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Archive for the ‘otoplasty’ Category

Otoplasty as Prevention for Bullying

Wednesday, June 27th, 2012

One of the historic physical features that commonly leads to teasing and ridicule is that of the ears that stick out too far. Known as ‘dumbo’. ‘elephant ears’ and other equally unflattering names, ears that project too far away from the side of the head causes a child or  an adult to look different. Undergoing an otoplasty or pinning of the ears is a well known and highly successful plastic surgery procedure that can cure that physical problem.

While teasing for protruding ears is unfortunately not rare, I recently saw a young patient whose mother told me that she was being bullied because of her ears. While I am not sure it matters whether one is being teased or bullied, it does cause me to ponder what the difference between these two undesireable behaviors are.

Teasing is a behavior that has been around since the beginning of time. Poking fun at each other to some degree is what children do. A little bit of it is natural and some may argue that it is even an important part of a child’s social development. A little bit of it can have a positive social impact as it helps develop friendships and bonding. It can have a positive impact if not carried too far.

Bullying, conversely, has a negative social impact. Bullying is teasing carried to the level of creating harm, usually with the purpose of the bully gaining increased social status. And it is almost always very personal, directed at a physical feature or a personal behavior. While at one time such behavior was limited to a smaller circle of people, today’s electronic world makes its impact much more substantial and exposed to a larger number of people. One could argue today that being teased about an obvious personal feature is no longer just teasing but constitutes bullying because of its wide reaching audience. It is always harmful and certainly does not help a child’s self-image.

Whenever possible, otoplasty surgery should be done when a child is being teased about their protruding ears. If a child reports to their parents about being teased about their ears, you can be certain that it is being done much more than the child states and is already having a negative impact. The good news is that otoplasty can be done quite early, even as young as age 4 or 5. It can be done as a pre-emptive strike on what may happen if the parents so desire before the child starts formal schooling.

Otoplasty is a fairly simple outpatient procedure that takes about one hour to perform. In children it is always best to do the procedure under general anesthesia. The procedure is tailored with children in mind so no sutures need to be removed from the back of the ear. An ear dressing is kept in place for a few days. Summertime is a common time of the year for otoplasty in children as it does not interfere with school.

Bullying for protruding ears can be remedied quickly with otoplasty and is associated with very high satisfaction rates and dramatic improvements in their self–image.  

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Angle of the Ear

Thursday, May 17th, 2012

The prominence of the ears is determined aesthetically by how much it sticks out from the side of the head. Known as the auriculocephalic angle, it is the angular measurement that the ear is situated from the scalp. The normal angle is somewhere between 20 and 30 degrees and is measured on the back of the ear. When the ear sticks out too far, its angle is definitely greater than 30 degrees. Otoplasty, or the pinning of the ears back, is designed to change an auriculocephalic angle that is too great and bring it back into the normal range. While these numbers provide a quantitative measurement as to what looks normal and abnormal for the ear, one can intuitively tell when the amount of ear protrusion is too much or just right.

The Role Of Plastic Surgery In Bullying Management

Monday, April 16th, 2012

Bullying for school age children and teenagers has reached unprecented awareness recently. While it is a social phenomenon that has gone on forever, many recent examples of internet intimidations and even suicides has made it newsworthy of late. The recent movie release “Bully’ has brought an awareness particularly to adults that brings back unfortunate memories for many and is perhaps why the movie has appeal to more than just those in school. Unlike days of old when bullying may have been limited to school time, there is nowhere to hide in today’s internet and smartphone age.

While bullying occurs for many reasons, physical deformities and differences are a frequent source. It is one thing when a child and teenager know that they are structurally different, but it reaches a malicious and psychosocial altering situation when it is brought to public attention. Whether it is a big nose, ears that stick out or breasts that are too large, such visually apparent features can be a source of torment and intimidation.

Is plastic surgery a solution for bullying when these physical conditions exist? Before bullying reached its current awareness, such plastic surgery procedures have been done for a long time for those children and teenagers whose self-images were affected by them. There is no question that such operations as rhinoplasty, otoplasty, congenital facial deformity surgery (e.g., cleft lip and palate) and breast reduction have psychologically helped many young patients. I have seen and been told by parents of patients that they have become less introverted and shy after their plastic surgery. I can often see it in their eyes and facial expressions that they are feeling better about themselves.

