Plastic Surgery - Charles Thorne MD - New York City

Post-Pregnancy Surgery

charlesthornemd@gmail.com (Charles Thorne MD) — Mon, 31 Aug 2009 20:34:39 PDT

Pregnancy and breast-feeding often take their toll on the mother’s body, resulting in excess abdominal skin with stretch marks and sagging, deflated breasts.

Plastic Surgical procedures can help with these demoralizing changes.

Timing. It is generally recommended that the woman wait until she has completed her child bearing before going ahead with a “Mommy Makeover, “ as it has been called. Additional pregnancies will stretch out a repaired abdomen or lifted breasts and, as a general rule, it is better to wait until the woman is sure she will have no further children. Of course there are exceptions to this rule. For example, if a woman has a divorce after the first child and feels uncomfortable getting back into the dating scene, it may make sense to undergo surgery, even if there may be additional pregnancies in the future.

Abdomen. The most common procedure on the abdomen is an abdominoplasty or “tummy tuck.” If there is extensive amounts of excess skin and stretch that extend above the belly button, a full abdominoplasty is usually necessary. If the excess and stretch marks are limited to the lower abdomen, a more limited or “Mini abdominoplasty” may be adequate. The surgeon should attempt to keep the scar as low as possible so that it may be hidden in most underwear. The recovery after standard abdominoplasty is more painful than after facial procedures (such as a facelift) and is similar to the recovery after a C-section. Ouch! Surgery makes such a dramatic difference, however, that most patients feel that it is definitely worth it.

Breasts. The effects of pregnancy and breast-feeding on breasts are greater for larger breasts. Patients who start with an A or B cup frequently do not suffer extreme deterioration in their breast shape/size. Larger breasts, on the other hand, tend to sag and deflate. The result are breasts that may need either a lift (mastopexy) or an implant (augmentation) or BOTH.

These procedures can be done separately or together depending on the needs of the patient, the recommendation of the surgeon, financial considerations etc.

Some women go through pregnancy with minor changes and require no surgical help afterwards. Others, however, for no known reason, develop significant changes in their bodies. For these latter women, plastic surgery can often help tremendously.

Tear Trough and Lid/Cheek Junction

charlesthornemd@gmail.com (Charles Thorne MD) — Tue, 26 May 2009 09:07:58 PDT

Discussion: continuation....According to Codner and Ford, the tear trough deformity overlies the muscular triangle formed by the orbicularis pculi, the lavtor labii superioris, and the levator alaeque nasi muscles. They also point out that, with age, there is postseptal fat herniation and prezygomatic fat ptosis that accentuates the defect. Barton et al. referred to the tear trough triad: (1) heniation of orbital fat, (2) tight attachment of the orbicularis along the arcus marginalis. and (3) malar retrusion.

Regarding the issue of apparent descent of the lid/cheek junction, Lambros has pointed out that the lid/cheek junction is in fact stable over time and the perception of the descent is attributable to herniation of the orbital fat following orbital septal and preseptal orbiculairs oculi muscle attenuation.

These shadows exaggerate the tear trough deformity and palpebromalar groove. Furthermore, skin atrophy leads to darkening of the preseptal skin, causing an increase in contrast and therefore an accentuated lid/cheek junction. Our study suggests that the tear trough deformity is not related to facial "descent, the arcus marginalis, the orbital rim, or the junction of the levator labii superioris alaeque nasi muscle and the orbicularis oculi muscle. To be continued....

Tear Trough and Lid/Cheek Junction

charlesthornemd@gmail.com (Charles Thorne MD) — Tue, 19 May 2009 10:40:17 PDT

DISCUSSION: continuation.... Loeb described three theoretical malformations that cause what he termed the nasojugal groove. These include (1) fixation of the orbital septum at the level of the inferomedial portion of the arcus marginalis; (2) the existence of a triangular gap limited by the lateral portion of the angular muscle on one side and the medial portion of the orbiculares oculi muscle on the other; and (3) the absence of fat tissue from the central and medial fat pads subjacent to the orbicularis oculi muscle in the area below the groove . Loeb also noted that this natural sulcus may be inconspicuous until neighboring fat pads grow and exaggerate the defect. To manage these spatial derangements, Loeb described a number of treatment options, including (1) transplant of free fat grafts; (2) sliding fat from the medial and central hypertrophic fat pads; and (3) liposuction of excess fat on the cheek region.

