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Archive for the ‘lip augmentation’ Category

Case Study – Long Terms Results of Subnasal Lip Lift

Tuesday, June 30th, 2015

 

Background: Lip augmentation is one of the most popular non-surgical cosmetic facial procedures and is one of the most common sites for the placement of injectable fillers.  But injectable fillers only add volume and in the vermilion deficient lip may create a very pouty lip or ‘fish’ lips. Without adequate vermilion height the filler merely pushes the lip forward and not up as well.

For the vermilion deficient upper lip, there are several surgical procedures to change the location of the vermilion-cutaneous junction. Such change is instrumental in getting a good and natural lip augmentation effect. These two well known procedures are the lip lift and the vermilion advancement. The subnasal lip lift is, literally, a lifting procedure of the lip by removing a segment of skin from right under the nose. It achieves two important effects, shortening the lip-nose distance and creating more of a central lip pout. In some patients and with enough tissue removed more tooth show may also result. (but the risk of excessive tissue removal and a ‘chipmunk look’ can be created with too much  of a lip lift) It is equally important to appreciate that it is does not create a corner to corner lip change and only augments the portion of the nose that lies between vertical lines drawn from the sides of the nostrils.

There are several criticisms/concerns about the subnasal lip lift. Some feel that if only skin is removed there will be significant relapse.(recurrent lengthening) This has led to lip lift techniques that remove or tighten the orbicularis muscle which can lead to its own set of problems. (lip tightness, smile deformity) There is always the concern about the appearance of the scar right under the nose and whether it will deform the nostrils or the base of the columella.

Case Study: This 26 year-old female wanted a lip lift to shorten her lip to nose junction and provide some some additional central lip pout. She already had reasonably good vermilion fullness and did not need/want any direct vermilion augmentation. Given her greater skin pigment there was good presurgical discussion about the resultant scar.

Subnasal Lip Lift immediate result front view 2Subnasal Lip Lift immediate result side viewUnder local anesthesia, a subnasal lip lift was performed removing 25% of the distance of the philtral column. (4mms) Only skin was removed without any muscle manipulations. Only small resorbable sutures were used on the skin as she lived far out of town.

Subnasal Lip Lift long-term results front view Dr Barry Eppley IndianapolisSubnasal Lip Lift long-term results side view Dr Barry Eppley IndianapolisWhen seen one year later, the subnasal scar was barely detectable and there was no nostril/nose deformity. Comparing her immediate and one year pictures, the subnasal lip lift result has remained stable. (no change in the lip-nose distance or the amount of central lip pout)

The subnasal lip lift can be an effective procedure that has minimal risks if it is not overdone or involves muscle manipulation. It must be meticulously measured and executed to be both symmetric with a good scar outcome.

Highlights:

1) The subnasal lip lift is a surgical procedure for enhancing the central part of the upper lip and shortening the nose-lip distance.

2) The amount of relapse or recurrent skin stretching is 10% or less and is not that noticeable.

3) A skin excision (muscle sparing) subnasal lip lift is both safe and effective and has a very low risk profile.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Lip Advancement Revisions

Monday, March 2nd, 2015

 

Background: Lip augmentations are very popular and are most commonly done with the use of injectable fillers. But not every smaller lip can be satisfactorily augmented by fillers alone and, even when a satisfactory result is achieved, women may eventually tire of the need for repeated injection sessions and their cost.

Lip Advancement Dr Barry Eppley IndianapolisA lip advancement is one of the three surgical lip augmentation options which include lip lifts, lip advancements and lip implants. The lip or vermilion advancement procedure is the most effective lip augmentation procedure because it does what ultimately makes lips permanently bigger…it changes the vermilion or pink part of the lip to have more vertical exposure. And it does so from one mouth corner to the other which is what differentiates it from the lip lift which only changes the central part of the upper lift. The lip advancement can be done equally well on the lower lip as well as the upper lip.

The one disadvantage to the lip advancement is that it creates its powerful effect at the expense of a fine line scar at the vermilion-cutaneous border. These lip advancement scars can be very minute and acceptable in most cases. But there is very little tolerance for even the smallest asymmetries in the shape of the lip particularly in the cupid’s bow area.

