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Archive for the ‘buttock implants’ Category

Case Study – The Ultimate Buttock Makeover

Saturday, March 26th, 2016

 

Background: Aesthetic buttock deformities consist of two types of undesired structural changes. Inadequate volume is the far more recognized buttock problem which can occur from either inadequate natural development (or natural development that one sees an inadequate) or from volume loss due to aging or weight loss. The other is tissue sag over the infragluteal crease (known as banana rolls) which can also occur from aging and weight loss. An induced cause is a result of the sequelae from liposuction of the lower buttocks.

The treatment of lack of adequate buttock size is either fat injections (BBL surgery) or buttock implants. While fat and implants may seem interchangeable in buttock augmentation, they are not. Implants are reserved for those patients who simply do not have enough fat to do BBL surgery. When using buttock implants the decision is whether to go into or above the muscle. When placed in the intramuscular position, it is possible to combine fat injections with buttock implant surgery.

Lower buttock sag is occurs when the superior skin and fat ‘fall’over the fixed infragluteal fold. Buttock ptosis or sag can also occur when the infragluteal fold attachments are lost or disrupted. In either case, a lower buttock lift or tuck is done to remove the overhanging tissues and recreate a fixed infragluteal fold position.

Case Study: This 48 year-old male wanted to improve the appearance of his buttocks. He had lost some weight over the past several years and his buttocks had gone flat. He also did not like the tissue overhang on the bottom of the buttocks. (the sagging)

Ultimate Buttock Makeover intraop result one sideUnder general anesthesia in the supine position he initially had his abdomen and flanks aspirated of fat by liposuction. Once moved into the prone position his flanks was also aspirated. Total liposuction aspirate was 1,800ccs. Once processed by filtering and washing a total of 360ccs of concentrated fat was available for injection. Through an infraguteal incision, solid silicone 270cc buttock implants were placed in the intramuscular position. A lower buttock lift was done on each side removing a predetermined strip and skin and fat. Through suturing to the muscular fascia, the infragluteal fold was remade. Lastly, 180ccs of concentrated fat was injected in various locations of the buttocks that had not been previously undermined for the placement of the buttock implants.

Ultimate Buttock Makeover intraop left oblique viewUltimate Buttock Makeover intraop left side viewUltimate Buttock Makeover intraop result back view Dr Barry Eppley IndianapolisHis immediate intraoperative results showed a significant improvement in the size and shape of his buttocks. While the amount of fat that will be retained remains to be determined, the contributions of the buttock implants and the lower buttock lift will be retained.

This case of buttock augmentation demonstrates the concept of the ultimate buttock makeover. Between implants, fat grafting and a buttock lift, there is no more aesthetic changes that can be performed on the buttocks at one time.

Highlights:

1) Genetics and aging affects the buttocks like any other body area with loss of volume and sagging.

2) Intramuscular buttock implants can be combined with subcutaneous fat injection grafting for an overall buttock augmentation effect.

3) Buttock augmentation can be combined with a lower buttock lift to create the ultimate buttock makeover.

Dr. Barry Eppley

Indianapolis, Indiana

Injection Fat Grafting after Buttock Implants

Saturday, February 20th, 2016

 

Buttock augmentation can be done by two different methods. The most popular method today is the Brazilian Butt Lift (BBL), more generically known as fat injection buttock augmentation. It is popular because many people have excessive fat and this is a method of fat redistribution that creates improved body contours. Conversely buttock implants is less commonly done and with a longer recovery time.  It is reserved for those women who do not have enough fat for a BBL buttock augmentation procedure.

While often seen as an either/or approach, buttock implants and the Brazilian Butt Lift can be complementary to each other in certain patients. In women that do not have enough fat to harvest for a significant buttock augmentation effect, buttocks implants can be initially placed. Often this will be adequate for many patients. But for those buttock implants placed in the intramuscular location, the size limitations of the pocket or the lack of adequate lateral volume near the hip area may create a desire for a second stage fat injection treatment.

