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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘bariatric surgery’

The Outcomes of Armlift (Brachioplasty) Surgery

Friday, April 12th, 2013


Armlifts have a surprisingly long history dating back well over fifty years ago when it was initially described. While once only done as an occasional procedure for the diet-induced weight loss patient, the number of armlifts now done has virtually exploded since the increase in bariatric surgery procedures. While once done as an isolated procedure, armlifts are now more commonly done in conjunction with other body contouring procedures as part of a multiple-operation body contouring procedure.

While armlifts are very effective at reducing the circumferential size of the upper arm, they do place a scar in a disadvantageous location that is prone to wound breakdown, scar hypertrophy and prominent scar visibility. As a result, the desire for a revision of an armlift is not rare to improve the appearance of the scar or remove more arm tissue.

In addition, another change in armlift surgery has been the concomitant use of liposuction to get a better result. Removing fat from parts of the upper arm that are not affected by the tissue excision, as well as around the shoulder, helps produce a better upper arm contour. Whether concomitant liposuction increases the risk of armlift healing problems has not been well studied.

Since many armlifts today are done in conjunction with other body procedures, it would be relevant to know if this impacts their results, incidence of complications and need for revision. In the April 2013 issue of the journal of Plastic and Reconstructive Surgery, a review of armlift (brachioplasty) outcomes was reported. From a multipractice pool of 69 patients, half had an armlift done as part of a collection of body contouring procedures and half had arm liposuction done as part of their armlift. Major complications occurred in 18% of the patients and included hypertropic scarring and infection. Revisions of the armlifts were done in over 20% of the patients.

This study found that combining armlifts with other body contouring procedures did not increase the risk of complications. In addition, the use of liposuction in armlifts did not increase the risk of complications either. Higher complications rates were found, however, in patients who previously had bariatric surgery.

The revelance of this study supports what I counsel my Indianapolis armlifts patients in regards to what they can expect after surgery. Armlifts are easy to go through and are extremely effective…but at the price of a scar that can be problematic and may require a scar revision later if one is seeking the best apppearance of it as possible. The incisional closure is also prone to minor wound healing problems most commonly seen up near the armpit area. The change that I have done in my armlift surgery technique was to place the excision and scar on the back of the arm rather than on the inside of the arm where the skin is thinner.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: The Extended Armlift in the Bariatric Surgery Patient

Sunday, October 30th, 2011

Background:  The shape of the upper arm is primarily determined by the front (biceps) and the back (triceps) sides of it. While men are notoriously concerned about the biceps region, women are much more concerned about the opposing triceps region, particularly as they age. Loose and floppy skin on the back of the arm affects many women and a desire to undergo some treatment for it is common.

For minor amounts of upper arm fullness or loose skin, liposuction or non-surgical skin tightening can be effective. While armlifts create the most dramatic change in the shape of the arm, it should only be employed in the most severe sagging arm cases. The  scar of an armlift is simply not acceptable to most women, short of those who have had a lot of weight loss. This makes the bariatric surgery female the most likely to accept an arm scar as a better aesthetic problem than that of a low hanging skin on the back of the upper arm.

The severe sagging of many bariatric or extreme weight loss patients also presents another aesthetic problem. The amount of excess rarely stops in the arm or at the armpit. Rather it extends past the armpit down into the lateral chest wall to the side of the breasts. When planning an armlift in most bariatric patients, this excess skin outside of the arm must be factored into the excision pattern. Having a scar cross the armpit poses risks of tightening and restriction or painful abduction of the arm when lifted above shoulder level.

Case Study: This 40 year-old female had bariatric surgery (bypass) two years previously. She had lost over 120lbs. Besides her abdomen and waistline, her next most important concern was her arms. She was embarrassed by the floppy skin and how it swung back and forth with arm movement. She agreed to multiple body contouring procedures performed simultaneously including armlifts, an extended tummy tuck, and breast implants with nipple lifts.  

During her multiple bariatric plastic surgery procedures, an extended armlift was planned that had a cutout pattern that run from her elbow up to her armpit and then down to the side of her breasts. This was marked out just slightly in from the very backside of her arms toward the inner side of the arms. Skin and fat was excised down to the muscle fascia of the upper arm and into the subcutaneous fat of the armpit and the lateral chest wall. Closure of the long incision was done with subcuticular sutures without any z-plasty or break-up of the incision as it crossed the armpit. Drains were used for both sides.

Her drains were removed five days later and she wore compression wraps for three weeks after surgery. Her armlifts results were immediate and dramatically improved. At six months after her armlifts, she had scar that were still slightly red, had developed some widening but had no scar contracture or  restriction of movement across the armpits. Fading of the redness of her scars is expected to take up to one year after surgery.

The scar location could be seen to be completely on the back of her arms which was not apparent to her. But the scars can be seen from behind by others.

Case Highlights:

1) Armlifts can produce a dramatic reduction in the circumference of the upper arm by removing excess skin and fat from the back (triceps) area.