Lip Advancement Asymmetries Dr Barry Eppley IndianapolisCase Study: This 40 year-old female has a prior upper and lower lip advancement  from another surgeon that turned out to have significant lip asymmetries. The cupid’s bow was oriented to the left of the midline and the height of the lower lip vermilion was very different between the two sides. This gave the lips a very unnatural and twisted appearance.

1st Stage Lip Advancement Revision Dr Barry Eppley IndianapolisUnder local anesthesia in the office, new lip vermilion edges were marked to realign the lips shape. New skin areas were cut out and the vermilion edges realigned. Her postoperative result showed substantial improvement but healed with some minor scar hypertrophy at the peak of the left cupid’s bow and along the outer thirds of the right lower lip.

2nd stage lip advancement revision Dr Barry Eppley IndianapolisA second stage lip revision was done under local anesthesia six months later. The left cupid’s bow was repositioned and the right lower lip hypertrophic scar excised.

Lip Advancement Revisions front view Dr Barry Eppley IndianapolisLip Advancement Revisions Indianapolis Dr Barry EppleyAfter two revisions, a satisfactory lip advancement revision result was obtained.

While the concept of lip advancements is simple, its execution requires careful preoperative markings, precise skin cutouts and a meticulous closure. The very visible presence of the lips on the face make any amount of asymmetry or hypertrophic scarring very apparent. Revisions of lip advancement problems usually led to a much improved and more symmetric outcome.

Case Highlights:

1) Lip advancements are technically precise procedures that must be measured before surgery and technically executed carefully.

2) Revisional surgery can salvage asymmetric lip advancement results.

3) It may take more than one revision to optimize lip shape and scar outcomes from adverse lip advancement problems.

Dr. Barry Eppley

Indianapolis, Indiana

The Perma Facial Implant For Lip Augmentation (PermaLip)

Saturday, June 7th, 2014

 

Lip Augmentation Dr Barry Eppley IndianpolisDespite that lip augmentation is sought by many women (and a few men), the perfect procedure to accomplish it remains elusive. A wide variety of treatment options exist to achieve bigger lips from injectable fillers and fat to surgical manipulations of the vermilion and skin excisions. Injectable fillers are by far the most common lip augmentation method because of their simplicity and immediate results. Their drawback is that no FDA-approved injectable filler is permanent and the treatments have to be repeated. Those filler materials that are permanent (silicone oil) is both non-FDA approved and has a propensity for nodules and foreign body reaction if improper injection techniques are used. (and sometimes even if they have been placed with good technique.

A lip implant, just like any other facial implant, would provide a stable and permanent lip augmentation effect. But the history of synthetic implants in the lip is very checkered with numerous materials and implant designs introduced and then eventually removed from the market (and often from the patient’s as well) due to a high rate of complications.

Permalip Implants Indianapolis Dr Barry EppleyIn the May 2014 issue of Plastic and Reconstructive Surgery Global journal, an article describing a newer lip implant was published entitled ‘Five Year Experience With Perma Facial Implant’.  This paper reports on the experience and long-term effects of the silicone lip implant known as PermaLip which is a very soft smooth solid elastomer tapered tube. The authors placed 832 lip implants on 420 consecutive patients.(91% female, 6% transgender and 3% men) with an average follow-up of over two years. The vast majority had both upper and lower lips done simutaneously. (98%) Of the three available implant thicknessess, the 4mms was most commonly used (78%). The largest 5mm diameter was only used for implant replacement when patients wanted more lip volume. Of the three implant lengths available, the 60mm and 65mm comprised almost 90% of the implants used. Of the 832 implants placed, the complication rate was 12% with malposition representing the majority of them. Infection, hematoma or extrusion was less than 1%. Equally relevantly, implant buckling or permanent loss of lip sensation was not seen in any patient.

While one may interpret that a 12% complication rate with a two-year follow-up of lip implants is high, it is not. (it is far less than that seen in breast augmentation for example) One must remember that this is an implant placed in the body which will always be more prone to complications than when one uses natural tissue. Since it is a smooth silicone tube, it is easily reversible which was a big drawback to previous lip implant materials and design.

