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Archive for the ‘brow bone reduction’ Category

Five Things You Did Not Know About Brow Bone Reduction

Friday, February 7th, 2014

 

Brow bone reduction is often aesthetically necessitated when the frontal sinus air cavities become too large. This is almost exclusively a male problem since the development of the frontal sinuses is highly related to levels of circulating testosterone and growth hormone during development. As a result, it is often associated with other strong facial bone features in men as well. Very strong brow bones due to frontal sinus pneumatization is almost never seen in women.

Brow Bone Reduction - Bone Flap Technique Dr Barry Eppley IndianapolisWhile brow bone reduction can occasionally be done by a burring technique, the thin cortex of the overlying brow bone does not allow for more than a few millimeters of reduction with that approach. More substantial brow bone reduction requires an osteoplastic flap technique whereby the bulging bone cover of the frontal sinus is removed, reshaped and then replaced. This can increase the amount of brow bone reduction by three or four times than of just burring the bone.

When it comes to brow bone reduction surgery, here are five things you may not have known about it.

Brow Bone Reduction and Browlift Surgery Are Related. The osteoplastic technique for making the brow bone less prominent requires an open incision and forehead flap turndown for exposure. Several types of browlifts also require an identical surgical approach through either a hairline or scalp incision. This also means that a browlift can be done with brow bone reduction if needed, which often is the case in Facial Feminization Surgery.

Brow Bone Reduction and Migraine Surgery Can Be Done At The Same Time. For those individuals that suffer from frontal migraines caused by supraorbital nerve compression, decompression of the nerve by stripping off the surrounding muscle and opening up the bony foramen can reduce symptom frequency and intensity. Working on the brow bones requires coincidental exposure of the supraorbital nerve, thus potentially solving an aesthetic and pain problem during the same operation.

Frontal Sinusitis Is Not Caused By Brow Bone Reduction. While the osteoplastic technique does expose the frontal sinus cavity, often not leaving the underlying mucosal lining completely intact. such exposure does not place one at increased for subsequent sinus infections. Almost every frontal sinus cavity that i have ever seen is completely healthy and no patient has ever reported a frontal sinusitis problem later.

Air Leaks Are Uncommon Sequelae from Brow Bone Reduction Surgery. By taking off the overlying bone and some mucosal lining with it, broad frontal sinus exposure does occur. But putting back the reshaped bone provides a near complete seal on most cases. When small openings around the replaced bone are seen, which is common, patching of them are done. This is accomplished by a variety of materials from temporalis fascia, bone cement or even bone wax. Despite these efforts, it is possible that extreme sinus air pressure (usually from blowing one’s nose) can open up a small hole (‘blow hole’) right after surgery. This is seen by the filling up of the forehead with air. Time and avoiding blowing one’s nose usually makes this a self resolving problem as the tissues eventually scar down.

Upper Forehead Augmentation May Be Needed When The Brow Bones Are Reduced. Some prominent brow bone patients have the opposite problem in the upper forehead. While the lower forehead may be too prominent, the upper forehead may be too recessed or sloped backwards. This can be simultaneously treated by building up the forehead above the brow bones with bone cement after the brows are reduced. The angulation of the forehead in profile should be assessed before surgery to avoid missing this aesthetic problem and the opportunity to simultaneously correct it. (the ying and yang of forehead reshaping)

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: One-Sided Brow Bone Reduction

Tuesday, November 12th, 2013

 

Background: Prominent brow bones are the direct result of the development of the underlying frontal sinus. While all of the frontal forehead bone above the brows is very solid and thick skull bone, the brows are made up of air with only thin bone in front and back of its thickness. The anterior or frontal part of the brow bone beneath the eyebrows is remarkably thin, often only being a few millimeters thick.

Brow bone reduction is done for two main reasons. Men who have large and very prominent brow bones often want them reduced to look less ‘Neanderthal-like’. Women  with larger brow bones or men to women transgender patients who want a softer and more feminine appearance may want their brows reduced and the tail of the brow bone reduced and flared upward. In some cases simple burring may be effective to achieve these goals but most of the time the outer table of the frontal sinus bone must be removed and reshaped to get a significant reduction. The thin outer bone of brow bone makes only a few millimeters reduction possible with burring.

