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Posts Tagged ‘laser resurfacing’

Sciton HALO Hybrid Fractional Laser Resurfacing

Monday, December 21st, 2015

The introduction of CO2 lasers in the mid-1990s largely replaced the traditional of chemical peels like TCA and phenol. They initially created a deep resurfacing effect and were associated with a hypopigmentation effect in some patients and a prolonged recovery. Modern day skin resurfacing laser have gotten around these issues through the use of pulsed and scanning technology as well as the use of ‘lighter’ power sources than CO2. (Er:Yag) This Erbium technology allows for better control of the laser energy with improved results and less downtime and risk of complications.

Fractional laser resurfacing is the gold standard of facial laser treatments today. By treating just a fraction of the facial skin’s surface, recovery is very quick and the risk of complications is virtually eliminated. But it does require more laser treatments to achieve the final resurfacing result. Combining full coverage ablative resurfacing in conjunction with a fractional treatment simultaneously removes a thin layer of epithelium as well as cuts/removes small vertical columns of epithelium and dermis which leads to tissue remodeling. But recovery is often not as quick as the patient would like and multiple treatments are still needed.

th-1Now along comes Sciton’s Hybrid Fractional laser resurfacing technology which combines an ablative fractional laser with a non-ablative fractional laser. This allows patients to get an ablative result with a non-ablative quick recovery. Known as the HALO or hybrid fractional laser, it works by delivering ablation followed by coagulation. This is done by using a 2940nm Er:YAG which delivers ablation up to 100 microns of epidermal depth with a 1470nm diode to deliver coagulation from 100 to 700 microns into the dermis. This is a novel approach being able to deliver separate treatments to the epidermis and dermis in the same treatment.

The Sciton HALO device has undergone years of testing to perfect the Hybrid Fractional Laser technology. During this testing it was discovered that patients treated with the HALO had a much better skin texture and pigment improvement than expected. These results were obtained in just one to two treatments compared with four to six treatments with older non-hybrid lasers. In addition pore size and number had unexpected improvements not seen before.

thThe Sciton Halo Hybrid Fractional Laser is the future of facial laser resurfacing. It produces targeted and effective improvement in the appearance of skin damage with little to no side effects. Patients prefer the HALO treatments over other forms of laser resurfacing due to the improved healing experience. The treatment is also less uncomfortable and does not require local anesthetic nerve blocks. Patients can wear makeup in just one day after treatment with a short duration of skin peeling

Dr. Barry Eppley

Indianapolis, Indiana

Combining Facelift, Cheek Implants and Laser Resurfacing for Total Facial Rejuvenation

Monday, November 3rd, 2014

 

When most people think of facial rejuvenation undertandably the thought a facelift emerges. But contrary to popular perception, a facelift only addresses the lower third of the face. While smoothing out the neck and the jawline provides a youthful improvement, it does not address the middle of the face. Even if it could pulling the middle of the face outward would produce an unnatural distortion and is rarely the answer to midface rejuvenation.

Loss of facial volume and removal of tissue support is a well recognized mechanism of facial aging. Thus volume restoration is a very useful approach to helping to reverse midface deflation. This can be done by either malar/submalar implants or fat injections and there are advocates for each approach. Implants tend to produce a more consistent augmentation method that is stable long-term.

Neither a facelift or the addition of volume restoration to the midface will improve the texture of the skin. Chemical peels and laser resurfacing are the known effective approaches for smoothing out fine wrinkles and improving the look of the skin.

A more complete facial rejuvenation approach would include all of these elements from a facelift, midface augmentation and skin resurfacing. In the September 2014 issue of the American Journal of Cosmetic Surgery, an article appeared entitled ‘Total Face Rejuvenation: Simultaneous 3-Plane Surgical Approach Combined With Ablative Laser Resurfacing’. In this paper, a retrospective review of 21 female patients (age 58 to 71 years old) undergoing combined extended-SMAS facelift, mid-ace augmentation with implants, and full-face ablative laser resurfacing by a single surgeon was done. None of the facelift skin flaps suffered any healing problems. The skin healed (re-epitheliazed) within ten days and makeup was able to be worn again within two weeks. One hematoma occurred as well as one implant infection. This study showed that all three facial procedures can be performed at the same time.

