EXPLORE
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.

April 30th, 2014

Liposuction for the Full and Aging Neck

 

There are many signs of aging and most look to the face to see them. But the neck is one of the first areas above the shoulders to show it (second only to the eyes) but is often only recognized as aging much later. When it comes to neck aging, there are three issues that are bothersome, too much fat or fullness, loose skin and neck bands or cords. Aging causes the last two but a fuller neck can occur even in a younger patient who has otherwise not even started to age yet.

Neck Liposuction result front viewAs an isolated neck problem, one may have inherited a fuller neck or can develop one as an early sign of neck aging through fat accumulation. (technically fat cell enlargement) Liposuction can be en effective treatment strategy as a fat removal method. While numerous other non-surgical treatment options exist, from fat dissolving injections to external energy-based devices, none currently are as effective or as efficient at fat removal as liposuction.

As a stand alone procedure, liposuction of the neck is best done on younger patients (less than 50 years old) who still have reasonably good skin tone. It does not work well for those that have loose skin or any significant amount of neck (platysmal) banding. The fat that is removed will be permanent unless one undergoes significant weight gain, making it an effective procedure. But not all fat cells are removed, since this is an impossibility, so fat regrowth is possible but only under extreme circumstances.

Neck Liposuction result side viewThe more relevant issue in liposuction of the neck is how the overlying skin adapts to the fat that is removed to create the new neck contour. The excess fat causes what is perceived as an excess of skin that must be managed for a positive benefit to be seen. Neck liposuction uses the principle of skin retraction to ultimately show the results of the procedure. While many patients fear that the skin will fall down away from the neck, this never occurs in skin with good elasticity and the skin always ‘sticks back up’ for an improved contour. This effect can be significantly diminished in skin with poor elasticity and laxity.

The procedure can be done under local anesthesia as a stand alone operation although many patients opt for a little IV sedation for optimal comfort and amnesia of the actual experience. While immediate changes in the neck are seen by the surgeon at the procedure’s conclusion, it takes time for patients to ultimately see the same. The swelling and bruising that ensues obscures the results and requires complete resolution to see what the surgeon initially saw. Some refer to this aesthetic recovery as ongoing neck tightening but that is a rather glorious way to describe it. Rather it will be lumps, irregularities and firmness that is felt and these temporary problems can initially be disturbing. It takes a full four to six weeks to have a near full recovery from neck liposuction and to be in the benefits phase of the procedure.

Much is made of the different liposuction technologies, most of them claiming superiority of results and recovery. While every liposuction technology has their own unique merits, the small area of the neck obscures any real benefits that they may have to offer. Small cannula traditional liposuction, done through a small incision under the chin and possibly behind the earlobes, offers good and predictable results.

Neck Liposuction with Chin Implant Dr Barry Eppley IndianapolisThe effects of neck liposuction can be enhanced further when done with either chin or jawline augmentation. When the chin projection is underdeveloped and the jawline support weak, chin or jawline implants can improve the neck reshaping efforts. Unlike neck liposuction, jawline skeletal augmentation produces a permanent and lifelong change.

While liposuction is a good neck contouring procedure, it is not a permanent one. As time passes and one ages, the neck skin will eventually loosen and bands will eventually appear. These neck changes will require further corrective surgery. How long a neck liposuction will last depends at what age it was done.

Dr. Barry Eppley

Indianapolis, Indiana

April 28th, 2014

Five Things You Didn’t Know About Breast Augmentation

 

Breast Augmentation (Easy Aug) Indianapolis Dr Barry EppleyBreast augmentation is one of the most effective and highly satisfying of all body contouring plastic surgery procedures. Making one’s breast instantly larger in just an hour of surgery is truly transformative for many women. Thousands of before and after photographs and advertisements for the procedure that can easily be found on the internet testify as to the benefits of getting breast implants.

But one of the realities of breast augmentation is that these instantaneous enlarging results are achieved through the use of an implantable medical device. Breast implants are composed of a containment bag or shell which is filled with either salt water or a silicone gel material. To get the desired results, the breast implant devices must be properly placed in the desired tissue pocket in as symmetrical fashion as possible. The short and long-term success of the breast augmentation procedure is thus controlled by three factors, the initial placement of the implants, how one’s body responds to them and the stability of the implant devices over one’s lifetime.

