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Archive for the ‘chin implant’ Category

Case Study – Three Implant Jawline Augmentation

Thursday, October 27th, 2016

 

Background: Creating a stronger male jawline can be done by a variety of methods, most of which are done by permanent implants. While many plastic surgeons still think that the approach to a better jawline comes from chin implant augmentation alone, that approach excludes any consideration of the back of the jaw which makes up two-thirds of its structure. A more contemporary treatment approach takes the whole jawline into consideration.

The traditional jawline augmentation approach uses three standard styles and sizes of facial implants. This include a chin and two jaw angle implants. The choices for chin implants are either a more commonly used anatomic or convex implant shape and a more square formed shape style. Jaw angle implants can be either a widening or vertical lengthening style. Historically only the widening jaw angle style was available but newer vertical lengthening styles offers a better option for those patients with high jaw angles.

The advantage of a standard three implant jawline augmentation are economy and time efficiency. Unlike a custom implant which requires a 3D CT scan and a month to design and manufacture, standard facial implants are available off the shelf and at a lower implant cost. The one aesthetic disadvantage is that the implants are not connected so there will be an indentation along the jawline between the chin and the jaw angles. For some patients this may not be an aesthetic detraction and may even be a desired effect.

Case Study: This 25 year-old male wanted a stronger jawline with a more square chin and wider jaw angles.

standard-chin-and-jaw-angle-implants-result-front-view-dr-barry-eppley-indianapolisUnder general anesthesia, a medium square chin implant was placed through a submental skin incision. Widening jaw angles of 7mms were placed through bilateral intraoral incisions.

three-piece-chin-and-jaw-angle-implants-result-oblique-view-dr-barry-eppley-indianapolisthree-piece-chin-and-jaw-angle-implants-result-side-vuew-dr-barry-eppley-indianapolisHis postoperative result showed a satisfied patient with a more defined jawline. The chin was more square and the jaw angles wider. The jaw angles even had a slightly more increased vertical length to them by a few millimeters.

As long as the patient can accept a non-connected jawline look through chin and jaw angle implant augmentation, the use of standard implants can be an effective total jawline augmentation approach.

Highlights:

1) Total jawline augmentation consists of increasing the dimensions of the its three main points, the chin and the two jaw angles.

2) A three implant approach to total jawline augmentation includes the use of a square chin implant and two jaw angle implants.

3) A three implant jawline procedure creates a three point augmentation with an intervening concavity of the body of the mandible.

Dr. Barry Eppley

Indianapolis, Indiana

OR Snapshots – Vertical Lengthening Genioplasty

Wednesday, October 19th, 2016

 

Chin augmentation is traditionally thought as a choice between a chin implant and a sliding genioplasty. While seen as the two procedure choices for chin reshaping they are not really interchangeable. Besides the difference between synthetically augmenting the bone vs actually cutting and moving the bone, they can achieve different dimensional chin changes.

The one movement that a sliding or bony genioplasty can do much better than an implant is changing the vertical dimension of the chin.  While it is obvious that an implant can not shorten the chin, it historically could not lengthen it very well either. That has changed more recently with vertical lengthening chin implant styles. But the intraoral genioplasty remains an historic mainstay for increasing the vertical length of the lower face. (chin)

vertical-lengthening-genioplasty-intraop-dr-barry-eppley-indianapolisDone through an intraoral mucosal incision, the chin bone is cut well below the level of the lower tooth roots. An opening wedge is performed by dropping down the chin bone to the desired vertical distance that is needed to create the aesthetic result. In most cases the vertical gap that needs to be created is at least 7mms. Much less does not produce a very obvious vertical lengthening. The amount the vertical gap can be opened is only limited by the length of the fixation plate used and what other chin dimensions need to be changed if any.

A debatable issue with vertical chin lengthening is whether the bone ago created between the two chin segments needs to be filled in. In small gaps in the range of 5mms or less grafting of the defect is probably not needed. The body will fill it in on its own. But larger bone gaps should be grafted. I prefer to use allogeneic cadaveric bone grafts which conveniently come in wedge forms that can fit nicely as an interpositional bone graft.

