Your Questions
Your Questions
Q: Dr. Eppley, I was interested in getting a consult for myself for the Vanquish vs. Exilis for several areas. I was also going to potentially buy a gift for my significant other as he is very concerned about abdominal fat. He also is considering Liposuction, so I looked that up. In your article about Liposuction you indicated that non-surgical, non-invasive fat removal methods are often not realistic and over hyped. Now, I am not sure whether to pursue the consult for the Exilis and/or Vanquish.
A: Any non-invasive body contouring procedures can not be compared in results as to what surgery can do. (e.g., liposuction) They rarely are even close. In general, there is a often a disconnect between patient expectations and what these types of treatments can do. Between a patient’s hopefulness and device marketing (by both manufacturer and practitioner), there is ample opportunity for patients to be disappointed. This does not mean that these devices are not beneficial and can not create moderate body contouring results, but each patient needs to be assessed individually to determine how non-surgical vs. surgical ROI (return on investment) compares. That requires a thoughtful and honest discussion which I regularly do for many potential patients seeking such treatments. I own both Vanquish and Exilis, so I have great insight into their potential value, but I also have no interest in patients making a ‘poor investment’ either if they are not good candidates for them. I would recommend that you and your husband come in and talk to me about it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a consult scheduled with you in the next few weeks for a breast lift and removal/replacement implants. I was also wondering if you could answer some questions about the differences between Exilis, Vanquish, Venus Freeze, Cool Sculpting and I-lipo. A friend of mine has tried the I-lipo. I have read about all of them online. Hard to tell what the “best” option for a little targeted fat loss and skin tightening would be. Maybe they are all good options.
A: In today’s world of non-invasive/non-surgical body contouring, there are a number of devices that are currently available for some degree of fat loss and a little bit of skin tightening. (and I want to emphasize the phrase ‘a little’) All available devices are based on some form of penetrating energy from ultrasound, infrared, radiofrequency and thermal sources. They all claim effectiveness but whether one is better than the other can never be proven since there are no comparative clinical studies of them. I have used most of these devices and, in the properly selected patient, can offer some reasonable results. Currently we use Vanquish and Exilis for the best non-invadive body contouring results, They are best used in those patients who are never going to have surgery to those that want to give it a try with actual surgery as a final treatment if needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Specifically I have had a problem with “marionette lines” since my early thirties, I am now 41. I had Juvaderm twice about five years ago and I had Restylane this past October. I definitely prefer the Juvaderm and I was going to do that again. Maybe with some Botox as well because I also have smokers lines around my lips. I am not a smoker but I have a habit of constantly chewing on the sides of my mouth and that, along with genetics, appears to be a big contributor. I have not actually tried any Botox yet but research indicates the two treatments together could get me a nice result.
The reason I am inquiring about the Thermage is because my face is aging just like my mother’s, she had Thermage done in 2009 and had a great result. She has not had any follow up treatments and her face is looking very saggy again but I do think if she had kept up treatments she would be looking pretty good right now.
I am wanting to know which treatments would give the best long term results. The Thermage appeals to me more than injecting things into my face and it appears that it is something I could maybe do around once a year, where as the injections would need to be done more often. I am not opposed to injections and pain is not a factor. It is more about what is being injected into my face.
I currently get microdermabrasion every two weeks and I use vitamin C and lots of sunscreen because I am very pale.
I have been doing research on line for years about procedures. Now that I have some background information on what seems like a million options, I need to know what would work best for me and still be in my comfort zone. I have a big fear of looking plastic and unnatural, but now my fear of looking older than I really am is becoming bigger.
A: Thank for clarifying your problems. While the options for your concerns may seem endless, they really are not. The reason it seems there are so many is that none of the non-surgical approaches have any lasting effect and the differences in the results many of them produce are negligible. Hence, many things exists when none of them really work that well…at least compared to surgery.
For marionette lines, injectable fillers are the only real effective non-surgical option as you already know. Botox is not going to help the marionette lines because that it is not a muscular/animation problem. Botox can be effective for helping reduce some vertical lines in the lips and may help turn up the corners of the mouth a bit but it is a deanimator not a filler.
The use of Thermage is for the treatment of jowls and for some mild facial skin tightening. While once state-of-the-art in its day, it has largely been surpassed by many other ‘tissue heating’ technologies such as Ulthera or Exilis. They all work the same even though the energies that cause their effects are different. (ultrasound vs radiofrequency) While they do some good facial effects for some patients, they don’t really make new collagen that is sustainable and thus their effects are short-term. It takes a lot of maintenance treatments to keep their effects and that can quickly surpass the effects of surgery which is much longer-lasting. Face and neck treatments like Exilis when combined with overlay treatments of light fractional laser resurfacing skin treatments is a very fine combination that for the right patient can produce some really good effects.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I would like to find out if I am an appropriate candidate for lipodissolve. I had a tummy tuck about 7 years ago and do not wish to have another surgical procedure. I have always had issues with my flanks.
