The Plastic Surgery Room

The reconstructed breast looks like a breast. It feels like a foreign object. One intercostal nerve, one nerve coaptation, and 12 months of patience might give her back sensation — or might not. The intercostal nerve anatomy from T2 to T6, why mastectomy destroys sensation, the DIEP flap's thoracodorsal nerve and why it does not naturally innervate the breast, direct coaptation versus nerve gr...

The scar looks terrible now. But give it 12 months and it may look acceptable. And if you revise it at 2 months, you will have two scars instead of one — the original and the revision. The healing timeline and collagen remodeling, red versus white scars, hypertrophic versus atrophic versus contracture scars, when conservative measures work and when they do not, silicone sheeting and steroid inject...

he ulcer is not just a wound — it is a symptom of a patient who cannot move. Closing it with a flap does not solve the mobility problem, so the patient gets another ulcer somewhere else unless something changes fundamentally about how they manage their pressure. Superior gluteal flap anatomy and pedicle, tensor fasciae latae as an alternative, why flap reconstruction must provide padding not just...

Filler is not a simple aesthetic injection — it is intravascular surgery without the operating room. One inadvertent arterial puncture in the wrong zone, and the patient loses her vision. The five danger zones where intra-arterial injection causes retinal occlusion and blindness, the supratrochlear artery in the glabella, the angular artery in the nasolabial fold, blunt cannulae versus sharp needl...

The hairline is not where you think it is. The temporal branch is exactly where you forgot it was. And the brow that looked perfect in the OR is resting at the eyebrow level at one month. Brow ptosis patterns, frontalis muscle anatomy, temporal branch danger zones, the middle temporal vein as a depth guide, trichophytic versus coronal versus endoscopic techniques, the hairline elevation that devas...

kin removal seems simple — until the patient cannot close her eye and is facing corneal scarring. The nine layers of the eyelid, the orbital septum barrier that fails with age, the levator palpebrae and its aponeurosis, the tear trough and orbitomalar ligament, Müller's muscle and sympathetic tone, the lacrimal system in the medial lower lid, the difference between transconjunctival and transc...

The tissue is not supposed to be there. It grew because of hormones, maybe stopped growing, maybe didn't. And surgery removes it — but only if you can distinguish it from the normal breast tissue the man is supposed to keep. True gynecomastia versus lipomastia, the Tanner-Bostwick grades, why puberty gynecomastia regresses in most but not all adolescents, anabolic steroids and aromatisation, s...

The tissue is not supposed to be there. It grew because of hormones, maybe stopped growing, maybe didn't. And surgery removes it — but only if you can distinguish it from the normal breast tissue the man is supposed to keep. True gynecomastia versus lipomastia, the Tanner-Bostwick grades, why puberty gynecomastia regresses in most but not all adolescents, anabolic steroids and aromatisation, s...

Master the complete clinical continuum of burn care, from emergency resuscitation to long-term reconstruction. This brief, high-yield episode breaks down initial assessment using the Rule of 9s and the Lund-Browder chart , alongside fluid calculation with the Parkland formula . We discuss when to perform an emergent escharotomy , how to select appropriate topical creams and dressing choices, and w...

In this episode, we debunk the classic, outdated advice to "leave a wound open to the air". Grounded in modern medical evidence, we reveal the golden rule of wound care: a clean, moist wound actually heals faster and with less pain than a dry one .We walk you through the essential timeline for managing injuries, starting with the critical steps in the first 24 hours. You'll learn how...

In this episode, we review cleft lip and cleft palate from a plastic surgery resident’s perspective. We will cover embryology, anatomy, classification, associated syndromes, timing of repair, surgical principles, multidisciplinary care, and long-term follow-up. The episode focuses on how to think clinically and surgically about cleft patients, from newborn evaluation to lip repair, palate repair,...

In this episode, we explore the  superficial circumflex iliac artery perforator flap , known as the  SCIP flap . Designed for plastic surgery residents, this episode explains the anatomy, indications, flap design, surgical technique, advantages, limitations, and common uses of the SCIP flap in reconstructive surgery. We will focus on why the SCIP flap is popular for thin soft-tissue reconstruction...

