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Archive for the ‘plastic surgery case study’ Category

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

Case Study – Male Mouth Rejuvenation

Sunday, January 22nd, 2017

 

Background: Aging affects all areas of the face and is always most observed in the sphinteric areas of the eyes and mouth. The mouth develops very consistent age-related changes including thinning of lip vermilion show, lengthening of the upper lip and a downward slant to the corners of the mouth. It is all part of the overall tissue shrinkage and southern drift that occurs in overall facial aging.

One of the main differences in male vs. female perioral aging is that men develop far less vertical lip wrinkles. The thicker skin of men due to containing hair follicles and the lifelong use of microdermabrasion (shaving) accounts for the far less number and depth of perioral wrinkles.

The other difference between men and women in age-related mouth changes is that men generally tend to care less about them. This, however, does not mean all men do and there is one mouth change that even most men will eventually dislike…the downturning of the mouth corners.

Case Study: This 68 year-old male was bothered by his mouth appearance. He felt his upper lip was too long and he particularly disliked his mouth frowns. He felt that people viewed him as being angry and unpleasant…when he was not really that way. He felt that people saw him as unapproachable and unfriendly because is mouth at rest had a frown.

Male Subnasal Lip Lift and Corner of the Mouth Lifts drawings Dr Barry Eppley IndianapolisUnder local anesthesia, a subnasal lip lift was initially performed. His upper lip length along the philtral columns was 20mms. This was reduced by 6mms to 14mmw, a more normal upper lip length. Corner of the mouth lifts were performed using the pennant technique. An 8mm lift was done with skin excision and orbicularis muscle plication. This also had about 2 to 3mms of a  mouth widening effect at each corner.

Male Subnasal and Corner of Mouth Lifts immediate result Dr Barry Eppley IndianapolisMale Subnasal Lip Lift and Corner of the Mouth Lifts immediate result Dr Barry Epley IndianapolisThe thicker beard skin of men makes lip lifts and corner of mouth lifts more favorable in their scar formation than women. Such perioral rejuvenation procedures can work well for men as long as they are not overdone. (over lifted) The other potential adverse scar formation is that with corner of the mouth lifts…but this potential revisional issue is the same for both men and women.

Highlights:

1) Aging of the male mouth consists of upper lip lengthening, thinning of the upper lip vermilion and downturning of the mouth corners.

2) A subnasal lip lift in a male rejuvenates the lip-nose relationship and is an important part of many male mouth rejuvenation efforts.

3) A corner of the mouth lift in a males strives to achieve a neutral or unfrowning mouth appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Occipital Scalp Roll Excision

Sunday, January 22nd, 2017

 

Background:  The scalp is a remarkably thick and well vascularized tissue as it covers the entire skull surface. Its thickness, however, varies at different areas of the skull. It is the thickest on the back of the head where it blends into the posterior neck tissues. The base of the occipital skull also ends up much higher than one thinks, leading to a thick collection of tissue over the back of the head without any underlying bone support.

Scalp rolls on the back of the head appear to occur due for a variety of reasons. Naturally thick scalp and neck tissues, excessive scalp laxity, short necks and being overweight can all contribute to a bunching up of scalp soft tissues in this area. Scalp rolls can appear as a single, double and even a triple roll. The most common presentation is a double roll with deep horizontal skin crease between them.

Skin rolls on the back of the head is an almost exclusive male aesthetic concern. Shaved heads and very closely cropped hair make them visible and can be a source of embarrassment.

Occipital Scalp Roll Reduction drawings Dr Barry Eppley IndianapolisCase Study: This 28 year-old male had a thick neck with two very prominent scalp rolls with an intervening skin crease with his head in neutral position. It turned into a triple roll when he extended his head backwards. Presurgical markings were made of a elliptical excision incorporating portions of the upper and lower skin rolls with the skin crease at its horizontal middle.

