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.

September 28th, 2016

Case Study – Breast Augmentation and Cleavage

 

Background: One of the well known mottos amongst plastic surgeons regarding breast augmentation is that implants merely take what you have and make it bigger. While simplistic, this statement is largely true. Other than mound enlargement and the potential creation of enhanced cleavage from that effect, many of the other breast features remain the same albeit larger.

There is a difference between younger vs. older breast augmentation patients. Younger women who have not had children have breast mounds that are well shaped with good overlying breast tissue. Older women, or younger women that have had children, often have breast mounds that are not well shaped and have stretched out overlying soft tissues. That difference alone can make a big difference in the aesthetic outcome of breast augmentation surgery.

Case Study: This 3o year-old female presented for breast implants. She had small but wide breast bases with well centered nipples on the mound and well defined inframammary creases at the bottom of the mound. In addition she had breast mound swhere the nipples where pointed directly forward and the breasts were almost too close together. (compared to many other women)

breast-augmentation-with-cleavage-results-front-view-dr-barry-eppley-indianapolisUnder general anesthesia and through 3.5 cm inframammary skin incisions, 450cc round high profile silicone gel breast implants were placed in the partial submuscular position.breast-augmentation-and-cleavage-results-side-view-dr-barry-eppley-indianapolis

breast-augmentation-and-cleavage-results-oblique-view-dr-barry-eppley-indianapolisHer breast augmentation results clearly show how the implants made all features of her natural breasts simply bigger. There was no reason to lower her natural inframammary folds which is actually very uncommon in my experience. She already had a good distance between her nipples and inframammary folds despite her small natural breast volume. The naturally close position of her breasts allowed for actual cleavage to be achieved even without a bra.

Highlights:

1) Breast implants take the breast mounds a patient has and merely makes them bigger.

2) Breast implants make cleavage if the breasts are spaced close together naturally.

3) The east-west nipple position after breast augmentation remains exactly the same as it was before surgery.

Dr. Barry Eppley

September 28th, 2016

Fat Grafting for the Stiff Medpor Ear Recconstruction

 

Microtia is a congenital condition where all or major parts of the ear are missing. Two methods of microtia reconstruction have evolved using either one’s own ribs or through the use of a synthetic framework. Autologous microtia reconstruction is done to using portions of the cartilaginous #7, 8 and 9 ribs to create the base framework of the ear. Alloplastic microtia reconstruction uses a synthetic performed ear framework made of a Medpor material that is simultaneously covered by a vascularized temporal fascial flap. Such ear reconstructions are usually done around ages 6 to 8 years old.

medpor-ear-framework-dr-barry-eppley-indianapolismedpor-ear-framework-back-side-dr-barry-eppley-indianapolisBoth microtia ear reconstruction methods have their own unique advantages and disadvantages. The Medpor ear reconstruction framework offers the advantages of a well-shaped preformed ear framework and the avoidance of a donor rib scar and harvest site. Because it is a stiff material, however, it can feel fairly rigid. The rigidity of the wedge on the back part of a Medpor ear framework, which allows it to have good projection from the side of the head, can be a source of ear stiffness and rigidity.

medpor-ear-framework-reduction-dr-barry-eppley-indianapolismedpor-ear-reconstruction-fat-grafrt-dr-barry-eppley-indianapolisTo reduce the rigidness of a Medpor ear reconstruction, the wedge on the back part of the ear framework can be shaved down from an incision on the back of the ear. This is then filled with a dermal-fat graft placed into the space where the wedge of Medpor material was removed. Some slight projection of the ear reconstruction may be lost but the ear will have some flexibility when pressed on.

While many rib graft microtia reconstructions need projection and a more rigid graft placed behind it, a synthetic framework often needs the opposite. The preformed framework provides good projection but at the expense of ear stiffness. The ear is made of flexible cartilage that springs in and out and that is a feature that a plastic material can not do.

