EXPLORE
Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

June 12th, 2016

The Subtotal Buccal Lipectomy

 

Buccal Lipectomy Dr Barry Eppley IndianapolisThe buccal fat pad has a unique role in facial contouring surgery, It is a unique encapsulated fat pad and the only one that exists outside of the orbit on the face. This makes it a prime target for removal for several reasons. It is relatively easy to remove through a small intraoral incision. Once located beyond the buccinator muscle opening its capsule allows it to be extracted quite easily. Given the size of the fat pad, a buccal lipectomy procedure would also seem to create a substantial facial thinning effect.

The influence of removal of the buccal fat pad can be substantial on the face but in different ways that most people think. Its thinning effect is much higher that is often envisioned. It affects the area right under the prominence of the cheekbone and not all the way down to the jawline. While the immediate intraoperative effect of its removal is apparent, that effects will become greater with time as the overlying tissues shrink and contract around the voided buccal space.

While the buccal lipectomy procedure has been around for decades, it is fallen into a condemned procedure by some surgeons. With the acknowledgement that the face loses fat with aging, long-term sequelae from a buccal lipectomy may create a scenario where fat grafting restoration may be needed much later in life. In other words there may be a price to paid when one is older for what was done when one was younger.

While these long-term facial volume loss with aging (and other conditions) are real, this done not mean that a buccal lipectomy should never be performed. In the right full face which is genetically prone to roundness and thicker tissues, a buccal lipectomy has a valid facial contouring role. These are the type of faces that have a low risk of ever becoming too thin or developing a gaunt facial appearance.

Buccal Lipetomy Fat Pad AnatomyTotal vs Subtotal Buccal Lipectomy Dr Barry Eppley IndianapolisThe other approach for this type of facial fat removal is a subtotal buccal lipectomy. The buccal fat pad has multiple lobes and extensions. While large amounts of buccal fat can be teased out through an intraoral incision, this does not mean that the maximum amount of fat needs to be removed. In a subtotal buccal lipectomy the extraction is stopped after the first large lobe has been delivered. This will preserve a portion of the facial fat pad and prevent pulling down its temporal extensions.

Facial Fat Reduction Zones Dr Barry Eppley IndianapolisTo get a good facial contouriong effect, a subtotal buccal lipectomy must be combined with perioral liposuction to get a more complete effect below the cheek bones.

Dr. Barry Eppley

Indianapolis, Indiana

June 12th, 2016

Case Study – Female Jaw Angle Implants

 

Background: A strong and well defined jawline used to be an exclusively male trait. And the pursuit of a stronger jawline through implant surgery used to be only pursued by the young male patient. But that has changed in recent times as now women often desire a stronger jawline as well.

When patients, men or women, seek a stronger jawline they are usually referring the back part of the jaw known as the jaw angles. The chin at the front of the jaw may also be part of the desired jawline effect. But stronger jawlines almost always refer to a stronger and more defined jaw angle region even if the chin is adequate.

Brad Pitt JawlineAngelina Jolie jawlineBut a stronger jawline has slightly different connotations for men vs. women.  Men often want a square and wider jawline such as that seen in Brad Pitt or Tom Cruise. Women, on the other hand, often long for the jaw-dropping effect that vertically lengthens the jaw angle as it defines it such as Tyra Banks or Angelina Jolie. Understanding this difference in jaw angle shapes between men and women is critical in selecting the right jaw angle implant.

Case Study: This 32 year-old female desired  stronger and more defined jaw angles. She had a thin face with little facial fat. She had a good chin but high and narrow jaw angles.

Vertical Lengthening Jaw Angle Implant sizes Dr Barry Eppley Indianapolisvertical lengthenign jaw angle implant style dr barry eppley indianapolisUnder general anesthesia she underwent the intraoral placement of vertical lengthening jaw angle implants. This style of jaw angle implant drops the level of the jaw angle downward while only adding enough width for the implant to adequately engage the mandibular ramus bone This style of jaw angle implant is unique because half of the implant is not on the bone. This design is necessary to create the vertical lengthening effect.

Female Square Jaw Angle Implants result frnt view Dr Barry Eppley IndianapolisFemale Square Jaw Angle Implants result oblique view Dr Barry Eppley IndianapolisHer result at three months after surgery showed much more defined angle that was both lower and wider. This helped ‘square off ‘ her face to some degree and created increased facial angularity.

