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Posts Tagged ‘fat injections’

Fat Injections for Chin Dimples

Sunday, May 1st, 2016

 

Chin dimples appear as a central circular depression on the soft tissue chin pad. They are differentiated from chin clefts which are vertical depressions of variable depths in the lower central chin pad going down to the lower level of the chin bone. It is believed that chin dimples occur because of a soft tissue defect in the underlying muscle and fat layer. Since the chin is formed by the midline union of brachial arches in utero, dimples represent some small area of failure to merge.

Chin dimples can be seen as an attractive facial feature (often to those who do not have them) or an undesired facial feature to those who do have them. Fortunately there are surgeries available to either create or reduce/eliminate chin dimples to satisfy either desire.

Over the years I have used numerous methods to remove the unwanted chin dimple. Injectable fillers are the simplest method to reduce an unwanted chin dimple but they are not permanent. The one permanent option would be the use of silicone oil injections (Silikon 1000) although it is not FDA approved for soft tissue augmentation.

Fat Injection Chinj Dimple technique skin release Dr Barry Eppley IndianapolisFat injections for chin dimple reduction are the mainstay of treatment today. They are both natural and have a chance for some permanence. The key in doing them is to do a needle release of all tissues under the chin dimple skin. Using an 18 gauge needle it is inserted centrally beyond its beveled edges. It is then rotated around 360 degrees  allowing the bevel edge of the needle to act like a small scalpel.

Fat Injection Chin Dimple technique fat injection Dr Barry Eppley IndianapolisOnce the soft tissue release is done, fat is injected using a 2mm blunt cannula. The cannula is inserted perpendicular to the skin entrance and directed down into the muscle. Fat is injected on withdrawal of the cannula slowly, making small .05ml deposits on the way back up to the skin. It is important to ‘stack’ the fat deposits so a maximum push on the dimple indentation occurs. Usually about .5ml to .9mls of fat are injected for small dimples and up to 2mls for larger ones.

Fat Injections to Chin Dimple result oblique view Dr Barry Eppley IndianapolisFat Injections to Chin Dimple result front view Dr Barry Eppley IndianapolisFat Injections for chin dimples usually accomplish a significant reduction although not a perfectly flat smooth skin surface. It may be necessary to perform a second fat injection treatment for optimal chin dimple correction/elimination.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – The Ultimate Buttock Makeover

Saturday, March 26th, 2016

 

Background: Aesthetic buttock deformities consist of two types of undesired structural changes. Inadequate volume is the far more recognized buttock problem which can occur from either inadequate natural development (or natural development that one sees an inadequate) or from volume loss due to aging or weight loss. The other is tissue sag over the infragluteal crease (known as banana rolls) which can also occur from aging and weight loss. An induced cause is a result of the sequelae from liposuction of the lower buttocks.

The treatment of lack of adequate buttock size is either fat injections (BBL surgery) or buttock implants. While fat and implants may seem interchangeable in buttock augmentation, they are not. Implants are reserved for those patients who simply do not have enough fat to do BBL surgery. When using buttock implants the decision is whether to go into or above the muscle. When placed in the intramuscular position, it is possible to combine fat injections with buttock implant surgery.

Lower buttock sag is occurs when the superior skin and fat ‘fall’over the fixed infragluteal fold. Buttock ptosis or sag can also occur when the infragluteal fold attachments are lost or disrupted. In either case, a lower buttock lift or tuck is done to remove the overhanging tissues and recreate a fixed infragluteal fold position.

Case Study: This 48 year-old male wanted to improve the appearance of his buttocks. He had lost some weight over the past several years and his buttocks had gone flat. He also did not like the tissue overhang on the bottom of the buttocks. (the sagging)

Ultimate Buttock Makeover intraop result one sideUnder general anesthesia in the supine position he initially had his abdomen and flanks aspirated of fat by liposuction. Once moved into the prone position his flanks was also aspirated. Total liposuction aspirate was 1,800ccs. Once processed by filtering and washing a total of 360ccs of concentrated fat was available for injection. Through an infraguteal incision, solid silicone 270cc buttock implants were placed in the intramuscular position. A lower buttock lift was done on each side removing a predetermined strip and skin and fat. Through suturing to the muscular fascia, the infragluteal fold was remade. Lastly, 180ccs of concentrated fat was injected in various locations of the buttocks that had not been previously undermined for the placement of the buttock implants.

