Explore Plastic Surgery

Spring is finally here – and this is the time of year when one starts looking in the mirror and seeing dull, dry winter-time skin. I’m often asked which skin care treatments are most effective and how patients can best maintain their surgical results. While the answers aren’t the same for everyone, I can tell you there are three truly effective things that you can do to improve your skin’s condition – and doing these things with the start of each new season can really establish a routine easily.

Microdermabrasion. This is easy; effective – and is affordable to do on a regular basis. Honestly, this is the most consistent method to maintain skin that is in good condition – without muss or fuss.

SkinTyte™ Laser Treatments. I am seeing very good results with these treatments, and they have proven to be even more effective when combined with an exfoliative treatment (such as Microdermabrasion). SkinTyte™ is non-invasive, so it’s also easy to do on the way home from work and does not require any recovery time.

MicroLaser Peels™ These are far and away the fastest way to better skin. MicroLaser Peels™ (also called the ‘Weekend Peel’) are the treatment I most often recommend to my own family as a quarterly ‘maintenance’ treatment. Laser peeling has changed drastically since the days when carbon-dioxide lasers were all that were available to us, and we’re now able to do light to medium to deeper peels in the office that produce only a few days of redness and flaking skin – and can be repeated on a monthly basis- rather than requiring weeks of recovery and the expense of surgery. We can be as aggressive or as conservative with each peel as a patient wants, and can base each peel on your needs at the time and any activities you have planned.

This new season is the ideal time to re-evaluate your skin care routine. The above three treatment options, combined with a good skin care program of topical solutions, can being on the sunshine in your own skin!

Dual-Protection Sunscreens

Anti-aging skin management 101 is….protection from excessive sun exposure and damaging UV rays…and one in which many patients fail to consistently do. This has become easier over the past few years as many moisturizers and some makeup now contain them. What most people don’t realize is that most sunscreens do not block all UV rays equally well. While many suncreens historically block UVB rays, they did nothing to prevent UV A exposure. UV A penetrates the deepest and induces the greatest amount of aging on the skin. Sunscreens that contain both UV A and B filters is what you should look for today.

It is now recommended that your sunscreen have an equal proportion of SPF and PFA to provide maximal protection.Understanding the methods to measure sun protection is also important (so you know what products to buy) but is usually not understood by most consumers. The SPF system (Sun Protection factor) applies only to UV B protection. SPF 15 blocks 93%, SPF 30 97%, SPF 45 99%, so a minimum SPF would be 15. UV A light, however, is not covered by the SPF grading system. It is graded by the relatively unknown PFA system. (Protection Factor Ultraviolet A) PFA correlates well to the SPF system meaning, for example, if you normally begin to tan or burn after 20 minutes in the sun, a PFA of 15 will extend your protection 15 times longer, or 300 minutes.

New UV A filters are being introduced in the marketplace. Meroxyl, for example, was approved in 2006 and has been widely used in Europe and Canada for years. You will see this in many sunscreen products today.

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

Topical Peptides have the Potential to Stimulate Collagen

One of the newer skin ’stimulants’ that have come onto the scene recently are peptides. These are small proteins that help stimulate collagen production in the deep layers of the skin, tyhus having an anti-aging effect. There has been a buzz about these proteins and they are now becoming prevalent in many topical skin preparations.

These peptides are numerous and some of the more prominent names include Argireline (acetyl hexapeptide), GABA (gamma amino butyric acid), Biopeptide CL, Pentapeptide (Levuphase), Heptapeptide (snap 7), palmitoyl tripeptide-3, and copper complex, to name just a few. Some of these peptides like Argireline have a very mild muscle-relaxing effect (saying it is similar to Botox is a stretch) by blocking the release of chemicals that stimulate muscles. I use topicals that contain this in my patients that get Botox as a supplement to it. Other peptides are more like traditional growth factors which may increase the production of collagen through fibroblast stimulation and helping decrease wrinkle formation by this approach.

One of the real problems with the peptide formulations is their inherent instability and whether they can actually penetrate into the deeper layers of the skin. While they are becoming popular and skin preparations that contain them are expensive, I am not quite ready to endorse them as living up to their hype just yet. More clinical evidence needs to come forth to determine their potential effectiveness. In addition, where in one’s skin care regimen do they fit? And how do they compare to the anti-oxidants? Or is an alchemy of everything, a skin cream stew so to speak, the best approach?

