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Dr. Barry Eppley

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Posts Tagged ‘tummy tuck’

Case Study – Tummy Tuck in Severely Damaged Abdomen

Sunday, May 1st, 2016


Background: Tummy tuck surgery is one of the most common of all body contouring procedures and can create some dramatic waistline changes. The operation is designed to reverse some of the tissue expanding effects caused by pregnancies and/or weight loss. While it can be tremendously effective at this purpose, its main effects are largely limited to the area of tissue excision. What lies beyond this zone is less significantly changed as it is pulled closer to the location of the suture line.

While the severe stretching effects of pregnancy affect women’s abdominal areas differently, some women develop a tremendous amount of stretch marks and loose skin. Large amounts of weight gain, small body frames and thin skin all lends themselves to the development of such abdominal skin damage. In these cases stretch mark radiate outward from the belly button like the rays of the sun. The redundant skin can be so significant that the loose and thinned out tissues can be stretched and pulled out like a piece of taffy.

Case Study: This very petite 36 year-old Hispanic female had two children that left here with a ‘wrecked’ abdominal area. She was very thin and had little subcutaneous fat but the loose skin on her abdomen was considerable. She had stretch marks from the pubic region all the way up to just below her lower ribcage.

MR Tummyb Tuck result front viewUnder general anesthesia,  a full tummy tuck was performed from hip to hip removing a large abdominal skin segment that measured 18 inches in the midline. The skin was so loose that no skin undermining was needed of the upper abdominal skin flap other than to free up the tissues around the umbilicus. With such little tissue undermining, no drains were used due to the small dead space at closure. She was so thin than no liposuction was needed around the perimeter of the tummy tuck zone to reduce tissue fullness.

MR Tummy Tuck result oblique viewMR Tummy Tuck result side viewWith extensive abdominal tissue damage as exemplified by a large number of stretch marks, only those stretch marks within the outline of the excised tissues will be removed. Stretch marks will remain with many mid- to upper abdominal marks being pulled down lower closer to the incision line.


1) The extent of tummy tuck surgery due to stretched out abdominal tissues depends on how large the zone of damaged tissues emanates out from the belly button area.

2) Large amounts of loose and damaged abdominal skin can often be removed during tummy tuck surgery with limited tissue undermining.

3) The quality of a tummy tuck result is influenced by the scar’s location, amount of pubic hairline distortion, appearance of the new umbilicus and whether dog ears are present at either end of the horizontal scar.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Male Tummy Tuck after Weight Loss

Sunday, December 27th, 2015


Background: Large amounts of weight loss has created a need for some patients to pursue secondary body contouring procedures. While the initial weight loss, whether achieved by surgery or on their own, may have been initially satisfying the goals of even improved results drives some to go even further.

There is a unique subset of extreme weight loss patients that ‘graduates’ on to having plastic surgery. They almost always have done their weight loss on their own through a near addictive approach to diet and exercise. Once the weight is off they continue to work  diligently to hone and shape their bodies. But they reach a limit, even with extreme efforts, that is limited by whatever abdominal skin excess remains. They reach a point where the realization is that you simply can’t exercise off loose skin.

The most common body contouring procedure after weight loss is a tummy tuck. But a tummy tuck can have numerous variations in how it is performed and it must be tailored to each patient’s needs. In the male tummy tuck, for example, there is no need for muscle tightening and the incision will be ultimately obscured by hair in many men.

Case Study: This 48 year-old male had lost 60 lbs through diligent diet and exercise over a several year period. While he was in terrific shape, there remained a lower roll of excess abdominal skin that extended around into his flanks that he could not get rid of no matte what he did.

Mark Tummy Tuck result front viewUnder general anesthesia, he had a tummy tuck done through removal of a horizontal segment of abdominal skin that reached up just above his existing belly button. It extended back just to the hips. No rectus fascial plication was done. Aggressive liposuction was done around the waistline through the flanks back to the near the midline spine.

Mark Tummy Tuck result oblique viewThe male tummy tuck after weight loss is different from women in that no muscle tightening is usually needed. When done in men that achieved their weight loss by their own personal efforts and have continued to reshape their body, any loose lower abdominal skin is a frustrating problem. The low horizontal excision of abdominal skin can be the final change that they seek.