When it comes to breast augmentation surgery, here are five things you may not have known about it but should be aware.

Breast Implants Enlarge The Natural Features Of The Breasts. While the breast implants make have round or anatomical (tear drop) shapes, the final breast shape result will also be influenced by the breast tissues that lies on top of them. How much breast skin and glandular tissue one has, how it hangs or sags (or doesn’t) and the differences or similarities between them will affect how the final breast augmentation result will look. In short, all breast implants do is take what you have and make it bigger.

Breast Implants Magnify Existing Breast Features and Characteristics. When the breasts are small or deflated after pregnancy or weight loss, women often are not aware of differences between their two breasts. These differences are often subtle and seemingly insignificant. But when breast implants are placed, the size of the breasts may be increased anywhere form 100% to 500% in volume. (and two or three cup sizes) Such a magnitude of size increase can take very small differences between the breasts and make them much bigger and very obvious.

The Body’s Healing Response To Breast Implants Can Affect How They Look. Every synthetic implant that is placed in the body generates a healing response. This healing response is a layer of scar tissue which is known as a capsule. It is the body’s natural way to separate the implant from itself. Because a breast implant is round and needs to move freely to feel soft and natural, its encasement in this layer of scar can affect how it looks and feels. If abnormally thick scar tissue develop around a breast implant, known as a capsular contracture, the breast can feel firmer and be asymmetrically positioned compared to the other side. Whether and why capsular contracture may form is both unpredictableand not well understood.

Breast Augmentation Rarely Produces Perfect Breast Symmetry. Between the natural breast asymmetry that almost all women have and how the body heals around newly placed implants, ideal breast symmetry should not be expected after breast augmentation no matter how well the surgery is performed.

The Revision Rate in Breast Augmentation Surgery Is Not Insignificant. Because it is a medical device being placed in the body, there are a wide variety of short and long-term issues that can develop that may affect the breast augmentation result. Some of the issues may require additional surgery to correct. The breast implant manufacturers, who have studied their breast implants for decades, state that there is a rate of over 30% of patients requiring revisional surgery within the first three years after breast augmentation surgery. While in my practice this revision rate is closer to 10% or less, suffice  it to say that these numbers indicate that the need for revisional breast augmentation surgery is not rare.

Dr. Barry Eppley

Indianapolis, Indiana

April 26th, 2014

Engineered Cartilage for Nasal Reconstruction

 

Cartilage very often needs to be harvested in rhinoplasty and ear reconstructive surgeries. Even in elective aesthetic rhinoplasty, the use of cartilage grafting is quite frequent. While the septum is often the best source of cartilage graft harvest, it may be depleted from prior surgeries or may simply not have enough graft volume. This then entails going to the ear or even the rib with the tradeoff of some additional scar and discomfort.

Engineered Cartilage for Nasal Reconstruction Dr Barry Eppley IndianapolisIn the April 2014 issue of Lancet, an article was published entitled ‘Engineered Autologous Cartilage for Nasal Reconstruction after Tumour Resection: An Observational First-In-Human Trial’. In this reported clinical study in humans, five patients underwent nasal reconstruction after excision of non-melanoma skin cancer that took more than 50% of the alar lobule. Chondrocytes were initially harvested from the patients’ nasal septum (at time of tumor biopsy) and grown in culture over a four week period. This created engineered cartilage grafts of a size of 25mm x 25mm and 2mms thick. These grafts were then used under local flap reconstruction of nasal defects. During subsequent flap revisions, biopsies and one year assessment of the implanted cartilage grafts were done. The results showed that the histology and reconstructive stability of the cartilage grafts were adequate and comparable to an autogenously harvested cartilage graft.

Growing tissues in cell culture has long been and continues to be a lofty surgical ambition. To be able to make the tissues or organ needed for reconstruction would spare the need for a donor site harvest. Cartilage has been grown in cell culture for decades and its theoretical benefits have been touted numerous times with the most famous example of an ear being grown on a mouse’s back. But the jump as not yet been made to its use in humans. This paper is the first to do so and to demonstrate the use of engineered cartilage.

