What are the steps involved in proceeding with surgery?

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September 16, 2013

If you are a good candidate anatomically a surgical date can be scheduled. Photographs and preoperative laboratory studies follow. Older men with significant medical conditions will need to obtain clearance from their internist or other specialist beforehand.

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Feb 26

Under the armpit (transaxillary) breast augmentati

Under the armpit (transaxillary) breast augmentation leaves no scar on the breasts. It’s an ideal procedure for young women with good shape to start with. The incision is only 3/4 inch long and typically blends into adjacent skin folds under the arm. Saline implants are placed collapsed and inflated once in position. Silicone implants are possible but not best suited to the technique. Placing implants through the navel is a similar concept but has major technical drawbacks and is not recommended.

For the surgeons: Endoscopy is not required and makes the procedure unnecessarily complex. Releasing/lowering the crease adequately is the biggest challenge to consistency. Bolster sutures for focal over-dissection are a simple and reliable tool to allay “fear of flying” and increase precision.

#breastaugmentation #breastimplants #salineimplants #noscars #nycplasticsurgeon

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Feb 22

Result at 8 months! Reverse tummy-tucks are possi

Result at 8 months! Reverse tummy-tucks are possible for those with both loose skin above the naval and existing scars under the breasts, a rare combination. However, in the right patient it avoids the long lower abdominal scar and preserves the delicate anatomical nuance of the navel.

For the surgeons: Inverted- T patterns with glandular ptosis the best scenario. Jumping the midline should be avoided.

#abdominoplasty #flatabs

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Feb 18

The aging nasal tip is a detail not overlooked whe

The aging nasal tip is a detail not overlooked when planning facial rejuvenation surgery. It is an important adjunct that completes the whole picture, much like lip lifts, chin implants, and skin resurfacing. Our patient is shown at the completion of her surgery today with only the nasal tip changed. The next screen gives some details and the last is the late veteran actor Carl Malden’s classic tip that shows the cartilages in their full anatomical glory!

#rhinoplastysurgery #allinthedetails #newnose #naturalresults

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Feb 16

Our patient was offered a more complicated facial

Our patient was offered a more complicated facial surgery plan elsewhere. We are thrilled that she trusted our judgement. This text came from a mutual friend we did not realize we shared!

#upperblepharoplasty #nobrowliftneeded

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Feb 13

This charcoal drawing has been quite the weekend p

This charcoal drawing has been quite the weekend project! It’s called “First Date” and the girl’s face, now complete, is a key part of the composition. Zooming in reveals more detail. What’s left to do is less detailed and the pace will quicken.

#charcoaldrawing #robertlongo #fineartist #finearts

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Feb 9

Working with Ashley, my scrub tech, on a rhinoplas

Working with Ashley, my scrub tech, on a rhinoplasty! The headgear consisting of a light and magnifying glasses called loupes are used for rhinoplasties to enhance visibility within the depths of the nasal cavities and also to make precise changes in the more superficial structures.

Ashley is the perfect partner for such endeavors. She is always 100% focused and rarely utters a word as she methodically anticipates my every move. It is the closest thing to having four hands controlled by one brain and such a joy!

#rhinoplastysurgery #openrhinoplasty #lovemyjob

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Feb 4

Our postpartum patients have a different goal: jus

Our postpartum patients have a different goal: just fill the skin and optimize aesthetics. They are mostly beyond a desire to “weaponize” the breasts! This allows the surgeon to focus more on aesthetics and less on having to achieve a specific size increase. The 275cc implants in this patient are just right.

For the surgeons: Many of these patients are candidates for a nipple reduction due to breast feeding. This minor ancillary procedure really helps to complete the picture of restoration and rejuvenation.

#breastaugmentation #breastimplants #siliconeimplants #underthemuscle #lookinggood

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Feb 2

Eyes and dermabrasion too. Making subtle changes i

Eyes and dermabrasion too. Making subtle changes in a lot of areas adds up to a dramatic but natural transformation. We appreciate our lovely patient allowing us to share these images.

For the surgeons: This is a lot to do in one procedure, particularly since some component parts like rhinoplasty add a lot of time due to its modern complexity. A lip lift may have been beneficial too but one has to draw the line in order to keep overall operating time within a safe limit.