If I have a specialty, it is the Facelift.

charlesthornemd@gmail.com (Charles Thorne MD) — Wed, 13 May 2009 06:49:02 PDT

NYC Patients frequently ask, "What technique do you use- SMAS, deep plane, short scar, MACS-lift.?" The answer is, "Whatever technique the patient needs." To have only one technique at your disposal calls to mind the adage, "If you have a hammer, the whole world looks like a nail!"

The truth is that every patient is different, with an aging pattern all his/her own, with a unique skin type, with a particular pattern and color of hair, individual medical issues/medications and personal expectations. An experienced surgeon has many tools available, not just hammers, and chooses the combination of techniques and procedures that best suit that patient. I have performed every conceivable facelift procedure, and try to choose what is best for each patient.

Dr. Thorne's technique
www.CharlesThorneMD.com

That being said, there are certainly procedures I use and others I do not. My philosophy of facelifting, like my philosophy on all cosmetic procedures, is to do as LITTLE as possible to give the patient the result he/she seeks. The goal is NOT to do as much as one can think of. This approach of minimal intervention for maximal results leads to more consistent results, fewer complications, and is least likely to result in an "operated look."

The technique I use most often consists of skin undermining, vertical elevation of the posterior SMAS and platysma, suspension of the cheek fat, and selective liposuction and lipoinjection. I do NOT redrape the skin vertically. I do not like the appearance of neck skin pulled up on to the face-the neck skin has different pigmentation, different creases and belongs in the neck! I frequently combine the procedure with elevation of the outer part of the brow only. See section on browlifting. I hate conventional browlifts, which tend to make people look older, stranger and surprised.

Goal of facelifting

The goal in facelifting, for most patients, is to make the patient look like herself/himself, just a crisper version. An occasional patient wants/needs a more dramatic change but this is the exception, not the rule.

Harmony and avoiding the "facelifted look."

Almost every patient tells me that they don't want a "facelift look." What do they mean? In addition to avoiding over-correction in any area, the key is to keep the face looking harmonious as a whole. If one part of the face is out-of-synch with the rest of the face, it does not look natural. It looks artificial or "man made." An occasional patient will ask me to correct only the neck. I rarely agree to such a request because I fear creating disharmony-a tight neck with uncorrected jowls! Not a good look. My goal is to make you look BETTER, more harmonious than when you started, not to create a disharmonious, operated appearance. I would rather have your friends say, "She looks great," than say, "She had a facelift!"

To see before and after images, just click Facelift.

To read Charles Thorne's facelift chapter in The Plastic Surgery Book, please click Plastic Surgery Book

For more information, please click here.

Tear Trough and Lid/Cheek Junction

charlesthornemd@gmail.com (Charles Thorne MD) — Mon, 11 May 2009 08:33:27 PDT

DISCUSSION: Continued... Flowers described a set of factors contributing to the formation of the tear trough deformity, including (1) descent of the cheek with the junction of cheek skin and eyelid skin occurring at a lower point than usual; (2) a muscular defect between the orbicularis muscle and angular head of the quadratus labii superioris muscle; (3) underdevelopment of the suborbital malar complex (hemiexophthalmos); and (4) a progressive loss of facial fat with age. Flowers focused his efforts on developing alloplastic implants designed to fill varying degrees of tissue inadequacy. In a related observation, Freeman noticed that the formation of the nasojugal deformity was associated with the inferior migration of the sub-orbicularis oculi fat pad. to be continued....

Charles H. Thorne MD
Plastic Surgery - New York City

Facelift-State of the Art

charlesthornemd@gmail.com (Charles Thorne MD) — Wed, 06 May 2009 08:17:45 PDT

In October I moderated a panel discussion at the 25th Anniversary Meeting of the Northeastern Society of Plastic Surgeons on the subject, "Facelift--State of the Art". The concept was, "How far have we come in facelifting in 25 years?"