Ultimate Buttock Makeover intraop left oblique viewUltimate Buttock Makeover intraop left side viewUltimate Buttock Makeover intraop result back view Dr Barry Eppley IndianapolisHis immediate intraoperative results showed a significant improvement in the size and shape of his buttocks. While the amount of fat that will be retained remains to be determined, the contributions of the buttock implants and the lower buttock lift will be retained.

This case of buttock augmentation demonstrates the concept of the ultimate buttock makeover. Between implants, fat grafting and a buttock lift, there is no more aesthetic changes that can be performed on the buttocks at one time.

Highlights:

1) Genetics and aging affects the buttocks like any other body area with loss of volume and sagging.

2) Intramuscular buttock implants can be combined with subcutaneous fat injection grafting for an overall buttock augmentation effect.

3) Buttock augmentation can be combined with a lower buttock lift to create the ultimate buttock makeover.

Dr. Barry Eppley

Indianapolis, Indiana

Steroid Injections for Periorbital Lipogranulomas

Saturday, December 26th, 2015

 

Fat injections have become a widely used cosmetic procedure for a variety of aesthetic facial concerns. Fat grafts are viewed as safer than any other injectable material since it is an extract of the patient’s own tissues. Despite its safety fat injections are not perfect and they are prone to aesthetic complications of which irregular contours (lumps and bumps) being the most common. In rare cases with periorbital injections, fat (and any other synthetic injectable filler) can lead to acute visual loss.

lipogranulomasA more recent fat injection complication that has been described is that of lipogranuloma. It is most commonly described as occurring in the periorbital area. Injected fat cells that become non-viable/necrotic can elicit an inflammatory reaction that can turn into granulomatous nodules. The exact mechanism of why these non-viable fat cells create an inflammatory reaction rather then being passively absorbed is not known. But when it occurs in the thin eyelids it can cause intermittent swelling and lumps. The traditional treatment for periorbital lipogranulomas has been surgical excision.

In the December 2015 issue of Aesthetic Plastic Surgery, an article entitled ‘Periorbital Lipogranuloma Following Facial Autologous Fat Injections: Non-Surgical Treatment’ was published. In this paper the authors encountered twenty-seven (27) patients with periorbital lipogranulomas after fat injections. Interesting nineteen (19) of the female patients were treated with cryopreserved fat. Twenty one (21) of the patients were treated by corticosteroid injections and oral steroids. The steroid injection protocol  was 0.1ml of Kenalog 40 initially followed by a second injection four weeks later if not responsive. The oral prednisone dose was 0.5mg/kg for one week which was tapered off over the next month. Resolution was achieved in 15 patients (71%) and partial resolution in 5 patients. (24%) One patient (5%) has no response.

Periorbital granulomas are diagnosed by history and physical examination. CT and MRI evaluations can be done but do not take precedence over a recurrent swollen lump in the lower eyelid after fat injections. This study shows that the first approach should be steroid injections. Surgical excision is reserved for those that have a failed response to non-surgical treatments.

It is interesting that in rare cases fat can create a reaction similar to that of synthetic injectable fillers. I can not help wonder that the use of cryopreserved fat made up a disproportionate number of these cases. This makes a case for not storing and reusing a patient’s own fat for subsequent fat injections.

Dr. Barry Eppley

Indianapolis, Indiana

Power-Assisted Fat Injection Buttock Augmentation

Sunday, December 13th, 2015

 

Buttock augmentation by fat injections, more commonly known as the Brazilian Butt Lift (BBL), has become widely popular over the past decade. The simultaneous body contouring by a liposuction fat harvest and the use of the fat for buttock augmentation offers a dual body contouring benefit. Compared with the use of buttock implants, a fat transfer can create a better buttock shape with a lower risk of complications and a faster recovery.