#faceliftsurgery #upperblepharoplasty #lowerblepharoplasty #rhinoplastysurgery #dermabrasion #chinimplant #worththeeffort #naturalresults

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Jan 28

Our long-standing patients (with the thickest char

Our long-standing patients (with the thickest charts!) are among our favorites. There is established trust that allows us to recommend “maintenance” procedures when beneficial but also periodically deny surgery requests that are not right for them. This patient is a little further along in the aging process where things like a long upper lip, enlarging earlobes, a dropping nasal tip, and skin texture issues become paramount. Also, the neck ages faster than the face and benefits from more frequent tightening. She did not need another facelift but rather a plethora of smaller procedures that are collectively impactful. This list was posted on the operating room wall along with her photos to keep track of the many disparate parts of her custom plan.

#necklift #skinresurfacing #cuteears #chinimplant #faceliftsurgery #lookyourbest

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Jan 26

Our patient refreshed her appearance by having the

Our patient refreshed her appearance by having the distracting hooded upper eyelid skin and lower eyelid fat bags/circles surgically removed. Properly done, surgery does not change the shape of the eyes but instead enhances the eyes as a bright focus of facial expression. Eyelid surgery is the starter procedure for looking better and is commonly done beginning in the early 40s. Not much discomfort or downtime associated.

For the surgeons: lowers done by fat excision, transposition, and a 30% TCA peel. The latter two components effectively decrease the need for skin excision by preserving volume and minimizing rhytids.

#blepharoplasty #upperblepharoplasty #lowerblepharoplasty #eyelidsurgery #beautifuleyes #brighteyes #eyelidexpert

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Jan 23

Our former breast reconstruction patient from 27 y

Our former breast reconstruction patient from 27 years ago accompanied a family member consulting on a quite different topic. She expressed deep gratitude for the work done so long ago and the memories started coming back. She had skin and fat tissue transplanted from the abdomen to create a new breast. This is a tour de force procedure taking 7 hours that allows the surgeon to create a perfect and permanent match for the other side. In any event, she brought us this lovely picture she painted to express her thanks for the effort made on her behalf so many years ago.

For the surgeons: The late Dr. William Shaw, pioneering microsurgeon and my mentor, uttered one of my favorite quips which this happy reunion epitomizes: “Surgery is a one time event for the surgeon, but a lifetime event for the patient”.

#lifetimeexperience #doitright

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Jan 19

Patients undergoing facial surgery want to look be

Patients undergoing facial surgery want to look better without revealing the process. Interestingly, even dramatic changes go unnoticed when the results appear completely normal, albeit aesthetically enhanced. Even those close to you can miss the change, as happened here (see next screen).

#facialsurgery #rhinoplasty # nose job #faceliftsurgery #keepthemguessing #noworries

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Jan 7

Hyaluronic acid (HA) fillers like Juvederm, Restyl

Hyaluronic acid (HA) fillers like Juvederm, Restylane and others are widely used injectables for all areas of the face. However, even when done by experts, fillers placed in the lower eyelids can create an unnatural, puffy look that can linger for years (mild example shown). Moreover, even a perfect result will need upkeep that also has to be perfect every time. The cumulative cost can exceed a “one and done” surgical alternative. Perhaps most importantly, fillers placed around the eyes are actually less safe than surgery. Filler consent forms always mention the potential for causing permanent blindness. While an exceedingly rare occurrence, it does happen. Every injector worries about this.

Unsuccessful lower eyelid fillers also interfere with subsequent evaluation for surgery. Fillers can be “dissolved” beforehand, but not always completely. Finally, the notion that fillers are a better alternative for mild lower eyelid “bags and grooves” is debatable. Surgery works well in those situations too (see second image).

For the surgeons: If you cannot get rid of the eyelid fillers completely beforehand, proceed with caution! Otherwise, fat excision and transposition is done by guesswork and you may even unmask a great filler defect.

#fillersinjection #hyaluronicacid #teartroughfillers #vitrase #eyebags #blepharoplasty #lowerblepharoplasty #eyelidsurgery #eyelidexpert

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Jan 5

Our surgeon patient is in his seventies, super bus

Our surgeon patient is in his seventies, super busy, and wants to keep at it! He also wanted a practical solution for looking better. He is the ideal candidate for simply cutting out the loose neck skin directly. The scar in the front heals amazingly well in older men, making them ideal candidates for this option (this is not done in women).