The consensus was that most of the "new" techniques have NOT delivered what they promised. While it is true that the big operations of the past may no longer be necessary, it is also true that 'small operations mean small results.' Another way of saying it: 'If it seems too good to be true, it probably is!'

It was agreed that a good facelift will require a week or two of recovery--not a month or two, but not an hour or two, either.

Charles H. Thorne MD
Plastic Surgery - New York City

charlesthornemd@gmail.com (Charles Thorne MD) — Wed, 06 May 2009 08:16:46 PDT

I have been practicing plastic surgery in New York City for 20 years and have been lucky to be listed in the Castle and Connolly and New York Magazine "Best Doctor" publications many times. Although I enjoy the leadership positions that I have in plastic surgical societies, my editorial position with the Journal of Plastic and Reconstructive Surgery, and my position on the American Board of Plastic Surgery, my real interest and expertise is performing surgery and taking care of patients. Making people happy never gets old.

Charles H. Thorne MD
Plastic Surgery - New York City

Tear Trough and Lid/Cheek Junction

charlesthornemd@gmail.com (Charles Thorne MD) — Wed, 06 May 2009 08:16:04 PDT

DISCUSSION: continuation...
In the suborbicularis plane, the tear trough and the lid/cheek junction differ. Along the tear trough, the palpebral portion of the orbicularis oculi muscle is rigidly attached to the bone, with no dissectible anatomical plane deep to the muscle. it was not technically possible to dissect above the periosteum and below the muscular attachment. Along the lid/cheek junction, however, the orbicularis muscle has a ligamentous attachmentto the bone by means of the orbicularis retaining ligament. Unlike the tear trough region, there is a plane deep to the muscle into which material can be injected or surgical dissection performed. Although there appeared to be on main orbicularis retaining ligament, there were several weaker ligamentous attachments between the orbital rim and the attachment of the main orbicularis retaining ligament. To be continued.....

Charles H. Thorne MD
Plastic Surgery - New York City

Tear Trough and Lid/Cheek Junction

charlesthornemd@gmail.com (Charles Thorne MD) — Wed, 29 Apr 2009 08:18:41 PDT

DISCUSSION: The anatomical features that explain the external landmarks known as the tear trough and lid/cheek junction exist in three different planes: at the skin level, at the subcutaneous plane, and at the suborbicularis plane. In the subcutaneous plane, the tear trough and lid/cheek junction corelate with the junction of the palpebral and orbital portions of the orbicularis muscle. Along the tear trough, there tends to be a particularly obvious cleft between the two portions of the orbicularis muscle. In addition, there is virtually no fat between the skin and the muscular junction, accounting for its visibility as a cutaneous landmark. Further contributing to external visibility is the fact that the eyelid skin above the landmark and the cheek skin below the landmark have distinctly different textures and thicknesses. In addition, the malar fat pad begins precisely at the same muscular junction, providing further definition. To be continued.....

Charles H. Thorne MD
Plastic Surgeon New York City

Tear Trough and Lid/Cheek Junction

charlesthornemd@gmail.com (Charles Thorne MD) — Wed, 29 Apr 2009 08:18:23 PDT

RESULTS: Continuation....
Although the anatomy of the tear trough and its lateral continuation, the lid/cheek junction, were identical in the subcutaneous plane, this was not the case deep to the orbicularis. Rather, the palpebral portion of the orbicularis was rigidly attached to the maxilla where it takes origin. Laterally, however, along the lid/cheek junction, the attachment between the orbicularis muscle and the underlying bone was ligamentous (the orbicularis retaining ligament). In this region, there was a dissectible plane deep to the orbicularis muscle.

The orbicularis retaining ligament was attached to the underlying zygoma caudal to the arcus marginalis at the orbital rim. The orbicularis retaining ligament was furthest from the rim in the midpupillary line (4 to 6 mm) and terminated closer to the rim near the lateral canthus (2 to 4 mm). To repeat, the orbicularis retaining ligament did not arise from the infraorbital rim but, like the cutaneous landmark overlying it, was several millimeters caudal to the rim.

Finally, attenuation of the orbital septum accompanied by orbital fat herniation was transmitted through the relatively lax palpebral orbicularis, further accentuating the tear trough. This was especially evident medially, where the strong orbital orbicularis attachments originate.

