Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘zerona’

The Distribution Of Abdominal Fat In Men And The Effectiveness of Non-Surgical And Surgical Fat Treatments

Wednesday, December 21st, 2011

There are several very popular non-surgical methods of fat reduction using external devices based on a variety of penetrating energies. One example is the Zerona device which uses a form of light known as a ‘cold laser’. While it is a fat reduction device that is associated with some level of controversy, it has generally been effective in my two practice locations over the past two years. By our own experience and post-treatment evaluations, we have an approximate 70% satisfaction rate.

However, this satisfaction rate is based on a patient population that is almost exclusively women. When asked by a husband of a patient that I was treating for another plastic surgery problem about how well the Zerona would work for him and his big belly, my answer was both hesitant and reserved. It was at this point that I launched into an explanation of the anatomy of abdominal fat.

Fat in the abdominal area is comprised of several very distinct anatomic locations or layers. When most people think of abdominal fat they are thinking of what exists in the subcutaneous layer, that fat that lies between the skin and the abdominal muscle wall. I would call this superficial abdominal fat. But deep to this on the other side of the abdominal muscles lies intra-abdominal or the deep fat. Technically, intra-abdominal fat is divided into either intraperitoneal and retroperitoneal sites. The more relevant intraperitoneal fat is distributed in the mesentery of the intestines and an abdominal organ known as the omentum. Depending on the size of the person, intra-abdominal fat can make up as much as 10% of one’s total body fat mass and high amounts of it are associated with increased risks of cardiovascular and metabolic diseases.

When men ask about methods to reduce the size of the stomachs, the issue of intraperitoneal fat becomes very relevant. In andromorphs, fat is commonly stored intraperitoneal. So men with a big ‘beer belly’ have a considerable amount of intraperitoneal fat and much less, by comparison, of fat in the superficial or subcutaneous layer. This can be felt by examination in how the belly feels to the touch. The big belly in a man will usually feel very firm and hard like a watermelon. This is the intraperitoneal fat underneath the muscle pushing the abdomen out and explains why it feels so firm. In contrast, women have a much higher percentage of their belly fat in the subcutaneous layer. This is why a woman’s big abdominal area will feel much softer and jelly-like. (although this is not true for every big-bellied woman)

So for most men, whether it is a non-surgical device or even liposuction, much of the target fat is too deeply located for them to be effective. This can led to disappointing results. An examination is needed of a man’s belly to determine if there is any significant thickness to the subcutaneous layer. If there is some softness and compressibility and a handful of skin and fat can be pulled off of the underlying muscle layer, then there is enough target fat that may justify non-surgical or surgical fat reduction treatment. Otherwise, only weight loss through diet and exercise will be effective.

Dr. Barry Eppley

Indianapolis, Indiana

Facts and Myths about Cellulite

Sunday, August 15th, 2010

If there is one body concern in plastic surgery that remains both ubiquitous in occurrence and refractory to treatment. is that of cellulite. So many women have it that the only comparable beauty affliction is that of stretch marks and wrinkles. Largely located on the thighs and buttocks, it interestingly affects almost no men. It is a true gender-biased concern.

Suffice it to say that there is no one definitive solution for the cellulite problem. The only thing we know for sure about it is its appearance can be lessened with weight loss and being very fit. Thin women tend to have less cellulite than those who are heavier.

But once one has it, it is basically impossible to get completely rid of it. The testament to its difficulty in treatment is the many topical products and even medical devices that purport to offer a solution to your cellulite concerns.

Because it is hard to treat, numerous fallacies and myths exist about cellulite. One of the most common is that it is composed of a different kind of fat. While its outer classic cottage cheese appearance on the skin may suggest otherwise, the fat in cellulite-afflicted areas is just plain fat. It is the surrounding fibrous bands that run between the underside of the skin to the deeper tissues that is the key anatomic difference. Like the quilted appearance of a spring mattress, the fat between these band is squeezed upward as the bands keep the skin where they attach pulled down. This is why it is important to keep one’s weight down if possible…increased fat deposits makes the appearance of cellulite worse.

Despite the many product and treatment claims, the myth (hope) of a cellulite cure persists. From massages and body wraps to topical creams and supplements, there are countless products promising to make your cellulite disappear. Quick fixes to cellulite are not reality. Surgical solutions have equally been unsatisfactory. While liposuction and the technique of pickling (a forked instrument that passes right under the skin) do disrupt the fibrous bands, the improvement in the appearance of cellulite is only short-term. The use of laser liposuction (Smartlipo), because of the heat generated in the fat along with fibrous band disruption, offers some theoretical improvement over traditional liposuction. Once can also use the small fiberoptic laser probe like a pickling instrument to disrupt the fibrous bands. I have see improvement in some of my Indianapolis liposuction patients but I certainly wouldn’t call it a cellulite cure.

The current use of the Zerona cold laser for body slimming says that it will also improve cellulite. But this treatment approach also employs intake of water, use of exercise, and oral supplements, all components of an active healthy lifestyle. Such a lifestyle combined with the inevitable weight loss which will occur makes the most sense in the battle against cellulite. Decreasing the fat between the bands and improving the lymphatic outflow of that same fat will improve its physical appearance.

Other medical devices employing external skin disruption and penetrating energies such as ultrasound, acoustic and infrared can also be of benefit. They have visible short-term improvement but they also require long-term maintenance treatments. Their adjunctive use  to lifestyle changes is a matter of a cost:benefit assessment. For the improvement seen are they worth the cost?

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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