While the size of the nasal cartilage defects in this paper could have been done just as easily with septal cartilage harvested at the time of surgery, the use of relatively small nasal defects is a safe start on which to build future efforts.

Rib Graft Ear Reconstruction Dr Barry Eppley IndianapolisThe biggest challenge for engineered cartilage would be in subtotal or complete ear reconstruction. This is the single greatest cartilage graft done in humans and always involves the harvest of ribs for the ear reconstruction. Making a whole ear framework for implantation is a great cartilage engineering challenge but would be a supreme test of the technology.

Dr. Barry Eppley

Indianapolis, Indiana

April 25th, 2014

Functional Implications of Aesthetic Temporal Muscle Reduction

 

Temporal Muscle Anatomy Dr Barry Eppley IndianapolisThe temporalis muscle is the largest and most powerful muscle of the face and skull. It runs from almost to the back of the head down below and behind the cheek bone to attach to the lower jaw. It can be seen to have two parts. The anterior or front part runs almost vertically and moves the lower jaw forward (protrudes the lower jaw). The posterior part of the muscle above the ear runs almost horizontally and pull the lower jaw backwards. If both parts of the muscle are activated, it causes one to bite down. This is the classic functional and anatomic description given to the temporalis muscle seen in any anatomy textbook or article.

It is the posterior part of the muscle that has aesthetic relevance as it relates to the perceived width of the head above the ears. The posterior temporalis muscle in this area can be surprisingly thick, often 5 to 7mms in thickness. (in not more in some men) Reducing or removing the posterior temporalis muscle can make a very noticeable change in head width, bringing in the sides above the ears considerably. While this is an aesthetic benefit, it would seem that removal of the posterior part of the muscle would cause problems with bringing in the lower jaw during closure. (per anatomic descriptions as previously noted)

Temporal Reduction Dr Barry Eppley IndianapolisBut the reality is that removal of the posterior temporal muscle appears to have no negative functional repercussions. Having performed many posterior temporal resections for head width concerns, I have yet to have one patient who has had a single muscle symptom. Not even a single case of immediate after surgery trismus. (difficulty with opening one’s mouth or temporary mouth opening stiffness) Such clinical findings run counter to classic teachings. But it actually is consistent with a long-standing finding in an another surgical specialty…neurosurgery. It is not rare to see patients after a temporal craniotomy (and most severely seen when combined with radiation) to have severe temporal hollowing. (muscle wasting) But yet they rarely if ever have any mouth opening or stiffness problems.

Aesthetic temporal reduction by muscle removal (myectomy) is a safe and effective procedure. Despite what one would anatomically expect and is written, the posterior segment of the temporalis muscle can be completely removed without causing any dysfunction of jaw movement.

Dr. Barry Eppley

Indianapolis, Indiana

April 21st, 2014

The Success of Temporal Migraine Headache Surgery

 

Certain types of migraine headaches have been attributed to compression of the extracranial portions of the trigeminal nerves. One of the four main types of peripheral compression migraines are temporal-based which result from the temporal muscle squeezing the zygomaticotemporal branch of the trigeminal nerve. (there could also be a concomitant effect of a tight fascial opening as well) It is where the nerve passes through the muscle and fascia on its way to supply the overlying skin in the temporal region as to where it is affected. This is at an approximate point in the temporal skin between the corner of the eye and the eyebrow.

Decompression of this affected nerve for temporal migraines is really an avulsion technique. Through an endoscopic approach, the nerve is identified as it comes through the deep temporal fascia, grasped and pulled like a small piece spaghetti. There is no harm in eliminating this nerve as it only supplies a small area of skin with feeling in the temporal region. As the nerve is avulsed, its most proximal end retracts into the temporal muscle under the fascia which is helpful for prevention of potentially painful neuromas. While  this technique is uncomplicated to perform, how success is it in reducing temporal migraines.

In the April 2014 issue of the journal Plastic and Reconstructive Surgery, a study entitled ‘In-Depth Review of Symptoms, Triggers and Treatment of Temporal Migraine Headaches (Site II)’ was published which examines this very question. Over a ten year period, a total of 246 patients who underwent temporal migraine decompression surgery were assessed to determine the success of the procedure. It was determined that 85% of the patients had at least a 50% improvement in their headache symptoms at one year after surgery. Over half (55%) reported a complete elimination of their headache symptoms.

