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Archive for the ‘non-invasive body contouring’ Category

The Fat Cell Effects of Vanquish Radiofrequency Treatments

Monday, September 7th, 2015


Vanquish Fat Reduction Dr Barry Eppley IndianapolisSelective radiofrequency (RF) is the energy basis for how the fat reduction device, Vanquish, works. Through the use of an external applicator, RF-based energy is delivered to the subcutaneous fat. This is purported to cause fat cell death and it does so without discomfort or recovery. But with so many other energy-based devices that do cause some discomfort with their use, does Vanquish really work as claimed?

In the June 2015 issue of the Journal of Drugs in Dermatology, an article appeared entitled ‘Human Adipocyte Apoptosis Immediately Following High Frequency Focused Field Radiofrequency’. In this paper two adult women underwent abdominal skin and fat biopsies before and just after after one 45 minute RF treatment. Temperature measurements were also done at 1 and 2 cms below the skin level. Fat cell death (histologic apoptotic index) had an average increase of almost 500%. Temperature measurements showed an average skin temperature of almost 32 degrees C. After treatment the average skin temperature was just over 39 degrees C.  At 1 cm depths the temperature rose from 40 degrees C to 45 degrees C in 15 minutes after treatment and remained so for the remaining 30 minutes.

This small but human study shows that an RF treatment causes an appreciable increase in fat cell apoptosis at one hour from the beginning of treatment. This occurred at a subcutaneous fat temperature of 45 degrees. The skin surface temperature remains substantially lower than that of the fat temperature.

Radiofrequency Vanquish treatments cause apoptosisThe term ‘apoptosis’ sounds strange and unfamiliar but it is better interpreted as meaning a programmed cell death. This occur from a series of biochemical events that causes cell changes that ultimately lead to its death. Apoptosis should not be confused with the term, ‘necrosis’, which is cell death from an acute injury. That distinction is critical as apoptosis is a more gentle process rather necrosis which is a very traumatic one. As a simple analogy, it is the difference between getting a house to fall down by pushing on its walls versus dropping a bomb on it. In short the collateral damage between the two methods of cell death is quite different. This explains how selective RF treatments induce cell death by doing so without damaging nearby tissues in the process.

Dr. Barry Eppley

Indianapolis, Indiana

Vanquish Radiofrequency Fat Treatments

Sunday, September 6th, 2015


Energy-based devices have achieved a viable status in the non-surgical elimination of fat. With numerous devices available, the question is what is the right energy-based technology that can achieve the best results. Options include ultrasound, radiofrequency and electromagnetic waves as well as laser and thermal energies.

Vanquish  Fat Reduction Dr Barry Eppley IndianapolisThe use of selective radiofrequency (RF) is an FDA-approved method to reduce the fatty layer just below the skin. Known as Vanquish, its applicator is positioned over the treatment area where it delivers RF-based energy to subcutaneous fat which causes adipocyte cell death. (apoptosis) Vanquish has now been proven to be a fast, safe and effective method to treat unwanted fat without downtime or complications. Many practices combine it with the companion device, Exilis, which is used for overlying skin tightening.

Vanquish Body Contouring Dr Barry Eppley IndianapolisOne of the most appealing features of Vanquish is that it can treat a large body area in a short treatment time. For example the entire abdomen from one side to the other can be treated all at the same time. This is very different from CoolSculpting, for example, which can only treat a much smaller area and does not treat skin laxity. This is of particular advantage in older patients who are more prone to developing loose skin with fat reduction.

While cryolipolysis (CoolSculpting) is effective, some patients will be uncomfortable with the treatments particularly at the central stomach area. Vanquish treatments will induce no such discomfort despite that they are treating a much surface area of the body.

Energy-based devices are here to stay in one form or another. With any non-surgical fat treatment method, patient selection and education are crucial. Patients need to be given and have realistic expectations and chosen carefully for the treatments. Non-surgical fat treatments draw a wide range of patients through the door from lean to overweight, all hoping to lose a few inches or more. Vanquish can be very effective at modest fat reduction results and its ability to treat large body areas safely without complications is an appealing aspect of its use.

