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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘plastic surgery product review’

Plastic Surgery Product Review: Vanquish Fat Melting Device

Monday, December 16th, 2013


The search for non-surgical methods to reduce fat has been ongoing for decades and recent devices are beginning to produce results that match some of the hype and the marketing. All use different types of energies that can pass through the skin without injuring it and help shrink fat that lies underneath it.

Vanquish Fat Melting Device Dr Barry Eppley IndianapolisOne such device is Vanquish and it can melt fat without surgery. The Czech-made Vanquish device uses “focused-field radio frequency” to target fat cells without ever touching the patient’s body in delivering its effects. It is FDA-approved for deep-tissue heating, a known method for targeting fat, and has minimal side effects. Its fat melting effects are due to be ing able to heat the fat up to 120 degrees which causes lipid release from the cell and actual cell death. The overlying skin only reaches a temperature of 101 degrees F which is not hit enough to cause skin damage.

It requires a series of treatments, usually four sessions spaced a week apart. Each treatment sessions takes about 30 minutes to complete. One lies underneath a device which has adjustable panels that are positioned around the areas of the body to be treated but doesn’t actually touch them. Sensors built into the device keep track of the temperature levels in the body fat and adjust the amount of energy that is delivered during the treatment period.

Vanquish Fat Treatments Dr Barry Eppley IndianapolisEven though the fat is heated up to 120 degrees, patient’s don’t say they feel pain, just a warming sensation. Afterwards there may be a few days of redness or swelling (confirming some injury occurred to the deeper tissues) over the treated area. Patients are advised to drink plenty of water after the treatments which helps flush out the broken down fat and dead fat cells. According to data from the manufacturer, there have been no complaints of tissue damage or injury.

While reported clinical studies are not extensive, one study put forth by the manufacturer of 25 patients demonstrated visible results after the first treatment. Over a course of four treatment sessions, an average of  a two-inch reduction in waist size was seen. . And because the device kills fat cells themselves, and not just releases the fat within cells, the results theoretically should be long lasting.

Vanquish panels Dr Barry Eppley IndianapolisCurrently, Vanquish’s clinical use is for the treatment of abdominal, love handle and back fat. That is due to the current limitations of the external panel designs. No doubt in the future that will be improved delivery designs for many other body areas.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review: Juvederm Voluma XC Injectable Filler

Thursday, October 24th, 2013


Injectable fillers are the other half of injection treatments (Botox is the other half) that have revolutioned the approach to facial. Evolving from the first FDA-approved injectable filler in 2002 (Restylane), there are now over a dozen different facial fillers from various manufacturers. The latest filler options have become focused on filling a specific type of facial volume indication which is not a surprise as the filler field has become crowded and new product introductions must fill a specific niche to become a used option.

Such is the role that the latest facial filler that has just received FDA approval has. Juvederm Voluma XC (Allergan) is the first and only filler approved to treat age-related volume loss in the cheek. (midface) It has been shown in clinical trials to create a more youthful appearance in the face with results that can last up to two years. The value of this long-lasting but temporary filler treatment is that as people age the cheeks lose volume and sag, creating a midfacial flattening look. Adding back volume with Voluma XC helps restore convexity back to the cheek area, like a poor man’s submalar cheek implant.

Juvederm Voluma XC is made with the proprietary Vycross technology that allows the gel to be injected smoothly and consistently through a needle or microcannula. Like other Juvederm products, it also contains lidocaine which provides a numbing effect during the treatment. Juvederm Voluma XC is not new, it has been used in Europe since 2005 without lidocaine  and since 2009 with lidocaine in it. The potential side effects with its use are exactly like that of any filler, temporary swelling, bruising, and lumps and irregularities.

Juvderm Voluma XC is a hyaluronic-acid injectable filler that can now rival other fillers used for their facial volumizing effects such as Sculptra and Radiesse.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review: Brazilian Butt Lift Shaping Garment

Tuesday, October 22nd, 2013


The Brazilian Butt Lift  (BBL) is one of the most popular body contouring procedures today. Using the patient’s own fat which is harvested by liposuction and then concentrated, it is injected into the buttocks to increase its size. It is not really a buttock lift per se but one could argue that the increase in buttock size provides a bit of a volumizing lift. Regardless the name and its acronym, BBL, have stuck in the plastic surgery nomenclature.

Once the fat has been injected, there is no consensus as to how to keep fat in the desired buttock position or to help shape the fat-injected buttocks afterward. Most plastic surgeons use a general compression garment that is typically used for liposuction of the thighs and abdomen. It applies a generalized light compression force to the entire buttocks but it is certainly better than no wearing no after surgery garment at all.