But that does not make plastic surgery a solution for bullying? You can change the physical deformity but you can’t change their social circumstances. Plastic surgery is but one tool, one aspect of the therapy so to speak, in bullying management for the physically affected. In the properly selected patient who has parental support and permission, plastic surgery correction can make an invaluable contribubtion.

This should not be confused with other plastic surgery procedures that do not correct a physical deformity but are done in an effort to alter one’s natural, albeit not desired, body shape. These would be so-called efforts to make one look more thin or shapely. Or to help one have a body that is more like that of some celebrity or model. Breast augmentation and liposuction, while a personal decision for adults, are not what I would consider important self-image surgeries for younger patients to help them escape bullying or criticisms from their peers.

Dr. Barry Eppley

Indianapolis, Indiana

Earology and Plastic Surgery of The Ear

Wednesday, February 1st, 2012

Despite their small size, the ears have a very complex morphology. The ear may well be the most topographically diverse structure of the whole external body. With numerous convexities and concavities of which each has a name, the ear is a marvel of human development. What is even more remarkable about its shape is appreciating how it develops embryologically from six separate tissue islands to coalesce into what we recognize as an ear. As a plastic surgeon, changing the shape of the ear or reconstructing any missing parts brings the appreciation of its anatomy to a whole new level.

The complexity of ear shape has apparently been appreciated by more than just plastic surgeons. I had no idea until I recently an article on the use of ears for establishing human identification, known as Earology. In  two books written on this subject by Alfred Iannarelli, it has been proposed and used as a method of forensic science. What it is not widely accepted and highly controversial, it is postulated that each human ear is uniquely different and no two are exactly alike. As such, one’s ear print is purportedly as unique as one’s fingerprint. This has lead to the use of ear print identification as a potential method in forensic science.

A few clinical studies done long ago on a limited number of adults and babies concluded that no two ears are alike. But it was the work of Iannarelli, author of the book “Ear Identification’ published in 1964, who is said to have studied thousands of ears that lays the foundation for the pseudoscience of Earology. Using a self-devised method of anthropometric measurements which would baffle a high school geometry student, the ear is extensively measured and analyzed and one’s uniqueness established. In a revised edition published twenty-five years later, the use of latent ear prints, much like taking fingerprints, has also been proposed for use in crime scenes.

 

Despite forty years of research, Iannarelli has failed to provide sufficient evidence to convince scientists of his theory, as with fingerprints, that no two ears are exactly identical. As a plastic surgeons who has seen and worked on many hundreds of ears from cosmetic otoplasty, microtia reconstruction and earlobe repairs, many quite frankly look more similar than dissimilar. I am certain that linear measurements between many of the ear components of different patients will show some differences. But overall ear shapes are most certainly not as distinct as fingerprints from a two-dimensional standpoint.  Furthermore, the ear is a very elastic and deformable structure which would make getting an earprint, unlike a fingerprint, subject to a lot of three-dimensional distortion and variability based on the technique used.

Plastic surgery of the ear is challenging due to its complex three-dimensional shape. Reshaping the ear through otoplasty by suture manipulation of the helical fold and the angle of the concha is less difficult than creating part or all of an ear from scratch. (microtia) But both spectrums of external ear surgery require an appreciation of the anatomy of the affected ear and its opposite member on the other side of the head. Unlike earology, earplasty is a precise surgical science that takes into consideration the uniqueness of each patient’s ears…no matter how subtle they may be.

 

Dr. Barry Eppley

Indianapolis, Indiana

Revision of the Overcorrected Otoplasty

Wednesday, August 10th, 2011

Otoplasty correction of the protruding ear can be one of most satisfying plastic surgery procedures one can undergo. The immediate change of prominent ears that stick out to an instantaneous normal appearance is often nothing short of dramatic. While the cartilaginous cause of the prominent ear can be easily determined, its correction involves a lot of artistic technique in its reshaping. As a result, undesireable otoplasty results can occasionally happen as the surgery is not an exact science.