Case Study – Chin Implant Revision

Monday, July 25th, 2016

 

Background: The most common facial augmentation procedure is the chin implant. It has been done for over fifty years with the silicone implant as the most common device used for most of this time. It is often combined with a rhinoplasty but can also be done along or in conjunction with anti-aging procedures like a facelift or other face and jawline procedures like jaw angle implants.

Chin implant designs have evolved over the years with the standard style now used being an extended or anatomic shape. These longer wings that go back along the jawline from the central area of projection allow a smoother transition into the jawline without an obvious ‘bump’ sitting on the chin. This creates a more natural chin augmentation result.

But these extended wings on a chin implant have some potential disadvantages as well. They require a longer dissection along the jawline for the wings to fit. And great attention has to be paid to their symmetrical pocket development and placement. A slight degree of tilt to the implant can have the back end of the wings more significantly displaced up or down. In fact the number one complication of such chin implants today is wing asymmetry.

Chin Implant Malposition Dr Barry Eppley IndianapolisCase Study: This 60 year-old female had a prior history of a chin implant placed several years ago. She developed problems with chin asymmetry, a bulge in the right intraoral mandibular vestibule at the gumline and stiffness in moving the lower lip which also had some asymmetry.

Chin Implant Revision with Screw Fixation Dr Barry Eppley IndianapolisUnder general anesthesia through her existing submental scar, the chin implant pocket was opened and the implant removed. The implant had its right high up on the right side and low on the left side creating  a clockwise tilt. The right implant pocket was opened up and lowered while the left implant pocket was opened and raised. The wings on the implant were shortened 7mms per side and placed in the midline and secured with a single 2.0 x 10mm screw. Closure was done in three layers.

Chin Implant Revision Surgery results Dr Barry Eppley IndianapolisThe improvement in the appearance of the chin became evident as the swelling subsided over the first postoperative month. The chin was more symmetric as was the lip. The lip also moved more naturally. The chin will take several months to feel more soft and to have normal mentalis muscle function. There may also be some chin pad indentations develops as the part of the implant pocket that is no longer used needs to shrink back down to the bone. These chin pad soft tissue irregularities should eventually subside.

Many chin implant revision cases s are due to an asymmetry caused by a tilt of the implant (yaw) or a side to side shift. While the best way to prevent this from occurring is to secure it firmly when initially placed, this becomes doubly important when repositioning the implant during a chin implant revision.

Highlights:

1) Extended style chin implants can develop asymmetry by malposition of their long wings.

2) Repositioning an asymmetric chin implant (chin implant revision) is best stabilized by screw fixation in its new position to prevent relapse.

3) The extended chin implant can have its wings shortened if that is aesthetically advantageous at the time of repositioning.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Chin Implant Revision

Saturday, May 21st, 2016

 

Background: Chin augmentation is one of the original facial reshaping surgeries and has been performed for decades. Whether done through the mouth or done from an incision below the chin, the fundamental concept is that an implant is placed over the central aspect of the lower chin bone. (pogonion)

While the basic technique for chin augmentation has not changed over the years, the styles of chin implants has. Chin implant shapes have evolved to be large with long lateral wings. Known as anatomic chin implants, these lateral wings are added to the implant to allow it to transition more smoothly into the lower border of the jaw behind the chin.

While this lateral wing concept has its merits, it is also prone to creating chin implant asymmetry. Even slight amounts of chin implant rotation can cause the end of the wings to be asymmetric. The higher wing can even be felt inside the mouth as it encroaches into  the vestibule and may even put pressure on the mental nerve.

Chin Implant MalpositionCase Study: This 67 year-old female had two previous chin implants. An initial larger implant was placed two years ago and subsequently downsized due to dissatisfaction with its size. Once the swelling subsided the patient noticed an asymmetry of the chin with a higher wing on the right side.  The implant asymmetry was seen externally across her chin. She could feel it inside her mouth at the gumline on the right side which caused intermittent tingling and numbness sensations on the right side of her lip.