Permalip Implant Size Options Dr Barry Eppley IndianapolisLike all implants, sizing and proper tissue positioning are the key factors in a low rate of complications for the PermaLip implant. For many patients, the largest 5mm size implant is too big for an initial augmentation, thus the popularity of the 4mm size. The hardest or trickiest part of the procedure is to get the implant is an even tissue plane across the whole lip and this is what accounts for implant malpositions. It is a problem that has always existed in lip implants. Because the lip is a curved structure and the implant instruments for placement are straight, it is not always easy to be in the same tissue plane from the side of the lip enter the instrument to the opposite side you exist from the corners of the mouth. This takes a bit of practice and and experience to keep the malposition rate low.

The Permalip implant is the best lip implant that I have seen in the past 25 years. It is nor perfect but it offers a simple and easily reversible method of lip augmentation for those women who are tired of repeat injectable filler treatments. Patient selection is critical as one has to have enough vermilion and lip tissue in which to place the implant with good soft tissue cover. Thus it is for patients who have very thin lip with little vermilion show unless they have had a prior or simultaneous subnasal or vermilion advancement lip procedure.

Dr. Barry Eppley

Indianapolis, Indiana

 

 

Case Study: Upper Lip Advancement in a Man

Monday, April 14th, 2014

 

Background: There are many options for lip enhancement today of which injectable fillers is by far the most commonly used. But for a permanent change in size, surgical options must be considered. Two basic types of lip lifts exists done either from under the nose (subnasal lip lift)or from the edge of the top of the upper lip. (lip advancement) Each of these has their own advantage sand disadvantages but the very thin (pencil thin) upper lip can only be effectively treated by a lip or vermilion advancement.

The lip advancement procedure works because it physically moves the upper border of the pink portion (vermilion) of the lip upward. (in the case of the upper lip) By so doing, the vertical length of the lip is increased permanently which creates a bigger visible lip appearance. The lip advancement also has the advantage of being able to change and enhance the shape of the cupid’s bow of the upper lip, which frequently is flat in the lip with little vertical vermilion exposure.

While women are most commonly seen as having lip enhancement procedures, men occasionally do as well. Men usually consider lip augmentation for a very thin upper lip not necessarily to make an already decent sized upper lip just a little bigger. Men also do not usually want to have repeated procedures but would prefer a one time permanent result.

Case Study: This 40 year-old male wanted to have a permanent upper lip augmentation. He wanted have an upper lip that matched the size of his lower lip with better accentuation of the cupid’s bow. Interestingly, he had a full goatee that covered much of his upper lip perhaps as a camouflage for his perception of his upper lip size concerns.

Male Lip Advancement markings before surgery Dr Barry Eppley IndianapolisHis upper lip hairs were trimmed back to expose the amount of upper lip advancement to be done. With a calipers, a 4mm skin excision was marked (1/4 of the total philtral length)mwith a cupid’s bow highlight and lack of a taper near the corners of the mouth. Under vestibular local anesthetic blocks with direct upper lip infiltration, the skin was excised and the upper lip advanced along the line of the marks. The incision was closed with 6-0 plain sutures with a few deep 6-0 monocryl sutures. Antibiotic ointment was applied as the dressing.

Male Upper Lip Advancement result fronkt viewMale Upper Lip Advancement result side viewThe final lip advancement result with mature scars was seen four months later. While he still had a goatee, the upper lip scar was virtually undetectable and the increase in the size of the upper lip was doubled.

While there is always a concern about the scar from any lip advancement surgery, that concern is magnified in men. (because they do not ever use lipstick) But my experience in men has shown that the lip advancement scar heals well and is not more of a concern than when done in women.

Case Highlights:

1) Thin upper lip concerns in men, while not as common as in women, can be treated with the same types of lip enhancement techniques.

2) An upper lip or vermilion advancement offers a permanent solution to an improved lip size and shape.

3) Upper lip advancement scars heal well in men ( and perhap better than even in women) presumably due to the hair follicles in the skin.

Dr. Barry Eppley

Indianapolis, Indiana

Postoperative Instructions for Lip Implants

Friday, September 27th, 2013

 

The use of implants for lip augmentation is a surgical procedure that adds permanent volume to the lips. It is done as an office procedure under local anesthesia if done alone or in the operating room under general anesthesia if it is included as part of a collection of other plastic surgery procedures. The implants are inserted through small incisions inside the corners of the mouth through the body of the lip form one corner to the other. The following is a list of after surgery care and considerations for the lip implant procedure.

