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Dr. Barry Eppley

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Posts Tagged ‘facial laser resurfacing’

Platelet-Rich Plasma (PRP) Use In Facial Laser Resurfacing

Sunday, January 4th, 2015


Fractional Laser Resurfacing Face Dr Barry Eppley IndianapolisLaser resurfacing is a long-standing treatment that can have a profound rejuvenative effect on wrinkled and sun damaged facial skin. By burning off the top layer of skin and allowing it heal, a fresh skin surface is created with fewer surface imperfections.While effective, it is associated with a significant healing time, discomfort and  temporary facial redness. This has been improved by changing from a fully ablative laser treatment, which treats the entire skin surface, to a fractional approach.

Fractional laser resurfacing treats a portion or fraction of the skin surface’s  (usually 5% to 22%) but with deeper channels cut down into the thickness of the skin. This has the dual effect of shortening healing time due to less injured skin surface and causing greater collagen regeneration and tightening. But despite the advantages and reduced recovery time of the fractional laser, adjuvant treatments are still sought to reduce healing time and facilitate a faster recovery. One such treatment is that of platelet-rich plasma. (PRP)

Platelet Rich Plasma PRP Therapy Dr Barry Eppley IndianapolisPlatelet-rich plasma (PRP) has been used for many applications in various surgical fields for its ability to improve wound healing, hemostasis, and graft survival. It is a blood concentrate that is full of platelets. Platelets contain many different growth factors and cytokines in high concentrations which serve as the theoretical basis for the use of PRP in tissue repair. Studies are mixed as to its true effectiveness across a broad spectrum of applications. But the superficial nature of laser resurfaced skin seems like a good application for it.

In the Online First edition of the November/December 2014 issue of JAMA Facial Plastic Surgery, a study was pubished entitled ‘Evaluation of the Effect of Platelet-Rich Plasma on Recovery After Ablative Fractional Photothermolysis’. This was a blinded study using small human forearm test sites that were treated with fractional laser treatments at consistent depths in both arms. The treated sites were immediately treated with either topical PRP or saline. (control) Significant improvement was seen in PRP-treated arms compared to controls in all 15 treated patients. Improvement was defined as the erythema rating of the untreated arm minus the erythema rating of the PRP-treated arm. Patients noticed a reduction in the amount of redness, swelling, itching and pain in the PRP-treated sites.

These study results suggest that PRP can improve the healing rate of facial laser resurfacing sites. It presumably does so by creating a faster rate of skin cells growing across the injured skin surface through earlier induction of cell turnover. It is interesting that such positive results were seen with just one application immediately after the laser resurfacing. Given the reduced cost to acquire a single concentrate of PRP today, it should enjoy broader useage.

Dr. Barry Eppley

Indianapolis, Indiana

Fully Ablative vs Fractional Facial Laser Resurfacing – Which Is Better?

Saturday, January 19th, 2013


Facial laser resurfacing has evolved over the past twenty years from in both how the energy is delivered to what depths into the skin that is treated. When initially introduced laser resurfacing was known as ‘fully ablative’, meaning that at any energy level it treated 100% of the skin’s surface. While many of the results a fully ablative laser resurfacing treatment creates can be impressive in the amount of wrinkle reduction and skin tightening, it can be associated with loss of skin pigment and long healing and recovery times.

Such skin resurfacing concerns led to the development of fractionated or a ‘fractional’ laser technique. In this approach the laser only treats a part or fraction of the skin’s surface. By leaving untreated or skipped zones of skin, there is less traumatized tissue which substantially reduces the risk of hypopigmentation and shortens the recovery time. Treating less skin may seem counterproductive to getting a good skin result (less wrinkles) but this is compensated for by having each penetrating laser light column go much deeper. This is why fractional laser treatments create pinpoint bleeding areas while fully ablative lasers do not.

The theoretical benefits of fractional laser resurfacing is that these deeper penetrating columns of laser light cause at least an equal amount of increased collagen formation and skin tightening as that of more superficial fully ablative laser treatments. This would seem to make perfect sense given the greater depth of dermal injury and it has always been assumed to be true. It also accounts for its popularity as a widely used treatment.

In the October 2012 issue of Dermatologic Surgery, a human study was done to directly compare the molecular changes that result from fractional vs fully ablative carbon dioxide (CO2) laser resurfacing in skin damaged skin. In 34 adults with substantial facial skin damage, matched facial areas with treated between the two laser types. Real-time reverse transcriptase polymerase chain reaction technology and immunohistochemistry were used to quantify molecular responses to each type of laser treatment. Their results show that both fully ablative or fractional laser resurfacing resulted in significant skin changes of dermal remodeling and the creation of new collagen. After one treatment, however, fractional laser resurfacing effects were only about half of that seen by a fully ablative treatment. The fully ablative laser treatments created greater changes with more pronounced collagen formation.

What this study indicates is that the fractional laser approach is not superior to fully ablative treatments (in a single treatment) as many may believe or purport that it is so. This is no surprise given that much less skin surface is treated, often 78% to 95% less.  The value of fractional laser resurfacing is that it has less risks of skin problems particularly in patients with more natural skin pigment.Whether better skin results, particularly in its tightening effect, may occur with repeated treatments can not be determined from this one study. The value of fractional laser resurfacing is that such repeated treatments can be safely done.

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

The Top Ten Instructions After Facial Laser Resurfacing

Wednesday, August 20th, 2008

Resurfacing of damaged and wrinkled skin by the laser is a very effective procedure for creating smoother skin with a better texture. Because laser resurfacing is really a big burn and it is on your face, the after care is both significant and a little laborious. Not to mention somewhat psychologically disturbing as you see your face during the first week after treatment. The degree of care needed is dependent on the depth of the laser resurfacing. In general, if the procedure was done in the operating room under some form of anesthesia then it is likely is was DEEP laser resurfacing and the following list of instructions apply. In office-based laser resurfacing, this is either light or medium depth levels and the healing is much faster without the need for extensive after care.
1) Keep all treated areas covered with Aquaphor ointment constantly. Clean the
facial wounds gently with Cetaphil soap and cool water every 6 hours or so
the first two days and then twice a day thereafter.
2)Aquaphor ointment should be applied liberally to keep the treated areas moist.
The formation of scabs is not desired. If they appear, it is because either not enough ointment is
being applied or it is not being applied frequently enough. If scabs do appear, do not scrub, pick,
or rub off any of them.
3) The more fluids you drink, the better your skin will heal. Try to drink 8 – 10
ounces of fluid every 2 to 3 hours during the first week after surgery.
4) You should continue oral antibiotics (e.g., Kelfex) for 7 days after surgery.
5) If the area around the mouth was treated, you should continue antiviral
medication (e.g., acyvlovir) for 5 days after surgery.
6) Take your pain pills (e.g., Vicodin) as prescribed.
7) You may experience mild itching 3 to 7 days after surgery. Ice packs gently
applied on top of the treated areas during the first day or two after surgery will
alleviate most itching. For more severe itching, you may try over-the-counter
Benadryl 30mg every 6 hours. (this will make you sleepy so no driving)
8) Once the skin is healed (7 – 8 days), apply your regular moisturizer to the
the treated areas liberally for the next few weeks to keep it from getting dry.
9) NO make-up until 7 – 10 days after surgery. A mineral-base foundation is
is recommened to both conceal the redness and sensitivity of the skin in the
first month.
10) Avoid direct sunlight during the first month after surgery. The skin is very
sensitive during this early healing phase. After the first week after surgery, wear
sunprotection (SPF 30 or higher) for the next 3 months when going to be exposed
to the sunlight.
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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