Fat Injections after Buttock Implants Dr Barry Eppley Indianapolis2nd Stage Fat Injections after Buttock Implants Dr Barry Eppley IndianapolisWhile the amount of fat a patient has may be inadequate for a full BBL procedure, most patients will have enough for a smaller contouring BBL procedure after buttock implants. A few hundred ccs of fat injected around the upper and outer perimeter of the buttock implants can create a fuller and more shapely buttock augmentation result. This is perfectly safe as the plane of the fat placement remains above the muscle and well away from the implant pocket.

Injecting around buttock implants that are above the muscle (subfascial plane) is a bit more treacherous. While fat injections can still be done, it is critically important the injected fat does not violate the implant capsule. If that should happen, there is a substantial risk of creating an implant infection.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Natural Contour Buttock Implants

Monday, December 21st, 2015

 

Background: Buttock augmentation is most commonly done by fat injections. But when not enough fat is available for transfer, buttock implants must be used. While buttock implants have an historic mixed reputation when done by surgeons experienced in doing them and with intramuscular placement, they have a good success rate with a low incidence of complications.

While improved buttock implant results are obtained by skilled intramuscular placement, this anatomic location poses some implant limitations. The intramuscular pocket is smaller and more restrictive than that of the more superior subfascial pocket. This means that smaller buttock implant volumes must be used. In addition the height of the implant needs to be lower to get a competent muscle closure over it.

Natural Contour Buttock Implant Dr Barry Eppley IndianapolisTraditional buttock implants have really been made for the subfascial plane with a very round shape and many larger size options available. The intramuscular pocket requires smaller implant sizes that has a lower implant profile. These type of solid silicone implants are known as natural contour buttock implants. They are available in sizes of 230, 285 and 330cc with implant projections of 3.2 to 3.6 cms.

Case Study: This 25 year female wanted augmentation of her upper buttocks which has become flat after an ill-conceived upper buttock lift.  The excision of upper buttock tissue may have provided a slight buttock lift but it also created a flattening effect. She did not have enough fat to harvest to do an adequate fat transfer.

Intraoperative Intramuscular Buttock Implant results 230ccUnder general anesthesia, she had intramuscular placement of 230cc natural contour buttock implants through bilateral intergluteal incisions. The intramuscular pockets were made through a muscle splitting technique. This added a nice upper pole fullness that was not too round or overly projected.

Natural Contour Buttock Implants results left side viewNatural Contour Buttock Implants results right side viewThe intramuscular placement of buttock implants fundamentally changes their long-term success rate. Like any implant in the face or body, the deeper it is placed and the more well vascularized tissue that covers it, postoperative complications are substantially decreased. But getting the implant into an intramuscular pocket and getting the muscle closed over it requires smaller volume implants with a lower projection.

Highlights:

  1. Buttocks implants are the only option for buttock augmentation in thinner patients that do not have enough fat to transfer.
  2. Natural contour silicone buttock implants provide an augmentation effect that is not abnormally round or looks like a ‘bubble.

3) Smaller buttock implants can compensate for upper buttock volume loss after a superior buttock lift.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Buttock Implants in Asian Buttock Augmentation

Sunday, November 8th, 2015

 

Background: Buttock augmentation is the fastest growing body contouring procedure in the U.S. which is primarily done by fat injections. Known as the Brazilian Butt Lift (BBL) it is a natural procedure that has a coincidential body contouring effect from the liposuction areas. (primarily abdomen and flanks) When adequate fat is available this is the clear choice for buttock augmentation.

But not all patients that desire buttock augmentation have enough body fat to use. This is particularly true in the Asian population where many females are smaller and thinner and rarely are great candidates for the BBL procedure. This leaves buttock implants as the only buttock augmentation option in the fat deficient patient. While necessitating a longer recovery period, buttock implants offer an assured buttock augmentation result.

Buttock implants can be placed above the gluteus maximus muscle or inside the muscle. (intramuscular location) While there are advantages and disadvantages to either location, deeper placement of the implant  usually offers a long-term result with fewer potential complications. This is particularly true in the Asian female who usually has little subcutaneous tissue and a subfascial location will end up with a visible implant outline show.

Case Study: This 35 year old Asian female wanted buttock augmentation to correct a very flat buttock shape. She had no visible buttock contour and was very flat across the upper and lateral buttock surface.

Kelly Buttock Implants result back viewUnder general anesthesia she had natural contour silicone gel low profile buttock implants (300cc in size) placed in an intramuscular position. This was done through a single intragluteal incision of 7 cms in length.