  1. Significant weight loss results in excessive abdominal skin and small fat collections that can not be exercised off.
  2. Loose lower abdominal skin in men after weight loss can be unraveled and removed through an ‘simple’ tummy tuck approach.

3) The acceptance of a low horizontal scar must be seen as a worthy trade-off instead of the loose abdominal skin.

Dr. Barry Eppley

Indianapolis, Indiana

Tummy Tuck Rib Removal

Monday, November 9th, 2015


Waistline narrowing by rib removal is almost an urban myth. There is a lot of internet chatter and interest in the procedure but it is hard to actually find a surgeon who does it or a patient who has had it. In reality, it is a plastic surgery procedure that is done but only by those few surgeons who feel comfortable working around the rib structures and can do it with small incisions and a low risk of any serious complications. (e.g., pneumothorax)

Typically the ribs removed for waistline narrowing have been described as that of the free floating 11th and 12th ribs. This is done through a small incision in the back. While these are the ‘easiest’ ribs to remove because they are well below the lowest level of the pleura, they often are not enough to get the best waistline narrowing result. I prefer to also remove rib 10 or do an intermediate resection of it (so that the distal end will naturally move inward without a posterior attachment) to get maximal waistline narrowing. The addition of rib #10 removal can make a dramatic difference as this rib turns the corner around the waistline much more so than the free floating ribs below it.

Tummy Tuck Exposure of Ribs Dr Barry Eppley IndianapolisRib Removal through Tummy Tuck Incision for Rib Protrusion Dr Barry Eppley IndianapolisRib removal can also be done through a tummy tuck approach.  But this is for a different torso effect. The ribs removed through a tummy tuck are #8 and #9 ribs. This is done by splitting the rectus muscle vertically which allows  access to the subcostal area. Ribs # 8 and 9 are easily removed but they will not have a waistline narrowing effect per se as they lie above the anatomic waist.  They may help to vertically lengthen the torso but their anterior position prevents from creating a true inward waistline effect.They are removed to reduce a subcostal prominence or protrusion.

While it seems like a long way from a low abdominal incision (and it is), the subcostal margin is well within reach. It does require a full length tummy tuck to do so however. It is best and less uncomfortable for patients after surgery to vertically split the rectus muscle rather than transecting it horizontally. The intraoperative injection of Exparel into the muscle as well as an intercostal block goes a long way with managing postoperative discomfort with this surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Tummy tuck with Abdominal Liposuction

Sunday, May 31st, 2015


A tummy tuck is a major abdominal operation that usually removes a large horizontal ellipse of lower abdominal skin and fat. While tremendously effective, many patients having the procedure have excess fat beyond the zone of the tummy tuck excision whose reduction would improve the overall abdominal contouring result. While liposuction of the flanks is commonly done with a tummy tuck, liposuction of the abdominal area above the cut out has been frowned upon because of concerns of impairing healing of the tummy tuck excision.

Tummy Tuck without Abdominal Liposuction Dr Barry Eppley IndianapolisAvoidance of any upper abdominal liposuction at the time of a tummy tuck is certainly the safest approach as there is no chance of vascular compromise by not doing so. But this can leave an upper abdominal fullness that protrudes out beyond the more inwardly located tummy tuck scar the entire lower abdominal area. Many patients interpret this postoperative finding as swelling only to discover it never goes away. This is due to a simple anatomic fact the thickness of the upper abdominal fat largely remains the same while the lower abdominal contour is better because a large segment of tissue has been removed.