Dr. Barry Eppley

Indianapolis, Indiana

September 28th, 2016

Tragal Flap Ear Canal Hair Removal

 

Hair that grows on the ear is a well known phenomenon amongst men as they age. Often joked as hair that has migrated from the scalp, it appears as outcroppings of black hair from various parts of the ear. The greatest concentrations appear on the earlobes, helix and, interestingly, the tragus. Often ear hair is dark even if the man’s hair color has turned gray.

excessive-tragal-ear-hair-dr-barry-eppley-indianapolisHair on the tragus of the ear, also known as ear canal hair, is the most interesting/unusual place for ear hair to develop. It is well known to develop hair since it gets its name from the Greek word, tragos, meaning goat because its hair growth on its undersurface resembles that of a goat’s beard.

The traditional methods of ear hair removal include plucking and shaving. While effective these methods require near daily maintenance as they only remove the most visible part of the hair shaft and not the growth center. (follicle) Laser hair removal can be done for more permanent results but this requires multiple treatments, is a difficult place to treat because of the shape and location of the tragus and can be quite uncomfortable to have done.

tragal-ear-skin-flap-for-hair-removal-dr-barry-eppley-indianapolistragal-ear-hair-removal-electrocautery-dr-barry-eppley-indianapolisA surgical treatment for tragal ear hair removal can be done that is near 100% effective and can be completed in one session done under local anesthesia. This is known as tragal flap hair depilation. In this technique a skin flap is raised off of the tragal ear cartilage. The tragal skin flap is then everted and all of the dark hair follicles can be easily seen. The hair follicles are amputated by scissors and then cauterized, thus permanently removing the actual growth center of the hair.

tragal-ear-skin-flap-closure-for-hair-removal-dr-barry-eppley-indianapolisThe tragal skin flap is trimmed as it has been mobilized,  further removing any hair-bearing skin. The skin flap is then closed back over the tragus with small dissolveable sutures. No dressing is applied and the suture line remains hidden on the underside of the tragus or ear canal. Swelling and bruising are minimal to undetectable. Full healing takes place in about ten days.

Ear canal hair is difficult to permanently remove with any traditional hair treatment method. Surgical tragal flap hair removal is a highly effective one-time treatment that can be done in the office under local anesthesia with virtually no recovery.

Dr. Barry Eppley

Indianapolis, Indiana

September 27th, 2016

Custom Orbitozygomatic Implant in Facial Asymmetry

 

Facial asymmetry is common and it is often said that everyone has some degree of it. While this is true, more significant facial asymmetries are not common and are a source of frequent patient self-esteem issues. In significant facial asymmetries the entire face is affected from the brow down to the jawline. The affected side is almost always lower as if it is pulled downward. It is extremely rare to ever see a facial asymmetry where the affected side is higher rather than lower than the normal side

The most significant component of facial asymmetry is often around the eye area. This is usually manifest by a difference in the horizontal level of the pupils. The eyeball sits lower as the orbital floor is located more inferior than the opposite normal side. But the orbital floor is not the culprit but a symptom of the overall facial asymmetry. The entire orbitozygomatic bony complex is situated lower. This is seen by the presence of a smaller and less projected cheek and greater soft tissue fullness below the cheek.

In correcting the orbital or midfacial component of facial asymmetry, orbital floor and cheek augmentation are the two skeletal components of the problem that needs to be addressed. There are a variety of materials and methods to this type of skeletal augmentation and all can be successful when done well.

orbitozygomatic-implant-for-facial-asymmetry-dr-barry-eppley-indianapolisorbitozygomatic-implant-design-for-facial-asymmetry-dr-barry-eppley-indianapolisThe more recent availability and use of 3D CT scan imaging and computer designing, however, brings greater precision to the level of the surgical result obtainable for orbito-zygomatic reconstruction in facial asymmetry. Comparing the lower side to the higher normal side allows for an implant that can create a bony augmentation that matches to the other side with millimeter precision. In addition a total one-piece implant can be made that augments all outer areas of the bone including the infraorbital and lateral orbital rim. This would be the most accurate method of implant reconstruction available.

orbitozygomatic-implant-placement-for-facial-asymmetry-dr-barry-eppley-indianapoliscustom-orbitozygomatic-implant-placement-incision-closure-dr-barry-eppley-indianapolisA custom orbitozygomatic implant is placed through a lower blepharoplasty incision. This is a subciliary incision with a small lateral canthal extension. A skin-muscle flap is raised down to the bone where subperiosteal undermining is done to placed the implant. It is important on closure that the orbicularis muscle suspension is done as well as closing the deeper tissue layer over the lateral orbital rim.

