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Real Self 100 2016 Dr Barry Eppley

Tuesday, March 28th, 2017

 

Real Self 2016 Dr Barry Eppley IndianapolisIndianapolis plastic surgeon Dr. Barry Eppley has again recognized as one of 100 doctors worldwide to receive the RealSelf 100 Award, a prestigious award honoring the top influencers on REAL SELF the most trusted online destination to get informed about elective cosmetic procedures and to find and connect with doctors and clinics.

In 2016, more than 82 million people visited RealSelf to research cosmetic treatments and connect with local medical professionals. The RealSelf 100 Award, now in its seventh year, honors the top rated and most engaged board-certified aesthetic doctors who consistently demonstrated a commitment to patient education and positive patient outcomes throughout 2016. This elite group of 100 doctors have excelled at sharing their expertise, free of charge, with tens of millions of RealSelf community members actively searching for information and the right provider, and together contributed 25 percent of the half a million total answers posted on RealSelf in 2016.

“The RealSelf 100 represents an exclusive group of doctors who embody both excellent patient service and an ongoing commitment to educating consumers shopping in the aesthetics market,” said Tom Seery, Founder and CEO of RealSelf. “Our research shows that more than 95 percent of patients expect a practice to engage with them online. These doctors are leading the way in terms of their online engagement and focus on empowering patients with good information.”
RealSelf is the largest online destination to get informed about elective cosmetic procedures and to find the right doctor or clinic. More than 9 million people visit RealSelf each month to find out which treatments and providers live up to their promise of being “Worth It.” RealSelf is powered by unbiased experiences shared by consumers for hundreds of treatments, ranging from simple skincare to highly considered cosmetic surgery. Offering millions of photos and medical expert answers, RealSelf has become the essential resource and service for those seeking to find the right doctor or clinic.

Buffalo Hump Reduction

Friday, September 30th, 2016

 

The buffalo hump neck deformity refers to a collection of fatty collections on the back of the neck. The size of the fat collection can vary greatly from small lipomas to very large hump-shaped fatty tumors. They can appear gradually with no apparent reason or can occur because of well known causes such as HIV lipodystrophy as the most recognized etiology of large buffalo hump deformities.

Appearing on the back of the head, they present as masses that stick out as the name implies. Because of their location they often create discomfort and restriction of neck extension. Their location on the back of the neck determines what type of treatment would be used to treat them.

buffalo-hump-lipoma-removal-dr-barry-eppley-indianapolisBuffalo humps can occur at two different tissue locations. One anatomic location is partial intramuscular. These present as well formed and encapsulated lipomas. They can only be completely removed by an open excision. Their encapsulated form allows for complete removal from their partial intramuscular location.

Buffalo humps can also occur at the subcutaneous level. The native posterior neck subcutaneous fat becomes enlarged. The dysmorphic fat is not necessarily encapsulated like the traditional lipoma. It is more diffuse in nature and is often larger than the encapsulated lipoma. This form of buffalo hump can be treated by liposuction. Its subcutaneous location allows for it to be more easily and effectively removed. While open excision can be performed liposuction is usually the procedure of choice. Because of its more fibrous consistency, energy-driven forms liposuction are preferred.

Dr. Barry Eppley

Indianapolis, Indiana

Tragal Flap Ear Canal Hair Removal

Wednesday, September 28th, 2016

 

Hair that grows on the ear is a well known phenomenon amongst men as they age. Often joked as hair that has migrated from the scalp, it appears as outcroppings of black hair from various parts of the ear. The greatest concentrations appear on the earlobes, helix and, interestingly, the tragus. Often ear hair is dark even if the man’s hair color has turned gray.

excessive-tragal-ear-hair-dr-barry-eppley-indianapolisHair on the tragus of the ear, also known as ear canal hair, is the most interesting/unusual place for ear hair to develop. It is well known to develop hair since it gets its name from the Greek word, tragos, meaning goat because its hair growth on its undersurface resembles that of a goat’s beard.