Kelly Buttock Implants result side viewHer six months results show an uncomplicated buttock implants augmentation result with a visible improvement in the size and shape of her buttocks. The intergluteal incision was well healed with a slight widening of the scar line

Natural Contour Silicone Buttock Implants Dr Barry Eppley IndianapolisButtock augmentation in the Asian female often requires the use of buttock implants. Because their buttock augmentation goals are often more modest and designed to improve a flat buttock contour, large buttock volumes are not needed. Buttock implants provide the most assured method when there is a thin subcutaneous fat layer. To avoid an unnatural and too round of a buttock augmentation result, the lower profile natural contour buttock implant is an excellent choice for an intramuscular implant placement.

Highlights:

  1. Buttock implants are the only option for buttock augmentation in the fat deficient patient.
  2. Buttock implants offer assured buttock volume retention albeit with a more significant and prolonged recovery.
  3. The intramuscular location of buttock implants limits the ultimate size of the buttock augmentation result.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Brazilian Butt Lift

Monday, October 26th, 2015

 

Brazilian Butt Lift Dr Barry Eppley IndianapolisBackground: One of the most commonly requested body contouring surgeries today is that of the Brazilian Butt Lift.  (aka BBL) While sounding both Brazilian and touting a butt lift, it is really buttock augmentation by fat injections. Fat is derived from liposuction of any body area that one wants reduced. The buttock augmentation is then done by processing the harvested fat in a concentrated fashion and then injecting it in a dual plane location both at the subcutaneous as well as the intramuscular buttock locations.

While may patients have an ideal or dream goal for their buttock augmentation, the limiting factor is always how much fat does one have to harvest. Thinking in an incrementally decreasing fashion, the final result of any BBL procedure is a function of the original fat harvested reduced by a factor of 4. Less than half of the fat aspirate harvested will be able to be used for injection. (in females the capture rate for the injectate is usually about 40% of what is harvested) Then, on average, if only 50% of the fat survives that will be the final buttock augmentation retained. Thus, for example, a 2000cc fat harvest becomes 400cc injected per buttock with the final volume retention of 200cc. That would be a small but noticeable buttock augmentation improvement.

Case Study: This 32 year old female desired a Brazilian Butt Lift procedure. She wanted the fat harvested from her abdomen and flanks which she had been unable to lose since her pregnancies. She approached her BBL surgery with the concept that the most important goal was the waistline contouring and any increase in her buttock size would be a bonus.

Brazilian Buttock Lifts result front view Dr Barry Eppley IndianapolisUnder general anesthesia power-assisted liposuction (PAL) was used to harvest far from her abdomen and flanks. A total of 1,875cc f far aspirate was obtained. When filtered and double washed with Lactated Ringer’s solution a total of 700cc of concentrated fat was availablee for injection. That was split between her two buttocks for a total of 350cc per side.

Braziilan Buttock Lift results oblique view Dr Barry Eppley indianapolisBrazilian Butt Lifts results side view Dr Barry Eppley IndianaoplisAt three months after surgery her buttocks showed a nice shape improvement with an overall modest size increase. Much of her buttock dimpling had been improved. Her apparent buttock size increase is as much a function of the waistline reduction as it is the actual increase in buttock size. This dual effect creates  the BBL result for many patients who have less than large amounts of fat to harvest.

Highlights:

1) The success of a Brazilian Butt Lift depends on how much fat one has to harvest and how well it survives.

2) For many patients the success of Brazilian Butt Lift surgery is a function of the waistline narrowing above and the buttock augmentation below the waistline.

3) Many BBL surgeries (fat injections buttock augmentation) surgeries produce noticeable but more modest improvements which are quite satisfying to the patient.

Dr. Barry Eppley

Indianapolis, Indiana

Incisional Techniques for Buttock Implants

Saturday, August 29th, 2015

 

Buttock augmentation has become a procedure today that almost rivals that in public interest and in procedures performed like that of breast augmentation. By far the most common method of buttock augmentation uses the patient’s own fat as an injectable technique known as the Brazilian Butt Lift. (BBL) But not everyone is a candidate for a BBL due to either lack of fat for adequate injectable volume or has been through a BBL procedure where the fat has not adequately survived.

