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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘chemical peels’

Mini-Mommy Makeover Procedures

Sunday, May 19th, 2013

The concept of a Mommy Makeover plastic surgery procedure is about combining abdominal and breast reshaping in one operation. The breast and abdominal components are not new and include many well known procedures such as tummy tucks, breast implants, liposuction and breast lifts in whatever combination each individual women needs. While the effects of a Mommy Makeover can be dramatic, breast and abdominal procedures are major surgery with significant recovery as well.

But there are numerous other procedures of lesser magnitude that could also be lumped into the Mommy Makeover category and consist of a variety of ‘nips, tucks and sticks’ that create effects that mothers would also like. Here are some of the most noteworthy.

BOTOX  For reduction of those facial expression lines that come from the stress of balancing mother and wife roles, Botox injections are probably the most common injectable Mommy procedure.

Vi/PERFECT PEELS With only a few days of redness and flaking, these medium-depth facial peels are essentially painless to go through and provide a real boost to one’s complexion. A few of these a year will keep a mother’s skin radiant and glowing.

C-SECTION SCAR REVISION For those women that don’t need a tummy tuck and have a noticeable c-section scar with just a little pooch above it, widely cutting out the scar can produce a flatter upper pubic area. This scar revision can be combined with some lower abdominal liposuction for an additional and wider flattening effect.

UPPER LIP PLUMPING Some well placed Restylane or Juvederm injections into the upper lip has an instant youthful volumizing effect. This is particularly evident if the cupid’s bow and philtral columns are accentuated.

NIPPLE REDUCTION Breast feeding can elongate the nipple which can be a source of embarrassment and out of proportion to the size of the areola. Under local anesthesia, the nipple length can be reduced by half or more.

EARLOBE REPAIR Fixing stretched out ear ring holes or complete tears through the lobe can allow old or new ear rings to be comfortably worn again.

BELLY BUTTON REPAIR (Umbilicoplasty) Pregnancies can change an innie belly button to an outie due to a small hernia through the umbilical stalk attachment. Tucking the peritoneal fat back through the hole and reattaching the stalk of the belly button back down to the abdominal wall will recreate that an old inne look again.

EXILIS For those stubborn fat areas that just won’t go away despite some diet and exercise, this non-surgical fat treatment can easily fit into a busy mom’s schedule. It takes a series of treatments to see the effects but there is no downtime with 30 minute in-office treatment sessions.

These mini-Mommy Makeovers provide changes that do not require major surgery or recovery and can fit into anyone’s hectic schedule.

Dr. Barry Eppley

Indianapolis, Indiana

Skin Care Before and After a Facelift

Saturday, May 11th, 2013


Any patient that undergoes a facelift has understandably great expectations given the commitment involved. But a facelift alone can not correct all facial aging problems. Preparing for a facelift is not only a matter of education but also benefits from before and after surgery skin care. When a patient is looking for and is ready for a facelift, their skin is also ready for a makeover as well.

Because a facelift only treats the sag in the skin and underlying tissues due to effects of gravity and other environmental factors, additional skin issues such as finer wrinkles, brown spots, large pores, red spots and generalized poor skin texture are not treated. Simply lifting up and pulling the skin tight will not get rid of every facial imperfection. Undergoing skin treatments both before and after a facelift can really put the ‘icing’ on the effects of the surgery.

Treatment options before a facelift can include microdermabrasion combined with light chemical peels (what I call a medical microdermabrasion) or medium-depth chemical peels like a Vi peel or the Perfect peel. These should be done no sooner than three or four weeks before surgery. These skin treatments will really freshen up the skin and an immediate improvement in skin texture will be seen.

In addition, the use of Retin-A is a great topical daily treatment in addition to or in lieu of the patient’s existing skin care regimen. While Retin-A has been around for decades and is not a sexy new topical agent, its benefits to the skin are well proven. It makes the skin healthier by thickening the dermis and improving its vascularity. This makes it heal better after surgery or just skin resurfacing. The strength of the cream or gel and how many times to apply it daily depends on the patient’s skin. The thicker the skin, the greater strength and number of applications it will tolerate without becoming too irritated.

