Plastics in Practice (Resident Review)

Hand infections deteriorate fast — the same anatomy that gives the hand its function turns ordinary swelling into ischemia, tendon necrosis, and permanent loss of motion. This episode walks through how to recognize and manage everything from paronychia and felon to pyogenic flexor tenosynovitis, deep space infections, bite injuries, and necrotizing fasciitis — with the surgical pitfalls every resi...

Upper extremity surgery is, at its core, a regional anesthesia specialty. Choose the right block in the right place and most hand and arm cases never need general anesthesia. In this episode of Plastics in Practice, we work through the practical anesthesia decision tree for the upper extremity: brachial plexus block locations and their trade-offs, peripheral nerve blocks at the elbow and wrist, th...

Every hand case rests on the same foundation: knowing which joints need mobility, which need stability, and how to run an acute hand with a trauma-first mindset. Get this layer right, and every chapter after it makes sense. In this episode of Plastics in Practice, we cover the foundational anatomy and operative principles of the upper extremity: how the thumb, finger, and wrist joints differ in th...

Lymphedema is the chronic disease plastic surgeons are best positioned to treat — and the most commonly mismanaged. After axillary node dissection, up to 50% of breast cancer patients develop it, and most never get the early, disciplined care that prevents progression to fibrofatty disease. In this episode of Plastics in Practice, we review the essentials of lymphedema management — from how the ly...

Pressure sores are the wound the plastic surgeon gets consulted on after everything else has gone wrong — and the recurrence rate is brutal if you skip the basics. The lesson nobody teaches you in residency is that the surgery is the easy part. In this episode of Plastics in Practice, we review the basics of pressure sore management: the pathophysiology of pressure-time injury, the six-stage NPUAP...

Few regions punish poor planning like the perineum — the pelvic outlet sits at the crossroads of the urinary, gynecologic, and GI tracts, and the wrong flap choice in an irradiated or contaminated field gets you back in the OR fast. In this episode of Plastics in Practice, we walk through the core principles of perineal reconstruction: anatomy and vascular supply, the reconstructive ladder, pelvic...

Saving a foot is rarely about the flap. It's about the angiosome you re-perfuse, the millimeters of debridement you take, and whether you lengthen a tight Achilles before you ever think about closure. In this episode of Plastics in Practice, we cover the principles of foot and ankle reconstruction: the six angiosomes and how they should drive every revascularization, incision, and flap design;...

Lower extremity reconstruction is the most unforgiving testing ground in plastic surgery — every decision is graded by whether the patient can bear weight, walk, and protect a sensate foot for the rest of their life. In this episode of Plastics in Practice, we walk through the core principles of lower extremity salvage: the zone-of-injury concept, when to fix vs. amputate, fracture management, sof...

Abdominal wall reconstruction is where plastic surgery principles get tested in real time — and it's where most failures start with one wrong assumption about force distribution. In this episode of Plastics in Practice, we review the basics of abdominal wall reconstruction: how to think about the abdomen as a pressurized cylinder, why supported repairs beat bridged repairs almost every time, how t...

Chest wall reconstruction is where rigid skeletal support and versatile soft tissue coverage meet — and where a wrong flap choice or a missed debridement step turns a small defect into a respiratory disaster. In this episode of Plastics in Practice, we review the basics of chest wall reconstruction: the anatomy that drives every decision, when you actually need to rebuild the skeleton, how to clas...

Hair restoration is one of the most planning-dependent procedures in plastic surgery — a single wrong call on the hairline or the donor strip can show up for the rest of the patient's life. In this episode of Plastics in Practice we walk through what residents actually need to know about modern hair transplantation: how to evaluate the donor area, how to think about lifetime donor yield, the trade...

Osseous genioplasty is the most versatile tool the plastic surgeon has for the lower face — and the most commonly mis-planned. In this episode of Plastics in Practice, we review the basics of chin surgery: when to pick the osteotomy over an implant, the five-pillar physical exam, the technical steps that decide your aesthetic result, and the pitfalls that cause the bizarre "overadvanced" chin we'v...

