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Plastic Surgery Product: EMEND Antiemetic Drug

Wednesday, May 14th, 2014

 

One of the greatest fears of many elective cosmetic surgery patients is the fear that having anesthesia will induce after surgery nausea and vomiting. This is most manifest in those patients that had surgery and general anesthesia before and developed exactly that…prolonged wretching after surgery. It is not the fear of surgery and pain or undergoing anesthesia but the very uncomfortable upper GI symptoms that invokes fear about the procedure in some patients.

While there are a lot of antiemetic medications that are used in surgery, from steroids to scopolamine patchs, they are not universally effective. Despite pills, patches and intravenous medications, the nausea and vomiting prone patient can still develop what he or she fears the most.

EMEND in PLastic Surgery DR Barry Eppley IndianapolisAn alternative antiemetic approach is to prophylactically begin treatment hours before surgery even before the patient arrives at the facility. This is now possible with EMEND. (Aprepitant) This is an antiemetic compound that is a substance P antagonist. It has its effect by blocking the neurokinin 1 receptor. It was initially FDA-approved in 2003 to prevent nausea and vomiting from chemotherapy and after surgery.

But if EMEND is taken three hours before the actual surgery time, it can have a profound preventative antiemetic effect. This requires a prescription from your doctor and a call to the pharmacy beforehand to make it is in stock. It is fairly expensive at around $60 for a single pill and it is often not covered by insurance. But for those patients that have ever had prolonged after surgery nausea and vomiting, that is a very small price to pay for its potential prevention.

I would highly encourage those patients who have a history of nausea and vomiting problems after anesthesia and surgery to take EMEND beforehand. This would be particularly important in cosmetic plastic surgery patients where the choice to have surgery is purely elective and their biggest fear can be remedied by the ingestion of one pill beforehand.

Dr. Barry Eppley

Indianapolis, Indiana

The Reality of Non-Surgical Skin Tightening

Monday, March 14th, 2011

There are numerous cosmetic devices that claim to be able to tighten loose skin. This is of tremendous interest to many patients, whether it be on the face or the body. Galvanized by such non-invasive treatments as Botox and injectable fillers, obtaining tighter skin without surgery seems plausible. With the focus on non-invasive treatments over the past decade, skin tightening is a prime cosmetic target with great public appeal.

From wrinkle reduction to body fat loss, energy-based devices (laser, high intensity light, ultrasound, radiofrequency) have been developed and applied with variable success. Extending such devices for non-surgical skin tightening has a lot of applications such as improving sagging jowls, abdominal skin rolls, or loose skin on the back of the arms. I regularly see patients who come in to get rid of their turkey neck, bat wings, sagging breasts or roll of skin that bulges over their beltline…with the hope and belief that such devices will avoid the need for surgery.

In reality, non-surgical skin tightening devices (e.g., Thermage, Smartlipo) do produce some amount of skin tightening. A few patients will demonstrate dramatic improvements while most patients will have more modest changes. Despite their skin tightening abilities, many patients will never be happy with the outcomes of these treatments alone. This has to do with the differences in how patients perceive skin tightening and in how much skin tightening these devices can do.

My observation is that a patient’s perception of skin tightening can be measured by centimeters and inches. Any device’s skin tightening ability can be measured in millimeters or just small fractions of an inch. It is not that these devices can not tighten skin but that most patient’s loose skin problems far exceed what can be done without surgery. No skin tightening device can replace a facelift, armlift or a tummy tuck when truly sagging skin exists. Non-surgical skin tightening works best for very modest amounts of loose skin…that one wouldn’t consider undergoing surgery to remove.

Like trying to lose fat with only taking a pill, wiping the appearance of cellulite and stretch marks clean by a skin massager, or getting rid of those dark undereye circles by just applying a cream, hope is eternal. Getting rid of loose skin, as most patients define extra skin, will almost always defy any current method of device-based skin tightening. It is not always appealing to realize that surgical removal is still the best way to get rid of unwanted loose areas of skin. Having a ‘nip and tuck’ may not be high-tech, but it continues to provide a level of improvement that will satisfy most patient’s expectations.

There is a fine balance between creating some skin tightening by contraction (heat shrinkage) and causing a skin burn and irreversible damage. Unfortunately, the amount of energy required to cause the degree of skin tightening that most patients require is currently beyond what both patient’s and their skin can tolerate.

Dr. Barry Eppley

Indianapolis, Indiana

Soft Tissue Approaches to Treatment of the Gummy Smile

Sunday, August 22nd, 2010

Sitting a close second behind that of one’s eyes, the smile is the face’s greatest expression of emotion. The movement of the upper lip in a smile exposes the underlying teeth which plays a role in how attractive that smile appears. While the teeth are exposed in a smile, the gum tissue usually is not. When more than a little gum tissue appears between the upper lip and the teeth, it becomes known as the gummy smile.