In the May 2015 issue of the journal Plastic and Reconstructive Surgery, an article appeared in print entitled ‘Safely Combining Abdominoplasty with Aggressive Abdominal Liposuction Based on Perforator Vessels: Technique and a Review of 300 Cases’.  A retrospective review of 300 consecutive patients who had a tummy tuck combined with liposuction. The tummy tuck was performed saving several perforators from the deep superior epigastric artery.  The abdominal liposuction was fairly aggressive removing an average of 660cc. Their overall complication rate was 17% (52 patients) of which the vast majority of the patients suffered minor complications (the need for scar revision, seroma evacuations, and non-surgical treatment of incisional dehiscences being the most common) and 1% encountered major complications. (non-fatal pulmonary embolus, severe infection and need for blood transfusion)

Tummy Tuck with Abdominal Liposuction Dr Barry Eppley IndianapolisCombining extensive liposuction with a tummy tuck has been a somewhat controversial combination since the early 2000s. What has changed since then is a better appreciation of the blood supply to the abdomen. This study uses a tummy tuck technique that preserves perforator vessels to the central abdominal  skin flap. This then permits the central abdominal area to safely undergo liposuction with impairing perfusion to the central abdominal skin above the incision line.

In the standard lipoabdominoplasty technique the liposuction is performed first followed by the tummy tuck. The liposuction loosens up enough of the upper abdominal tissues that extensive abdominal flap undermining is not needed and all perforators are preserved. This tummy tuck technique performs the liposuction after the tummy tuck. The difference is that some upper abdominal flap undermining is done and the perforators are deliberately seen and preserved.

Dr. Barry Eppley

Indianapolis, Indiana

The Occurrence of Seromas in Tummy Tuck Surgery

Monday, March 30th, 2015


Tummy Tuck results front view Dr Barry Eppley IndianapolisA tummy tuck is one of the most commonly performed aesthetic body contouring procedures performed. In many ways it is a ‘big’ operation when one looks at the size of the tissue segment removed and the amount of abdominal surface area manipulated. Despite the magnitude of the surgery, most patients heal remarkably well and suffer no major complications.

Tummy tucks do, however, have numerous minor early postoperative issues or complications. I hesitate to call them ‘complications’ as these minor wound healing issues rarely necessitate a return to the operating room for correction. The single greatest complication in tummy tuck surgery is that of seroma. This fluid collection which usually appears within weeks of the surgery can develop in ‘drainless’ tummy tucks as well as those that even use a drain.

In the April 2014 issue of the journal Plastic and Reconstructive Surgery, a paper was published entitled ‘Natural Evolution of Seroma in Abdominoplasty’. In this clinical study the aim was to evaluate when seromas after tummy tucks occur and how they progress. Using twenty one (21) female tummy tuck patients, abdominal ultrasound was performed in five abdominal wall regions at five different time points after surgery at four, eleven, eighteen, twenty-five and thirty-two days. Their findings shows that the incidence of seroma was roughy 5% percent on postoperative day 4, 38% percent on day 11, 33% percent on day 18, 24% percent on day 25, and 19 % on day 32. The left iliac fossa region had the highest volume of fluid collection on postoperative day 4, as did both the right iliac fossa and left iliac fossa regions on postoperative day 11. At other time points, the relative volume of fluid collection was significantly higher in the right iliac fossa region.

Large Tuck results side view Dr Barry Eppley IndianapolisWhile very annoying to patients, seromas are usually self solving problems aided by the use needle aspiration (tapping) in the office under local anesthesia. Rarely does a drain need to be inserted (or reinserted) to help solve it. What I always tell the tummy tuck patient that has developed a problematic seroma (which usually becomes evident 10 to 21 days after surgery) is that it will require tapping once a week for about a month before the fluid collection is solved. This study shows that seromas become most evident around two weeks after surgery and are still evident even at a month after surgery…supporting that these fluid collections are not quick to stop accumulating.

The location of the seromas is not always in the midline as one would suspect since this is the ‘bottom of the well’ so to speak. They often develop/persist more to the sides near the hips which is why they can be sometimes problematic to aspirate and why it is helpful to turn the patient on one side or the other to successfully tap them.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Long Terms Effects of Tummy Tuck Surgery

Monday, March 16th, 2015


Tummy Tuck abdominal reshaping Dr Barry Eppley IndianapolisBackground: Tummy tuck surgery can be an incredibly effective body contouring procedure. It achieves its effects through the removal of a large segment of loose skin and fat often combined with liposuction fat removal in areas beyond the zone of the cut out tissue segment. The benefits of tummy tucks can easily be seen in numerous plastic surgeon’s before and after photos.

But an interesting tummy tuck question is how long does the result last? Do the impressive early results persist and, if so, for how long?

