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Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

November 26th, 2014

Technical Strategies in Plastic Surgery – Cartilage Spreader Grafts in Primary Rhinoplasty

 

The middle third of the nose is usually viewed as a mere bridge between the top of the nose and the tip. But it actually has a very significant functional purpose as what lies beneath it and is created by it is the internal nasal valves. Formed by the junction of the septum and the inner edge of the upper lateral cartilages, this creates the most constrictive part of the internal nasal airway for breathing. These conjoined cartilages also create the appearance of the nasal dorsum in this area known as the middle vault.

Airway Preserving Rhinoplasty Dr Barry Eppley Indianapolis front viewAirway Preserving Rhinoplasty Dr Barry Eppley side viewTreatment of a collapsed middle vault and/or collapsed nasal valves is well known to be done by spreader cartilage grafts. Spreader grafts have their history in treating an overdone rhinoplasty where too much dorsal line cartilage has been removed and the middle vault is pinched, creating a classic inverted V deformity and difficulty breathing through pinched internal nasal valves. Its use over the years has been expanded to be part of many primary rhinoplasties to correct a crooked dorsal septum that deviates to one side and help to create an overall straighter nose.

In addition to improving breathing, integrity of the internal nasal valves influences the outer contour of the middle vault. How the upper lateral cartilages articulate with the dorsal septum plays a central role in the brow to tip aesthetic lines. (dorsal aesthetic lines)  Too much narrowing in the middle vault will produce an inward deviation to what would be an otherwise straight line resulting in an unaesthetic ‘hourglass’ or inverted V shape.

Spreader grafts are usually harvested from the septum, being  just 1 to 2mms thick (wide) and up to 25mms long. As long as one has a good septum from which to harvest the spreader grafts, one’s own cartilage is always the best. But lack of good straight cartilage pieces may lead one to opt for synthetic materials, such as PDS, from which the fabrication of spreader graft shape and dimensions is easy and assured. While the synthetic material may resorb, it is replaced by scar tissue which may still serve a space-maintaining role long-term.

Dr. Barry Eppley

Indianapolis, Indiana

November 24th, 2014

Plastic Surgery Case Study: Combined Tummy Tuck and Brazilian Butt Lift

 

Background: Two of the most popular body contouring procedures today is one from the past and a relatively new one. Tummy tuck surgery has been around for over five decades and is highly successful at reshaping the abdominal wall often in a dramatic fashion. Conversely, buttock augmentation by fat injections (aka Brazilian Butt Lift) has been available now for only a decade and is the fastest growing body contouring procedure in total number done being done compared to just five years ago.

Brazilian Butt Lift Reshaping Garment Dr Barry EppleyWhile a tummy tuck works by removing and discarding unwanted tissues, a Brazilian Butt Lift works by recycling/redistributing them. Fat removal by liposuction is part of many tummy tucks to help extend its contouring effects around the waistline and is an additive ‘bonus’ to the procedure. Conversely, fat harvest by liposuction is an essential part of a Brazilian Butt Lift and the more fat that can be harvested the better the buttock augmentation result will be.

It is not uncommon that the desire for abdominal reshaping and buttock augmentation exist in the same patient. The first question is whether a tummy tuck and buttock augmentation can be safely done at the same time. Depending upon the magnitude of the liposuction harvest and the extent of the tummy tuck, the answer would be yes if neither one was particularly extensive.

The other question is whether any part of the excised portion of the tummy tuck can be used for the buttock augmentation. This is a debate between aggressively harvesting fat from under the tummy tuck prior to its excision or using the tummy tuck discard as a dermal-fat graft ‘autoimplant’ in the buttocks.  The vast majority of plastic surgeons today would use liposuction to harvest fat at the same time as the tummy tuck. There are growing numbers of reports in which the tummy tuck segment is being recycled and used like a buttock implant.

Case Study: This 30 year-old female wanted to have a tummy tuck to reshape her abdominal waistline as well as a buttock augmentation at the same time. It was agreed that she did not really have an optimal amount of fat to harvest to achieve a substantially larger buttocks. But she wanted to take any fat that could be harvested and place it into the buttocks as a ‘bonus’ to the procedure.