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

Vitamin A has Anti-Aging Properties in Different Formulations

One could argue that the original, and certainly now the most-studied, anti-aging topical skin care cream is Vitamin A, specifically the retinoid family of Vitamin A derivatives. The pharmaceutical compound of Retin-A has been around for two decades and its effectiveness at decreasing wrinkles is well established. Its mechanism of action has been shown to be the result of increasing collagen production in the deeper layers of the skin while increasing exfoliation of the outer epithelial layer. This combined effect results in smoother skin. Unfortunately, many of the differing pharmaceutical concentrations and preparations are irritating for many patients, particularly those with thin, fair, and sensitive skin. As a result, many patients don’t use the topical product as regularly as they ideally should or stop using it altogether.

Better compliance and more regular use has been obtained with weaker concentrations of Vitamin A that are available in many over-the-counter products. These formulations are known as Retinol and contain a fraction of the strength of Retin-A concentrations. Such formulations usually contain other anti-oxidant compounds such as Vitamin E and others to create an alchemy of ingredients that are much better tolerated than prescription-strength retinoids. I used to have the perception that retinoids were ineffective and were merely piggybacking on the well-proven benefits of their much stronger and better known relatives. A marketing gimmick if you will, which is not an uncommon phenomenon in the cosmeceutical industry. However, recent studies have shown that retinol preparations have definite anti-wrinkling effects compared to similar skin topicals that did not contain them, even in older patients.

This new information suggests that the use of retinols does have a role to play in skin care. For those patients that have had problems in the past with Retin-A or are younger with minor wrinkling issues, retinol-containing products are a good place to start. Eventual tolerance to low-level pharmaceutical grade Retin-A may be acquired by several months of retinol use.

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

Over-the-Counter Antioxidant Skin Care Nutrients

The single most popular and touted anti-aging ingredient in skin care are the anti-oxidants. They are in many topical products and are the buzz word in skin care over the past few years. They chemically work by destroying free radicals, which are destructive unstable molecules that form in the skin which has been exposed to sun, pollution, and general wear and tear. The free radicals are destructive to the collagen and cells in the skin and, hence, contribute to and accelerate skin aging. Anti-oxidant compounds work by neutralizing these free radicals, thus preventing their harmful effects.

The interesting question is what are the most effective antioxidants? Vitamins A and E are well known as well as CoEnzyme Q (CoQ10). How these directly compare in effectiveness and in what type of formulations are best has not been established. We are left to be swayed by marketing claims and packaging until further evidence is forthcoming. The most talked about antioxidant is from the coffee berry extract. What makes it so appealing is its apparent potency. It appears to have the highest antioxidant rating of any of the known antioxidants. Since penetration into the skin and delivery to the target, so to speak, is the rate-limiting step for any antioxidant, a high potency would suggest that even if only a fraction is actually absorbed, an anti-aging effect will still be seen. Or put another away, the coffee berry extract may be more effective at neutralizing free radicals than other antioxidants. We shall undoubtably see many more skin care products with it in 2008.

Regardless of the the type of antioxidant, the incorporation of these compounds in skin care products is important. They would be most effective in creams or serums that are applied at bedtime when the exposure to ongoing skin damage is minimized.

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

WHAT NEW IN MEDICAL SKIN CARE: Fractional Laser Resurfacing

I frequently get asked what is the new in the world of medical skin care by my patients as well as others. As I think back over 2007, I have put into my practice the following anti-aging medical treatments which I feel are quite promising.

The removal of an outer facal skin layer to improve its tecture is a concept that has been around for decades. Historically, this has included chemical peels and, in the past decade, laser resurfacing. Laser resurfacing essentially ‘burns’ off a top layer (the depths can be very varied from 6 microns to hundreds of microns) and allows new skin (epithelium) to heal over it, removing some imperfections and improving the texture of the skin. Recovery from laser resurfacing varies by the depth to which it is done, a 10 micron laser peel may be a few days, a 100 micron laser peel will be 7 to 10 days. The depth issue aside, laser resurfacing always involves some recovery (as it is a burn) and it only treats the outer layers of the skin.

