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Archive for the ‘custom facial implants’ Category

Case Study – Custom Infraorbital Rim Implants

Wednesday, March 29th, 2017

 

Background: The infraorbital rim is the lower eye socket bone that accounts for the bottom half of the bone that encircles the globe. It is formed by the union of the zygomatic bone laterally and the maxillary bone medially. Between the two bones is a suture line that may or may be present in adults. The location of this inferior orbital rim suture line lies just above the infraorbital nerve foramen.

Augmenting the infraorbital rim can be done in several ways depending upon what one is trying to achieve. The rim can be augmented on its anterior edge to give greater horizontal projection. It can also be augmented vertically to raise up the level of the bony rim for increased lower eyelid support. Or both horizontal and vertical infraorbital rim augmentation can be done if needed.

The only effective method of infraorbital rim augmentation is with implants. One type of infraorbital implant is that of tear trough implants. Designed originally to fill in the classic soft tissue indentation along the medial half of the bony rim, they can be used to augment the entire anterior rim across its entire length. But there are no preformed implants that are actually designed to sit along the rim to built it up vertically.

Bilateral Orbital Rim Fractures 3D CT scan Dr Barry Eppley IndianapolisOld Infraorbital Rim Fractures Dr Barry Eppley IndianapolisCase Study: This 24 year-old female had an uncommon history of having had bilateral infraorbital rim fractures during birth due to a forcep delivery. She never had any fracture repair surgery as could have been predicted as an infant. Now as an adult she had a palpable stepff along the infraorbital rim at the old fracture site at the suture line. (this was undoubtably an original bend in the rim at the location of the suture line from the forceps) Her 3D CT scan shows the lateral orbital rim displacement.

Custom Infraorbital Rim implants design for fracture treatment Dr Barry Eppley IndianapolisCustom Infraorbital Implants design Dr Barry Eppley IndianapolisCustom infraorbital rim implants were fabricated to create a more elevated lower rim out to and around the lateral orbital rim to create a more natural contour.

Under general anesthesia the custom infraorbital rim implants were placed and secured through a lower blepharoplasty incision.

Recreating the height of the infraorbital rim, or at any location of the orbital rim, requires a custom implant approach. Getting the vertical dimension of the orbital rim can be done very effectively or securely with any other type of standard implant design.

Highlights:

  1. There is no true preformed infraorbital rim implants that actually sir or cup the rim itself.
  2. Custom infraorbital rim implants are design to sit along the rim and increase its vertical height.
  3. An infraorbital rim fracture can displace the normal smooth and horizontal shape of the lower bony rim.

Dr. Barry Eppley

Indianapolis, Indiana

Custom Jawline Implant Designs

Friday, March 24th, 2017

 

Custom jawline implants provide a powerful tool for lower facial change. Covering the entire jawline from angle to angle provides a lot of surface area coverage to create significant augmentation effects.

These powerful implant changes have a double edge sword effect. With the right implant design and dimensions many desired patient jawline effects can be seen. What the right implant design and dimensions are, however, is never exactly clear before surgery in the designing process. There is no formula or design method that is available that can predict what the implant design to final effect result will be. This remains an artistic process that lacks complete clinical predictability.

Custom Jawline Implant Angle Widths Dr Barry Eppley IndianapolisHaving done many custom jawline implant designs there are three components of the process to consider. They are the chin, the jaw angle area and the connecting body portion. I find that the chin and the connecting body portions are usually straightforward and create few design quandries.

Custom Jawline Implant Angle design and dimensions Dr Barry Eppley IndianapolisCustom Jawline Implant Flare Design Dr Barry Eppley IndianapolisDesigning the jaw angle areas of the implant, however, is a different story. The 3D effects  of its vertical, horizontal and transverse dimensions creates challenging design considerations. Because much of the jaw angle dimensions are off the bone and ‘out into space’ it is hard to precisely predict its effects. How the soft tissue will respond and redrape over expanded hard tissue boundaries is one issue. What aesthetic effect will a larger prominence create at the back of the jaw on both sides is another. The larger the change in the jaw angle area the more unpredictable these effects become.

