Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘permanent makeup’

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

Permanent Makeup (Micropigmentation) in Plastic Surgery

Wednesday, November 26th, 2008

Permanent makeup, also known as micropigmentation or intradermal pigmentation, is an established method of applying small amounts of colored pigments into the deep (dermal) layer of the skin. This technology has been around for over twenty years and has been proven to be medically safe and highly effective. Micropigmentation is used for a variety of common permanent cosmetic improvements such as eyeliner, eyebrow, and lips. Less common but equally effective is its use in nipple-areolar breast reconstruction. Other uses which have some effectiveness is in scar camouflage, making a hairline or creating the perception of more hair density, or in the treatment of vitiligo. (loss of skin pigment)

By far, intradermal pigmentation is done for permanent eyeliner. Pigment dots are placed in the lash line that mimic thousands of eyelashes. The additional shadowing of color can be added to create a soft natural liner or a much more bold defined line. Permanent makeup is ideal for those who are allergic to makeup, who wear contact lenses, or can not see well enough to do good eyeliner application. It is an excellent option after blepharoplasty surgery when freshening up the eyes draws greater attention  to them. A good eyeliner application is like ‘adding icing to the cake’ so to speak.

Micropigmentation in the eyebrows can mimic the appearance of hair. At the least it creates color and the shape of any eyebrow. For those that use pencil to create the eyebrow, this is an excellent procedure. It not only saves time but eliminates the fear and potential embarrassment of loosing your eyebrows from being in water or sweating. For the physically impaired woman, this can be a great procedure. I have found it also useful for those reconstruction patients who have lost their eyebrows due to a burn injury or a scalp avulsion which included the forehead skin.

Micropigmentation can be an alternative to traditional injectable fillers for the lips. It can appear to change the size and shape of the lips as well as the color. By extending the vermilion line upward or downward, it not only makes the lips bigger but can also help prevent lipstick from bleeding into those fine vertical lines in the older patient. This is an area, however, where the pigments placed are not quite as permanent. If they are used to extend the vermilion where they are actually placed in skin, then there is good permanency. But when it is placed into dry vermilion, this tissue is not the same as skin and it holds pigments less well. More touch-ups are usually required.

Micropigmentation or permanent makeup is an excellent addition to a plastic surgery practice. Plastic surgery provides lots of patient opportunities for permanent cosmetic treatment, whether it be for pure cosmetic reasons or in certain types of reconstruction. When done inside a plastic surgery practice, there is also the benefit of having the plastic surgeon around to provide local anesthetic blocks to make the treatment sessions more comfortable.

Dr. Barry Eppley

Indianapolis, Indiana

The Basic Concepts of Permanent Makeup (Micropigmentation)

Monday, June 23rd, 2008

An appealing alternative to the daily regimen of applying cosmetics is the concept of permanent makeup which can be a good option for many patients. Whether it is the common practice of eyeliner application, the need to fill in a thin eyebrow or reconstruct a lost one, or to accentuate one’s lips, the placement of permanent pigments into the skin provides long-term relief from daily makeup applications.
Permanent makeup, medically known as micropigmentation, is the precise placement of color into the skin. Through small needles, differing colors of iron oxide pigments are placed into the deeper portion of the skin, known as the dermis. Precise placement of needle sticks creates many tunnels into the skin which then carry the colored pigments along with each needle stick. Once the tiny pinholes heal over, the pigments are forever trapped in the deeper layers of the skin, creating a permanent color effect. The size of the pigment particles prevents the body from being able to remove them from their embedded site. Because some of the embedded tattoo particles may be smaller, there is always some fading of portions of permanent makeup over time which is why occasional touchups may be needed.
When considering undergoing permanent makeup, I recommend that each potential patient be aware of the following concepts surrounding it. First and foremost, as the term implies, permanent makeup is……permanent. There is no good way to remove the color once it has been placed. Lasers can not remove them and may actually make them appear worse. The decision to have permanent makeup should be well thought out in advance. As a result, you should undergo a thorough pre-treatment assessment of color selection and exact location of color placement. Meeting with a professionally trained and licensed aesthetician in a medical setting who has specific training and certification is usually best, although technicians from many different backgrounds perform the procedures. They will perform a thorough pre-treatment consult using removeable liners with the proper color to ensure you are comfortable with the look. The procedure will not be done the same day as you need time to think about the selections of color and placement. As the use of many needlesticks from tattooing is uncomfortable, I always provide some sedative medication for the procedure and I personally inject local anesthetics to minimize every patient’s level of discomfort. Be aware that the initial placement of the tatto color is designed to be a little too dark as they will be some mild fading over the next few months. For this reason, some touch-up of the permanent makeup work is almost always necessary in the first six months after the initial application.
Permanent makeup can be ideal for many reasons beyond the inconvenience of those who detest a daily cosmetic application. Physical reasons such as age, decreased vision, and mental impairment may make permanent makeup a ‘medical need’ that the patient otherwise would not be able to do. Very active lifestyles that involve strenuous activities and frequent exposure to water make permanent makeup a near necessity for some patents.
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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