It is important to recognize that a custom orbitozygomatic implant provides bone correction but the overlying soft tissues of the eye must often be addressed as well. These could include lateral canthoplasty for outer corner of the eye correction as well as potential upper eyelid ptosis repair. As the eyeball is lifted a ptosis may be created as the upper eyelid position will not have changed. This eyelid correction should be corrected secondarily three months later when all the swelling has resolved and the tissues have stabilized.

Dr. Barry Eppley

Indianapolis, Indiana

September 26th, 2016

Technical Strategies – Nasal Base Fixation

Smiling is the single most important facial expression. It takes a lot of facial muscles to smile and their pull causes surrounding facial structures to move beyond that of just the lips. The superiorly positioned nose can move when one smiles as the upper lip elevates. The flexible tip of the nose is what can change at either the tip or the nostrils.

nasal-base-retraction-with-smilingWhile nasal movement with smiling is usually regarded as incidental and not aesthetically bothersome, there are certain nasal movements that can be. The most common is the downturning of the nasal tip caused by a hyperactive depressor septi muscle. The more rare adverse aesthetic movement is an undesired elevation of the base of the nostrils. This is an upward and inward movement of the nostrils where they attach to the face. This is caused mainly by the quadratus labii superioris muscle.

This muscle has two portions, the medial and lateral heads. The medial head is known as the levator labii superioris alaeque nasi muscle. This slip of the muscle originates from the frontal process of the maxilla and comes downward to insert into the alar cartilage and the skin of the nostril attachment to the face. (another slip of the muscle goes on to insert into the upper lip. Since muscles pull towards their origins it is this action that pulls the base of the nose upward.

Counteracting the action of the legator labii superiors alaeque nasi muscle can be done by disinsertion of the muscle from the nose. But to be absolutely certain that the action of the muscle is countered an addition technical maneuver can be helpful. Securing the base of the nose in a downward direction to the bone provides a point of fixation that can resist any residual muscle action.

nasal-base-fixation-technique-dr-barry-eppley-indianapolisintraoral-nasal-base-fixation-technique-dr-barry-eppley-indianapolisThis is done by a bone anchoring technique to the pyriform aperture. Using a permanent 4-0 Tevdek suture attached to a 1.5mm x 5mm titanium microscrew, the anchor is initially placed into the bone through a small intraoral incision. The needle of the suture then takes a bite of tissue just under the nostril attachment. The suture is tied down loosely, making it tight but not cinching it down enough that it pulls the nostril inward.

This intraoral bone anchoring technique provides firm fixation to prevent the nasal base from pulling upward when smiling. It is a useful adjunct to muscle release and provides a two-way approach to the nasal animation problem.

Dr. Barry Eppley

Indianapolis, Indiana

September 25th, 2016

Case Study – Custom Skull Implant for Occipital Plagiocephaly

 

Background: Plagiocephaly is a well known congenital condition that results in a variety of craniofacial skeletal malformations. One of the most consistent findings is that of flatness of the back of the head. This flatness occurs as a result of the overall twisting rotation of the skull around its vertical axis. The flatness on one side of the back of the head is often accompanied by some protrusion on the opposite side of the occiput. This protrusion may only appear so because of the contralateral flatness or may be actually beyond what the normal shape would be.

Beyond infancy there is no non-surgical treatment for occipital plagiocephaly. As an adult surgical contouring through bone removal and reshaping is also not a viable option. For a largely cosmetic deformity the magnitude of the surgery does not justify the associated risks and inevitable contour deformities that would result. This leaves the only treatment for asymmetries of the back of the head as an onlay approach.