It has been historically thought that combing certain procedures, such as laser resurfacing and a facelift, runs the risk of skin loss and other healing problems. But this study shows what has been known now for some time that combining multiple facial rejuvenation procedures is not only safe but necessary in most cases to have the best results. As long as the laser resurfacing is not done too deep over the raised skin flaps of the facelift, a negative effect of skin and incisional healing does not occur.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Laser Resurfacing for Facial Brown Spots

Sunday, December 1st, 2013

 

Background: Solar lentigines, also called age spots and liver spots, are brown colored skin patches that can appear anywhere on the face and body. They most commonly appear on those skin areas that have a long history of sun exposure. As a result, these brown spots usually do not appear until age 40 and older although they can appear in younger people as well. Brown spots vary in size and depth of color and can often be seen on the face given that it is a highly sun exposed area.

???????????While brown spots may appear ominous for skin cancer, they are harmless and are treated for their unsightly aesthetic appearance. They occur as the result of concentrations of melanin triggered by the sun’s ultraviolet radiation waves. Thus they are focused areas of hyperpigmentation. They are a wide variety of hyperpigmentation treatments for brown spots including lightening by topical bleaching creams (e.g., hydroquinone), chemical peel exfoliators (salicyclic and glycolic acids), and intense pulsed light (IPL) therapies.

But not all brown spots come off with these treatments and, even if they have a positive effect, take time to work and often multiple treatments are needed. Some very dark brown spots or those patients with a large number of them may consider laser resurfacing to create a more immediate and complete effect. As much of the hyperpigmentation lies in the deeper layers of the epithelium, its removal is assured of making a significant reduction in their appearance.

Case Study: This 55 year-old female had developed a large number of brown spots all over her face. She was a heavy sun bather in your youth and never wore any sun protection. Her brown spots continued to develop and get darker as she aged to the point that she wore heavy makeup to hide them. She had tried many lightening creams and IPL treatments but their effects were minimal.

Brown Spot Laser Removal result side view Dr Barry Eppley IndianapolisUnder general anesthesia, a full face ablative laser resurfacing was done. Only a first pass  laser treatment was needed as when the epithelium was removed, all of the brown spots came off with it. Light antibiotic ointment was used for dressing.

Brown Spot Laser Removal results oblique view Dr Barry Eppley IndianapolisWhen seen one month after the procedure, all of her brown spots remained gone. It is now critically important that she wear sun protection at all times and avoid even moderate sun exposure as some recurrence of them or new areas will develop if she does not.

Case Highlights:

1) Brown spots are benign sun-related areas of hyperpigmentation that commonly occur in patches on the face.

2) Facial brown spots are typically and effectively treated by a variety of external therapies design to reduce and fade hyperpigmentation.

3) Refractory facial brown spots that are present in large numbers can be removed by ablative laser resurfacing that removes the top layer of the skin.

Dr. Barry Eppley

Indianapolis, Indiana

Treatment Options for Vertical Upper Lip Lines

Tuesday, June 11th, 2013

 

The face develops many visible signs of aging. But none are more problematic or pesky than that of upper lip lines or vertical rhytids. Such lip lines are very bothersome to women as they not only suggest an older lip but also cause problems with lipstick, often bleeding into the lower end of the vertical line. By far, vertical lip lines occur most commonly in Caucasian women of Northern European descent. They are very rarely ever seen in women that have more skin pigment, thicker skin and fuller lips.

While upper lip lines are often perceived as being caused by those smoke (and this certainly is a contributing factor), but many other factors contribute as well. The most significant, as previously mentioned, is light skin pigment and a genetically thin upper lip. This means that the upper lip has thin skin thickness and less subcutaneous fat which offers little buffer from the motion of the underlying circumferential orbicularis oris muscle. (facial wrinkles develop perpendicular to the action of the underlying muscle movement)

The treatment of upper lip lines is challenging because the source of the problem, movement of the mouth, is something that can not be changed after surgery. One can adopt a new diet to protect a liposuction result or avoid the sun and do numerous topical therapies to preserve other facial surgery changes, but one can not change the thickness of the upper lip or stop eating, drinking or smiling after lip line treatments.