A: While I obviously do not know what your flanks look like, I highly doubt they could be signficantly improved by Lipodissolve injections. That is a fat reduction technique that has largely faded from use due to limited effectiveness. I still use it occasionally for small revisions after liposuction surgery but it is too ineffective and inefficient to treat laregr fat areas. You may consider other non-surgical alternatives such as Exilis radiofrequency treatments which have been shown to be more effective than these old-style fat injections. But whether even this approach is appropriate would depend on the size of your current flanks. I would encourage you to come in for a free consultation to find out the advantages and disadvantages of both flank liposuction and Exilis treatments to the flanks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 63 year-old female who just recently had a facelift. Because I am thin, I really had no fat just loose kin in the neck and jowls. Now that I have gotten the skin tightened up, how can I keep the facelift in place? I have read about a lot of things such as Thermage, Ultherapy, Exilis and others and, while they sound good in theory, I have read and been told that they don’t work for a lot of people. Some have said that the only really effective method of skin tightening is through collagen regeneration using a fully ablative CO2 laser. But laser resurfacing of the face can be associated with long-term pinkness of the skin. What do you recommend?
A: The reality is that nothing can keep a facelift ‘in place’ forever as surgery does not stop the effects of time and gravity. But there are certainly things to do to help slow down the process. Skin tightening and collagen rebuilding would be the correct approach after a facelift and, for many, should be considered maintenance therapies. There are numerous enery-based devices for skin tightening and you have named a few of the most well known. I do think they do have some benefit even if it is not the same for every patient as each person’s skin is different. In my practice, I currently offer Exilis and BBL (Skin Tyte) as methods of skin tightening maintenance after a facelift in which a series of treatments (usually 4) could be once a year. If appropriate based on how many skin wrinkles one has, light laser resurfacing is also a good choice and can be done with the other skin tightening treatments. Just don’t have any deep laser treatments but more regular lighter ones. That will avoid the prolonged redness and recovery. These treatments will not stop the aging process completely and more tissue sag is to be eventually expected but it will slow down the process and maintain the facelift result much longer. Also don’t forget basic preventative measures for skin aging which includes avoidance of excessive sun exposure, no smoking, a stable weight and a good daily skin treatment regimen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, even though I am fairly young (35 years old), I have some bags over my cheeks. These are not lower eyelid bags but cheek bags/puffiness. I tried injectable fillers in the tear trough but that just made me look puffy and did not solve my problem. I have heard about using some external devices to help shrink them and tighten the skin. In talking to several doctors and reading, I am looking at the Exilis device for the treatments. But one doctor is saying the Exilis is the first generation radiofrequency device (RF) and they now use this Ultherapy instead. There is also an Apollo device whichi is powered by TriPollar technology which is the 3rd generation of RF, allegedly the most advanced RF technology currently in the market. Many clinical studies published on the TriPollar technology demonstrated that it is very effective for wrinkle reduction, skin tightening and body contouring I don’t understand why or what to do. I have set up some consultations with some docs but I am worried. Can you tell me what I should do?
A: The world of non-surgical fat reduction and skin tightening devices is very confusing. It is filled with much inaccurate and sometimes deceiving information. Between manufacturer promotions of the devices that they make and doctor’s pushing the devices that they own, it is impossible for any patient to weave their way through this maze of voluminoos and often contradictory information.
What I can tell you with great certainty is that there is no single device out there that has been proven to be superior to any other…no matter what you are told or have read. Many devices may have comparative results but none can claim to be more effective at fat reduction or skin tightening than another one. We know this because no comparative studies have ever been done between the devices that exist nor it is likley any will be done.
I mentioned Exilis only because I am familiar with it and use it in my practice so I know its effects. This is what I would try if you were coming to my practice. This does not mean it is the best device available or that there may be others that worko just as well and perhaps even better. Exilis is not a first generation RF device nor is it similar to ultherapy which uses a different enegy to creates its tissue effects.
I think the conclusion is that some effort using any of the available energy-based devices is what you should try. I would not get hung up on which one. Availability and reasonable costs are the parameters to use on what device to try. The point is that if it does not have any effect, it is not likely any other device will be any better.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 30 years old and have had one child. Last year, I had liposuction to get rid of some ugly fat deposits on my stomach and thighs. It turned out very well and I am overall very pleased with the contour reduction of the treated areas. But I have noticed a little loose skin on my stmach and there are a few small uneven areas. My skin doesn’t look quite as tight as it did before the procedure. Is this normal? Is there anything that can be done to help tighten and smooth out the skin any further?
A: It is very common after liposuction to have less than perfectly smooth skin. That is often the trade-off for the volume reduction. Simply put, when you have less fat you need a little less skin. That accounts for what you perceive as skin that is just not as tight as before. This particularly occurs in the abdominal region in women who have lost a little skin elasticity after pregnancy. There certainly is no harm in trying any of the numerous skin tightening devices that are available, such as Exilis. The only question will be how effective it may be.