Recent studies have shown that tummy tuck surgery may lead to significant and persistent weight loss for many women, particularly those who were overweight before surgery. (February 2013 issue of the journal Plastic and Reconstructive Surgery) It is postulated that this weight loss is due to a feeling of greater satiety after eating or other neuroendocrine mechanisms that may promote weight loss after surgery. It may be that the large loss of fat cells from the excised tissue segment may cause a lowering of certain hormonal levels that affect appetite. This is a plausible but unproven theory.

Case Study: This 38 year-old female wanted to get rid of her stomach rolls and reshape her waistline. She was not at an ideal weight but needed something to get her going in a positive direction and  decided that surgery would be a good impetus for it.

Long term Tummy Tuck result front view Dr Barry Eppley IndianapolisUnder general anesthesia, a full tummy tuck was performed along with liposuction of her flanks. She recovered well and after six weeks recovery and a few follow-up appointments was not seen again…until ten years later when she returned for breast reshaping surgery.

Long Term Tummy Tuck result oblique view Dr Barry Eppley IndianapolisLong Term Tummy Tuck result side view Dr Barry Eppley IndianapolisHer long-term tummy tuck results showed an overall body that was thinner and much more shapely than before surgery. It was clear she had continued to lose weight and get in better shape beyond what the initial tummy tuck surgery had achieved. This may have ben the result of a neuroendocrine effect but the psychological effects of increased patient motivation can not be denied as a contributing cause as well.

Case Highlights:

1) Tummy tuck surgery can dramatically change the shape of one’s stomach and waistline through a combined excisional and fat extraction approach.

2) Many tummy tucks will have a sustained and long-term effect through the removal of loose skin and fat cells in the excisional segment.

3) Some tummy tuck patients will go on to even improve their tummy tuck results through additional weight loss and body toning efforts.

Dr. Barry Eppley

Indianapolis, Indiana

Lovenox for DVT Prevention in Tummy Tuck Surgery

Sunday, January 25th, 2015


Tummy Tuckj Surgery Indianapolis Dr Barry EppleyDeep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) is the most dreaded complication of tummy tuck surgery. For that matter it is an increased risk for any aesthetic surgery around the abdomen/pelvic regions that involves compression (binder/garments) and any period of immobility after the procedure.While it is rare, it can occur and is a postoperative problem that has gotten a lot of attention recently.

There are a variety of before and after surgery considerations that can increase the risk of developing a DVT and/or PE. Genetics/family history, current medications (e.g. birth control pills), lack of movement after surgery and fluid levels (dehydration) can all contribute to an increased tendency for blood flow to slow down and have an increased tendency to clot.

Of all aesthetic plastic surgery procedures, the tummy tuck is at the highest risk for DVT/PE. The binding of the abdomen, the discomfort of muscle plication,the increased pressure on the vena cava and the subsequent tendency for limited early mobility after surgery are a potential setup for slowed venous blood flow return from the legs. If you factor in other adjunctive procedures like liposuction of the thighs and hips, and the subsequent circumferential binding used, the risks are further increased.

Lovenox Injections Indianapolis Dr Barry EppleyThe most common DVT preventative medication used for tummy tuck surgery and other high risk patients is Lovenox. Known generically as Enoxaparin, Lovenox is a low molecular weight heparin that is given by subcutaneoous injection. It works by binding to and increasing the activity of antithrombin III. By so doing it inhibits coagulation factor Xa. Since factor Xa assists in the conversion of prothrombin to thrombin, decreased thrombin levels prevent the formation of fibrin clots.

There is certainly a debate whether every tummy tuck patient should get Lovenox or just those that are at the highest risk. That is an individual plastic surgeon’s decision. The prophylactic dose of Lovenox is 30 mg subcutaneous injection twice daily with the initial dose administered within two or three hours of surgery and continuing for one week thereafter. There is no specific dose for weight-based Lovenox for use as DVT prophylaxis but most surgeons do not exceed 0.5 mg/kg every 12 hours.