In this episode, we review the essential types of sutures used in plastic surgery, focusing on how to choose the correct thread based on tissue type, wound tension, location, healing time, and cosmetic outcome. Designed for plastic surgery residents, this episode explains absorbable vs non-absorbable sutures, monofilament vs braided sutures, and common materials such as Vicryl, Monocryl, PDS, Nylo...

The nose is not one structure. It is three vaults, two valves, six grafts, and one artery that becomes the entire tip blood supply the moment the columellar incision is made. The keystone area and why hump reduction opens the roof, the L-strut and why violating it produces a saddle nose, the spreader graft that simultaneously corrects valve collapse, the inverted-V, and the open roof, the septal e...

The abdominoplasty is not one operation — it is five. And choosing the wrong one produces a result that is better than nothing and worse than it should have been. Huger zones, Scarpa's fascia, T7–T12 and the lateral femoral cutaneous nerve, the perforator-preserving logic of lipoabdominoplasty, the superolateral tension vector of high-lateral-tension, the T-junction that always breaks in fleur...

Four incisions. Five planes. Two implant shapes. One capsule classification that every resident must know cold — and one combined operation that can turn a purple NAC into a surgical emergency before you close the skin. The T4 nerve and why the periareolar incision puts it at risk, ductal bacterial contamination and capsular contracture, the SNAP mnemonic for Baker grades, dual plane vs submuscula...

She holds a photograph of herself at 35 and asks what happened. The answer is six simultaneous processes in six anatomical layers — and surgery addresses only three of them. Skeletal resorption, fat compartment deflation and descent, the six retaining ligaments and exactly what each one does, what fails when it weakens, where it is, and which surgical technique releases it. The zygomatic ligament...

Three symptoms. Three nerves. Three completely different anatomical stories — and only one of them needs to be seen today. McKinney's Point, the five danger zones, the temporal branch on the deep temporalis fascia, the marginal mandibular branch dipping below the mandible, Stensen's duct across the masseter, the external jugular vein in the posterior triangle, and why the buccal branch alm...

Same face. Same ageing. Same surgeon. Two completely different results — because one operation moved the tissue up and the other pulled it back. The SMAS as a system from galea to platysma, the five techniques compared, the retaining ligaments that must be released for true midface correction, the vector of pull that separates a natural result from a pulled look, and the facial nerve that gets clo...

The facelift fixed the structure. The laser fixes the surface. Without both, you have only done half the job. Fitzpatrick classification, peel depth and frosting levels, phenol cardiotoxicity, fractionated versus fully ablative CO2, PIH in darker skin types, HSV reactivation in an open wound, and the laser eye injury that is always preventable and never forgivable. Episode 32 — peels and lasers, f...

A foreign body in a mastectomy field. Ischaemic skin flaps. And the radiotherapy that hasn't happened yet but will change everything if it does. ADM anatomy, DTI versus two-stage expander, pre-pectoral versus submuscular placement, radiation-induced contracture, animation deformity, infected implant removal, and the conversion to autologous reconstruction that nobody plans for but everyone eve...

One breast is bigger. One is smaller. It sounds simple — it almost never is. Tuberous breast deformity, Poland syndrome, IMF asymmetry, the augmentation-mastopexy blood supply problem, radial scoring of the constricted lower pole, and the intraoperative sit-up that reveals every mistake before you close. Episode 29 — asymmetric breast, from the diagnosis that changes everything to the periareolar...

Same operation. Different tumour. Completely different margin. Get it wrong and the patient either loses their face or their life. Breslow thickness, surgical margins by tumour type, Mohs micrographic surgery, sentinel lymph node biopsy, specimen orientation, frozen vs. paraffin histology, and the positive margin that arrives after you have already reconstructed the cheek. Episode 28 — excisions a...

He won't take his shirt off. His right ventricle is being compressed. And the treatment is a steel bar passed blindly through the mediastinum anterior to his beating heart. Haller index, the Nuss procedure, the modified Ravitch, perichondrial sleeve preservation, bar displacement, and the cardiac perforation that happens when the introducer goes one centimetre too deep. Episode 27 — sternoplas...

It feels like a lump. It looks like a lump. It has been there for years. And then the CT comes back and it isn't what you thought. Differential diagnosis of the hard skull lump, CT bone windows, osteoma excision technique, frontal sinus involvement, mucocele formation, and the missed malignancy that no imaging could have predicted. Episode 26 — osteoma and benign skull tumours, from the GP ref...