Fractional CO2 laser resurfacing takes a conceptually different approach. Rather than ‘burning’ 100% of the skin’s surface that it hits, it only treats or penetrates a ‘fraction’ of it. For every area treated, it may only actually hit 10 - 20% of the skin area. Hence, a fractional treatment approach. But equally importantly, the laser penetrates much deeper (hundreds of microns) into the skin, actually stimulating the deepest part of the skin layers. (think of it as boring holes much like you do to your lawn to allow nutrients to get ‘to the roots’ so to speak) Because only a fraction of the skin is treated, there is less recovery than with traditional laser resurfacing even though the depth of laser penetration is much deeper. Also because it is fractional, it requires a series of treatment, at least five, to effectively get all of the skin’s surface treated. In theory, there is more of an anti-aging effect (due to the deeper penetration) but less recovery due to less skin being injured at any one time.

Fractional laser resurfacing of facial skin is being currently touted as being better than traditional laser resurfacing. The evidence to support that claim, to date, is still conclusively lacking. Plus, I am not sure how the laser knows during sequential treatments to hit previous skin areas that have yet to be treated. (of course, it cannot know, so some skin areas undoubtably get treated more than once and some probably are missed altogether as we are talking about fractions of millimeters here) For this reason, it probably take 6 or 7 treatments to truly treat all facial skin areas in the laser’s target. Despite these reservations, fractional laser resurfacing remains appealing and more time will tell exactly what its role in medical skin resurfacing actually is.

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

SPF and PFA - What do they mean?

Protection from excessive sun exposure and UV rays is one of the most basic approaches to anti-aging skin management. The importance of the use of sunscreen is well acknowledged but most people do not realize that their sunscreen does not block all UV rays well. Of the three types of UV rays (A, B, C), UV A light penetrates the deepest and induces the greatest amount of aging on the skin. Sunscreens that contain both UV A and B filters provide better protection than those with UV B filters only. Historically, most sunscreens had only UV B protection but, more recently, UV A protection is more commonplace in topical preparations. Check your sunscreen and make sure it has both.

Understanding the methods to measure sun protection is also important but poorly understood by most. The SPF system (Sun Protection factor) applies only to UV B protection. SPF 15 blocks 93%, SPF 30 97%, SPF 45 99%, so a minimum SPF would be 15. UV A light, however, is not covered by the SPF grading system. It is graded by the relatively unknown PFA system. (Protection Factor Ultraviolet A) PFA correlates well to the SPF system meaning, for example, if you normally begin to tan or burn after 20 minutes in the sun, a PFA of 15 will extend your protection 15 times longer, or 300 minutes. It is now recommended that your sunscreen have an equal proportion of SPF and PFA. Check your labels carefully.

A new UV A filter has been recently approved in 2006, Mexoryl. This has been widely used in Europe and Canada for years and we will begin seeing here in the U.S. as well now that it has been approved.

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

Stretch Marks – Magical Solutions??

Stretch marks are scars that occur, usually as a result of pregnancy, when the skin stretches enough to cause tearing within the deepest layers of skin. New stretch marks are usually pink or red before they fade to white, though they never completely disappear. But some women are more prone, expecially those that gain weight rapidly and carry multiple or big babies.

Many women attribute a lack of post-pregnancy stretch marks to body cream. Whether used to ease the itching associated with stretching or in an effort to keep stretch marks at bay, moisturizers certainly feel good. But, medically speaking, there is no topical cream or anti-stretch mark product that has been proven to have any benefit, despite claims to effectiveness that are often wildly exaggerated and not substantiated by any scientific evidence. Despite unproven benefits, there is certainly no harm to using moisturizing as prevention. Balms that are blends of oils and butters keep skin supple as it stretches. Since it is being used in pregnant women, the topical agent should be composed of natural products that are unscented.

Once present, repairing stretch marks likewise remains an enigma. Many laser and light therapies are currently being investigated but none yet have been shown to be an effective treatment. One topical ointment, Retin-A, has been found to help reduce the appearance of stretch marks. Just like it does for facial wrinkles, it boosts collagen production and increases skin turnover to aid the creation of new skin. Since it contains a Vitamin A derivative (a proven cause of fetal birth defects), it should not be used until after delivery.

