I am just returning home from our regional plastic surgery meeting and reflecting on how beneficial it was to be back in person at an educational conference after so many digital/Zoom conferences. The content was outstanding, and the presentations from my Ohio colleagues were excellent. It was not just the plastic surgery knowledge that made it so special, but connecting with my colleagues who I have known for so many decades and sharing our personal surgical stories from the last year—what we are doing and what we have stopped doing!
In this blog, I will touch on the newest innovations in plastic surgery—some of which are years away from becoming the standard of care, some that apply only to a very narrow slice of the population, and also other innovations that I will be adding soon to my plastic surgery practice in Columbus Ohio.
Cool New Ideas Not Yet Ready for Prime Time
There are always a few of my plastic surgery colleagues who are so far out in front of the curve that they are the real trailblazers and innovators in our specialty. These friends of mine work in large academic settings, usually the university hospital, where this type of practice can be supported and rewarded. The majority of plastic surgeons are not in this type of setting, and we do not have the financial resources of an academic institution to support this type of surgery, but we appreciate and admire the work they are doing on our behalf as they create novel techniques.
One of the coolest presentations was on doing nerve grafts to the nipple in breast surgery. Some surgeries require the nipple to be removed and re-attached, which can cause the nipple to lose sensation. Gynecomastia, female to male transgender top surgery, breast reduction, and breast reconstruction surgeries all have this situation with the nipple. These patients have to accept the trade-off of having a nipple with no sensation. At least for now, they do—but in the future, we will do nerve grafts to the nipple so that the sensation returns! This is the future and it is so very exciting!
Up Next on This Station: Addressing Breast Implant Issues
Attending meetings with colleagues you know and trust is a unique educational opportunity. These are the doctors who are out there operating every day and are presenting their experiences so that we can all benefit. It is not a grandstand or showy grab for attention—like some presentations at bigger meetings. So when there is a presentation about something you already do, and they show their outcomes, it is gratifying when you already do the procedure and have similar good results.
There was a presentation on the phenomenon called animation deformity. It’s when the breast implants placed under the muscle move when the patient flexes her pectoral muscles. This is something I have been interested in for over 20 years and have studied. I reported our findings that patients were unhappy about animation deformity at the national meeting many years ago.
Now at this meeting, my colleague presented their findings of the same unhappy patient population and their resolution to this problem— which is the same thing I do in my practice, a procedure to put the implants above the muscle. The innovation to this concept though is in the smaller details, which include adding a layer of support material called mesh or acellular dermal matrix and also doing fat grafting on very slender patients. Seeing these two additional maneuvers and seeing how much they improved the result was visible proof of a great idea that can be easily incorporated for the appropriate patient. Stay tuned!
Body Lift: Difficult Surgical Situations Require Innovative Ideas
When it comes to the massive weight loss patient, the patient has done the hard work necessary to lose the weight but there is so much extra skin that they are often dejected about the amount of surgery that is needed. And some of the surgical procedures look good at first, but then over the ensuing 6 to 12 months, gravity pulls everything down, and the result can suffer. There are also areas that were not addressed using traditional body contouring procedures, such as the flank. Up until now, we did the lower body lift and usually did liposuction of the flank and lower back.
The awesome innovative idea presented at the meeting was simply to extend the abdominoplasty incision toward the back but in a diagonal or oblique upward direction to directly remove the skin and fat of the flank. The innovative aspect of this idea is the waist-defining result that can be achieved and the long-lasting result—gravity will not have it’s usually negative effect here, so the result is long-lasting. The author of the paper and innovator was at my meeting and convinced us all about the safety and efficacy of this idea. The procedure is called the OFLA (oblique flankplasty lipoabdominoplasty) and you can read the seminal article in the journal Plastic and Reconstructive Surgery.
Designed in response to the failure of circumferential lower body lifts to deepen the waist, oblique flankplasty with lipoabdominoplasty aesthetically not only reshapes the waist but also the hips, buttocks, and upper lateral thighs with minimal morbidity.
Why It Is Called the Practice of Medicine
Going to a medical meeting is both work and play. Networking with friends and colleagues is invaluable. And after a day in a dark auditorium learning about the innovations and also feeling gratified that I am doing what is considered the safest and most efficacious procedures, we do have an evening of socializing. And even then, we are discussing our practices, including the complications, and asking for advice on so many topics. The learning continues!
One of the coolest parts of medicine and surgery is the constant evolution and the requirement to continue our education. We are all better surgeons after attending this type of event. I am excited to continue my personal quest to become the best surgeon I can be. Tomorrow is Monday and time for more practice, practice practice!