Tummy Tuck and Brazilian Butt Lift result front view Dr Barry Eppley IndianapolisUnder general anesthesia, liposuction was initally done very aggressively under the tummy tuck portion which was to be removed. Liposuction was also done around the waistline and into the flank areas to harvest as much fat as possible. The tummy tuck procedure was then completed. The harvested fat was processed and concentrated, obtaining a total volume of 480cc. Each buttock was injected with 240cc in a cross tunneling fashion.

Tummy Tuck and Brazilian Butt Lift result back view Dr Barry Eppley IndianapolisTummy Tuck and Brazilian Butt Lift result side view Dr Barry Eppley IndianapolisHer recovery was typical for a tummy tuck and the buttock augmentation do not prolong it. At three months afterwards, she showed marked improvement in her abdominal contour and mild enhancement of her buttock size. While the increase in her buttock size was not substantial (nor was it expected), its effect was greater due to reshaping of the waistline above both buttocks.

Some buttock augmentation procedures are done as a ‘bonus’ to other body contouring efforts. While the amount of fat that is often obtained by liposuction may be inadequate to justify a ‘stand alone’ Brazilian Butt Lift, some patients may want the fat used for the buttocks with the attitude that it can not hurt and anything they get is more than they currently have.

Case Highlights:

1) Combining a tummy tuck with a Brazilian Butt Lift is not uncommon and can safely be performed together.

2) The planned excisional portion of the tummy tuck can be aggressively liposuctioned as  part of the donor fat for the Brazilian Butt Lift.

3) Like all Brazilian Butt Lifts, the result is a combination of how much fat can be harvested and how much fat survives.

Dr. Barry Eppley

Indianapolis, Indiana

November 23rd, 2014

Plastic Surgery Case Study: Natural Breast Augmentation with Shaped Implants

 

Background: Breast augmentation is an operation whose effect is completely derived from the use of an implant. The push of the implant on the overlying breast tissue creates the size and to some degree the shape of the breast that results. While a women’s natural breast tissues do play a role in how the augmented breast will look, that contribution depends on the quantity and quality of these tissues.

Breast implants, whether they be saline or silicone, have historically been semi-round in shape. This seems logical since the breast can be perceived as somewhat of an oval shape. In addition, as the implant moves around in the breast pocket it is important that it keeps the same shape to prevent an external breast deformity.

While round breast implants work for the majority of women, there are some women who do not like the look they create. Specifically they prefer a resultant breast shape that has less upper pole fullness. They feel that too much fullness in the upper pole looks unnatural and produces an obvious ‘augmented’ look. This concern is more commonly seen in ‘older’ women, particularly greater than 40 years of age. Many younger breast augmentation patients actually prefer the rounder breast look and do not mind looking like they have implants.

Shaped Breast Implants Dr Barry Eppley IndianapolisThe introduction of the shaped breast implant offers an option for the woman who wants the most natural looking breast augmentation result. Going by a variety of names, such as anatomic, tear drop or shaped breast implant, these newer breast implant styles are differentiated from their round counterparts by one side of the implant being fuller than the other. With two-thirds of the implant volume being in the larger lower part of the implant, less upper pole fullness is assured.

Case Study: This 40 year-old female wanted to restore her breast size that was lost after having children. Her biggest fear about getting breast implants was that she would look unnatural and look like she had obvious breast implants. For these reasons she was attracted to the shaped breast implant style.

Textured Shaped Silicone Breast Augmentation result front view Dr Barry Eppley IndianapolisUnder general anesthesia, 3.5 cm skin incisions was made 1 cm below her existing inframammary folds. Using Sientra shaped textured silicone gel breast implants of 330cc size, they were inserted using a no-touch technique with a funnel in the dual plane position.

Textured Shaped Silicone Breast Augmentation result oblique view Dr Barry Eppley IndianapolisTextured Shaped Silicone Breast Augmentation result side view Dr Barry Eppley IndianapolisHer recovery was very rapid and by three weeks after surgery she had returned to all physical activities. Even at this early point after surgery, she never developed any significant upper pole fullness even with the typical swelling that occurs after breast augmentation.