But there are very specific types of buttock reshaping garments that are available that apply a circumferential compression around the buttocks, like a circular ring. This would seem to be a better method of force distribution, in theory keeping the fat localized to the desired area of maximal buttock projection. This forced projection is largely negated when one sits down but in a vertical or prone position helps  keep the fat grafts localized. Such garments do the obvious, leave a large hole so that the buttocks is pushed up and out.  These garments are available on eBay or Amazon at prices from 10 to 45 dollars.

While there is no real science behind the concept of shaping the fat-injected buttocks by an external garment, it seems to make sense and will certainly do no harm. Until one day an active buttock reshaping garment becomes available, these passive garments that provide buttock mound protrusion by compressing around it are an inexpensive option to help get the best buttock shape after fat augmentation.

Dr. Barry Eppley

Indianapolis, Indiana


Plastic Surgery Product Review – Refine Soft Tissue Suspension System

Wednesday, September 11th, 2013


The ideal youthful breast has fullness in the upper pole, does not sag, and has a slightly pendulous lower pole. The slope of the upper pole should be slightly convex, straight, or slightly concave. With time, and gravity, many women lose that nice fullness in the upper pole, aging the breast and making it less attractive. In order to combat this problem, plastic surgeons have tried many different techniques in order to reestablish or make upper pole fullness.

The Refine internal suspension system is a new device that has been developed an use with this problem in mind. The Refine system is a soft and flexible suture-mesh-anchor system that provides the soft tissue with internal support. It is made from medical grade polyester. It has been FDA approved and is indicated for the reinforcement of soft tissue.  The Refine system is placed percutaneously using specialized needles and is a two part system. The first part is the anchor utilizing a small piece of flexible mesh which is placed just deep to the pectoralis fascia. The second part using anchors which engage into the soft tissue, lifting the tissue up.  The two parts are then secured together, burying the knots deep in the soft tissue of the breast.

The most common use of the Refine system is for breast lifts in order to maintain upper pole fullness. When performing a breast lift or a breast reduction, with time, the breast tissue settlesor bottoms out and loses that upper pole fullness that many women want. By using the Refine system, plastic surgeons can permanently lift the breast tissue, maintaining that fullness for a more youthful look. The Refine system is not palpable and cannot be seen on mammography.

Plastic surgical experiences with the Refine suspension system in the breast have been promising and results have been maintained. Overall complications from this device seem to very low and patients report minimal discomfort after placement. This is an exciting new tool for plastic surgeons that is optimally used in conjunction with other breast procedures such as reductions, lifts and with fat injection breast augmentations.

Dr. Barry Eppley

Dr. Jane Namkung

Indianapolis, Indiana

Plastic Surgery Product Review: Radiesse Injectable Filler

Sunday, August 18th, 2013


While there are over a dozen injectable fillers available for human use in the U.S., many share similar chemical compositions. The vast majority are hyaluronic acid-based and, although they have different brand names and some differences in their duration of effects, they are vastly similar in their handling properties.

One of the very different injectable fillers is Radiesse whose composition is a combination of calcium hydroxlapatite particles and a sodium carboxymethyl cellulose gel carrier. It was FDA-approved in 2006 and has many similarities to other fillers such as its immediate effects, persistence of up to a year, a natural looking result and the stimulation of some temporary collagenesis as it resorbs.

But what really separates Radiesse from other fillers is its potential to really push or lift the tissues into which it is injected. Because it is a ‘stiffer’ material, it provides a greater push to the overlying tissues. More scientifically, it is it’s rheological properties of a high G prime or elastic modulus that enables it to be an effective lifting or supporting filler. G prime, the elastic modulus, is a measure of its firmness and resilience. A high G prime means that it is more resistant to external pressures and can hold its shape without being displaced or undergo shape distortion with facial movement. Thus the material stays where it is injected and has little tendency to spread.

As a result of these properties, the best use of Radiesse is for deep injections for facial voluminization as well as for the back of the hands. It is best thought of as a structural filler and is the closest a filler can get to resembling autologous fat injection grafting. Placement of Radiesse down to the bone in the preperiosteal plane allows the overlying muscles to be lifted  and refills the deeper fat compartments of the face. When placed over more prominent bony areas, like the cheeks, paranasal, chin and jaw angles, it can have more of a pseudoimplant effect.

Because of its tissue push capabilities, it creates a greater volumizing effect per ml of material than any other filler. Since it is available in up to 1.5cc syringes, it can provide a lot of correction in a cost effective manner.