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

Total Skin Rejuvenation (TSR) Program

Welcome to OLOGY’s extraordinary anti-aging skin care approach. This program has been developed as a collaboration between myself and aestheticians to bring the best of medical science and skin care together to create a comprehensive and effective skin treatment program, Total Skin Rejuvenation. This program offers the most advanced laser technology and anti-aging treatments available today. Digital skin analysis combined with multimodality laser and microdermabrasion treatments targets each patient’s skin care concerns and helps them achieve optimal skin health and beauty at any age.

PHASE I ASSESS

Customized Digital Evaluation and Treatment Planning

The initial phase of the program utilizes the latest computer technology to identify the patient’s specific skin care needs. Besides a clinical examination under magnification, we analyze the superficial damage to the skin with our Visia Complexion Analysis Photo Imaging System. Through digital facial photography, we are able to analyze 6 specific features of the skin: wrinkles, smoothness, pore size and count, bacteria, age spots and UV sun damage. Using this quantitative data, a customized treatment program will be created based on the patient’s skin type.

PHASE I REVIVE

Exfoliation and Skin Regeneration

During this most intense phase of treatment, the guest receives 4 laser treatments (10 micron laser micropeeling) at 4 week intervals which are immediately preceded by microdermabrasion (MDA). Microdermabrasion is an intense exfoliation of the skin and enhances the results of the laser. After only one such treatment, results are apparent as superficial damage to the skin begins to be reversed. The laser diminishes the signs of aging by improving the appearance of skin tone and texture. Evenness improves and pore size decreases. New collagen production occurs even after the first treatment and will increase markedly by the end of all treatment sessions.

PHASE II STIMULATE

Rebuilding and Strengthening Collagen

In the second phase of treatment, the patient receives four laser treatments (1319nm wavelength) at one month intervals immediately preceded by microdermabrasion (MDA). This wavelength of laser specifically targets the collagen in the reticular dermis to stimulate its production. As a result, collagen levels and cross-bundling in the skin increase markedly during this phase, further softening the appearance of fine lines and wrinkles and restoring the natural youthful beauty of the skin.

PHASE III PRESERVE

Maintenance of Results

Due to the natural aging process and environmental factors, many of the benefits of the initial treatment phases will decrease over time. We offer this third phase of the program to maintain the wonderful results obtained from the Revive and Stimulate phase treatments. Microdermabrasion (MDA) combined with glycolic peels are administered at 3 month intervals over a one year period.

For those patients with additional problems of skin damage and aging such as deep brown spots, facial telangectasias, and deep lines and wrinkles, other treatments may be needed.
These will be determined on an individual basis and may include:

BBL (Broad Band Light) Therapy

Vascular Laser (1064nm) treatments

Deep Laser MicroPeeling (20 – 50 microns)

Botox Injections

Injectable Fillers (Restylane, Captique)

Chemical Peels (TCA)

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

VISIA – A unique complexion profile and the first step to
skin health and vitality

Your complexion is the window through which your image is projected to the world – and now VISIA Complexion Analysis provides the information necessary to truly individualize facial rejuvenation and skin care regimens to match your unique complexion profile.

A VISIA imaging session uses multi-spectral imaging and analysis to capture key visual information for six areas affecting complexion health and appearance: wrinkles, spots, evenness (color variation in the skin tone), porphyrins (evidence of bacteria in the pores), and UV spots (characteristic of photodamage, typically from overexposure to sun). Additionally, VISIA provides an informative comparison of your complexion’s characteristics to those of other women of the same age and ethnicity. VISIA generates printed reports, which you can take home, that provides details of your imaging session.

This comprehensive information enables OLOGY to formulate the optimal treatments and regimens that are right for you per our Total Skin Rejuvenation (TSR) program. This program combines cutting-edge laser technology, prescriptive medications, exfoliating and vitamin-based topicals, and microdermabrasion treatments to enhance your skin’s health and restore a radiant youthful appearance. This innovative skin care program is safe and effective for patients of all skin colors and ethnicities.

Based on your complexion profile, TSR recommended rejuvenation and skin care options will appear on your VISIA report, and VISIA imaging will continue to be used on a periodic basis as an invaluable aid in monitoring your complexion’s vitality and checking the effectiveness of your skin care regimen over time. Your vision of healthier, younger looking, more beautiful skin can be a reality with the help of VISIA and the direction in provides for your customized skin care program.

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