Chin Implant Malposition surgery Dr Barry Eppley IndianapolisChin Implant Repositioning surgery Dr Barry Epley IndianapolisUnder general anesthesia, her chin implant was approached through her existing submental incision. The chin implant was found to be located about 1 cm above the lower border of the chin bone and the midline shifted to the right with obvious canting of the implant. The implant was removed, the lateral wings reduced and the implant pocket adjusted. The chin implant was out back in a central position lower on the bone and secured with a single 1.5mm screw.

Chin implant malposition is especially prone when a large implant is replaced with a smaller one. The smooth surface of silicone implant makes it especially prone to sliding around on the smooth underlying capsular layer. This is where the value of placing a single screw ca be invaluable in its prevention and/or correction.

Highlights:

1) Chin implant malposition is not an uncommon complication of chin augmentation surgery.

2) With today’s winged chin implants, asymmetry of the lateral wings of the implants can easily occur.

3) Chin implant revision surgery creates a new pocket for the implant and secures it centrally with a screw placed in the midline.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Square Chin Implant

Saturday, May 14th, 2016

 

Background:  Chin augmentation is one of the most popular lower facial reshaping procedures and has been so for many decades. Its benefits are most commonly perceived in the side profile demonstrating increased horizontal projection of the chin. While changes in how far the chin projects forward is one of the most important benefits of a chin implant, that view alone is an inadequate perception of the overall chin augmentation  effect.

Chin augmentation should be seen as a 3D procedure and not just a 2D one. This takes into account the frontal view as well, assessing the vertical and transverse dimensions. The frontal view of the chin includes its width which is highly gender specific. The female chin ideally has a amore narrow and tapered shape. Conversely the male chin is wider, more angular  and can even have a square shape.

While there are numerous styles of chin implants, they have only two basic frontal shapes…convex and square. The square chin implant is unique in that it maintains a square shape when applied to the front edge of the chin bone which is usually convex. It does so because it is thicker on the sides of the chin so when pressed against the bone it maintains a square shape.

Case Study: This 45 year-old male had a chin implant placed several years previously through an intraoral approach. While it did improve his profile, he had been unhappy with how his chin looked straight on and he also felt it was sitting too high. He wanted more of a masculine square chin shape.

Chin Implant Removal Dr Barry Eppley IndianapolisChin Implant Replacement Dr Barry Eppley IndianapolisUnder general anesthesia, his existing chin implant was removed through a submental skin incision. The implant was positioned high and was asymmetric in position. It was a central style of chin implant that was curved with no lateral wings. It was replaced with a style 1 square chin implant of similar anterior projection thickness. (7mms) A centrally placed 2 x9mm screw was inserted to ensure its central position low on the chin bone.

Square Chin Implant replacement result Dr Barry Eppley IndianapolisA square chin implant is uniquely made for men who desire a wider and more angular chin shape. It comes in two widths known as a style 1 and style 2 chin. In the style 1 the square chin width is 45mms and in the style 2 the square chin width is 55mms. Which style of square chin width is best for each patient depends on the horizontal width of their mouth and how strong they want the square chin to appear.

Highlights:

1) Chin implants come in both different styles as well as sizes.

2) When considering chin augmentation how the chin will look in the frontal view is often overlooked.

3)  For men who seek a more angular and wider chin look, the square chin implant can help achieve this type of frontal chin shape.

Dr. Barry Eppley

Indianapolis, Indiana

The Vertical Lengthening Chin Implant

Sunday, January 24th, 2016

 

Chin augmentation is the most historic but still the most commonly performed facial augmentation procedure. While many other types of facial implants have been developed, increasing projection of a deficient lower face is still the most potentially dramatic facial augmentation change of them all.

Chin implants have evolved considerably over the past few decades with numerous new styles. The fundamental concept of these style changes has been to create a more natural chin augmentation look or augment different regions of the chin area. But the one constant of all the chin implant styles is that they create a straight horizontal dimensional increase. This is so because all of the implant remains on the front edge of the chin bone.

But some chin deficient patients have more than just a horizontal bone deficiency. Certain short chins are also vertically deficient as well. Historically the only surgical method to substantially increase chin height was an opening wedge sliding genioplasty.  While effective some patients would prefer to avoid a bone cutting surgery.