The traditional methods of ear hair removal include plucking and shaving. While effective these methods require near daily maintenance as they only remove the most visible part of the hair shaft and not the growth center. (follicle) Laser hair removal can be done for more permanent results but this requires multiple treatments, is a difficult place to treat because of the shape and location of the tragus and can be quite uncomfortable to have done.

tragal-ear-skin-flap-for-hair-removal-dr-barry-eppley-indianapolistragal-ear-hair-removal-electrocautery-dr-barry-eppley-indianapolisA surgical treatment for tragal ear hair removal can be done that is near 100% effective and can be completed in one session done under local anesthesia. This is known as tragal flap hair depilation. In this technique a skin flap is raised off of the tragal ear cartilage. The tragal skin flap is then everted and all of the dark hair follicles can be easily seen. The hair follicles are amputated by scissors and then cauterized, thus permanently removing the actual growth center of the hair.

tragal-ear-skin-flap-closure-for-hair-removal-dr-barry-eppley-indianapolisThe tragal skin flap is trimmed as it has been mobilized,  further removing any hair-bearing skin. The skin flap is then closed back over the tragus with small dissolveable sutures. No dressing is applied and the suture line remains hidden on the underside of the tragus or ear canal. Swelling and bruising are minimal to undetectable. Full healing takes place in about ten days.

Ear canal hair is difficult to permanently remove with any traditional hair treatment method. Surgical tragal flap hair removal is a highly effective one-time treatment that can be done in the office under local anesthesia with virtually no recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Vanquish ME for Non-Surgical Fat Reduction

Tuesday, August 30th, 2016

 

The market leader for nonsurgical fat reduction is Cryolipolysis or Cool Sculpting. It is the market leader not necessarily because it is the best body contouring device but because it is certainly the most heavily marketed to both physicians and patients. But it is not suitable for every patient that seeks nonsurgical fat reduction because of the limitation  of applying the paddles which deliver the cooling energy to create its effect. Thus it is usually limited to patients that have a BMI less than 25.

Vanquish Body Contouring Dr Barry Eppley IndianapolisVanquish ME is a better device for larger patients like those with BMIs over 30. Because of the large spot size and non-contact external applicators, it can treat many patients that are not suited for Cool Sculpting and other modalities. A recent study found that a series of four Vanquish treatments without manual massage resulted in an average reduction of the abdominal fat thickness of over 5mms as assessed by MRIs.

Given that 30% of the population has a BMI that is over 30, spot treatments offered by many devices would be completely ineffective. This leaves a large number of people not seeking to undergo liposuction has candidates for Vanquish treatments. Vanquish results usually become evident in just a month after beginning treatments so patients usually stay motivated to complete the treatments and often go on to a second series.

When Vanquish is combined with Exilis Ultra to increase tissue heating the amount of skin contraction and tissue tightening is enhanced. The new Cellutone also speeds he onset of results. Adding a massage component to body contouring techniques is well known to be beneficial. When added to a non-invasive fat reduction treatment series it has been shown to nearly double the amount of abdominal reduction seen.

Dr. Barry Eppley

Indianapolis, Indiana

Hydroxyapatite Granules for Facial Augmentation

Monday, July 4th, 2016

 

I get a lot of inquiries regarding the use of hydroxyapatite(HA) for facial augmentation. Some requests are for whether it will work for their facial augmentation needs. Others are with concerns about indwelling HA materials at various craniofacial implantation sites. Depending upon what you read and whom has written it, the advisability and safety of HA facial augmentation can be positive or negative.To provide some clarity to the use of HA, I have written the following brief review on the topic.

Hydroxyapatite is a calcium phosphate materials that is similar to bone (HA is 70% of the inorganic mineral in bone) and has bioactive and osteoconductive properties. Calcium phosphate materials come in a very wide variety of forms such as cements, blocks, granules and coatings and are used in many medical and dental applications. Such calcium phosphate synthetic materials come in two common forms, hydroxyapatite and tricalcium phosphate. (TCP) These two materials are often confused and are in appropriately used interchangeably. Hydroxyapatite is best thought of as non-resorbable  while TCP is resorbable. To matters somewhat more confusing there are even combined biphasic HA-TCP composites for clinical use.

It is important to realize that the term, hydroxyapatite, is really a generic one. There are many different forms of synthetic HA based on its porosity, density and how it is processed. Because it can be made fairly inexpensively there are many manufacturers around the world. Their similarities and differences are impossible to know from a surgeon and patient standpoint. Thus it would be presumptous to assume they all behave the same biologically or are even equally safe.

hydroxapatite granuleshydroxapatite granule porosityFor facial augmentation, hydroxyapatite granules are what is commonly used. Their ability to be introduced by an open syringe injection method and molded into place intraoperatively has considerable merit. Hydroxyapatite granules can be non-porous (dense) or porous. There are many different porosities of HA granules that are usually measured in microns such as ultrasmall porosity (10-50 µm where even capillaries have a hard time getting in), small porosity (50-150 µm which is amenable to both blood vessel and bone ingrowth) and medium to large porosities. (100-300 µm and 500-1000 µm) It is not known which porosity is more advantageous, if any, for onlay facial augmentation use. It is generally believed that porous HA granules in the range of 50 to 150 µm are ideal from a biologic perspective although no comparative clinical studies have ever been done.