Female Square Jaw Angle Implants result side view Dr Barry Eppley IndianapolisJaw angle implants historically were one style that only widened the jaw angle and often did not create much jaw angle definition. But with increased patient demand for jawline augmentation, newer jaw angle implant styles are needed. Vertical lengthening of the jaw angles is often needed much more than width for many patients. This is particularly true in females where the strength of the jawline comes from greater angle definition than increased jaw angle width.

Highlights:

1) Women today often seek a stronger jawline with more defined jaw angles.

2) Most women need vertical lengthening jaw angle implants as opposed to a jaw angle widening style jaw angle implant.

3) Female jaw angle implants aim mainly to create a well-defined jaw angle.

Dr. Barry Eppley

Indianapolis, Indiana

June 10th, 2016

Postoperative Instructions – Rib Removal Surgery

 

Rib Removal Surgery Dr Barry Eppley IndianapolisRib removal is done for waistline reshaping. This could be for waistline narrowing (posterior ribs #10, 11 and 12) or for waistline lengthening or correction of subcostal protrusions. (ribs #7, 8, 9) Rib removal is done through small incisions on the back or at the bottom of the ribcage in front. (and occasionally through a tummy tuck approach)

The following are the typical postoperative instructions for rib removal surgery:

1.  Rib removal surgery usually have a moderate amount of postoperative discomfort due to the separation of the muscles associated with the surgery. Some of this discomfort is managed by intercostal nerve blocks and muscle numbing injections even during surgery. (Exparel) This helps a lot during the first few days after surgery. In addition to taking your pain medication, using the wrap around binder can also be helpful through its circumferential support.

2.  Get up and walk periodically even in the first few days after surgery. This will help you breathe deeper and ultimately feel better. Judge your activity level on how you are feeling. You will tire more easily than expected, even up to one month after surgery.

3. You may shower on the first or second day after surgery. Do not submerge your incisions in a bath tub or hot tub/jacuzzi until 2 weeks after surgery. By this time, your incisions will have healed adequately to prevent the risk of infection.

4. Tapes are will be placed across your incisions to completely cover them. This eliminates the need for any immediate incisional care. You may get them wet in the shower. They will not easily come off, even when allowed to get wet, because they are glued into place. They should be left in place and you can remove them 7 to 10 days week after surgery.

5. You are to continue wearing your wrap around binder for several weeks after surgery. Its use is very support and comfort. So you use it as long as it is making you feel better. The binder has no role in obtaining the final rib removal surgery result.

6. Numbness of the back or abdominal skin is to be expected and complete return of feeling may take up to several months after surgery. During this period, exposure to heat (e.g., heating pads) should be done with this consideration in mind to avoid potential skin burn injuries.

7. Avoid strenuous exercise and heavy lifting for 3 to 4 weeks after surgery. Lighter forms of exercise (e.g., walking) can be done when you feel comfortable doing so.

8. All sutures used to close the incisions are under the skin and are dissolvable. Thus no suture removal is needed. Topical or laser scar therapies can be started at 3 weeks after surgery.

9.   You may drive when you feel comfortable and can react normally and are off pain medication.

June 10th, 2016

Revisional Custom Jawline Implant Surgery

 

Custom Jawline Implant Replacement Dr Barry Eppley IndianapolisThe most dramatic and successful augmentation of the entire lower third of the face is best done in most patients by a custom jawline implant. Such an implant is made from a 3D CT scan of the patient. Inserted as a single piece implant that augments the lower face from jaw angle to jaw angle, it can create a a wide range of jaw shape changes.

While the custom design process has many advantages, it is not a perfect aesthetic jawline procedure. This is because the computer nor the surgeon can know exactly how the design will really look on the patient. This is no accurate method to know how the jawline implant design and dimensions will translate to an external facial change in appearance.

Three is also the variable that even the patient does not really know how they will react to the jawline shape change. What one thinks they may have wanted can change when one actually sees it on their face. There is also the issue that some patients may be happy with their custom jawline implant result but may decide later that they would like some change in its design for additional enhancement.

