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Dr. Barry Eppley

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Posts Tagged ‘cellulaze’

Top Plastic Surgery Searches in 2012

Tuesday, January 1st, 2013


On the final day of 2012, it is interesting to look back and see what some of the trends and interests were in plastic surgery over the past year. While plastic surgeons may perform the surgeries, the interest of patients drive the number and type of surgeries that are done. For this reason, it is noteworthy to look at what procedures were most searched for online.

The popular plastic surgery website, Real Self, reported its top searches for 2012 based on over 50 million searches. The top 10 included tummy tuck, breast implants/augmentation, rhinoplasty, Brazilian butt lift, Botox, Coolsculpting, Breast Reduction, Cellulaze and Liposuction. The procedures that had the greatest increase in interest over the past year were the Brazilian butt lift (up 28%), Cellulaze (up 32%) and labiaplasty. (up 22%)

These search results, albeit just from one source but a very reliable one, provides insight into the public’s evolving interest in face and body modifications. Three of the historically popular and still highly performed procedures, tummy tuck, breast augmentation and rhinoplasty, remain on the top of the list. Not surprisingly, flatter stomachs and more shapely waistlines, larger breasts and nose reshaping are still highly desired. While they were far from being up on % increase in searches, it would be hard to do so when you have been so popular for decades.

The popularity of the Brazilian butt lift, a procedure that was largely unknown just less than a decade ago, is a reflection of society in general. Largely an ethnic procedure for Hispanics and African-Americans, it parallels the changing population mix of the U. S.  It is also an indication of the influence of celebrities on plastic surgery. (the Kardashian effect) While buttock implants have been around for awhile, the allure of using one’s own natural fat and getting some fat reduction in other body areas as part of the procedure is undeniably appealing. The large percent increases in interest in the procedure over the past two years is primarily a result of its ‘newness’. But I would wager five or ten years from now, buttock augmentation will be a permanent member of the all-time top 10 plastic surgery procedures of any year.

Coolsculpting and Cellulaze have made their way on the list because they are new body contouring technologies. Both have been approved for use less than five and two years ago respectively and offer non-surgical methods for common concerns about fat reduction and improvement in the appearance of cellulite. Whether they will be on the top ten list a few years from now will depend on how effective they turn out to be in widespread use.

Botox, one of the few drugs used for aesthetic changes, keeps it place in the top ten list and may well be the number one cosmetic procedure performed in the U.S. by number of treated patients. (amongst surgery and minimally invasive procedures) Despite the large number of treated patients, it is not searched as much as some of the other popular procedures largely because its effects and benefits are so well known.

Labiaplasty, reshaping of the external vagina, is gaining in popularity and public awareness. Once just done by a few gynecologists, it is becoming more widely practiced by plastic surgeons as well. As women become increasingly aware of its potential benefits, the interest in how and where it can be done is rising as well.

Dr. Barry Eppley

Indianapolis, Indiana

A Review Of Available Cellulite Treatment Approaches

Sunday, February 26th, 2012

Cellulite remains a challenging aesthetic problem. While it is fairly well understood what comprises it anatomically, there remains no concensus on its etiology and ideal treatment. New technologies are emerging, however, that have begun to show improved and sustained results. Given these promising improvements in cellulite treatment, it is relevant to review what we know about this common aesthetic deformity and the cadry of treatment options available to treat it.

While cellulite appears as an external skin irregularity, often called an orange peel, dimpling or mattress appearance, its origin is much deeper. It is known to be the result of multiple anatomic conditions of the subcutaneous tissues including decreased elasticity of the skin, fat hypertrophy, contraction of the fibrous septae and increased compression of fat into the underside of the skin. Studies have shown that the fat in cellulite is no different in any way than that of fat in non-cellulite areas. It most commonly affects the thighs, buttocks and lower abdomen and predominantly occurs in women.

The earliest forms of cellulite treatment where cosmeceutical, the application of topical drugs and herbs applied to the skin. These have included a variety of agents including derivatives of the aminophylline family, caffeine, yohimbine, carnitine and a variety of herbal extracts. Improvements from this approach have been largely anectodal and few if any scientific studies can show any consistent improvement in the appearance of cellulite.

Mesotherapy injections are often touted for cellulite treatment. They became more popular in the ‘lipodissolve’ craze from a few years ago. Using primarily phosphatidylcholine and deoxycholic acid formulations, these detergents primarily work on breaking down fat cell walls. They are more proven to have a fat reduction effect, mild as it may be, than they are at improving the overlying skin irregularities.

Endermologie has been around for over 15 years and is FDA approved for body contouring and cellulite reduction. It is essentially a suction massage approach applied manually through a roller-type device. Studies have shown some skin contour improvement that to be maintained requires regular maintenance treatments.

Carbon dioxide therapy is the instillation of a gas under the skin with low pressure infusion. This purportedly breaks the septae and stimulates collagen production in the skin to help even it out. There has been no conclusive and reproduced studies that have documented this effect.

UltraShape is a body contouring device that uses pulsed focused ultrasound energy for fat cell destruction by cavitation. While it has some fat reduction and body shaping effects, it is not approved for cellulite treatment in the U.S.

Ultherapy is another form of focused ultrasound that is used in the face for lifting sagging tissues. It is FDA cleared for eyebrow lifts and forehead rejuvenation. It is also being studies for cellulite treatment but these studies are ongoing and not yet available for review.

Liposonix is a high-intensity focused ultrasound device that is FDA cleared for non-invasive waist circumference reduction. It has no proven effect in cellulite reduction.