Dr. Barry Eppley

Indianapolis, Indiana

Exils and Vanquish Combination Treatments for Skin Tightening and Fat Reduction

Monday, July 20th, 2015


There are numerous non-invasive no downtime body contouring procedures for skin tightening and fat reduction specifically. One of these technological approaches is that offered by BTL Aesthetics. They offer plastic surgeons two-energy driven devices that work together to produce the best outcome without patient discomfort or recovery. These two devices include the Exilis and Vanquish.

Both BTL devices used monipolar radiofrequency energy to create their effects. Exilis is primarily used for skin tightening and a superficial fat reduction that lies right under the dermis of the skin. Conversely Vanquish directs radiofrequency energy much deeper to reach larger fat areas much further past the skin. By creating cellular apoptosis fat layers are reduced in thickness. It is easy to see when both Exilis and Vanquish are done together they create the best non-surgical contouring effect possible.

Exilis Dr Barry Eppley IndianapolisExilis is able to tighten skin at high energy levels due to its sophisticated cooling system in a small handpiece. Vanquish creates a safe effect by spreading its radiofrequency energy over a much larger area using external panel applicators. With these panel applicators Vanquish can treat the abdomen, flanks, thighs and arms.

Vanquish Fat Reduction Dr Barry Eppley IndianapolisThe usual sequence of treatment is to use Vanquish first for bulk fat treatment/reduction. To treat the abdomen and flanks fir example it takes a 45 minute treatment session. Four treatments spaced one week apart will produce a noticeable change. Vanquish does have some skin tightening effect but Exilis is even more effective. Using Exilis right after Vanquish increases the skin tightening effect which is usually needed when the fat loss ensues.

Despite their body contouring benefits it is important to realize that the Exilis-Vanquish combo treatment are no weight loss devices. They work best on those patients who need focal areas of body contouring, need to lose just a few inches and understands that it will not create a ‘liposuction’ result. A healthy lifestyle, some exercise and good hydration are patient contributions that are needed for optimal results.

The pursuit of fat reduction and skin tone improvement in the 30 to 50 year old range through non-surgical means is highly sought after. The BTL Vanquish and Exilis combo performs as well as any other non-invasive devices and does so with no discomfort or downtime. They also work well after other surgical body contouring procedures like liposuction and tummy tucks.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Exilis Elite for Cellulite Treatment

Monday, April 13th, 2015


Cellulite is a well recognized aesthetic skin condition that occurs most commonly in women and involves the buttocks and thighs. The cottage cheese appearance is recognized today to be the result of compartmentalized fat hypertrophy and the contraction of dermal-fascial bands in the involved regions. New device based treatments continue to emerge for its treatment that either focus on fat reduction, fascial release or both.

Exilis Skin Tightening Indianapolis Dr Barry EppleyExilis is a monopolar radiofrequency device that is used to heat the skin, resulting in collagen remodeling and skin tightening. It was first introduced in early 2011 after FDA clearance for the treatment of loose skin and body contouring. It has proven to be a valuable non-surgical treatment for reducing loose skin and wrinkles on the face and body.

Exilis Elite Dr Barry Eppley IndianapolisIn February 2015 the FDA has approved the use of Exilis for the temporary reduction in the appearance of cellulite. Using a new treatment protocol that can effectively target the fat underneath cellulite involved skin that helps give it its dimple lumpy external appearance, temporary improvement in the appearance of the skin is obtained. It takes multiple treatments, usually four to six, spaced several weeks apart to get the full effect. Full results can take up to three months after treatment.

Exilis Elite joins a growing number of devices for cellulite that offers non-surgical treatments of an aesthetic problem that defies any universally effective solution.

Dr. Barry Eppley

Indianapolis, Indiana

Mini-Mommy Makeover Procedures

Sunday, May 19th, 2013

The concept of a Mommy Makeover plastic surgery procedure is about combining abdominal and breast reshaping in one operation. The breast and abdominal components are not new and include many well known procedures such as tummy tucks, breast implants, liposuction and breast lifts in whatever combination each individual women needs. While the effects of a Mommy Makeover can be dramatic, breast and abdominal procedures are major surgery with significant recovery as well.

But there are numerous other procedures of lesser magnitude that could also be lumped into the Mommy Makeover category and consist of a variety of ‘nips, tucks and sticks’ that create effects that mothers would also like. Here are some of the most noteworthy.

