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Dr. Barry Eppley

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Posts Tagged ‘plastic surgery product reviews’

Product Review – Vitagel in Plastic Surgery

Friday, February 26th, 2016


The most common expected early outcomes and complications from many types of plastic surgery are various types of undesired fluid collections. These are caused by bleeding (bruising and hematomas) as well as prolonged lymphatic leaks. (seromas)

While the body has many natural clotting and healing mechanism to limit the occurrence or extent of these fluid collections, they can be frequently overwhelmed or not optimally effective. Plastic surgeons are well aware of this potential and employ a variety of  strategies to help including intraoperative electrocautery and hemostatic materials as well as the use of postoperative drains and pressure dressings.

Vitagel Indianapolis Dr Barry EppleyThe past decade has seen the advent of adjunctive biologic approaches that can be applied during surgery to work with the body’s natural hemostatic and healing mechanisms. One such agent is VITAGEL.This is an FDA-approved, composite liquid hemostat that combines the thrombin and collagen with the patient’s own plasma. When applied to human tissues, Vitagel creates an adherent gel and an impermeable barrier to blood flow. This helps control bleeding and facilitates healing using the patient’s own biology.

Vitagel Dr Barry Eppley IndianapolisVitagel is promoted as a surgical hemostatic product that combines microfibrillar collagen with thrombin, fibrinogen, and platelets. This unique combination of components forms a 3-D scaffold of collagen and fibrin which is augmented with activated platelets.This is created during surgery by using a draw of the patient’s blood which is spun down by a centrifuge to create an extract of plasma and platelets. This is then mixed with prepackaged thrombin and collagen to create the final hemostatic product. By using the patients own blood, the risk of viral transmission associated with products containing pooled human donor components is eliminated.

Microbrillar collagen in Vitagel Dr Barry Eppley IndianapolisOne very unique component of Vitagel is the microfibrillar collagen.  Collagen is a well known essential element for both inducing the coagulation cascade as well as promoting healing. The microfibrillar structure allows for better coherence of the collagen fibers to irregularly shaped bleeding sites.This type of collagen also aids the healing process through the formation of a biologically active 3-D scaffold for cellular ingrowth and fibroblast attachment.  Such a scaffold becomes a template for new tissue growth. This is unlike any other surgical hemostatic agent.

Vitagel Spray Indianapolis Dr Barry EppleyVitagel can also be applied to the surgical site in a variety of ways including a standard spray and a powered aerosolized mist. This ensures optimal coating of the tissues even into the smallest crevices.

Vitagel has great application for many plastic surgery procedures that involve the creation of large skin and tissue flaps. Such procedures as tummy tuck and facelifts, for example, involved the undermining of large tissue flaps for which drains are commonly used and the risk of hematomas and seromas are well known. The use of Vitagel would help decrease these risks and may either eliminate the use of drains or reduce the length of time they are in after surgery. At the least the amount and duration of postoperative bruising and swelling may be lessened.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Lip Augmentation with Juvederm Ultra XC

Wednesday, October 7th, 2015


Lip Augmentation Dr Barry Eppley IndianpolisLip augmentation is one of the most common and historic procedures for hyaluronic acid-based injectable fillers. It would surprise many then to find out that despite its popularity and common usage, few of these injectable fillers are actually FDA-approved for use in the lips. There are a variety of reasons for this lack of approval but safety and effectiveness are not among them.

On October 1, 2015 the US FDA has approved Juvederm Ultra XC for injection into the lips and perioral (mouth) area for aesthetic augmentation in adults. Juvederm Ultra XC and Juvederm Ultra Plus XC injectable fillers are already FDA-approved for injection for moderate to severe facial wrinkles and folds around the nose and mouth. (nasolabial folds) Juvederm Ultra XC is a well known modified form of hyaluronic acid with prolonged duration (up to a year) that has lidocaine in it to improve the comfort of the treatment.

juvderm ultra xc injectable filler, dr barry eppley indianapolisIn FDA trials of Juvederm Ultra XC for lip augmentation, almost 80% of patients had visible improvement in lip fullness three months after injection. A near similar percent, (78%) stated that they had persistent improvement in lip size one year after injection. The most common adverse effects for Juvederm Ultra XC injectable filler are the same as other hyaluronic acid gels such as temporary swelling, redness and lumps and bumps.

