Our patient today is fit, near ideal weight, and has tight skin without cellulite. She also exhibits the classic areas of fullness largely resistant to nonsurgical measures. Liposuction is the most effective one step treatment for this with only modest discomfort and rapid recovery typical.
About half of our breast implant patients seek to restore their original look before multiple pregnancies rather than primarily for size enhancement. Implants do this much better than lifts because the implant insertion scars are largely inconsequential. Silicone is the preferred choice in this group because the tissues have thinned out too much from breast feeding to be compatible with saline implants. Silicone implants must be changed every ten years but our young patients accept the trade off. Moreover, there are other options down the road to mitigate this requirement.
This patient had a rhinoplasty elsewhere and liked everything except for the tip. I love these cases because they are real art projects! They often require unique, off the beaten track solutions using multiple cartilage grafts to re-create smooth, symmetric contours.
For the surgeons: columellar strut, right alar batton graft, left transdomal suture, interdomal sutures, camouflage grafts both sides, infralobular tip graft, membranous septum resection.
Our patient is only six weeks after open rhinoplasty! The straight profile looks the most elegant over time, even in a longer nose. We had another patient recently ask for a “ski slope” profile, a concept popular 40-50 years ago. We see many of those old results in our patients seeking facelifts today, and they have not aged well! Fortunately the old “ski-slope” concept has been abandoned by rhinoplasty surgeons long ago. The overall improvement in shape on the front view can be appreciated despite the residual swelling present at six weeks.
For the surgeons: spreader grafts, columellar strut, transdomal and interdomal sutures. Repair of Pitanguy’s ligament has been transformational for reinforcing supratip break and minimizing postop supratip swelling.
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Abi admires the charcoal drawing in the waiting room of her two boys (in the middle) with their friends. When she showed me the original photo years ago I knew it would make a great drawing because of the perfect composition and message of spontaneity and happiness. Abi has run our operating room for 18 years better than I would run it myself! Loyal, hardworking, expert logistician, and the perfect foxhole mate when the going gets tough.
Meet Samantha, hired out of nursing school a year ago. She is smart and has an indefatigable work ethic. We have barely scratched the surface of her capabilities. A common response to requests is “I’ve already taken care of that”. We are thrilled to have her as part of our team!
Like the recent similar post this patient also had a rhinoplasty elsewhere and liked everything except the tip. I love these cases! They are interesting puzzles. While having a good idea from the outside what needs to be done, there are always hidden surprises within. Cartilages are often more weakened and deformed than surmised. Rearranging and rebuilding, typically borrowing cartilage from other sites, is the order of the day.
For the surgeons: left spreader, caudal septum extension graft, columellar strut after resecting medial crura 3 mm, resect redundant left lateral crura, alar rim grafts. Septum + MTF sources
Our beautiful patient had it all there - we just adjusted one feature. These rhinoplasty selfies are taken 11 months after surgery. Not that she needed it but she is in the beauty business herself! IG:@balayage_courtney
For the surgeons: L-shaped strut on right as both spreader and to support weak anterior septum, normal spreader left, columellar strut, transdomal and interdomal sutures, lateral crura repositioned inferiorly (after Sheen), minor trim left medial crura, Pitanguy ligament repair.
Many patients say “I just want my neck done, I don’t want a facelift.” Actually, a facelift only treats the lower face and neck, not the whole face. It also corrects the jowls and provides a more powerful neck lift because the cheek and neck are rotated both upward and backward thereby creating more neck movement. A neck lift alone, in contrast, pulls in only one direction that is less effective by itself: straight back. Notice the improvement in the jowl area in this patient. The downward lines at the mouth are eliminated which enhances the rejuvenating effect of the neck lift.
For the surgeons: that’s not a chin implant, just a jaw thrust effect from the other side as we took the airway out and snapped the picture! Platysmal plication and subplatysmal fat excision.
Our lovely patient sent us this photo 4 years after her rhinoplasty. I am thrilled that she thought of us to express her delight with the outcome!
Quick sketches with a model are great training for getting proportions, foreshortening, and anatomical shapes correct. It’s a relaxing counterbalance to focusing on minute details all day long in surgery!
Eyelid aging changes occur earliest and often become disproportionate by the 40s. Removing hooded upper eyelid skin is straightforward. Lower eyelid bags and circles can be treated without a visible incision. The excess fat is partially removed and the rest of it used to fill in the deep circles from behind. Typically little discomfort and a two week recovery.
David A. Hidalgo, MD
Some of our patients seeking a “tummy tuck” not only have the bulging abdomen but also a “swayback” spine. The front will normally parallel the back in these individuals because there has to be room for all the internal organs in between. Therefore it is challenging (and sometimes not possible) to get the front completely flat when the back has such a deep indentation. In this case it worked out great!
For the surgeons: Thin patients who have markedly protuberant abdomens (i.e. not an excess intra-abdominal fat issue) should always be checked behind for deep lordosis. Not recognizing this can lead to disappointment later. This patient required three rows of vertical plication and a major transverse plication to get the abdominal wall flat. Keep in mind compartment syndrome in these situations!
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Our patient is in her 50s and lost over 50 pounds! There was no abdominal muscle weakness from previous pregnancies so only skin had to be removed. Recovery is far easier in this setting. She also had an inner thigh lift, a much less commonly done procedure. It is reserved for more severe cases due to the scars required. She is thrilled with the outcome!