When the frontal sinus is enlarged, it most always involves both sides of the brow bones. This is because the frontal sinus in most people is paired and exists under both eyebrows. But the frontal sinuses are rarely symmetrical and the septum that exists between them frequently deviates to one or other side, allowing for one frontal sinus to become larger than the other. This can account for the rare occurrence of asymmetrical brow bone hypertrophy.

Case Study: This 33 year-old male had one enlarged brow bone that had bothered him for years. He had no specific history of trauma to the area. It had just developed naturally that way. It created the appearance of a large knot or ball on his brow that also pushed down into the eye socket, giving it a swollen appearance. He had no pain or numbness over the brow area.

Under general anesthesia, a coronal scalp incision was made way behind his hairline. A full-thickness scalp flap was raised down to the underside of the brows exposing the enlarged brow bone. The supraorbital nerve was identified and preserved. A reciprocating saw was used to remove the brow bone prominence. Internal osteotomies were made to infracture the part of the brow bone that had expanded into the orbit. Burring was done around the osteotomy site to remove additional protruding areas. The removed brow bone was reduced, reshaped and placed back as a cover with resorbable sutures over the exposed frontal sinus. The scalp incision was then closed with a total operative time of less than two hours. He was discharged later in the day as an outpatient.

Immediately during surgery the change in the brow bone was apparent with improved symmetry between the two sides of the brow bones. He went on to heal uneventfully with a satisfied symmetrical brow bone result.

Case Highlights:

1) Brow bone hypertrophy most commonly occurs on both sides and rarely on just one side.

2) Brow bone reduction is done through an open coronal (scalp) approach by removal and reshaping of the bone overlying the enlarged frontal sinus.

3) Brow bone reduction has no adverse effect on the frontal sinus.

Dr. Barry Eppley

Indianapolis, Indiana

Patient Testimonials: Brow Bone Reduction/Forehead Reshaping

Sunday, August 25th, 2013

Brow Bone Reduction and Forehead Reshaping

‘Had brow bone and forehead bone reshaping done recently by Dr. Eppley. The results are amazing. I had a really big protruding brow bone that made me look like a Neanderthal man. The whole process was very smooth and transparent. A large amount of bone was removed, some of it was reshaped and put back. This way not only sinus size was reduced, but also brow bone on the sides and along orbits was made smoother. Recovery was very quick, I was able to return to work two weeks after the procedure. 

If you have this kind of forehead problem I would recommend this surgery. I would get a 3D CT scan, as Dr. Eppley suggested to me, to make the consultation more productive and results more predictable.

Victor Z.

Durham, North Carolina

Commentary

For brow bones that are really prominent, particularly in men, the only really effective reduction method is going to be the osteoplastic bone flap technique. The anterior wall of the frontal sinus (visible brow bone ridge) is very thin, often less than 3 or 4mms, so to expect a significant change from burring is not going to happen. The entire brow bones must be removed, reshaped and then put back in place. By so doing up to 10mms of brow bone setback can be achieved. But no matter how brow bone reduction is done it requires a scalp incision to do it. Whether it is way back in the hairline or along the edge of the frontal hairline (women only) a turn down scalp flap is needed.

While all of this sounds quite ghastly the procedure actually is fairly easy to go though and has a quick recovery. Most patients have little pain after surgery and the biggest issue is some eyelid swelling and occasional bruising. By a week after surgery most people look good enough to walk around in public or even be at work without detectable signs of  having had surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Forehead Augmentation for Correction of Pseudo Brow Protrusion

Tuesday, August 20th, 2013

 

Background: A brow bone prominence is largely a male feature caused by a greater pneumatization (expansion of air cavity) of the frontal sinuses than in women. While female brow bones are relatively flat, most men will have some degree of prominence or ridging that creates a brow bone break as it ascends into the forehead. Thus some degree of a brow prominence is well tolerated in men and may even be aesthetically desireable as a strong gender trait.