The fundamental treatment of upper lip lines has historically been laser resurfacing. Using deeper laser treatments, the objective is to bring down the entire epithelial thickness of the skin and cause some collagen thickening as well. Much like sanding an irregular surface, significant reduction in lip lines can be achieved by total ablative laser treatments. But it can thin out the skin, cause pigment loss and can not usually be done more than once if the initial laser depth was deep. Thus enters the concept of fractional laser resurfacing where the risks of skin thinning and color loss is minimized. By cutting deep laser holes in just a fraction of the skin surface (22% or less), better collagen production and skin tightening is achieved. When combined with an initial very superficial ablative laser pass (< than 50 microns), significant and sustained lip line reduction can be achieved.

Other lip skin resurfacing methods are available including the dermaroller and old-style dermabrasion. For very deep lip lines, dermabrasion provides the most aggressive method of ‘sanding’ that actually produces the best results. But it is a highly technique sensitive method of resurfacing and is prone to a higher risk of hypertrophic scarring and severe skin thinning. The dermaroller is very much like a poor man’s fractional laser that punches small holes in the skin but its ability to induce collagen production is not as powerful and multiple treatments are needed to approximate even one laser resurfacing.

The other approach to lip lines is to add volume by injectable fillers. Most patients think this means trying to directly inject the vertical lip lines, and this can be done for the very deepest ones, but it really means augmenting the size of the upper lip vermilion. This will  increase the size of the upper lip which directly plumps out the lower end of the vertical lines as they join into the pink part of the lip. For those women that do not mind some increase in their lip size this is an essential step in a lip line reduction strategy. Whether one should use any of the available hyaluronic acid-based fillers (e.g., Restylane, Juvederm) or consider some autologous fat is a matter of discussion with each patient. There is also the option of a lip lift or lip advancement which provides a permanent change in the vertical size of the lip vermilion and cuts out some lower lip lines as well. (lip advancement only)

The best upper lip line reduction therapies incorporate a combination of skin resurfacing and volume addition. If done in the office, fractional laser (22%, 100 microns) with Juvederm upper lip injections is my preferred technique done under topical anesthesia. If done in the operating room, as part of a facelift for example, then I would do a more ablative laser treatment (two passes) with fat injections into the upper lip. Either way the patient needs to be aware that lighter maintenance fractional laser treatments will be needed in the future.

The key word to use in the treatment of vertical lip lines is reduction, few patients will achieve complete elimination of them in a single treatment.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Myth of Laser Scar Removal

Monday, August 6th, 2012

 

When most people think of scar revision they usually think of two things; elimination of the scar and the use of lasers to do it. The reality is that both of these perceived principles of scar revision are wrong. Scars may be able to be improved but they can almost never be removed. Plastic surgeons wish this was possible but it is not. Once the skin has been injured and healed by scar, it will be forever changed. It is merely a question of how much reduction can be obtained and how much less visible it can be. Secondly, while lasers have a role to play in scar revision it is less significant than excisional techniques. Lasers are not magical wands that work like erasers. They are most effective in prophylactic treatment of early scars and incisions. They will make little difference in well-established mature scars, particularly those that have visible surface contour issues. (wide, deep, raised) Revision of significant scars requires excision and closure, often using geometric rearrangement techniques. Laser resurfacing may then be done after to get the best camouflaged appearance.

Plastic Surgery’s Did You Know? Lip Wrinkles

Sunday, July 29th, 2012

 

Lip lines, particularly the vertical wrinkles of the upper lip, are a common problem amongst many Caucasian women. Thinner less pigmented skin is more prone to wrinkling due to repeated lip motion and less dermal thickness and elastic fiber content. The wrinkles form perpendicular to the horizontal orientation and sphincteric movement of the underlying orbicularis muscle. Regardless of how they form, they are very pesky problems to treat so prevention plays a critical role. Stopping smoking is one of the most important preventers as its toxins damage collagen, resulting in fine lines. Sun protection with lipsticks and balms that contain sun protection factors and hydrate the lips works from both the outside and inside. Pursing the lips when drinking through a straw or sipping should be avoided. But when lip lines do occur, they can be substantially reduced by injectable fillers, fractional laser resurfacing or even dermabrasion if severe enough.

Total Hand Rejuvenation

Wednesday, July 11th, 2012

While the aging of the face seems the most visible and subsequently the most treated by plastic surgery, it is not the only visible and unclothed body part that ages. I have seen many older women whose face is quite smooth because of numerous facial rejuvenation procedures but whose hands give their age away. The hands simply don’t go with their face, age or lifestyle. The hands are as much exposed to the elements as the face but are far less pampered and protected.

