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Archive for the ‘product reviews’ Category

Product Review – Lip Augmentation with Juvederm Ultra XC

Wednesday, October 7th, 2015


Lip Augmentation Dr Barry Eppley IndianpolisLip augmentation is one of the most common and historic procedures for hyaluronic acid-based injectable fillers. It would surprise many then to find out that despite its popularity and common usage, few of these injectable fillers are actually FDA-approved for use in the lips. There are a variety of reasons for this lack of approval but safety and effectiveness are not among them.

On October 1, 2015 the US FDA has approved Juvederm Ultra XC for injection into the lips and perioral (mouth) area for aesthetic augmentation in adults. Juvederm Ultra XC and Juvederm Ultra Plus XC injectable fillers are already FDA-approved for injection for moderate to severe facial wrinkles and folds around the nose and mouth. (nasolabial folds) Juvederm Ultra XC is a well known modified form of hyaluronic acid with prolonged duration (up to a year) that has lidocaine in it to improve the comfort of the treatment.

juvderm ultra xc injectable filler, dr barry eppley indianapolisIn FDA trials of Juvederm Ultra XC for lip augmentation, almost 80% of patients had visible improvement in lip fullness three months after injection. A near similar percent, (78%) stated that they had persistent improvement in lip size one year after injection. The most common adverse effects for Juvederm Ultra XC injectable filler are the same as other hyaluronic acid gels such as temporary swelling, redness and lumps and bumps.

What is unique about Juvederm Ultra XC injectable filler is that it offers long-term retention of lip augmentation results. Many hyaluronic acid-based injectable fillers are used for lip augmentation but their results often last six months or less.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Restylane Lyft

Wednesday, July 8th, 2015


Restylane Lyft Dr Barry Eppley IndianapolisThe anticipated approval of new injectable fillers shows no sign of stopping with the development of ‘niche’ filler products. This was demonstated this week as the FDA (US Food and Drug Administation) approved Restylane Lyft for cheek augmentation. Restylane Lyft, formerly known as Perlane-L, was approved for the standard injectable filler indications of treating nasolabial folds.

Per the manufacturer Gladerma In a clinical trial of 200 patients, almost 90% of treated patients with Restylane Lyft showed increased and persistent fullness in the cheeks. More than half of the treated patients demonstrated such persistent fullness out to one year followup. Adverse reactions for this hyaluronic-based injectable filler were typical with a low incidence of redness, swelling and itching, all of which resolved within two weeks after injection.

Restylane Lyft is the fifth member of the well known Restylane brand name that has been approved over the years.  Other well known companion injectable products include Restylane, which is used to correct smile lines and augment the nasolabial folds, and Restylane Silk for lip augmentation and wrinkles and lines around the mouth.

Restylane Lyft is clearly a competitive analogue to Allergan’s Juvederm Voluma. It is ongoing evidence that all companies offering injectable filler products will need to develop and market a broader spectrum of treatment offerings for very specific facial indications. What differentiates the injectable filler products is that the viscosity or so called G prime of the filler is modified to treat the array of soft tissue defects from superficial fine wrinkles to deeper areas of volume loss. Long gone are the days when one tried to use one type of filler for every aesthetic facial need.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Radiesse for Hand Rejuvenation

Saturday, June 6th, 2015


One important aspect of hand rejuvenation is volume restoration of the back (dorsum) of the hand. Skeletonization of the hand occurs through loss of subcutaneous fat allowing the tendons and bones to be easily seen which is associated with aging.  (bony hands) This has been shown to be effectively treated using a variety of filler materials. The most commonly used are many of the off-the-shelf synthetic fillers since they can be done in the office under local anesthesia for a quick plumping of the back of the hands.

Radiesse Plus Injections Dr Barry Eppley IndianapolisRadiesse Injectable Filler Dr Barry Eppley IndianapolisOne of the potential synthetic injectabl efillers to use in the hand is Radiesse. This is an opaque injectable filler that contains calcium hydroxyapatite microspheres in a water-based gel carrier. It has been used for facial augmentation since it was introduced in 2001 and has a longevity of around one year after injection.