Excessive pneumatization of the frontal sinuses creates a brow bone prominence that extends well beyond the natural plane or slope of the forehead. Whether a brow bone prominence in some cases is excessive is a matter of personal judgment, in others it is so extreme that it is obvious. Brow bone reduction surgery, usually by an osteoplastic flap method, is the only effective treatment to reshape this lower portion of the forehead.

When considering whether brow bone reduction should be done, the shape of the forehead above it must also be considered. In many cases, the upper forehead is normal and setback of the brow bones is all that is needed. In other cases, a combination of brow bone setback and forehead augmentation produces the best profile change. In rare cases, the brow bone position is normal and it is the excessively sloped forehead that is the culprit. (pseudo brow bone prominence.

Case Study: This 35 year-old male felt he had too strong of a brow bone and disliked his forehead shape. He had a significant retroclined angulation to his forehead and this raised the question as to whether his brow bones had too much horizontal projection or that the forehead projection was deficient. Computer imaging was done to determine whether brow bone reduction or forehead augmentation produced a better forehead profile appearance.

Under general anesthesia, he had a coronal (scalp) incision placed way behind his hairline (16 cms) and raised to expose his forehead down to his brow bones. The forehead above his brow bones was built up using 50 grams of hydroxyapatite cement into a smooth transition into the upper forehead and staying within the temporal lines and off of the temporalis muscles. (fascia)

His after surgery result showed exactly what was predicted by computer imaging beforehand. He has a much better forehead shape and his brow bone prominence was ‘gone’.  Changing the slope of his forehead was the source of his aesthetic forehead deformity.

Of great interest for any man is the risk of adverse scarring from a coronal scalp incision. Scalp incisions in men must be done with the greatest of care and concern for the aesthetic outcome. The healing of his incision, as judged across the top where his hair was the thinnest, was amongst the finest that I have ever seen. (very hard to detect even on the closest of inspection)

Case Highlights:

1) A prominent brow bone can be the result of a recessed forehead. (pseudo brow bone prominence)

2) Computer imaging done in the profile view can determine whether forehead augmentation or brow bone reduction produces the better aesthetic facial result.

3) Forehead augmentation is done through an open scalp incision and can be done with either hydroxyapatite or acrylic bone cements.

Dr. Barry Eppley

Indianapolis, Indiana

The Uniqueness of Male Plastic Surgery – Facial Procedures

Saturday, June 15th, 2013

 

The facial aging process is one that is well known as everyone will eventually see it on their face. The eyes get heavy, the brows descend, the cheek fall, jowls develop and the neck sags. Women become concerned earlier in the aging process and proceed to do procedures to treat or slow it down in an overall more comprehensive manner. Men take a much more delayed approach to it often waiting until one facial area becomes a major concern or until the facial aging process is fairly advanced.

While the face ages largely similar in both men and women, the facial procedures used to treat them are often done differently. Not as many men have facelifts as their aging neck and jowls are more tolerated. But in men that have facelifts they must be done very carefully, respecting the natural hairlines of the temples and behind the ears and being careful not to displace the beard skin into the ear canal. Incisions must be placed very inconspicously and often less of a tightening result must be accepted to keep the scars hidden. That is not a bad thing as men look better underdone than having their faces pulled too tight anyway.

While men also develop heavy upper eyelid skin and lower eyelid bags just like women, their eyelid lifts (blepharoplasties) need to be done more conservatively. Browlift options in men are more limited due to the frequent lack of adequate scalp hair and a well defined frontal hairline. The most common male browlift method is through the upper eyelid (transpalpebral browlift) using the endotine device to accomplish the lift. This produces a very modest browlift but creates no visible scars and with more conservative eyelid skin and fat removals can avoid overfeminizing the male face and creating an unnatural overdone look.

Men do not engage in as many Botox and injectable fillers treatments as women as some wrinkles and signs of aging are more tolerated. A more natural result for men is one that reduces the worst of the wrinkles but does not eliminate all of them. This is the same reason men, at best, will only do a bare minimum of facial skin care. Many men would rather seek more definitive surgical procedures, or do nothing at all, that engage in non-surgical procedures that require frequent efforts to maintain.