Like the face, the hands age in a similar way. They lose volume through fat atrophy, the skin loses elasticity and becomes wrinkled and age spots appear. As the fat layer in the hands disappears, which is already thin to begin with, the skin becomes partially translucent and thinner. This creates the classic skeletonized hand appearance where the veins and tendons are clearly visible. The rows between the hand bones become sunken in. The skin when you pinch it on the back of the hands doesn’t bounce back due to loss of elasticity.

The aging of the hands can clearly be seen in many tabloids and magazines. Famous aging women with youthful faces and great bodies have old-looking hands. Their veins can clearly be seen bulging out on their emaciated hands. This may be why some performers wear fingerless gloves in an effort to hide the back of their hands.

Treatment of the aging hands can be done through various rejuvenation methods. The most common treatment by far is for the brown age spots or sunspots. Intense pulsed light (IPL) or broad band light (BBL) can quickly remove brown spots, many of which can be eliminated in a single treatment session of about 15 minutes. It turns them dark and speckled and they then fleck off over the next week or so. A touch-up treatment may be needed a month later to clear what remains. It is important to wear sunscreen on the back of the hands afterward to prevent reflaring of some of the brown spots. A minimum of SPF50 sunscreen should be used.

These light therapies can be supplemented with laser resurfacing to help tighten the loose skin and reduce the wrinkling. Fractional is the best laser method because it has enhanced collagen stimulation effects. Laser resurfacing can be combined with light therapies to get a better overall effect than either one alone. Laser treatments take the same amount of time to do, about 15 minutes per hand.

Most so-called ‘hand lifts’ employ the use of injectable fillers to plump out the atrophic subcutaneous tissues and ‘deskeletonize’ the back of the hand. Fillers like Juvederm, Restylane and Radiesse can be quickly injected in the office for an instant filling effect. Placed right under the skin near the wrist level, they can be pushed into the indented rows once injected right under the skin. While they are not permanent the filling effect will last anywhere from six months to a year.  Fat injections are another option and generally create a better result because the volume injected is greater. It is a minor surgical procedure where fat is harvested from inside the belly button, concentrated, and then injected just like synthetic fillers. Unlike off-the-shelf fillers, fat has the potential to be longer lasting.

Other hand treatment options included the use of skin tightening devices like Exilis and the sclerosing of hand veins by injection or their actual extraction like varicose veins of the legs. One treatment option that is not used is a formal hand lift where skin is excised and the skin tightened. While it can be done by making an incision at the wrist level, the scarring is not acceptable.

A complete hand rejuvenation approach is the combination of injectable filling, light therapy for brown spots and fractional laser for wrinkling and skin tightening. Both hands can be treated in one hour in the office with complete healing in just one week.

Dr. Barry Eppley

Indianapolis, Indiana

Skin Wrinkle Types and Their Treatments

Sunday, March 11th, 2012

Wrinkles are a part of aging and there is no way to completely prevent many of them from happening. While topical creams and lotions once were the only players for wrinkle prevention and treatment, that has changed significantly over the past decade. Botox, injectable fillers and various energy-based device treatments (e.g., laser) have moved in to now play major roles in wrinkle treatment.

 

But those facial lines which develop are more complex than they appear. They are numerous causes of wrinkles which range from the movement of facial muscles to gravity and sun damage. This creates different types of facial wrinkles which are structurally different. Getting the best treatment results depends on matching the facial wrinkle type with the appropriate treatment.  Facial wrinkles and lines can be divided into four general types.

 

The most common facial wrinkles are known as dynamic expression lines. They have become well known because of Botox injections, which are used to specifically treat them. They are known by a variety of names such as smile lines, crow’s feet and the ‘11s’. They develop due to the repetitive movement of muscles of facial expression and the wrinkling of the skin appears perpendicular to the direction that the muscle moves. The most obvious example are horizontal forehead wrinkles which develop because of the movement of the vertically-oriented large forehead frontalis muscle which runs from the eyebrows to the back of the head. By weakening these expressive muscles with Botox injections, the lines become less evident with movement. This works well around the eyes because less movement is always good. Around the mouth, however, less movement can affect how one smiles so injections are done more carefully or not at all.