Lovenox is historically expensive but generic versions (enoxaparin) have become available which dramatically lowers the cost. Insurance often covers its use but for an aesthetic surgery it may not be covered.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: Combined Tummy Tuck and Brazilian Butt Lift

Monday, November 24th, 2014


Background: Two of the most popular body contouring procedures today is one from the past and a relatively new one. Tummy tuck surgery has been around for over five decades and is highly successful at reshaping the abdominal wall often in a dramatic fashion. Conversely, buttock augmentation by fat injections (aka Brazilian Butt Lift) has been available now for only a decade and is the fastest growing body contouring procedure in total number done being done compared to just five years ago.

Brazilian Butt Lift Reshaping Garment Dr Barry EppleyWhile a tummy tuck works by removing and discarding unwanted tissues, a Brazilian Butt Lift works by recycling/redistributing them. Fat removal by liposuction is part of many tummy tucks to help extend its contouring effects around the waistline and is an additive ‘bonus’ to the procedure. Conversely, fat harvest by liposuction is an essential part of a Brazilian Butt Lift and the more fat that can be harvested the better the buttock augmentation result will be.

It is not uncommon that the desire for abdominal reshaping and buttock augmentation exist in the same patient. The first question is whether a tummy tuck and buttock augmentation can be safely done at the same time. Depending upon the magnitude of the liposuction harvest and the extent of the tummy tuck, the answer would be yes if neither one was particularly extensive.

The other question is whether any part of the excised portion of the tummy tuck can be used for the buttock augmentation. This is a debate between aggressively harvesting fat from under the tummy tuck prior to its excision or using the tummy tuck discard as a dermal-fat graft ‘autoimplant’ in the buttocks.  The vast majority of plastic surgeons today would use liposuction to harvest fat at the same time as the tummy tuck. There are growing numbers of reports in which the tummy tuck segment is being recycled and used like a buttock implant.

Case Study: This 30 year-old female wanted to have a tummy tuck to reshape her abdominal waistline as well as a buttock augmentation at the same time. It was agreed that she did not really have an optimal amount of fat to harvest to achieve a substantially larger buttocks. But she wanted to take any fat that could be harvested and place it into the buttocks as a ‘bonus’ to the procedure.

Tummy Tuck and Brazilian Butt Lift result front view Dr Barry Eppley IndianapolisUnder general anesthesia, liposuction was initally done very aggressively under the tummy tuck portion which was to be removed. Liposuction was also done around the waistline and into the flank areas to harvest as much fat as possible. The tummy tuck procedure was then completed. The harvested fat was processed and concentrated, obtaining a total volume of 480cc. Each buttock was injected with 240cc in a cross tunneling fashion.

Tummy Tuck and Brazilian Butt Lift result back view Dr Barry Eppley IndianapolisTummy Tuck and Brazilian Butt Lift result side view Dr Barry Eppley IndianapolisHer recovery was typical for a tummy tuck and the buttock augmentation do not prolong it. At three months afterwards, she showed marked improvement in her abdominal contour and mild enhancement of her buttock size. While the increase in her buttock size was not substantial (nor was it expected), its effect was greater due to reshaping of the waistline above both buttocks.

Some buttock augmentation procedures are done as a ‘bonus’ to other body contouring efforts. While the amount of fat that is often obtained by liposuction may be inadequate to justify a ‘stand alone’ Brazilian Butt Lift, some patients may want the fat used for the buttocks with the attitude that it can not hurt and anything they get is more than they currently have.

Case Highlights:

1) Combining a tummy tuck with a Brazilian Butt Lift is not uncommon and can safely be performed together.

2) The planned excisional portion of the tummy tuck can be aggressively liposuctioned as  part of the donor fat for the Brazilian Butt Lift.

3) Like all Brazilian Butt Lifts, the result is a combination of how much fat can be harvested and how much fat survives.

Dr. Barry Eppley

Indianapolis, Indiana

Tummy Tucks May Improve Urinary Incontinence

Saturday, September 27th, 2014


One of the most common body contouring operations after pregnancies and significant weight loss is the abdominoplasty or tummy tuck. The known benefits of tummy tucks lie in the change they bring to the shape of the abdomen and waistline. If the abdominal tissue cut out is big enough, patients may also see improvement in back pain and skin hygiene in the groin creases. One of the other potential benefits for some patients that has been reported in several small studies is an improvement in urinary incontinence.