What is unique about Juvederm Ultra XC injectable filler is that it offers long-term retention of lip augmentation results. Many hyaluronic acid-based injectable fillers are used for lip augmentation but their results often last six months or less.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Restylane Lyft

Wednesday, July 8th, 2015


Restylane Lyft Dr Barry Eppley IndianapolisThe anticipated approval of new injectable fillers shows no sign of stopping with the development of ‘niche’ filler products. This was demonstated this week as the FDA (US Food and Drug Administation) approved Restylane Lyft for cheek augmentation. Restylane Lyft, formerly known as Perlane-L, was approved for the standard injectable filler indications of treating nasolabial folds.

Per the manufacturer Gladerma In a clinical trial of 200 patients, almost 90% of treated patients with Restylane Lyft showed increased and persistent fullness in the cheeks. More than half of the treated patients demonstrated such persistent fullness out to one year followup. Adverse reactions for this hyaluronic-based injectable filler were typical with a low incidence of redness, swelling and itching, all of which resolved within two weeks after injection.

Restylane Lyft is the fifth member of the well known Restylane brand name that has been approved over the years.  Other well known companion injectable products include Restylane, which is used to correct smile lines and augment the nasolabial folds, and Restylane Silk for lip augmentation and wrinkles and lines around the mouth.

Restylane Lyft is clearly a competitive analogue to Allergan’s Juvederm Voluma. It is ongoing evidence that all companies offering injectable filler products will need to develop and market a broader spectrum of treatment offerings for very specific facial indications. What differentiates the injectable filler products is that the viscosity or so called G prime of the filler is modified to treat the array of soft tissue defects from superficial fine wrinkles to deeper areas of volume loss. Long gone are the days when one tried to use one type of filler for every aesthetic facial need.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Exilis Elite for Cellulite Treatment

Monday, April 13th, 2015


Cellulite is a well recognized aesthetic skin condition that occurs most commonly in women and involves the buttocks and thighs. The cottage cheese appearance is recognized today to be the result of compartmentalized fat hypertrophy and the contraction of dermal-fascial bands in the involved regions. New device based treatments continue to emerge for its treatment that either focus on fat reduction, fascial release or both.

Exilis Skin Tightening Indianapolis Dr Barry EppleyExilis is a monopolar radiofrequency device that is used to heat the skin, resulting in collagen remodeling and skin tightening. It was first introduced in early 2011 after FDA clearance for the treatment of loose skin and body contouring. It has proven to be a valuable non-surgical treatment for reducing loose skin and wrinkles on the face and body.

Exilis Elite Dr Barry Eppley IndianapolisIn February 2015 the FDA has approved the use of Exilis for the temporary reduction in the appearance of cellulite. Using a new treatment protocol that can effectively target the fat underneath cellulite involved skin that helps give it its dimple lumpy external appearance, temporary improvement in the appearance of the skin is obtained. It takes multiple treatments, usually four to six, spaced several weeks apart to get the full effect. Full results can take up to three months after treatment.

Exilis Elite joins a growing number of devices for cellulite that offers non-surgical treatments of an aesthetic problem that defies any universally effective solution.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Exilis Skin Tightening

Friday, February 6th, 2015


Exilis Indianapolis Dr Barry EppleyRadiofrequency has become a popular treatment method for the non-invasive improvement of wrinkles, skin looseness and spot body shaping. There are numerous such devices that are currently available, one of which is the Exilis from BTL industries. Exilis is different from other radiofrequency devices is that it uses monopolar focused radiofrequency which allows for a layering of energy at different depths. This equates to uniform heating of the skin.

Several clinical studies have shown visible skin tightening and reductive body shaping results with up to 35% reduction in skin looseness, a 42% reduction in wrinkles and a 33% reduction in skin photodamage. Given that the average age of the women in these studies was 57 years old, this proves positive changes can occur even in older and damaged skin. Histologic studies of the treated skin showed full thickness collagen remodeling and elastin production. Like most non-invasive devices, a series of treatments is always needed to gain maximal results.

Such results are possible because of the advanced cooling system in Exilis which keeps the temperature below 45 degrees C. This is important because above that temperature the patient will experience a painful burning sensation. But without getting close to this temperature the desired skin changes will not occur.