There is extensive clinical evidence that hydroxyapatite granules are very safe, well tolerated and exhibit substantial bony ingrowth/overgrowth. I have seen and treated many HA granule facial augmentation patients and have seen their results both preoperatively by 3D CT scan and intraoperatively for removal/adjustment. I have always been impressed by the bony growth in and around the granules. Inflammatory reactions and bone destruction/degradation have never been observed.

Hydroxyapatite Jawline-Augmentation-Dr-Barry-Eppley-IndianapolisBut what I have also been impressed with is their general lack of smoothness and very lumpy appearance. They create a bone surface that is anything but a smooth and regular contour. Whether this is due to the irregularity of the bone ingrowth into the granules or that the laying down of the granules occurs in a lumpy fashion is speculative. I would say it is both but the biggest culprit is probably that it is virtually impossible to have it placed in a smooth and lump-free fashion. There is no linear flow to a HA granule injection placement. Thus it is assured that it can not be deposited on the bone’s surface as smoothly as that of a hyaluronic-based injectable filler for soft tissue augmentation for example.

In conclusion I like hydroxyapatite granules for onlay facial augmentation for its safety, effectiveness and method of application. But its aesthetic effects are often problematic and severely limits its use. For small craniofacial augmentation sites it has a role but patient selection is critical. It works best when it is not asked to do too much.

Dr. Barry Eppley

Indianapolis, Indiana

First U.S. Penis Transplant

Monday, May 23rd, 2016

The first U.S. penis transplant was performed in Boston on May 8 and 9th by a team lead by a plastic surgeon. This is the third such penis transplant in the world. The 64 year-old male patient had his penis previously removed due to cancer. The operation took 15 hours over two days with the penile transplant coming from a deceased donor. The transplant surgery was part of a research program whose ultimate goal is to aid combat veterans with significant pelvic injuries as well as those men who have had penile resection due to cancer and penile amputations due to trauma.

Like all organ transplant surgeries, they are a marvel and plastic surgery has been at the leading edge of many of them for decades. While face transplants have gotten the most attention over the past few years, it is a far more complex type of tissue transplantation than that of a solid organ like the penis.

penile anatomyBut a penis transplant is still a challenge and this single operation belies the work that lead up to it. The hospital team spent several years preparing for the penile transplant which involved a lot of cadaver work to learn the intricate details of the anatomy as well as becoming proficient at harvesting a penis from a donor. Like so many things in life, a  single event if it is to be successful comes with a lot of preparation. Every new type of tissue transplant has required thousands of hours of preparation for the actual event. While microsurgery and reattaching blood vessels and nerves has been around for over 25 years, performing it on a new organ still requites a lot of forethought.

Plastic surgery continues to develop new techniques for reconstructive and aesthetic surgery. What will be learned for performing a pioneering surgery like penis transplants will one day translate into other more everyday surgical techniques. That has been the history of plastic surgery over the past 100 years.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Congenital Lip Nevus Surgery

Saturday, April 30th, 2016

 

Background: The congenital melanocytic nevus is one form of a mole that is present at birth. It occurs in about 1% of all births and occurs about 15% of the time on the face. It usually appears as a very distinct brown-colored lesion whose color is very homogenous. One of its distinct features is that it is associated with hair that is usually dark in color.

The melanocytic nevus grows proportionally as the child grows and will usually become thicker and raised above the surrounding skin’s surface. Its hair growth becomes greater after puberty and the hair growth may become darker in color. Very large congenital nevi are at higher risk for malignant conversion into melanoma. And for this reason early excision is standard practice to eliminate this potential risk.

Melanocytic nevi are classified by size based on diameter. Small size are those that are less than 2 cms. But when they occur on the lip a 1 or 2 cm nevi can be considered large when considering how to reconstruct it after excision.