Braziilan Buttock Lift results oblique view Dr Barry Eppley indianapolisBBL results back viewTo achieve a successful Brazilian Butt Lift, a fair amount of fat needs to be harvested. To make it really worthwhile from a size standpoint, as much as 500 to 1000ml of fat is needed per side. And this represents concentrated fat not just liposuction aspirate harvest. To get an adequate fat harvest in many patients, it is an effort dependent process on the part of the surgeon. The use of power-assisted liposuction (PAL) makes it less fatiguing for the surgeon and has become my liposuction device of choice in large liposuction harvests such as is needed in BBL surgery.

In the November/December 2015 issue of the Aesthetic Surgery Journal the article entitled ‘Power-Assisted Gluteal Augmentation: A New Technique for Scultping, Harvesting, and Transferring Fat’ was published. In this paper the authors describe their technique to large volume buttock augmentation that combined power-assisted liposuction (PAL) and fat harvesting of the zones around  the buttock with autologous fat transfer. In 110 patients liposculpting and fat harvesting were done with a power-assisted liposuction device. Fat was then transferred to the buttocks with simultaneous power-assisted vibration and tunnelization. Harvested liposuction volumes ranged from 1400 to 5000mls and injection volumes ranged from 300ml to 900ml per buttock. Patients were followed for an average of 20 months. Complications included a persistent burning sensation (5%), persistent swelling in the lower back (3%) and a mild infection in one patient. (1%)

Buttock Fat Injections Dr Barry Eppley IndianapolisWhile the use of PAL for far harvest is well known, the use of the power-assisted device for fat injection/placement has not been described previously. Previous studies have shown that fat harvested from PAL offers superior fat cell yields to that of non-power assisted methods. Injecting the fat through a 3mm liposuction cannula under the vibration of the device is an interesting approach to the multiplanar delivery of fat to the buttock tissues. Whether this truly improves the fat graft survival rates has not been proven, and this study certainly does not do so, but it appears to have a good mechanical effect at dispursing the fat throughout the buttock tissues. It certainly appears to be easier to place the fat than through traditional syringe injection methods.

Dr. Barry Eppley

Indianapolis, Indiana

Hand Rejuvenation by Fat Injections

Sunday, December 13th, 2015

 

Aging affects every structure of the body and the hands are no exception. Age-related changes to the hands have been well described and includes thinning of the skin, brown spots and wrinkles and visible skeletonization with prominent veins, tendon and bone structures. Loss of fat volume is one of the key features in hand aging just as it is in the face.

Fat Injections to Hands Dr Barry Eppley IndianapolisIt is no surprise then re-voluminization of the dorsal side of the hand has become an established ant-aging strategy in hand rejuvenation. Fat is preferred over the use of injectable fillers due to its better volume retention and ultimately lower cost in the long run. It also has the potential benefits of providing improved skin tone and texture through dermal regeneration induced by blood vessel ingrowth and stem cell effects.

In the December 2015 issue of the journal Plastic and Reconstructive Surgery, an article entitled ‘Technical Refinements in Autologous Hand Rejuvenation’ appeared. In this paper the authors describe their technique for fat injections into the dorsum or back of the hand. Fat is harvested from the inner thighs. Approximately 20 to 25mls of aspirated fat is required for each hand. A central injection point is used located between the 3rd and 4th metacarpal joints. Fat is injected in a radiating fashion in the subcutaneous plane using about 10 to 15mls in the distal two-thirds of the hand to augment the region dorsal to the hypothenar eminence. A second injection site is done from between the first and second metacarpals where an additional 10mls of fat is injected into the proximal one-third of the hand  to augment the region dorsal to the thenar eminence. They have experienced no complications such as infection or any problens with hand function or sensation.

Fat injections into the hands places the grafts into the dorsal superficial lamina, the upper fascial  where the fat normally resides. The fascia that contains the veins and nerves lies deep to this layer. The deepest fascial layer is where the tendons and bones reside. Placing fat into the hands is easy as placing it right under the skin keeps it in the upper fascial layer and avoids the visible veins which seems like they would be unavoidable. The use of blunt cannulas avoids any risk of vein puncture. The injected fat must be massaged around to avoid lumps and irregularities. Aggressive and persistent massage is the key to a smooth fat distribution.

Fat Injections to the Hands Dr Barry Eppley IndianapolisWhile the authors inject from the distal part of the hand (metacarpal joint areas), I prefer to inject from the proximal area at the wrist. Three injection site are used  and the fat is placed in a retrograde fashion. The ability to distribute the fat by massage throughout the upper fascia layer of the hand makes the location of injection irrelevant.