Facial reshaping surgery is vastly different in men than women. Male rhinoplasties must keep a high and straight dorsal line and avoid an overly upturned tip while most women desire a smaller less projecting tip and lower dorsal lines. The shape of the face in men is dominated by a strong jaw and requests for chin, jaw angle and even total jawline enhancements are not uncommon to pursue a more masculine appearance and even the so called ‘male model’ look. Men favor higher more angular cheek augmentations while women prefer a lower more anterior rounded cheek prominence. Men pursue brow bone surgery for either reduction of an overlying prominent one or for augmentation to create a more masculine brow prominence and a more backward sloping forehead profile.

Plastic surgery for men has its own unique requirements both in the type of surgeries and the demeanor of the patients. One should not assume that every plastic surgeon or plastic surgery practice is equally adept about meeting the needs of the male patient. Just like breast reconstruction for women or body contouring after massive weight loss, the male patient presents unique challenges for a satisfying surgical outcome.

Dr. Barry Eppley

Indianapolis, Indiana

Forehead Feminization with Combined Brow Bone Reduction, Browlift and Hairline Lowering

Sunday, April 21st, 2013

 

There are numerous surgical procedures to feminize a masculine facial appearance. They include jawline reshaping (chin and mandibular angle reduction), rhinoplasty, cheek reduction, tracheal shave and forehead reduction/reshaping. While every transgender patient’s face is different and may need just a few or all of these facial feminization procedures, the forehead is one of the top considerations for most patients. The female forehead has a very distinct shape with a rounded contour from the brows up to the hairline with no obvious bone break.

Forehead reshaping incorporates reduction of the prominence of the central glabellar region as well as the projection of the brow bones. The brow bones must not only be deprojected but should also have the tail of them near the lateral orbit reshaped to have more of a sweeping effect up and towards the temples. Since this procedure requires an open scalp approach, this creates the oportunity to lower the frontal hairline as well. Together this type of foreheadplasty has a significant impact on the gender identification of the face.

The prominent glabella and brow bones are always due to the pneumatization of the front sinus. In cases of minor protrusion, the outer table of the frontal sinus can be simply burred down. Unfortunately this rarely can be successfully done due to the thin bone thickness overlying the frontal sinus. A few millimeters of change is rarely enough to make a noticeable external change. Most patients require the anterior wall of the bone to be removed, reshaped and repositioned back into place with resorbable sutures or metal microplates and screws. This method sets back the bulging bony prominence while preserving sinus function. The outer brow bone areas that lie outside of the sinuses can be reshaped as desired by burring.

When significant brow bone reduction is done (flattening of the bone), there is the potential for an excess of overlying skin. Loose skin on the brows can result in sagging or overlying brow ptosis. This can be easily addressed at the time of the brow bone reduction by a comcomitant browlift using the transcoronal or hairline incision made for access to the brow bones. An alternative approach is a direct browpexy from the galea below the eyebrows to underlying bone holes or the fixation plates (if used) above the reshaped brow bones.

A final component of the feminizing foreheadplasty procedure is the potential to simultaneously lower the frontal hairline. A long forehead (> than 6.5 to 7 cms between the brow and hairline) is unaesthetic for any gender but is particularly so in the male to female transgender patient. If a hairline approach (trichophytic) is used, a simultaneous scalp advancement can be done by securing the galea of the advanced scalp by sutures to bone holes in the outer table of the skull. By bringing the scalp forward, the lifted forehead skin will need to be trimmed creating a combined forehead skin reduction and browlift.

Ultimate feminization of the forehead can be done by simultaneous brow bone reduction, browlift and hairline lowering.

Dr. Barry Eppley

Indianapolis, Indiana

Postoperative Instructions for Brow Bone Reduction Surgery

Tuesday, April 9th, 2013

Most brow bone reductions need to be done through an open scalp incision. Unless the amount of brow bone reduction is very minimal (a few millimeters) the underlying frontal sinus must be factored into the operative technique. Brow bone reductioin can be done by burring, burring and infracture and removal of the brow bone with reshaping and replacement.

The following are the typical instructions for brow bone reduction:

1. Brow bone reduction is associated with a only a very moderate amount of pain in the first few days after surgery.  Narcotic pain medications are prescribed and use them if you need them. In a few days, you may switch to Tylenol or Ibuprofen or alternate between doses with the narcotic medication.