Charles H. Thorne MD
Plastic Surgeon New York City

Tear Trough and Lid/Cheek Junction

charlesthornemd@gmail.com (Charles Thorne MD) — Wed, 29 Apr 2009 08:17:44 PDT

RESULTS: All cadavers were older than 50 years. There was no distinction between the anatomy of the tear trough and the adjacent lid/cheek junction in the subcutaneous plane. Rather, they were continuous and correlated in every case with the junction between the palpebral (or preseptal) and orbital portions of the orbucularis oculi muscle.

Additional features contributed to the visibility of these landmarks. The skin overlying the palpebral orbicularis (eyelid skin) was thin, with no subcutaneous fat. The skin over the orbital orbicularis (cheek skin). In contrast, was thicker and was separated from the underlying orbicularis muscle by the malar fat pad. The cephalic border of the malar fat pad was located, in every case, precisely at the junction of the palpebral and orbital portions of the orbicularis oculi muscle.

The tear trough, and the underlying anatomical features that explain it, begin at the medial canthus and extend inferolaterally away from the orbital rim, terminating 4 to 6 mm caudal to the arcus marginalis at the orbital rim. The gap between the orbital portion of the orbicularis and the levator labii superiors alaeque nasi muscle, thought by some to explain the tear trough, was always inferomedial to the tear trough and did not contribute to the overlying surface anatomy.
to be continued.......

Charles H. Thorne MD
Plastic Surgeon New York

Tear Trough and Lid/Cheek Junction

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 23 Apr 2009 05:44:31 PDT

METHODS: Twelve fresh cadaver lower lid and midface dissections were performed (six heads; three male three female cadavers). The ages of the cadavers were noted, the anatomical components of the region were examined, and photographs were taken. Dissection was performed carefully, layer by layer, to evaluate whether there were multiple anatomical contributions to the overlying surface anatomy. Attention was directed to the thickness of the skin, the amount of subcutaneous fat, the origin and configuration of the orbicularis oculi muscle, and the attachments between the orbicularis oculi muscle and the underlying bone.

Charles H. Thorne MD
Plastic Surgeon New York

The Tear Trough and Lid/cheek Junction: Anatomy and Implications for Surgical Correction

charlesthornemd@gmail.com (Charles Thorne MD) — Mon, 13 Apr 2009 10:07:06 PDT

Given the diversity of anatomical explanations, it is not surprising that numerous and often conflicting surgical and injectable procedures have been described as treatments for the tear trough deformity and the lid/cheek junction. Treatments for the tear trough include alloplastic implants, release of the orbicularis oculi muscle origin, transposition of the pedicled orbital fat, grafting of fat by injection, and injection of other materials such as hyaluronic acid fillers. Proposed treatments for the deepening lid/cheek junction are even more diverse and include midface lifting, redraping, and cephalic traction on the orbicularis muscle; transposition of pedicled orbital fat; and injection of wither fat or other materials. In addition, traditional treatment for orbital fat herniation, namely, orbital fat excision, may disguise the tear trough deformity and the lid/cheek junction interface to some extent.

Charles H. Thorne MD
Plastic Surgeon New York

The Tear Trough and Lid/cheek Junction: Anatomy and Implications for Surgical Correction

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 09 Apr 2009 07:24:22 PDT

The terms "tear trough" and "lid/cheek junction" are ubiquitous at plastic surgery meetings and in the literature. There is general agreement that these landmarks become more visible with age. Disagreement exists, however, regarding the anatomical explanation for these landmarks and which procedure is best to disguise, improve, or correct them.

The tear trough, also known as the nasojugal groove, is the natural depression extending inferolaterally from the medical canthus. When this external landmark is deep enough to be unsightly in the eyes of the patients or the surgeon, it is known as the "tear through deformity". The tear trough is short (no more than 3 cm in length) and terminates approximately in the midpupillary line. Extending laterally from this point, below and approximately parallel to the infraorbital rim, is another indentation that become more obvious with age. This groove has been variably referred to as the palpebromalar groove or, by some, the lid/cheek junction. A tear trough deformity and a well-demarcated lid/cheek junction, along with visible bulging of orbital fat, may stimulate a patient to seek periorbital aesthetic surgery. To be continued.......