Total hand rejuvenation requires both an internal and an external approach. Fat grafting treats the intrinsic problem of aging by restoring/adding volume. But the external appearance of the hand should not be forgotten and treatments such as laser resurfacing and pulsed light therapy (BBL) should not be overlooked for optimal improvement in the appearance of the back of the hands.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Brazilian Butt Lift

Monday, October 26th, 2015

 

Brazilian Butt Lift Dr Barry Eppley IndianapolisBackground: One of the most commonly requested body contouring surgeries today is that of the Brazilian Butt Lift.  (aka BBL) While sounding both Brazilian and touting a butt lift, it is really buttock augmentation by fat injections. Fat is derived from liposuction of any body area that one wants reduced. The buttock augmentation is then done by processing the harvested fat in a concentrated fashion and then injecting it in a dual plane location both at the subcutaneous as well as the intramuscular buttock locations.

While may patients have an ideal or dream goal for their buttock augmentation, the limiting factor is always how much fat does one have to harvest. Thinking in an incrementally decreasing fashion, the final result of any BBL procedure is a function of the original fat harvested reduced by a factor of 4. Less than half of the fat aspirate harvested will be able to be used for injection. (in females the capture rate for the injectate is usually about 40% of what is harvested) Then, on average, if only 50% of the fat survives that will be the final buttock augmentation retained. Thus, for example, a 2000cc fat harvest becomes 400cc injected per buttock with the final volume retention of 200cc. That would be a small but noticeable buttock augmentation improvement.

Case Study: This 32 year old female desired a Brazilian Butt Lift procedure. She wanted the fat harvested from her abdomen and flanks which she had been unable to lose since her pregnancies. She approached her BBL surgery with the concept that the most important goal was the waistline contouring and any increase in her buttock size would be a bonus.

Brazilian Buttock Lifts result front view Dr Barry Eppley IndianapolisUnder general anesthesia power-assisted liposuction (PAL) was used to harvest far from her abdomen and flanks. A total of 1,875cc f far aspirate was obtained. When filtered and double washed with Lactated Ringer’s solution a total of 700cc of concentrated fat was availablee for injection. That was split between her two buttocks for a total of 350cc per side.

Braziilan Buttock Lift results oblique view Dr Barry Eppley indianapolisBrazilian Butt Lifts results side view Dr Barry Eppley IndianaoplisAt three months after surgery her buttocks showed a nice shape improvement with an overall modest size increase. Much of her buttock dimpling had been improved. Her apparent buttock size increase is as much a function of the waistline reduction as it is the actual increase in buttock size. This dual effect creates  the BBL result for many patients who have less than large amounts of fat to harvest.

Highlights:

1) The success of a Brazilian Butt Lift depends on how much fat one has to harvest and how well it survives.

2) For many patients the success of Brazilian Butt Lift surgery is a function of the waistline narrowing above and the buttock augmentation below the waistline.

3) Many BBL surgeries (fat injections buttock augmentation) surgeries produce noticeable but more modest improvements which are quite satisfying to the patient.

Dr. Barry Eppley

Indianapolis, Indiana

Fat Injections for Chronic Scalp Pain and Tightness

Monday, October 12th, 2015

 

Tightness and pain after scalp surgery is fairly uncommon. The scalp can become tight after a variety of procedures for aesthetic and reconstructive surgery. Usually these procedures have one thing in common…closure of a scalp wound after tissue loss. The tissue loss may be from removal of a benign or malignant tumor or for a graft harvest for hair transplantation for example. Regardless of the cause, scalp tissues are mobilized and stretched to provide coverage of the defect.

Scalp tightness is hard to treat since there is no way to add tissue. While mobilization and release of the affected scalp tissue may seem like it would work, by itself it just creates as much scar tissue as it releases.

The addition of tissue is the apparent solution to chronic scalp tightness and pain. This is best done through the use of injectable fat grafting. Fat grafts adds new healthy cells and helps create some tissue expansion through its volumetric effect. By stretching the tissues and introducing a variety of soft tissue cells, including stem cells, the fibrotic tissue condition can be improved.

