THE DIEP FLAP
In the mid- 1990's it was recognized that the TRAM flap could be harvested without the rectus abdominis muscle by dissecting the blood vessels (the perforating vessels to the skin and fat) through the muscle (see figure 2). This flap, called the deep inferior epigastric perforator or DIEP flap (see figure 3), uses the same skin and fat of the lower abdomen as the TRAM to reconstruct a breast. There are several published series in the medical literature that show that patients who undergo this procedure have less pain and a faster recovery than patients who undergo TRAM flap reconstruction. There is also less risk of abdominal wall weakness and herniation. Finally, since the flap is taken from the low abdomen like a TRAM flap, there is the added benefit of a "tummy-tuck", with the abdomen nicely re- contoured.


Figure 2


Figure 3

The DIEP harvest is longer and more complicated than a TRAM flap, but for most patients this is more than offset by the benefits to the abdominal wall.

This is pretty interesting information. personally, I had no idea breast surgery was this involved. The techniques and the advances in breast surgery are simply astonishing. Even Specialists at the forefront of researching new surgical techniques, like San Francisco Plastic Surgeon Dr Gabe Kind agree that the DIEP FLAP reconstruction technique is bay far the most advanced form of breast reconstruction available today. Anyone have any comments? Has anyone ever had this type of breast reconstruction? Let's discuss Shall we?

Many people wish to reshape their nose to better fit the proportions of their facial features. In fact, changing the nasal shape is one of the most common reasons an individual consults a plastic surgeon like Southern California Plastic Surgeon Dr Dan Mills, MD.

If you want to decrease or increase the size of your nose, change the tip or bridge shape, narrow the span of the nostrils, or alter the angle between your nose and upper lip, plastic surgeons can perform a rhinoplasty to reshape your nose. This Procedure is also used to correct a birth defect or injury, or in some cases to help relieve some breathing problems.

While there is no age cap for rhinoplasty, Most surgeons prefer not to operate on individuals until they have hit the mid to late-teens, when the nose is near full development. Typically, the earliest age fro surgery is around 16 years for girls and about 18 for boys. This standard typically yields the best result, as one’s facial proportions tend to change significantly through puberty.

So what do you all think? It is obvious that Rhinoplasty is here to stay and the number of patients who have or will get a nose surgery procedure is increasing. What about the youngest age people can have rhinoplasty procedures? Should there be regulations in place to prohibit teens from having a rhinoplasty? Let's Discuss this further.

The standard implant in the United States has been saline filled, ever since the FDA moratorium on silicone gel filled breast implants in 1992. The type of implants that were available before the ban are available today as part of an "adjunct study," which is open to patients with congenital deformities or having a revision for particular reasons.

What distinguishes cohesive implants is that the silicone gel is firmer, essentially a soft solid. If a cohesive implant is cut in half, there is no gross movement of gel, and the implant maintains its shape. The way these are made is that the company uses more "crosslinker" in the making of the implant. The ingredients are the same, but with more crosslinker added, it makes the gel firmer.

I have seen several videos regarding the "Cohesive" or "gummy bear" implant. It is a huge improvement over the standard Saline and silicone Implants. What does everyone think?