Charles H. Thorne MD
New York Plastic Surgeon

The Tear Trough and Lid/Cheek Junction: Anatomy and Implications for Surgical Correction

charlesthornemd@gmail.com (Charles Thorne MD) — Mon, 13 Apr 2009 10:07:26 PDT

Background: The tear trough and the lid/cheek junction become more visible with age. These landmarks are adjacent, forming in some patients a continuous indentation or groove below the infraorbital rim. Numerous, often conflicting procedures have been described to improve the appearance of the region. the purpose of this study was to evaluate the anatomy underlying the tear trough and the lid/cheek junction and to evaluate the procedures designed to correct them.
To be Continued...............

Charles H. Thorne MD
New York Plastic Surgeon

The over-corrected nose

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 09 Apr 2009 07:23:58 PDT

It is not unusual to see patients who have had nasal surgery in the past and are unhappy because something was “overdone” resulting in either collapse during breathing or visible, cosmetic problems, or both.

As in most areas of cosmetic surgery, it is easier to repair a problem when something has been underdone (residual hump, for example), than when something is overdone. The latter usually requires addition of cartilage.

Examples of the above are: Nasal bridge too low resulting in what we call a “saddle nose” deformity, visible points or knuckles in the nasal tip, retraction of the nostril rims, partial collapse of the nostril rim during inspiration, or an overly turned-up nose.

Correction of these deformities requires the addition of cartilage. The cartilage can be found within the nose (nasal septum), the ears or the ribs. Which site is used depends on what is available within the nose and what is required in a particular case.

Nasal bridge: Correction of a nasal bridge problem requires long, straight pieces of cartilage. The nasal septum or rib is the location of choice. If the defect is especially large, then sometimes a bone graft from the hip is necessary.

Nostril rims: Retraction or weakening of the nostril rims requires the placement of thin slivers of cartilage from the septum or the ears and can often result in dramatic improvement.

Tip deformities: If there are sharp points or visible irregularities in the tip, it is usually necessary to remove them and replace them with smooth, curved pieces of cartilage from the ear.

Turned up nose: This is probably the most difficult problem to correct. Lengthening the nose requires placement of pieces of cartilage that push the tip downward. The ideal place to obtain these pieces is from the nasal septum, if it is available.

The take home message is, surprise, that it is better to under-do rather than over-do a procedure on the nose. If such problems occur, however, we have good tools to improve them.

Charles H. Thorne MD
New York Plastic Surgeon

Preoperative Preparation

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 26 Mar 2009 05:29:07 PDT

The most common complication of facelifting is a hematoma and therefore the history focuses on factors that predispose to postoperative bleeding. Specifically hypertension and medications that affect clotting. Surgery is not performed until the patient has been off aspirin for 2 weeks. Facelifting is probably contraindicated in patients on warfarin (Coumadin) or clopidogrel (Plavix), even if they are allowed by their physicians to stop these medications. At the very least, facelifting on such patients is performed with extreme conservatism and only after every possible means of eliminating the effects of these medications has been pursued. Hypertension is probably the single factor that most closely correlates with postoperative hematomas, thus blood pressure must be under strict control.

Charles H. Thorne MD
New York Plastic Surgeon

Should I get silicone or saline breast implants?

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 26 Mar 2009 05:29:29 PDT

Patients frequently ask this question. There is no right or wrong answer.

SAFETY. First of all, let’s talk safety. It has now been shown to the satisfaction of everyone (the government regulatory agencies, doctors, medical journals etc) that implants containing silicone gel are safe. That is, the risk that patients with silicone implants will get any diseases (including breast cancer) is the same as the normal population.

SOFTNESS. When examined outside the body, silicone implants are slightly softer and more “natural” than saline implants. When placed in the body, however, the implants are covered with skin, fat, and muscle and both types of implants tend to feel soft and of acceptable texture. In thin patients with small amounts of breast tissue, the silicone implants may yield a softer result because there is less tissue disguising them.

CLEAVAGE. Saline implants are rounder and provide more dramatic cleavage. Patients differ in their goals in this regard.

