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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘smart lipo’

Timing of Liposuction (Smartlipo) and Weight Loss

Saturday, August 8th, 2009

One of the common questions or concerns in patients considering liposuction (Smartlipo) is the timing of the surgery. Given one’s existing weight, and whatever plans one has for weight loss, at what point should one undergo liposuction?

 Ideally, and the opinion that is most widely espoused, is to wait until one has lost as much weight as possible. Once one has either hit or come close to a desired weight, liposuction can be done to remove those last stubborn areas. This approach certainly maximizes the effect of liposuction on body contouring and theoretically lessens the extent and duration of the procedure. Placing liposuction at the end of the body morphing process following a regimented diet and exercise program likely leads to a more long lasting result. While no long-term clinical studies have ever evaluated the validity of that weight loss and body contouring sequence, it seems logical that using liposuction as a reward for a significant lifestyle change would be better sustained.

The reverse approach, however, is not unreasonable in select patients. There are certainly some patients who, purportedly with good effort, simply can not lose significant weight. They have managed to lose some but then they ‘hit the wall’. They simply can not go down in weight further. These patients have hit, what I call in my Indianapolis plastic surgery practice, their lifestyle weight.

This does not mean that it is not possible that they can not lose more weight. It is just that given their habits (i.e., lifestyle), this is the amount of weight that they are willing to lose. They have reached their physiologic weight given their intake vs output ratio. Liposuction in this scenario can serve as a jumpstart toward more weight loss as well as have a body contouring effect. This occurs from the combination of the fat that is removed surgically and the subsequent catabolic effect that occurs from the energy used for healing and recovery. Seeing these bodily changes in a short period of time may serve as a stimulus to seek greater lifestyle changes and, at the least, work to preserving their financial and physical investment. This approach does not produce as a significant body change initially and is likely more prone to relapse and regain of weight.

The timing of liposuction (Smartlipo) and the state of one’s weight is not etched in stone. Numerous factors must be considered to determine the best approach for each individual.  

Dr. Barry Eppley
Indianapolis, Indiana


Severe Cellulite Treatment with Laser and Fat Injections

Monday, March 9th, 2009

The search for an effective treatment for cellulite is ongoing and is far from reaching a consistent solution. Various methods of treating cellulite have been espoused including liposuction, fat injections, endermologie and other mechanical disruption methods, injection lipolysis, subcutaneous carbon dioxide infusions,  herbal and dietary supplements, and numerous creams and lotions. While some of these do have a mild beneficial effect, none work consistently or have scientific data supporting their long-term efficacy. Some of these treatments, such as liposuction, can even make cellulite appear worse.

Cellulite is caused by bands of fibrous tissue that connect the skin down to the muscle from the skin. Because the bands are tight, the fat between the skin and the muscle bulges out between them creating dimpling around each band. Women are much more predisposed to cellulite due to genetic predisposition, hormonal changes and weight gain although some men can get it too.

A new study published in the November/December 2008 issue of Aesthetic Surgery Journal shows that a combination treatment of laser energy and fat injections improves cellulite. The treatment uses a 1064-nm Nd:YAG laser passed underneath the skin to help melt fat and tighten the overlying skin. The laser treatment is followed by spot injections of the patient’s own fat into the depressed cellulite dimples. In the study, 52 women between the ages of 18 to 47 with severe cellulite were treated. After the laser tightening and fat injections, the women had weekly massage therapy treatments to help evenly distribute the fat. Patients were followed for at least one year or longer and nearly 85% of the patients rated their results as good or excellent.

While this studied treatment was not non-invasive (it was actually surgery), it does appear to offer some real effectiveness in cases of severe cellulite. I am not surprised that this approach worked as it disrupts the contracting bands from the heat of the laser probe (e.g. smart lipo) and adds select areas of fat to fill in the dimples. The postoperative massage  therapy helps smooth out the injected fat which may help the cellulite from reforming. For milder cases of cellulite, which makes up many cellulite problems, this approach is not appropriate and is too invasive. Milder cases of cellulite must rely on non-invasive external treatment methods of which none have shown significant effectiveness.

Dr. Barry Eppley

Indianapolis, Indiana

Getting Rid Of Fat – Liposuction vs. Lipodissolve

Friday, July 4th, 2008

Even though we are in the middle of the summer (or maybe because we are), you may have decided to get serious about getting rid of those unsightly fat areas that diet and exercise just won’t. But with different methods of fat removal available, which one is right for you? It may be tempting to think that a non-surgical method such as LipoDissolve which offers low cost and no recovery time is best, but let’s examine the facts first.
Traditional liposuction is still the gold standard to which all other methods of fat removal must be compared. Done through small incisions near where the fat is to be removed, a small thin hollow tube (cannula, about the width of a pencil or less)) is placed underand the dislodg the skin. By moving the cannula back and forth, fat is dislodged and the vacuum to which the cannula is attached removes the loose fat. This is the preferred method among board certified plastic surgeons for removing larger amounts of fat tissue and has been used in the United States for almost thirty years.All liposuction today is done with the tumescent or wet technique which keeps blood loss to only about 1% of the total fat removed. Liposuctioned fat volumes removed today are kept around five or six liters in a single operation to keep the risk of complications low. Serious side effects with liposuction are very rare. The most common problem with liposuction is skin irregularities but this problem is kept limited when done by skilled and experienced hands. Very good results can be obtained in the neck, stomach, waistline, outer thighs, and knees. More modest results are seen in the arms, back, inner thighs, and buttocks.
Liposuction done with the aid of a laser, also known as Smart Lipo, is one of the newer FDA-approved types of liposuction. A laser is inserted through tiny incisions in the skin. When the laser is fired, it melts the fat purportably tightening the skin at the same time. Smart Lipo has not been proven to produce better results than traditional liposuction but may be an alternative for removing smaller fat areas. This is certainly the way it is currently being sold, particularly to non-plastic surgeons which make up a significant percent of the targeted market. Because the removed fat volume is more limited, serious side effects are unlikely. The real question in my mind is whether Smart Lipo can help perform smaller liposuction procedures under local anesthesia in the office setting. This is where it would offer an advantage over traditional liposuction.
Lipodissolve, also known as injection lipolysis, uses a mixture of emulsifying chemicals (lecithin and cholic acid) which are injected under the skin to the targeted fat areas. This is a non-FDA approved treatment method although in my experience has proven to be safe. I have not seen any of the complications that are widely reported. Lipodissolve is certainly not a replacement or alternative to liposuction. It is best viewed as a fat removal technique when any form of liposuction is a bigger solution than the problem justifies. It is done as a series of injection done in the office over three or four months.I have found that it works well for small fat areas in the neck, jowls, bra rolls, stomach, flanks, thighs, and knees. The emphasis here is on the concept of small fat area, generally no bigger than the size of my hand. The biggest issue with LipoDissolve is whether the results, and time to get them, justify the cost. It is also a great method to touch-up any excess areas of fat after a liposuction procedure. As an Indianapolis liposuction surgeon, I find the role of LipoDissolve useful but it is not a replacement to liposuction surgery but an occasional adjunct to it.
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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