Thus, a custom jawline implant does have the risk of revisional surgery which is almost always for an aesthetic reason. Such revisional custom jawline implant surgery does have several issues that are somewhat different than the initial implant placement. These can impact the recovery period and the attainment of the final aesthetic result.

custom jawline implant replacement designs intraopRevisional; Custom Jawline Implant Surgery Dr Barry Eppley IndianapolisWhile the computer can make any change in the implant’s design, placing the new custom jawline implant can be challenging in some cases. This is mort relevant when the implant is bigger than the initial design. Because the tissues have created an enveloping layer of scar tissue (capsule), it is not just as simple as ‘removing the old implants and slipping in a new one’. The capsule must be either released (capsulotomy) or removed (capsulectomy) to create the necessary space (pocket). This maneuver can be quite challenging in the tight space of the jawline implant pocket which uses small incisions to create and/or modify it.

Because of the difficulty in adequately opening up the capsule, a new custom jawline implant may create more swelling and bruising than the first one. It may also take more operative time than the first operation. It requires patience and diligence on the part of the surgeon to get the new implant properly positioned.

Dr. Barry Eppley

Indianapolis, Indiana

June 8th, 2016

Case Study – Hispanic Breast Augmentation

 

Background: Breast augmentation is a common body contouring procedure. Of the many pictures of breast augmentation results on the internet, the vast majority are of Caucasian type. The main difference with Hispanic or Latin women is their increased propensity to develop dark pigmentation at incision/scar sites. While they almost never develop hypertrophic or keloid scars, the color of the scar may still make it noticeable.

Case Study: This 21 year-old hispanic female never had any breast tissue develop. Her chest was completely flat with a small diameter areola.

Hispanic Breast Augmentation results front view Dr Barry Eppley IndianapolisUnder general anesthesia she underwent the placement of 300cc smooth high profile silicone breast implants through a high axillary incision. (3 cms length) Her implants were placed using a funnel insertion technique.

Hispanic Breast Augmentation results obique view Dr Barry Epley IndianapolisHispanic Breast Augmentation result side view Dr Barry Eppley IndianapolisHer result at six weeks after surgery showed a scarless breast augmentation with tight skin over the implants. With six to none months more time her very round breast augmentation result will soften and they will become more natural and softer.

Young Hispanic breast augmentation patients may want to avoid even the smallest scar at the inframammary fold area. The transaxillary incision offers a scarless approach that is appealing to women of increased pigments. Being placed in the hair bearing skin of the axilla, it heals very well and rarely develops any significant hyperpigmentation.

Highlights:

1) Breast augmentation can make a dramatic change in one’s self image for young women who have no breast tissue. (flat chest)

2) The young juvenile appearing female chest with tight skin will create more of a rounder appearing breast implant result.

3) Hispanic breast augmentation women may prefer a ‘scarless’ method using high axillary skin incisions.

Dr. Barry Eppley

Indianapolis, Indiana

June 6th, 2016

Facial Feminization Surgery – Outcome Assessment

 

Facial feminization surgery (FFS) is well recognized collection of hard and soft tissue reshaping procedures. While most commonly seen as a transgender procedure, it is also done for non-transgender females who have more masculine facial features. While it is unknown how many such FFS procedures are performed around the world, it is very clear that the numbers are increasing. This is sure to continue to increase as the internet makes awareness and access easier, more surgeons are performing the procedures and medical insurances are beginning to offer some coverage for them.

While various facial feminization surgery procedures exist, there are few studies that have been done that have assessed their outcomes. How successful is the change in the facial appearance, are patients satisfied and what is the rate of complications from this type of facial reshaping surgery.

In the June 2016 issue of the journal Plastic and Reconstructive Surgery, a paper appeared in print entitled ‘Facial Feminization: Systematic Review of the Literature’.  In this paper the authors performed a literature search and identified fifteen articles that were either case reports and clinical series. Of the over 1120 patients that were reviewed in these articles, seven (7) complications were reported. These complications were fluid collections in PMMA forehead augmentations (3), excessive mobility from bony nonunion from forehead contouring with brow bone reduction (3) and one rhinoplasty complication. Patient satisfaction was high although such determinations were not done using any method of quantified assessment.

facial feminization surgeryFacial feminization surgery consists of a collection of procedures of which the brow and forehead are the most recognized. It is well acknowledged that the upper third of the face is the most important in making for a female appearance. Alloplastic forehead augmentation, frontal bone narrowing, brow bone contouring using either burring or an osteoplastic bone flap setback method, and hairline lowering and browlifting create the potential for a major gender appearance change. While all of these procedures are effective at achieving these feminization goals, there are not without potential complications. Bony irregularities, visible scarring, supraorbital nerve injuries and infection from alloplastic materials are all possible.