The US Food and Drug Administration (FDA) just announced that they have approved Radiesse for hand augmentation to correct volume loss in the dorsum of the hands. FDA approval essentially means that it is both safe and effective for this use and that its benefits outweigh the potential risks. The clinical study data to support its use was done in the hands of over 100 middle-aged women using grading scales of aesthetic improvement. Compared to a placebo (control) filler, Radiesse treated hands had at least a one-point improvement at three months after treatment compared to just 3% for the controls and 98% of the patient reported visible improvement by their assessment. Any adverse effects that occurred from the treatments were common to what is known for any injectable filler such as temporary redness, swelling and bruising which all resolved within one week after injection.

Fat Injections to Hands Dr Barry Eppley IndianapolisRadiesse provides an effective method of hand rejuvenation that has some of teh better persistence of any filler on the market today. Despite its white opaque color it is not seen through the skin as such and is not visible through the skin.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – XAF5 Ointment for Eye Fat Reduction

Friday, May 29th, 2015


XAF5 Ointment for Eye Fat Reduction Dr Barry Eppley IndianapolisAn ointment that would help melt fat? Sounds to good to be true? Well it might be but preliminary clinical studies suggest that such an ointment exists and will be a clinical fat treatment in the not so far future. An active ingredient used in the treatment of glaucoma is showing promise as a nonsurgical option in the reduction of periorbital fat. (fat around the eyes)

Like many coincidental cosmetic medical discoveries (minoxidil was originally a high blood pressure medication, finasteride was a prostate shrinking drug), prostaglandin eye drops for glaucoma have a common side effect of reducing fat around the human eye. They have also been shown to do in fat cells in tissue cultures.

Topokine ointmentAs reported in the Dermatology Times, the company Topokine has been studying compound XAF5 in phase 1 FDA clinical trials with it being well tolerated and showing fat reduction at the treatment site.  XAF5 ointment has just completed Phase 2 FDA clinical trials to reduce excess eyelid fat. (steatoblepharon) Their researchers report that almost half of patients in the XAF5 ointment group showed visible improvement in both eyes of at least one level on their rating scale as well as a patient satisfaction scale which was superior to that of a placebo. The majority of patients saw improvement in facial appearance and were satisfied with the treatment. XAF5 ointment had few adverse side effects of which temporary redness around the eyes was the most common.

Once approved, XAF5 ointment would be the first topical drug scientifically studied and proven to reduce excess fat under the skin.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Emend in Plastic Surgery for Nausea and Vomiting Prevention

Sunday, April 19th, 2015


While patients have many different fears about having surgery, one of the most common is postop nausea and vomiting afterwards. (PONV) While this is a concern regardless of the type of surgery, it is of paramount importance in cosmetic surgery because it is completely elective. For some this concern may even make them think more than twice about having surgery at all.

The patients that are at greatest risk of nausea and vomiting after plastic surgery are those patients that have a prior history of it. Also the risks are increased in those patients that are having longer operations, such as a facelift or Mommy Makeover for example. While anesthesiologists use a much more aggressive anti-emetic approach today, including the use of perioperative IV medications such as phenergan, zofran and steroids, it is not fool proof. Some patients will still have breakthrough PONV. Besides its uncomfortability, episodes of PONV cause elevated blood pressure which can induce bleeding and even hematoma formation.

Emend in Plastic Surgery for Nausea and Vomiting Prevention Dr Barry Eppley IndianapolisA newer medication, Emend (aprepitant), can provide an improved preventative approach to PONV. This drug has been approved in the U.S. since 2003 for the treatment of nausea and vomiting from chemotherapy in cancer patients. It works by an entirely different mechanism that other anti-emetic drugs being a Neurokinin 1 antagonist which blocks the neurokinin 1 receptor. Emend is also different in that it will not work if you are already suffering from nausea and vomiting. It is a preventative drug not a therapeutic one. It must be taken 6 hours prior to surgery to have an anti-emetic effect. In plastic surgeons that prophylactically provide it to their high risk patients along with conventional drugs, there is a near 100% prevention of PONV.

