WHAT'S NEW

The patient is an Asian man who had difficulty seeing and felt aged secondary to extra upper eyelid skin.  He had an upper blepharoplasty (removal of eyelid skin).  Asian blepharoplasty is a different operation than the one performed on Caucasian patients.  The skin is thicker, the incision goes in a lower location, and the medial (towards the nose) lid must be handled carefully.  The operation must be performed in a way which gives improvement, maintains function of the eyelid (a bit of extra skin is needed to protect the eye - like a roll top desk), and preserves ethnicity.

Before

After

The patient is a post partum woman with abdominal laxity primarily below her umbilicus ( belly button ).  She had a mini abdominoplasty ( defined as no incision made around the umbilicus ).  The upper abdomen is not optimally improved, but there is some benefit to releasing the umbilicus from below and allowing it to “float” downward when the abdominal skin is pulled.  This allows some tightening to the upper abdomen.  The biggist benefit is that there is no scar around the umbilicus and that allows the abdomen to look unoperated upon when the lower scar is covered by a bikini.  Approximately 2/3 of the abdominal wall can still be tightened ( plicated ).

Pre Op

Post Op

The patient is a young woman who had breast cancer on the left requiring mastectomy, but not radiation therapy.  Expander and implant reconstruction only would have left her with superior fullness on the left and significantly asymmetric versus the right.  The addition of an implant on the right for a superiorly round shape would have made the right too large for the left’s maximum potential volume.  The solution was to add a latissimus flap on the left.  This would allow enough expanded tissue to accommodate a larger implant to match the appropriately sized implant used the right.  The trade off for optimal shape and size in a unilateral mastectomy defect in this case was undergoing a latissimus flap.  The patient tolerated the process well.  Studies show at one year that patients usually have minimal residual pain and have near baseline function secondary to recruitment of synergistic muscles.

Pre Op

Post Op

The patient is a young woman with breast cancer who underwent bilateral mastectomy with aesthetic delayed reconstruction.  She has a keel shaped chest which is evident only post mastectomy.

AP pre op

AP post mastectomy

AP post reconstruction

Oblique pre op

Oblique post mastectomy

Oblique post reconstruction

The patient is a young woman with good breast size, but volume loss and ptosis (droop) post pregnancy. Breast Augmentation fills the “empty bag” and provides superior fullness to make attractive cleavage in a bra.  For this approach to work without a mastopexy (lift) with its accompanying scars, two things are necessary.  First, the patient must accept that she will be relatively large as there must be adequate implant weight to get the device to the bottom of the breast (bag).  Second, a bi-planar technique is used.  This keeps the upper part of the implant covered with muscle while allowing the extra breast tissue to distribute over the implant surface.   In patients with good breast volume, saline implants are usually well hidden by this technique as well.  Third, the patient should have downward pressure on the  implant with a bandeau (an elastic strap) for at least several weeks.  The implant usually reaches a good position.  Even if the implant position is not all the way at the bottom of the breast, it nonetheless looks very good and need for a mastopexy is usually avoided.

Pre op anterior view

Post op anterior view

Pre op oblique view

Post op oblique view