2.  There will be a circumferential head wrap placed right after surgery. This is in place to control extreme swelling and does not play a role in maintaining the new position/shape of the brow bones. You may take it on the next day after surgery. If it should get loose or come off during the night, just leave it off. It is not a critical part of brow bone reduction surgery.

3.  The sutures in the scalp incision are dissolveable and do not need to be removed. There is no need to apply antibiotic ointment to the incisions as all it will do is make your hair greasy and be hard to shampoo out.

4. Bruising and swelling will develop around the eyes after surgery which is perfectly normal. In some patients the eyes may almost swell shut by the second day after surgery.

5. You may shower and wash your hair 48 hours after surgery. There is no harm in getting your sutures wet with soap and water.

6. Your forehead will feel stiff and may not move normally for up to a month after surgery. It will also feel numb for even longer. This is all normal and as the feeling comes back in the forehead you will experience strange sensations such as shooting pains or itching as the nerves recover.

7. You may wear any type of hat around your forehead whenever you feel comfortable doing so.

8. There are no restrictions on normal daily activities after the surgery. You may do light exercise anytime afterwards that you feel comfortable. But no strenuous exercise that involves bending over for three weeks after surgery.

9.   You may drive within several days after the procedure, provided you are off pain medication and can react normally to driving conditions.

10.  If any redness, tenderness, or increased swelling develops on the forehead or around the eyes after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.

Consent for Plastic Surgery – Brow Bone Reduction

Monday, April 8th, 2013

Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the brow bone reduction procedure. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all, of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.

ALTERNATIVES

There are no alternatives to surgical reduction of he prominent brow bones. One potential alternative is to build up the forehead above it to make the whole forehead smooth.

GOALS

The goal of brow bone reduction is to reduce the brow bulging and bring the brow bones back into a smooth contour with the forehead that lies above it, if possible.

LIMITATIONS

The limitations of brow bone reduction is the thickness of the overlying anterior table of the frontal sinus and the size of the frontal sinus that lies beneath the bone. (inner half of the brow) The outer half of the brow bone is limited is reduction only the thickness of the skull bone.

EXPECTED OUTCOME

Expected outcomes include the following: temporary swelling and bruising of the forehead and eyes, a temporary or permanent numbness of the forehead and scalp, temporary weakness of the forehead muscles, and permanent scalp scars. It may take four to six weeks before the final shape and appearance of the brow bones is seen.

RISKS

Complications may include bleeding, infection (wound or frontal sinusitis),  poor scalp scarring, bone fixation palpability,  undercorrection of the brow prominences and brow asymmetry.

ADDITIONAL SURGERY

How the foerhead heals and the occurrence of complications can influence the final shape and appearance of the brows. Should complications or the desire to enhance the result further by additional surgery be needed, this will generate additional costs.

Endosopic Reduction of Prominent Brow Bones

Wednesday, March 13th, 2013

 

A prominent supraorbital or brow bone is known as bossing. While some degree of bossing is acceptable in men, it rarely is so in women. The shape of the lower forehead in men can have a brow bone prominence as evidenced by a brow bone break into the mid-forehead area. In contrast, women desire a smooth transition from the brow area into the forehead which requires no bossing.

While the brow bone looks and feels like solid bone, it is not. The brow bone and its outer shape is determined by the size or aeration of the underlying frontal sinus cavity. This creates a comparatively thin layer of bone over an underlying air space. Reducing frontal bossing, therefore, requires a knowledge of the thickness of the outer bone comprising it to determine how much it can be reduced and what is the best technique to do it.

The most common method of brow bone reduction is an open approach using either a burring reduction, an infracture technique or osteotomies and reshaping. Simple burring can be effective if the outer table of the brow bone is thick enough. This then raises the question of whether a burring procedure can be done short of using an actual open scalp method.

In the March 2012 issue of the Plastic and Reconstructive Surgery journal, an article was published entitled ‘Endoscopic Correction of Frontal Bossing’. In this paper, the authors performed a retrospective review of 10 patients who had the endoscopic procedure done over a seven year period. The degree of frontal bossing correction was rated as moderate improvement. No violation of the frontal sinus occurred in any patient. The limiting factor in achieving better outcomes was the thickness of the outer table of the brow bone.