While it is true that a standard chin implant can be placed very low on the  bone(on its ledge so to speak), this is not how the implant is designed or made to be used. This makes it potentially unstable to sit on the lower end of the bone and, even in doing so, produces a a very limited vertical lengthening effect.

Vertical Lengthening Chin Implant vs Standard Chin Implant Dr Barry Eppley IndianapolisTo address the combined horizontal and vertically lacking chin with an implant, the vertical lengthening chin implant (Implantech) has been developed. What is unique about this chin implant style is that the projection of the implant goes down from the chin at 45 degrees. This creates a combined horizontal and vertical increase. The implant actually sits on the ledge of the chin by design and thus it is more stable. To ensure optimal stability and positioning, a single 2.0mm screw can be placed through the implant to the bone when done from a submental incision. When done intraorally, a 1.5mm screw can be placed through the top edge of the implant to prevent any risk of upward migration. (which actually should be done with all chin implants placed intraorally)

Vertical Lengthening Chin Implant result 1 Dr Barry Eppley IndianapolisVertical Lengthening Chin Implant result 2 Dr Barry Eppley IndianapolisProper patient selection for the vertical lengthening chin implant is critical. It should only be used in patients with a significant vertical deficiency of the chin that also has a horizontal shortness as well. Most of these patients with have an almost 45 degree backward slant between the lower lip and chin. In general, the shorter the horizontal chin deficiency the more likely there will chin height shortness as well. Because it is an implant the width of the chin will also get bigger as the chin gets longer with greater horizontal projection. (a key aesthetic consideration)

Vertical Lengthening Chin Implant result 3 Dr Barry Eppley IndianapolisIn some men with slight or even no real vertical deficiencies, the addition of chin height will create a stronger or more masculine lower facial appearance. While this may be effective for some men, this is not a good strategy for women.

Vertical Lengthening Chin Implant sizes Dr Barry Eppley IndianapolisDifferent sizes (angulations) of the vertical lengthening chin implant are available which can increase the vertical up to 7ms while increasing the horizontal up to 12mms. Such chin augmentation changes may allow some patients to avoid an osteotomy of the chin.

The vertical lengthening chin implant is truly the first 3D chin implant ever made as it increases all three chin dimensions.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Four-Piece Total Jawline Augmentation

Sunday, December 20th, 2015

 

Background: The desire for a more pronounced and visible lower jawline exists in both men and women. The surgical methods to do so are more commonly requested by men particularly when it comes to a substantially larger jawline change. Making a jawline more evident focuses on increasing the size and shape at its ‘corners’, that of the projecting chin and the back ends at the bilateral angles.

When creating a total jawline augmentation effect, there are two basic approaches.  The historic and still most commonly used method is a three implant approach of independently placed chin and jaw angle implants. In some cases the chin implant may be substituted with a siding genioplasty. The newer method of jawline augmentation is the fabrication and placement of a one-piece custom made jaw implant that wrap around the chin from angle to angle. It is the preferred method of total jawline augmentation given the preoperative designing of the implant and its smooth one-piece construct. But cost considerations may lead some patients to still undergo the classic three implant method.

Chin and jaw angle implants exist in standard styles and sizes. While for some patients these historic standard chin and jaw angle implant styles will effectively work, newer implants styles offer improved total jawline augmentation results for many patients. Newer vertical lengthening jaw angle implants have allowed for increased visible angularity of the back part of the jaw. When vertical elongation of the chin is needed either newer vertical lengthening chin implants can be used or the historic approach of an opening sliding genioplasty. When significant vertical and horizontal chin augmentation is needed, chin implants and a sliding genioplasty can be combined.

Case Study: This 25 year male wanted a total jawline change. Not only was his lower jaw horizontally short but it was vertically deficient as well. This was evident in the short chin and large overbite which are directly related. When he opened his mouth slightly the improvement in his chin and jaw height could be seen confirming the needed vertical dimension of his chin and jawline.

Chin and Jaw Angle Jawline Augmentation result side viewChin and Jaw Angle Jawline Augmentation result oblique viewUnder general anesthesia, he had an opening sliding genioplasty (7ms done and 7mms forward) with a chin implant overly (5mm horizontal augmentation) done through an intraoral approach. Through posterior intraoral incisions jaw angle implants that added 7mm vertical length and 5mm width were placed.