1.  Lip implant surgery will cause some slight discomfort for the first 24 to 48 hours. Most patients find it can be relieved with mild pain relievers such as Alleve or Ibuprofen. The lips may be sensitive to touch and pressure (caused by activities such as drinking from a straw and kissing) for up to two weeks.

2.  There are no dressings applied after lip implant surgery. Antibiotic ointment can be applied to the corners of the mouth at the incision site to keep the area soft and supple.

3. You will experience swelling in the lips after surgery. Swelling typically takes three days to peak and then will begin to subside over the next two weeks. You may use ice packs to help reduce the swelling and provide comfort during the first day after surgery.

4. The incisions in the corners of your mouth can get wet with no concern for infection. You may shave (men), wash your face and perform oral hygiene (brushing your teeth, mouthwash) as normal.

5. The small incisions in the corners of your mouth will have sutures that need removed one week after surgery (unless you are from out of town). These sutures should be kept moist with antibiotic ointment, applied three times a day, to the corner of the mouth. If dissolvable sutures are used, it is normal for the corners of the mouth to get slightly red in color as those sutures dissolve, applying antibiotic ointment can help lessen this effect.

6. Your lips will feel a little tight when you open your mouth widely. That will take several weeks to a month to return to normal. You may stretch open your mouth and lips as much as feels comfortable. You may eat whatever you like.  Focus on liquids and soft foods for the first few days after surgery.

7. You may experience some bruising after surgery. Taking Arnica Montana tablets prior to your surgery may help to prevent bruising. In addition, topical Arnica gel may be applied after surgery to help reduce any bruising that may occur.

8. There are no physical restrictions after lip implant surgery. You may return to work and resume physical activities such as working out as soon as you feel comfortable.

9. You may begin driving again as soon as you are off pain medications, can react normally and feel comfortable doing so.

10. If any lip redness, tenderness, or drainage develops after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.

Consent for Plastic Surgery – Lip Implants

Thursday, September 26th, 2013

 

These explanations are intended to improve your understanding of the lip implant procedure that has been discussed with you. Please read them carefully and understand that this list includes many, but not all of the different outcomes from this surgery. Please feel free to ask Dr. Eppley any further questions regarding your surgery.

ALTERNATIVES

Augmentation of the lips can be done by a variety of synthetic or fat injectable fillers to increase the size of the pink part of the lip. (vermilion)  Other lip augmentation procedures include lip lifts and lip advancements. How the results achieved by injection and lift techniques compares to that of an implant should be thoroughly understood before surgery.

GOALS

The goal of lip implants is to permanently increase the size of the lips.(increase vermilion show)

LIMITATIONS

The limitations of lip implants is the size of the lips that can be achieved. Lip implants range in sizes from 3 to 5mm diameter at their thickest central section. The effect of the implant in increasing lip size (vermilion show) is also controlled by how much visible vermilion one initially has.

EXPECTED OUTCOME

Expected outcomes of placing lip implants include the following: temporary bruising and swelling of the lips and temporary lip numbness. All lip implant procedures will create some temporary stiffness on lip movement and mouth opening.

RISKS

Significant complications from lip implant surgery are very rare but could include infection. More likely complications could include aesthetic deformities such as asymmetry and irregularities of the implants and lip size and shape and under vs. overcorrection of the desired lip size achieved. Any of these risks may require revisional surgery for improvement.

ADDITIONAL SURGERY      

Should additional surgery be required to adjust the position or size of the implants, this will generate additional costs.

Dr. Barry Eppley

Indianapolis, Indiana

Treatment Options for Vertical Upper Lip Lines

Tuesday, June 11th, 2013

 

The face develops many visible signs of aging. But none are more problematic or pesky than that of upper lip lines or vertical rhytids. Such lip lines are very bothersome to women as they not only suggest an older lip but also cause problems with lipstick, often bleeding into the lower end of the vertical line. By far, vertical lip lines occur most commonly in Caucasian women of Northern European descent. They are very rarely ever seen in women that have more skin pigment, thicker skin and fuller lips.

