Explore Plastic Surgery

Fat in the neck and jowl area would certainly classify as a Type LipoDissolve problem. I find that LipoDissolve injections in the neck to be a particularly effective treatment, probably the best use of an injectable fat reduction method. It works in this area for one good reason, the neck has a small surface area to it and therefore the fat problem is likewise limited. It fits in well with my concept of the ‘hand’ evaluation method to determine LipoDissolve candidacy. If the area fits into the size of my hand (size 6 ½) then it is reasonable to treat with LipoDissolve. In many necks that I have treated, the results with LiposDissolve can be close to that of liposuction.

The concept to grasp about LipoDissolve is that it is an inefficient method of fat treatment, albeit non-surgical. Unlike liposuction, fat injections require months of treatments to achieve its final results. So while it can be effective, it is not efficient. Liposuction surgery achieves its results in less than 30 minutes, albeit through a surgical process. Generally, the inefficiency of LipoDissolve would not be an issue if the treatment was hidden and not socially obvious. However, in the neck and jowl area, the effects of LipoDissolve treatment are for all to see and I am not just talking about the final results. After each LipoDissolve treatment session, the injected area will immediately swell and stay that way for about five days. And when I mean swell…think of doubling in size! Yes I did say double in size, you will have a bullneck. And this swelling process must be repeated each time that a treatment session is done, generally around three treatment sessions are needed to get the best result. For many patients, this neck swelling and how to explain it is enough for them to choose liposuction over LipoDissolve. For others, the importance of not having to go to surgery, and the additional expense, is worth the temporary neck swelling.

Besides the neck swelling, the other consideration is if the neck fullness is an isolated problem. LipoDissolve makes no sense if you are having other procedures anyway. The whole purpose of LipoDissolve is to avoid a surgical procedure. If you are getting on the operating room table anyway, then opt for liposuction and enjoy the benefits of the efficiency of surgery. One final consideration is how much much loose skin you have in the neck. While LipoDissolve can tighten some skin, do not think of it as an alternative to other truly neck tightening procedures such as a facelift. In older patients with more loose skin, these procedures are likely better and neck liposuction is part of every facelift (necklift) anyway.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Whether you are young or old, some people end up with that annoying double chin even if they are not overweight. And while there are some ways to camouflage it, like wearing a turtleneck, that often is not practical or desired. Many times, that double chin or extra ‘neck’ is not seen or fully appreciated until one sees themselves in profile in a photograph. I have had many patients tell me that want initiated the consult was that they saw themselves in a school reunion, family picture, etc and they were surprised how they looked. Almost always, the surprise is the appearance of the jowl line and neck.
Double chins or neck waddles are the result of excess fat and hanging loose skin for some. In the younger patient, it may be a lot of extra fat and not so much extra skin although the weight of the fat pulls it down, making it look like there is more extra skin than there is. That distinction is important as it changes the strategy for what will be the most effective treatment.
If extra neck skin is not the dominant problem (usually the younger patient), then a fat-based treatment method shoudl be fairly effective. If the amount of fat or the double chin is small, then office-based Lipodissolve injections could be very effective. This is a slow process that takes months for maximal results to be seen. The biggest issue with Lipodissolve, however, is not the series of treatments but the swelling that will occur after each treatment session. It may only last for 4 or 5 days but the neck will essentially double in size for that time period. The most efficient treatment method for the fat neck would be liposuction. While that is surgery, it is both more efficient and effective and one only has to go through swelling and bruising of the neck one time.
When extra skin is a more significant issue, then a fat treatment alone will not work well and one will likely end up with even more loose sagging neck skin. In these cases, some type of neck lift (aka a facelift) must be done to remove the loose skin by lifting and working it out around the ear area where incisions can be placed more discreetly. In the older man, a direct neck lift can be done which is much simpler and highly effective although one has to be able to accept a fine line scar running from under the chin down to the adam’s apple.
Double chin reduction can be a very gratifying procedure and can be approached with Lipodissolve injections, liposuction, or some form of a facelift. The best procedure is the one that matches the cause of the double chin…too much fat, too much skin, or both.
Dr. Barry Eppley
http://www.eppleyoplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