The eyes play a critical role in determining sex and the female orbit. The shape of the orbital rims in females are higher, less rounded and appear larger creating a softer eye appearance. A wider palpebral fissure also leads to a more feminine appearance. This leads to the role of superior orbital contouring and lateral canthoplasties to affect these changes. Removal of upper eyelid skin can also be done to feminize the upper eyelid area.

Female faces are heart-shaped with prominent well defined cheeks. One element of the female cheek area is that the zygomas are wider than in men. Whether this is best done with a widening zygomatic osteotomy with interpositional graft, cheek implants or fat injections can be debated. But increasing the width of the zygomatic arch creates a rounder more female face. In my hands this is best done with silicone zygomatic arch implant that can go the whole back to just in front of the ear.

Feminizing the nose through an open rhinoplasty has several well known reshaping goals. A slight concavity to the dorsal profile with a supratip break, an increased and more open nasolabial angle and a thinner nose from the nasal bones down to the tip cartilages are all features that are more consistent with a female nose.

Lip augmentation for increased vermilion on both upper and lower lips with a more full cupid’s bow region are classic and desired female lip shapes. For many transgender patients this really require lip advancements and lip lifts to permanently increase the amount of vermilion show. Fat grafts or lip implants can be added for even more volume.

A smaller and more v-shaped jawline is an essential lower face contouring change for many FFS patients. Jaw angle reduction by burring and chin rehaping by a T-pattern ostectomy is an effective strategy for a softer jawline.

While the influence of the voice that emanates from the voicebox is more important in sexual recognition, a protruding laryngeal prominence is a male neck characteristic. Flattening the profile of the laryngeal prominence by direct excision (tracheal shave) can help flatten the neck profile in many transgender patients.

Facial feminization surgery can include a comprehensive facial reshaping from the top of the skull down to the neck. Whether one does a few or all of these FFS procedures depends on a variety of factors of which the cost of the surgery is a major consideration. But most FFS procedures are associated with few significant complications and appears to offer satisfactory facial appearance changes.

Dr. Barry Eppley

Indianapolis, Indiana

June 5th, 2016

Short Scar vs Full Incision Facelift

 

Facelift surgery is far from a homogenous procedure. Since its introduction over one hundred years ago there have been a large number of facelift techniques used, all claiming some aspect of superiority in either results or recovery. Despite claims from many surgeons, little scientific evidence exists that supports the superiority of one facelifting technique over another.

Short Scar Facelift Indianapolis Dr Barry EppleyShort Scar Facelift Dr Barry Eppley IndianapolisA very popular facelift technique that has emerged in the past decade or so has been the short scar facelift. This facelifting method places no incisions on the back of the ear. Besides the elimination of any postauricular scarring and more limited dissection, it also has an associated quicker recovery. While popular amongst potential patients, many plastic surgeons believe that a short scar facelift does not produces limited and subpar neck improvement.

In the June 2016 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘A Comparison of the Full and Short-Scar Facelift Incision Techniques in Multiple Sets of Identical Twins’. Using four sets of identical twins and one set of identical triplets, different types of facelift surgery were performed in a randomized with the first born twin undergoing the more complete full incision facelift. Short (one year) and long-term (five years) patient photographs were assessed. No difference was found at one year but at five years the full incision technique showed superior and more sustained neck results.

The differences between facelift techniques is very hard to compare because of a wide variety of factors of which the most noteworthy is anatomic and genetic dissimilarities between patients. Only in genetically identical patients at the same age using the same surgeon and the same surgical techniques could real facelift comparison be done. Such a study would seem impossible…until this study appeared in print. While the patient numbers in this study are understandably low, their results have value nonetheless.

What this study shows is what most plastic surgeons believe…that a full incision facelift more effectively improves the aging neck. The larger amount of undermining is the reason for the neck improvement and its sustained improvement several years later.

