potential methods for male chest enhancement. Refined liposuction techniques, known as etching, provides better definition to the pectoral muscle outlines which can be combined with any of the other chest contouring procedures.

Eyelid surgery (blepharoplasty) in the male is the best way to get rid of that tired and saggy eye look. Unlike women, most men wait until they have a lot more loose eyelid skin and wrinkles before considering surgery. Browlifting is rarely done in men lest they end up having the ‘Kenny Rogers’ result. Removal of eyelid skin and fat should be conservative in men to appear less tired and more rested, not create a new look. In the more senior male, the upper eyelids can become heavy with skin hanging down onto the eyelashes resulting in obstruction of one’s vision. Upper eyelid surgery in this situation can help one see better than they have for years.

Facelifts are the most misunderstood cosmetic procedure for men. As a tuck-up for the neck and jowls, a facelift only improves the jaw line and neck angle. Like eyelid tucks, men often wait until they have a very noticeable neck wattle that may interfere with shirt closure and may move unflatteringly when the head turns. Facelifting in men is best done in moderation, producing a neck change that is improved but not too dramatic. In very large neck wattles, a direct neck lift is a simpler and easier solution with the trade-off of a thin neck scar.

Dr. Barry Eppley

Indianapolis, Indiana

Hospitals certainly do advertise, as evidenced by the many billboards around the city but they rarely play the name game. While promoting new facilities, equipment and services, five star ratings and open houses are common marketing approaches in health care, ear grabbing phrases and slick-sounding names are not needed. When you are providing a service with proven benefit – such as a new hospital wing or MRI center, it is more about creating awareness, trustworthiness, and availability.  In plastic surgery, however, marketing often veers from the path of traditional medicine. In the world of cosmetic surgery, thanks to the reach of the internet, we are seeing the emergence and widespread use of clever names (and sometimes deliberately confusing ones) to entice patients to have procedures and surgery.

The  most well-known example is that of the ‘Lifestyle Lift’. Through their national magazine and television ads, this is a franchise approach to getting a facelift…or some version of it. Promising to turn the clock back at least ten years and look recovered in just a few days, its snazzy name seeks to assure patients that it will fit into their ‘lifestyle’. Interestingly, nowhere in their advertising does the company suggest it is actual surgery. I have seen numerous patients who have visited their facilities and were surprised to learn that it was actually an operation. These same people are certainly surprised to learn that the ‘Lifestyle Lift’ is an operation that is over twenty years old and is practiced by most plastic surgeons. This ‘mini-facelift’ operation has now cloned many spinoffs including Quicklift, Swiftlift and Weekend Lift to name just a few. Often touted as being innovative and original by the advertising surgeon, the names suggest that getting a fresh, younger look is really easy.

The fear of what transpires during a ‘Tummy Tuck’ keeps many women from actually having one. While there are different versions of tummy tucks, they all involve some degree of invasion of your mid-section, and some period of recovery. The ‘Smooth Tuck’ procedure puts a different twist on it. Promising less than a week of recovery and six-pack abs, who would not want to have one?  After all it is smooooth. The reality is the closest most tummy tuck patients can get to a six-pack is at their local convenience store. Flat, fairly taught tummies can be realistically achieved,  and that is more than enough for most patients. But getting back to work in less than a week looks better in an advertisement than it will feel in real life.

My current favorite is the Vampire Lift. Yes, that is an actual name that I hate to admit even exists in the industry. Using modern platelet and stem cell biology, the concept of extracting and purifying your blood for its healing components is used in many surgical specialities. While it can be a useful adjunct to certain surgeries, the fact that it is natural does not give it ‘pixie dust’ properties. The Vampire Lift  takes that concept and uses it as a substitute for injectable fillers to plump up your face. Promising to grow your own tissues to make lips bigger,  and injecting blood to make facial parentheses less noticeable certainly seems better than any synthetic product off-of-shelf. While this is an organic way to dispose of your money, it is a far fantasy from actual medical science.

What’s in a name? In cosmetic surgery, clever names often disguise an established procedure and might be just another way to catch the attention of a prospective patient.  

Dr. Barry Eppley

Indianapolis, Indiana

The debate over the Health Care Reform Act is all but a faint rumble now but it was really a largely economic and taxing exercise over an issue that has long been decided. With Medicare and Medicaid now making up well over half of whom most doctors and hospitals service, and with the percent growing, we have insidiously grown into a nationalized health service that existed before this recent discussion. Throw in the large Veteran’s Administration and military service health facilities and the government is by far the biggest payor for our nation’s health. The recent legislation was merely the tipping point that made the path to greater government control over heath care just go faster and even more evident.

While many clamored that the health system in the U.S. was broken, the reality is that it functions pretty well but is overwhelmed with demand that exceeds the economics to pay for it. The idea of insurance coverage and a societal safety net established in the 1960s never could have envisioned the population demand and the magnitude of health care advancements that have occurred in the past forty years. The very feature that makes our health care system the best  in the world…a system driven by entrepeneurship…is exactly what is making it suffocatingly affordable to many individuals and businesses now.