I have done many custom jawline implants with very satisfying aesthetic outcomes. But I have also seen many other such implants where its effects were unpredicted and had to be revised. In almost every instance it was the jaw angle component that posed the problem. In most instances its appearance not its position on the bone was the issue.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Implant for Vertical Orbital Dystopia

Wednesday, March 15th, 2017

 

Background: Few faces are perfectly symmetric and most of us have some noticeable differences between the right and left sides. Such facial side differences are usually well tolerated or may not even be known. We all recognize that ‘no one is perfect’ and everyone has a little bit of facial asymmetry which is seen within the range of normal.

But asymmetry of the eyes is often different because it is so easily recognized and almost impossible to visually ignore. While there are different types of eye asymmetry, many of which are related to the eyelids, one of the most recognized causes of is that of orbital dystopia. Orbital dystopia is bone-based with the orbital bony box being at different levels between the two sides. The most common type of orbital dystopia is vertical and the affected side is almost always lower than the normal side.

In vertical orbital dystopia, the affected eye sits lower which can be seen and measured by the horizontal positioning of the pupil of the eye.  The eye sits lower because the orbital floor, including the circumferential orbital rims and cheek bone, sit lower. In more minor cases the orbital dystopia is isolated to the eye area. But in more significant cases the entire side of the face from the eyebrows down to the jawline is lower.

Right Orbital Dystopia 3D CT scan Dr Barry Eppley IndianapolisCase Study: This 43 year-old male presented for cheek augmentation for which a custom designed approach was chosen. He had always been by a mild degree of eye asymmetry as well which was most apparent in pictures. A 3D CT scan shows that the affected eye had a vertical dystopia of around 3mms. The lower infraorbital rim and malar eminence as well as more inferiorly positioned orbital floor could be seen as the bony origin of the vertical dystopia.

Orbital Dystopia Orbital Floor Implanty with Custom Cheek Implants design Ddr Barry Eppley IndianapolisCustyom Cheek Implants with Orbital Floor Implant design Dr Barry Eppley IndianapolisHis custom cheek implants designs included a component on the affected side that wrapped over the infraorbital rim and onto the orbital floor to create the needed amount of globe elevation.

Orbitozygomatic Implant placement for Facial Asymmetry Dr Barry Eppley IndianapolisCustom Orbitozygomatic Implant Placement incision closure Dr Barry Eppley IndianapolisUnder general anesthesia and through a subciliary eyelid incision, the custom orbital floor-rim-cheek implant was placed and secured to the orbital rim with two microscrews. An orbicularis muscle rsuspension and lateral canthopexy was performed at closure.

Orbital Floor Augmentation result front view Dr Barry Eppley IndianapolisHis one year after surgery results showed improvement in the symmetry between the eyes. As is often the case in vertical orbital dystopia raising up the eye reveals the other components of the dystopia including the more inferiorly positioned upper eyelid and eyebrow. These are planned for adjustment in the future. (right upper blepharoplasty with ptosis repair and transpalpebral browlift.

Highlights:

  1. One cause of eye asymmetry is a malpositioned orbital box which causes the eye to sit at a lower horizontal level than the normal side.
  2. Orbital floor and infraorbital rim augmentation is one technique in the treatment of vertical orbital dystopia but it will not correct every aspect of the eye asymmetry.
  3. The orbital floor-rim augmentation implant is best made from a 3D CT scan in a custom implant fashion.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jaw Angle Implants and Sliding Genioplasty

Thursday, March 2nd, 2017

 

Background: Jaw angle implants are enjoying a surge in popularity as patients are seeking improved shapes to their jawlines. Filling in the back part of the jaw offers a good complement to well established chin implants to create a more complete jawline augmentation effect.

Like just about every other facial implant, no one size or style fits all. This applies equally well to jaw angle implants. While the widening version has been around for over twenty years, a newer vertical lengthening style now exists. The key to which jaw implant style to use is the natural anatomy of the mandibular ramus. A highly positioned jaw angle and a steep mandibular plane angle are the indications for extending the jaw angle down through the vertical lengthening style.

