drdavidhidalgo

Many patients express concern about changing the shape of their eyes with eyelid surgery. Eyelid surgery does not do that. However, in some the lower eyelids sag with age and the eye opening becomes a less youthful looking round shape, like seen in the upper image shown. In these cases a subtle tightening of the lower eyelids can actually restore a more desirable “almond” shape. This patient had both upper and lower eyelid surgery with tightening the outside corner of the lowers included at the same time. Not many need this but it makes an appreciable but subtle difference when called for.

For the surgeons: cantholytic canthopexy of both superficial and deep heads, though perhaps tedious, gives the best control and permanence.

Facial fillers have great utility but generally should be avoided for the lower eyelids. They can cause chronic swelling and discoloration that resists attempts to dissolve them. Fortunately, surgical removal can be quite successful as part of a planned rejuvenation effort.

For the surgeons: Following transconjunctival fat treatment raising a skin flap to the base of the orbital rim will give access for filler removal by a combination of direct debridement and gentle cautery of the muscle surface.

Making a nice nose better poses a greater challenge than the big deformities. The margin for error is small and the changes sought are subtle. Note the aesthetically pleasing highlights in the casual poses.

Thanks to our patient for allowing us to share!

Despite living 3000 miles apart these two Leo’s have celebrated family birthdays together every year. Happy 23 Alessia!

girl cake

Nasal tip cartilage grows as we age, making tips more prominent and droopy. As a result, rhinoplasty in our older patients often focuses on just making the tip smaller and higher (example 1). Sometimes though, a complete rhinoplasty is in order. This is for those who always thought about it but never got around to it. Results are similar to our young patients, including adding a chin implant for better facial balance in some (example 2).

So pleased to be included once again in this year’s peer reviewed selection of the best plastic surgeons in the country. Flattered too to be highly ranked in all 5 procedure categories!

augmentation

Great staff holiday party! So much fun unwinding together outside the office. One of our traditions is for each to share 3 highlight photos of their year with the group, making for a wonderful bonding experience too.

Thanks to Meg for organizing and the festive decor!

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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!

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.

I painted this 5’ x 6’ oil painting in college and it hangs in my garage today. It was done when photorealism was at its height in the art world and took 6 months to do. I was inspired after taking my then girlfriend on a date to the Watkins Glen races. She married me anyway! LOL

Individual plastic surgery procedures are most popular at different times of the year. Summertime “rhinoplasty season” is winding down as the school year starts. The fall “facelift season” is now starting in earnest, an early start facilitated by the quarantine and mask wearing. I love the change in procedures that these transitions bring, just like the change in the seasons themselves!

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.

This patient had a previous rhinoplasty elsewhere and liked everything except the tip. I love these cases because they are real art projects! They typically require unique, off the beaten tract 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.

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Long before doing facelifts my first job was at Memorial Sloan-Kettering Cancer Center repairing faces. Microsurgery techniques permitted transplanting blocks of tissue including muscle, skin, and bone from non vital areas of the body to restore missing tissue. Circulation to the tissue was re-established by sewing small blood vessels together with stitches finer than human hair under the microscope! The tissue was then shaped as needed. The next screen shows an example of what was accomplished with these techniques. A short procedure was 8 hours! Sometimes I miss those days!



For the surgeons: secondary reconstruction with fibula and scapula free flaps at two separate procedures. Result shown is twelve years later.

We are thrilled to see our article published in the number 1 specialty journal Plastic and Reconstructive Surgery September issue. The topic is a successful new method to treat breast implant hardening.

Writing is important to advance the field but is challenging. You need a good idea and enough patient experience to provide meaningful data. Then comes designing the study, writing it up and submitting it to a peer review process, all done on your personal time!

The rewards are great if you consider the prospect of affecting 1000 surgeons more impactful than treating 1000 patients yourself!

For the surgeons: take home point of this paper is for either recurrent unilateral CC or first time bilateral CC, use ADM to line the implant pocket. See procedure videos at: www.capsularcontracturecures.com

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!

Non surgical fat removal with CoolSculpting works for small spots in certain areas. However, liposuction is best suited for treating multiple areas simultaneously in one step. Much larger volumes can be removed too. Tight skin and lower BMI favor best results.

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These timed art class sketches are great training for the eye! You have assess proper proportions quickly to finish the figure in time. The benefits are transferable to making aesthetic judgements in surgery too.

Lucky me! Best picture I ever took too.

The life shortening meal on the left is mandatory fuel before undertaking a male facelift! Men have bigger heads and bleed more. This makes the procedure much more arduous and time consuming. Male facelifts are uncommon and many are sought as part of the overall strategy for career extension by boomers. Both the patient and I took 24 hours to recover!

For the surgeons: see next screen. The midface deflation, prominent nasolabial folds, and midline cervical laxity (no platysmal bands) all disappeared completely when supine. As a result the enormous vertical skin shift required necessitated substantial subsideburn incisions to excise the temporal dog ears (well worth it). TXA in the injectate (Zins et al.,June ASJ) a real game changer, don’t need it IV. Also did deep malar FG, and exceedingly rare direct brow lift + upper/lower bleph. I still go back and forth on pretragal vs. retrotragal in men. Which do you prefer?

This new charcoal drawing is based on a recent post (second screen) by Dr. Alfredo Hoyos, the master of six pack etching with liposuction . I struggled with how much definition to include in the drawing because aesthetic norms in women have not been established with respect to this. How about a Saturday afternoon opinion poll? What do you think? See last screen and reply. Get your friends involved so we get good data. I will report back!

Ten year old silicone implants, done elsewhere originally. The right side hardened from rupture and the left side dropped inexplicably. Implant surgery is never a one time event but developments like this are fortunately unusual. Large silicone implants age worse than more conservative size saline implants. Corrective surgery can be challenging but successful in experienced hands.

For the surgeons: right side anterior capsulectomy with lower pole extracapsular scar lysis, TXA soak; left side capsullorhaphy with interrupted 0-silk, capsule only, no ADM support. Implants changed to moderate-plus profile for less wrinkle/risk of buckle formation, one size larger to preserve diameter.

Good friend, colleague, and fellow Leo, Dr. Rohrich is the most accomplished plastic surgeon worldwide! Former department chair UTSW, former president of our national PS society, Editor of our specialty’s most prestigious journal (which he transformed), runs the Dallas Rhinoplasty Symposium and a major figure at the renowned Baker Gordon Symposium and most other meetings, published 900 articles, and runs a fellowship training program turning out freshly minted plastic surgeons, among many many other endeavors. Whew! Maybe time to take a day off Rod. Leo the lion indeed. .rohrich

Dr. Marn, NYU and Hopkins trained, delivers a smooth ride for our patients. We often treat patients with co-morbidities that he evaluates first. If he says a patient is a no-go he’s the boss and we defer surgery. With over 10,000 safely performed surgeries over the last 20 years we thank him for his contribution!

If it’s not the operating room, or the art studio, it’s the garage. Always a procedure to do!

My good friend and colleague Dr. Val Lambros took this picture of me at the best aesthetic surgery meeting in the country run by our mutual friend Dr. James Stuzin. Val has been a pioneer in the study of facial aging and how it impacts our concepts of aesthetic facial surgery. Truly landmark work. Val’s whimsical photography efforts are also illustrated in the next screen showing a comet above his home.

This 4’ x 5’ drawing titled “First Date” was adapted from the next image seen. The boy was moved closer to the girl and his arm drawn back to increase the connectivity between the two. The third image shows the hanging dice that were added for three reasons: it was a period correct practice to have them; it symbolizes the crap shoot that all early relationships are; and it provides a visual connecting element between the two heads as the eye scans the drawing. The last image is just a detail shot. Many more months before complete!

Monday we are ready to go. The office is prepared and our protocols are in place. We may look different but it’s the same familiar faces under the masks! augmentation @ Manhattan, New York

My co-author Dr. Andrew Weinstein and I discuss our new breast implant paper with journal editor Dr. Rod Rohrich (below right). We developed a new treatment algorithm that is a game changer. As satisfying as it is to help our patients individually, moving the specialty forward has even greater impact!

Constructing detailed office and operating room protocols. We are ready to begin this challenging new era, with safety our highest priority.