BOTOX  For reduction of those facial expression lines that come from the stress of balancing mother and wife roles, Botox injections are probably the most common injectable Mommy procedure.

Vi/PERFECT PEELS With only a few days of redness and flaking, these medium-depth facial peels are essentially painless to go through and provide a real boost to one’s complexion. A few of these a year will keep a mother’s skin radiant and glowing.

C-SECTION SCAR REVISION For those women that don’t need a tummy tuck and have a noticeable c-section scar with just a little pooch above it, widely cutting out the scar can produce a flatter upper pubic area. This scar revision can be combined with some lower abdominal liposuction for an additional and wider flattening effect.

UPPER LIP PLUMPING Some well placed Restylane or Juvederm injections into the upper lip has an instant youthful volumizing effect. This is particularly evident if the cupid’s bow and philtral columns are accentuated.

NIPPLE REDUCTION Breast feeding can elongate the nipple which can be a source of embarrassment and out of proportion to the size of the areola. Under local anesthesia, the nipple length can be reduced by half or more.

EARLOBE REPAIR Fixing stretched out ear ring holes or complete tears through the lobe can allow old or new ear rings to be comfortably worn again.

BELLY BUTTON REPAIR (Umbilicoplasty) Pregnancies can change an innie belly button to an outie due to a small hernia through the umbilical stalk attachment. Tucking the peritoneal fat back through the hole and reattaching the stalk of the belly button back down to the abdominal wall will recreate that an old inne look again.

EXILIS For those stubborn fat areas that just won’t go away despite some diet and exercise, this non-surgical fat treatment can easily fit into a busy mom’s schedule. It takes a series of treatments to see the effects but there is no downtime with 30 minute in-office treatment sessions.

These mini-Mommy Makeovers provide changes that do not require major surgery or recovery and can fit into anyone’s hectic schedule.

Dr. Barry Eppley

Indianapolis, Indiana

The Role of the Exilis Device In Fat Reduction and Skin Tightening

Saturday, June 23rd, 2012

The desire for fat reduction is ubiquitous and a large number of methods exist from dieting to surgery to achieve it. While liposuction and bariatric surgery are all effective means of fat removal and weight reduction respectively, they are not equivalent and have very different outcomes. But they do share the similarity of being invasive surgery. And many people understandably want to avoid surgery for fat removal if possible. This has led to a large number of non-surgical devices that are currently available for use.

One of these devices is Exilis, coined as a body shaping and tissue tightening method. Exilis is an FDA-approved devices that employs radiofrequency (RF) energy for the reduction of targeted fatty deposits, skin tightening and sundamaged and wrinkled skin anywhere on the face and body. Radiofrequency energy is a safe form of radio waves that drives heat to fat cells that lie within one inch of the skin’s surface. This heat causes the metabolism of the fat cells to speed up and subsequently shrink. The heat also stimulates the skin to strengthen its collagen structure which provides some improvement in skin laxity.

Because it creates heat that passes into and through the skin, does it cause pain during a treatment? Generally it does not. While the RF energy is heating the skin, the system monitors the skin’s temperature  so it does not get too warm and the patient remains  both safe and comfortable. A grounding pad is also applied prior to treatment so there is no chance of arcing and causing a burn. Patients usually feel a deep heating sensation as the probe goes over a treatment area. Treatments last around 15 minutes per treatment area and are done in the office. Other than some mild redness of the treated areas for a few hours, there are no sequelae after treatments including any restriction of physical activities.

Which are the best areas for Exilis treatments? Regardless of body area, whether a man or a women, it is important that the amount of fat not be too excessive. While the definition of ‘excessive fat’ varies, a general rule is that if it is much bigger than one or two hand sizes, it will not be as effective as one would like. Most women are interested in face and jowl tightening and fat reduction of the abdomen, arms, flanks, bra rolls and thighs. Men have more restrictive needs involving the abdomen, flanks and chest.

Exilis always involves more than one treatment, it needs a series. The number of treatments will depend on the areas treated and whether fat reduction or skin tightening is the main objective. In most cases, four treatments will be needed spaced one or two weeks apart. The final outcome of the treatments may take two to four months to see the maximal benefits of the therapy.