While the use of three implants (one chin and two jaw angles) is one method of total jawline augmentation, some patients may not prefer their chin augmentation to be done with an implant. A sliding genioplasty can be combined with jaw implants if that is more favorable for the chin. (severe horizontal chin deficiency, lower lip incompetence, mentalis muscle strain) The consideration must then be given to the smoothness of the jawline since the front end of the jaw implant will not cover the back end of the sliding genioplasty bone cut.

Malpositioned Jaw Angle ImplantCase Study: This 43 year-old female previously had a chin implant and two jaw angle implants placed for a total jawline makeover by another surgeon. Unfortunately the right jaw implant became infected and the left jaw implant was severely malpositioned. The chin implant was fairly well placed but she did not like it because it made her chin too wide and did not improve her presurgical lower lip incompetence, mentalis muscle strain and chin dimpling.

Custom Extended Vertical Jaw Angle Imlpants design Dr Barry Eppley IndianapolisCustom Vertical Jaw Angles vs Standard Widening Jaw Angle Implants Dr Barry Eppley IndianapolisIt was decided to remove her chin implant and replace it with a sliding genioplasty which would better address the functional aspects of her chin deficiency. (as well as making her chin less wide) The style of jaw angle implants would also be changed to be more vertical lengthening and to come far enough forward to cover the notch at the back end of the proposed sliding genioplasty. These jaw implants would need to be custom made using a 3D CT scan.

Under general anesthesia and through an intraoral approach, the chin implant was removed and a sliding genioplasty done in its place. The chin was brought forward 8mms and vertically shortened 3mms. The custom jaw angle implants were also placed intraorally and their anterior ends were positioned over the ends of the sliding genioplasty  to create a smooth and unbroken jawline effect.

A sliding genioplasty can be combined with jaw angle implants. In many cases standard jaw implants may suffice. But for a more assured seamless transition from the jaw implants to the bone of the chin advancement, custom jaw angle implants work best.

Highlights:

1) The wrong jaw angle implant style will still be a failure even if it is well placed.

2) Many women need a vertical lengthening jaw angle implant style and not a widening jaw angle implant style.

3) When combining jaw angle implants with a siding genioplasty, a custom implant design approach is often best.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – V-Line Jaw Reduction Reversal

Wednesday, February 22nd, 2017

 

Background: One of the most popular jawline surgeries around the world, particularly in Asian people, is jaw reduction. Know more commonly as V-Line jaw reduction surgery, it involves removal of wide or flared jaw angle (amputation) and chin reshaping. (narrow and shortening through am intraoral T-shaped ostectomy) For those patients that have a wide jaw and and a lower facial prominence as a result, it can be an effective lower facial reshaping procedure. It is easy to see why this would be of aesthetic predominantly in Asian patients given their natural facial bone shape.

Because the procedure is performed exclusively through an intraoral approach, it can be very difficult to have even and symmetric bone cut lines. There is also the issue of how the bone heals and the smoothness that may or may not result. For this reason, it is really the norm to expect some bone asymmetries between the two sides of the jaw and even at the chin. Fortunately the overlying soft tissues are thick and can help mask such bony asymmetries/irregularities should they result from the procedure.

But like reduction surgery anywhere on the face and body, losing bone support can also cause adverse soft tissue issues. This is an issue primarily in the jaw angle areas in V-line jaw reduction surgery. It is not rare that I hear from a patient who has had jawline reduction surgery that they do not like the subsequent flattening/weakness of the back of their jaw and that they feel the soft tissues now sag along the jawline.

Jawline Deformity after Jaw Angle AmputationJawline Deformity after Jaw Angle Reduction fronkt viewCase Study: This 45 year-old Caucasian female had V-line jaw reduction surgery three years previously. She did not like the subsequent loss of her jaw angles, lack of jawline definition and how it made her lower face too narrow and more aged in appearance. She wanted more defined jaw angles vertically and a smoother and more linear jawline coming forward. A 3D CT scan shows the loss of jaw angles, higher positioned jaw angles, severely increased mandibular plane angle and inferior border jawline asymmetry.