The gummy smile is historically defined as more than 2mms of gum (gingival) show during a smile. The amount of gum show is a function of several factors including the height of one’s incisor teeth, the vertical length of the upper jaw and how much the upper lip moves up during smiling. As a result, there are different types of gummy smiles. Exceeding large gummy smiles (greater than 6 to 8mms of gum show) are primarily a bone-based problem. (length of the maxillary bone) Smaller amounts (2 to 4mms) are often more soft-based. (lip thickness and movement)

Treatments for the gummy smile are far from established or standard. Even though very large gummy smiles are best treated by a maxillary impaction (LeFort 1 osteotomy), that option requires a commitment of a course of orthodontics and a significant surgical procedure. In gummy smiles less than 6mms, most patients will be resistant to such a ‘drastic’ approach.

Soft tissue management of the gummy smile has been based on two goals; to diminish how far the upper lip moves (muscle weakening and/or release) and techniques to bring the upper lip down. (lengthen vertically) The combination of both approaches is really needed to make a significant difference in the appearance of the gummy smile. Neither approach alone has been shown to be effective long-term.

One of the primary upper lip elevators is the levator labii superioris. From its origin below the lower rim of the eye socket to its insertion into the underside of the skin of the upper lip, this vertical strip of muscle runs just outside of the nostril. Severing this muscle can be done from an incision inside the nostril and does weaken upper lip excursion. (as has been shown by Botox injections) But keeping the muscle ends from healing and returning to normal excursion requires something else. This is where the role of the spacer has been shown to be effective. Using a premaxillary implant after muscle release can help the muscle ends from healing back together again. At the least, this spacer helps push the upper lip down. While advocates for this spacer in the past have used synthetic materials, I prefer the use of rolled allogeneic dermis. It is soft, can not be felt like an implant, and will integrate naturally into the surrounding tissues. This is a better way to introduce scar between the muscle ends without risk of long-term complications.

The other component of soft tissue management is upper lip release and lengthening. The upper lip can be released from the inside and its attachments freed up from the bone along the pyriform aperture to the canine fossa. By making the initial incision vertically through release of  the maxillary frenum, such released upper lip tissue can be put back together in a classic V-Y closure pattern which will provide some upper lip length from the inside. When combined with a levator myotomy and spacer, realistic gains in upper lip length and decrease in gingival show can be anywhere from 2 to 6mms.

Such soft tissue gummy smile reconstruction can be done as an outpatient procedure under IV sedation in a simple one hour procedure. While it could also be performed under local anesthesia, patient comfort is better under some a little sedation. There will be some considerable swelling of the upper lip which returns to normal in about 10 days. The upper lip will move a little unnaturally for a few weeks after surgery. While the amount of gummy smile reduction will vary per patient, there are no long-term risks or deformity than can occur from this approach.   

Dr. Barry Eppley

Indianapolis, Indiana

Brazilian (Bikini Line) Waxing and Infection Risks

Thursday, July 9th, 2009
 

I read a recent article on the internet that talked about the potential dangers from getting a Brazilian wax, also known as waxing for a smooth bikini line. They described a case of cellulitis that resulted  after such a waxing treatment. In this case, the patient required weeks of IV antibiotics and a surgical drainage to recover. The article described her experience as not unique.

While there are no reliable statistics on waxing-related complications, such waxing complications are extremely rare. Cellulitis is an early stage of infection that starts out as a diffuse redness and comes from a small break in the skin. Bacteria are introduced through this small skin break into the tissues underneath. While such a phenomenon occurs all the time (thinking about the nicks from shaving for a minute), cellulitis rarely develops in the vast majority of people. This is because it takes a unique set of circumstances to develop. And these unique circumstances are the right type of bacteria and a person’s susceptibility (or sensitivity) to that bacteria. Patients with compromised immune systems or diabetics are usually at greatest risk. The pubic area is probably slightly more prone to this set of circumstances than any other waxed areas due to the different bacterial types that exist around the genital region.

Waxing, by literally pulling off a few cell layers of the outer skin, causes a temporary inflammatory (redness) reaction. But this should be subsided within 24 hours or so after a waxing treatment. If redness persists or becomes more intense or starts to cover a larger area, then one should see a plastic surgeon immediately. Early cellulitis can be treated and reversed with oral antibiotics. But if you wait for 5 days (like the lady in the article) and have severe redness and a fever, than a hospital course will await you. Cellulitis untreated can turn into an abscess or even necrotizing fasciitis.

While waxing is a very common treatment, there are several guidelines that will help to avoid this possible risk. First, make sure the person performing the treatment is a state licensed cosmetologist or aesthetician and that they perform the treatment regularly. Bikini waxing is more difficult due to the many different directions of hair growth and the sensitivity of the area. Secondly, look at the waxing work station and see that it appears clean and orderly. Is the wax fresh and does it look like it has been used before? (double-dipping) Ask about the type of wax being used. There are now special types of wax that are used just for bikini waxes. Hard or crème waxes may be used based on the type of hair that one has. The wax must not be too hot and most good quality waxing units have a visible temperature setting. After waxing, the treated area should be covered with an antibiotic cream and/or a 1% hydrocortisone cream.

Brazilian or bikini line waxing is a safe and predictable procedure. Because it is close to the genital region, it is not the same as waxing one’s legs or back. Although rare, one should be more aware of any prolonged redness in this area and seek a prompt evaluation if it persists beyond a day or two.