After facelift skin care initially can include oral and topical Arnica and mineral makeup to cover the bruising. A return to one’s normal skin care regimens should wait a few weeks after surgery until the bruising is gone and most of the swelling has subsided. A month to six weeks after a facelift is a good time to have a microdermabrasion treatment to exfoliate the skin and buff up the facelift result. While there are many skin care product lines available, the use of topical Retin-A at some frequency of application after a facelift is always a good product to incorporate into one’s skin care regimen.

For many facelift patients, this surgery may be done only once in their lifetime. Many of these patients have never had a good skin care regimen and this surgery provides an opportunity to embark on one. Helping the facelift patient enhance and protect their surgery efforts is a valuable educational service.

Dr. Barry Eppley

Indianapolis, Indiana

New Paradigm in Chemical Peeling – The VI and Perfect Peels

Monday, May 28th, 2012

Chemical peels are the most ancient form of skin rejuvenation. For thousands of years, topical agents have been applied to the skin for an exfoliative effect. Chemical peels have evolved considerably in the past few decades as many different levels of penetration and exfoliation exist based on the agents in the formulations and their concentration.

Chemical peels have evolved into three basic levels of skin penetration which affects the result and the amount of recovery. Superficial peels, like glycolic acid and alpha-hydroxyacids, have a light effect with minimal recovery and are administered by aestheticians in a variety of clinical settings. Medium-depth peels, like trichloroacetic acid (TCA), produce more significant results but have longer recoveries particularly in the 25% and 35% strengths. These may be administered by physicians or aestheticians. Deep peels using phenol are physician administered peels that produce profound skin changes but with weeks of recovery.

In an almost linear relationship, the deeper the chemical peel the greater is the discomfort to undergo it. Similarly, deeper penetrating peels are associated with increased risks of skin burns and pigmentary changes. As the old motto goes, the greater the pain the greater the gain.

New peel formulations have appeared recently that blur these traditional lines of distinction and challenge some of these traditional peel concepts. Ushering in this shift in the chemical peel paradigm was the VI peel. This peel formulation cleverly combined all three depths of peeling agents including salicylic acid, TCA and phenol. It is the small phenol component that is revolutionary. Its main effect is that it acts like a topical anesthetic. As soon as the solution is applied, the skin goes numb. This allows the other agents to penetrate more deeply than a patient would normally find tolerable. In essence, a medium depth chemical peel that has the minimal discomfort associated with a more superficial peel.

As one might suspect, when a revolutionary change in a treatment occurs there is sure to be copycats, knockoffs and even improvements. In that vein along comes the Perfect Peel. This medium depth peel has many of the same ingredients as the VI peel with the exception of the addition of kojic acid and glutathione. Kojic acid is a well known agent for the treatment or prevention of hyperpigmentation, which can occur after any deeper exfoliative treatment. Glutathione has antioxidant properties through the neutralization of free radicals. It also effects melanin production so it too has a depigmentation effect.

In this new chemical peel paradigm, the VI and Perfect Peels offer exciting and advanced skin rejuvenation treatments. Since they can safely be applied by aestheticians in an office setting, they can have widespread use at a reasonable cost compared to more expensive laser treatments. Since the Perfect Peel has additional agents in its formulation that helps control the potential for hyperpigmentation, some have touted it as the superior choice. I would recommend that you try both and do your own comparison. You will be impressed with both the ease of the peeling experience and the skin results

Dr. Barry Eppley

Indianapolis, Indiana

Fundamental Concepts About Facial Photoaging Treatments

Friday, June 11th, 2010

Wrinkles, tiny blood vessels and brown spots are very typical signs of aging and can add years to your facial appearance. While many feel that these are just the effects of aging, in reality they are the long-term effects of unseen sun damage from years ago.What may have been a love affair with the sun in our early years eventually appears as something we hate decades later.

