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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘fractional laser’

Plastic Surgery Product Review: Dermapen for Acne Scars

Wednesday, August 14th, 2013


The concept of treating a variety of skin irregularities with a fractional skin injury approach is seen from the use of laser to dermaroller therapies. The basic premise is that deep small channels are cut into the skin which creates a subsequent healing cascade that causes new collagen formation in the holes and ultimately thicker skin that is smoother. Such an approach has proven useful for a variety of scar problems including those caused by acne.

A new fractional approach is that of the Dermapen. This hand-held device is about the size of a large felt-tip pen and it uses microneedles to cause the fractional skin injury. The tip of the pen as an array of 11 tiny steel microneedles that can achieve depths anywhere from 0.25mm to 2.5mm based on the head chosen. The microneedles are driven into the skin vertically by a frequency-adjustable piston for consistent wounding depths. To prevent cross-contamination between patients the microneedle tips are single use. It does require topical anesthesia to be used and is FDA cleared for acne scar treatments.

The skin microneedling effect caused by Dermapen generates no additional thermal injury to the skin like that caused by a laser. Because there is no heat generated, recovery is quicker, there is virtually no risk of after treatment hyperpigmentation and treatments can be spaced very close together and can be repeated as much as one desires. For patients with greater skin pigments this approach offers a virtually complication-free treatment option. In addition, because Dermapen technology is just a fraction of that of lasers, one would presume that the cost of an individual treatment would also be appreciably lower.

A very relevant but unknown question about Dermapen is how it’s effectiveness compares to the current gold standard of fractional laser treatments for acne scars, stretch marks, wrinkles and surgical and traumatic scars. To date, the safety and efficacy profiles between the two have not been published in any peer-reviewed journal.

Dr. Barry Eppley

Indianapolis, Indiana

The Treatment of Upper Lip Wrinkles

Monday, June 16th, 2008

I read a recent article that reports that drinking directly from water bottles can cause just as many upper lip wrinkles as smoking. I wouldn’t doubt it as any activity that makes your lips pucker, which activates the orbicularis oris muscle which encircles the mouth, can cause wrinkles to appear on the upper lip. The development of such wrinkles is a function of both the activity and how often it is done. Drinking water these days for some people is about as frequent as a regular smoker who does one or two packs per day.
As a general principle, wrinkles form on the face perpendicular to the direction of action of the underlying muscle movement. For example, horizontal forehead wrinkles are the result of ther vertically-oriented and moving frontalis muscle which extends from the brows upward into the scalp. Since the mouth’s main muscle (like the eyes) is a sphincter or encircling muscle which lies parallel (horizontal) to the upper and lower lip (except at the corners), it is no surprise that the lips (particularly the upper) develops vertical wrinkles in some people. The other factor that highly contributes to lip wrinkles is the thickness of your skin and the size of your lips. (which is interrelated) The thicker your skin, the less likely you will ever develop them. Take a look at African-Americans and people of Middle Eastern Descent, you rarely ever see them develop wrinkling of the lips. (and they have larger lips to begin with….as their skin is thicker)
Treatment of lip wrinkles is a challenging problem. I tell patients to think of it as improvement as there is no complete cure in most cases. For small and fine lines that are mainly located at the junction of the skin and the lip, an injectable filler can make a nice improvement…if you can accept having slightly to substantially larger lips. (whichever you desire) When the lip wrinkles are deeper and run higher into the upper lip, the concept of skin resurfacing comes into play. Usually this means laser resurfacing and it is just a question of how deep to go and how much recovery does the patient want. Laser resurfacing with lip augmentation with an injectable filler is the most common method by which I treat more significant lip wrinkling issues. This is done in the office under local anesthesia unless the patient is having other facial procedures which requires a trip to the operating room with the use of deeper anesthesia. There is some current debate between the laser techniques of resurfacing or peeling and the use of fractional (fraxel) laser treatments, but there is no hard clinical evidence at this point to say conclusively that fractional laser treatments are better. In the more severe cases, a small amount of Botox to help reduce the amount of muscle movement can also be helpful when done with fillers or laser resurfacing but you must be careful to not use to much lest you make your smile have an unnatural appearance.
Other methods of upper lip resurfacing for lip wrinkles is currently being evaluated. One method is to combine laser resurfacing with the use of sandpaper (yes I said sandpaper), known as laserbrasion. With this technique, the laser is only used for the first pass (to remove the very top layer of skin) and the deeper layers are then taken done by fine sandpaper. The concept here is that the use of sandpaper causes less trauma (no heat) and will heal faster without the prolonged redness. And it is just as effective as the laser but safer and with less complications than if one used traditional dermabrasion. The other method is known as percutaneous collagen induction therapy. (PCIT) Known aerating your lawn, a small wheel with fine needles is run over the upper lip, cutting many fine holes into the deeper portions of the skin. As this heals it causes the skin to thicken which helps reduce the amount of visible wrinkling.
Upper lip wrinkles in some women are unavoidable and can be very troubling. Injectable lip fillers, laser resurfacing, and Botox can help but there is no permanent cure. The alternative treatments of fractional laser treatments, laserbrasion, and collagen induction therapy are interesting but it is too early to know if they will offer better results.
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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