 

Elastic skin creases occur in areas that are exposed to skin folding and have high sun exposure, most frequently on the cheeks and at the base of the neck. They are not the result of muscle movement but occur in those areas where the skin frequently becomes ‘creased’. This could be the result of sleeping repetitively on the side of one’s face (e.g., vertical or oblique skin creases in the forehead) or other external force that sheers against the skin. The best prevention is to avoid activities that crease the skin and keep it well moisturized.

 

Gravitational folds are not really wrinkles per se but lines that form from the effects of falling skin. They are the result of skin sagging and falling. The most well known are the nasolabial folds and marionette lines. Nasolabial folds appear and deepen as the cheek tissue above them descends, pushing lower cheek tissues against the fixed and non-falling upper lip tissues. The same occurs as jowl and facial tissues fall downward against the fixed tissue of the chin, creating marionette lines. Gravitational folds are best treated by either lifting procedures  that pull the weight of the descending tissues upward and back (e.g., lower facelift, cheek lift) or by plumping the fold with an injectable filler material.

 

Atrophic wrinkles occur from thinning skin and loss of its elasticity. These are the fine smaller wrinkles that often appear between and around dynamic expression lines, elastic creases and facial folds. They create what is known as creapy skin and usually appear as one of the last wrinkle types to occur. Excessive sun exposure and smoking make huge contributions to their occurrence and are what creates the ‘prune-face’ appearance in those with a long-history of sun bathing and have developed a more leathery skin appearance. Exfoliative skin treatments such as laser resurfacing and chemical peels are very effective because these wrinkles are often very superficial and their appearance can be lessened by removing some of the outer skin thickness.     

 

Between topical skin products, Botox, fillers, lasers and surgery, a wide variety of skin wrinkle treatments exist. But these treatments must be applied to the wrinkle type in which they work the best to get good results. Most patients need three or more of these over time to lessen the inevitable appearance of facial wrinkling.

 

Dr. Barry Eppley

Indianapolis, Indiana

Trichloroacetic Acid (TCA) Facial Peeling – An Old But Still Relevant Skin Resurfacing Technique

Monday, August 2nd, 2010

Skin resurfacing is a very useful facial rejuvenation procedure that brightens one’s complexion and helps reduce or eliminate the appearance of fine wrinkles. Once done exclusively by chemical peels, the introduction and evolution of laser technologies  have pushed the use of topical chemicals to the background. Most people recognize laser treatments such as CO2 and fractional as the most cutting edge skin resurfacing approaches.

While laser skin treatments can provide some significant skin improvements, they are not without their downsides. They are expensive, in the range of thousands of dollars per full face treatment, and have significant social recovery. Such shortcomings make them not ideal for many patients.

Chemical peeling may be old, dating back thousands of years, but it has a long history of successful results.  Phenol is the most aggressive facial peel and was the gold standard for a deep result. But its use required a lot of experience and expertise to avoid problems such as tissue burns, loss of skin pigment, and cardiac reactions and toxicity. The replacement of chemical peels with the laser was spurned by a method of skin resurfacing that was more controllable and posed less systemic risks.

Lost in this shuffle has been the trichloroacetic acid (TCA) peel.. This peel, while not as deep, is much safer and predictable than that of phenol. It is a very versatile peel, being available in concentrations from 10% to 70% , which produces different depths of penetration and results. TCA exerts its action by the almost immediate coagulation of dermal proteins, which produces a classic white frost as the coagulation proceeds because of temporary blood vessel constriction.

TCA peeling can be safely used on all skin types, unlike laser resurfacing. However, it is not without some risk of pigment changes. Therefore, darker skin types in the Fitzpatrick four to six classification should be done only with lower TCA peel concentrations and with the use of before and after hyperpigmentation topical treatments.

One of the big advantages to TCA peels is the various concentrations available for different amounts of results and associated recoveries. As a general rule, the higher the concentration of TCA the deeper the peel, the better the results, and the longer the facial recovery.

A good office-based peel is 15% TCA. This limits the damage to the epidermis and the recovery would be 2 to 3 days without much noticeable peeling. When the recovery is this short with no peeling, significant results will not be seen. This falls more into the category of an upper end superficial chemical peel. As long as no more than two coats is applied, it can be done without any form of anesthesia. The traditional use of topical anesthetic creams (e.g.,  4% LMX) that is used with microlaser peeling should not be used with peels as it excessively hydrates the skin and limits their penetration. Oral sedation (10mg valium, 25 mg phenergan) taken 30 minutes before can be very helpful for reducing anxiety during the peel.