The only downside to the use of Emend is its relatively high cost, of around $50 per pill. But to those patients who have had PONV before, this is no doubt they would say it is well worth it.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Exilis Elite for Cellulite Treatment

Monday, April 13th, 2015


Cellulite is a well recognized aesthetic skin condition that occurs most commonly in women and involves the buttocks and thighs. The cottage cheese appearance is recognized today to be the result of compartmentalized fat hypertrophy and the contraction of dermal-fascial bands in the involved regions. New device based treatments continue to emerge for its treatment that either focus on fat reduction, fascial release or both.

Exilis Skin Tightening Indianapolis Dr Barry EppleyExilis is a monopolar radiofrequency device that is used to heat the skin, resulting in collagen remodeling and skin tightening. It was first introduced in early 2011 after FDA clearance for the treatment of loose skin and body contouring. It has proven to be a valuable non-surgical treatment for reducing loose skin and wrinkles on the face and body.

Exilis Elite Dr Barry Eppley IndianapolisIn February 2015 the FDA has approved the use of Exilis for the temporary reduction in the appearance of cellulite. Using a new treatment protocol that can effectively target the fat underneath cellulite involved skin that helps give it its dimple lumpy external appearance, temporary improvement in the appearance of the skin is obtained. It takes multiple treatments, usually four to six, spaced several weeks apart to get the full effect. Full results can take up to three months after treatment.

Exilis Elite joins a growing number of devices for cellulite that offers non-surgical treatments of an aesthetic problem that defies any universally effective solution.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Lipo-202 Injections for Abdominal Fat Reduction

Monday, March 23rd, 2015


The non-FDA approved and compounding pharmacy approach of the early 2000s for an injectable fat reduction concept (LipoDissolve) has long disappeared as a franchise concept. But the popularity of an injectable fat treatment was not forgotten. This has spurned into a more scientific approach to injectable lipolysis with several companies putting their drugs through the FDA regulatory process for approval.

Lipo-202 Abdominal Fat Reduction InjectionsOne of these potential injectable fat melting drugs is Lipo-202 (Neothetics) which is being studied and in clinical trials for  abdominal fat reduction. This is noteworthy because of Kythera’s ATX-101 recent FDA approval for submental fat reduction. Lipo-202 is for the reduction of central abdominal bulging due to subcutaneous fat in non-obese patients, known as a pot-belly or stomach pouch. There is currently no FDA-approved drug for the treatment of abdominal fat reduction.

Lipo-202 contains salmeterol xinafoate known for its use as a highly selective beta 2 adrenergic bronchodilator. (Severent Diskus) Adrenergic receptor stimlation is well known to increase lipolysis and is the historic basis for mesotherapy with the injection of adrenergic agonists like aminophylline, isoproterenol and caffeine.

Abdominal Fat Injections Dr Barry Epple IndianapolisAn abdominal Lipo-202 treatment involves roughly 20 shots given with a very small needle. (30-gauge needle) The injections are dispersed evenly over the abdomen at about 4 cm intervals and are performed once a week for eight weeks. Each treatment takes about 5 minutes. Preliminary data suggest that the treatments produce measurable results as soon as 4 weeks from initial treatment and that the benefits last for a minimum of 3 months after treatment.

Lipo-202 will initiate Phase 3 clinical trials during 2015 with clinical data hopefully being ready for FDA submission by 2016.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Radiesse Plus Injectable Filler

Monday, March 23rd, 2015


Radiesse Injectable Filler Dr Barry Eppley IndianapolisRadiesse is a semi-permanent injectable filler that has been in clinical use for over a decade since its initial FDA approval inj 2004.. It is unique amongst injectable fillers because of its composition and mechanism of action. It is composed of approximately 30% calcium hydroxyapatite spheres contained in a 70% aqueous gel carrier. The aqueous gel carrier is comprised of sodium carboxymethycellulose, glycerin and water. There are no human or animal derived components in it. While the aqueous gel carrier gets absorbed, the calcium hydroxypatite spheres remain much longer leading to a collagen reaction that creates a sustained volume retention result.

