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06/05/2026

Deep plane” is much catchier moniker than “SMAS facelift” thereby contributing to its greater popularity as a descriptor. Nevertheless, both procedures are closely aligned, separated conceptually by the small but important differences presented here. However, facelift results are determined more by the skill and aesthetic sense of the surgeon as well as a given patient’s age and anatomy rather than the type of technique employed. Not covered here is the fact that there are multiple SMAS variations that can be tailored to a specific patient’s anatomy whereas deep plane technique is the same for every patient regardless of anatomical differences. More to come on that.

05/29/2026

This is a common practice that should be avoided. Other misleading practices, whether intentional or not, include different lighting in the before and after images. Lighting from above casts shadows that often makes a condition appear worse compared to full frontal lighting. Facial expression is also important. Subjects should be shown in repose in both the before and after images. A slight smile in the after images always makes the result look better. Fortunately, the vast majority of surgeons are faithful in observing these principles as closely as possible.

05/22/2026

Every new technique in plastic surgery goes through the zealot phase both because it is new and there is FOMO. “Over the muscle” breast augmentation is the latest example. It is heavily marketed by an implant manufacturer whose product is especially suite ti this approach. Also, some surgeons looking for differentiating niche embrace it enthusiastically. It definitely is a valuable addition to our tool box of techniques but more time is needed to appreciate not just its advantages but also its limitations

There are a lot of different ways to accomplish breast augmentation today. The current rage is using silicone implants p...
05/17/2026

There are a lot of different ways to accomplish breast augmentation today. The current rage is using silicone implants placed in front of the pectoral muscle. This is a great option for patients with favorable anatomy and more conservative size goals. The method shown here offers the most stable long term results in suitable candidates. Having no visible scar is another advantage but not the main driving force in selecting this method. Additionally, MRI scans are not needed to monitor implant integrity down the road when saline implants are used.

Grateful to be recognized as a Castle Connolly Top Doctor in their annual peer nominated survey, now for the 25th time i...
05/15/2026

Grateful to be recognized as a Castle Connolly Top Doctor in their annual peer nominated survey, now for the 25th time in a row. The real star of this duo though is the girl of my dreams: the first woman Chairman of the Real Estate Board of New York in their 130 year history, the most NYC Real Estate Deal of the Year Awards in history (10), the most space leased for tenants (over 100 million square feet), a key player in Times Square revitalization in the 90s as well as leasing most of the new buildings at the rebuilt World Trade Center site. Truly the GOAT! Here listed #15 in Crains 100 most powerful NYC leaders.

05/08/2026

First time facelifts in patients well over 65 can achieve excellent results. However, they are more challenging because the skin is much thinner and less elastic. Also, facial fat content is typically depleted making it difficult to create elegant contours. These cases require much more finesse than the results in 45 year olds commonly touted on social media!

05/01/2026

Sam & Meg present a primer on eyelid surgery . They covered it all except to say that discomfort is typically minimal and the results commonly last twenty years before a touch up may be indicated.

04/24/2026

This patient is shown three years after her surgery. Long term results are the best measure of a successful outcome. This case highlights the subtle but critical contribution that a small chin implant makes to the final result. It evens the facial plane from top to bottom and by itself makes the nose appear less prominent. An extra small size is most commonly used in women and it is a “one and done” procedure. Rhinoplasty is complex and time consuming. Every imperfection is visible “on the table” and the procedure cannot conclude until all is perfect, regardless of the time necessary.

Placing Motiva silicone implants “in front of the muscle” is the rage today to the point of being over hyped. It works ...
04/22/2026

Placing Motiva silicone implants “in front of the muscle” is the rage today to the point of being over hyped. It works best with small implants in those with thicker tissues. The advantages are that it is an easy procedure with a quick recovery. Also, there is no unwanted breast movement with “pec” muscle contraction. On the other hand, under the muscle is better for mammograms and gives a much nicer upper breast contour when large implants are used. This was done in this very thin patient to produce a smooth upper breast contour with a larger implant.

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