Occipital Scalp Roll Reduction incisionks Dr Barry Eppley IndianapolisOccipital Scalp Roll Reduction Excision Dr Barry Eppley Indianapolis copyUnder general anesthesia and in the prone position, an elliptical excision of scalp skin and a wedge of tissue was removed. The periosteum and some soft tissue was maintained on the bone for subsequent placement of quilting sutures at closure. The upper and lower skin flaps were undermined to release some of the additional skin rolls. Closure was done with quilting sutures to close the deep space as well as up to the skin level where a subcuticular closure was placed.

Occipital Scalp Roll Reduction Immediate result Dr Barry Eppley IndianapolisThis excisional and undermining method will remove most of the skin rolls and create a smoother back of the head contour. While it does create a fine line scar, it appears similar to the horizontal skin crease that already existed.

Highlights:

1) Occipital scalp rolls can have multiple presentations from one to three rolls on the back of the head.

2) Excision of a wedge of skin and deeper tissues allows for scalp roll reduction.

3) Widely undermining the scalp flaps above and below the excised tissues helps to work out adjoining rolls as well.

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

Case Study – Fat Injection Breast Augmentation Outcome

Monday, January 16th, 2017

 

Background:  Breast augmentation is the most common as well as recognized body contouring operation. Performed through the placement of an implant, its after surgery volume retention is assured. Its downside is that the use of a gel or saline-filled device makes it susceptible to numerous long-term implant related issues and further surgeries.

Fat injection breast augmentation (FIBA) is an appealing alternative to the use of implants in an elective aesthetic procedure. Since the breasts are composed of fibrofatty tissue, adding fat would be a natural and well accepted augmentation tissue. In addition, some patients do have excess fat they would like to get shed and putting in the breasts at the same time is more than a logical exchange.

But many younger women with small breasts have thin body frames. There can be a correlation between breast size and body habitus in some women. Even in women with some visible fat to harvest, it is important to remember the ‘halving principle’ in injectable fat grafting. This goes as follows…half of the harvested liposuction aspirate is removed by concentration, the concentrated fat is split or halved between the two breasts and half of the injected fat will be resorbed. (or 50% volume retention)

Understanding this principle helps patients to determine if fat injections are a good choice for their breast augmentation as well as to have realistic expectations about the volume increase outcome.

Case Study: This 20 year-old female wanted to have breast augmentation by fat injections. She did have some modest fat to harvest from her abdomen and flanks and was well informed that this approach to her breast augmentation would result in a very modest change at best.

Fat Injection Breast Augmentation Dr Barry Eppley IndianapolisUnder general anesthesia she had 845cc of liposuction aspirate harvested from her abdomen and flanks. The aspirate was concentrated down to 430cc of injectable material which was used to inject 215cc into each breast.

Fat Injection Breast Augmentation result front view Dr Barry Eppley IndianapolisFat Injection Breast Augmentation result obloque view Dr Barry Eppley IndianapolisHer one year after surgery results showed a visible augmentation benefit that was about a 1/2 cup size increase. She eventually decided to get breast implants for a much larger result.

Fat Injectionk Breast Augmentation result side view Dr Barry Eppley IndianapolisFat injection breast augmentation is a very appealing alternative to implants but patient selection is critical. Until the science of fat grafting is better understood and fat cell survival can be increased, its use in breast augmentation will remain limited to those patients seek very modest breast size increases.

Highlights:

1) The success of fat injection breast augmentation depends on how much fat one has to harvest and how much survives after being injected.

2) Enlarging the breasts by injectable fat grafting usually result in modest change in the range of a 1/2 cup bra size or so.

3) Potential patients need to consider the ‘halving principle’ when considering augmentation by injectable fat grafting.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Asian Double Eyelid Surgery

Sunday, January 8th, 2017

 

Background:  The double eyelid surgery is a well known blepharoplasty technique that creates an upper eyelid crease in the typical Asian monolid. While the supratarsal fold is present in many ethnic groups around the world, it is missing in many Asian patients. The operation per we does not really create two upper eyelids or removes a single eyelid per se. But the placement of a crease creates two discernible upper eyelid sections which make it appear more interesting and even energetic.