Buttock implants offers a method of buttock augmentation that exerts its effect by the placement of a non-degradable solid silicone implant. While it is a far more invasive procedure and has a longer recovery, it offers a permanent buttock size increase.

The biggest ‘controversy’ in buttock implants is the pocket location as to whether it is on top of the muscle (subfascial) or inside the gluteus muscle. (intramuscular) This decision has great relevance for options in implant size  and the risk of long-term complications. Intramuscular buttock implants permit only smaller implant sizes but have a better long-term prognosis and lifespan. Subfascial buttock implants permit much larger sizes but has a potentially higher rate complications. (e.g.,s seroma, implant visibility)

One controversy of buttock implants that is less written about or addressed is that of the incision used to place them. All buttock implants are placed through an intergluteal incision that should stay below the superior end of the crease to remain hidden. When one considers that the most common complication of buttock implants, regardless of pocket location, is wound dehiscence or incisional separation, how the incision is made and closed has considerable merit.  While usually a self-healing problem, an intergluteal incision can take a long time to heal and potentially exposes the implants to contamination and risk of infection.

The intergluteal incision for buttock implants can be placed as a single midline technique or a double parallel off midline incisional technique. Each has their own advantages and disadvantages.

Single Incision Buttock Implant Approach Dr Barry Eppley IndianapolisThe most commonly used intergluteal incision is the single midline technique. This has the advantage of a more limited single scar of usually 6 to 7 cms length and both right and left buttock implants can be placed through it. But it does expose both sides of the implant pockets to each other (less significant if the implants are placed intramuscular) should incision breakdonw occur. The incision is also located at the greatest site of wound tension and shearing and, as a result, has a 20% to 30% incidence of some degree of wound separation.

Double Incision Buttock Implant Approach Dr Barry Eppley IndianapolisThe double intergluteal incision technique uses two separate parallel incision 6cm to 7 cm in length that are off the midine by about one centimeter on each side. While requiring double the time to close the incisions, it keeps the two implant pockets separate by a healthy bridge of tissue. The incisions are also located in intergluteal buttock skin that is more pliable and elastic and less prone to separation by shearing forces.

Both the single and double intergluteal incision techniques can be used very successfully in buttock implants. Both seem to scar well and neither in my experience has necessitated scar revision due to their healed appearances. But I tend to favor the double incision technique as it has less risk of postoperative wound dehiscence problems which makea a patient’s recovery quicker and less problematic.

Dr. Barry Eppley

Indianapolis, Indiana

Subfascial vs. Intramuscular Buttock Implants

Monday, April 20th, 2015

 

Buttock Enlargement Dr Barry Eppley IndianapolisButtock augmentation has gained tremendous popularity as a surgical procedure in just the past decade. This has largely been due to the use of fat injections for buttock augmentation, an approach that offers a diametric effect with enlargement of one body area (injection site) and reduction of many other body areas (liposuction harvest) during the same procedure. While buttock implants have been around much longer, their use is a fraction of that of fat injections due to a more invasive procedure with greater risks and a longer recovery.

But despite the popularity and success of buttock fat injections (aka the Brazilian Butt Lift or BBL), it is not for everyone that desires buttock enlargement. The biggest reason is lack of adequate fat to harvest. Thin or even medium build patients may not have enough to harvest by liposuction to make an immediate or sustained buttock enlargement result. Gaining weight for a BBL can be a flawed approach since such fat volumes can be lost after surgery with dieting an exercise.

Buttock implants will continue to play a small but important role in buttock augmentation. And more buttock implants are done today than ever before because of the overall societal desire for larger and more shapely buttocks. But the rise in buttock implant procedures has given risen to some misunderstandings with their use. The main issue to consider is the pocket into which they are placed. Understanding the implications  between subfascial and intramuscular location is the most important buttock implant decision.

Subfascial Buttock Implants result back viewSubfascial Buttock Implants result right oblique viewThe subfascial buttock implant location has several advantages. It is technically easier for the surgeon to perform, has somewhat shorter and less uncomfortable recovery and permits the placement of much larger buttock implant sizes. Its disadvantages are that the development of seroma and the risks of infection are higher. The use of postoperative drains are critical to educe these risks. In addition, the occurrence of capsular contracture  and implant ‘show‘ is also higher as well as that of chronic discomfort. An important anatomic key is that one should have good soft thickness between the skin and the deeper fascia for this buttock implant location.