This study is not a condemnation of the short scar facelift. Rather it supports that patient selection is the key for any type of facelifting technique. If one does not have significant neck issues and the jowls and a deepening nasolabial fold are the main concerns, then a short scar technique is fine. But if the neck is an important part of the patient’s concerns also then a full incision technique would be preferred.

Dr. Barry Eppley

Indianapolis, Indiana

June 2nd, 2016

Case Study – The Cleft Septorhinoplasty

 

Background: The well known congenital cleft lip and palate deformity affects much more than its name alone indicates. Affected as much as the lip is the nose from its internal breathing structures to its external appearance.

While the nose in the cleft patient may be treated during surgery as an infant or child, these early efforts do not avoid the need for a definitive nasal procedure as a teenager or an adult. The teenage years is when a more thorough and aggressive approach may be taken to a rhinoplasty procedure. The septum, turbinates and any amount of cartilage grafting can be done to the nose without risks of any adverse growth effects.

Like the cleft nose deformity, the cleft lip can almost always be improved during the teenage years. Fortunately most of these cleft lip revisions are minor and can easily be combined with an open cleft septorhinoplasty procedure.

Case Study: This 15 year-old teenage male was born with a unilateral cleft lip and palate deformity. He had been through primary cleft lip, palate and alveolar bone grafts repairs. He waited until his teenage years to formally address his cleft nasal deformity. He had all of the typical cleft-related nasal changes including a large septal deviation away from the cleft side, large inferior turbinate enlargement, a wide nasal tip with thick skin, a slump ed ipsilateral lower alar cartilage, a widened nostril, wide nasal bones and a skeletal defieciency under the left cleft nostril base. He also had a disruption along the vermilion-skin border along the philtral scar line of the left upper lip.

Cleft Rhinoplasty and Cleft Lip Revision result front view Dr Barry Eppley IndianapolisCleft Rhinoplasty and Cleft Lip Revision result oblique view Dr Barry Eppley IndianapolisUnder general anesthesia he underwent a combined open septorhinoplasty with a cleft lip revision at the cupid’s bow area. Cartilage grafts used for the nose came from his septum. His results six months later showed a better nasal appearance with an improved nasal tip and left nostril shape. He could breathe better through both sides of his nose. In addition, his cleft lip scar was better aligned along the cupid’s bow area.

Cleft Rhinoplasty and Cleft Lip Revision result side view Dr Barry Eppley IndianapolisThe more complete cleft septorhinoplasty occurs during the teenage years. I prefer to do it early in the patient’s teen years for social and self-image reasons. There are no growth concerns at this age. Cleft nasal surgery would be delayed if orthognathic surgery needs to be done as a maxillary advancement will have a significant alteration of the nasal skeletal base.

Highlights:

1) The cleft lip and palate deformity causes significant malformations of the nose as well.

2) The cleft nasal deformity is one of the mot challenging in all of rhinoplasty due to both tissue displacements and tissue deficiencies.

3) An open cleft septorhinoplasty can be combined with cleft lip revision for a more definitive repair during the teenage years.

Dr. Barry Eppley

Indianapolis, Indiana

June 1st, 2016

Volume Comparison of Cheek Implants and Injectable Fillers

Cheek augmentation is a common facial reshaping procedure that is done for both aesthetic enhancement and volume restoration due to aging. It is the one facial procedure that, while historically only done with cheek implants, is now done more often by injection methods using synthetic fillers or fat.

The emergence of injectable methods is now the most common approach for cheek augmentation. Any of the synthetic fillers can be used since the cheek is a broad area and is spread out over the cheekbone as well as below it in the submalar region.While no synthetic injectable filler provides a permanent result, it does provide an instantaneous result and the opportunity for the patient to determine if this type of facial enhancement is appealing to them.

Cheek implants offer the only guaranteed permanent method  for cheek augmentation. But this requires a surgical commitment to an invasive procedure and has certain risks and complications. Injectable fillers can also be placed over a broader surface area greater than that which most cheek implants can.

An interesting but relevant issue when using injectable fillers for cheek augmentation is how do they compare volumetrically to that of cheek implants. To create an injectable cheek augmentation effect, what volume of injectable filler is needed to compare to what a cheek implant does? An injectable method is only a fair test in facial augmentation if similar volumes of material are placed that compares to what an implant does.