Shaped silicone breast implants offer a more natural breast augmentation result for those women that view a tear drop breast shape as desireable. Shaped implants will feel a bit more firm than smooth silicone implants and will be fairly fixed to their position on the chest wall. These features are due to the textured surface of the implant.

Case Highlights:

1) The use of shaped or tear drop implants for elective breast augmentation is to prevent an overly round or unnatural look.

2) Shaped breast implants have a textured surface to prevent implant rotation in the pocket and must be placed through an inframammary approach.

3) The placement of shaped breast implants must be precise as there will be little settling afterwards.

Dr. Barry Eppley

Indianapolis, Indiana

November 23rd, 2014

Old Age and Wound Healing in Plastic Surgery

 

Older Plastic Surgery and Wound Healing Dr Barry Eppley IndianapolisPlastic surgery today is done literally from head to toe and from the ages of soon after birth to octogenarians. Like never before older patients are undergoing non-surgical and surgical procedures for face and even body enhancements. When a plastic surgeon or a patient is considering surgery in these ‘advanced’ years it would seem logical that the basic success of any surgery, the ability to heal, may be decreased or even impaired. While this may seem to be true, since all bodily functions are known to slow down with age, there are no scientific studies that validate that supposition.

In the November 2014 issue of the journal of Plastic and Reconstructive Surgery, a study was published as ‘Wound Healing in Plastic Surgery: Does Age Matter? An ACS NSQIP Study.’  Using the American College of Surgeon’s NSQIP database, over 25,000 patient records were retrospectively analyzed using a wide variety of parameters from patient age, comorbidities, drug and tobacco use to wound healing problems including infection. Multivariate statistical analysis was done to see how age influenced the development of wound complications such as dehiscence.

There was an overall incidence of surgical wound dehiscence that was under 1%. No differences were found in these wound dehiscence patients when comparing the number of them under 30 years  vs those over 60 or 70 years old. There were relevant factors that did affect wound complication and they were well known and expected ones like steroid and tobacco use and being overweight. The authors conclude that n patients undergoing plastic surgery, wound dehiscence is an uncommon complications. Aging was not shown to be associated with increased rate of wound dehiscences.

Wile this study provides retrospective data that age does not affect wound healing in an easily identifiable rate, and I think that is largely true, there are equally if not more relevant questions for older plastic surgery patients. Their overall general health, medications that may be on and the type and length of the plastic surgery procedures must be considered carefully. This is where the older patient really differs from the younger ones. Because of excellent health and the amazing ability of the human body to heal, plastic surgery in younger patients can be more ‘aggressive’ and extensive with still relatively low rates of medical and wound problems. Such an approach in older patients, however, will get both surgeon and patient in trouble. This is why most plastic surgery in older patients is disproportionately focused on the face where the traumatized surface area remains small even if it extremely valuable ‘real estate’.

Dr. Barry Eppley

Indianapolis, Indiana

November 19th, 2014

Technical Strategies in Plastic Surgery – Muscle Resuspension in Vertical Chin Reduction

 

While a short chin is both common and easily treated by an implant or bony in most cases, the long or big chin is a much more challenging aesthetic issue. The tissue excess over the front end of the lower jaw makes its reduction fraught with problems of redundancy and potential tissue sag. Where does all the soft tissue go if the bone that is supporting it is reduced or removed?

It is these soft tissue considerations that make an intraoral approach for chin reduction usually problematic. While a pure vertical reduction can be done by a wedge removal bony genioplasty from an intraoral approach, burring reduction or reverse sliding genioplasties ‘create’ soft tissue excesses or tissue sagging. These ‘new’ soft tissue problems will mar any aesthetic change that the bone reduction has accomplished.

A submental approach to chin reduction offers dual management of bone and soft tissue excesses. Through an incision under the chin, the soft tissues are initially freed off of the bone. The chin bone can then be reduced in any dimension whether it is vertical, width or horizontal projection. Once the bone is reduced, the amount of soft tissue excess becomes apparent.