For the surgeons: This is the best option too! Strong midline cervical laxity like this responds poorly to facelifts. Open platysmaplasty a joy!

#turkeygobbler #keepworking #platysmaplasty #lookyourbest

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Jan 2

My brother and I with our father years ago is the

My brother and I with our father years ago is the subject of this just completed charcoal drawing. Dad was an orphan who came to the U.S. by himself at age 17. After the Army and WWII he went to M.I.T. to become an aerospace engineer. He was involved in nuclear missile design during the Cold War and later with missile defense systems. A serious guy who taught me all about work ethic among other key life lessons. Check out the epitaph he wrote for himself on the last screen.

#charcoaldrawing #robertlongo #photorealism

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Dec 31

Immediate operating room result yesterday. Thanks

Immediate operating room result yesterday. Thanks to today’s technology we can text these images to our patient before they even get home! It’s a great preview for them while they are living under the nasal splint for 5 days. It’s also fun for us to hear back from them (next screen)!

#rhinoplasty #nosejob #crookednose #rhinoplastysurgeon #nycplasticsurgeon

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Dec 29

Our lovely patient’s comments refer to the resul

Our lovely patient’s comments refer to the results of both a breast lift and abdominoplasty. Her abdomen was particularly challenging! (see before images).

For the surgeons: while using mesh is popular it is entirely unnecessary for rectus diastasis, even severe forms like this.

BTW, we love receiving late follow-ups from our patients! Please send to us at info@drdavidhidalgo.com.

#tummytuck #abdominoplasty #flatabs #rectusdiastasis #mommymakeovers #crunches #nycplasticsurgeon

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Dec 22

Our lovely former patient returned to us years lat

Our lovely former patient returned to us years later for facial rejuvenation. Here she is six weeks after a facelift ready for the holidays!

For the surgeons: extended SMAS, platysmal plication, extra small curvilinear chin implant, excision of “witches chin”, mild upper lip dermabrasion.

#facelifting #faceliftbeforeandafter #smaslifting #platysmaplasty #chinimplant #lookyourbest

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Dec 18

One of the more challenging scenarios in plastic s

One of the more challenging scenarios in plastic surgery practice!

#familyfirst #family❤️

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Dec 17

Walking Madison Avenue to work this morning. Our u

Walking Madison Avenue to work this morning. Our undeterred surgical patient is already there. Despite assault by disease, politicians, and now the weather, the city is tough and will be back before long!

#i❤️ny (still)

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Dec 14

Our patient had a previous rhinoplasty elsewhere y $Our patient had a previous rhinoplasty elsewhere years ago. Her nose was reconstructed using both her own cartilage as well as cartilage from a tissue bank. These projects are intricate and rely on both art and science to accomplish. This one took 4.5 hours to get both the front and side views right! The result is shown at 6 weeks with some swelling still evident. For the surgeons: MTF + septal cartilage: spreaders, columellar strut, alar rim, tip grafts; in fracture; thin Alloderm for minor irregularities. #rhinoplastyspecialist #secondaryrhinoplasty #openrhinoplasty #crookednose #somuchbetter$

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Dec 11

Samantha and Meghan are two of our ace nurses who

Samantha and Meghan are two of our ace nurses who will present topics from the nursing perspective each week. This is their inaugural effort describing how we determine implant size for our breast augmentation patients. Enjoy!

#supernurses #breastaugmentation #amazing #rn #superstar

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Dec 9

Our lovely patient wanted a conservative breast au

Our lovely patient wanted a conservative breast augmentation with optimal aesthetics. It only took 215 cc to do it! She is thrilled with the outcome and so are we. This is a good example of what’s possible when size goals are made secondary to best aesthetics.

#breastaugmentation #siliconeimplants #underthemuscle #lookinggood

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Dec 7

Pleased to be included with a small group of colle

Pleased to be included with a small group of colleagues in the new @goop plastic surgery guide!

#breastaugmentation #upperblepharoplasty #lowerblepharoplasty #nycplasticsurgeon

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Dec 5

Slow but steady progress on this weekend project.

Slow but steady progress on this weekend project. I do love the way the cumulative effort creates a permanent record of the time spent though. Drawing is also a sublime form of meditation!