 

Dr. Barry Eppley

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

 

 

Testosterone Supplementation for Men on Indianapolis Doc Chat Radio Show Indianapolis

Monday, March 16th, 2009

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 1:00 – 2:00PM, hosted by Dr. Barry Eppley, the topic of testosterone deficiency and supplementation for men was presented.  With an anti-aging medical specialist from Ology in Indianapolis, the symptoms and testing for testosterone deficiency were reviewed. How testosterone supplement gels work, who would benefit by them, and what risks it poses by using them was discussed. Feeling tired? Low sexual desire and performance? Gaining fat but losing muscle? Over 50? Testosterone supplements may be for you!

Complication Differences Between Face vs. Body Plastic Surgery

Monday, May 12th, 2008

Plastic surgery encompasses a wide variety of procedures for the face and body. From nose jobs to breast implants, we perform a broad scope of body changes. While the vast majority of these procedures do very well and patients have an uncomplicated after surgery course, some patients will experience complications. The occurrence of complications in plastic surgery, of the minor variety, are not rare. Major complications in plastic surgery, fortunately, are very rare.

 

Interestingly, there is a vast difference in the occurrence rate and types of complications between plastic surgery of the face and that of the body. While patients understandably place a greater emphasis on procedures done to their face, the actual rate of significant complications from facial plastic surgery is quite low. There are several reasons for this that include; the tremendous blood supply to facial tissues which is quite resistant to infection and allows most wounds to heal quite quickly (including the clearing of bruising and swelling), cosmetic surgery of the face is really ‘superficial’ surgery and does not enter any major body cavities or cause major pain and surgery on the face does not disrupt the body’s physiologic functions (like temperature control and fluid shifts) like body plastic surgery does. For these reasons, facial plastic surgery procedures do not pose the same systemic risks as body plastic surgery such as deep vein thromboses, pulmonary embolisms, and infection. Most complications in the face, short of bleeding and hematomas, are mainly about appearance, symmetry, and scarring. Not that these are not significant, but they rarely are life-threatening or invoke major medical problems.

 

Body plastic surgery, conversely, carries with it bigger risks in my opinion. First, body plastic surgery is ‘bigger’ and involves more surface area of the body than the face. Whether it be liposuction or a tummy tuck, large body areas are being opened or manipulated. As a result, the issues of blood loss, adverse temperature changes, and fluid shifts are real potential issues and expose the patient to greater medical risks such as fluid collections (seromas) and blood clots. Second, the blood supply below the neck to any one body part is not as great as any part of the face. Therefore, infection rates for body plastic surgery are definitely greater than that of the face. While patients are more tolerant to small differences or asymmetries on the body as opposed to the face, the chances of more significant differences is also likely because the surgery site is much bigger and the changes being made are bigger. No where are these issues more evident than in bariatric plastic surgery, the extreme end of body plastic surgery,  where big skin cutouts, long incisions, and extended operating times test the ability of any patient to heal in an uncomplicated manner.

 

Potential complications are part of any form of plastic surgery and fortunately most are relatively minor and are often just a bump (aggravating as that is) along the way of recovery. However, body plastic surgery is associated with longer recoveries (for many of the procedures) and higher rates of complications such as wound dehiscences, seromas, and asymmetry between body parts. This is in contrast to plastic surgery of the face where the surgical sites by comparison are smaller and healing is much quicker and less complicated.

 

 Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Dr Barry Eppley and YouTube

Sunday, March 9th, 2008

Dr Barry Eppley, board-certified plastic surgeon of Indianapolis, has posted a series of practice videos on the very popular video website, YouTube.  These videos describe his practice philosophy and include many procedure specific videos of surgical techniques and results. Over 60 videos are available that describe numerous plastic surgery procedures from breast augmentation to chin osteotomies.

Dr Barry Eppley and My Space

Sunday, March 9th, 2008

Dr Barry Eppley, plastic surgeon of Indianapolis, has placed his education and training as well as a practice philosophy video describing his approach to patients on the popular website, My Space.This has been made available for potential new patients and general public viewing under the name DrEppley.

Dr Barry Eppley and Flickr

Saturday, March 8th, 2008

Dr Barry Eppley, board-certified plastic surgeon of Indianapolis, has placed an extensive photographic log of the hospitals and his Ology Spa offices at IU Health North Hospital in Carmel Indiana and IU Health West Hospital in Avon Indiana on the photo website of Flickr.

Photos of some of his staff and views of the facilities can be viewed. Plus there are hundreds of before and after photographs of various procedures that Dr. Eppley regularly performs.

Dr Barry Eppley and Ezine Articles

Sunday, February 24th, 2008

Dr Barry Eppley, board-certified plastic surgeon in Indianapolis, has achieved platinum author status on Ezine Articles.  Ezine Articles is a website that matches expert authors and enewsletter publishers, providing such publishers with access to expert author content. Dr. Eppley is a prolific writer in plastic surgery with three textbooks, 250 peer-reviewed medical journal publications, 4 websites, 16 landing pages, and blog sites containing over 300o entries.


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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