Scalp Scar Release Instrument Dr Barry Eppley IndianapolisFat Injections Scalp Dr Barry Eppley IndianapolisThe scalp is a tight space and does not require large amounts of fat to be effective. It is first necessary, however, to create tissue planes for the fat to be introduced. This can be done using small liposuction cannulas or a picklefork cannula. I prefer the picklefork because it not only breaks up the scalp scar tissue but it creates internal bleeding surfaces which can help improve graft survival by promoting early revascularization.

Fat injections for chronic scalp pain, tightness or other pathologic conditions should be considered to improve the quality of the scalp tissues. It may require multiple fat injections but almost always the scalp can be made more supple.

Dr. Barry Eppley

Indianapolis, Indiana

Total Hand Rejuvenation by Fat Injections

Monday, August 31st, 2015

 

One of the classic giveaways for the women who has had a facelift is how her hands look. While the face can be very successfully rejuvenated by many different techniques, the hands historically have been ignored until more recent times. It is now acknowledged that restoring volume through injectable fillers and fat injections can create hand rejuvenation. If combined with other skin resurfacing/remodeling techniques (laser skin resurfacing, brown spot removal by pulsed light therapies), a more complete hand rejuvenation approach can be done.

In the September 2015 issue of Aesthetic Surgery Journal, an article appeared on hand rejuvenation entitled ‘Lipomodeling: An Innovative Approach to Global Volumetric Rejuvenation of the Hand’. In this paper, the authors describe their approach with fat injections to total hand rejuvenation including adding fat volume to the radial and ulnar sides of the fingers. They term this ‘global hand rejuvenation’. In a review of 22 women who had  global hand rejuvenation by fat injections, no postoperative complications occurred.. Aesthetic outcomes were deemed satisfied to very satisfied in almost all patients (21 of 22 patients) to both patients and plastic surgeons alike. The authors advocate that since the fingers represent almost 50% of the length of the hand, volumizing efforts of the hand should extend into the fingers as well.

Fat Injections to the Hands Dr Barry Eppley IndianapolisFat injections into the dorsum (back) of the hands is relatively easy to do as there is a natural tissue plane between the skin and the fascia overlying the finger bones and the spaces between them. One can introduce a long blunt cannula near the wrist and deliver the fat in long linear rows as the cannula is pulled back. Once in place the fat can be digitally manipulated and massaged into a smooth distribution all along the back of the hand. This minimizes the risk of lumps and irregularities forming.

Extending the fat injections out further into the web spaces is a logical extension of this hand rejuvenation technique. There is no anatomic reason why this can not be done short of a lack of adequate fat to inject. Entering the sides of the fingers for fat injections poses a slightly different risk than the rest of the hand due to the neurovascular bundles blood vessels and nerves) that are located in the web space and course along both sides of the fingers. One does have to be careful to not place too much fat volume in this area to avoid neurovascular compression. Fortunately fat is soft and as a natural body component has a very low risk of this potential problem.

Global hand rejuvenation offers an aesthetic improvement over isolated dorsal hand injections and requires minimal extra fat to do so

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Fat Injections for Restoring Upper Pole Breast Fullness

Thursday, May 7th, 2015

 

Background: Fat injections has become one of the most popular plastic surgery procedures in the past decade. Used for a wide variety of face and body procedures, variable voluminization amounts can be created. Body contouring obviously takes more fat to achieve its effect and is often combined with aggressive liposuction to get maximal fat harvest to be processed for injection.

For augmentation of the breasts and buttocks, fat injections are an alternative choice for some patients. For buttock augmentation fat injections are preferred because a larger result and less of a recovery usually occurs than what implants can do. Conversely in the breasts, implants are preferred because they are more reliable and can create larger results.

Breast Fat Injections Dr Barry Eppley IndianapolisFat injections, while appealing, are not widely used for breast augmentation as many women have too little fat to use and sustained breast volume is far from assured. But for smaller breast augmentation volume needs fat injections have a defined role, that despite its shortcomings, may make it preferable to an implant.

Case Study: This 42 year-old female presented for liposuction of her saddle bag areas. (outer upper thighs) She could not lose this fat no matter what level of diet and exercise she underwent. She finally came to realize that this body area required a surgical solution. She also expressed dissatisfaction with the shape of her breasts, most notably the loss of any upper pole fullness. She did not think her breasts were too small and she was not unhappy about the mild sagging that they had.