Intramuscular Buttock Implants back view Dr Barry Eppley IndianapolisIntramuscular  Buttock Implants right side view Dr Barry Eppley IndianapolisThe intramuscular buttock implant has several advantages. It has a lower risk of seroma and infection due to a partial muscular cover. It also has no risk of implant show and probably has the best long-term retention due to its thicker soft tissue cover. Its disadvantages are that it is technically harder for the surgeon to master, limits the size of implant that can be placed (rarely bigger than 350ccs) and has a longer and more uncomfortable recovery. Patients that have thin tissues over the buttock with a scant subcutaneous fat layer or only want a more modest buttock augmentation result are the best candidates for the intramuscular implant position.

As can be seen by their various advantages and disadvantages, buttock implant augmentation results are highly influenced by the pocket location. Besides the recovery, the biggest difference is the size of the implant that can be placed.

Dr. Barry Eppley

Indianapolis, Indiana

Subfascial vs. Intramuscular Buttock Implants

Saturday, March 7th, 2015

 

voluptuous back in pink pantiesThe use of implants is one effective method for buttock augmentation. It is far surpassed by fat injections (aka Brazilian Butt Lift, BBL) in number of buttock enhancements done, however, due to the appeal and usual availability of adequate fat to harvest to do the procedure. The exact numbers are not known but I would estimate that for every 25 to 50 BBL surgeries done in the U.S.,  only several buttock implant procedures are done. It is probably a 10:1 ratio of BBL to implant surgeries.

But the tremendous rise of BBL surgeries has also led to an increase in buttock implant surgeries. This is because some people are not good candidates for fat injections because they do not have an adequate donor source of material. There may also be some ‘failures’ in BBL surgeries due to fat absorption and minimal augmentation outcomes as a result.

Buttock Implants Augmentation Dr Barry Eppley IndianapolisButtock implants is the most reliable method of buttock enhancement because the implant’s volume is stable and does not change after surgery. Unlike BBL surgery, implants can achieve only a certain amount of augmentation due to the limits of implant sizes made and the tissue pockets that can be created to contain them.

Like breast implants, there are two locations in which the buttock implants can be placed. Buttock implants can be placed either intramuscular (not beneath but inside the gluteus maximus muscle) or subfascial. (above the gluteus maximus muscle) There are advantages and disadvantages to either implant location. Neither implant location is necessarily better than the other and each patient must be considered individually based on their buttock shape, tissue thickness and their buttock enhancement goals.

Subfascial Buttock Implants Dr Barry Eppley IndianapolisSubfascial Buttock Implants Indianapolis Dr Barry EppleyHistorically subfascial buttock implant placement has been most commonly done. It is somewhat simpler to technically perform, has a less painful recovery, and enables the largest buttock implant sizes to be placed. Since the implant is more superficial with less tissue coverage, it is best to place in patients that have some subcutaneous fat tissue thickness. Its disadvantages are that it has a higher rate of infection and seromas and the outline of the implants could be more visible. If intergluteal wound dehiscence occursm the implants are at greater risk of infection. It also has a higher long-term risk of tissue thinning and greater implant profile visibility.

Intramuscular buttock implants is becoming a more common surgical technique but it is still done far less than subfascial buttock implants. It has the advantages of providing good vascularized tissue coverage of the implants and has a lower risk of infection and seroma formation as a result. Because the implants are placed deep, one can still have fat injections done above them for further augmentation later if desired. Its disadvantages are that it is a more ‘complex’ surgical technique to master and its is more painful with a more difficult recovery in the first few weeks after surgery. Its most limiting aspect is that the intramuscular space offers only a limited capacity to handle implant size with the upper limits in the 300cc to 350cc range.

Buttock implants will never rival fat injections but they have a significamt role to play in buttock augmentation. They remain as the only option for those patients that have inadequate fat stores for the BBL procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Intergluteal Skin Closure in Buttock Implants

Sunday, February 8th, 2015

 

Buttock implants today are becoming increasingly done using the intramuscular technique. While this implant is better long-term due to an increased well vascularized soft tissue cover,  it is not complication free. It is still exposed to potential infection, hematoma and seromas like the subfascial implant location…although at a much lower rate.