LipoDissolve, or the injection introduction of a fat-emulsifying chemical solution to treat small areas of excessive fat for cosmetic improvement, is a controversial procedure that is not FDA approved. (or even off-label as it has no approved medical uses) Despite its regulatory status in the United States, I have found LipoDissolve in my practice to be a valuable adjunct for mild to moderate fat reductions if it is used carefully and on those patients with very small fat issues. I have not experienced to date in over 150 patients any of its potential complications as reported on the internet and other media venues. I believe that my methods of rigid patient selection and keeping the number of injections per treatment sessions limited is the basis for my very favorable patient experience. All patients do get a fair amount of swelling in the treated areas for the first week with some discomfort but they are well apprised that this will occur prior to treatment. The amount of fat reduction has met most patient’s expectations whichi have been kept to a modest level by thorough pre-treatment counseling. One application that I have found particularly useful is in the treatment irregularities or residual fat areas AFTER liposuction surgery.
Even in the best of hands, some small percentage of liposuction patients will have irregularities in the skin over the treated areas. These areas may be made up of either depressions (too much fat removed), high spots (not enough fat removed), or some admixture of both. The decision to treat any of these residual liposuction issues should be delayed for at least 6 weeks after surgery and ideally not until 3 months after the original procedure, giving the body time to completely heal and resolve temporary irregular areas due to swelling and retained fluids such as blood. Once an irregular area is confirmed and the target is stable (meaning it will not improve with any more time and everyone is certain of that), it must then be determined what the cause (too much or little fat left) of it is. Depressed areas can only be treated by fat injections through another surgery. Elevated or too high areas represent too much fat still which can be improved by further fat removal. This is where the role of LipoDissolve can be very valuable.
The thought and expense of returning to surgery is not appealing to patient and plastic surgeon alike. Plus, to get at the area a long straight cannula from afar must be introduced which will traumatize some treated areas which look fine and has the potential of causing another ‘problem’ while trying to solve the current one. A spot treatment, like LipoDissolve, is ideal. It can be injected directly into the problem area, in the office, with no recovery, and at a very low cost. Most ‘high spots’ after liposuction are generally small and each area may only require a few injections. While it may require a few injections sessions over several months to get the desired result, the ease of LipoDissolve administration and the ability to place it exactly where the problem is makes it a better solution to those postoperative liposuction issues where too much fat is the cause.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