While upper lip lines are often perceived as being caused by those smoke (and this certainly is a contributing factor), but many other factors contribute as well. The most significant, as previously mentioned, is light skin pigment and a genetically thin upper lip. This means that the upper lip has thin skin thickness and less subcutaneous fat which offers little buffer from the motion of the underlying circumferential orbicularis oris muscle. (facial wrinkles develop perpendicular to the action of the underlying muscle movement)

The treatment of upper lip lines is challenging because the source of the problem, movement of the mouth, is something that can not be changed after surgery. One can adopt a new diet to protect a liposuction result or avoid the sun and do numerous topical therapies to preserve other facial surgery changes, but one can not change the thickness of the upper lip or stop eating, drinking or smiling after lip line treatments.

The fundamental treatment of upper lip lines has historically been laser resurfacing. Using deeper laser treatments, the objective is to bring down the entire epithelial thickness of the skin and cause some collagen thickening as well. Much like sanding an irregular surface, significant reduction in lip lines can be achieved by total ablative laser treatments. But it can thin out the skin, cause pigment loss and can not usually be done more than once if the initial laser depth was deep. Thus enters the concept of fractional laser resurfacing where the risks of skin thinning and color loss is minimized. By cutting deep laser holes in just a fraction of the skin surface (22% or less), better collagen production and skin tightening is achieved. When combined with an initial very superficial ablative laser pass (< than 50 microns), significant and sustained lip line reduction can be achieved.

Other lip skin resurfacing methods are available including the dermaroller and old-style dermabrasion. For very deep lip lines, dermabrasion provides the most aggressive method of ‘sanding’ that actually produces the best results. But it is a highly technique sensitive method of resurfacing and is prone to a higher risk of hypertrophic scarring and severe skin thinning. The dermaroller is very much like a poor man’s fractional laser that punches small holes in the skin but its ability to induce collagen production is not as powerful and multiple treatments are needed to approximate even one laser resurfacing.

The other approach to lip lines is to add volume by injectable fillers. Most patients think this means trying to directly inject the vertical lip lines, and this can be done for the very deepest ones, but it really means augmenting the size of the upper lip vermilion. This will  increase the size of the upper lip which directly plumps out the lower end of the vertical lines as they join into the pink part of the lip. For those women that do not mind some increase in their lip size this is an essential step in a lip line reduction strategy. Whether one should use any of the available hyaluronic acid-based fillers (e.g., Restylane, Juvederm) or consider some autologous fat is a matter of discussion with each patient. There is also the option of a lip lift or lip advancement which provides a permanent change in the vertical size of the lip vermilion and cuts out some lower lip lines as well. (lip advancement only)

The best upper lip line reduction therapies incorporate a combination of skin resurfacing and volume addition. If done in the office, fractional laser (22%, 100 microns) with Juvederm upper lip injections is my preferred technique done under topical anesthesia. If done in the operating room, as part of a facelift for example, then I would do a more ablative laser treatment (two passes) with fat injections into the upper lip. Either way the patient needs to be aware that lighter maintenance fractional laser treatments will be needed in the future.

The key word to use in the treatment of vertical lip lines is reduction, few patients will achieve complete elimination of them in a single treatment.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Adult Primary Cleft Lip Repair

Monday, May 6th, 2013

 

Background: Cleft lip and palate deformities are a well recognized birth defects that affects around 1:1000 births. In the U.S., they commonly undergo a primary repair of the cleft lip in the first three to six months of life. Outside of the U.S., American plastic surgeons are well known to travel all over the world to use their skills to repair cleft deformities at all ages. (e.g., Operation Smile) Many of these international cleft patients are often older, some even adults, as they have never had access to plastic surgery care before.

Case Study: This 28 year-old male from Mexico presented for a cleft lip repair. He was born with a right incomplete cleft lip with no cleft palate component. He had never had any surgical efforts at repairing his obvious cleft lip.

Under general anesthesia, he underwent a full rotation-advancement type cleft lip repair. The medial lip segment was rotated down and the orbicularis muscle was repaired from the base of the nose down to the vermilion. The lateral lip segment was advanced into the upper lip defect left by the downward rotation of the medial lip segment. The vermilion-cutaneous border was realigned and the full length of the lip vermilion vertically closed.