#charcoaldrawing #photorealism #robertlongo #chuckclose

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Dec 3

Our immediate operating room result today. Breast

Our immediate operating room result today. Breast asymmetry like this is distressing for our teenage patients. Self consciousness with friends and in swimwear is common. Corrective surgery requires a combination of lift and augmentation techniques, either one or both for each side. This patient needed a vertical scar lift alone on the right, and an implant with a scar only around the nipple on the left. The difference it makes for our young patients is well worth the 4-5 hours it takes to get it as perfect as possible!

For the surgeons: saline implants are a great choice for these because of the precision volume adjustment possible and the superior device longevity and stability of results

#breastaugmentation #mastopexy #plasticsurgeonnyc #teenagegirls

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Dec 1

Immediate view at surgery today. Our patient want

Immediate view at surgery today. Our patient wanted a tasteful size increase and preferred silicone implants. The incisions are under the breast and off to the side to be least conspicuous. The implants are also “under the (pectoral) muscle”. This combination of implant type, incision location, and muscle position is the most popular approach today.

#breastaugmentation #siliconeimplants #nycplasticsurgeon #underthemuscle #lookinggood

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Nov 30

Our patient’s family celebrated with this playfu

Our patient’s family celebrated with this playful cake inscription. Personally, any excuse for Carvel ice cream cake is a good one!

#rhinoplastysurgeon #openrhinoplasty #nosejob #noses

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Nov 28

Six days following surgery! Our patient had a comb

Six days following surgery! Our patient had a combination of neck defatting, muscle tightening, and a chin implant as part of her facelift (these component procedures were featured separately earlier this week).

She came to us from afar after “much research” and we are both flattered and honored to be entrusted with making this change for her.

For the surgeons: you would expect that either a HOM or large chin implant would prove necessary. However, only a small curvilinear type was needed. Extra-small is used most frequently in our female patients. Extended SMAS used to contour the cheeks.

#faceliftsurgery #nycplasticsurgeon #platysmaplasty #chinimplant #smaslifting

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Nov 27

This immediate operating room result was achieved

This immediate operating room result was achieved by sculpting the superficial and deep fat compartments (see second screen) and tightening the superficial muscle in between (the platysma). The best you can achieve is to reveal the contour of the deep neck muscles and trachea. These structures form a 90 degree angle with the jaw in the best cases and a softer, more obtuse angle in a patient like this one. Tomorrow a radical “Stage III” example combining deep fat sculpting, platysma tightening, and a chin implant will be posted.

For the surgeons: Not a fan of sub max gland excision and digastric muscle shaving - many look over-operated and do not age well.

#faceliftsurgery #necklift #platysmaplasty

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Nov 26

Thankful today for the skills I have and being abl

Thankful today for the skills I have and being able to share them. This lovely patient had a breast reconstruction that aged poorly over time. I felt I could help her and reached back to a skill set not exercised for 20 years. It was a 5 hour labor of love with a great outcome, aided by some modern technology not available back in the day.

#giveback #helpeachother #soworthit

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Nov 25

Neck lifts are part of every facelift. The results

Neck lifts are part of every facelift. The results are more dramatic from the side even though patients are more concerned about the front view. We have several options to optimize results. One is adding a chin implant to lengthen the line from the side. It does not take much to accomplish this, only the smallest of implants, about the size of an almond (next screen). The “stage” of necklift here is arbitrary and refers to the chin implant option. On Friday our post will show Stage II, sculpting a new neck shape, and on Saturday will be “ Stage III” showing a recent patient having both radical neck sculpting and a chin implant. Wait until you see that one!

For the surgeons: the simple curvilinear type without the wings in extra small size is usually all that is needed, just like a rhinoplasty.

#faceliftsurgery #rhytidectomy #smaslifting #necklift #chinimplant

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Nov 21

The seven surviving chief residents out of 24 inte

The seven surviving chief residents out of 24 interns starting 5 years previously. 110 hours a week back in the day but the clock meant nothing. We lived instead by what the disease timeline dictated as we took care of our patients. We saw everything imaginable and by the time this picture was taken there was NOTHING we did not feel comfortable taking care of ourselves. Dr. Frank Spencer in the foreground was a pioneer in cardiac surgery and our chief. A fearsome figure in our lives!