LipoDissolve, or the introduction of a chemical formulation by injection to treat spot areas of undesired fat for cosmetic purposes, remains a controversial and non-FDA approved procedure at this point in time. Despite these issues, I have found in the past 3 years in my practice a role for LipoDissolve if it is used judiciously and with good patient selection. I have not experienced any of the complications or problems that I have read about on the internet and I suspect that rigid patient selection, keeping the injections less than 100 per session, and good sterile technique are the reasons why. One application that I have found LipoDissolve injections particularly useful is in the treatment of lipomas.
Lipomas are fatty tumors that can appear anywhere on the body from the scalp to the legs. They are soft, easily moveable (non-adherent) masses under the skin that are always round in diameter. They are usually right under the skin and are very slow growing. Most patients seen usually just have one in isolation. There are, however, some patients who have a familial lipomatosis syndrome in which they develop many lipomas throughout their body continously over their lifetime. Lipomas are traditionally treated by excision which removes them in their entirety, establishes their pathology by visual and microscopic examination (if sent to the pathologist) and leaves a residual scar.
In some locations, and at the desire of some patients, a scar is not wanted nor is any type of surgical procedure if possible. LipoDissolve offers a non-surgical alternative to traditional excision for some lipomas. If the excision will leave a scar over a prominent area (e.g., the shoulder of a woman) and you are fairly certian that the mass is a lipoma by examination and history, then injection treatment are an option.
I have found that full-strength LipoDissolve injections can work quite well in the nearly 15 lipomas that I have treated thus far in the past two years. The concept is that it is a series of injections, spaced four to six weeks apart, to either reduce the size of the lipoma or completely eradicate it. In the nine patients (14 lipomas) that I have treated, the average number of injection sessions is nearly 5 (4.8) per patient. This does not take into account that the largest of the lipomas that I have treated (14 x 10 cms) took eight injection sessions while very small ones (2 x 2 cms) may take only one or two injections. Patiens will experience a large amount of swelling for the first week and some discomfort which is typical but not lifestyle-limiting.
Since lipomas represent a concentrated nucleus of fat, it is not surprising that LipoDissolve injections can be effective. Its use, however, is not as efficient as surgery (and insurance does not cover the procedure) but it does save a scar and, in large lipomas, the risk of a fluid build-up after surgery or the need for postoperative drains. Before treatment, one has to be fairly certain that the mass is indeed a lipoma. An MRI may be done if necessary to establish the diagnosis in larger lipomas. I have not yet seen a recurrence in any lipomas that I have treated but it is too early to be absolutely certain of that in my present patient series.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Even though we are in the middle of the summer (or maybe because we are), you may have decided to get serious about getting rid of those unsightly fat areas that diet and exercise just won’t. But with different methods of fat removal available, which one is right for you? It may be tempting to think that a non-surgical method such as LipoDissolve which offers low cost and no recovery time is best, but let’s examine the facts first.
Traditional liposuction is still the gold standard to which all other methods of fat removal must be compared. Done through small incisions near where the fat is to be removed, a small thin hollow tube (cannula, about the width of a pencil or less)) is placed underand the dislodg the skin. By moving the cannula back and forth, fat is dislodged and the vacuum to which the cannula is attached removes the loose fat. This is the preferred method among board certified plastic surgeons for removing larger amounts of fat tissue and has been used in the United States for almost thirty years.All liposuction today is done with the tumescent or wet technique which keeps blood loss to only about 1% of the total fat removed. Liposuctioned fat volumes removed today are kept around five or six liters in a single operation to keep the risk of complications low. Serious side effects with liposuction are very rare. The most common problem with liposuction is skin irregularities but this problem is kept limited when done by skilled and experienced hands. Very good results can be obtained in the neck, stomach, waistline, outer thighs, and knees. More modest results are seen in the arms, back, inner thighs, and buttocks.
Liposuction done with the aid of a laser, also known as Smart Lipo, is one of the newer FDA-approved types of liposuction. A laser is inserted through tiny incisions in the skin. When the laser is fired, it melts the fat purportably tightening the skin at the same time. Smart Lipo has not been proven to produce better results than traditional liposuction but may be an alternative for removing smaller fat areas. This is certainly the way it is currently being sold, particularly to non-plastic surgeons which make up a significant percent of the targeted market. Because the removed fat volume is more limited, serious side effects are unlikely. The real question in my mind is whether Smart Lipo can help perform smaller liposuction procedures under local anesthesia in the office setting. This is where it would offer an advantage over traditional liposuction.
Lipodissolve, also known as injection lipolysis, uses a mixture of emulsifying chemicals (lecithin and cholic acid) which are injected under the skin to the targeted fat areas. This is a non-FDA approved treatment method although in my experience has proven to be safe. I have not seen any of the complications that are widely reported. Lipodissolve is certainly not a replacement or alternative to liposuction. It is best viewed as a fat removal technique when any form of liposuction is a bigger solution than the problem justifies. It is done as a series of injection done in the office over three or four months.I have found that it works well for small fat areas in the neck, jowls, bra rolls, stomach, flanks, thighs, and knees. The emphasis here is on the concept of small fat area, geernally no bigger than the size of my hand. The biggest issue with liposuction is whether the results, and time to get them, justify the cost. It is also a great method to touch-up any excess areas of fat after a liposuction procedure.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

One of the earliest signs of facial aging is the development of jowls or jowling. The jowls are areas of skin and fat that have fallen from the side of the face to hang along or below the jawline. As we age, these areas tend to become more noticeable as the sag worsens. The once straight jawline of youth is gradually replaced by the saggy full jowls of the aging face. Why this occurs is the age-old phenomenon of time and gravity, weakening the attachments of the skin to the underlying muscle so that a tight bond between the two no longer exists.
I see many patients who are bothered by jowling, including younger patients who often see this as one of the first signs of real aging. There are numerous options to treat the jowls, both surgical and non-surgical, with varying degrees of effectiveness. The most effective methods, to no surprise, are surgical and include facelifts and liposuction. A facelift in its fullest extent is a jowl-neck lift. In its more limited form, it is primarily a jowl lift. It works by pulling skin and deeper tissues up and back, eliminating the jowls by pulling loose tissue above the jawline again. The loose jowl tissue is simply repositioned and not removed. More minor procedures that have recently gained popularity, which aims to do the same thing, are the Threadlifts or Featherlifts. In this simple procedure, barned sutures are passed deep into the cheek and facial tissue above the jowl area and cinched up from above. For very minor degress of jowling, this has some benefit but is not effective enough with large amounts of jowling and the long-term results with these procedures is suspect. Actually removing jowl fat can be done with liposuction, reducing their size. This can be done alone or in conjunction with some form of a facelift. When performed alone, liposuction of the jowls must be done very carefully and conservatively, lest you get irregularities that are apparent in the overlying skin. When done with a facelift, the lifting and tightening of the skin usually eliminates this concern.
Non-surgical options include skin tightening by heat-generating devices and LipoDissolve. neither approach treats both of the jowl issues, skin and fat, and therefore they are usually less effective than surgery. Heating the underside of the skin through a series of treatments can cause a tightening effect. Devices such as Thermage or SkinTyte do it differently but the objective is the same, heat up and the skin on its underside and cause it to tighten. The long-term results of this procedure appear to be short-lived and that is why I perform them in conjunction with other procedures rather than as a stand alone technique. LipoDissolve treats the jowls by fat-dissolving injections done as a series. As the fat dissolves, the jowl is reduced in size. In my experience, it is just as effective as liposuction, albeit a lot slower. When performing non-surgical jowl reduction, I like the combination of LipoDissolve and Skin Tyte. That combination seems be particularly effective as both components of the problem, skin and fat, are addressed. They are also great touch-up procedures to do after a facelift when a little rebound relaxation in the jowl area occurs.
The jowsl can be treated by numerous surgical and non-surgical methods. Limited and full facelifts produce the best and most long-lasting results and should be the first choice when moderate to severe jowling is present. In more minor jowling, LipoDissolve and Skin Tyte work well if the patient can tolerate a slower speed of noticeable improvement.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