At one year after surgery the improvement in his jawline could be appreciated. Ideally longer vertical lengthening jaw angle implants would have improved his result and are being considered. The sliding genioplasty and chin implant overlay produced a satisfactory improvement to the front part of his jawline

Total jawline augmentation can be effectively done using a non-custom implant approach. It can require the thoughtful application of newer chin and jaw angle implant styles and the selective use of sliding genioplasty techniques.

Highlights:

  1. Total jawline enhancement consists of front (chin) and back (jaw angle) augmentation.
  2. Preformed chin and jaw angle implants is the historic and standard approach to total jawline enhancement.

3. Vertical chin augmentation in total jawline enhancement can be done by a combined sliding genioplasty with a chin implant overlay.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – The Extended Custom Chin Implant in Facial Deformities

Sunday, November 29th, 2015

 

Background: Soft tissue contractures of the face cause a variety of deformities. Even with normal underlying bone structures, loss of overlying soft tissue volume and shape can make the face appear deficient and distorted. This is most classically illustrated by burn patients who suffer the greatest amounts of soft tissue loss and deformity when suffering extensive burns to the face. But there are a variety of other diseases and medical conditions that can also cause soft tissue facial contractures.

The jawline is one of the most notable features of the lower face as it creates a clear separation of the face from the neck. Also because it is the only bone that moves on the face, its projecting prominence helps create a distinct facial profile. A more evident  lower jawline and a nicely shaped chin prominence is valued as part of a proportionate and attractive shape. Distortion of its overlying soft tissue along the bony jawline can create a distinct degree of distortion of its form including the anterior projecting chin and lips.

Case Study: This 46 year female presented with an overall facial deformity caused by a rare medical condition with extensive soft tissue deformities and scars. She had been through dozens of soft tissue procedures of the face, through excision and reconstruction, that led to her present facial state.

Extended Chin Implant design and placement Dr Barry Eppley IndianapolisCustom Extended Chin Implant result side view Dr Barry Eppley IndianapolisShe subsequently underwent a variety of reconstructive procedures including injectable fat grafting, dermal-fat grafts, lip reconstructions and an extended custom chin implant to augment the chin and the jawline behind it. The implant was designed from a 3D CT scan of the patient.

Custom Extended Chin Implant result oblique view Dr Barry Eppley IndianapolisCustom Extended Chin Implant result front view Dr Barry Eppley IndianapolisThe re-establishment of facial volume from contracture and volume loss can be aided by augmentation of the bone beneath it. While this is of value over any of the bony prominences of the face, the extent of the surface area of the jawline makes it most useful in this boundary area between the face and the neck. Such a custom chin implant serves a tissue expander to stretch out the contracted overlying soft tissues.

Highlights:

  1. Chin augmentation can include the entire length of the  body of the mandible back to the angle with a custom designed chin implant
  2. Adding volume and structure along the jawline can expand the overlying soft tissue in cases of contracture and deformity.

3) Adequate chin projection and a straighter jawline improve facial proportions.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Intraoral Chin Implant Placement

Sunday, November 22nd, 2015

 

Chin implants are the most common permanent method of facial augmentation. Chin implants of various materials have been used for almost fifty years. Whatever the material composition of the implant is and its shape and size, chin implants can be introduced from either a superior approach (intraoral mucosal incision) or from below. (submental skin incision) There are advantages and disadvantages of either incisonal approach as well as surgeon advocates for either chin implant introduction technique.

The submental incision for chin implants offers the most direct access to the bottom of the chin bone where the implant should be properly placed. It also provides a pocket which eliminates the risk of any upward migration of the implant provided the pocket is not made too high. Firm fixation of the implant can also be done to the bottom edge of the bone to ensure its midline positioning. Because of a sterile skin prep, it also has a very low risk of infection. From a recovery and potential complication standpoint it also does not disrupt the superior attachment of the mentalis muscle. Its only real downside is that it does create a scar under the chin which can be objectionable to some patients.