2) The most important consideration in an armlift is the patient acceptance of a scar trade-off. This scar is easy to accept in the bariatric patient who usually has a large amount of hanging arm tissue.

3) The best location of the armlift scar is on the backside of the arm. This location also heals better with less scar widening than when it is placed on the inside or medial aspect of the arm.

Dr. Barry Eppley

Indianapolis, Indiana

The Fleur-de-lis Abdominoplasty after Massive Weight Loss

Monday, May 10th, 2010

Without question, the number one concern of bariatric surgery patients after their weight loss is abdominal reshaping. When the weight loss is in the neighborhood of 75 to 100 lbs., the abdominal skin does not redrape or shrink back down. Rather, a large amount of redundant skin results which both hangs and has multiple rolls.

The traditional tummy tuck or abdominoplasty is almost always inadequate to create the best abdominal result in the massive weight loss patient. This is because the excess skin exists in a true three-dimensional fashion, being excessive in both horizontal and vertical dimensions. As a result, I almost always use the combined vertical and horizontal tummy tuck procedure known as the fleur-de-lis abdominoplasty in my Indianapolis plastic surgery practice for bariatric patients. This results in abdominal scars that have a midline vertical and a low horizontal line, known as the anchor scar pattern. Adding the vertical part to the traditional tummy tuck does require more surgery time for dissection and closure, but most relevantly increases the amount of deep space underneath the skin after closure.

In theory, the fleur-de-lis abdominoplasty should be associated with more complications than a traditional abdominoplasty. It takes longer to do and has incisions that meet at an inverted-T area. It also removes a very large segment of skin which leaves more dead space uinderneath. To investigate if this seemingly truth is reality, the May 2010 issue of the journal Plastic and Reconstructive Surgery published a study on this very question. Over 400 abdominoplasty patient were evaluated of whom 154 (31%) had a fleur-de-lis abdominoplasty operation. The overall abdominal complication rate was 26%. This included all types of complications of which 5% would be considered major. (requiring further surgery) Traditional horizontal excision abdominoplasties and fleur-de-lis abdominoplasties were very similar in complication rates with the exception of a higher rate of wound infections in the more extensive abdominoplasty.

My Indianapolis plastic surgery experience is slightly different than that reported in this very extensive and thorough study. I have seen no greater incidence of wound infection between the two types but have certainly seen more wound openings/separations at the inverted-T area. A traditional abdominoplasty does not have this zone and, as a result, significant wound openings are very uncommon. The dead space in the fleur-de-lis abdominoplasty is managed with an extra drain and I am more conservative about their removal, keeping at least one in place for two weeks after surgery.

The fleur-de-lis creates a better abdominal result in the bariatric patient if they feel that the trade-off of a vertical scar is worth an improved upper abdominal area. In days gone by with open gastric bypass surgery, a vertical scar already was present so the decision for the fleur-de-lis was easy. With laparoscopic gastric bypass today, the patient must consider a new obvious vertical scar.

Another consideration for bariatric patients considering the fleur-de-lis abdominoplasty is insurance coverage. If one’s health insurance will provide an abdominoplasty coverage, that does not include the vertical component of the fleur-de-lis. The insurance company covers the horizontal abdominal excision only. There will be an extra out-of-pocket charge for adding the vertical component to the procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Bariatric Plastic Surgery on Indianapolis Doc Chat Radio Show

Saturday, August 1st, 2009

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 1:00 – 2:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of Bariatric Plastic Surgery was discussed. After massive weight loss (MWL) which is usually done through bariatric surgery (lapband and bypass procedures),  many patients suffer with a lot of excess and hanging skin. What to do with all the excess skin has led to the development of specialized plastic surgery procedures for these patients. Todays guest was plastic surgeon Dr. Peter Rubin from the University of Pittsburgh. As one of the world’s authorities on bariatric plastic surgery, he discussed when such procedures should be considered in the MWL patient, whether medical insurance will provide coverage for them, the differences between a tummy tuck and a lower body lift, breast and chest reshaping, arm lifts, and thigh and buttock lifts. Numerous body contouring after weight loss procedures can be combined in a single operation but overall body recontouring requires several stages to complete. These operations are complex and one must be nutritionally sound to go through them to prevent wound healing problems from the long incisions that are required.

Free Body Contouring and Bariatric Plastic Surgery consultations with Dr. Eppley can be arranged by calling his Indianapolis suburban area facilities at IU Health North or IU Health West Hospitals at 317-706-4444 or sending an inquiry by e-mail to: info@eppleyplasticsurgery.com.

Bariatric Surgery and Bariatric Plastic Surgery on Indianapolis Doc Chat Radio Show

Saturday, May 16th, 2009

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 1:00 – 2:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of Bariatric Surgery was discussed. Many aspects of obesity and the different types of  bariatric surgery to treat it were reviewed. Who is a good candidate for bariatric surgery, when should surgery be performed, what are the different types of bariatric surgery, will my insurance cover the procedure, how quickly will the weight loss occur, what are the complications of the surgery, what do I do after my surgery, and what can one do with the hanging skin after the weight loss (Bariatric Plastic Surgery) were discussed.