LipoDissolve offers an alternative non-surgical treatment option for select fat problems. While liposuction, when it was originally in the United States in 1981, was to be used for ’spot reduction’ (and we know its application has been extended well beyond that initial use), successful use of LipoDissolve really depends on the spot reduction concept. Careful patient selection is of the utmost importance in getting good results with an injection-based fat reduction treatment.
After using LipoDissolve in my plastic surgery practice now for two years and having performed hundreds of injection sessions, I have developed my own system for patient selection. This is a simple system based on one practical consideration, how would LipoDissolve compare to Liposuction for each patient’s problem. I divide patients into 4 types. Type 1 problems are ideal for LipoDissolve treatments as one can expect close to similar results if the area was similarly treated with liposuction. This includes areas about the size of your hand and could include areas such as the neck, small abdominal areas, flanks, back rolls, small saddlebags, and the knees. Generally an area that is small enough that it would be hard to justify the expense of going to the operating room for liposuction surgery. Type 2 patients are the opposite of Type 1. In Type 2 fat concerns, liposuction would result in a much better result than LipoDissolve, often considerably so. These would be larger areas or a combination of more than 3 Type 1 areas. The entire abdomen, combination of inner and outer thighs, back, buttocks, or large flanks are typical Type 2 areas. Type 3 areas are patients who have had liposuction and have some residual areas of irregularities due to underresection. (postoperative LipoDissolve therapy) Type 4 patients are those have have fat tumors known as lipomas. I have found lipomas respond particularly well to LipoDissolve injections, although large ones may require 4 to 5 treatments for complete eradication.
With this relatively simple system of classification, it is easy to not only carefully select those patients most likely to be happy with LipoDissolve therapy but it also makes it easy to counsel patients and make them understand their candidacy for treatment or why liposuction is a better treatment option.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

In the most recent issue of our prestuguous journal, Plastic and Reconstructive Surgery (April), I read an article on evaluating the effectiveness of mesotherapy on body contouring. This was a study out of Seoul, Korea on 20 women who had mesotherapy injections on their inner thighs on one side and not the other over a 12 week period. The results showed, not surprisingly, that no measureable improvement could be seen.
This study highlights several important points on aesthetic treatments that are frequently confused. Mesotherapy is the injection of a mixture of different compounds into the skin. (the study cited above used aminophylline, buflomedil, and lidocaine) This is different than LipoDissolve therapies where one specific compound, phosphatidylcholine, is injected into the underlying fat. Mesotherapy (meso = mesium or skin) and LipoDissolve are terms that are often used interchangeably but they really signify completely different types of treatments. Just because both come out of a small needle, like Botox and injectable fillers, doesn’t mean they all do the same thing. I have always questioned the effectiveness of mesotherapy approaches for fat removal or cellulite treatment. It is difficult to see how injecting chemicals into the skin can effect the underlying fat. Perhaps cellulite may have some improvement with mesotherapy since this problem has a skin component to it. But I have yet to see well-controlled studies that have provided convincing evidence to date. But the removal of fat requires agents that directly contact it such as what happens in LipoDissolve. While LipoDissolve requires more study and better analysis, given the large number of patients that are being treated (it is NOT an FDA-approved procedure), but I have first-hand experience with its outcomes and there clearly is some benefit to its use. The issue with LipoDissolve is not its effectiveness but in choosing the right patients for treatment and analyzing for each patient the cost-benefit analysis versus other treatment options, most typically that of liposuction.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Liposuction vs LipoDissolve – Dr Eppley’s from Indianapolis Comments on the Importance of Patient Selection

