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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘xiaflex’

An Injectable Approach for Cellulite

Monday, April 22nd, 2013


The sheer number of cellulite therapies that have appeared over the years is a testament to two basic issues. First, cellulite is a difficult aesthetic problem that defies one single effective treatment. While Cellulazae and Cellusmooth are two new laser treatments, they are invasive. Otherwise, topical treatments of either creams or energy-based devices have dominated the non-surgical approaches before them. Secondly, short of the more recent laser treatments none of them have worked extremely well or have had any sustained results.

But an intermediate approach between an external non-invasive and an internal invasive cellulite treatment is on the horizon. An injectable drug that has been used for the treatment of Duputryn’s contracture, Xiaflex, is in FDA-approved phase II clinical trials for cellulite treatment. Known as CCH for clostridial collagenase histolyticun, it is an injectable form of the enzyme collagenase. The mechanism of action is that the injections break down the collagen bands that pull down on the skin creating the classic dimpled and irregular skin appearance.

The initial phase I pilot study with the cellulite injections were done on 10 women on the back of their thighs. The average reduction in the appearance of cellulite was 77% and was seen as early as the next day after injection. After six months, these same patients had a lasting 76% reduction in their cellulite. The injections were initially associated with temporary bruising, mild discomfort and swelling…as would be expected based on the experience of using it in the release of Duputryn’s contractures and its mechanism of action. This study served as evidence of its safety and effectiveness in the treatment of cellulite and allowed the aforementioned phase II clinical trial to be initiated.

While it is going to be a few years before this injectable approach for the treatment of cellulite will be commercially available, it will likely fall into the current array of injectable aesthetic therapies like Botox, fillers and sclerotherapy.

Dr. Barry Eppley

Indianapolis, Indiana

Xiaflex Injections for Duputryen’s Finger Contractures

Tuesday, June 1st, 2010

Dupuytren’s contracture is a hand deformity that is most peculiar. No one knows what causes it or why it develops exactly. Dupuytren’s contracture affects the connective tissue under the skin of the palm of your hand, forming knots of tissue under the skin. It develops slowly and insidiously over years, eventually forming a thick cord that pulls one or more of your fingers into a bent position. It usually affects the ring finger and pinky and occurs most commonly in older men of Northern European descent. Once this occurs, the fingers affected by Dupuytren’s contracture can’t be straightened completely. This seems like an innocent problem but it makes everyday activities such as putting your hands in your pockets, putting on gloves or even shaking hands difficult.

A number of treatments are available to relieve the finger contractures of Dupuytren’s.  Surgery is the most commonly used. This requires incisions and cutting out of the contarcted cords so the flexor of the finger can go to full extension. While this is initially very successful, the recurrence rate is significant and recurrent cord formation is not uncommon.

An injection method for the non-surgical treatment of Duputryen’s contracture was approved by the FDA earlier this year. Xiaflex, manufactured by the Auxilium company, has been shown to release the contracted cords of Duputryen’s within a day after injection. Xiaflex is a collagenase enzyme derived from the clostridium histolyticum bacteria. It breaks down scar tissue in a rapid and aggressive fashion.

In my Indianapolis plastic surgery practice, I do not perform hand surgery and have not done so since my plastic surgery training a long time ago. I was unaware of Xiaflex until a relative of mine asked me to do the injections for him. He had a Duputryen’s contracture of his ring finger on his left hand which started five years ago. After receiving injection training from the manufacturer, I performed the 0.25ml injection with a 27 gauge needle along the cord in the palm. It was only mildly uncomfortable for him. He had some mild discomfort and soreness within the hour as well as some swelling over the injection site. When he came back the next day for the planned release (popping of the finger out to full extension), he already had a near complete release which happened on its own. He told me that it had started to release and get more loose that very night. I easily completed the finger release and put him in a splint that he is to wear at night for the next month. He can continue to stretch the finger out several times a day, an at-home physical therapy program if you will.

While I am not a hand surgery expert, I do not know from my plastic surgery training that Duputryen’s contracture is a difficult problem. Surgical release is associated with a high recurrence rate and the hand is disabled during the recovery period. Xiaflex, in my single case experience, was very effective with minimal recovery and immediate initiation of physical therapy.

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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