Radiesse is the only FDA-cleared filler that is approved to be mixed with lidocaine by the physician at the time of injection. Besides the obvious benefit of the numbing effect, lidocaine adjust its rheological properties. This allows it to be injected with less force and decrease the risk of post-injection clumping.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review: Exparel Local Anesthetic

Sunday, February 10th, 2013


The use of local anesthetics is commonly done in numerous plastic surgery procedures for both immediate and prolonged pain relief. One such operation would be a tummy tuck where the rectus muscles are sutured together. This is the most common source of significant pain after the procedure. Indwelling pain pumps or the injection of long-acting Marcaine (bupivacaine which lasts up to 24 hours) into the muscle is commonly used to help control the patient’s pain after surgery. While pain pumps can work up to 48 hours after surgery they are an additional tube(s) that exits the body and adds hundreds of dollars to the cost of surgery. Injected marcaine with epinephrine will last somewhere in the range of 18 to 24 hours but no longer.

Exparel is a newer local analgesic agent that combines bupivacaine with a unique liposome delivery vehicle known as DepoFoam. This is a multivesicular liposome that entraps the local anesthetic agent and slowly releases it as it breaks down over a few days after injection. This is why the solution looks white and flows like low fat milk due to the suspended liposome particles. This allows a single dose to have a duration of effect of around 72 hours or 3 days. A large number of clinical trials (21) evaluating over 1300 patients who had various surgical procedures were tested for both safety and effectiveness.

Exparel (bupivacaine liposomal injection suspension, 1.3%) has the potential to simplify postsurgical pain management by reducing the need for oral narcotics and/or pain pumps by delivering bupivacaine with a single injection. Better postsurgical pain management may potentially result in less discomfort and earlier mobility in the first few days after a tummy tuck which is the most difficult phase of the recovery. There are other potential applications in plastic surgery where such pain control could be beneficial as well such as breast augmentation.

Dr. Barry Eppley

Plastic Surgery Product Review: Microcannulas for Injectable Filler Treatments

Tuesday, January 1st, 2013


While injectable fillers are highly popular and one of the top non-surgical aesthetic treatments, it does involve the use of a needle and is not pain-free. Placing injectable fillers is more difficult and can be more uncomfortable than a ‘simpler’ Botox injection session. The use of sharp needles for placing injectable fillers has been improved upon by the use of blunt microcannulas.

Made now by several different manufacturers, a blunt microcannula has a rounded tip with a side port for the extrusion of the injectable material. While requiring a needle stick for passing the microcannula under the skin, the blunt tip allows it to be slide around under the skin without discomfort. Since the blunt tip does not cut tissues, there is no discomfort and no risk to create bleeding and bruising.

My patient experience with the microcannula technique for injectable fillers has been exceedingly positive. Any patient that has had filler injections in the past with needles becomes their biggest advocate. They consistently comment on how much more pleasant it is to receive the injections without any topical anesthetics or nerve blocks even in the very sensitive lips. No patient has experienced any bruising.

This raises the question of why is not the microcannula the standard method that everyone uses for injectable fillers? Incredibly its extra added cost of $5 per treatment is likely the limited issue. But the peace of mind to the patient is well worth the cost of using the microcannula. There is also the unfamiliarity of  how to use the microcannula and the need for a needle entrance site.

Besides avoiding discomfort and bruising, microcannulas have the advantage of being to be maintained in place as the filler in injected and moving back and forth as necessary. This is different than when using needles, trying to get the needle out as soon as possible and then trying to massage the material into place. The only real limitation of the microcannula is that it can not be used to inject intradermally when treating superficial wrinkles, but this is a minor drawback and one can still use conventional sharp needles to treat them.

Dr. Barry Eppley

Plastic Surgery Product Review: Egrifta for HIV-Related Abdominal Fat Reduction

Monday, December 31st, 2012


HIV-positive people are well known to develop unusual increases of fat in very specific areas of their bodies. The abdomen and neck are the two most common areas of this  unique form of lipohypertrophy. While some plastic surgery fat reduction procedures can be done in the neck, the intraperitoneal location of the abdominal fat makes it impossible to treat with surgery.

In 2010 an injectable medication Egrifta (tesamorelin, Theratechnologies) was approved for specific use in HIV-positive patients with lipohypertrophy. Egrifta is a growth hormone-releasing factor medication that has been studied for the reduction of visceral (intraperitoneal) fat accumulations. This could be helpful for many patients who are on antiretroviral medications in which it is estimated that up to 1/3 of them will develop abdominal fat accumulation. Studies show that HIV-positive patients taking Egrifta had a near 20% reduction in visceral fat. While 20% may not sound that impressive, it translates into a very visible and satisfying external change in appearance. The visceral fat loss was maintained as long as Egrifta was taken but tended to show a reversal of the improvement when taken off the medication.