We are thrilled to have Meghan join our team today! She is a 2019 Villanova grad and spent her first year at NYU hospital: all great preparation. We already know we picked a future star!
This lovely former patient returned to us years later now interested in facial rejuvenation. A facelift was done today to improve her lower face and neck. Neck muscles were tightened in the front and from the sides, a very small chin implant added, and the cheeks tightened in two layers. This is the immediate result in the operating room!
For the surgeons: “witches chin” direct subcutaneous excision too.
In the old days surgeons simply removed those pesky bags, accessing them through the back of the eyelid. The problem was the eyelids often looked hollow. Today we remove only some of the excess fat and reposition the rest to obliterate the “circles” below the bags. If it’s just the bags it is 1 hour and 10 days to look normal! Glasses hide the early swelling nicely.
For the surgeons: 30%TCA peel too, a great adjunct.
It was a great honor to serve our #1 journal for eight years, reviewing over 900 articles, writing article discussions, and occasional editorials. Thanks to Dr. Rod Rohrich @rod.rohrich, Dr. James Stuzin, Aaron Weinstein and the rest of the fantastic PRS staff @plasticreconstructivesurgery for maintaining the highest standards for our journal. I learned a lot and am a better surgeon for it!
Our beautiful patient is seen here only two weeks after breast augmentation. She asked for something conservative to compliment her curves and that is what we did!
For the surgeons: Very petite with small base diameter. 215 cc just right.
Our patient had two previous rhinoplasties elsewhere and just wanted to look normal. These cases become more challenging each time a previous attempt fails. Most entail intricate reconstruction of the underlying framework using proven methods, but often also require unique artistic solutions off the beaten track to be successful. You cannot plan how long it will take to finish one of these projects - 5 hours in this case!
For the surgeons: pretty much everything. SMR for grafts + MTF, infracture, tip shaping sutures, medial crura resection to deproject, columellar strut to stabilize, two tip grafts and one over the dorsum, upper lats OK, no alar rim grafts.
The latest quarterly newsletter from our national organization, the American Society for Aesthetic Plastic Surgery, has one of our drawings on the cover! They solicit artwork from the membership and we are thrilled to have been selected for this issue.
“All In”, 2020. Charcoal pencil 34” x 41”
Eyelid surgery is precise and predictable enough that aging changes do not have to be advanced to qualify, like our patient shown here. Modern techniques coupled with good judgment can turn back the clock without leaving fingerprints!
Six days following surgery! Our patient had a combination of neck defatting, muscle tightening, and a chin implant as part of her facelift (these component procedures were featured separately earlier this week).
She came to us from afar after “much research” and we are both flattered and honored to be entrusted with making this change for her.
For the surgeons: you would expect that either a HOM or large chin implant would prove necessary. However, only a small curvilinear type was needed. Extra-small is used most frequently in our female patients. Extended SMAS used to contour the cheeks.
Blepharoplasty surgery is effective and properly done does not change eye shape, a common concern. Recovery is two weeks and discomfort minimal. While a brow lift could have been included most patients do not want a radical change.
For the surgeons: partial corrugator excision at the same time can be helpful but has proven less effective than BOTOX.
Our lovely patient wanted a conservative breast augmentation with optimal aesthetics. It only took 215 cc to do it! She is thrilled with the outcome and so are we. This is a good example of what’s possible when size goals are made secondary to best aesthetics.
Our lovely patient wanted a conservative breast augmentation with optimal aesthetics. It only took 215 cc to do it! She is thrilled with the outcome and so are we. This is a good example of what’s possible when size goals are made secondary to best aesthetics.
David A. Hidalgo, MD
Our lovely former patient returned to us years later for facial rejuvenation. Here she is six weeks after a facelift ready for the holidays!
For the surgeons: extended SMAS, platysmal plication, extra small curvilinear chin implant, excision of “witches chin”, mild upper lip dermabrasion.
Our patient had a previous rhinoplasty elsewhere years ago. Her nose was reconstructed using both her own cartilage as well as cartilage from a tissue bank. These projects are intricate and rely on both art and science to accomplish. This one took 4.5 hours to get both the front and side views right! The result is shown at 6 weeks with some swelling still evident.
For the surgeons: MTF + septal cartilage: spreaders, columellar strut, alar rim, tip grafts; in fracture; thin Alloderm for minor irregularities.
My brother and I with our father years ago is the subject of this just completed charcoal drawing. Dad was an orphan who came to the U.S. by himself at age 17. After the Army and WWII he went to M.I.T. to become an aerospace engineer. He was involved in nuclear missile design during the Cold War and later with missile defense systems. A serious guy who taught me all about work ethic among other key life lessons. Check out the epitaph he wrote for himself on the last screen.
Immediate operating room result yesterday. Thanks to today’s technology we can text these images to our patient before they even get home! It’s a great preview for them while they are living under the nasal splint for 5 days. It’s also fun for us to hear back from them (next screen)!
Our surgeon patient is in his seventies, super busy, and wants to keep at it! He also wanted a practical solution for looking better. He is the ideal candidate for simply cutting out the loose neck skin directly. The scar in the front heals amazingly well in older men, making them ideal candidates for this option (this is not done in women).
For the surgeons: This is the best option too! Strong midline cervical laxity like this responds poorly to facelifts. Open platysmaplasty a joy!