#nyu #bellevuehospital #generalsurgery #lifechanging #besttraining

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Nov 20

Blepharoplasty surgery is effective and properly d

Blepharoplasty surgery is effective and properly done does not change eye shape, a common concern. Recovery is two weeks and discomfort minimal. While a brow lift could have been included most patients do not want a radical change.

For the surgeons: partial corrugator excision at the same time can be helpful but has proven less effective than BOTOX.

#upperblepharoplasty #lowerblepharoplasty #blepharoplasty #lookyourbest #nomoretired

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Nov 17

Chemical peels smooth out lower eyelid wrinkles an

Chemical peels smooth out lower eyelid wrinkles and treat discoloration. It is painted on the skin and the frosting reaction reflects the strength of application. The patient on the next screen had only a TCA peel of the lower eyelids, no surgery. See the difference it made! TCA stands for trichloroacetic acid.

#acidpeel #eyewrinkles

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Nov 16

A heartfelt note is the best gift but we got spect

A heartfelt note is the best gift but we got spectacular orchids too! Such a privilege and pleasure to help our patients!

#ilovemyjob #faceliftsurgery #smas #smaslifting #rhytidectomy

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Nov 13

Eyelid surgery is precise and predictable enough t

Eyelid surgery is precise and predictable enough that aging changes do not have to be advanced to qualify, like our patient shown here. Modern techniques coupled with good judgment can turn back the clock without leaving fingerprints!
#upperblepharoplasty #lowerblepharoplasty #blepharoplasty #eyelidsurgery #lookyourbest #plasticsurgeonnyc

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Nov 10

Our very elegant and statuesque (6’!) patient is

Our very elegant and statuesque (6’!) patient is shown after a very conservative breast reduction. While looking good beforehand (next screen) she wanted more slender proportions and is thrilled with the outcome. Scar patterns can be reduced in these cases to make it a good trade for a conservative size change.

For the surgeons: 200gm per side. The NAC is usually a normal diameter and at the right height in these cases. Therefore the superior periareolar incision component can be deleted to end up with a “Y” scar pattern, which makes a difference. In those with perfect shape and no element of ptosis a reduction can be accomplished using a 7 cm inframammary incision alone!

#breastreduction #macromastia #worthit. #plasticsurgeonnyc

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Nov 9

Our patient had two previous rhinoplasties elsewhe $Our patient had two previous rhinoplasties elsewhere and just wanted to look normal. These cases become more challenging each time a previous attempt fails. Most entail intricate reconstruction of the underlying framework using proven methods, but often also require unique artistic solutions off the beaten track to be successful. You cannot plan how long it will take to finish one of these projects - 5 hours in this case! For the surgeons: pretty much everything. SMR for grafts + MTF, infracture, tip shaping sutures, medial crura resection to deproject, columellar strut to stabilize, two tip grafts and one over the dorsum, upper lats OK, no alar rim grafts. #openrhinoplasty #nosejob #rhinoplastysurgeon #somuchbetter #naturalresults$

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Nov 6

The latest quarterly newsletter from our national

The latest quarterly newsletter from our national organization, the American Society for Aesthetic Plastic Surgery, has one of our drawings on the cover! They solicit artwork from the membership and we are thrilled to have been selected for this issue.

“All In”, 2020. Charcoal pencil 34” x 41”

#charcoaldrawing #photorealism #ASAPS

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Nov 5

Immediate result in the operating room today! A f

Immediate result in the operating room today! A facelift was done to address the common problem areas indicated. Smoothing of the lower cheek is achieved by tightening the deep (SMAS) layer from the side of the face whereas tightening the neck muscles is done from the front under the chin. Most patients become candidates in the early to mid fifties, far less commonly before age 50.

#facelifting #SMAS #platysmaplasty

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Nov 4

A sculpture by Michelangelo, painter of the Sistin

A sculpture by Michelangelo, painter of the Sistine Chapel ceiling and one of the greatest artists of all time. Amazing that he had a blind spot, in this case, sculpting the female breast. I noticed when I saw them for the first time how they were just distorted afterthoughts. We know he could do it, he apparently was not interested! How else to explain? They actually resemble the distortion seen with breast implant capsules that occur in a small percentage of women (example on second screen). Fortunately, these can be fixed (third screen). The sculpture though, not so much. It has been 500 years and going on forever!