Fortunately, there are numerous treatments to help treat these chronic signs of sun damage known as photoaging. Lasers, peels and light treatments, and many combinations thereof, can help offset the damaging effects of our lifelong exposure to ultraviolet light.

While there are many available skin treatments, their sheer number makes it very confusing to patients. Here is a brief overview:

PEELS. For patients with light skin damage and fine wrinkles, a chemical peel can be a great treatment. By removing several superficial layers of outer skin, one can smooth the skin and get rid of some brown spots. There are many types of peels but those that provide real therapeutic benefit are light TCA and the newer Vi peel. These peels are usually combined with a microdermabrasion which helps prep the skin to receive the peel. In general, peels help most with pigmented skin problems and less for significant wrinkle issues.

LIGHT and LASERS. Light treatments, known as IPL or BBL, are excellent for brown spots and telangectasias. They work by emitting a polychromatic light with multiple absorption targets. (melanin in brown spots and hemoglobin in telangectasias) Since they pass through the skin and only hit the target, there is no real downtime. Lasers work by burning off the top layers of skin. As of now, there are two fundamental laser skin resurfacing approaches, micropeeling and fractional. Micropeeling removes 100% of the outer surface at a set depth. Fractional punches holes in the skin but only treats about 10% of the surface area in a single treatment. When it comes to which is better for skin resurfacing, the jury is still out. Fractional is the newest laser toy so it receives a lot of press, but it is not magic and the choice between the two (or combination) is up to the practitioner’s experience.

COMBINATION APPROACHES. If a patient has significant wrinkles or skin texture problems, then I would recommend a laser resurfacing with the depth based on how much recovery they can allow. This is often combined with some Botox for muscle action decrease and injectable fillers for volume loss. If the photoaging damage is less, then BBL and chemical peels can suffice.

Many times, the combination of BBL for brown spots, laser resurfacing for wrinkles and texture and Skin Type (for tightening some loose skin) can be safely combined in a single treatment. While this will not create the same results as a facelift, for those with lesser amounts of skin laxity it can create a really significant improvement with much less recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review: The Vi Chemical Peel for the Face, Neck and Chest

Sunday, May 9th, 2010

The use of lasers and light therapies has dominated the talk about skin retexturing and resurfacing over the past decade. While they do produce some wonderful results, their use has overshadowed the historical approach of chemical peeling of the face. Chemical peeling today has been largely relegated to the superficial peels done by aestheticians and not physicians. When combined with microdermabrasion, they are known to produce a nice refreshening effect but the results are not comparable with laser treatments.

Most chemical peels that produced any significant results, such as trichloroacetic acid (TCA) and phenol, have involved significant recovery and discomfort. Medium to deep-depth peels done by physicians required significant skin penetration to produce their results. This produces significant upper layer skin sloughing and downtime. Personally, I had assumed that ‘state-of-the-art’ chemical peeling was more about technique than the chemical compositions of the solutions.

My understanding of chemical peeling has undergone a change in the past year since we have begun using the Vi Peel. This chemical peel is an innovative combination of different ingredients. Cleverly combining TCA, phenol and salicylic acid peels with retinoic acid, Vitamin C and a proprietary mineral blend, a very interesting chemical peel has been created. It can create a significant skin change (repair) without the associated pain on application and with very little downtime. I am not sure of the chemistry of exactly how it works since skin results from peeling have been historically associated with the concept of ‘deeper = better results = more pain and recovery’.