Case Study: This 13 year-old female  was born with congenital nevus on her lip. It grew proportionately with her and developed a lot of hair growth. It was a source of ridicule for her in school and requires regular hair trimming. She was finally ready to have it removed. Because of its size, treatment options included serial excision, total excision with skin grafting and excision with local flap reconstruction.

Upper Lip Nevus Excision and Skin Grafting result front view Dr Barry Eppley IndianapolisUpper Lip Nevus Skin Graft Neck Donor Site Scar Dr Barry Eppley IndianapolisUnder general anesthesia, the entire lip nevus was excised with 1mm margins. A full thickness skin graft was harvested from a skin crease in the lower neck. It was applied to the excision site and covered with a tie over bolster. The bolster was removed 10 days later. When seen none months after the procedure, the skin graft had matured and the lip was soft and supple without distortion. The harvest site from the neck had a barely discernible scar.

Upper Lip Nevis Excision with Skin Grafting result oblioque view Dr Barry Eppley IndianapolisThe benefits of full thickness skin grafting are that there are no additional scars created in its reconstruction. It is essentially trading off one patch of discoloration for another. But that tradeoff is easy since a lighter color match of skin without hair that is flat is a certain improvement. Consideration can be given later to scar treatment methods such as laser resurfacing and even serial excision.

Highlights:

1) Congenital lip nevi are present at birth and are usually associated with extensive hair growth as the child develops.

2) Large lip nevi can not be primarily closed after total excision without significant lip distortion.

3) Complete excision of congenital lip nevi requite full thickness skin grafting to prevent transverse lip deformities/constriction.

Dr. Barry Eppley

Indianapolis, Indiana

2015 Real Self Top 100 Dr. Barry Eppley

Wednesday, March 23rd, 2016

 

Real Self 100 2015 Dr Barry Eppley IndianapolisReal Self is a community-driven website where readers can review treatments and find a plastic surgeon to perform them. The website is chocked fill of reviews, popularity rankings and lots of general information on plastic surgery and aesthetic medicine. The layout of the site allows readers to post questions for doctors to answer and is one of its strongest and most unique features. In addition to posting questions to doctors, it also allows the readers to write treatment reviews and share photos of their plastic surgery experiences. It is estimated that Real Self attracts close to 8 million visitors a month.

Real Self has a 13,000 member doctor community who are registered with the site. Every year the company lists its Top 100 doctors who have contributed the most to the site through answering patient questions, posting before and after pictures and through patients who have reviewed them.

The 2015 Real Self 100 lists Indianapolis plastic surgeon Dr. Barry Eppley as one of its top 1% of its doctors. As a Real Self 100 honoree, Dr. Eppley is recognized as a leading consumer influencer in aesthetic surgery and medicine. This award is a testament to his commitment and contributions through the 2015 year. By contributing to Real Self at this level, he has helped set the standard of excellence in consumer education.

Plastic Surgery Statistics 2015

Saturday, February 27th, 2016

American Society of Plastic Surgery statistics 2015The American Society of Plastic Surgeons (ASPS) just released their annual plastic surgery statistics from procedures performed by their members in 2015. The annual number of procedures done rose 2% from 2014 with close to 16 million surgery and non-surgical procedures done. To no surprise the overall number of procedures performed from 15 years ago has doubled due to the development of new products and surgical technologies.

While the historic use of the word ‘lift’ in plastic surgery almost always meant a facelift, today there are a wide variety of body lifts that collectively exceed the number of facelifts done. Breast lifts, buttock lifts, arm lifts and lower body lifts are now common. Fifteen years ago many of these types of lifts were virtually non-existant. The widespread need for body contouring after large amounts of weight loss through bariatric surgery and other weight loss methods has created the demand for these newer types of body lifts.

If the almost two million cosmetic surgeries performed by ASPS members in 1015, the top were breast augmentation, liposuction, rhinoplasty, blepharoplasty and tummy tucks. Once change from the prior year is that facelifts were no longer in the top five list. Total breast augmentations were down 2% at close to 280,000. Liposuction had a 5% increase to just over 220,000 fat removl surgeries done. Rhinoplasty surgery was a close third at 218,000 which was unchanged from 2014. Blepharoplasty or eyelid surgeries were down 1% with just over 200,000 performed. At fifth place were tummy tucks, entering the top five procedures with an increase of 10% from the prior year with close to 128,000 abdominal reshaping operations done.