Endoscopic reduction of the prominent brow bone requires two things; proper endoscopic instrumentation and frontal bossing that has thick enough bone. Adequate bone thickness has to be at least 5mms in thickness as determined by a lateral skull x-ray. A 1 or 2mm reduction is not going to make a noticeable difference. But a 3 to 4mm reduction will make a discernible reduction in the amount of frontal bossing. This determination can be done beforehand by tracing out the frontal bossing outline and seeing how the soft tissue profile changes as the bone is thinned.

Endoscopic reduction of the prominent brow bone is a safe and effective procedure. Its use, however, is restricted to a very few patients whose brow bone thickness allows visible improvement with a burring technique.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Reduction of Prominent Brow Bones in Men

Monday, January 30th, 2012

Background:One important aesthetic area of the forehead is the brow region situated at its lowest extent above the eyes. Men and women have different brow and forehead shapes that are considered desireable and gender specific. Females have non-protrusive brow bones that taper towards the temples on the sides and give a smooth rounded forehead appearance with no slope. In contrast, men have slightly more prominent brow bones that transition into a forehead that has more of a retroclined vertical slope. In essence, the masculine forehead is characterized by heavier more prominent eyebrows due to the greater growth of the brow bones.

The brow bones, while called a bone, is really not one at all. They are caused by the growth and size of the frontal sinus which lies beneath it. Surprisingly the outer layer of the brow bones, known as the outer table of the frontal sinus, is remarkably thin. While a big brow bone looks quite stout, it is usually only just a few millimeters thick. The bigger and more prominent the brow bones, the bigger is the air cavity of the frontal sinus.

While some brow bone prominence is desireable in a man, it can become too extreme. When the frontal sinus cavity grows too big, it causes a large amount of brow bone protrusion. Jutting out from the forehead in a very conspicuous manner, it gives the appearance often unflatteringly called the ‘Neanderthal’ or Cro-Magnon’ look. This can be reduced to a more aesthetic appearance but can not be done by a bone burring techniqiue.

Case Study: This 35 year-old male from Los Angeles California had been bothered by his large brows since he was a teenager. Even though he was successful at many levels from professional to personal, he still remained sensitive about his facial appearance, particularly in a profile view. He fully realized that reduction would require more than just bone burring and also understood that a scalp incision would be needed to do the procedure.

Under general anesthesia, a bicoronal scalp incision was made to expose the entire forehead and the large brow bones. The supraorbital neurovascular bundles were seen exiting the outer aspect of the brow bones and were dissected out and preserved.

The base of the brow bones was marked out where it joined the forehead bone. A burr was used to take down the bone at the base of the protrusion around its entirety with the exception of the lower edge. A reciprocating saw made an osteotomy at the base of the brow bossing and the entire anterior table of the frontal sinus was then removed.

The removed frontal bone flap was reshaped by multiple osteotomy cuts. This allowed the bone flap to be made straight by gentle pressure through microfractures. The bone flap was made completely flat from its natural convex shape.

The frontal sinus bone flaps were stabilized and then secured over the open sinus cavity with multiple microplates and screws. (1.0mm) The numerous small bone defects between the osteotomy cuts was filled in with a demineralized bone paste on top of a netting of resorbable collagen sheeting. The scalp flap was repositiond, 1 cm. of scalp skin and hair across the top removed for a coronal browlift and closed with resorbable sutures over drains.

The head dressing and drains were removed the next day. While there was some mild swelling, he had no periorbital bruising. Even being just one day after surgery and with brow swelling, his improvement was very visible. Further improvement would be expected over the next month as the swelling resolves and the tissues shrink down and adapt to the newly shaped brow bones.

Case Highlights:

1) Significant brow bone bossing or protrusion in men is a result of overgrowth or excessive pneumatization of the frontal sinus.

2) Reduction of large brow bones, brow bone reduction, can only be done by an osteoplastic bone flap technique with reshaping and repositioning with microplate stabilization.

3) Male brow bone reduction should not be overdone and some small amount of brow protrusion should remain.

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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