The intraoral approach offers a scarless method for chin implant augmentation as its main advantage. Because of going through the mouth (although this is not exactly true because the lower lip is pulled out and away from the oral cavity) and detachment of the superior mentalis muscle, many surgeons feel that it is associated with a higher rate of complications. Superior malposition of the chin implant is actually the most common problem with the intraoral approach.

Intraoral Chin Implant Placement Technique Dr Barry Eppley IndianapolisIntraoral Chin Implant Placement Technique 2 Dr Barry Eppley IndianapolisSeveral modifications of the intraoral approach can avoid most of the potential chin implant problems. First the intraoral incision should be vertical in orientation, paralleling the fibers of the mentalis muscle. This splits the mentalis muscle but does not separate the mentalis muscle attachments. With the lip pulled away from the teeth, it provides the angle to develop the subperiosteal pocket along the inferior edge of the anterior mandible.  Secondly, implant sizers are used to ensure that the pocket has been properly developed prior to inserting the formal chin implant. Lastly, the implant is inserted, positioned and then secured in its midline position with a single 1.5mm microscrew to prevent superior implant migration.

The intraoral approach for chin implants is sometimes preferred by patients with more pigment in their skin, females and any patient that wants to avoid an external skin scar. The incisional technique should be different than that needed for a sliding genioplasty and other chin surgeries with a more limited and less dissected approach By so doing all of the potential disadvantages of the intraoral chin implant approach can be avoided.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Vertical Jawline Augmentation

Saturday, October 10th, 2015

 

Background: Lower jaw deficiencies are most commonly perceived as being of the horizontal variety. A short chin invokes the need for horizontal chin augmentation and this certainly is the most common jaw augmentation procedure. It is also the simplest and most easily performed. But jaw deficiences can occur in other dimensions as well and their diagnosis and treatment require a greater understanding and surgical expertise to treat.

Vertical jaw deficiences usually present with a visible shortening of the lower third of the face. Other clinical findings include a very flat mandibular plane angle, some percentage of dental overbite at the incisors and downturning of the corners of the mouth. Patients usually know how to make their lower jaw look better by opening their mouth a bit vertically to create a longer jaw.

The hardest dimension to change in the lower jaw is the vertical one.  This is why vertical jawline augmentation is rarely written about or discussed. While the chin can be vertically changed by using one’s own bone through an opening wedge bony genioplasty, the ramus and body of the mandible must be vertically elongated by implants. Since there are no preformed vertical lengthenng jaw implants other than that of the chin, custom implants must be made for vertical change in the back of the jaw.

Case Study: This 23 year old male had a vertical jaw deficiency that he camouflaged by opening his mouth slightly. He felt that this made his face look better along his entire jawline as well as around his mouth. Measuring the vertical change at his incisors between when he occluded completely and when he felt he looked the best was 7mms.

Chin Implant Overlay on Sliding Genioplasty intraop Dr Barry Eppley IndianapolisUnder general anesthesia he had combined chin and jaw angle procedures for a vertical jawline augmentation effect. For the chin he had a sliding genioplasty that opened 7mms and brought the chin forward 8mms. A silicone chin implant was overlaid on front of the sliding genioplasty for greater horizontal projection. Vertical lengthening jaw angle implants were used for the back part of the jaw that dropped it down 10mms and widened it by 5mms.

Jawline Surgery result front view Dr Barry Eppley IndianapolisJawline Surgery result side view Dr Barry Eppley IndianapolisHis very early after surgery results showed a significant improvement in the lower third of his face. It was not only vertically longer but the chin and jaw angles had more definition.

Vertical lengthening of the entire lower third of the face can be done by either the three piece combined autologous/alloplastic approach as in this patient or it can be done by a complete custom implant. Each has their own advantages and disadvantages with the custom approach being more unified but also being more costly.

Highlights:

1) Lower jaw deficiencies can occur in the vertical dimension as well as in horizontal under development.

2) Vertical jaw deficiencies must be treated differently using vertical lengthening sliding genioplasties, vertical lengthening jaw angle implants or vertical lengthening custom total jawline implants.

3) Management of the chin determines the total overall approach to the type of vertical jawline augmentation done.

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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