Custom Jawline Implant foir Jawline Reconstruction after Jawline Reduction side view Dr Barry Eppley IndianapolisCustom Jawline Implanty after Jawline Reduction Surgery design front view Dr Barry Eppley IndianapolisA custom jawline implant was designed with the main purpose of re-establishing the jaw angles in a much lower position but without adding any significant jaw angle width. It also established a more symmetric and smooth jawline coming forward to the chin. A little anterior chin projection was added but creating very minimal chin width. Under general anesthesia and through an exclusive intraoral approach, the custom jawline implant was placed.

Custom Jawline Implant design for Jaw Angle Reconstruction Dr Barry Eppley IndianapolisV-line jaw reduction reversal has to be done using some form of implants. Custom jawline implants are best as the multidimensional jaw augmentation needs are very difficult, if not impossible, to adequately address with any standard jaw angle implant shapes.

Highlights:

1) Unfavorable aesthetic results can occur from jawline reduction (V-line jaw surgery) with loss of jawline definition and tissue support.

2) ‘Reconstruction’ of lost jaw angle and chin from V-line surgery requires a vertical lengthening of the shortened jaw angles and widening of the chin.

3) A custom jawline implant is the best approach to V-line jaw surgery reversal.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Chin Implant

Wednesday, February 8th, 2017

 

Background: Chin augmentation has been around for a very long time and many implant materials and sizes have been used to do it. From this experience has come standard implant sizes that work for the vast majority of people seeking chin enhancement surgery.

But some patients seek changes that exceed what these standard size can create or have discovered through prior surgery that their expectations have not been met. In these cases only a custom designed implant may suffice.

Custom Square Chin Implant Design Dr Barry Eppley IndianapolisCase Study: This 35 year-old male had a prior history of multiple chin procedures including a square chin implant and a sliding genioplasty. While all of these procedure produced a better chin, they fell short of his ideal chin shape and size goal. Therefore a custom chin implant was designed that brought the chin forward 25mm and gave it a very square shape without having any lateral wings.

Custom Square Chin Implant placement Dr Barry Eppley IndianapolisUnder general anesthesia and through a existing submental incision the custom chin implant was placed over the end of the chin bone after removal of the indwelling implant. It was secured with a single 2.0mm titanium screw.

Custom Square Chin Implant front view Dr Barry Eppley IndianapolisCustom Square Chin Implant result oblique view Dr Barry Eppley IndianapolisAt six months after surgery his chin shape was more square with some increased projection. He was pleased and had finally reached his aesthetic chin shape goal.

While custom chin implants can be made to any size and shape, it is important to consider how the soft tissue chin pad will drape over it. (or whether it will) While not all custom chin implants are of large dimensions, many are. The chin soft tissues will not adapt well with large amounts of spontaneous horizontal projection. This often causes tight tissues, lower lip stiffness and an abnormal appearance. It helps to have the chin soft tissues stretched out from prior chin augmentation procedures which is often the case before many patients seek a custom chin implant solution.

Highlights:

1) A custom chin implant is needed when the dimensions of standard chin implants can not create the desired effect.

2) An implant that provides significant horizontal projection with limited width requires a  custom design.

3) Very large chin implants require previous soft tissue expansion from prior chin augmentation procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Male Forehead Implant

Monday, February 6th, 2017

 

Background: The shape of the forehead is well known to be gender specific. Besides the prominent brow bones, the male forehead has a slight backward slope to it and is broader than that of a females. This slight backward slope contributes to the prominence of the brow bones with increasing slopes making the brow bones look bigger. (pseudo brow bone projection)

While there can be an acceptable retroinclination to the male forehead there comes a point when it slopes back too far and becomes aesthetically undesireable. What the exact angle is as to how much backward slope is aesthetically excessive defies a specific number but it is in the range of greater than 15 to 20 degrees.

3D Forehead Deficiency Dr Barry Eppley IndianapolisCase Study: This 45 year-old male was bothered by the backward slope to his forehead. While much of his forehead was covered by hair, he knew that beneath the hair the forehead sloped backward with two specific grooves heading back into the hairline along the temporal lines. A 3D CT scan of his forehead revealed its slope and lateral deficiency.

Custom Forehead Implant design Dr Barry Eppley IndianapolisCustom Foreheasd Implant design 2 Dr Barry Eppley IndianapolisA custom forehead implant was designed to decrease his forehead slope and make the whole forehead wider. At its thickest point the central thickness of the design was 5mm while the lateral thickness was 7mm before it tapered into the temporal muscle.