INCISIONS. There are cases where saline implants are preferable because of the incisions. Since saline implants can be placed in the deflated state, they can be placed through smaller incisions than silicone implants which are placed in the fully inflated state. Very thin patients of Asian descent with small areola diameter may not be good candidates for silicone implants because of considerations regarding the incisions. The areola diameter may be too small to use a periareolar incision and the surgeon and patient may be hesitant to use an inframammary incision for fear of an obvious scar in patients of this skin type. That leaves the axillary (armpit) incision. The armpit incision is a good approach but it is difficult to insert a silicone implant via that incision. Therefore, patients in this situation may do better with saline implants placed through the axilla.

EXPENSE. Silicone implants are more expensive. A pair of silicone implants cost approximately $800 more than a pair of saline implants.

SUMMARY. All things being equal, I generally recommend silicone implants. But remember, silicone implants were not available for a ten-year period while the government investigated their safety. We only performed saline augmentations during that period and patients were very happy.

Charles H. Thorne MD
New York Plastic Surgeon

Cigarette Smoking

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 09 Apr 2009 07:33:08 PDT

Smoking increases the risk of skin slough, the second most common complication after facelifting. Patients are encouraged to quit smoking permanently. Cigarette smoking, with all its deleterious effects on health, and having a facelift to feel better about oneself, are fundamentally contradictory. At the very least, patients should cease smoking 2 weeks prior to surgery.

Charles H. Thorne MD
New York Plastic Surgeon

Biggest Myths in Plastic Surgery

charlesthornemd@gmail.com (Charles Thorne MD) — Fri, 20 Mar 2009 06:22:15 PDT

1. Fillers/Botox are cheaper than a facelift. Fillers and Botox are good products for certain things but for people over 45, the single best and cheapest procedure is a facelift.A good facelift will last 10 years. If you use injectible products for that period, you will definitely spend more than you would for a facelift. More importantly, for the vast majority of people, a facelift will do more for your overall appearance than fillers/Botox.

Charles H. Thorne MD
New York Plastic Surgeon

"Why all the talk about the lid-cheek junction?"

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 26 Mar 2009 05:29:55 PDT

Plastic Surgery meetings are full of talk about the "tear trough" and the "lid-cheek junction", but in 20 years of practice I have never heard a patient say, "Dr. Thorne, please fix my lid-cheek junction."

Patients do say they look "tired" or "old" or that they "need something", however, and one area that is frequently their biggest concern is the lower eyelid region.

In young people, the lower eyelid and cheek frequently blend together, whereas in "older" people there is an obvious demarcation between the lower eyelid and the cheek--that is the lid-cheek junction!!

As an individual ages, an indentation or groove develops, which serves to separate the lower eyelid from the cheek and also serves to exaggerate any bags or creases in the lower lid. The result is a convexity-concavity-convexity (easier understood as a bulde-dent-bulge) where the lower lid meets the cheek.

What causes this? Remember that aging is not just about sagging; it also involves atrophy. As fat atrophies around the eyes, the indentation of the lid-cheek junction gets deeper and the patients feels he/she looks tired.

What is the treatment? While some plastic surgeons think the treatment is lifting the cheek, I think the treatment is restoration of volume. Injection of fillers or fat can provide a significant improvement in this area.

Office or OR? The treatment can be administered in the office under local anesthesia as an isolated procedure OR can be performed at the same time as lower eyelid and/or facelift surgery.

Charles H. Thorne MD
New York Plastic Surgeon

Barbed Sutures

charlesthornemd@gmail.com (Charles Thorne MD) — Fri, 20 Mar 2009 06:21:57 PDT

In an effort to make facelifting quicker and less invasive, several authors describe the use of barbed sutures in facelifting. The longevity of the result does not compare favorably with traditional methods. At the present time, the sutures are made of polypropylene and are permanent. Concerns have been raised regarding the safety of permanent barbed sutures in the subcutaneous position. long-term data are not yet available.