Despite the appeal of Exilis and many satisfied patients, it is important to realize that no non-surgical fat reducing technology works for everyone. There is always the risk that no or limited results will be seen. For this reason, it is most ideal to go to facility or a plastic surgeon who performs all methods of fat removal and skin tightening. Their recommendation will be noteworthy because they are not captive to the monthly lease payment of an expensive device. They can offer the best treatment method, even if it is a surgical one that the patient is trying to avoid.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review: Exilis Non-Invasive Body Contouring

Saturday, May 5th, 2012

Liposuction provides the most effective method of body contouring that we currently know. Its invasive approach is the direct subcutaneous disruption of fatty deposits followed by their vacuum extraction. The final result is a combination of the fat removed and how the overlying skin shrinks and adapts to its reduced underlying support structure. While effective, it is fairly traumatic to the tissues and substantial recovery is required in most cases.

Because of the desire to avoid liposuction surgery, the field of non-invasive body contouring has emerged in the past decade as an alternative treatment option. These are device-driven technologies that direct and drive various types of energies into the underlying tissues in an effort to either shrink fat, tighten skin or both. One of these energy technologies is that of radiofrequency. Known by the acronym RF, radiofrequency is the oscillation of electrical currents at radio frequencies. In essence, it is another name for radio waves which is one form of electromagnetic energy. Radiofrequency energy has been used in medicine for well over fifty years in such applications as radiofrequency ablation of tumors and magnetic resonance imaging to create images of internal structures of the human body.

The power of RF and its ability to penetrate tissues is a function of its wavelength (distance covered by one cycle of the wave) and its frequency. (the number of waves passing a given point in a second) The wavelength multipled by the frequency equals the speed of light. The frequency of RF energy is expressed in Hertz Units. (one Hz = one wave/second)  One thousand waves equals one kilohertz (KHz), one million waves equals one megahertz (MHz) and one billion waves equals one gigahertz. (GHz) Most RF waves are in the range of about 3 KHz to 300 GHz. As a common comparison, microwaves have radiowaves in the frequencies of 300 MHZ to 3 GHz. Exilis has RF energies in the 2 MHz range which can be seen to be just a fraction of the energy emitted by a standard kitchen microwave. Such wave oscillations affect underlying tissues by causing their molecules to vibrate creating a heating effect. The depth of wave penetration is ultimately controlled by the amount of power (watts), wavelength and the heat generated by the treated tissues. The Exilis device has been shown to penetrate up to 2.5 cms (one inch) below the skin.

Exilis treatments are delivered through a handheld wand device known as a transducer. It is a monopolar RF device that will rapidly heat up tissues, known as the therapeutic thermal temperature. The safety of the device is the real time monitoring of the skin’s temperature so it does not become too hot/burned. This allows the maximum of power to be delivered with reasonable comfort. A liquid gel interface between the skin and transducer is critical as well as the technician keeping the transducer head in motion based on the skin’s temperature.  The software of the Exlis device has a unique energy flow control feature so that it eliminates energy peaks to ensure more uniform energy distribution. It is these energy peaks, which if uncontrolled, that can lead to intermittent patient discomfort.

RF wave stimulation breaks down the well known triple-helix structure of collagen in the dermis of the skin. This unraveling by the focused energy is followed by healing of the dermis through the creation of new collagen by fibroblast production. This accounts for the skin thickening and skin tightening effect. It is not yet known whether thinner or thicker skin is more influenced by this RF-induced collagen remodeling. Fat within an inch of the undersurface of the skin is affected by cell breakdown of the adipocyte walls. The RF waves cause weakening of the fat cell walls which results in extrusion of their fatty acid content. The released lipids are naturally absorbed and eliminated by the lymphatic system which is why high daily water intake is recommended during the treatment period. With loss of some of their content, the fat cells shrink reducing the overlying skin contour. With this penetration distance limitation, areas of thinner fat will respond more rapidly and effectvely than thicker areas to Exilis treatments.

