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Surgeon Dr. Barry Eppley

Posts Tagged ‘pro’

Injectable Facial Rejuvenation with Platelet-Rich Plasma (PRP)

Sunday, October 4th, 2015

 

PRP (platelet-rich plasma) has earned a role in a variety of facial rejuvenation procedures. One of its most well recognized uses due to social media and marketing is in the Vampire Facelift procedure. Its name is an obvious spinoff of the use of PRP which requires a blood draw to create the platelet concentrate. It is not a pure PRP procedure as it requires the use of injectable fillers to create the facial volume needed. In theory the PRP acts as a stimulant for soft tissue rejuvenation with its own growth factors and other stimulants…although that is far from proven science.

PRP injectable facial rejuvenation is an all natural treatment. There is no chance of allergic reactions or fear of foreign body interactions in response to these plasma concentrate injections. But what it is not is a facelift by any definition of this procedure. It does not reshape, tighten or otherwise involve removal of loose or sagging tissues as a traditional facelift does. Conversely it is a plumping procedure by adding volume through the use of the combination of PRP and hyaluronic acid-based fillers. The plumping helps stretch out some wrinkles and creates a bit of a tissue lift in some facial areas.

Platelet Rich Plasma injections Indianapolis Dr Barry EppleyWhile PRP is known for its healing properties, its success in causing cell stimulation and rejuvenation in normal people to help ‘reverse’ or treat aging tissues is more speculative. Stimulating tissue repair in injured tissues is one thing, making the body create new cells to treat otherwise normal tissues, albeit aging ones, is more of a biologic stretch. But this is the contention of the Vampire Facelift approach. Inject PRP under the skin and the body takes it from there presumably generating new collagen from stimulated fibroblasts.

There is no question that these injection treatments are safe as they involve PRP and other well known injectable fillers. There is very little possibility of any untoward reactions and complications. It is just a question of how much skin benefit is obtained from injecting the plasma and platelets and whether it provides any longevity benefit to the hyaluronic acid fillers that are also simultaneously placed.

The injection procedure does create some mild bruising and swelling for a few days that, at its worst, completely resolves within a week after the procedure. With the use of blunt injection cannulas, the creation of bruising is virtually eliminated. The effects of volume addition are seen immediately, any tissue stimulation occurs much later. (weeks to months) Whatever tissue stimulation and growth that may occur from the injections is not known how well or long it will persist. There is no question that repeated treatments produce better results. Stacking two to four treatments several months apart will create the optimal facial rejuvenative effect.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Platelet Rich Plasma and Hydroxyapatite Granule Maxillary Defect Reconstruction

Saturday, August 22nd, 2015

 

Background: The nasopalatine cyst is a well known pathology of the maxilla that often presents as an asymptomatic anterior palatal swelling. It usually develops behind the maxillary incisors and is thought to be caused by the ductal tissue within the incisive canals. It appears radiographically as a round or heart-shaped mass in occlusal plane or 2D CT x-rays or as a very distinct round tumor in 3D CT facial scans. While benign it can cause significant bony erosion through its expansile growth.  By the time it appears as an anterior palatal swelling the amount of bony destruction is significant.

Treatment of the nasopalatine cyst is done through excision by raising a posteriorly based soft tissue flap. When removing the cyst lining from the palatine bony defect it is important to get all of the cystic lining up into the nasopalatine ducts to prevent recurrence. When the resultant bony defect is small no reconstruction is needed. But by the time a nasopalatine cyst is discovered the bony defect is large and ensuring bony fill is often needed to provide hard tissue support to the maxillary incisor teeth. While an autologous bone graft is ideal patients understandably would like to avoid a graft harvest.

Demineralized bone substitutes as well as hydroxyapatite synthetic grafts are appealing in the facial bony defect that has good vascularity and numerous walls to contain it. This may be enough for some patients but agents that can accelerate or magnify the bony response are appealing. One such healing is that of platelet-rich plasma.

Platelet-rich plasma (PRP) has been used in a wide variety of bony and soft tissue applications to expedite healing and tissue repair. As an extract of a patient’s blood, the platelet concentrate is known to contain powerful growth factors which are important participants in the wound healing process. PRP undoubtably has its greatest effect when it is combined with other natural tissue grafts such as bone and fat grafts. But it can also be useful with allogeneic and synthetic type grafts which have no cellular component and rely heavily on the body providing the proper healing milieu.