While often called ‘westernizing’ the eyelid, this is not really the objective of the surgery nor is what most Asian patients want. Rather it makes the eye area more interesting than a monolid and is also a cultural sign of beauty. This accounts for its tremendous popularity in eastern Asian culture particularly amongst younger people.

There are a lot of variations in the Asian upper eyelid. It is common to see patients who have a hint or partial upper eyelid fold. Having some fold dictates where the new fold will be in most cases. Setting the new fold position can widely vary from its location above the lashline to its shape across the upper eyelid. There are numerous different techniques for creating the fold from no to a full incisional approach…each with their surgeon advocates.

Case Study: This 21 year-old female wanted double eyelid surgery to enhance her appearance. Her right eyelid was a monolid while the left eyelid had an incomplete crease, most promienently seen in the outer half of the lid.

asian-double-eyelid-surgery-intraop-dr-barry-eppley-indianapolisUnder general anesthesia, she had a full incisional double eyelid procedure using 5 points of levator-tarsal-dermal fixation for each eyelid. The crease height used was based on the of her incomplete crease level of the left upper eyelid. She declined medial epicanthoplasties. The immediate intra- and postoperative appearance can be striking with what appears to be creases that are too high.

asian-double-eyelid-surgery-results-front-view-dr-barry-eppley-indianapolisHer six months after surgery results show a pleasing upper eyelid appearance with defined creases and good symmetry between them.

Highlights:

1) Double eyelid surgery is an Asian eyelid procedure to make the upper eyelid more defined. (monolid to two distinct sections of the upper eyelid)

2) Many double eyelid procedures include treatment of the epicanthal fold as well. (medial epicanthoplasty)

3) Recovery from double eyelid surgery takes 3 to 4 weeks to see the final result

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Older Female Jaw Angle Implants

Saturday, January 7th, 2017

 

female-strong-jawline-dr-barry-eppley-indianapolisBackground: The strength of the lower jaw is a known favorable feature for a male. But it has become increasingly desired and requested for women as well. Partially spurned on by various well known celebrities and actresses’ jaw shapes, younger women are seeking stronger jawlines as well.

An important part, and until recently overlooked, of a well defined jawline is the jaw angles. When patients refer to a ‘stronger jawline’ they are usually referring to the jaw angle area. A well defined and prominent jaw angle is one that is clearly seen from the front view and often creates more of a V-shape to the jawline. While once considered more masculine, a female with more prominent jaw angles are now seen as youthful and atractive.

One unexpected but favorable effect of jaw angle augmentation is that it provides a lift along the jawline. Making a stronger jaw angle requires increased soft tissue coverage. This recruits tissue from the neck to cover the increased bony prominence. This can have a favorable effect in the older patient who has developed loose skin along the jawline and posterior neck.

Case Study: This 61 year-old female was to undergo a variety of facial rejuvenation procedures. One of her requested procedures was jaw angle augmentation. She wanted more defined jaw angles and v-shaped jawline. She previously had a facelift.

female-jaw-angle-implants-result-front-view-dr-barry-eppley-indianapolisUnder general anesthesia, she had medium widening jaw angle implants placed through posterior intraoral incisions. The implants were placed under the masseter muscle, snuugly fitting up against the existing bone angle posterior and inferior contour.

cw-jaw-angle-implants

A more sharply defined jaw angle has both a jawline reshaping effect and a lower facial rejuvenative influence in older patients. Even in the older female patient who has already had a facelift, a stronger jaw angle adds to a rejuvenated jawline.

Highlights:

1) Jaw angle implants add shape and definition to the back part of the jaw/lower face.

2) Females are having an increased interest in the shape and definition of their jawline.