Conform Submalar Implants Dr Barry Eppley IndianapolisConform Midfacial Implant Dr Barry Eppley IndianapolisComparing facial implants and injectable fillers is done using volumetric displacement. Based on the Archimedes principle of displacement, volume of displaced water would equal to the volume of the implant. (provided that they sink in water and cheek implants do) Using the most commonly used style of cheek implants (Conform Submalar and Conform Malar Shells from Implantech) of all available sizes, their weights in grams and volume displacement were as follows:

SUBMALAR CHEEK IMPLANTS

Small        1.89 grams     0.7ml

Medium   2.13 grams     0.8ml

Large        2.36 grams     1.1ml

Large        2.58 grams     1.3ml

MALAR CHEEK IMPLANTS

Extra Small  1.47 grams   0.6ml

Small             1.71  grams   0.7ml

Medium        1.96 grams    0.8ml

Large              2.43 grams   1.1ml

Extra Large   2.62 grams   1.3 ml

Volume Displacement of Facial Implants Dr Barry Eppley IndianapolisThe volume displacement of all injectable fillers is on the syringe so the comparison to cheek implants can be directly compared. It shows that a 1cc syringe of any of the hyaluronic acid-based fillers (e.g., Juvederm) would be equal to small and medium sized styles of cheek implants.ess than even a small chin implant. Larger cheek implants more directly compare to a 1.5cc syringe of Radiesse.

Volume alone, however, is not the complete story of any material’s external facial augmentation effect. Besides volume there is the issue of how well the material pushes on the overlying soft tissues to create their effect. This is known as G Prime Force or the elastic modulus. By feel it is obvious that cheek implants are stiffer than any liquid material and would have a higher resistance to deformation. (thus creating more outward effect given a similar material volume) It is therefore probable that comparing volume displacements alone overestimates the effect of injectable fillers compared to implants.

The comparison between injectable fillers and implants in the cheeks may be different than in many other facial enhancement sites. Because the cheeks cover a significant soft tissue area not supported by bone the direct volumetric comparison may be more similar despite its lower elastic modulus.

Dr. Barry Eppley

Indianapolis, Indiana

May 30th, 2016

HALO The Hybrid Fractional Laser Resurfacing Method

 

Facial laser resurfacing traditionally consist of two fundamental approaches, a fully ablative surface treatment or a deeper fractional method. Fully ablative laser resurfacing creates extended downtimes but fewer treatments are needed. Conversely, fractional laser resurfacing is associated with less downtime but requires more treatments. The newest generation of non-ablative fractional lasers, which coagulate tissues instead of vaporizing them, allows for rapid healing but often does not produce the desired results.

HALO Hybrid Fractional Laser Dr Barry Eppley IndianapolisThe face of laser resurfacing has changed with the emergence of the HALO hybrid fractional laser. The HALO combines non-ablative and ablative fractional lasers into a single dual-wavelength laser. It allows the delivery of both 1470nm and 2940nm wavelengths to the same microscopic thermal zone. HALO works by delivering ablation sequentially followed by coagulation to the treatment zone. The 2940nm wavelength delivers pure ablation from 0 to 100 microns into the epidermis. The 1470nm wavelength delivers pure coagulation between 100 to 700 microns to the epidermis and dermis. This ability to precisely deliver energies to the epidermis and dermis allows for customized treatments.

Beyond its hybrid technology, HALO has several other features that improves its usability. HALO uses intelligent energy-based parameters to ensure that there is a consistent and even treatment by taking the size of the treatment area and creating the exact amount of energy to treat it. Dynamic Thermal Optimization technology ensures that the treatments are even from beginning to end through skin temperature monitoring.

HALO laser resurfacingClinical tests have repeatedly shown remarkable improvements in skin texture and pigment reduction. There is even improvements in pore size and number. In a few treatments HALO produces results that are typically seen in 2 or 3 times as many treatments as with older non-hybrid lasers. Patients report less overall pain after the treatment compared other lasers. They also have a very short duration of peeling and are able to put on makeup the next day.

HALO has become the next great advance in laser resurfacing by offering a treatment experience and results that are clearly superior to existing laser resurfacing methods.

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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