My Indianapolis plastic surgery experience with the Vi Peel has shown that it is a real revolutionary peel. I say this for the following four reasons. First and initially important is that the peel produces a significant anesthetic effect on the skin on application. So one can have the peel without pain. That is really important to patients and encourages them to return for further treatments. I assume that the anesthetic effect is from the phenol component of the solution. Secondly, it does produce real skin improvement that appears to be equivalent to that obtained from micropeel laser treatments. (less than 50 microns) A series of Vi Peels can be a comparatively cost-effective skin rejuvenation program. Third, it can be safely used on all skin types (even a Fitzpatrick V or VI) as well as on the more sensitive areas of the neck and the chest. (historical ‘no-peel’ zones) Eliminating sunspots from the hands and chest and decreasing wrinkles in the décolletage areas has always been problematic with traditional peel solutions. Lastly, the peel can be safely applied by a trained aesthetician and does not require a physician to do so.

The Vi Peel is not a complete substitute for laser and light therapies. But it is a valuable addition to skin rejuvenation by providing a real effective option for the under 100 micron retexturing  needs in the face. For the neck and chest, however, this might be the best option that currently exists for real improvement without the risk of scarring.

Dr. Barry Eppley

Indianapolis, Indiana

Common Questions about Skin Rejuvenation

Sunday, February 7th, 2010

1.      What is the best approach to make my skin look better?


To make your skin look and feel more healthy and attractive, one must reduce or prevent wrinkles, sun spots and loose skin, improve skin texture and color, and remove blotches or damaged blood vessels.


Such total skin rejuvenation requires a program approach. Skin care is very similar to exercise and dieting…there is not one single thing that makes the big difference. It is a combination of different methods over the long-term which attains improved and better looking skin. One needs to avoid the idea that a single product applied daily is what works the best.


A comprehensive skin care program includes a daily topical regimen (at-home products), periodic exfoliative maintenance and refreshening (microdermabrasion and superficial chemical peels) and therapeutic laser and light treatments if needed. (deeper wrinkles, brown spots, and red lesions and vessels) Putting a individualized program together with the right products and types of treatments requires a skin care professional. (aesthetician) The skin care world is full of thousands of products and treatments. Knowing which is best for you requires a professional guide.

2.      How does microdermabrasion work?


The concept of microdermabrasion (often referred to as getting a  microderm) is to remove the most outer layer of the skin. (known as the stratum corneum which is dead skin cells) This is done by light abrasion usually using a wand with a roughened surface. It is not a painful procedure and requires no anesthetic. It is done either as a stand alone procedure but more commonly, and effectively, as part of a comprehensive facial treatment procedure.


Besides being a refreshening skin procedure, removal of the outer skin cells allows applied topical products, like light chemical peels, to penetrate deeper for more of an effect. It is part of a periodic maintenance facial skin treatment which is done every six to twelve weeks. Microdermabrasion is often touted has having benefits for scars and other superficial skin lesions but this is not true. It simply doesn’t go deep enough or remove enough skin layers to have any significant effect on these problems.There is no evidence that it can stimulate collagen formation either so it does not have a ‘rejuvenative’ effect on skin. Microdermabrasion can also be used as part of a treatment program for acne but chemical peels are usually more effective and less irritating. Because it is a superficial exfoliation treatment, there is no recovery needed.


Microdermabrasion should not be confused with dermabrasion, a much deeper form of skin removal. This requires some form of anesthesia, is effective for deeper scarring and wrinkles and requires a recovery period.


3.      How effective are IPL (photofacials) and what skin problems are they good for?


Light-based treatments are non-invasive procedures that are known by a variety of names, most popularly IPL or intense-pulsed light or BBL. (broad- based light) Unlike focused wavelength light (lasers), IPL treatments use non-focused broad-spectrum light targeting red and brown pigment which commonly develops from sun-damaged and aged skin. These treatments can leave skin with a more even colored complexion.  They are a safe and effective method to improve the signs of aging from the face, neck, chest, arms and hands.


Pulsed-light treatments have been credited for improving fine wrinkles and skin texture but theses effects are minor and not their primary benefits. One newer use for pulsed light is to help tighten skin. Without damaging the skin’s surface, pulsed light can safely heat the inner layer – dermis – of the skin, inducing the formation of collagen causing some mild skin contraction.