Animal studies have also shown effects on subcutaneous fat demonstrating that it can selectively heat fat with apoptosis and adipocyte shrinking. The cooling system is very important here so the heat can reach the fat but without burning the intervening skin. Thus Exilis can do some mild fat reduction in addition to skin tightening. But the fat reduction is limited to just the fat immediately under the skin.

Radiofrequency treatments like Exilis can be combined with a variety of other aesthetic treatments. It can be used in conjunction with Vanquish or Cool Sculpting, for example, to create combined maximal fat reduction and skin tightening. Injectable fillers can be placed under facial areas treated with Exilis on the overlying skin. Exilis can even be used with light fractional laser resurfacing. Our practice in Indianapolis has found it vey useful and safe for a variety of face and body aging issues.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review – Ideal Breast Implant

Saturday, January 17th, 2015


Breast implants have evolved considerably over the past twenty five years. Almost all of these technological improvements have occurred with silicone gel breast implants. Saline breast implants have essentially remained the same with the exception of the enveloping silicone shell bag. That is until recently.

Ideal Breast Implant Dr Barry Eppley IndianapolisIndianapolis Ideal Breast Implant Dr Barry EppleyThe FDA has just approved a new type of saline breast implant known as the Ideal Implant. The innovation is that inside the saline implant is a series of shells/baffles that control the movement of the saline as it moves within its containment bag. This reduces the sloshing of the fluid inside the shell.This makes the saline act like it has greater viscosity and it acquires physical characteristics that are more like silicone. This creates a saline implant that overcomes some of its well known shortcomings including rippling and bouncing. For the first time a saline implant exists that looks and behaves somewhat similar to a silicone breast implant.

The FDA approval was based on a five year clinical study which had 500 patients treated by 45 plastic surgeons. Complications occurred at rates that are well known for saline breast implants.The feel and shape of the implant is reported to be an improvement over the standard saline filled implant and the vast majority of the patients report high rates of satisfaction.

For women who desire breast augmentation with saline filled implants but would like more of the feel of a gel device, the Ideal Breast Implant is a good new breast augmentation option.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review – Bellafil Injectable Filler for Acne Scars

Monday, January 12th, 2015


Bellafil Injectable Filler Dr Barry Eppley IndianapolisBellafil is a ‘new’ injectable filler that really is a rebranding of Artefill/Artecoll which as been around been development and as a clinical product for over fifteen years.  It received FDA approval in 2006 to treat nasolabial folds/smile lines. It is a combination of bovine collagen and PMMA microspheres. It is classified as a semi-permanent filler as the PMMA beads remain behind while the carrier collagen gets resorbed. It has had a rocky company history and its ore recent acquisition by Suneva Medical has given it a boost back into clinical awareness.

Bellafil Artefill Injectable Filler Indianapolis Dr Barry EppelyBellafil recently received FDA approval to treat acne scarring which makes it the first injectable filler to do so. Acne and the scars it leaves behind is a very common skin problem that affects tens of millions of Americans alone. Because of its beaded composition, it is likely more effective than most other hyaluronic acid fillers in lifting depressed acne scars up to the level of the surrouding skin as it provides more soft tissue push.

The FDA approval was based on a study of 150 acne patients, all older than age 21, against a placebo injection. The Bellafil treated patients had a significant and sustained improvement in their acne scar appearance that continued for up to a year after injection.

The treatment of acne scarring requires multiple approaches from punch excision, laser resurfacing and injection therapies. No one treatment is best for acne scarring as they take on many different scar forms. But an injectable approach has s role for some acnes scars, like the boxcar type, in which a subdermal push is useful in lessening their appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review: Restylane Silk

Wednesday, June 18th, 2014


Restylane Silk Injectable Filler Dr Barry Eppley IndianapolisWith over a dozen injectable fillers on the aesthetic facial market in the U.S, and new ones appearing annually, a news release that another injectable filler product or indication has been approved is not revolutionary. Such is the case today as the Food and Drug Administration has given clearance for Restylane Silk injectable filler manufactured by Valeant pharmaceutical company. Restylane Silk is an injectable hyaluronic acid-based filler that contains 0.3% lidocaine. The uniqueness of this injectable filler product is that it is approved for lip augmentation and the treatment of perioral rhytids (mouth wrinkles) in patients 21 years or older.