The one certainty that will result from this legislation is that you will be paying more…and eventually getting less. No matter how it was painted and sold in Washington, this is an absolute certainty. As a result, we have been seeing for the past few years the development of the field of  concierge medicine. As a fee for service concept, you pay a flat fee per year for an individual or family and get access to medical care 24-7. Various tests that may be needed are still billed to your insurance company. This allows you to use your health insurance as a catastrophic plan (and even a one day stay in the hospital can be an economic catastrophe) and pay lower premiums. This may only lower your out-of-pocket a little but it changes the level of service and cuts down on the amount of paperwork needed for doctor visits, etc.

While concierge medicine may not be the right choice for everyone, it is taken out of the playbook that plastic surgeons have used for decades. Elective cosmetic surgery, such as breast augmentation, facelifts and tummy tucks, is the original form of the concierge medicine fee-for-service concept. The idea of paying a fixed price for a certain medical service is re-emerging and will become increasingly popular. As more doctors withdraw from Medicare and Medicaid, due to the abysmal reimbursements and the labryinth of befuddlling paperwork and coding schemes, cash providers and practices will again become more commonplace.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic surgery has been one of the early adopters of both social networking and digital communication in the medical world. Part of this is because so much of plastic surgery is visual. Almost all of what we do can be seen and easily imaged. This is a double edged-sword as assessment is easy but with that can come an equal opportunity for criticism. Plastic surgeons rely on imaging only less than that of radiologists, whose entire practice is essentially the analysis of complex three-dimensional arrays of pixels. While a plastic surgery patient can provide great verbal detail and descriptions of their concerns, a good picture or two can leapfrog hundreds (or is it thousands?) of words.

Because of the need to market fee-for-service elective surgery, social networking sites have become a popular medium for plastic surgeons and numerous other practitioners of cosmetic services. In the old days (2000?), one would rent a hotel conference room  and put on an evening program for the public. Advertising by word of mouth or newpaper ads might get an audience of 50 to 75 people. Post  a blog or a promo on Facebook or Twitter and the potential exposure is to thousands.

I could pontificate on the medical impacts of these technologies, and there are too many to mention here, but one recent story makes the point. Driving home one evening after a day of surgery, I received a call from an emergency room halfway across the city. They had a five year-old boy that had a laceration on his forehead after his older brother  yelled, fore!, and swung. These type of calls are common in plastic surgery and despite that I would have liked to fix this child’s problem, being up since 4AM and driving 35 miles was not beyond what I could muster. I asked the emergency room doctor to pass along my regrets and asked them to call another plastic surgeon. As I was settling down for the evening and just put my feet up, I received an unrecognized e-mail on my iphone with a one sentence message and a picture attachment. The message said, ‘My son is in need of your skills.’  signed by a mother’s name I had never heard of. The picture showed a close-up of a child’s face with a laceration down the center of the forehead between the eyebrows and the scalp…right down to the bone.

I don’t need to tell you what happened later that evening.  With estimates that at least two-thirds of American physicians have smart-phones, doctors are prime targets for access from multiple wireless methods. With nimble technologies, from smart phones to  health-monitoring devices, patients as well as doctors are becoming more empowered. Will this make health care better and reduce costs? Who knows but interactive health and wellness programs already surround us. Apple alone  has thousands of health-related applications. Cell phone services using the Droid are not far behind.

Medical care is becoming more wireless at a brisk pace. While receiving the actual care still requires an in-person visit, the day may not be too far away when all you need to do is hold your cell phone next to what hurts.

Dr. Barry Eppley

Indianapolis, Indiana

Upper eyelid surgery gets rids of hooding and excess skin that may be hanging down on your eyelashes. Upper blepharoplasty helps restore a natural, youthful appearance by removing skin through an incision in the eyelid crease. In some cases, fat may also be removed or redistributed. Since the incision is carefully placed, it is undetectable once healed. The only way that fine little scar can be seen in the upper eyelid is if they look while you are sleeping!

The lower eyelids are one of the first areas of the face to show age-related changes. Most of us know this because the appearance of bags and wrinkled skin.  Loose skin and muscle create a droopy appearance and a protrusion of fat, which normally is under the eyeball,  creates that classic but dreaded appearance of lower eye bags. These bags are really prone to absorbing fluids which is why they are more swollen in the morning or if you have eaten really salty foods the day before. The lower eyelids can be improved by an incision which is hidden either inside the eyelid (if fat only needs to be removed) or just below the lashline. (when all tissues need to be treated) The muscle, support tendon, and skin are reshaped and tightened back up against the eye. That protrusion of fat is either removed, tucked back in, or repositioned over the edge of the eye socket bone, dependent upon what will look best. In some patients, chemical peels or laser resurfacing can be done at the same time (only when the incision is on the inside of the eyelid) to improve wrinkles and loose skin on the lower eyelid and crow’s feet area.

One of the most interesting things about these procedures is that most patients say… the most surprising thing about eyelid surgery is the lack of pain during recovery. While eyelid surgery may look bad, it actually produces very little pain. Your recovery is largely social and about how you look.

The other comment that patients often say is…why did I wait so long?  I spent a lot of money on creams and other potions and none of them worked…and they promised they would! (hope still remain the #1 selling point) Eye creams are beneficial but they are largely about prevention and not about reversing the age changes that are already there. They simply can not tighten or lift skin to any visible degree.

Dr. Barry Eppley

Indianapolis, Indiana