Custom Forehead Implant placement Dr Barry Eppley IndianapolisUnder general anesthesia, a 9cm long scalp incision behind his hairline was made. Subperiosteal dissection was done down to the brow bones and out onto the temporalis muscle fascia to accommodate the width of the implant. Multiple perfusion holes were placed into the implant prior to its insertion. After central positioning and making sure the edges were unfolded and laying properly, the scalp incision was closed in multiple layers with resorbable sutures.

A custom male forehead implant is the best way to create an overall contour change of the upper third of the face. It ensures the smoothest result from side to side as well as the smoothest transition possible into the temporal regions. Equally importantly it also allows for the smallest insertion scalp incision possible which is of critical importance in a male.

Highlights:

1) The male forehead has less of an inclination and is wider than that of a females.

2) A custom forehead implant in a male offers the smallest incision for its placement.

3) Thicknesses of only a few millimeters that cover a broad surface area like the forehead can make a visible difference.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jawline Implant Replacement

Monday, January 23rd, 2017

 

Background: A more complete jawline augmentation is most commonly done using standard chin and jaw angle implants. With good implant selection and ideal placement on the jawbone, an enhanced and satisfying jawline can be achieved. While numerous options in both silicone and Medpor facial implants exist, the material used is of no biologic or long-term consequence. What matters is the shape and size of the implants used.

While more successful than not, a three implant jawline implant approach is associated with a higher rate of complications than any one single facial implant. With three implants the associated risks of infection, implant malposition and undesired aesthetic effects are…three times higher than that of a single implant. By far, implant malposition (asymmetry) of the jaw angles and undesired aesthetic results make up the vast majority of jawline implant complications and the need for revisional surgery.

When the aesthetic results of standard chin and jaw angle implants are inadequate the most effective approach is to make a new implant using a custom approach. This is particularly relevant if the standard implants were very inadequate for the patient’s desired aesthetic needs.

Before Custom Jawline Implant Dr Barry Eppley IndianapolisMedpor Chin and Jaw Angle Implant Jawline Augmentation Dr Barry Eppley IndianapolisCase Study: This 42 year-old male previously had Medpor chin and jaw angle implants to try and create a more masculine and well defined jawline. While he had no medical complications from his implants and they were placed fairly symmetrically, they did not come close to the desired jawline effect. A custom one-piece wrap around jawline implant was designed from a 3D CT scan and a stone jaw model as a replacement.

Medpor Jaw Implant Removals Dr Barry Eppley IndianapolisCustom Jawline Implant design on model Dr Batrry Eppley IndianapolisUnder general anesthesia, his Medpor chin and jaw angle implants were removed through his existing external submental and intraoral posterior incisions. The jaw angle implants were particularly difficult to remove due to tissue adherence and being wrapped around the bony jaw angles. The implants and their fixation screws were removed in many pieces.

Custom Jawline Implant Replacement of Medpor Implant result front view Dr Barry Eppley IndianapolisCustom Jawline Implant Replacement of Medpor Implants result oblique view Dr Barry Eppley IndianapolisCusytom Jawline Implant Replacement for Medpor Implants result side view Dr Barry Eppley IndianapolisHis new custom jawline implant was inserted and fit perfectly to the bone as designed on the 3D CT scan. His immediate surgery results showed a dramatically different aesthetic outcome from his standard implants with a much more defined jawline appearance.

Highlights:

1) Replacement of inadequate standard chin and jaw angle implants is best done with a custom jawline implant design.

2) Removing Medpor facial implants can be very challenging particularly over the jaw angle region.

3) Placement of a total custom wrap around jawline implant can be done through the same incisions as the original chin and jaw angle implants were placed.

Dr. Barry Eppley

Indianapolis, Indiana

The LeFort Custom Midface Implant

Sunday, January 22nd, 2017

 

LeFort 1 osteotomyThe LeFort osteotomy is the well known of all facial osteotomies and is used to correct midface retrusion. In its most commonly used form, the  LeFort I osteotomy, it is named after the fracture pattern originally described by Rene LeFort over one hundred years ago in that cuts are made across the maxilla above the tooth roots as well as through the pterygomaxillary junction. Although less commonly performed, higher levels of the LeFort osteotomy (II and III) are used for more complete midface deficiencies that are associated with craniofacial deformities.