In the August 2011 issue of Plastic and Reconstructive surgery, a good article on the secondary correction of the unfavorable result after otoplasty was published. The article covers both the secondary treatment of undercorrection and overcorrection. The section on undoing overcorrection of an otoplasty (ears pinned back too far) interested me the most as this is by far the more difficult problem.

While often lumped into the name, ‘telephone ear deformity’, ear overcorrections are apparent as the outer aspect of the ear touches or nearly touches the side of the head. This makes the outer edge of the concha being the visible outer edge of the ear rather than the helical rim. This could happen because the sutures used to create the antihelical fold are pulled too tight or back too far, the conchal hypertrophy cause of the prominence is left untreated, or too much skin has been removed from the back of the ear.

Ear overcorrections essentially take an ear, which has too much tissue or cartilage that is abnormally shaped, and turns it into a situation of relative tissue deficiency. As the authors point out in their revision description, the ear needs to be released from a postauricular approach and can often reveal a skin deficiency and a need for cartilage grafts. These two issues must be taken into consideration before surgery. If skin on the back of the ear is deficient, either a sliding skin flap from a sulcus incision or ‘finger flaps’ from the mastoid must be used to replace the missing skin. The donor site will require a small skin graft.

Once the ear cartilage is released, cartilage grafts will be needed to stent open a collapsed antihelical fold or to reinforce areas of cartilage fracture that have occurred from the release. Such cartilage grafts can only come from two sources, the ear concha itself or a small rib graft. The choice will be based on how much cartilage reinforcement is needed.

Reconstructing an overcorrected otoplasty can be difficult but almost always needs tissue grafts. If an overcorrection is treated very early after the initial otoplasty, suture release alone may be sufficient. But once scar and tissue adhesions is established, months to years later, the issue becomes of one of cartilage release and reinforcement and skin flaps or grafts.

Dr. Barry Eppley

Indianapolis, Indiana

Otoplasty For Protruding Ears: Matching The Cartilage Problem With The Surgical Technique

Monday, July 18th, 2011

Even though the ears are located off to the side of the face, they can have an influence on one’s facial appearance. Being made up of a collection of ridges and grooves with a dangling earlobe hanging off of a cartilage framework, the ear is often not appreciated for its complex shape…until it is abnormal. The most common ear shape anomaly is when it sticks out too far.

The ear should not be a dominant structure on one’s head. With a geometry that is as individual as one’s fingerprint, it remains obscure as long as it sits at an angle of less than 30 degrees from the side of the head. Once going beyond this angle, the ear becomes too prominent.This prominence is caused by an alteration in the shape of the ear cartilage. The two most common causes of the protruding ear are absence of the antihelical fold and a large concha.

The two primary folds of the ear are the helix and the antihelix. The second inward fold of the ear is the antihelix. Situated inside of the outer rim (helix) of the ear, this fold brings back the entire outer edge of the ear. When it is absent, the ear protrudes much like the inside of a cup. Complete absence of the antihelical fold accounts for the most dramatic of protruding ears…ears that stick out dramatically. This is the classic type of otoplasty correction in which horizontal mattress (Mustarde) sutures are placed from the back of the ear to create this ear fold. The result is easy to see before by folding back the outer helix and manually creating this ear fold.

The most inner component of the ear is the concha. It has a bowl shape that surrounds the ear hole or external auditory meatus. The size of this bowl can also be a source of ear protrusion. If it is very large, it pushes out the the antihelical and helical ear folds away from the size of the head. A large concha usually causes a less dramatic protrusion than an absent antihelical fold. A large concha makes the ear stiff when pushed against as it is a thicker cartilage and has more surface area than the outer ear folds. Correction of the conchal hypertrophy protruding ear involves pulling back the concha through sutures between it and the mastoid fascia. Often the stiffer concha needs to be weakened by thinning it or removing some cartilage.

Many protruding ear problems are a combination of both a large concha and the lack of an antihelical fold. Often there may be a weak antihelical fold and a slightly large concha. The use of combined antihelical fold sutures and a conchal reduction/setback is often needed. These are the hardest protruding ear problems to treat and require a careful eye beforehand to make the diagnosis and intraoperative artistry and persistence to get the best ear shape.

One of the most overlooked problems in the protruding ear is the earlobe. Since it is not part of the cartilage structure of the ear, it will not lay back when the cartilage is reshaped if it is also protrusive. Often the earlobe must also be folded back by skin removal on the back of the earlobe as part of the otoplasty procedure.