3) In older females a stronger jaw angle can fill out loose skin and give a bit of a facial rejuvenative effect.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Male Middle Eastern Rhinoplasty

Monday, January 2nd, 2017

 

Background: The shape of the nose is incredibly diverse and no two people have the exact same nose.  But in the world of rhinoplasty surgery, noses are lumped into different categories based on ethnicities. In general any rhinoplasty that is not performed on a Caucasian nose is called an ethnic rhinoplasty.

One such ethnic rhinoplasty is that of the Middle Eastern nose. As the Middle East region has over 17 countries, there is no one unifed nasal shape or deformity. But the most common patient objective is to reduce a large hump or bump on the upper half of the nose. In addition the nasal tip often droops down, creating less than a 90 degree nasolabial angle. The combination of hump reduction and tip elevation constitutes the backbone of the Middle Eastern rhinoplasty.

Frequently the Middle Eastern nose has a thick skin cover. At the least it is on average thicker than that of most Caucasian noses. This can create a challenge for the degree of tip refinement. But in the male patient in particular the goal is to make the nose more balanced but still retaining the ethnicity of the patient’s appearance.

Case Study: This 38 year-old Middle Eastern male desired to improve the shape of his nose. He did not like the large bump on his nose and wanted the tip lifted and thinned a bit. But he did not want the nose too upturned or the bridge area too low.

middle-eastern-male-rhinoplasty-resulys-side-viewmiddle-eastern-male-rhinoplasty-result-front-view-dr-barry-eppley-indianapolisUnder general anesthesia and through an open rhinoplasty, the dorsal hump as reduced requiring lateral osteotomes. The tip was lifted through combined caudal septal resection combined with tip cartilage reduction and suturing. Lastly alar base narrowing was done to stay in balance with the more narrow tip.

middle-eastern-male-rhinoplasty-results-oblique-view-dr-barry-eppley-indianapolisWhile rhinoplasty is changing the shape of the nose, it should not be significant enough for one to lose their Middle Eastern appearance. This is particularly relevant in the male patient where ‘less is often more’.

Highlights:

1) The dominant deformities of the Middle Eastern nose is the hump at the bridge and the drooping nasal tip.

2) The male Middle Eastern rhinoplasty should strive to achieve a straight dorsal line and a nasolabial able of 90 degrees.

3) A more pleasing appearance to the nose but without loss of ethnic appearance are the two important objectives on any ethnic rhinoplasty…unless the patient desires otherwise.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Hydroxyapatite Cement Forehead Augmentation

Saturday, December 31st, 2016

 

Background: The shape of the forehead is very gender specific. Men have foreheads with distinct brow bone prominences, a visible brow bone break and a forehead that slopes somewhat less than vertical above it. Conversely females have no distinct brow bone, have a rounded or more convex forehead shape that ideally has a near vertical inclination.

The request for forehead augmentation is females is usually to provide increased convexity and verticality. The female forehead that is flatter and more recessed requires augmentation usually from above the brow bones up to or just past the edge of the frontal hairline. The shape of the augmentation is more important than its thickness or size.

The choice of augmentation material for the female forehead depends on how much surgical exposure is needed and what type of scalp incision the patient can tolerate. The smallest scalp incision with the least exposure needed is the custom forehead implant. For the use of hydroxyapatite cement a longer scalp incision is needed for greater exposure to properly apply the material and shape it as it sets.

forehead-augmentation-with-hydroxyapatite-cement-intraop-dr-barry-eppley-indianapolisCase Study: This 40 year-old female wanted to increase the projection of her forehead and make it more vertical.Through a near complete coronal scalp incision, 65 grams of hydroxyapatite cement (Mimix) was applied to the forehead and shaped until dry. The hydroxyapatite cement was mixed with antibiotic powder in a ratio of 10:1 gram weights.

forehead-augmentation-with-hydroxyapatite-cement-result-side-view-dr-barry-eppley-indianapolisHer postoperative results shows a more convex and vertically oriented forehead shape. The convexity of the augmented forehead slightly exceeds the brow bones as it does in many pleasing female foreheads.