Applying more costs of 15% TCA increases the depth of the epidermal damage and will increase healing up to around five or six days. This use of 15% TCA improves the results and helps reduce the finest lines and wrinkles.

In stronger concentrations of 25%  35% TCA, the upper to mid-dermis is damaged with more laser-like results and is best described as a medium-depth peel. This is my favored use of TCA and is usually done in the operating room in conjunction with  facelifts and transconjunctival and pinch lower blepharoplasties.This depth of TCA peel is fully re-epithelialized in 1 week and the patient can then wear makeup. While there is some temporary redness, it does not last very long unlike that of deeper laser treatments. This type of peel works really well for brown skin discolorations and fine to moderate wrinkling.

While higher concentrations do exist and can be used (e.g., 70% TCA), their risks of skin problems rival that of the laser. If one is seeking this depth of skin penetration, the laser is more predictable and safer in my opinion.

Despite the avalanche of available laser technologies for skin rejuvenation, The TCA peel remains an economical and safe treatment that can be done in conjunction with facial plastic surgery procedures or as a stand alone skin treatment. Its ability to be used in different skin types safely and predictably is another valuable advantage.

Dr. Barry Eppley

Indianapolis, Indiana

Lip Wrinkles in Women: Anatomy and Treatment Approaches

Tuesday, March 9th, 2010

There are many physical signs that can give away one’s age. Women know these signs very well and they include such areas as the back of one’s hands, the neck at the sternal notch area, and the mouth. The mouth area is a particularly bothersome area for many women. As a plastic surgeon, the mouth seems to be an area that unfairly ages in women much more than in men. It is actually rare to see deep vertical lip lines in men, even if they have thin lips, until they get quite elderly.

In the November 2009 issue of the Aesthetic Surgery Journal,  a study was reported to investigate the differences between men and women around the mouth area.To determine how bad the wrinkles were, the upper lip of male and female fresh cadavers were analyzed using three-dimensional digital imaging and as well as histologic assessment of full-thickness lip resections in different male and female cadavers. Their results showed that women had more and deeper wrinkles than men. Men had a significantly higher number of sebaceous, sweat glands, and blood vessels in their skin. Somewhat surprisingly, the number of hair follicles did not significantly differ between men and women, although men had a higher number of sweat glands per hair follicle.

This study provides scientific evidence as to why women are more susceptible to the development of mouth and lip wrinkles.The skin around the mouth in women has lesser numbers of skin appendages (hair follicles and oil glands) as well as different connections between the skin and the muscles of the lips.

 

The key anatomic factor is that with less oil glands, there is less oil production to help keep the skin softer, smoother and better protected. I think the observation that the muscles around the mouth are closer to the skin in women than men is also important. This may allow the muscles to pull the skin in tighter, creating a ‘purse-string effect’ and causing more wrinkles.

Outside of this study, there are likely other contributing factors that accentuate these anatomic findings. One of these is the drop in estrogen in women with aging. This hormonal change causes a decrease in the fat (sebum) secreted by sweat glands. Coincidentally, women on hormone replacement therapy have been reported to have fewer wrinkles than those not taking the hormones. Also, most men perform a daily wrinkle treatment, shaving which is a  form of microdermabrasion. Such superficial skin exfoliation done tens of thousands of time over one’s lifetime will help lessen wrinkling also.

While avoiding smoking and sun exposure and using daily moisturizers are extremely helpful and will reduce the amount of wrinking which will develop, that advice does little for the women who already has significant signs of mouth aging.

Several treatment strategies exist that can help significantly with lip lines and wrinkles. These include injectable fillers, Botox, laser resurfacing, chemical peels, and fat injections. The fundamental concepts of these strategies (with the exception of Botox) is inflation (volume fill or restoration) and smoothing. While everyone does not need all or even most of them, a combination of inflation and smoothing will work better than just one of the concepts. Most commonly, the combination of injectable fillers and laser resurfacing is used. But treatment approaches can differ and I do not always do the same approach for everyone.

 

The anatomy of lip wrinkles indicates that no matter what is done, none of the treatment approaches actually ‘cures’ the problem. The skin of the lip can not be made permanently thicker and the natural oil production of the skin can not be improved. This indicates that no matter what treatments are done, they will have to be eventually repeated to maintain the improvement. 

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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