His lip sutures were removed one week later. He was not seen again for a year after his surgery. At that time his lip was fully healed and the scars matured. The vermilion-cutaneous border was well-aligned and he had good vertical lip length along the philtral column. There was some vermilion indentation along its vertical length which was going to have a revision to add some volume by fat grafting.

Case Highlights:

1) Unrepaired or poorly repaired cleft lip and palate deformities are become more common in the U.S. with an increasing immigrant influx.

2) Cleft lip repairs in adults are just as successful as in infants with a large amount of tissue in which to work.

3) Adult cleft lip repair patients are tremendously grateful for any surgical efforts of improvement. But like infants, most primary cleft lip repairs benefit by a secondary revision for the best possible result.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Male Lip Implant Augmentation

Saturday, December 8th, 2012

Background: Lip augmentation is a popular procedure that is most commonly done with the use of injectable fillers. Any of the family of hyaluronic-acid based fillers offers an immediate improvement in which the material can be placed in a variety of lip locations to create both increased size and/or enhancement of various lip features. Its only downside is that it is temporary and must be repeated for the effects to be maintained.

The overwhelming number of lip augmentations is done in women with only an occasional man ever having the procedure. The reasons for this is the obvious preference for fuller and larger lips in women from a fashion and beauty perspective. While fuller lips in men can also be attractive, it is not a primary facial feature that necessarily makes for a strong masculine appearance. The other reasons lip augmentations are done a lot less in men is that they, in general, are less tolerant of the injectable experience.

Lip implants offer a permanent option for lip augmentation. Over the years, a variety of implant types have been available for subcutaneous tissue implantation, all of which have been different forms of polytetrafluorethylene materials. All of these materials have been withdrawn from the market with mixed clinical results. Permalip (Surgisil, Plano, Texas) is a relatively new implant designed for the lips made of a very soft (low durometer) formed silicone material. Because of its very smooth surface and tapered design, it is easily reversible should that be desired in the future.

Case Study: This 45 year-old male was undergoing a variety of procedures for facial enhancement and was interested in doing a permanent lip augmentation at the same time. Options discussed included fat injections, a lip lift, an internal mucosal advancement and silicone lip implants. He wanted the simplest but the most reliable method that would ensure a sustained augmentation effect.

At the completion of his other facial procedures, both the upper and lower lips were infiltrated with a lidocaine solution that contained epinephrine. Small 5mms incision were inside the corners of both sides of the mouth in the mucosa and scissors used to make an intramuscular tunnel to the midline in both the upper and lower lips. A fine curved grasping instrument was then passed from one side of the lip to the other through the incisions and a 5mm implant was placed in the upper lip and a 3mm implant in the lower lip. Both implants were 65mms long. The incisions were closed with small dissolveable sutures.

After surgery he did develop the typical significant lip swelling that is typical from implant passage through the lips. Some bruising occurred on the left upper lip but in other lip quadrants. His lip achieved their final size at 3 weeks after surgery which remained unchanged three months later.

Case Highlights:

1)      Lip augmentation in men is uncommon and they are less likely to choose temporary injectable fillers.

2)      Silicone implants (PermaLip) offers a permanent option for lip augmentation when one has tried and/or does not prefer injectable fillers.

3)      Silicone implants slide easily into place through small incisions at the corners of the mouth and are available in sizes of 3, 4 and 5mms diameters with lengths from 55mm to 65mms. Men will almost always need the longest lengths.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Lip Anatomy

Thursday, May 24th, 2012

The lips on a face seem relatively uncomplicated, seemingly two simple strips of red-colored tissue placed in a horizontal orientation as the gateway to the mouth. But their shape is actually more complex than it seems as evidenced by the named descriptions of different anatomical points. (cupid’s bow, philtral columns, commissures, vermilion, vermilion-cutaneous junction) And each of these lip areas can be managed by numerous plastic surgery techniques such as injectable fillers, lifts and tucks. This has made lip reshaping a popular focus for women seeking to rejuvenate and enhance their mouth areas.


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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