Nasopalatine Cyst x-ray Dr Barry Eppley IndianapolisCase Study: This 26 year-old female presented with a painless swelling of her anterior palate. It measured 3 x 3 cms. She had a prior history of dental trauma as a teenager that resulted in endodontic treatment (root canals) of her anterior incisor teeth. An occlusal radiograph showed an irregular radiolucent mass of the anterior palate. She did not want a bone graft harvested should it be needed.

PRP and HA granules mixture for nasopalatine defect reconstruction dr barry eppley indianapolisNasopalatine Defect Reconstruction with Platelet Rich Plasma and Hydroxyapatite Granules Dr Barry Eppley IndianapolisUnder general anesthesia the anterior palate was exposed by raising a soft tissue flap. The cystic mass and its lining were removed down to the apices of the roots of the teeth. This left a bony defect that partially exposed the palatal surfaces of the tooth roots. Reconstruction of the bony defect was done by a combination of hydroxyapatite granules and PRP. She went on to a completely healed wound with teeth retention and stability.

Hydroxyapatite granules is one of the oldest synthetic bone grafts that can still be successful to its inorganic calcium phosphate similarity to natural bone. When mixed with PRP the surrounding bony ingrowth into the material is accelerated ensuring a rapid and complete bony fill of the defect.

Conclusions:

  1. Nasopalatine cysts can develop from periapical abscesses/non-viable tissue from teeth that had previously undergone root canals.
  2. Excision of the complete nasopalatine cyst is necessary for a long-term cure without recurrence.
  3. PRP mixed with synthetic bone grafts can be successful reconstruction strategy for larger maxillary bony defects.

Dr. Barry Eppley

Indianapolis, Indiana

Platelet-Rich Plasma (PRP) Use In Facial Laser Resurfacing

Sunday, January 4th, 2015

 

Fractional Laser Resurfacing Face Dr Barry Eppley IndianapolisLaser resurfacing is a long-standing treatment that can have a profound rejuvenative effect on wrinkled and sun damaged facial skin. By burning off the top layer of skin and allowing it heal, a fresh skin surface is created with fewer surface imperfections.While effective, it is associated with a significant healing time, discomfort and  temporary facial redness. This has been improved by changing from a fully ablative laser treatment, which treats the entire skin surface, to a fractional approach.

Fractional laser resurfacing treats a portion or fraction of the skin surface’s  (usually 5% to 22%) but with deeper channels cut down into the thickness of the skin. This has the dual effect of shortening healing time due to less injured skin surface and causing greater collagen regeneration and tightening. But despite the advantages and reduced recovery time of the fractional laser, adjuvant treatments are still sought to reduce healing time and facilitate a faster recovery. One such treatment is that of platelet-rich plasma. (PRP)

Platelet Rich Plasma PRP Therapy Dr Barry Eppley IndianapolisPlatelet-rich plasma (PRP) has been used for many applications in various surgical fields for its ability to improve wound healing, hemostasis, and graft survival. It is a blood concentrate that is full of platelets. Platelets contain many different growth factors and cytokines in high concentrations which serve as the theoretical basis for the use of PRP in tissue repair. Studies are mixed as to its true effectiveness across a broad spectrum of applications. But the superficial nature of laser resurfaced skin seems like a good application for it.

In the Online First edition of the November/December 2014 issue of JAMA Facial Plastic Surgery, a study was pubished entitled ‘Evaluation of the Effect of Platelet-Rich Plasma on Recovery After Ablative Fractional Photothermolysis’. This was a blinded study using small human forearm test sites that were treated with fractional laser treatments at consistent depths in both arms. The treated sites were immediately treated with either topical PRP or saline. (control) Significant improvement was seen in PRP-treated arms compared to controls in all 15 treated patients. Improvement was defined as the erythema rating of the untreated arm minus the erythema rating of the PRP-treated arm. Patients noticed a reduction in the amount of redness, swelling, itching and pain in the PRP-treated sites.

These study results suggest that PRP can improve the healing rate of facial laser resurfacing sites. It presumably does so by creating a faster rate of skin cells growing across the injured skin surface through earlier induction of cell turnover. It is interesting that such positive results were seen with just one application immediately after the laser resurfacing. Given the reduced cost to acquire a single concentrate of PRP today, it should enjoy broader useage.

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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