The key to getting skin tightening and far reduction effects with RF energy is the periodic ‘re-injury’  of the target tissues. This means that multiple treatment sessions are needed that are not spaced too far apart. (one to two weeks) For both skin and fat it is important to not give them adequate time to completely heal their structures. The fat cell walls need to be repeatedly weakened for maximal content release. The fibroblasts of the skin dermis benefit by repeated heat stimulation for collagen production. Exilis effects are continuous meaning that their full benefits can take several months to see. Although many patients report see benfits as early as after the first treatment.

Dr. Barry Eppley

Indianapolis, Indiana

Fat Burning Topical Creams – Hype or Hope?

Sunday, April 1st, 2012

Liposuction is the most effective method of fat reduction that we currently know. But it is surgery and there is recovery and significant cost associated for its assured benefits. The concept of a topically applied agent that would provide some fat reduction has been one promoted and tried for decades. There have been many such cream and lotion products put forth but none have really had any scientific testing and proof that they are really effective.

A recent such product that I have come across is known as Body of Knowledge. This is a European product whose active ingredients are Theophylline and Liporeductyl. Theophylline is a well known compound most commonly used in the treatment of asthma. It has vasodilator effects which delivers more oxygen to the treated tissues which can help metabolize fat that it comes into contact. (lipolytic effect) Its effects have never been dramatic but they do exist. It has been used in fat burning and cellulite creams in the past with some documented effectiveness. Liporeductyl is a tripeptide compound that contains three ingredients that have been historically used in the treatment of cellulite. These include lecithin, caffeine and carnitine. It is purported to have a lipolytic effect and to improve microcirculation as well, hence reducing cellulite and having a slimming effect.

Putting these two compounds together into a topical cream would logically suggest that an effective fat reduction cream could be the result. There are a few limited clinical studies that report up to two inches off the waistline after two months of use. Numerous consumer testimonials can be found on the internet, usually on websites that are selling the product. It has a cost of $125 for an 8 oz. bottle.

Is this a miracle fat reducing cream? Some have even called it a liposuction cream, implying a significant effect. I think the answer is no. But this does not mean that it has no effect just that one should not expect any results to be dramatic. For minor amounts of slimming and even as a topical cream after liposuction, it may a useful role. The Liporeductyl component is highly touted for its anti-cellulite effect but its effects in this regard to date have been anectodal in my research. At its price for the bottle size, it is a pricey cream however.

Will a highly effective topical fat-burning cream ever be a reality? Based on compounds currently known it does not appear likely in the near future. New compounds are going to have to be discovered for a really significant advance. What we continue to see is recycling of known compounds in different formulations but with similar modest effects. For more significant effects, the use of devices such as Exilis or liposuction surgery is still required.  

Dr. Barry Eppley

Indianapolis, Indiana   

Exilis and SkinTyte Devices For Fat Reduction and Skin Tightening

Saturday, February 18th, 2012

As the latest statistics published by the American Society of Plastic Surgery show in 2010, the fastest growing procedures in cosmetic surgery are not surgery at all. Rather it is such non-invasive procedures as Botox, injectable fillers and focused and high-intensity light face and body treatments. This is a trend that has been ongoing now for the past decade and shows no sign of slowing down anytime soon. Recent studies also show that up to 25% of people would have some form of cosmetic surgery if cost and recovery were not an issue.

Whether it is to avoid the costs and recovery of more expensive surgery or to treat cosmetic problems for which there is no good surgical solution, non-surgical treatments continue to expand. One such area of expansion is the use of light-based and energy therapies. From skin tightening, fat reduction or the the improvement of cellulite, treatment options appear as often as new devices become clinically available. While light-based treatments were once thought of as just laser devices, used largely for skin resurfacing and hair reduction, this is no longer the case. Energy-based devices are now available that uses infrared light, ultrasound, and radiofrequency waves, technologies that long have had FDA-approved uses in diagnostic and therapeutic traditional medicine.

One such recent device is that of Exilis. This is a monopolar radiofrequency device that has recently received FDA clearance for localized fat reduction and skin tightening. With penetration depths that past the skin level by a few centimeters, stubborn fat deposits can be treated even over large areas. The radiofrequency waves disrupt the membranes of the fat cells by the generation of heat causing them to spill their lipid contents. As the liquid fat is absorbed over time, the size of the fat deposit becomes less. Exilis treatments are done in the office as walk in and walk out therapies requiring no downtime or recovery. It takes a series of 4 to 6 treatments spaced a week apart to see the best results.

