The Plastic Surgery Room

Every defect has a solution. The skill is knowing which one fits — and understanding the geometry well enough to execute it. Langer's lines, random vs. axial flaps, Z-plasty, rhomboid flap, rotation flap, and the paramedian forehead flap that rebuilds a nose in two stages. Episode 15 — local flaps, from the geometry on the whiteboard to the trapdoor deformity nobody warned you about.

It looks like the simplest operation in plastic surgery. Harvest some fat, inject it somewhere else. Except one wrong injection near the glabella can cause permanent blindness. Adipocyte biology, ADSCs, the three-zone survival model, Coleman technique, and the vascular occlusion complication that every surgeon doing facial fat grafting must be able to manage in 60 seconds. Episode 14 — fat graftin...

The skull is the wrong shape. The brain is running out of room. You have one operation to fix both. Virchow's law, suture-specific deformities, bifrontal craniotomy, bandeau reshaping, air embolism, and a blood loss that can kill a 10-month-old in minutes. Episode 13 — craniosynostosis and cranial vault remodelling, from the first clinic visit to the paediatric ICU.

Three phases of take. One haematoma to kill it. Five days of immobilisation to save it. Split vs. full thickness, wound bed requirements, VAC-assisted take, Group A strep, and the donor site complications nobody warns patients about. Episode 12 — skin grafts, from dermatome to first dressing change.

The operation where the real work happens weeks after you close the skin. Sub-galeal pocket creation, antibiotic soak protocol, weekly inflation, and the complications that end with an expander on the floor of the OR. Episode 10 — tissue expanders, from insertion to flap advancement.

The cardiac ICU calls at 11pm. Exposed wires, sternal click, fever. This is what you do. Pectoralis major anatomy, IMA harvest and what it costs you, bilateral flap advancement, omentum as salvage, and the complications that carry a 25% mortality. Episode 11 — sternal wound reconstruction, from the phone call to the dressing.

When the free flap fails, the vessels are gone, and the patient needs coverage today — this is what you reach for. Pectoralis major, latissimus dorsi, pedicled TRAM — pedicle anatomy, arc of rotation, tunnelling, and the complications that are unique to flaps that can't be repositioned once they're down.

The ear has 12 named anatomical subunits. Getting them all right requires cartilage carving that takes years to learn and cannot be undone. Rib harvest, framework carving, Medpor vs. cartilage, the temporoparietal fascia flap, Mustardé sutures, and the complications that expose your implant years later. Episode 8 ear reconstruction and otoplasty, from the costal cartilage block to the compressive...

Ten hours, two teams, one chance to get the anastomosis right. Fibula anatomy, peroneal artery harvest, 3D surgical planning, microsurgical anastomosis, and the complications that send you back to the OR at 2am. Episode 7 — free flap head and neck reconstruction, from CTA to the first post-op Doppler check.

Five anatomical regions, one operation, and nerves you cannot afford to injure. The male vs. female skull, frontal sinus classification, supraorbital nerve protection, and the complications that show up on the face every time the patient looks in a mirror. Episode 6 — facial feminization surgery, from CT scan to closure.

The highest complication rate in elective plastic surgery — and most residents don't know why until it's too late. Huger zones, rectus diastasis, Scarpa's fascia, DVT prevention, and the rule about never combining abdominoplasty with lower body liposuction. Episode 5 abdominoplasty, from the abdominal wall to the compression garment.

90% of this operation happens before the first incision. Cleft lip anatomy, the misdirected orbicularis, Millard rotation-advancement markings, and the complications that follow patients for decades. Episode 4 — cleft lip repair, from embryology to the 18-year rhinoplasty.

The most revised operation in plastic surgery — because the margin for error is measured in millimeters. Nasal anatomy, the L-strut, osteotomies, internal valve collapse, and the complications that bring patients back. Episode 3 — rhinoplasty, from first incision to the 12-month revision conversation.

The most complex breast reconstruction in plastic surgery — and the one residents fear most. Free flap anatomy, perforator mapping, microsurgical anastomosis, and the hourly monitoring that decides whether the flap lives or dies. Episode 2 — DIEP flap, from CTA to closure.

Everything you need to know before scrubbing into a breast reduction. Blood supply, nerve anatomy, the six complications that matter, and the five questions your attending will ask you. Episode 1 — reduction mammaplasty, no fluff.