In reshaping of the protruding ear, it is important to match the corrective technique with the cartilage shape problem. Failure to do so results in many of the postoperative otoplasty problems which consist of unnatural shapes and bends of the ear’s cartilages. Once the ear cartilages are resected, unnatural bends created, or set back too far, secondary correction can be difficult.

Dr. Barry Eppley

Indianapolis, Indiana

Secondary Correction of Otoplasty Deformities

Tuesday, April 19th, 2011

Otoplasty is a cosmetic ear reshaping procedure that has been around for over a hundred years. While there have been numerous modifications to its surgical technique, it fundamentally involves cartilage manipulation to bring the protruding ear back to a more normal angle or relationship to the side of the head.

Outside of the earlobe, the ear is composed only of skin and cartilage and its shape is a complete result of whatever the cartilage dictates. In reshaping the ear, it is important to have a clear idea of what an ideal ear shape is and what creates it. The ear is composed of numerous convexities and concavities that appear complex and random. In reality, there is a precise arrangement of the cartilage that makes a recognizeable ear. The cartilage arrangement consists of three tiers, like steps. The outer or upper tier is the helix, the second tier is the antihelical fold, and the third or inner tier is the concha. From the front view, these tiers are aligned so that each one can be seen like a series of steps. It is also important to know that the concavities of the ear do not need cartilage support unlike the convexities.

Cosmetic or shaping complications in treatment of the protruding ear is the result of how the cartilage has been manipulated whose new shape violates ear aesthetics. One of the most common complications is the ear that is set back too far. Almost always this is the result of the antihelical fold which has been bent back too far. This occurs because the horizontal mattress sutures (Mustarde sutures) have either been tied too tight or placed incorrectly. This ends up placing the outer helical rim behind the profile of the antihelical fold. This otoplasty deformity is well known given that it has a name, the telephone ear deformity. It may also occur because the concha has been sutured too tightly down to the mastoid fascia.

Similarly, undercorrection of the protruding ear can be due to inadequate placement or tying of the antihelical fold sutures. Or it can be due to the knots of these sutures which have become unraveled fairly soon after the surgery allowing the ear shape to spring back out close to its original shape. But the most common reason for otoplasty undercorrection is not recognizing the contribution of a large concha to why the ear sticks out. When one has a large ear bowl (concha) the strength of this piece of cartilage will overcome any effort to pull the ear back unless it is weakened and reshaped itself. Sometimes sewing the concha to the mastoid fascia is enough but often it must be weakened by either scoring or cartilage resection and then sutured.

Even with good cartilage reshaping, some otoplasty results are marred by the protruding earlobe which juts out from its attachment to the cartilage framework afterwards. The position of the earlobe must be recognized either before or during surgery so it can be repositioned as well. This is done by removing a fishtail-shaped piece of skin behind the earlobe so that its outer skin margin can be brought into a smooth outer helical rim line.

When the ear shape from otoplasty is not ideal, secondary revision can correct most of these deformities. Timing is of critical importance for optimal secondary correction. Overcorrections should be operated on as soon as the problem is recognized. In this way the sutures can be released before substantial scar tissue makes for a more permanent change. Once scar tissue sets in, the constricted ear can still be reshaped but it may take cartilage grafts to hold the ear back out as it heals. When very early intervention is done, the ear can be reshaped just as easily as during the initial surgery. The timing in undercorrections is not as critical as the creation of scar tissue does not prevent secondary bending and reshaping. 

   

Dr. Barry Eppley

Indianapolis, Indiana

Otoplasty for Protruding Ears – A High Satisfaction Patient Procedure

Tuesday, November 23rd, 2010

Protruding ears are the most common aesthetic deformity of the external ear. Otoplasty is the operation for correction and is largely done in children and teenagers. While some may consider ears that stick out as a minor problem, children that have them do not as they are often exposed to teasing by others. This emotional stress can negatively effect their self-image leading initially to poor school performance and self-confidence possibly springboarding to other more lifelong life issues.