Aesthetic midface deficiences are common in certain ethnic faces (e.g., Asian), traumatic midface fractures as well as general developmental patterns in some people. Many of these patients, however, can not be treated by LeFort osteotomies as they have a normal Class I or orthodontically corrected occlusion. Without the simultaneous correction of a malocclusion, the bone can not be brought forward otherwise it would create one. In addition, most aesthetic midface deficiencies do not justify skeletal correction due to the magnitude of the surgery and its associated risks.

Custom Midface Mask Implant Dr Barry Eppley IndianapolisThe custom midface implant offers an effective aesthetic operation that can have much of the same midface augmentation effect as many of the Lefort osteotomies. (minus the potential aesthetic benefit of forward teeth movement on the upper lip) It can cover the anterior face of the maxilla up onto the orbital rims and the cheeks. This can effectively pull the entire midface soft tissues forward including the base of the nose. It appears much like a mask in its design.

Total Custom Midface Implant Dr Barry Eppley IndianapolisThe design of the custom midface implant can done in variable amounts of dimensional changes across the face of the implant. The greatest fullness can be around the base of the nose and anterior nasal spine or it can be the exact opposite where it is thicker over the cheeks and infraorbital rim. It all depends on each patient’s aesthetic facial needs.

The custom midface implant is usually completely inserted from inside the mouth. In some cases where the implant comes ups around the infraorbital rims a lower eyelid incision may be needed to ensure its accurate positioning. The implant is inserted around the infraorbital nerve by making a slit in the implant above the nerve hole so it may safely wrap around it during insertion.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Total Jawline Enhancement with Custom Implant

Friday, January 20th, 2017

 

Background:  The approach to improving the shape of the lower face has evolved beyond just chin augmentation. While the projection of the chin still has a valuable role to play in lower facial reshaping, it is not a comprehensive approach to lower facial aesthetics. The shape and size of the entire jawline must be considered.

The single most effective complete jawline augmentation method is by using a custom jawline implant design. While it is made from a 3D CT scan and fits the bone as designed, its effect comes from expanding the entire bony borders of the lower jaw.  Because it covers a broad surface area, its effect can range from a subtle to a dramatic type of facial change.

In some male (and most female) jawline augmentations the patient is seeking a more conservative change. This means that one wants the jawline to be sharper and more angular with modest chin and jaw angle size changes. This is the classic definition of a jawline enhancement as opposed to a major jawline augmentation. To do so the custom jawline implant is often smaller with thin connections between the chin and jaw angles.

male custom jawline implant design Dr Barry Eppley IndianapolisCase Study: This 35 year-old male wanted a stronger jawline but one that was not ‘too big’. He always wore a closely trimmed beard which helped to create the appearance of  stronger jawline. He stated that he would continue to have such a beard after and this had to be factored into the implant’s design and size.

male custom jawline implant design and actual implant Dr Barry Eppley IndianapolisUnder general anesthesia and through a three incisional method (extraoral submental chin and intraoral vestibular incisions), a custom jawline implant was placed. To prevent mental nerve injury it was placed in a midline split two-piece fashion.

Custom Jawline Implant results oblioque view Dr Barry Eppley IndianapolisCustom Jawline Implant result side view Dr Barry Eppley IndianapolisHis after surgery results show a subtle but evident change in the appearance of his lower face. Increased chin prominence was evident as was a more defined jawline heading back to the jaw angles on both sides.

Custom Jawline Implant result front view Dr Barry Eppley IndianapolisTotal jawline enhancement can be done using a custom jawline implant. Keeping the projections at the chin and jaw angle areas more modest with thin connections between these three jawline points can keep the jawline augmentation effect more limited and create a more angular jawline.

Highlights:

1) A custom jawline implant affects the entire jawline in a wrap around implant fabrication.

2) Creating three points of augmentation (chin and jaw angles) that are connected can have a powerful effect on the shape of the lower face.

3) A small custom jaw implant provides an increased angularity to the lower face witout making it too big.

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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