Breast Fat Injections Technique intraop Dr Barry Eppley IndianapolisBreast Fat Injections intraop result Dr Barry Eppley IndianapolisUnder general anesthesia, her saddle bag areas underwent liposuction with an aspirate volume of 1,100cc. Filtering and washing ended up with a fat concentrate of 470ccs. Through three different entrance sites, 235cc was injected into the upper half of each breast.

Breast Fat Injections result oblique view Dr Barry Eppley IndianapolisBreast Fat Injectiions result side view Dr Barry Eppley IndianapolisHer three month after surgery results a sustained increase in the upper pole of her breasts that was both visibly and by feel evident. It is estimated that she kept about 50% of the fat volume that was injected.

To help restore upper pole fullness in the breasts, fat injections can be a good alternative to placing a small implant. It is less invasive, has a quicker recovery and does not preclude opting for an implant later if desired. Like an implant fat injections will not lift up a sagging breast, it will merely add volume to select quadrants of the breasts.

Case Highlights:

1) Small volume breast augmentation with fat injections can be done in lieu of placing a breast implant.

2) Loss of upper pole fullness is a common sequelae of aging and after pregnancy breasts.

3) 100cc to 200cc of fat injected in the upper pole of the breast can restore some fullness.

Dr. Barry Eppley

Indianapolis, Indiana

Kybella Injections for the Treatment of Double Chins

Thursday, April 30th, 2015

 

atx101 or Kybella Injections for Double Chins Dr Barry Eppley IndianapolisIn clinical trials for years as an injectable fat reduction treatment, ATX101 has finally received formal FDA approval. Now known as Kybella from Kythera Biopharmaceuticals, medical grade deoxycholic acid has been approved to treat double chins. Specifically it is intended to create an improvement in the appearance of moderate to severe submental fullness in adults.

Deoxycholic Acid Kybella Injections for Double Chins Dr Barry Eppley IndianapolisKybella is a proprietary formulation of a synthetic version of deoxycholic acid. Deoxycholic acid, also known as deoxycholate (and technically as  3?,12?-dihydroxy-5?-cholan-24-oic acid) is a bile acid that in the human body in naturally produced by the liver and stored in the gall bladder. It is secreted into the small intestine to help break down dietary fat. Sodium deoxycholate, the sodium salt of deoxycholic acid, is often used as a biological detergent to breakdown cells and cell membranes and has served as one of the agents that has been used in mesotherapy for years.

As a liquid formulation of deoxycholic acid, Kybella is an injection that causes the destruction of fat cells through cell membrane breakdown. Once broken down the fatty acids in the fat cells are released and subsequently absorbed, creating the external appearance of reduced fullness. Kybella is an injection series that requires multiple treatments for maximum submental fat reduction. The submental area is injected in a grid pattern with a small 30 gauge needle spaced about 1 cm apart. The injection sessions are spaced four to six weeks apart and can take up to  four to six treatment sessions to see the full effect.

How safe and effective is Kybella for reducing double chins? In two clinical trials of over 1,000 patients (Kybella vs. a placebo), a significant percent of patients (up to 20%) who received Kybella had at least a two-grade improvement on a physician Submental Fat Rating Scale and a Patient-Reported Submental Fat Rating Scale. This compares to just 3% of the placebo patients. Nearly three-quarters of Kybella patients had at least a one-grade improvement. Additional testing showed that Kybella also had significant improvement as demonstrated by MRI scans of fat reduction and patient-rated appearance assessments.

While Kybella can help dissolve submental fat and is a non-surgical  treatment, there are some short-term after effects. The most common and are expected is swelling, bruising, pain, numbness, redness, and areas of hardness in the treatment area. These occur because it works by creating an inflammatory reaction which is how it breaks down the fat cells. Most of these reactions resolve in about one week after the injection treatment.

Kybella Double Chin Injections Indianapolis Dr Barry EppleyCurrently, Kybella is only FDA-approved for the treatment of double chins. (submental fat fullness) But it is only a question of time and further study that it will be applied to other small fat problems. (e.g., small abdominal fat collections, lipomas)

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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