This study supports the benefits of zygomaticotemporal nerve avulsion to reduce the severity and frequency of temporal-triggered migraine headaches.  Despite its relatively high success rates for headache reduction, it does not solve every patient’s symptoms. There may be other contributing factors to migraine headaches such as the auriculotemporal nerve and the anterior branch of the superficial temporal artery. In those patients who have minimal improvement, these sites may be considered for secondary treatment.

The ideal candidates for temporal migraine surgery are those that have very specific symptoms that are be traced to the topographic location of the zygomaticotemporal nerve location. For those that can specifically point to the exact temporal location, the use of preoperative Botox testing can be bypassed.

Dr. Barry Eppley

Indianapolis, Indiana

April 20th, 2014

Plastic Surgery Product Review: Living Proof Neotensil Under Eye Treatment

 

Under eye bags and wrinkles are a major aesthetic concern for most people as they age. No matter how many creams and topical treatments one may try, they are hard to improve without actual surgery for more advanced under eye aging. While lower blepharoplasty techniques are the definitive treatment, surgery involves recovery and does not produce an immediate effect.

Neotensil Undereye Treatment Dr barry EppleyNow along comes the Neotensil Under Eye reshaping product which is neither a surgical procedure, laser or cosmeceutical treatment. It is an clever and innovative use of a polymer film that can be applied to temporarily tighten and reshape the under eye area. The name is actually an acronym that after Neo stands for transforming (T), elastic (E), noninvasive (N), supportive (S), invisible (I) and layer. (L)

Neotensil Living Proof Dr Barry Eppley IndianapolisNeotensil uses a proprietary cross-linking polymer film technology which is applied  in a two-step process. Initially a base is mixed with an activator and then it is applied with a special tool. Once it dries, it creates a clear and flexible membrane on top of the under eye skin that tightens and smooths as the polymer contracts on setting. A clinical study showed that 99% of patients showed visible improvement in compressing and changing the shape of the under eye area. Many patients in the study (70%) showed substantial improvement with a change in at least two grades in an aesthetic improvement scale. Its effects are temporary and last from 16 to 24 hours.

Under the marketing name Living Proof, Neotensil is distributed through Valeant Pharmaceuticals as a kit. It retails for $500 and has enough product for 50 applications. This factors into $10 a use. While most people will probably not use it as an everyday cosmetic treatment, it is a great product for special events or a night out on the town for those who want to temporarily improve that tired under eye look.

Dr. Barry Eppley

Indianapolis, Indiana

April 20th, 2014

Cartilage Graft and Implant Techniques in Asian Rhinoplasty

 

Rhinoplasty of the Asian nose requires almost completely different techniques than that of the Caucasian nose. In the Caucasian nose it is usually about reduction and rearrangement of structures, while in the Asian nose it is about augmentation and extension of structures. The anatomy of the Asian nose is characterized by a weak and underdeveloped bone and cartilage support structure with usually a thicker overlying soft tissue layer. This creates an aesthetically short nose with poor tip projection and wider flared nostrils.

While augmentation of the bridge of the Asian nose  is often done by a silicone or PTFE-coated silicone implant, the management of the tip is a different matter. Attempting to extend the silicone implant in an L-shaped to increase nasal tip projection and a downward tip rotation is fraught with long-term problems due to the pressure of the implant on the overlying tip skin. As a result, nasal tip management should be done by using the patient’s own cartilage. However, donor cartilage from the septum in Asians is usually in short supply for the amount needed to extend and support the nasal tip.

The best method to control tip projection and rotation is through the use of septal extension and tip onlay grafts. But the paucity of septal cartilage requires an additional donor source for both types of grafts and this is the ear. The septum is the donor site for the septal extension graft(s) and the ear is the donor site for the cap or infralobular tip grafts. These two types of grafts combined with defatting of the underside of the dome skin and dome suture plication complete the nasal tip reshaping.