The treatment of undesired fat today can be done by either traditional liposuction or the newer fat injection technique known as lipoDissolve. The frequent question then for many patients is….which is best for me? The answer to that question lies in the understanding that liposuction and lipodissolve are different……in how they work, in how well they work, and the time course in which they work. As a result, selecting liposuction vs lipodissolve for each patient is critical if good results are to be achieved.

As a general rule, lipodissolve is good for small fat deposits (usually the size of your hand or a coke can) such as in the neck, back of the arms, side of the waists (flank), small saddlebags, or the inside of the knee. Fat collections this small are generally not worth making a trip to the operating room to treat nor the higher costs to do so, unless you are having other procedures done as well. In this case, a series of three or four lipodissolve sessions, and the swelling that occurs after, is usually worth it. For larger fat collections, or when more than one or two areas of the body are involved, liposuction surgery is far better. Yes the costs are higher and there is an immediate recovery phase after surgery, but so much more fat can be removed that the effort is well worth it.

In short, Lipodissolve is not a substitute or replacement for Liposuction. In select small fat deposits, it may give results close to liposuction. It provides an alternative treatment to liposuction in medium-sized fat deposits that are limited to one area if one is willing to accept less of a result than that achieved by liposuction. The critical issue in these cases is the issue of value….are you getting a good return on your investment. That is best decided by a thorough discussion with your plastic surgeon to weigh out the advantages and disadvantages of each approach.

Liposdissolve has one other use that is usually better than liposuction….in the treatment of post-liposuction irregularities. “Spot’ reductions can be done by precise placement of lipodissolve injections. This can avoid the costs of another trip to the operating room for a minor touch-up.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

The Skinny on Fat Removal by Liposuction in Indianapolis - Choosing the Right Patient for Surgery

Liposuction remains as one of the most popular and commonly done of all plastic surgery procedures. Part of its prevalence has to do with the ubiquitous problem that it treats….fat……and the many locations that can be treated from the neck to the arm, chest, back, abdomen, flanks, waistline, hips, thigh, knees, calfs, and ankles. It is no surprise, therefore, that liposuction remains in high demand since its introduction in the U.S. in 1981. When I see a patient who desires liposuction, the most important question is….are they a good candidate? Will they be happy with the results and, a year later, say that it was a wise way to spend their time and money.

The answer, in my opinion, about good candidates for liposuction are two-fold: qualifying the patient prior to surgery…..and asking the patients to do (be aware) of what they need to do after liposuction surgery.

Important pre-liposuction patient qualifiers:
1) Liposuction is not for obese people. The best candidates undergo liposuction for ’spot areas.’ If you are over 20% of your ideal body weight, you need to lose weight first.
2) Have a stable weight for at least 3 months prior to liposuction surgery.
3) Be on some type of exercise program before surgery. I don’t care what it is, even if it is just walking. It builds some strength for surgery and will help you lose some ‘easy’ weight.
4) Be on some form of a healthy diet first. You need to train yourself to eat right before liposuction…if you are to maintain a good weight after. Liposuction won’t make you eat better or in smaller portions….only your brain will!

Important post-liposuction tips:
1) Wear your compression garments until….they feel better off than on. They give you some comfort support and do help skin contraction.
2) Maintain your weight…..watch your diet! The loss of weight from fat removed from liposuction is usually not evident until about one month after surgery. That combined with the energy your body uses to heal usually gives most people some noticeable weight loss after liposuction. The real question is…….what is your weight 3 or 6 months after liposuction?
Without a healthy diet and regular exercise……the long-term results from liposuction will be disappointing!
3) Many areas that undergo liposuction surgery will be irregular and bruised for a while. It takes time (6 to 8 weeks) for the treated areas to settle and give the final appearance…so patience is a must.
4) Irregularities or asymmetries after liposuction are not rare…..secondary touch-ups may be necessary. Any residual ‘high spots’ or full areas (usually small) I now treat with LipoDissolve injections. These can be very effective after liposuction and avoids further surgery and significant extra costs.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis