Immediate breast reduction/lift with trunk liposuction. The goal was primarily to help reduce neck and back shoulder pain, and also to improve mobility and comfort. Many of our younger patients also note a lot of unwanted attention and negative assumptions about promiscuity. Here, 4 pounds of breast tissue was removed, and another 7.5 pounds was liposuctioned from her trunk. Despite … Read More

Breast lift and reduction are related surgeries with a lot of overlap, tailored to each patient’s anatomy and goals. Here, baseline asymmetry was improved, and the weight and downward pull of her breasts made lighter. It’s always fun when patients tell me they get to go without a bra now (though I have to remind them that gravity and time … Read More

An augmentation/mastopexy is offered when goals include both breast lift surgery and breast volume maintenance or augmentation. The further the nipple/areola needs to be raised to reach the goal position, the higher chance of wanting a revision (~30% in some series), or even planning a 2-stage surgery from the outset. Here, a modest 250cc implant placed under the muscle added … Read More

This woman wanted a lift and reshaping of her breasts. As with most of my reduction and lifts, a superomedial pedicle is used. This has reliable blood flow, and often blood flow from other major sources including the intercostal perforators from the chest wall and lateral perforators can be preserved to minimize wound healing problems. The skin pattern depends on … Read More

Yes! I have patients every week asking whether I do breast and body contouring, too, as my website and social media is being updated. Here is a sneak peek at a recent patient 4 weeks after a fleur-de-lis tummy tuck and mastopexy. She was interested in increasing her cup size to go with her lift, without use of an implant. … Read More

On-table results from Cleft Lip scar revision and rhinoplasty. The lip was lengthened with Z-plasty of the skin as well as underlying muscle. It was relatively mild, but a difference of 1-2mm can mean a big difference when it comes to the lip. In this instance, the nasal tip position and asymmetry was helped with asymmetric lateral crural strut grafts … Read More

What a sweet visit with this little one who has had a bilateral cleft lip and palate repaired. The first year with a cleft lip and palate can be quite busy for patients and their families. This may involve weekly visits for NAM adjustments until the lip repair at 3-6 months. After that, there is a referral to ENT to … Read More

Measure twice, cut once! Every cleft lip marking process has a few unique differences, but most of it can be simplified to focus on the key, anatomic landmarks that are respected. Here is a sped-up look at the marks for yesterday’s surgery. I favor Dr. Fisher’s anatomic subunit approach, with a backcut at the depth of the white roll. I’m … Read More

Thank you to Dr. David Fisher, Director of the Cleft Program Sick Kids Toronto for taking the time to answer a few of my questions at the most recent American Cleft Palate meeting. He also pointed me to a few Operation Smile Academy videos he helped film recently, including discussions about his markings and his surgical thought process. I enjoyed … Read More

Immediate Before and After Cleft Lip Repair. Thank you to Dr. Lun Jou Lo for teaching a muscle-oriented approach that is what works best in my hands. The goal is to help our patients with clefts lead healthy and happy lives. One piece of that is to get the cleft lip and nose repair as balanced and symmetric as we … Read More

The best part of our week is seeing our patients back, thriving and healthy! Some of the initial tightness of the on-table repair relaxes as the premaxilla falls back into place if needed, and as the absorbable sutures give way. I have been happy with the results of 1) minimizing/eliminating incisions at the alar sill and base (especially for patients … Read More

Even wider clefts are able to be repaired in a single stage with our technique. The skin markings are a hybrid of techniques based on Millard / Noordhoff / Chang Gung / Fisher principles. Adequate muscle release and reorientation is crucial for that Goldilocks-level of lip rotation and balance. Scarring can be thicker and darker — especially in our darker-skinned … Read More