Septal extension grafts in the Asian nose can usually extend up to 6mms or more after the lower alar cartilages and its attached soft tissues are released and stretched. The key maneuver is in how to fix the extension grafts onto the caudal end of the septum. A single graft can be overlapped onto the septum and brought forward. But the most stable method is to create a V-shaped graft construct. One extension graft is applied at the top of the causal septum in a horizontal direction and secured on one side of the septum. The other graft is applied between the tip of the initial extension down at 45 degrees and fixed to a lower position on the septum on its opposite side.  A recent study has shown/suggested that this septal extension construct is biomechanically more stable to resist the pullback of the stretched overlying tissues.

Once the nasal tip has been grafted and stabilized, the dorsal augmentation is then done. If the patient is not amenable to a rib graft for bridge augmentation, a silicone implant must be used. The thickness and length of the implant is determined by taking a ruler and placing it between the midpoint of the glabella and resting it on the nasal tip. The underlying space between the ruler and the nasal skin determines the graft shape and length. This is ideally measured and carved as the first part of the rhinoplasty procedure and is done before the nose is even opened. This allows for an accurate graft sizing since the tissues are not distorted.

My preferred technique in Asian rhinoplasty tip management is a dual cartilage graft approach with septal extension and onlay tip augmentation. Dorsal augmentation can be managed by  a rib graft implant, which is the patient’s choice.

Dr. Barry Eppley

Indianapolis, Indiana

April 20th, 2014

Comparing Botox, Dysport and Xeomin Injectable Facial Neuromuscular Modulators

 

The announcement this month that Johnson & Johnson (J & J) has pulled any further development of their aesthetic neuromuscular modulator PurTox was a surprise. It was certain several years ago that a fourth injectable drug would soon be on the market to compete with the big three, Botox, Dysport and Xeomin. But it now appears that these three cosmetic drugs will only have only to compete amongst themselves for some time into the foreseeable future.

Botox Facial Wrinkle Injections Dr Barry Eppley IndianapolisIt has now been three years since the last of the big three (Xeomin) was approved. And while there has been some minor new FDA approvals for indications that were already widely done off-label anyway (crow’s feet), the number of men and women seeking this injectable cosmetic treatment continues to grow. Having multiple products to treat unwanted facial lines and wrinkles has helped create awareness and grow the market. These drugs today are as accepted as capuccinos and are done almost just as much. To some degree, Botox and his competitors have very much become commodities where the lowest cost per unit often sways what provider/location that a patient will go to.

This raises the question of how do these drugs differ and, what advantages if any, do any of them offer over the others? What all three drugs share is that they are FDA-approved Type A botulinum toxins. They work exactly the same through the same mechanism of molecular action and all have the same type of heavy chain receptor. While Dysport and Xeomin have a little shorter onset (1 to 2 days), they last the same amount of time as Botox having a duration of action of between 3 and 4 months after injection.

Dysport Indianapolis Dr Barry EppleyThey do differ significantly, however, in their dosing and methods of storage. The dosing of Dysport is very different from that of Botox or Xeomin. This makes it difficult to compare Dysport to the other two in clinical studies. While the biologic activity is the same for Botox and Xeomin, it is quite different for Dysport and there is no standard dose conversion. While all three must be reconstituted on the day of administration, Xeomin does not require refrigeration which makes it more portable and not prone to be accidentally left out of cold storage after a treatment.

From a marketing and public awareness standpoint, Botox is the dominant force occupying close to 80% of the market. It is the ‘Coke’ of the injectable neuromuscular modulators, the most studied and also the most expensive. Dysport and Xeomin are the ‘Pepsi’ and ‘Seven-Up’ by comparison and are still trying to gain market share. As a result they are priced under that of Botox and is there only real method of improving their small market share given that they have no other advantages.

Xeomin Indianapolis Dr Barry Eppley IndianapolisSome small claimed advantages over Botox for Dysport is that it has wider zone of diffusion from the injection site. This may be an advantage in the bigger muscles areas of the frontalis muscle of the forehead and the orbicularis muscle of the crow’s feet area. But would be a disadvantage in a discrete muscular area like the glabella which is also the number one area for all aesthetic neuromuscular injections. Xeomin claims a less risk of allergic reaction than with Botox because it does not contain hemagglutin and non-hemagglutin complexing proteins. While this may be theoretically true, the incidence of allergic reactions to Botox is so insignificant after over twenty years of clinical use that this advantage is meaningless.