But the one complication that persists, regardless of buttock implant location, is wound dehiscence. Using an intergluteal incision places it in a fairly hidden location but one which is exposed to high shearing forces afterward. Separation of the intergluteal incision is not rare and, although the implant should be covered by a musculofascial closure, it does potentially expose the implant to infection from either skin or stool bacteria through the not yet fully healed dissection planes.

In the January 2015 Global Open issue of the journal Plastic and Reconstructive Surgery, a paper entitled ‘Case Study: Reduction of Gluteal Implant Infection Rates with Use of Retention Sutures’. To prevent the intergluteal wound incision, the authors used a simple  closure technique combined with intramuscular gluteal implantation to help reduce tension and wound dehiscence and ultimately lower infection rates. After intramuscular implant placement, a three layer closure was used, 0 Monocryl in the gluteal fascia, 2-0 Monocryl in the dermis, and 3-0 chromic simple running stitch in the skin layer. Final layer of closure of the gluteal flap included the use of retention sutures of 2-0 nylon tied over 2-cm pieces of silicone tubing cut from Jackson Pratt drains along the sacral incision. Drains were removed after one week. The retention sutures were removed at three weeks. Patients returned to full activities at six weeks. In three patients treated with this closure technique they all healed uneventfully.

There is little question that having a competent intergluteal incisional closure will help reduce complications from buttock implants. Different surgical wound closure techniques can be used, and they all can be successful, as long as great effort is protect the skin incision against postoperative shearing forces. The technique described in this paper is a good one and will be as successful as any. I use an additional suture layers between the gluteal fascia closure and the dermis to quilt down the dead space from the subcutaneous dissection. After dermal suturing, I use permanent horizontal mattress sutures and leave them in for weeks.

While the development of buttock implant complications can arise from many different reasons, striving to achieve an incisional closure is a simple and inexpensive technique that is withe small amount of extra operating room time to do.

Dr. Barry Eppley

Indianapolis, Indiana

Treatment of Buttock Implant Displacement

Saturday, October 11th, 2014

 

Buttock Implants Indianapolis Dr Barry EppleyButtock implant augmentation has historically been plagued by a high rate of complications. Since the intramuscular technique for implant location was introduced in the mid-1990s, the rate of complications has decreased and more natural and long-term results have been obtained. Its advantages over the subfascial location has led to more patients considering the procedure although it is important to realize there are size limitations of the implants that can be placed (300cc to 350ccs) due to the greater restriction of the intramuscular pocket space.

But with the increase in the numbers of such buttock implant surgeries being performed has come a new set of complications unique to the procedure. While incisional dehiscence and seroma are still the most common postoperative problems that can occur, implant displacement out of the intramuscular pocket (herniation) is now being recognized as another potential complication that can occur.

In the October 2014 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘Gluteal Implant Displacement: Diagnosis and Treatment’. The purpose of this paper was to describe, classify and standardize the treatment of buttock implant displacement. A cadaver study was done to determine the least intramuscular overlying muscle thickness needed for safe intramuscular dissection. This was shown to be a minimum of 2 cms. Over a three year period, 24 patients were treated for visible buttock implants. Treatment consisted of implant removal, radial capsulotomies, capsular pocket plication, and intramuscular pocket dissection. An anchoring suture was placed at the lateral edge of the muscle incision to prevent muscle rupture during implant insertion. This one-stage approach for implant relocation resulted in only one implant (3%) out of 47 patients that subsequently developed displacement back into the more superficial pocket.

Buttock Implant Surgical Technique Dr Barry Eppley IndianapolisButtock implant complications in the subfascial space (usually seroma) or the intramuscular space (herniation) can be difficult problems to correct. Herniation out of an intramuscular pocket can be associated with implant visibility, pain and recurrent seroma formation. Very much like relocating subglandular breast implants into the submuscular pocket, slipping back into the old pocket is always a possibility. Keeping a limited incisional approach to the intramuscular space is critical and this suture placement is one method to do so. This study shows that successful resolution of buttock implant herniation can be done with a high success rate.

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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