Submental Vertical Chin Reduction Dr Barry EppleyThere are two types of soft tissues excesses created by a submental chin reduction. The first is the amount of skin, muscle and fat over the chin prominence that is removed by a submental excision and tuck. The second, which is most manifest in a vertical chin reduction, is the loss of the mandibular attachments to the infrahyoid musculature. If not resuspended there will be a resultant submental fullness due to muscle retraction.

Muscle Resuspension in Submental Chin Reduction Dr Barry Eppley IndianapolisResuspension of the released anterior strap muscles is done through bone holes placed through the new lower edge of the chin bone. Reattaching this muscle helps tighten the submental area so that its contour fits better to the reduced chin without an abnormal bulge in the submental soft tissue triangle.

Dr. Barry Eppley

Indianapolis, Indiana

November 17th, 2014

Plastic Surgery Case Study: Calf Implants for Inner Lower Leg Reshaping

 

Background: One of the majn features of the lower leg is that of the calfs. The size of the calfs is due to its muscles which contribute to the shape of the leg below the knee. If they are well developed, the leg is seen as very muscular and athletic. If they are underdeveloped and very thin one can be perceived as having skinny or ‘chicken’ legs.

Gastrocnemius Muscle Augmentation by Calf Implants Dr Barry Eppley IndianapolisThe calf region is composed of the gastrocnemius muscles. It gets its name from being called the ‘stomach of the leg’ as it causes a bulge in the back part of the lower leg. It has two separate muscle bellies being a bipennate muscle known as the inner and outer heads of the gastrocnemius muscle. If one includes the deeper soleus muscle, they are a large combined superficial muscle that runs down from the knee and attaches to the heel bone through the achilles tendon.

While calf muscles can be developed through exercise alone, it can be difficult due to the tight and small muscle fibers which comprise it. Even if one can develop significant gastrocnemius muscle enlargement by fiber hypertrophy, it is not sustainable without continued weight training. In addition, some people with little calf muscle mass do not want to undergo an exercise program to try and enlarge them.

Case Study: This 40 year-old male wanted to improve the shape of his skinny lower legs. He felt he had ‘chicken legs’ and stated he was often referred to as such. He was not an exercise enthusiast and wanted calf implants. The question was whether to augment both heads of the calf muscles or just the inner head. He elected to have a single implant per leg to improve the inner leg bulge.

Calf Implant Surgical technique Dr Barry Eppley IndianapolisUnder general anesthesia in the prone position, a 3cm skin incision was made along the inner half of the popliteal skin crease. The fascia was identified and an incision made through it below the skin incision in a stair-step fashion. A long and blunt dissecting instrument was used to make a subfascial pocket over the medial gastrocnemius muscles.  Medium sized solid silicone calf implants was inserted into the subfascial pockets. The fascia and skin were closed in separate layers. An ace wrap was applied as the dressing.

Calf Implants result front view Dr Barry Eppley IndianapolisCalf Implants result back view Dr Barry Eppley IndianapolisHis recovery took a full three weeks before he could return to all activities including any form of exercise. (walking any distance and running) His legs showed greater muscle definition in the inner halfs which was particularly seen when the calf muscle was flexed (raising up on the toes)

Calf Implant results toes raised Dr Barry Eppley IndianapolisCalf implants are a very effective form of lower leg reshaping/augmentation. The inner calf bulge can be augmented by a single pair of implants while the entire calf can be circumferentially augmented by four total implants for both heads of the gastrocnemius muscles.

Case Highlights:

1) Soft silicone elastomer calf implants can create a permanent cosmetic enhancement of the gactrocnemius muscle.

2) The proper placement for a calf implant is under the fascia but on top of the muscle.

3) When placed bilaterally over the medial heads of the gastrocnemius muscles, a more shapely inner lower leg shape is obtained.

Dr. Barry Eppley

Indianapolis, Indiana

November 16th, 2014

Implant Options for Deep Glabellar Wrinkles/Furrows

 

The most common cosmetic treatment of the glabellar region is that of Botox injections. By decreasing the effects of the procerus and corrugator muscles, the creation of vertical glabellar wrinkles or furrows is diminished. But Botox only treats dynamic dynamic wrinkling and will not change static wrinkles which represent the long term effects of unrestrained dynamic glabellar muscle action.