While there are other aesthetic injectable neuromuscular drugs under development, none of them seem to have any major advantages over the big three that are available now. Every patient would like them to last longer (or be permanent) and cost less but that does not appear to be likely for as far as one can see into the future. The one promising approach is that of a topical botulinum type A gel of which several companies have ongoing clinical trials. Avoiding needle sticks could be the one advantage a new product could have that would help shakeup the market as we know it now.

Dr. Barry Eppley

Indianapolis, Indiana

April 20th, 2014

Plastic Surgery Wisdom: Achieving Natural Results

 

Plastic Surgery Wisdom Dr Barry Eppley IndianapolisMost everyone that considers some cosmetic plastic surgery procedure is interested in a natural result. While the concept of a natural looking result is open to wide interpretation, it usually refers to a procedure that is not overdone. Being overdone in plastic surgery often refers to cosmetic operations(s) that may have been performed in an aggressive manner. This could refer to the facelift that was pulled too tight, the breast implants that were too big or the browlift that was elevated too high, to name a few examples. While every patient wants the most ‘bang for their buck’, more of a physical change may not always be better. It becomes critical, therefore, for every patient to relay in as much detail as possible to their plastic surgeon as to the exact type of change they are seeking. Since so many patients use the term ‘natural’ to describe what they want, one had better be sure what the plastic surgeon sees as natural and how an unnatural outcome is going to be prevented. Don’t assume a natural looking result occurs ‘naturally’.

Natural Results in Plastic Surgery Needs To Be Defined Before The Operation

Dr. Barry Eppley

Indianapolis, Indiana

April 19th, 2014

The Benefits of Fat Grafting in Facial Reshaping Surgery

 

Facial skeletal surgery, what I often call facial structural surgery, offers many options for changing the form of the face. From jaw repositioning to bone reshaping to implants, significant foundational changes can be done. While much of facial skeletal surgery is done in the young (under age 45), this does exclude older patients as well. But no matter how the facial bones are changed or at what age, the final result is heavily influenced by how the overlying soft tissues settle and heal over the underlying bone changes.

While bone modifications can make a significant difference in the external facial shape, they can not always make every desired facial improvement. Some facial changes require a combination of both bone and soft tissue augmentation to get the desired effect.This is particularly true in cases of facial asymmetry and areas of differing soft tissue thicknesses.

One of the soft tissue effects of facial skeletal surgeries in some patients is that the overlying soft tissues can thin after surgery. This is almost exclusively the result of subcutaneous fat atrophy from the trauma and swelling of the surgery. This is seen in cases from facial fracture repair to orthognathic surgery.

Facial Fat Injections for Linear Scleroderma Dr Barry Eppley IndianapolisIn the April 2014 issue of Aesthetic Plastic Surgery Journal, an article was published entitled ‘Application of Fat Grafting in Facial Aesthetic Skeletal Surgery’. In this report, the authors describe a series of cases in which fat grafting was done as either done at the time of facial skeletal surgery or was performed as a secondary procedure afterward. In twenty one (21) patients, thirty-seven fat grafting procedures were done. The type of facial skeletal surgery included sliding genioplasties, facial bone reshaping and for facial asymmetry improvement. The fat injections were intended to improve asymmetries and irregularities over reshaped/repositioned bone or implants. Of the 37 procedures, four (11%) complications occurred of which most were infections.

Fat grafting today has many versatile uses in facial surgery. While often perceived for aesthetic facial augmentation only, it has many reconstructive uses as well. It is the missing link in facial skeletal surgery to make contour changes that may remain deficient despite underlying bone modifications. For example, I recently treated a middle-aged male patient with severe facial lipoatrophy from antiviral medication with temporal and combined malar-submalar implants. But as was suspected before surgery, the area between the temples and the cheeks across the zygomatic arch remained deficient, creating an ‘hourglass deformity’ This was filled in with fat injections as well as around the lower end of the cheek implants to give a confluent facial contour improvement.

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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