Building out the back of the head by expanding the bone contour can be done using a variety of bone cements or silicone implants. The concept of custom skull implants has proven to be the superior technique as it allows the exact implant design to be determined before surgery. In addition it allows the surgery to be done through the smallest scalp incision.

occipital-implant-for-plagiocephaly-design-dr-barry-eppley-indianapolisoccipital-implant-design-for-plagiocephaly-dr-barry-eppley-indianapolisCase Study: This 35 year-old male had a congenital plagiocephalic skull deformity with a flat back of the right side of the head which was bothersome to him. He had a history of multiple prior hair transplants using a linear strip harvest method across the back of his head. Because of concerns of scalp tightness a first stage fat injection session was initially. A custom skull implant was made using a 3D CT scan that built up the flatter side of the back of his head. By computer design the thickness of the implant was only 8mms to achieve symmetry with the opposite side of the back of his head.

custom-occipital-implant-fo-asymmetry-dr-barry-eppley-indianapoliscustom-occipital-implant-for-plagiocephaly-intraop-positioning-dr-barry-eppley-indianapolisUnder general anesthesia and in the prone position, his entire occipital scalp scar from his prior hair transplants was excised. This was good opportunity to have an uncommon amount of surgical access to place the implant. It also was an opportunity to do a simultaneous scalp scar revision at the same time. The skull implant had multiple perfusion holes placed through it prior to implantation. The arrow markers placed into the implant surface allowed for its proper orientation.

custom-occipital-implant-for-plagiocephaly-intraop-result-oblique-view-dr-barry-eppley-indianapoliscustom-occipital-implant-intraop-result-back-view-dr-barry-eppley-indianapolisHis immediate surgical result show adequate augmentation of the flatter side of the back of his head that was symmetric with the opposite rounder side. The use of his hair transplant scar made for convenient access for implant placement. But anytime there is a linear scar across the back of the head this also means that there is a tissue deficiency which may impact whether a scalp implant can be safely placed. In this case the thickness of the skull implant was modest at only 8mms. But fat grafting was still initially done just to be certain that some stretch of the scalp could occur.

Highlights:

1) The most common presentation of plagiocephaly is flatness on one side of the back of  the head.

2) The best correction for occipital plagiocephaly in adults is a custom occipital inplant made from a 3D CT scan.

3) A custom occipital implant is placed through a low occipital hairline incision from the prone position during surgery.

Dr. Barry Eppley

Indianapolis, Indiana

September 22nd, 2016

Tummy Tuck Rib Removals

 

The most perceived reason that rib removal surgery is performed is for narrowing of the anatomic waistline. This is done by removing portions of ribs 11and 12 and sometimes even rib #10. This operation works because it removes the outward support of the musculature that occurs from the very downward projecting terminal 11 and 12 ribs. This is done through a small oblique incision on the lower back. This is known as posterior rib removal as it is on the posterior or dorsal surface of the trunk.

anterior-rib-removal-dr-barry-eppley-indianapolisBut ribcage modifications for aesthetic purposes is not just limited to the posterior or lower ribs. Rib #s 7, 8 and 9 on the anterior subcostal margin of the chest can also be treated. Subcostal ribs that are too protrusive can be removed. Unlike the posterior ribs which are bony, anterior ribs are softer and cartilaginous in structure. These ribs run form the sternum out to the side where they turn into bone at their osteocartilaginous junction at the side of the chest. This is known as anterior rib removal or subcostal resections.

tummy-tuck-rib-removal-dr-barry-eppley-indianapolisThe access to anterior rib removal can be done through two very different incisional approaches. Like the posterior ribs a small incision over the subcostal margin can be used. (direct approach) Another option is to use a tummy tuck incision. (indirect approach) If one is having a tummy tuck anyway then this would be the obvious choice. It is a long way from the low tummy tuck incision up to the subcostal margin but it can be done without undue difficulty. The rectus muscles are split right over the subcostal edge of the ribs and they are then removed. Once could also choose the indirect approach even if they don’t need a tummy tuck but one has to accept the traditional low tummy tuck scar.

Anterior rib removals iare less known and discussed than the more well known posterior rib removals for waistline narrowing. But in my rib removal experience, there are as many requests for anterior rib removal as there is for the posterior ones. The incision chosen is based on whether they have had a prior tummy tuck or are in need of one.