Body Contouring after Bariatric Surgery

Tuesday, April 1st, 2008

According to the annual statistics of the American Society for Aesthetic Plastic Surgery, the number of body contouring procedures performed has dramatically increased over the past five years. Abdominoplasty, lower Body Lift, buttock lift experienced a 200% gain while thigh and upper arm lift experienced a 400% rise. This parallels and is due to the increased number of patients that have undergone bariatric weight loss surgery.” According to Allergan, manufacturer of the Lap-Band® bariatric procedure, 350,000 of these devices have been placed worldwide. Nearly 100,000 bariatric procedures, of either the LAP-Band or bypass variety, were performed last year in the Unisted States alone.
After these patients’ large weight loss, loose skin remains that can only be removed surgically. The abdomen, with the skin frequently hanging down like a drape hiding the belly button and pubic area, is a major problem as is excess skin of the arms, thighs, breasts, and faces. These patients seek out plastic surgeons to correct these problems. The American Society of Bariatric Plastic Surgeons(ASBPS)was founded to help meet the needs of these patients. It is composed of plastic surgeons that specialize in body contouring after weight loss.


Cheryl, who lost 125 pounds after her gastric bypass had an outward appearance left her disappointed and discouraged. She waited until her weight stabilized and then had face and body contouring. A Lower Body Lift (an Abdominoplasty and Buttock Lift) and Facial surgery were performed as a hospital inpatient. Then, several months later, she had a Breast and Upper Arm Lift and Liposuction as an outpatient. “For me, having the plastic surgery was like crossing the finish line with my weight loss journey,” said Cheryl.
As gastric bypass and lapband procedures exponentially increase, so too will body contouring operations. Even though the number of post-bariatric patients seen by plastic surgeons has dramatically risen over the past five years, it is projected that these numbers will become overwhelmed in the coming years by these same patients seeking cosmetic body improvements.

Dr Barry Eppley



Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana


Bariatric Plastic Surgery in Indianapolis

Monday, November 26th, 2007

You Did It!

Losing a lot of weight is the beginning of a new life. When you still have folds of loose skin left over, however, your body may be smaller but not be any more pleasing than before your bariatric surgery. Because of the loose skin, you may still feel inadequate and embarrassed. Fortunately, a unique plastic surgery program is available to you. Through the FORM program, we can tighten sagging skin after weight loss and give you the body shape that you have worked so hard to achieve. This specialty of plastic surgery is known as Bariatric Plastic Surgery or Body Contouring after Extreme Weight Loss.

Looking Your Best

Plastic surgery is often the final step in the surgical weight loss process. The overstretched skin is damaged, has lost its elasticity, and cannot conform to the new shape of the underlying body. This can result in sagging neck, breast, arm, stomach, back, and thigh skin. This excess skin poses cosmetic, hygiene, and comfort issues. Nothing can restore the skin’s elasticity, the excess skin must be removed and each body area reshaped. For some patients, only one or two excess skin areas are of concern. For others, sagging skin is present from the neck to the knees.

Your New Body

Through the FORM program, a series of body contouring surgeries is done, each targeting a specific area of loose and sagging skin. These operations require a high degree of surgical skill and attention to detail as well as an aesthetic eye to ensure that you achieve a pleasing body contour. Procedures include:

Abdominoplasty (Tummy Tuck)
Body Lift (Tummy Tuck and Back Lift)
Brachioplasty (Arm Lift)
Breast Augmentation (Breast Implant)
Facelift (Neck and Jowl Lift)
Mastopexy (Breast Lift)
Thighplasty (Hip and Thigh Lift)

The key to successful post-bariatric body contouring is to select not only the right operations but how to stage or sequence the body areas being contoured to safely obtain a good result. The FORM body program helps guide you through these decisions, choosing those surgeries that are of most importance to you.

Your physical and mental health is of utmost importance, both must be in good shape to undergo intensive surgery that can last up to six hours or more under general anesthesia. While dramatic body changes are possible, you must be willing to accept scars in place of the loose skin.

Surgical Expertise

The FORM program was developed by me as a method of approaching the cosmetic problems of the bariatric patient who has undergone massive weight loss. Through an in-depth consultation and thoughtful treatment planning, a safe and realistic plastic surgical plan can be created for your body to meet your goals and be done with attention to the needs of your home and work life.

Insurance and Body Contouring

The increasing number of bariatric surgeries performed has created many patients seeking body contouring procedures. Just because insurance has covered your bariatric surgery is not a guarantee that they will cover any body contouring surgeries. If there are medical problems that the loose skin is causing, then the surgery may be covered. This can only be determined, however, through an insurance predetermination process. We routinuely handle this insurance step for you. As a general rule, loose abdominal or thigh skin may be eligible for coverage; neck, arm, and breast problems are usually not covered.

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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