Urinary Incontinence IndianapolisIn the September issue of the Aesthetic Surgery Journal a study was published entitled ‘Improvement in Stress Urinary Incontinence after Abdominoplasty’. In this paper 250 women who underwent tummy tuck surgery were evaluated after surgery for urinary incontinence (UI) symptoms by survey. Only 100 patients (40%) completed the survey. Of these 100 patients, 60% reported an improvement in their UI symptoms while the other 40% did not. Lack of having had a prior c-section was the one factor identified that was a good predictor of improvement in UI symptoms after tummy tuck surgery.

Urinary Incontinence and Tummy Tuck Surgery Dr Barry Eppley InianapolisHow a tummy tuck may improve UI is speculative but it could be surmised that the relief of the pressure of excess abdominal tissue pressing down on the bladder is a contributing factor.  It could also be that elevation of the pubic mound as result of the tummy tuck affects the urethral sphincter favorably. There is very scant discussion in the medical literature about any correlation between UI and abdominal contouring surgery so the exact mechanism of how the improvement occurs is not yet known.

This study, while not proving a decisive link between abdominoplasty and UI improvement, is strongly suggestive. A 60% stated improvement by patients indicates that it is more than just an infrequent occurrence. Since not all patients who had UI symptoms before surgery got improvement, it would be important to figure out whom is most likely to do so. This would be beneficial for UI patients who may avoid the need for other treatments if a tummy tuck is done first.

Dr. Barry Eppley

Indianapolis, Indiana

Drainless Tummy Tucks Using A Surgical Adhesive

Wednesday, August 13th, 2014


The concept of a drainless tummy tuck has been around for several years now and has met with mixed success. Some plastic surgeons claim they never place a drain and do not have any seromas while others almost always place drains with a low incidence of problems including seromas. Patients would obviously not like to have a drain so the appeal not to use one is high.

The current drainless tummy tuck relies on the use of quilting sutures to close down the deep space that lies underneath the skin flap. While effective, it takes additional time and adds expense to place the number of quilting sutures needed. And it is not completely complication free with reported instances of dimpling of the abdominal skin and rarely as a cause of skin necrosis.

A new advance in the drainless tummy tuck is the use of a tissue glue to supplant the current use of sutures. By applying an adhesive substance inside the abdominal wound, the dead space would be largely eliminated through adhesion of the underside of the skin flap to the abdominal wall fascia. In essence, gluing the inside of the wound together and eliminating the space where fluids can accumulate.

TissuGlu No Drain Tummy Tuck Dr Barry Eppley IndianapolisTissuGlu (Cohera Medical) is a new high-strength surgical adhesive. It is a single component adhesive that begins as a low molecular weight, hyper-branched pre-polymer that cures in the presence of moisture. It cross-links to itself and the surrounding tissues to form a strong bond between layers. The cured adhesive remains soft and flexible through its network of large polymeric chains. But it eventually breaks down and is absorbed as the wound heals over time. It also has the advantage, unlike other tissue adhesives, that it requires no mixing and can be stored at room temperature.

No Drain Tummy Tuck TissuGlu Dr Barry Eppley IndianapolisTissueGlu surgical adhesive recently completed a clinical trial for tummy tucks. The purpose of the trial was to determine if TissuGlu was an effective alternative to the use of drains for the prevention of postoperative seromas. In 130 patients (66 TissuGlu, 64 drains) with a ninety day follow-up, patients underwent a lower need for after surgery aspirations than when drains were used and had a quicker return to normal activities.

The need to aspirate a fluid collection (seroma) after a tummy tuck is not rare. Even in patients that have a drain in place for 7 to 10 days after surgery, the incidence of seromas approximates about 30% in my practice. While never requiring the need for additional surgery, the prolonged need for weekly aspirations places a burden on the patient with an increased number of office visits and some level of chronic discomfort.

TissGlu appears to be a safe and effective method that has a role in tummy tuck as a useful adjunctive aid. It now awaits formal FDA approval and the company to set a price of the surgical adhesive…which will determine what role it will ultimately play in tummy tucks which are most commonly done on a cosmetic fee basis.

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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