With the over 14 million non-surgical and minimally invasive procedures done in 2015, the top five were Botox, injectable fillers, chemical peels, laser hair removal and microdermabrasion. Botox injections has lead this category for years and came in at close to 7 million patients treated. (up 1%) Soft tissue fillers were a distant second with almost 2.5 million patients injected. (up 6%) Chemical peels were up 5% (1.3 million), laser hair removal was unchanged and microdermabrasion down 9%.

Buttock enhancement procedures continue to increase in numbers as the U.S. population make-up changes and the awareness and acceptability of these procedures becomes more widespread. It is also a function of more plastic surgeons doing the buttock enhancement surgeries. Not surprisingly fat grafting (Brazilian Butt Lift) leads the way with almost 15,000 procedures done in 2015. (up almost 30%) Buttock implants was also up in a similar percentage with almost 5,000 surgical lifts done.Buttock implants were also up over 30% with just over 2,500 procedures performed.

One interesting gender change was seen in breast reduction surgery. An increasing number of men are having gynecomastia reduction surgery (over 27,000) which accounted for over 40% of all breast reduction surgeries performed.

While the annual plastic surgery statistics never show a dramatic change in one single year, they do show patterns of surgeon and societal preferences when compared over a longer period of time. This can be seen in the number of body contouring procedures such as buttock enhancements and the ongoing high number of Botox injection treatments done.

Dr. Barry Eppley

Indianapolis, Indiana

Revision Plastic Surgery

Friday, February 5th, 2016

 

Cosmetic procedures and their outcomes can be influenced by how the body responds to the traumatic insult of surgery and the unpredictable forces induced by wound healing. As a result, undesired aesthetic outcomes can occur. This may necessitate the need or desire for revision plastic surgery.

In plastic surgery, the occurrence of complications presents different issues from most other types of surgical disciplines. Unlike more typical postoperative problems such as infection or bleeding, the healing of the surgical site in a cosmetic procedure may be perfect but the desired appearance of the operated area less than desired. The development of a suboptimal appearance exposes the cosmetic surgery patient and the surgeon to the potential need or desire for revisional surgery.

Since appearance was the primary objective of undergoing the surgery, the rate of revisional surgery is going to change based on a patient’s perception of the outcome. While the actual need for revisional surgery varies amongst the type of cosmetic procedure performed,  it has been estimated that it averages in the range of 10% to 15%.  Certain procedures, usually those that involves implants, can be substantially higher. Conversely, many other procedures manipulate one’s own natural tissues to create their effect and, as a result, their revisional rate is in the low single digits.

While revisions of cosmetic surgery results may often be relatively minor, and usually way less than the original surgery, their risk of occurrence is most certainly not rare. Any cosmetic surgery patient needs to understand that the risk of revision plasticl surgery is real and not to make the assumption that such things just happen to others and they are somehow immune to this possibility.

When postoperative complications develop and the need for revisional surgery becomes apparent, it is not a moment of happiness for either the patient or the surgeon. The cosmetic patient is dissatisfied as they never really anticipated that this might happen, no matter how well disclosed this risk was before surgery. Surgical problems are often thought of as ‘something that happens to other patients’ or are the result of some type of ‘surgical negligence’…neither of which is rarely true.

The cosmetic patient is understandably focused on the potential benefits of the operation, not the statistical risks of revisional surgery. This thought process has been unintentionally fostered by plastic surgeons themselves with the many promotional advertisements promising ‘weekend facelifts’, ‘scarless surgery’, and many unrealistic outcomes or recovery times.  As a result, cosmetic surgery is often not seen as the very real surgery that it is with its many potential risks.

Like the patient, the surgeon is equally not enthused about the need for revisional surgery either. There are many reasons surgeons can feel that way, from knowing that the patient is disapppointed,  a perceived failure of their own abilities and as to how this may reflect on their own reputation and image. As a result of these opposing perspectives and even potentially conflicting agendas, a discrepancy may develop between the patient and surgeon as to the need and advisability of revisional surgery.

When needed, however, surgical revisions should be done in the proper setting and under the appropriate circumstances. Certain minor revisions can be reasonably performed under local anesthesia in the office. This approach is simple and avoids the use of the operating room. Many times, however, this office approach to surgery is ‘overused’ in an effort to save the patient further expense. Many revisions are best done in the operating room under an anesthetic that provides a more comfortable experience for the patient and also allows the surgeon to more adequately perform the revision plastic surgery.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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