Egrifta is an injectable drug taken in a single subcutaneous injection per day that is self-administered. The injection is given into the abdominal area just like an insulin shot. It works by being an insulin-like growth factor (IGF-1) which does not interact or reduce the effectiveness of concurrently taken antiretroviral medications. While it was specifically studied for abdominal fat reduction, it is not known if it would be effective for the classic buffalo neck lipohypertrophy which is also known to develop from antiretroviral medication therapies.

Dr. Barry Eppley

Plastic Surgery Product Review: Viafill Fat Grafting System

Saturday, November 3rd, 2012


The popularity of fat transfer by injection continues to grow due to the appeal of a natural biologic filler material for both small and large soft tissue volume needs. This interest continues to grow despite ongoing issues of inconsistency in graft take and survival. While the critical steps in fat transfer are well known, harvest, processing and injection, their exact influences on graft survival are less well understood. Each step in the process introduces variables and inconsistencies that play some role in eventual graft survival.

Because of the inconsistency in fat graft survival, the historic tendency has been to overfill or overcorrect. This technique seem logical but it results in a lot of short-term swelling and patient management issues. A fat transfer kit, Viafill (Aesthetic Factors LLC) was developed to overcome these fat transfer problems. It is based on a more efficient and self-contained method that reduces graft exposure to air, handles the graft more gently and produces more optimally-sized fat globules…all methods known to reduce fat cell death.

The viability of fat cells would seem to be better with virtually no exposure to air. Centrifuging the harvested fat at 50G for only two minutes removes unwanted liquids and cellular debris but has been shown to not damage adipocyte viability. Acquiring a collection of fat cells that are not larger than 2mm would seem to bolster survival due to quicker access to a critical oxygen supply. These three potential benefits of the Viafill system allow it to be used to the point of good fill with no need to overfill.

Complementing the Viafill kit is Viasilk cannulas. They are a disposable set of precision cannulas. Rather than using re-sterilizeable injecton cannulas, Viasilk cannulas are one-time use devices that have an internal coating that allows the fat to be passed through the cannula with minimal trauma to the cell.

Aesthetic Factors also owns Selphy, a platelet-rich fibrin matrix. When combining all three products, a comprehensive system is available to provide autologous tissue regeneration. Whether Selphyl can be an additive benefit to fat grafting to further improve survival is theoretical but is an ongoing area of clinical study.

Dr. Barry Eppley

Plastic Surgery Product Review – LaViv Injectable Filler

Tuesday, October 23rd, 2012


Other than Botox, injectable fillers are the most common minimally-invasive procedure performed for the treatment of facial aging concerns. But almost all commercially-available injectable fillers are synthetically-derived and their effects disappear as the material absorbs. But a few contemporary fillers take a different approach, using natural materials whose intent is to stimulate local cellular and tissue growth which then creates the volumetric effect.

One such recent natural product is LaViv, also known as azficel-T, manufactured by the Fibrocell Science company. This is a natural fibroblast cellular product derived from a patient’s own skin cells. It is an FDA-approved treatment to be used for the reduction of nasolabial folds (smile lines) in adults. The duration of LaViv’s effects have not been evaluated beyond six months.

LaViv is based on the concept of patient’s producing their own collagen filler from fibroblasts grown from their own cells. A skin biopsy is first obtained from the backside of the ear. It is then sent to Fibrocell where fibroblasts are grown from the tissue sample. To obtain adequate fibroblast cells, it takes three months from the time of the skin biopsy. The final solution is composed of 98% fibroblasts (tens of millions of cells) in a solution of water, sugar, vitamins, amino acids and antibiotics. The injections are performed in the office just like any other synthetic injectable filler. Three injection sessions are needed spaced 3 to 6 weeks apart to get the maximal effect.

Due to the use of bovine collagen and antibiotics in the final solution, skin reactions are possible even though it is the patient’s own cells. But clinical trials showed only a 1% incidence and the reactions were temporary and self-resolving.

For those patients interested in the most natural injectable facial filler, the use of one’s own fibroblasts grown in cell culture is now both possible and FDA-approved. It requires a committed patient who is willing to wait six months to get the final effect. It is also unknown as to the duration of LaViv’s effects which is undoubtably under study by the Fibrocell company.

Dr. Barry Eppley

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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