Dr. Barry Eppley

Indianapolis, Indiana

September 20th, 2016

Case Study – Custom Bicep Implants

 

Background: Most body implants are done for muscular enhancement. The only exception is that of the female breast implant. In augmenting the muscle size, it is usually most effective if the implant is placed on top of the muscle under its fascial lining. This is certainly true for muscular augmentations that are on the extremities such as the arms and legs. The gliding nature of the muscle inside the fascial sheath allows for a good dissection plane into which the implant can be inserted.

Bicep implants are one of the most uncommon body implants done. While men often seek out larger arm muscles, the appeal of a bicep implant remains limited. This is undoubtably due to the few surgeons that do them and the lack of a good implant which together offers limited public awareness and demand for the procedure. The shape of the bicep muscle is not unlike that of the calfs so the overall implant shape is largely cylindrical.

While there are no true marketed bicep implants, the most common form of them are known as contoured carving blocks. (Implantech) These solid implants come in half cylindrical shapes that go up to 2 cms in length and 6.5 cms wide. The maximal projections are around 2 cms. These implant dimensions will work for most. but not all, patients who seek upper arm augmentation.

custom-vs-standard-bicep-implants-dr-barry-eppley-indianapolisCase Study: This 45 year-old male was to undergo multiple body contouring surgeries, one of which was bicep implants. He was a larger man in stature so even the largest contoured carving blocks were inadequate. Custom bicep implants were made of dimenions 18 cm long, 8 cms wide and 3.5 cm in projection. The attached picture shows the difference between a preformed large bicep implant and that of the custom designed one.

right-biceps-implant-result-intraop-dr-barry-eppley-indianapolisUnder general anesthesia, the custom bicep implants were placed on top of the bicep muscle under the fascia through a high axillary incision.

custom-bicep-implants-result-dr-barry-eppley-indianapolisHis results at two months after surgery show good muscular augmentation with symmetrical implant positioning. The axillary incisions were well healed. He had no restriction of arm flexion or extension. He had just begun back to working out again.

While most bicep implants can be using conventional preformed shapes and sizes, larger men or those that seek more significant arm muscle size may need to consider the custom implant approach.

Highlights:

1) Bicep implants are soft solid implants that are placed in the subfascial location on top of the muscle through an axillary incision.

2) Bicep implants comes in several different sizes but larger dimensions requite a custom implant approach.

3) Custom bicep implants are made based on measurements of the patient arms in the partially flexed position.

Dr. Barry Eppley

Indianapolis, Indiana

September 19th, 2016

Case Study – Thick Skinned Revision Rhinoplasty

 

Background: Rhinoplasty involves changing the nasal shape through changes in the underlying bone and cartilage support. The only location for skin removal in a rhinoplasty is when the nostril width is reduced through various patterns of tissue excision.Thus in the large nose any reductive efforts and their results are heavily impacted by how well the overlying soft tissue shrinks down and around the reduced structural framework. This is also why in any rhinoplasty it may take up to a year to see the final result as the skin adaptation process can take this long to fully occur.

In the thick skinned nose, regardless of ethnicity, it can be a real challenge to achieve the rhinoplasty results many such patients want. This is particularly true when the overall goal is to make the nose smaller and have a more refined shape. This challenge is magnified when the patient has already had prior rhinoplasty surgery. The best chance for the nasal skin’s ability to shrink down is the first time before scarring forever limits what can occur with subsequent manipulations.

Case Study: This 35 year-old female presented with a history of two prior rhinoplasties by another surgeon. It was not clear what changes were done inside the nose but she felt that her nose was actually bigger after these two efforts than before any surgery was done. Her initial and revision rhinoplasties were done 15 and 9 months previously.

thick-nose-revision-rhinoplasty-result-front-view-dr-barry-eppley-indianapolisUnder general anesthesia an open rhinoplasty was performed. The nasal skin in the tip area was defatted and scar tissue removed. The lower alar cartilages were completely sewn together up to the middle vault without any evidence of resection. The lower alar cartilages were separated and releases, cephalic resections done and reshaped by dome suturing after the placement of a septal columellar strut cartilage graft. Nasal osteotomies were also performed.

thick-nose-revision-rhinoplasty-result-oblique-view-dr-barry-eppley-indianapolisthick-nose-revision-rhinoplasty-result-side-view-dr-barry-eppley-indianapolisHer results at just six weeks after revision rhinoplasty already show improvement in nasal shape even at this early postoperative time period. Further healing over the next year should continue to favorably improve the shape of the nasal tip.