Facial implants can dramatically change facial balance, but the difference between a natural result and an operated look comes down to planning, positioning, and fixation. In this episode, we break down the core principles of facial skeletal augmentation with implants for the plastic surgery resident. We review the major implant materials, the anatomic targets across the midface and mandible, and...

Prominent ears are not one deformity. They are usually a combination problem involving the antihelix, concha, and lobule. In this episode, we break down a practical, anatomy-first approach to otoplasty that helps you create a natural setback without a sharp, overdone, or obviously operated appearance. We review the major causes of auricular prominence, the aesthetic goals of correction, and the co...

Rhinoplasty is not a reductive operation anymore. Modern rhinoplasty is about precision, preservation, and structure. In this episode, we break down a practical framework for analyzing the rhinoplasty patient, protecting the airway, and executing reproducible tip and dorsal maneuvers with fewer long-term problems. We cover the anatomy that actually matters in the OR: skin/soft tissue envelope beha...

Master the principles behind modern facelifting. This episode breaks down the core concepts of rhytidectomy, focusing on high-yield surgical principles, SMAS manipulation, and complication avoidance. We move beyond outdated skin-tension techniques and focus on what truly matters: volume restoration, anatomic precision, and hemodynamic control . You’ll learn how to think about facelifts like a surg...

Blepharoplasty looks simple—but it’s one of the easiest ways to create devastating complications if you don’t respect the anatomy. This episode breaks down the high-yield principles of modern blepharoplasty , focusing on what actually prevents bad outcomes: proper evaluation, conservative technique, and understanding lid support. We cover upper and lower lid strategy , when to preserve vs remove f...

The brow lift has evolved. What used to rely on long coronal incisions has shifted toward anatomically precise, minimally invasive endoscopic approaches designed to restore brow position while avoiding the over-elevated, unnatural “surprised” look. In this episode of Plastics in Practice , we break down the modern principles of forehead and brow rejuvenation with a resident-focused review of upper...

Fat grafting is no longer just filler—it’s a cornerstone of modern plastic surgery. In this episode, we break down the principles that actually determine graft survival, contour outcomes, and safety across facial and mega-volume applications. From the Coleman technique to BRAVA-assisted breast reconstruction , this is a high-yield, resident-focused deep dive into what matters in real cases. Fat gr...

Botulinum toxin is simple—until you actually try to use it well. This episode breaks down what most people get wrong: it’s not about units, it’s about functional anatomy and precision. We walk through the true mechanism (SNAP-25 cleavage → presynaptic blockade) , why Botox affects nerves—not muscle or skin , and how that translates into real-world injection strategy. From glabella to platysma, thi...

Dermal fillers are more than just wrinkle tools. In this episode, we break down the science that actually drives filler performance: rheology, particle behavior, tissue planes, facial fat compartments, and complication management. This is a high-yield review of dermal and soft-tissue fillers for plastic surgery residents, fellows, and aesthetic surgeons. We cover how G′ (elastic modulus) and visco...

Skin resurfacing is one of those topics that looks simple on the surface but gets very nuanced once you start thinking about depth, target tissue, endpoint recognition, and complication profile . In this episode, we break down the science of skin resurfacing in a way that actually matters for plastic surgery trainees. We cover the core anatomy behind resurfacing, why the dermal-epidermal junction...

Congenital breast anomalies are more than aesthetic diagnoses—they carry major psychosocial weight and demand a thoughtful reconstructive plan. In this episode, we break down the high-yield clinical framework for evaluating and surgically correcting congenital breast deformities, with a focus on tuberous breast deformity, developmental asymmetry, and Poland syndrome. This is the resident-level ove...

Nipple reconstruction is not the “small final step” of breast reconstruction—it is the focal point. A great breast mound can be undermined by poor nipple position, poor projection, or a mismatch in size and symmetry. In this episode, we break down the high-yield principles that actually matter when planning and performing nipple-areola complex reconstruction. We cover how to mark the nipple though...

Free flap breast reconstruction is one of the most technically demanding and rewarding procedures in reconstructive microsurgery. In this episode, we break down flap selection, donor-site strategy, recipient vessel choice, perfusion monitoring, and the key complications every plastic surgery resident needs to know. We focus on why the abdomen remains the preferred donor site for most patients, how...