The Plastic Surgery Room

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...

The skull is missing. The brain is pulsating through the scalp. The patient flinches every time someone walks past him. Stored bone vs. PEEK vs. titanium mesh, dural adhesion release, temporal muscle re-suspension, bone resorption, infected implant removal, and the syndrome of the trephined that nobody teaches in medical school. Episode 25 — cranioplasty, from the 3D CT plan to the drain at 48 hou...

Everyone knows the scar goes in the groin. Almost nobody anchors it properly — and six months later it's on the inner thigh and the labia are pointing at the ceiling. Colles' fascia, lymphatic anatomy, great saphenous vein, fascial suspension, labial traction deformity, and the DVT risk nobody takes seriously enough. Episode 24 — thigh lift, from the pinch test to the compression garment.

Medial antebrachial cutaneous nerve anatomy, axillary Z-plasty, tension-free closure, lymphoedema risk after axillary clearance, and the scar that must be accepted before the patient goes to sleep. Episode 23 — brachioplasty, from the pinch test to the compression sleeve.

Everyone thinks it's simple. It's not. Scarpa's fascia, the subdermal plexus, tumescent lidocaine dosing, the zone rules that prevent skin necrosis, and the fever on day 4 that means necrotising fasciitis until proven otherwise. Episode 22 — liposuction, from patient selection to the compression garment.

She cannot close her eye, cannot smile, and her mouth is pulled to the right. Which problem do you fix first — and why does the answer determine whether she keeps her sight? Facial nerve anatomy, gold weight implants, cross-face nerve grafting, free gracilis transfer, masseteric nerve coaptation, and the 18-month wait before a smile appears. Episode 21 — facial palsy reconstruction, from corneal p...

Every other option has failed. The chest wall is irradiated, infected, and exposed. This is when you call for the omentum. Gastroepiploic artery anatomy, laparoscopic harvest, subcutaneous tunnelling, split thickness skin grafting over omentum, and the bowel injury that cannot happen in a contaminated chest wound. Episode 20 — omentum flap, from the CT scan to the VAC dressing.

She had augmentation 22 years ago. Now one breast is rock hard and painful. Before you touch her — take the history. Baker classification, capsule biology, BIA-ALCL and the late seroma that cannot be drained without cytology first, en bloc capsulectomy, implant rupture on MRI, and the animation deformity nobody warned the patient about. Episode 19 — breast implant complications, from the first cli...

Every surgeon debrides. Almost nobody talks about the decision-making behind it. Wound healing biology, biofilm, the paprika sign, the heel eschar rule, VAC therapy, maggot debridement, and the Marjolin's ulcer hiding in a wound that won't heal. Episode 18 — debridement, from the probe-to-bone test to the second look at 48 hours.

The most common aesthetic operation in the world — and the one where the difference between a natural result and a pulled look comes down to understanding which layer is doing the work. SMAS anatomy, retaining ligaments, facial nerve branches, deep plane vs. SMAS plication, platysmaplaasty, and the haematoma that must be evacuated before midnight. Episode 17 — facelift, from the anatomy of ageing...

The most anatomically demanding genital surgery in medicine — drawing on microsurgery, urology, and plastic surgery in the same operation. Penile inversion vaginoplasty, rectoprostatic space dissection, tube-within-a-tube phalloplasty, microsurgical anastomosis, and the complications that range from urethral fistula to rectovaginal fistula. Episode 16 — gender affirming surgery, from the anatomy t...