#michelangelo #GOAT #breastaugmentation #breastimplants

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Nov 2

Tummy-tuck navels are sometimes a tell-tale sign t

Tummy-tuck navels are sometimes a tell-tale sign that the surgery was done. The navel is the procedure finale after all of the “heavy lifting” has been completed. The surgeon has to focus on this delicate artistic element to get it right. There are many techniques that work well and each surgeon has their favorite. Thin patients with no fat cannot achieve an “innie” like shown in this 6 week “after” image. A certain amount of fat thickness is necessary to achieve a natural looking result like this.

For the surgeons: regardless of your preferred method making the skin opening slightly lower than the stalk position creates natural hooding. #abdominoplasty #tummytuck #flatabs #getitback #worthit

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Oct 31

My Italian-American wife was excited to be appoint

My Italian-American wife was excited to be appointed to Governor Cuomo’s @nygovcuomo commission to create a memorial to America’s first Catholic saint, Mother Cabrini. The end result is a perfect tribute to this great lady who did so much for immigrants in the early 20th century. The statue shows her both as a young girl and an adult with the boy representing the thousands of children she helped. The statue has a direct line of sight to the Statue of Liberty. Mother Cabrini founded 67 orphanages, schools, and hospitals! The governor’s commission picked the artist and the location. The statue was unveiled on Columbus Day.

#mothercabrini #italianamerican #helpingothers #saints #newyorkcity

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Oct 30

In the old days surgeons simply removed those pesk

In the old days surgeons simply removed those pesky bags, accessing them through the back of the eyelid. The problem was the eyelids often looked hollow. Today we remove only some of the excess fat and reposition the rest to obliterate the “circles” below the bags. If it’s just the bags it is 1 hour and 10 days to look normal! Glasses hide the early swelling nicely.

For the surgeons: 30%TCA peel too, a great adjunct.

#lowerblepharoplasty #blepharoplasty #eyelidsurgery #dontlooktired

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Oct 29

Due to the vagaries of wound healing, and sometime

Due to the vagaries of wound healing, and sometimes unrealistic expectations, a perfect effort in the operating room sometimes may not yield a perfect result. A touch-up procedure can turn 90% satisfaction to 100%. They are quick and have virtually no recovery. Less than 5% are candidates. BTW, like some other things in life, this is something that everybody does and nobody talks about!
#makeitperfect #keepthemhappy

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Oct 28

It was a great honor to serve our #1 journal for e

It was a great honor to serve our #1 journal for eight years, reviewing over 900 articles, writing article discussions, and occasional editorials. Thanks to Dr. Rod Rohrich @rod.rohrich, Dr. James Stuzin, Aaron Weinstein and the rest of the fantastic PRS staff @plasticreconstructivesurgery for maintaining the highest standards for our journal. I learned a lot and am a better surgeon for it!

#giveback #prsglobalopen #prs #americansocietyofplasticsurgeons

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Oct 26

Our beautiful patient is seen here only two weeks

Our beautiful patient is seen here only two weeks after breast augmentation. She asked for something conservative to compliment her curves and that is what we did!

For the surgeons: Very petite with small base diameter. 215 cc just right.

#breastaugmentation #breastimplants #siliconeimplants #underthemuscle #looking good #naturalresults

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Oct 24

Long ago facelifts were done by just pulling on th

Long ago facelifts were done by just pulling on the skin. They did not last very long and cheek distortion was common. Today the skin is lifted to expose the deep (SMAS) layer which is a stronger vehicle for moving the overlying skin. The first patient image shows how tightening this deep layer smooths the lower face while passively carrying the skin upward with it. The tightening effect is stronger without causing cheek distortion because the skin is not doing the work!

“Deep plane” and “SMAS lift” are two names for the same deep layer tightening concept.

#facelifting #SMASlifting #naturalresults

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Oct 22

That says it all! This is the immediate view at s

That says it all! This is the immediate view at surgery. Rhinoplasty is so sophisticated today. We make a lot of counterbalancing changes to the framework underneath to end up with a subtle but refined outside appearance.

#openrhinoplasty #rhinoplastysurgeon #nosejob #newnose #lookinggreat #naturalresult

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