Charles H. Thorne MD
New York Plastic Surgeon

Facelifting in Men

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 26 Mar 2009 05:30:57 PDT

The shorter hairstyles of men are less forgiving than the longer hairstyles of women. Male faces tend to be larger and dissection is more time-consuming. Modified incisions have been described for men, but I use the same incision in patients of both sexes. Some men may have a tremendous amount of excess skin in the neck. When this is redraped into the retroauricular area, care is required to avoid a large step-off in the hairline. the previously reported higher incisdence of hematomas in men than in women seems to be largely related to blood pressure.

Charles H. Thorne MD
New York Plastic Surgeon

Deep Plane or Composite Rhytidectomy

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 26 Mar 2009 05:30:21 PDT

Hamra described the depp plane facelift that he modified to its current iteration, the composite rhytidectomy. This brief description does not do the technique justice, but does outline the keypoints. The SMAS and skin are dissected together as a single flap, rather than independently, as in the techniques described above. The benfit of the procedure is that theoretically the flap is better vascularized and less likely to slough. The technique, as Hamra performs it, includes a supermedial elevation of the malar tissues and orbicularis oculi muscle and a brow lift with a similar superomedial vector. The disadvantage of the technique is the magnitude of the procedure and the prolonged recovery period.

It is my opinion, never having performed this procedure myself, that the benefits of the procedure do not justify the invasiveness, risk, and prolonged recovery associated with the procedure.

New York Plastic Surgeon

Facelift Techniques & Alternatives - "Redraping"

charlesthornemd@gmail.com (Charles Thorne MD) — Thu, 26 Mar 2009 05:30:43 PDT

The cheek skin is redraped along a line from the chin to the sideburn, overlapping the previosly fixed flap. A triangle of hairless, excess cheek skin is excised and the cheek is fixed under some tension with a single suture at the top of the ear, in such a way that there is no dog-ear at the anterior end of the transverse incision. The neck skin is redraped more horizontally, parallel to the neck creases. A second suture is placed under some tension at the apex of the retroauricular incision. Care is taken not to redrape the transverse neck creases up on to the face. This creates another bizarre "facelift look." Once these two tension-bearing sutures have been placed, the flap is incised so that the ear can barely be withdrawn from beneath the flap. The cheek flap is tucked up under the earlobe, leaving no pissibility that the scar will be visible.

Charles H. Thorne MD
New York Plastic Surgeon

Plastic Surgery - Charles Thorne MD - New York City

Post-Pregnancy Surgery

New York City Plastic Surgeon

Tear Trough and Lid/Cheek Junction

New York City Plastic Surgeon

Tear Trough and Lid/Cheek Junction

New York City Plastic Surgeon

If I have a specialty, it is the Facelift.

New York City Plastic Surgeon

Tear Trough and Lid/Cheek Junction

New York City Plastic Surgeon

Facelift-State of the Art

New York City Plastic Surgeon

New York City Plastic Surgeon

Tear Trough and Lid/Cheek Junction

New York City Plastic Surgeon

Tear Trough and Lid/Cheek Junction

New York City Plastic Surgeon

Tear Trough and Lid/Cheek Junction

New York City Plastic Surgeon

Tear Trough and Lid/Cheek Junction

New York City Plastic Surgeon

Tear Trough and Lid/Cheek Junction

New York City Plastic Surgeon

The Tear Trough and Lid/cheek Junction: Anatomy and Implications for Surgical Correction

New York City Plastic Surgeon

The Tear Trough and Lid/cheek Junction: Anatomy and Implications for Surgical Correction

New York City Plastic Surgeon

The Tear Trough and Lid/Cheek Junction: Anatomy and Implications for Surgical Correction

New York City Plastic Surgeon

The over-corrected nose

New York City Plastic Surgeon

Preoperative Preparation

New York City Plastic Surgeon

Should I get silicone or saline breast implants?

New York City Plastic Surgeon

Cigarette Smoking

New York City Plastic Surgeon

Biggest Myths in Plastic Surgery

New York City Plastic Surgeon

"Why all the talk about the lid-cheek junction?"

New York City Plastic Surgeon

Barbed Sutures

New York City Plastic Surgeon

Facelifting in Men

New York City Plastic Surgeon

Deep Plane or Composite Rhytidectomy

New York City Plastic Surgeon

Facelift Techniques & Alternatives - "Redraping"

New York City Plastic Surgeon