In addition, liposuction is about fat removal but it is a blind procedure. There is no way for the treating doctor to see what they are removing and how even that removal is underneath the skin. This is the art form of liposuction and it takes a lot of experience and attention to detail to get the smoothest result possible. Eventually the healing will reveal how close to even that fat removal was.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have some areas on my stomach and thighs that have a little extra fat and some loose skin. I do not want to undergo surgery however to make them better, that is just too much for me. I know that there are a lot of different non-invasive body contouring treatments out there that claim effectiveness. The one that has me intrigued the most is Exilis based on my research. How does Exilis work and what has been your experience with these treatments?
A: Exilis produces its effect through the use of highly controlled radiofrequency waves. It delivers high energy levels down to an inch under the skin. Its delivery technology allows that energy to be delivered without injury to the skin through a synchronized pulse delivery and cooling method. Thie keeps the treatments comfortable without risk of skin injury. (burns) It effects fat by breaking down their cell walls so the lipid contents are released and absorbed. It help tighten skin through a process known as neocollagenesis, which is the unraveling of the collagen fibers by the energy and the subsequent stimulation of fibroblasts to produce new collagen resulting in dermal thickening and increased skin density.
The transducer delivery system allows 17 different body areas to be treated from the eyelids down to the hands and everything in between. Our experience has been extremely favorable in properly selected patients who have been educated about achieveable results without surgery. Incremental, lasting and measureable results can be obtained in four treatment sessions or less of Exilis for many patients.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in some non-invasive body contouring. (stomach and flanks) I have read about the Exilis device and it seem very promising. I know it uses radiofrequency energy to do its work. But there are other devices out there that all use the same type of energy. Why would Exilis be any better than these other ones?
A: There are many new radiofrequency devices on the market and a lot of them are claiming that they have a similar or superior technology to that of Exilis. Regardless of what their product is called, almost all of them use bipolar radiofrequency. Bipolar radiofrequencies only have the capability to penetrate fairly superficially, generally no further than the deep dermis. Thus they are good for skin tightening but can not reach the fat layer nor reduce it effectively or consistently.
Exilis is different in that it uses monopolar radiofrequency. This allows it to penetrate more deeply generally up to inch (2.5 cms) below the skin. This does reach the fat layer. The cooling component on the Exilis allows it to bypass the dermis to effectively place the energy into the desired tissue (fat) and maintain penetration depth, all while keeping the skin cooled and uninjured. There is also an energy flow control on Exilis that allows the target tissue to quickly reach the desired treatment temperature. The combination of these two technologies allows Exilis to have effective fat reduction and skin tightening capabilities.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking for a non-surgical way to reduce my belly fat. I have had two kids and as a result I have a little loose skin on my lower belly but it is really not too bad. I don’t have any stretch marks except a few fine ones. My problem is this little bulge below my belly button which just won’t go away no matter how much I exercise or do situps. I can’t justify in my mind to go through liposuction surgery to get rid of it and I know my husband would never permit it anyway. I have read about several non-surgical methods but what do you think is best and do they really work?
A: Let us start with the premise that surgery, liposuction, is the most effective method of SPOT fat reduction that we know. And any non-surgical method is never going to be as good. Whatever result any non-surgical method can achieve can never compare to that of actual surgery. And thus by comparison it will be a have a poorer return on one’s economic investment.
Once one accepts that premise then the consideration of non-surgical fat reduction can begin. While there are many energy-based devices that currently exist to reduce fat without surgery, my current one of choice is Exilis. This is a deep radiofrequency device that targets fat below the skin but can also do a little skin tightening as well. (I said a little skin tightening, not to be confused with more than a small pinch) Treatments are fairly comfortable and a series of 4 to 6 sessions over 6 weeks can make a very visible reduction. The radiofrequency energy breaks down fat cells walls, causing them to spill their lipid contents which is then absorbed. In addition, there is no recovery or pain afterwards and one could go and work out immediately afterwards if they were so motivated. For the devout non-surgical person with some localized fat collections, this can be a good alternative to liposuction. You might also consider Smartlipo done under local anesthesia. While this is still surgery, small areas can be done without being put to sleep for the best result in the shortest period of time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in lipodissolve or laser liposuction of the lower abdomen. I am having a breast reduction done next month. My question is when is the best time for me to have the lipo procedures performed, before surgery or after surgery? I was informed that the best time would be during the same time as my breast reduction surgery. However, my insurance is covering the breast reduction and it does not cover the liposuction. I am also unsure if the doctor performing my surgery performs the lipo procedures I am interested in receiving. I was hoping for a lipo procedure that was less invasive such as lipodissolve or laser lipo.
A: Let me clarify some misconceptions that you have about various ‘lipo’ procedures. Lipodissolve injections are only useful for very small fat collections, no more than the size of one’s hand. I suspect your lower abdominal issue is bigger than that in size. Laser liposuction (aka Smartlipo) is simply an advanced form of liposuction and is just as invasive, it is not a minimally invasive procedure. In short, there is no non-surgical way to get rid of your abdominal fat concerns that would be as effective as liposuction. You could try Exilis radiofrequency treatments which does have some fat reduction effects.
In reality, there would be no better time than doing abdominal liposuction with your breast reduction and this is a common combination of cosmetic procedures. Otherwise you will have to have liposuction done separately where the out of pocket expenses will be higher.
Dr. Barry Eppley
Indianapolis, Indiana