Hydroxyapatite cement is a wonderful skull augmentation material, particularly in the forehead. It heals to the bone without a fibrous interface and can even have some bone growth into its microporous structure when set. Despite this major biologic advantage, it requires wide open access to properly apply the material. This means a coronal or pretrichial incision is needed to get an even application of the material that sets properly.

Highlights:

1) Forehead augmentation can be done by a variety of biomaterials, all of which can produce similar satisfactory results.

2) Hydroxyapatite cement is the most biologically favorable of all forehead augmentation materials.

3) The handling characteristics of hydroxyapatite cement requires wide open exposure for   an aesthetically pleasing forehead contour.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jawline Implant Replacement

Monday, December 26th, 2016

 

Background: Augmentation of the jawline by today’s standards usually means chin and jaw angle increases. This three-point approach typically uses performed chin and jaw angle implants. With the many different types of facial implants available today, most male and female demands for jaw augmentation can be met.

When using the three implant technique for jaw augmentation, there is a need for accurate placement of each implant. Implant malposition is the number one complication of facial implant surgery. Bilateral facial augmentations, such as the cheek and jaw angles for example, are prone to a unique risk of implant malposition…asymmetry. Even very slight differences in jaw angle implant positions can create visible external asymmetries that can be bothersome to the patient.

If you add up the general risks of implant malposition and size concerns with a single facial implant (around 10%), it is easy to see what the revisional surgery risks are in a three piece jaw augmentation procedure. Since surgical risks are additive for each implant, a total jawline augmentation with standard implants has risks of 30% or greater for issues that may merit revisional surgery. While it is true that some patients are more particular than others about ‘perfection’ or a result that meets their ideal aesthetic goals, my experience has been that most patients seek a result that is more than just close.

malpositioned-jaw-angle-implants-2malpositioned-jaw-angle-implantsCase Study: This 21 year-old female previously had chin and jaw angle implants palced for a complete jaw augmentation effect. While she liked the over all augmentation effect, she as bothered by the jaw angle asymmetry and the lack of a smooth jawline from front to back. A 3D CT scan showed a good chin implant position but obvious jaw angle implant asymmetry with standard widening angle implants. (She also had cheek implants which were asymmetric but that is not relevant to this case study)

custom-jawline-implant-replacement-for-malpositioned-jaw-angle-implants-front-view-dr-barry-eppley-indianapoliscustom-jawline-implant-replacement-for-mapositioned-jaw-angle-implants-side-view-dr-barry-eppley-indianapolisA custom jawline implant was created using the dimensions from her prior implants with some small changes. (9.5mm horizontal chin augmentation, 12mm wide jaw angle) Equally importantly the chin and jaw angles were connected by a smooth implant bar on each side.

custom-jawline-implant-replacement-for-malpositioned-jaw-angle-implants-overlay-dr-barry-eppley-indianapolisThis is a great example of how the custom jawline implant may keep many of the sizes of the standard implants but makes the entire jawline augmentation smooth and connected…like one’s natural jawline. This can be appreciated in the overlay of the existing implants (in green) with the new implant design (in light blue) on the implant planning pictures.

custom-jawline-implant-replacement-dr-barry-eppley-indianapolisUnder general anesthesia her existing submental and intraoral incisions were used to remove her indwelling implants and replace them with the one piece jawline implant.

A three-piece jawline implant augmentation can be prone to less than ideal implant positions and external aesthetic effects. A custom jawline implant can be used for a replacement. The existing implants serve as an invaluable guide in how to design the new one-piece implant.

Highlights:

1) A three-piece jaw augmentation approach using standard implants is prone to implant malpositions.

2) A custom jawline implant can replicate what standard jaw implants can do but in a single implant that is less prone to jaw angle malpositions.

3) A one-piece jaw implant permits a smooth linear connection between the chin and the jaw angles.

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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