4.      What is a good skin product?


The plethora of over-the-counter skin care products is overwhelming and certainly confusing. Yet there are some significant similarities amongst many of them. The majority of them are basically moisturizers with additional components of sunscreen and botanicals. The moisturizer component (petrolatum, dimethicone and/or glycerin) acts both as a humidifier for the skin as well as a delivery vehicle for the other active agents.


The botanicals, such as soy, silymarin, curcumin, green tea and retinol  provide antioxidant properties that may help in the reduction of facial lines and wrinkles. The botanicals have tremendous marketing appeal but they are not the most important component of the skin care preparation.


Whether the product is an anti-aging night cream or a facial foundation, find one that does not irritate your skin and contains sunscreen protection and some antioxidant agent.


Prescription skin care products have significant proven potency, particularly in wrinkle treatment and prevention and in skin lightening. (bleaching) Vitamin A (Retin-A) and hydroquinone and kojic acid are well known for their effectiveness. A prescription product used with a moisturizing over-the-counter cream can be a very useful combination.


5.      How do lasers help reduce wrinkles and improve skin texture?


Removing layers of the skin, like sanding wood, can help get a  more even and smooth skin surface. Lasers do this by literally burning off the outer layers. Unlike microdermabrasion, lasers go much deeper being capable of removing up to one-third of the skin’s thickness. This is known as deep or CO2 laser resurfacing and requires some form of anesthesia. The effects of the heat of the laser on the dermis can also cause some skin tightening. It will usually take a week for the skin to heal after this laser treatment.


To decrease the recovery and make it an office-based procedure without anesthesia (topical is still needed), the concept of microlaser or erbium peeling has become popular. Going less deep than the CO2 laser, this treatment requires a series of laser peels done every six to eight weeks. They require just a few days to heal and, when done over time, can create a skin result that may approximate a single deep laser peel in some cases.


A newer variation of laser skin treatments is that of fractional skin resurfacing. It strives to decrease the time it takes for the skin to heal after a treatment but to stimulate the deeper collagen layers of the skin. Fractional laser does this by only treating a small percent of the skin’s surface but goes much deeper. By cutting deeper holes in the skin that are spaced out (like aerating a lawn), less skin surface is treated but those areas that are have deeper channels cut into them.


Laser skin resurfacing today can be done at different depths which can be tailored for the patient’s lifestyle. Significant wrinkle reduction and skin texture improvement can be achieved by computer-controlled skin layer removal.


6.      What role does chemical peels have in improving skin?


Chemical peels have a long history of use as a skin improvement treatment. They work by the acid acting with the top layer of the skin, ultimately resulting in it being sloughed off. The acid penetrates into the skin until it is neutralized. This controls its depth of penetration.


Chemical peels come in three basic types based on how deep they penetrate, superficial, medium, and deep. Salicyclic lactic, and glycolic acids are superficial, trichloroacetic acid (TCA) is medium, and phenol is deep. They are differing concentrations of each. Superficial peels are part of most aesthetic facial and at-home treatments, require no anesthetic and heal in a day. Medium-depth TCA peels are done by physicians, require at least a topical anesthetic, and heal in less than a week. Phenol is a deep chemical peel that has largely been replaced by CO2 laser resurfacing.


How deep a chemical peel goes is affected by a variety of factors other than the concentration of the acid. Chemical peeling is very much an art form that requires a lot of experience to get consistent and safe results. Medium and deep depth chemical peels should only be done by an experienced physician.


7.      Which is better for improving wrinkles, chemical peels or laser resurfacing?


Both can significantly improve wrinkles and the quality of facial skin depending upon the type and concentration of the chemical peel and the depth of laser resurfacing. In well-trained and experienced hands, both treatment methods are effective. Laser resurfacing is better for the treatment of scarring and skin irregularities.  


Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

Advances in Chemical Peeling

Tuesday, September 8th, 2009

Chemical peels have a long history in skin rejuvenation and pre-date the use of lasers by decades. More than one million skin peels are performed each year which makes them one of the most common non-surgical cosmetic skin treatments. Their popularity is due to their relatively low cost of use and how they can be used in combination with microdermabrasion and light and laser skin therapies.

Chemical peels result in numerous clinical benefits  including a visible reduction in fine lines and wrinkles, lightening hyperpigmentation, improving acne and rosacea, and as a treatment method for precancerous skin lesions. Despite how many peels are currently done, they are probably underutilized in many plastic surgery practices.

The most common chemical peels are the superficial AHA peels of lactic and glycolic acids whose effects are limited to the stratum corneum.  (epidermis) They are the mainstay of skin rejuvenation due to their ability to do them in the office without any form of anesthesia and their quick recovery. They are essentially the mainstay of what most estheticians use. They are excellent refreshening peels but should not be thought of by patients as a therapeutic peel that will have an immediate effect on fine lines and wrinkles. They simply do not penetrate that deep.

They have historically been applied as single-acid peels but they have more downtime when used this way due to increased inflammation and irritation. This is why the use of blended peels has been a real chemical peel advance in recent years and now dominates how they are used. Many different combinations are available and the historic Jessner’s solution (salicylic acid, lactic acid, and resorcinol) is the ‘grandfather’ of the blended peel approach. Most recently, new ingredients have become available for use in making blended peel solutions. These include pyruvic acid, azelaic acid, and mandelic acid. These new ingredients are excellent exfoliating agents with very low risk profiles. Most major manufacturers now make blended peels, each one which touts the merits of their own mixtures. All of them are good, and when used in the right hands, probably produce similar results.

For greater therapeutic effect, one must consider medium-depth peels which can rival what similar-depth lasers can do. The most versatile chemical peel that I as a plastic surgeon use is the combination Jessner’s and Trichloroacetic acid (TCA) peel. This is a peel that can be done in the office as a stand alone procedure or the operating room in combination with other procedures. The application of a Jessner’s solution first acts as a keratolytic agent that allows the subsequent application of TCA to penetrate deeper and more evenly. For superficial wrinkles, a 25% TCA can be used but deeper wrinkles require a 35% concentration. This peel penetrates deep enough that both dermis and epidermis need to be regenerated, resulting in significant skin changes. The great thing about this peel is its versatility, being able to be done comfortably in the office (with a little sedation) or on top of raised facelift flaps in the oeprating room. It has a great margiin of safety and range of effectiveness, not being too deep but with more effect than a superficial AHA peel.

Despite the hype and marketing of lasers and mechanical methods of skin treatments, chemical peels have persisted in this highly competitive field. They provide an inexpensive and very safe alternative. With the many new peels that are available, more patients with various skin types and conditions can be treated. Between AHA peels for refreshening and maintenance and TCA peels for visible wrinkle reduction, good results can be safely and predictably obtained. Light-based (hyperpigmentation) and laser (vascular)therapies can be done and peels put on right after, allowing for multimodality skin rejuvenation treatments.

Dr. Barry Eppley
Indianapolis, Indiana


Medical Skin Care on Indianapolis Doc Chat Radio Show

Sunday, August 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 Medical Skin Care was discussed. Covering the popular facial treatments of ayurvedic facials, medical facials, microdermabrasion, chemical peels, and laser micropeeling, the medical aestheticians from Ology Spa explained when and why these are used and how they fit into a skin care program. Other skin care topics covered were laser hair reduction, micropigmentation, light therapies for brown spots, and eyelash rejuvenation with Latisse medication and eyelash extensions.

The benefits of a medical skin care porgram with the proper selection of treatments and topical products can have a real anti-aging effecte with better skin texture and reduced wrinkling.