TriActive is an FDA cleared device for cellulite reduction that combines differing treatment methods as the name implies. It uses an 808nm infrared diode laser, cooling and suction massage.

VelaSmooth  is another FDA cleared device for cellulite. It uses radiofrequency, infrared light and suction as  its multimodality treatment method.

SmoothShape is also FDA cleared for cellulite. It uses  a dual wavelength laser combined with suction massage.

Subcision is a limited surgical technique using an 18 gauge needle under local anesthesia. The objective is to release the septal bands by percutaneous severing of them in the depth of an indentation. It ahs failed to show consistent improvement.

Laser-assisted liposuction is an FDA-approved device for fat reduction but not cellulite. It is well known that fat reduction can even make the appearance of cellulite worse if not done judiciously. Thus Smartlipo and other laser liposuction devices should not be used primarily for cellulite reduction.

Cellulaze is the newest FDA cleared device in 2012 specifically for the improvement of cellulite. It uses a 1440nm pulsed laser with a side-firing fiber. Based on how it is angled, it can be used to release the fibrous septal bands, liquefy fat (no suctioning) and apply heat to the underside of the skin for collagen stimulation. Besides the unique delivery method, it is designed to be a single treatment.

While there are numerous available cellulite treatments methods, the most effective ones are device or energy-driven. Amongst such devices, most provide temporary improvement and require multiple treatments for maintenance. Only the newset device, Cellulaze, offers a single treatment with a lasting result. 

Dr. Barry Eppley

Indianapolis, Indiana   

Plastic Surgery Product Review: Cellulaze Laser For The Treatment Of Cellulite

Tuesday, February 7th, 2012

Cellulite remains the cosmetic bain of many women even those who otherwise have good size to their thighs and buttocks. While the anatomy of cellulite is well understood, why it is there and what causes it is not. Even worse is that a truly effective treatment for it remains elusive. The sheer fact that dozens of cellulite therapies have been proposed over the past several decades illustrates that none of the them work very well.

Surgical solutions for cellulite have been tried including liposuction and an instrument technique known as pickling. While initially effective, cellulite was seen to return once all the swelling went away and the tissues retracted. But an effective surgical solution appears to now be available as the FDA has just cleared a laser system from Cynosure called Cellulaze.

Cellulaze is a surgical procedure that is a spin-off of the popular Smartlipo procedure. Using a fiberoptic cable inserted under the skin, laser energy of different wavelength is delivered in a 360 fashion radiating out from the probe to melt fat, stimulate skin thickening and release vertical fascial bands. This causes the reduction in the dimpling effect that is a well recognized appearance of cellulite. These are the three components of the anatomic make-up of cellulite which would explain its effectiveness. After one treatment, results are said to be visible within a few weeks and continues to build over the next several months.

According to the clinical results published in the Aesthetic Surgery Journal in 2011 (and presumably part of the data submitted to the FDA for evaluation and approval), Cellulaze treatments can increase the thickness of the skin by 25% and the elasticity of the skin by 29% at one year after treatment. Most pertinently, a single treatment creates a noticeable improvement in the appearance of cellulite at one year after treatment. The majority of patients in the study (93%) were satisfied or very satisfied with their treatment results and would recommend the treatment to their friends.

The relevance of this new cellulite laser treatment is that it has significant and lasting benefits without the need for maintenance sessions. That is a major advance over previous surgical efforts for cellulite

Dr. Barry Eppley

Indianapolis, Indiana   

Plastic Surgery Product Review: Cellulaze Laser Treatment For Cellulite

Wednesday, January 4th, 2012

One of the most difficult problems to improve, let alone solve, in cosmetic plastic surgery is that of cellulite. It is particularly frustrating given that there are large numbers of women who are afflicted with cellulite and would love to invest in an effective treatment. While there have been a significant number of  device-based technologies over the past decade, none have lived up to their expectations and most have failed to produce a good return on a patient’s investment.

Cellulite is comprised of numerous anatomic elements that create the classic orange peel appearance which makes it easily recognized and disliked. The first defect is an overall undulation of the fatty tissue. The second known issue is the contraction and hardening of the vertical fibrous septae which causes the skin to be inward creating the overlying dimpling effect. Thirdly, the skin is usually thinner and weaker and this allows the fat to herniated upward. For a cellulite treatment to be truly effective, it has to address all three of these tissue elements.

One of the more promising cellulite technologies is Cynosure’s Cellulaze. This uses a side-firing 1440nm laser delivered through a fiberoptic cable. This wavelength has a great affinity for fat. It has many similarities to the more well known Smartlipo used for fat reduction which uses a forward-firing laser. By firing to the side, the laser can be directed in many directions including downward, sideways and upward by simply twisting the cannula. This is important since cellultite is a problem that is not just isolated to one tissue plane.

The Cellulaze laser treats the three components of cellulite with its 1440nm wavelength. By turning the cannula downward, energy is delivered to smooth the uneven fatty base. Turning the cannula 90 degrees, parallel to the skin’s surface, the laser can be used to  cut and release the vertical fibrous septae. When the cannula is turned upward the underside of the skin is heated, stimulating the growth of new collagen and elastin.

While Cellulaze is currently marketed and sold in Canada, Europe and Australia, it is awaiting FDA approval in the U.S.  In a clinical study conducted in the U.S., a single treatment for thigh cellulite was done. At evaluations at one, three, six and twelve months after treatment, measurements of skin thickness and elasticity showed significant increases at each visit. Patient satisfaction was high with minimal side effects other than expected amounts of swelling.

It is likely that Cellulaze will receive approval sometime in 2012 in the U.S. Many prospective patients will be anxiously awaiting.

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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