The radiofrequency of Exilis also has a skin tightening effect. By heating the underside of the skin (deep dermis) through the radiofrequency energy, collagen is produced which causes the skin to tighten. This is particularly effective in the face, the jowls and neck, where the skin and underlying tissues are thinner. Because lower energy levels are used, it feels very much like getting a hot stone massage. Since the production of collagen is more gradual, treatments need only to be done every two weeks for two to three months. Some may call this a RF (RadioFrequency) Facelift as it can tighten the face without surgery.

Another energy device example is that of Sciton’s SkinTyte device. As part of their multimodality laser platform, Skin Tyte is high intensity pulsed light known as BBL. (broad band light) By stacking pulses of light over a treatment area, the underside of the skin is heated. This also produces collagen and a skin tightening effect very similar to that of Exilis. Unlike Exilis, however, its energy does not penetrate deep and no fat reduction effect is achieved. As the name implies, it is a non-surgical method of skin tightening.

While Exilis can do fat reduction and Skin Tyte can not, this begs the question as to whether Exilis or SkinTyte is better for skin tightening. It s unknown at this time as to how these technologies compare for their effectiveness. Since my practice has both technologies, I will be able to answer this question better in the future as greater numbers of patients are treated.

Dr. Barry Eppley

Indianapolis, Indiana   

Plastic Surgery Product Review: Exilis Radiofrequency Fat Reduction and Skin Tightening

Tuesday, January 17th, 2012

Device-based energy therapies for skin tightening and fat reduction have been around now for about a decade. Like computer and all electronic devices, their effectiveness improves with technologic advances. One of the recent device advances in heating fat and tightening skin is Exilis technology. This uses a well known energy technology, radiofrequency, to create its effect. But its advantages are based on modifications to radiofrequency in how it is delivered.

Exilis uses radiofrequency which is basically sound waves that are delivered into and through the skin. Traditionally radiofrequency is delivered in a bipolar fashion which penetrates little further than the thickness of the skin. But Exilis’s uniqueness is that it is monopolar radiofrequency which allows the waves to penetrate deeper and deliver more energy to dissolve fat cells. By using a grounding pad on the patient, the radiofrequency is applied deeply and it does a return circuit back to the machine. The skin temperature is also monitored to make sure it never gets too hot (above 45 degrees C) to prevent skin damage and make it comfortable for the patient. In addition, Exilis has a proprietary technology called Energy Flow Control (EFC) which monitors the energy level to prevent burns and any energy arching if skin contact is not ideal.

While many non-invasive energy therapies have left physicians skeptical, Exilis is FDA-approved for tightening skin and reducing wrinkles. The heat generated in the dermis of the skin causes collagen production, generation of collagen networks and tightening of skin. Fat reduction has also been reported by both doctors and patients alike. The deeper penetrating heat can cause fat cells to break down (lipolysis), release their free lipids and shrink in size. This results in an external change in the size of the body part.

The application head of Exilis and its built-in cooling device make it possible and safe to treat loose skin and excess fat anywhere on the body. This could be as diverse as the neck and jowls, back of the arms, bra rolls, stomach and all the way down to the knees. The ability to ‘spot treat’ is a major advantage over other more cumbersome devices. Each treatment is not only safe but is not painful. Most patients equate an Exilis treatment similar to a hot stone massage due to precise temperature monitoring. It can be used to treat all skin types which is another advantage of the device.

Because the temperature and the duration of generated heat to any part body is controlled for safety, multiple treatments are needed and results gradually achieved. Exilis treatments are done in a series of 4 to 6 treatments spaced one to two weeks apart to get the best result. Treatments are done in 30 to 45 minute sessions with no pain during and no downtime afterwards. One can go right back to their regular activities without any change in routinue.

For those patients receiving treatments for fat reduction, we advise drinking lots of water after the treatments to flush out fat through enhanced lymphatic flow. Combined with regular exercise and a niacin-based supplement known as Curva, optimal fat reduction can be achieved.

Results from Exilis are gradual although most see some immediate results. But maximum results takes months to see, up to three months after the last treatment. Studies have shown that the results are long-lasting.

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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