This topic is about managing skin dips and appliance leaks around a permanent ostomy. The person sharing their experience has had a permanent ostomy since 2015 and is dealing with leaks under the barrier ring due to a dip in the skin next to the stoma. They are looking for ways to build up this area to extend the wear time of their appliance. Here are some helpful tips and insights shared by others:

1. Coloplast Solutions:
- Using a Sensura Mio Convex 2-piece wafer with Coloplast alcohol-free Brava paste around the wafer opening, and warming the wafer with a hair-dryer, can provide up to a week of wear even with mild skin dips.
- Light convex wafers from Coloplast may help stop leaks when dips are shallow. Combining convexity with a ring often works better than using paste alone.

2. Building the Dip with Rings or Seals:
- Cut an Eakin Seal or any barrier ring and place a piece directly in the depression, then apply the full ring on top before the wafer.
- Stacking two pieces of Eakin Seal can provide extra build-up if needed.
- Molding a half Convatec Slim Seal onto the flange where the dip is located can offer four leak-free days.
- A Hollister Adapt Convex barrier ring alone can fill uneven areas without needing extra strips, simplifying emergency changes.
- Safe ’n Simple flat barrier rings and Brava moldable rings are also effective in convex set-ups.
- Fortis Medical Products’ barrier ring is noted for slower breakdown and may last longer than other brands.

3. Paste vs. Rings:
- Many prefer rings because paste can be messier and less stable. Some apply Coloplast Brava paste only around the wafer hole for minor dips.

4. Extra Reinforcement Techniques:
- Warm rings or seals in your hand first, press firmly around the stoma opening, then sit for 15 minutes to ensure adherence.
- Adding cut Eakin strips along the wafer edges that crease when bending can extend wear up to a week.

5. Position & Lifestyle Tips:
- Side-sleeping or frequent bending often erodes one edge of the wafer. Reinforcing that side with ring strips helps.
- Wearing briefs with mild compression keeps the pouch flatter and adds outward pressure to minimize seepage.
- Leaving a little air in the pouch reduces pancaking, helping output drop away from the stoma and decreasing leaks.

6. Output Consistency:
- For watery output, sachets like Pearls or Absorbagel can thicken effluent and reduce the chance of seepage.

7. Two-Piece Security:
- Members report that in active lifestyles, a Sensura Mio 2-piece pouch has never detached from its wafer.