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

Nine Cosmetic Treatments to Rethink – Examining the Facts

Wednesday, March 11th, 2009

I read an article on MSN’s Health and Fitness section on the internet today, which while covering relevant cosmetic topics, did a disservice and injustice to many of them. The article was intended to suggest that the nine procedures/treatments reviewed were either unsafe or were not effective. As such, you should rethink them. Having either performed them in patients or studied the evidence, I think a critical review of the article’s content is in order. I will do so based in the orer they were covered in the article.


This one I would completely agree with everything said in the article. This is a ridiculous idea and anyone that knows anything about breast lift surgery would concur. This is simply someone trying to push the envelope of what Botox can do. Botox may be a miracle drug but it has no place or role in trying to lift a breast. Anyone that uses it as such should be ashamed of themselves for such chicanery….and subjecting patients to such a terrible waste of money.


Obviously a novel marketing idea from the nail industry but no small fish could do as good as job as a human with a file and scissors. Their mention of possible fish contamination is valid but I have enough trouble thinking of using instruments and baths that have been used and cleaned from other people….let enough a tank full of smelly fish.


This is commonly done and highly sought after from many patients. To condemn it as unsafe or at high risk for causing burns flies against broad experience in many good facilities with well trained people. This remains a simple and highly effective cosmetic procedure for shaping the eyebrows and getting rid of that ‘unibrow’.


This eyelash enhancer, while new, is FDA-approved and perfectly safe. Yes, some patients will develop eyelash or eyelid sensitivity with its use and be unable to use it. This is clearly on the packaging inserts and is discussed with all patients to which we prescribe. To the few patients who develop sensitivity to the problem, they are quickly and easily treated to resolve their mild allergic reaction.


Teeth are whitened primarily by different concentrations of hydrogen peroxide. The higher the concentration, the quicker and whiter most teeth become. But with higher concentrations come increased risk of tooth sensitivity. UV (blue light) lights enable lower concentrations of hydrogen peroxide to be used which enhance their effectiveness while keeping down sensitivity. In my teeth whitening protocol, we use two 20 minutes light sessions (with eye protection)  with a 7% hydrogen peroxide solution, followed by a final 20 minute session with 35% hydrogen peroxide without any light. This is perfectly safe and exposes the patient to less UV radiation than a single series of dental x-rays.


The placement of permanent tattoo pigments into the lashline and eyebrows has now been successfully done for nearly 20 years. I have yet to see a single case of  an inflammatory reaction to the implanted pigments. Patients are fully educated beforehand as to the irreversibility of their decision and that is why we spend time reviewing pigment placement and color before actually doing it. Patients are generally thrilled with the use of permanent makeup…so much so that they always come back for touch-ups over the years when there has been some fading of the color.


Despite the advent of the laser, facial skin exfoliation and rejuvenation is still done largely by chemical peels. There are numerous chemical agents in many different concentrations that can be tailored to the amount of improvement and recovery that the patient wants. A chemical peel is…..well it is a burn plain and simple. The depth of the burn is chosen between the provider and the patient. Light chemical peels, such as fruit acids (AHA) and glycolics, are always done by an aesthetician in my practice. They are perfectly safe and produce very gratifying results with little to no downtime. Moderate depth and stronger peels, such as trichloroacetic acid (TCAS), are done by me exclusively under the guise of more improvement with an accepted longer recovery time.


The issue here is not one of safety but of effectiveness. Most patients will not be happy with a 1/2 cup size improvement taking a long protracted time to get there. But for those small number of women who are ardent opponents of surgery and implants, this is their only real option.


Thermage touts some mild skin tightening of the face and select body areas. In some patients, they do get visible results, in others no real long-term improvement is seen. While it is possible to create too much heat and cause an injury, the issue with Thermage is one of expectations and value in my opinion. Most patients are motivated to get some jowl improvement. Limited facelifts or jowl lifts cost a little more with proven results. When the two are compared in terms of value, Thermage falls short.

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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