Does otoplasty just make an aesthetic difference or does it have other benefits as well? This very issue was reported on in the September 2010 issue of Plastic and Reconstructive Surgery where findings about the effect of otoplasty on health-related quality of life issues was published. In this study, 84 patients who had otoplasty were evaluated by questionnaires about their results. Of those that returned the questionnaires, 100% of adults were satisfied with the result and 91% of adults would again decide in favor of having otoplasty again. In children, 95% were satisfied with the result and 93% would again decide in favor of surgery again. The health-related quality of life was elevated in both 95% of adults and children.

This study confirms what all plastic surgeons know who perform otoplasty with some regularity…the satisfaction rate is quite high. This is not surprising given the often dramatic change that is evident in the ears as can be seen in any before and after photos of the surgery. While both children and adults benefit alike, the study reports that it is not to the same degree. Children appear to get greater lifelong benefits, both socially and in physical health, than that of adults. This is really no surprise in that correction of a congenital defect earlier allows for the benefits of an improved self-image and confidence for a longer period of time. Conversely, adults have lived with the deformity longer and the impact of correction, while significant, is not as great as the time length of the benefit is less.

One of the other interesting aspects of the study was the incidence of complications and the need for revisional surgery after an otoplasty using a suture technique. Relapse, asymmetry of the ears, and suture extrusion were the most common reasons for secondary surgery. The incidence was around 10%. Some adverse scarring and persistent pain were reported but it did not result in the need for surgical treatment.

Otoplasty done through cartilage reshaping with sutures is both highly beneficial and a satisfying experience for patients. The earlier in life protruding ears are corrected, the longer the benefits of the operation are enjoyed and the more significant those benefits will be. 

Dr. Barry Eppley

Indianapolis Indiana

Otoplasty (Ear Reshaping) in Teenagers

Monday, March 29th, 2010

The ear is a peculiar facial feature. While not existing on the face per se, it has a convoluted shape of hills and valleys that surround the ear canal. Like the nose, it is incredibly unique in its size and shape and each person has their own particular ‘ear print’.  Despite its complexity, it is not paid much attention to unless it stands out in some particular way.

One of the ways the ear stands out, literally, is when it protrudes too far from the side of the head. While the angle of the ear to the side of the head should not be much greater than about 30 degrees, how it looks is more important than some measurement. When someone’s ear sticks out too far, it is a social judgment that one knows well…usually having been told (ridiculed) about it since when they started school.  While some corrective ear surgeries (setback otoplasty) are done either before and after one starts their primary schooling, many are not done or considered until they are in their teenage years.

Whether a teen should undergo otoplasty or not is a personal decision. There is no medical reason whether one should be done or not or at any particular age. I have done otoplasties from age 2 to 78. The timing of corrective otoplasty is when one decides that it is a problem and they are tired of having their ears being a focus of attention or concern. Many teens are not prone to mention that their ears are a concern. Rather they will wear their hair long or pull it forward to cover them. Or even wear hats and other head attire that will hide them. Parents may often have a clue because they never see their teen’s ears. With today’s longer hairstyles and different head wear, it is easy for them to be camouflaged without  being out of style.

Otoplasty in the teenage years is just as common as when they are done at single digit ages. The primary problem behind most protruding ears, regardless of age, is that one of the ear folds is missing or only very weak. (antihelical fold) This allows the outer rim of the ear (helix) to stick out too far. One can easily tell if this is the problem if the ear looks better when the helix is pushed back. (the ‘fold test’) In some cases, the bowl of the ear (concha) may also be a contributing cause if it is too big. But the concha is very rarely the sole cause of the protruding ear. Corrective otoplasty will often change the ear shape by manipulation of both the antihelical fold and the concha through internal suture techniques.

Otoplasty is a fairly simple outpatient procedure. In one hour of  surgery, the ears can be dramatically reshaped. It can be done through a fineline incision on the back of the ear. No sutures need to be removed after surgery. There are no visible scars on the front of the ears. In teens, a head dressing is placed at the end of the operation but it is removed the very next day. Showering and washing one’s hair can be done after dressing removal. I like for my patients to wear a head or sweatband at night for several weeks so that they do not inadvertently fold or crimp newly shaped on the ears while sleeping. Some swelling and soreness can be expected but there rarely is any bruising. A teen can go back to school within several days, but should not need any longer than a week out at most. Contact sports should be avoided for at least 6 weeks.