For static glabellar wrinkles/furrows, this is where the role of injectable fillers comes into play. But very deep furrows, which are more of an inverted V shape, respond poorly to the push of injectable fillers because of their contracted indented nature. There is also the risk, albeit rare, of the risk of blindness that has been associated with the use of fillers in this area. An alternative treatment option is that of an implant.

In the December 2014 issue of the Annals of Plastic Surgery, an article was published entitled ‘Correction of Deep Static Glabellar Lines With Acellular Dermal Matrix Insertion’. In this paper the authors inserted a strip of acellular dermal matrix (ADM) underneath deep glabellar wrinkle lines. Over a three year period, thirty patients were implanted and then evaluated using the Lemperle scale for wrinkle depth assessment as well as patient questionnaires. No infections or material complications were seen. They reported that the improvement in the reduction of the depth of the glabellar furrow was sustained for a long time. This clinical study shows that this type of glabellar implant is simple and easy to do as well as effective. For deep glabellar furrows that do not correct well with an injectable filler, implant insertion is another treatment option.

Glabellar Implants Dr Barry Eppley IndianapolisThere is no question that deep glabellar furrows treated with an injectable filler can be disappointing. I have tried over the years a variety of allogeneic, autogenous and alloplastic implants into the deep glabellar furrow. The use of human (e.g., Alloderm) or even animal-derived (e.g. Permacol) materials offer an easy approach since they have easy availability by just opening the package. Fat, particularly a small dermal-fat graft, can also be effectively used but does require a graft harvest site. Synthetic materials can also be used, having placed Advanta (Gore-tex) tube in the past and more recently soft silicone tubes. (Permalip)

Because the glabellar furrow is a straight line and short, it is easy to thread almost any material into it. Whether any of the mentioned materials is better than another can be debated but all offer some degree of sustained improvement in the deep and problematic glabellar furrow.

Dr. Barry Eppley

Indianapolis, Indiana

November 15th, 2014

Technical Strategies in Plastic Surgery – Dermal-Fascial Suturing in Lower Buttock Lifts

 

There are numerous strategies to improving the shape of the buttocks of which the most popular is the Brazilian Butt Lift. (BBL) While this buttock augmentation method is called a lift, it really does not lift the buttocks at all.  It fills out the buttocks to make it bigger or more round but is not a formal buttock lift per se.

Prior to the current craze of BBL surgeries was the era of a true buttock lift procedure. Such procedures were excisional in nature, requiring the sagging buttock tissue to be removed and the remaining tissues tucked in its place. While many lifts are perceived as being pulled up, a buttock lift is really done on the bottom side of the buttocks for a tissue overhang or ptosis. Its goal is to create a more defined infragluteal crease with no tissue overhang. The most common reason women request this procedure is because they want to get rid of buttock tissues that hangs out of a swimsuit or underwear. (an overextended infragluteal fold)

Lower Buttock Lift technique side view Dr Barry Eppley Indianapolis Lower Buttock Lift technique back view Dr Barry Eppley IndianapolisPrecise markings are done before surgery to define the new location of the fold and to prevent its lateral extent from going to far to the side lest it become visible after surgery. The amount of tissue to be excised is done by creating a fold of the lower buttock tissue to the level and shape desired and then mark the upper and lower edges of it. A crescent pattern is then marked. During surgery, the crescent-shaped zone is excised and the skin edges anchored to the gluteal fascia to create a more defined infragluteal crease.

Lower Buttock Lift Excisions back view Dr Barry Eppley IndianapolisIt is important to remove full thickness skin and fat in the lower buttock lift rather than simply de-epitheliazing the skin and folding it together for a higher gluteal fold  position. This effectively gets rid of the tissue overhang to allows for a better fold shape.

Dr. Barry Eppley

Indianapolis, Indiana

November 14th, 2014

Plastic Surgery Case Study: Female Teenage Rhinoplasty

 

Background: With its central position on the face, it is no surprise that the nose is often a major focus of a teen’s attention. The constant exposure to social media, a developing self-image and peer pressure to be attractive and popular can have a teen preoccupied with their appearance. The nose can often become a focus of this attention as a flaw that ‘needs’ to be corrected. Thus many teens turn to rhinoplasty to improve the shape of their nose. This is validated as numerous plastic surgery societies rate the number one cosmetic procedure among teens is that of rhinoplasty.