The thick skinned revision rhinoplasty is a challenge and there are limits as to how much further improvement can be obtained. Thinning out the soft tissues of the nasal tip and proper supportive nasal tip cartilage reshaping can offer some improvement over prior rhinoplasty efforts.

Highlights:

1) The thickness of the nasal skin in any form of rhinoplasty poses limitations as to the quality of results seen.

2) Revision rhinoplasty in the thick skinned nose poses significant challenges in getting a smaller and more refined nasal shape result.

3) Defatting of the nasal tip and avoiding over resection or over plication of the lower alar cartilages can provide some narrowing of the thick skinned nose.

Dr. Barry Eppley

Indianapolis, Indiana

September 19th, 2016

Case Study – Forehead Horn Reduction

 

Background: The shape of the frontal skull bone known as forehead is an important aesthetic facial feature. Since the forehead occupies one-third of the visible face it is not surprising that it has significant aesthetic value even though it seems like it is just a flat a amorphous structure. In reality there are very distinct gender differences in the shape of the forehead as well as having a good proportion in size to the rest of the face.

The forehead can have a variety of aesthetic deformities or disharmonies. One such aesthetic problem is the forehead that is too big or protrusive. This is most manifest as an upper forehead bulge or protrusion. Known as frontal bossing the upper forehead sticks out and can even protrude further out than the eyebrows. This is almost always due to an overgrowth of skull bone.

A unique form of a forehead protrusion is that of the forehead horns. While the term horns usually implies a pathology due to a keratinized growth from the skin, forehead horns in frontal skull surgery refers to an overgrowth of bone. This is not to be confused with an osteoma which would never present in a paired or bilateral presentation and is an outcropping of new bone growth not just part of the normal development of the skull.. These paired upper forehead bony mounds may appear like two very distinct paired protrusion or may also have a ‘dumbbell’ appearance if a ridge of bone connects between the two of them.

Case Study: This 25 year-old male presented with concerns about the appearance of his upper forehead. He had two distinct bony protrusions of his upper forehead that were particularly obvious in certain lighting due to the shadowing that it caused. There was also a small horizontal ridge of bone that connected the two more prominent outcroppings of bone.

forehead-horn-reduction-dr-barry-eppley-indianapolisforehead-reduction-incision-dr-barry-eppley-indianapolisforehead-reduction-surgery-technique-burr-guarding-dr-barry-eppley-indianapolisUnder general anesthesia a 5 cm scalp incision was made about 1.5 cms behind his frontal hairline. With the edges of the hairline protected by sponges and using a guarded rotary instrument and burr, the forehead horns were reduced as well as the connection of bone between them. The incision was closed in two layers with no loss of any external hair shafts.

forehead-horn-reduction-surgery-intraop-results-top-view-dr-barry-eppley-indianapolisforehead-horn-reduction-surgery-intraop-results-side-view-dr-barry-eppley-indianapolisForehead horn reduction is accomplished by removing the outer cortex of the frontal bone. The only preoperative question is what incisional approach is to be used. There are three incision options; 1) a direct approach using a horizontal forehead wrinkle line, 2) a superior pretrichial incision or 3) a more posterior incision back behind the hairline. the first two incision options are the ‘easiest’ since the rotary instrument is on the same linear problem as the bony protrusions. The scalp incision adds a level of difficulty because it is ‘over the top of the hill’ so to speak and one has to change the angle of the drill to reach the bony forehead protrusions. Protection of the hair shaft and follicle also adds a difficult factor as well. But all three incisions can produce equally good forehead horn reduction results.

Highlights:

1) Forehead horns are a pair of congenital upper forehead bony skull protrusions that may or may not be connected.

2) They can be satisfactorily reduced through three different incisional approaches, all work equally well.

3) Bone burring is the corrective technique for forehead horn reduction.

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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