Radiesse Plus Injections Dr Barry Eppley IndianapolisRadiesse Plus contains 0.3% lidocaine and has recently received FDA approval. Its approval was based on a clinical study with over 100 patients who had ‘regular’ Radiesse injected on one side of their face and Radiesse plus on the other side. Based on pain ratings patients rated their pain about 6.7 on a scale of 0 to 10 for the side of the face injected with ‘regular’ Radiesse  compared to about 2.3 on the same scale for the side of the face treated with Radiesse Plus. One hour after treatment, patients rated their pain about 1.1 on a scale of 0 to 10 for the side of the face injected with Radiesse compared to about 0.3 on the same scale for the side of the face treated with Radiesse Plus.

Not surprisingly, Radiesse that contains a local anesthetic is less painful to inject. This is compatible with what all of the hyaluronic acid-based fillers that have previously incorporated a similar approach have shown. This is particularly useful in an injectable filler like Radiesse which by its composition is thicker to inject and takes a bigger needle to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Exilis Skin Tightening

Friday, February 6th, 2015


Exilis Indianapolis Dr Barry EppleyRadiofrequency has become a popular treatment method for the non-invasive improvement of wrinkles, skin looseness and spot body shaping. There are numerous such devices that are currently available, one of which is the Exilis from BTL industries. Exilis is different from other radiofrequency devices is that it uses monopolar focused radiofrequency which allows for a layering of energy at different depths. This equates to uniform heating of the skin.

Several clinical studies have shown visible skin tightening and reductive body shaping results with up to 35% reduction in skin looseness, a 42% reduction in wrinkles and a 33% reduction in skin photodamage. Given that the average age of the women in these studies was 57 years old, this proves positive changes can occur even in older and damaged skin. Histologic studies of the treated skin showed full thickness collagen remodeling and elastin production. Like most non-invasive devices, a series of treatments is always needed to gain maximal results.

Such results are possible because of the advanced cooling system in Exilis which keeps the temperature below 45 degrees C. This is important because above that temperature the patient will experience a painful burning sensation. But without getting close to this temperature the desired skin changes will not occur.

Animal studies have also shown effects on subcutaneous fat demonstrating that it can selectively heat fat with apoptosis and adipocyte shrinking. The cooling system is very important here so the heat can reach the fat but without burning the intervening skin. Thus Exilis can do some mild fat reduction in addition to skin tightening. But the fat reduction is limited to just the fat immediately under the skin.

Radiofrequency treatments like Exilis can be combined with a variety of other aesthetic treatments. It can be used in conjunction with Vanquish or Cool Sculpting, for example, to create combined maximal fat reduction and skin tightening. Injectable fillers can be placed under facial areas treated with Exilis on the overlying skin. Exilis can even be used with light fractional laser resurfacing. Our practice in Indianapolis has found it vey useful and safe for a variety of face and body aging issues.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Products: Ocumend Gel Pads for Facial Recovery

Sunday, January 25th, 2015


Bruising is a common sequelae of many aesthetic facial surgeries. While all bruising eventually goes away on its own, every patient would like it to be sooner rather than later. Besides surgical technique, the use of cold compresses and oral Arnica taken before and after surgery have been the most commonly used strategies for both prevention and the treatment of bruising and swelling.

Ocumend Gel Pads Dr Barry Eppley IndianapolisOcumend gel pads (Cearna Aesthetics) provide a topical hydrogel pad that contains Arica and Ledum. While Arnica is a well known homeopathic remedy, Ledum is less well known. Derived from the wild rosemary herb, Ledum is useful in healing bruising around the eyes as well as has antiseptic properties. The gel pad is purported to deliver fifty times the concentration of Arnica over other topical preparations. A recent study showed that Ocumend improved healing times in blepharoplasty and rhinoplasty surgery patients. Blepharoplasty patients had less swelling and bruising at one week after surgery than those patients that did not use the gel pads.

Ocumend Gel Pads Indianapolis Dr Barry EppleyOcumend gel pads are applied right after the procedure and are worn as much as possible the first day after surgery. They are then applied at night for the next five days to a week. They contain no adhesives so there is no residue left behind on the skin.

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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