The most common reasons that teens decide to undergo rhinoplasty are varied. These can include a bump on the bridge of the nose, reshaping the tip of the nose, straightening a crooked nose, or improving breathing through the nose. Often times the overall goal is to make a nose a smaller and more proportionate to their face.

Teen Rhinoplasty Dr Barry Eppley Indianapolis copyIn teen rhinoplasty the question is often at what age can the surgery be done. How soon is too soon? Historically rhinoplasty was not thought to be done before most of facial growth was complete. This would be the age of 14 or 15 for girls and 16 for boys. However there is no compelling medical evidence that manipulating the nasal bones or external nasal cartilages earlier has an adverse effect on their growth. While septal cartilage has a significant influence on nasal development, there is little need for surgical resection of the septum before the teen years.

When it comes to the influence of age on rhinoplasty, there are no absolute rules and each patient should be evaluated individually. An equally important issue is that of a teen’s emotional maturity and whether they have realistic expectations of the result and the recovery involved after the procedure.

Case Study: This 13 year-old teen female did not like the shape of her nose. She was bothered by the large bump on the bridge and the tip which was broad and not defined. She wanted to have it reshaped even though she was very young. Her mother was supportive of her desire for an early teenage rhinoplasty surgery.

Under general anesthesia, an open rhinoplasty was performed. The dorsal hump was reduced and osteotomies done to close the small open roof. The tip cartilages were reduced in size, narrowed and rotated slightly upward. Her results at one year after surgery showed a better nasal shape and proportions.

Teen rhinoplasty can be safely performed early after puberty. The key qualifications are realistic expectations and parental consent/support. The bone and cartilages of the nose are not adversely affected by surgical manipulation even if they are yet not completely grown. Extensive septal work or resection should be minimized in the still growing nose.

Case Highlights:

1) Teenage rhinoplasty can be very effective at improving the shape of a nose and the teens concern about it.

2) The timing of teen rhinoplasty is influenced by their age, degree of nasal deformity, having realistic expectations and parental support.

3) In the right teen, very early rhinoplasty can be safely done.

Dr. Barry Eppley

Indianapolis, Indiana

November 9th, 2014

Plastic Surgery’s Did You Know? Gummy Bear Breast Implants

 

Gummy Bear Breast Augmentation Dr Barry Eppley IndianapolisJust about anyone considering silicone breast implants has heard the term ‘gummy bear’ breast implants. Some women even come in requesting this specific ‘type’ of breast implant. Besides the catchy name, what is the appeal of it?

Gummy bear implants are made of a highly cohesive silicone gel which does not act like a liquid. Rather it acts like a soft solid…just like the gummy bear candy. Compared with the previous types of liquid silicone gel implants, the silicone particles in the gummy bear implants are highly cross-linked so the gel is held more closely together. This creates a breast implant that has a more natural feel. It also creates a breast implant that when cut in half, the gel stays put. (as demonstrated in the video) This eliminates any concern about what happens when the implant shell ruptures which will inevitably occur in some patients over their lifetime. There would be no errant gel getting loose and running amuck in or beyond the breast implant pocket.

What most don’t realize is that today all silicone breast implants are of the gummy bear variety. The breast implant term, ‘gummy bear’, is really an urban and not a manufacturer’s term. While at one time unique to one specific manufacturer, all breast implant manufacturer’s have them.Three gummy bear implants are approved by the Food and Drug Administration (FDA) for use in the United States: Sientra’s Silimed implants, Allergan’s Natrelle 410 breast implant and Mentor’s MemoryShape™ Breast Implants, formerly known as the contour profile gel (CPG).

The only downside to a gummy bear breast implant is that its stiffer feel may necessitate a larger incision in which to insert it through. But this concern is overcome by the use of an insertion funnel which allows even large implants to be put in through relatively small incisions.

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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