In a clinical study that led to its approval, Restylane Silk was studied in over 220 patients for its effectiveness and safety for lip augmentation and direct injection into the dermis of mouth wrinkles. The study results showed that almost 100% had improvement in lip fullness two weeks after the treatments and over 75% had sustained lip fullness improvement six months later. Adverse events reported were very typical including temporary swelling and bruising and pain on injection.

Lip Augmentation Dr Barry Eppley IndianpolisLip augmentation by injectable fillers has been around long before even the first FDA-approved product (the original Restylane) was initially approved in 2002. They have been used ‘off-label’ for lip and perioral treatments for over twenty years. They have been and will continue to be in high demand for lip enhancement due to their immediate effects and usually good results. (which are highly injector dependent) The major players in the injectable filler market have been slowly getting around to get formal FDA approval for lips and Restylane Silk now fulfills that objective for the Valeant product line.  It is now the second injectable filler after Juvederm to get formally approved for lip augmentation.

The key to a good injectable filler for the lips are that it should be hyaluron-based (for assured and uncomplicated resorption), have a viscosity that permits an easy flow through a 30 gauge needle (to lessen the occurrence of lumps and clumps) and it has a lidocaine additive. (to lessen immediate after injection discomfort)

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review: Living Proof Neotensil Under Eye Treatment

Sunday, April 20th, 2014


Under eye bags and wrinkles are a major aesthetic concern for most people as they age. No matter how many creams and topical treatments one may try, they are hard to improve without actual surgery for more advanced under eye aging. While lower blepharoplasty techniques are the definitive treatment, surgery involves recovery and does not produce an immediate effect.

Neotensil Undereye Treatment Dr barry EppleyNow along comes the Neotensil Under Eye reshaping product which is neither a surgical procedure, laser or cosmeceutical treatment. It is an clever and innovative use of a polymer film that can be applied to temporarily tighten and reshape the under eye area. The name is actually an acronym that after Neo stands for transforming (T), elastic (E), noninvasive (N), supportive (S), invisible (I) and layer. (L)

Neotensil Living Proof Dr Barry Eppley IndianapolisNeotensil uses a proprietary cross-linking polymer film technology which is applied  in a two-step process. Initially a base is mixed with an activator and then it is applied with a special tool. Once it dries, it creates a clear and flexible membrane on top of the under eye skin that tightens and smooths as the polymer contracts on setting. A clinical study showed that 99% of patients showed visible improvement in compressing and changing the shape of the under eye area. Many patients in the study (70%) showed substantial improvement with a change in at least two grades in an aesthetic improvement scale. Its effects are temporary and last from 16 to 24 hours.

Under the marketing name Living Proof, Neotensil is distributed through Valeant Pharmaceuticals as a kit. It retails for $500 and has enough product for 50 applications. This factors into $10 a use. While most people will probably not use it as an everyday cosmetic treatment, it is a great product for special events or a night out on the town for those who want to temporarily improve that tired under eye look.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review: Funnel 2 Device for Breast Augmentation

Thursday, February 20th, 2014


Breast augmentation requires the insertion of an implant through an almost always smaller incision than the size of the implant. This is not an issue with saline breast implants since they are inserted in a rolled fashion and inflated once in place. But silicone breast implants must be placed fully filled and their placement through small skin incisions stresses the implant shell and may lead to premature rupture and a shortened lifespan of the device.

Introduced in 2009, the use of a funnel device improved this aspect of silicone breast augmentation surgery. This unique device, shaped just like its name implies, allows a silicone implant to be ‘shot through’ small skin incisions easily and with far less stress placed on the implant shell. It also allows the implant to be go from package to breast pocket without ever being touched by human hands or touching any skin surface reducing  risk of bacterial contamination.The funnel’s shape is one reason why it works but its slippery inner lining is just if not more important than the device’s shape.

Funnel 2 Breast Augmentation Indianapolis Dr Barry EppleyNow the funnel device has been improved and is known as the Funnel 2. It is now clear as opposed to the  first generation opaque device which allows the breast implant to be easily visualized and oriented prior to insertion. This is not only helpful to keep the base of the round silicone implant downward against the chest wall but also critical when placing textured shaped breast implants. Turning a textured breast implant around in a breast pocket is not always easy and proper orientation is critical to the final shape of the breast after surgery.

The Funnel 2 has the same interior hydrophilic coating that creates a slick surface which allows the breast implant to glide easily into the pocket with the same no-touch technique. This improved device continues to be an essential component of contemporary breast augmentation surgery.

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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