Otoplasty in the teenage years can make a big difference at a time when conformity in appearance is exquisitely important. A simple one hour operation can provide a lifetime of relief. Few physical problems can be solved so simply and effectively in plastic surgery. It is one of those teenage physical concerns for which a ‘cure’does exist.

Dr. Barry Eppley

Indianapolis Indiana

Case Study: Otoplasty Surgery for Protruding Ears

Tuesday, February 9th, 2010

Background: Protruding ears are a frequent source of embarrassment and ridicule. Whether it is a young school-age child or an adult, ears that stick out too far can make one very self-conscious. There is an established angle number between the side of the head and the ear. (auriculo-cephalic angle, 20 to 30 degrees) However, how one feels about the position of the ear is more important than any number.

Otoplasty, corrective ear reshaping, can be done at almost any age. In my Indianapolis plastic surgery practice, I have performed otoplasty on patients from age two to seventy-four. Otoplasty is a simple cartilage manipulation of the ear that is not affected by the age of the patient.   

Case Study:This is a classic case of pediatric or school-age otoplasty. An eight year-old male was seen with very prominent ears. Often called cupped ears when they are very prominent, the ear angle is close to 90 degrees. The cup description comes from the large concha (bowl or cup) that is responsible for driving the ear away from the side of the head. Interestingly, his mother had her ears done when she was a child and his younger sister also had prominent ears, demonstrating that ear shape and position has a familial influence. In some families, there must be a gene loci for this condition when it affects so many members of the same family.  

There has been some debate about the timing of otoplasty surgery. It was historic teaching that otoplasty should not be done until at least age six, when the ear is near fully grown. The concern was that early cartilage manipulation would affect its growth. This has not been borne out by both experimental research and clinical experience. Otoplasties done as early as age two have failed to show any subsequent growth problems. Conversely, there is no upper age limit when it can be done either. The cartilage never becomes too stiff to be folded and bent. Feel the ear in a senior citizen as you will find it is still quite pliable.

While there are a variety of otoplasty techniques, the most reliable methods use an open approach. Incisionless and minimally-invasive methods can be effective when the ear cartilage is not stiff or too severely deformed. While they are theoretically appealing because they are ‘less-invasive, open otoplasty is not that much more of an operation. The difference between open vs closed otoplasty is not as vastly different, for example, as between open vs closed gall bladder removal.  

This boy’s otoplasty was performed as an office-based procedure under general anesthesia. Through incisions on the back of the ear (postauricular incision), the cartilage was exposed.  Some plastic surgeons prefer to take a strip of skin from the back of the ear, others do not. The original methods of otoplasty believed that skin removal was a necessary part of the procedure to ensure setback. That is no longer believed to be true.  A combination of  horizontal mattress sutures for antihelical fold creation and simple sutures for conchal setback were done. Placing these sutures is a  bit of an art form and there is no precise science as to how many sutures should be used. Nor what type of sutures should be used. I prefer braided non-resorbable (mersilene) sutures but slow resorbing sutures can be used as well. The incision is closed with dissolveable sutures.

A circumferential head dressing is placed at the end of surgery. In teenagers and adults, it is removed the next day. In children, it will stay in place for up to a week if tolerated. The ears will be sore for a few weeks and little swollen for seven to ten days. One can shower and get the ears wet as soon as the dressing is removed. One only needs to be careful about inadvertent bending or pulling on the ears so the sutures are not dislodged. Ultimately, it is scar tissue which keeps the ears in their new position but the sutures do this task in the short-term.

The effects of otoplasty are immediate and dramatic. They may initially look a little pulled back too far in the beginning but that relaxes into a more natural position in the first few months after surgery.  

Case Highlights:

1)      Otoplasty can be performed at almost any age. The timing of surgery is based purely on the psychological motivation of the patient or parents in the young child.

2)      Ear reshaping in otoplasty is done primarily by either folding the cartilage to create more of an antihelical fold or suturing the conchal cartilage back to the mastoid fascia. Sometimes a wedge of conchal cartilage is removed to break the recoil of the cartilage and prevent some relapse of ear position.

3)      Otoplasty is a reliable and proven method of ear repositioning that has few complications with a quick recovery.

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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