Tuesday, June 8, 2010
Facelift Surgery
While the deep plane facelift affords excellent correction of the nasolabial folds, jowls, and neck, I have found that the aperture of the upper eyelids can yield a significant positive impact on the aesthetic result on the overall youthful appearance of the face.
It is very common for women as they age to have an accumulation of skin on their upper eyelids. This accumulation of skin has been given the medical term, dermatochalasis. Often this accumulation can be asymmetric-meaning greater on one side versus the other and can create differences in the aperture of the eye. It is important when correcting this asymmetry to note the location of the tarsal fold or eyelid crease.
As you can see in the above photograph the patient's right eye has significantly more skin pre-operatively than the left eye. Careful notation of these asymmetries is important so that post-operatively the eyes can have equal apertures and yield an optimal aesthetic result.
Friday, April 23, 2010
Vascular and Endovascular Surgery Publication May 2010 44: 315-318
Tuesday, March 23, 2010
The Impact of Upper Blepharoplasty on Facelift Surgery
Analyzing my own results is an important part of my practice so that I can continually improve. While the correction in the nasolabial folds, jowls, and neck are more obvious from the deep plane facelift, I continue to learn more about the impact of the aperture of the upper eyelids as their appropriate placement can yield a significant result on the overall youthful appearance of the face.
It is very common for women as they age to have an accumulation of skin on their upper eyelids. This accumulation of skin has been given the medical term, dermatochalasis. Often this accumulation can be asymmetric-meaning greater on one side versus the other and can create differences in the aperture of the eye. It is important when correcting this asymmetry to note the location of the tarsal fold or eyelid crease. As you can see in the above photograph the patient's right eye has significantly more skin pre-operatively than the left eye. Careful notation of these asymmetries is important so that post-operatively the eyes can have equal apertures and yield an optimal aesthetic result.
I continue to see great improvements in the overall skin texture and quality with the deep plane facelift.
Brian P. Dickinson, M.D.
http://www.drbriandickinson.com/
Wednesday, March 17, 2010
Hand Surgery:Flexor Pollicis Brevis
Laceration of the flexor pollicis brevis due to trauma significantly impairs hand function as the patient is unable to fully oppose the thumb to the small finger.
Thursday, March 11, 2010
Fitness Model Revsion Aesthetic Breast Surgery
Revision breast augmentation in Fitness Models possess unique challenges to the surgeon. Aesthetic results are usually quite optimal after complete capsulectomy, but the thinning tissue often allows implant visibility or rippling. I often choose to perform complete capsulectomy to allow the breast to re-drape over the implant. It is important for the surgeon to have a thorough knowledge of the previous operations, as implants may have been in prior planes, or neosubpectoral pockets may have been created from prior capsules and have subsequently contracted. I have used the neosubpectoral pocket on many occasions for revision aesthetic breast surgery and have found it useful. However, in women who present with recurrent capsular contracture, it is important to remove the capsules to allow the breast to re-expand and produce an optimal aesthetic shape.
The Roxbury Clinic & Surgery Center continues to grow as a center for capsular contracture as well as revision aesthetic breast surgery. An increasing number of women choose to undergo their mastopexy/augmentation, capsular contracture surgery, breast augmentation, removal and replacement, as well as second stage breast reconstruction surgery at the Roxbury Clinic & Surgery Center.
Friday, March 5, 2010
Strattice for Revision Aesthetic Breast Augmentation
We are starting to see many patients come from out of state to have their revision augmentation procedures or capsulectomy surgeries performed at the Roxbury Clinic & Surgery Center. I have been using the Strattice in the manner as taught to me by Neal Handel, M.D. When working through small incisions, I have found the use of appropriately and carefully placed marionette sutures to align the Strattice in correct position while the remaining sutures are performed through the limited incision.
I have found Strattice to be very helpful in the revision breast augmentation patient who has rippling, implant palpability, synmastia, bottoming out, and fold asymmetry. I have also found Strattice to be helpful as a barrier between the nipple areola complex incision and the capsule of the breast implant.
I remember repeatedly, the lessons on tendon healing by one of my great mentors, Malcolm Lesavoy, M.D. He would always describe the "one wound/one scar" theory for tendon healing. I find that the same theory can apply to breast implant capsules.
Frequently, I see patients who present for capsular contracture surgery who have a thickened scar beneath their periareolar incision with a "scar rind" that is aggressively fixed to their underlying capsule. It is my belief that the interposed Strattice may prevent the "scar rind" that I frequently see beneath the periareolar incision that is firmly fixed to the capsule. I hope this has great implications for reducing capsular contracture.
Brian P. Dickinson, M.D.
www.drbriandickinson.com
Monday, March 1, 2010
Friday, February 26, 2010
Adipose Derived Stem Cell Fat Transfer for Breast Augmentation
Kotaro Yoshimura,1 Katsujiro Sato,2 Noriyuki Aoi,1 Masakazu Kurita,3 Toshitsugu Hirohi,4 and Kiyonori Harii3
Aesthetic Plast Surg. 2008 January; 32(1): 48–55.
My interest in this grows, as I continue to having a growing group of patients who are interested in a small to modest increase in breast size and who do not want an implant of either silicone or saline. In these patients, available fat can be harvested from the lower abdomen, buttocks, and thighs and transferred to the breast for augmentation.
I am very satisfied with the results we are achieving with silicone gel implants and find that there will always be a continued role for them in women who desire a larger augmentation or require replacement of significant breast volume following mastectomy. I believe that fat transfer will not replace silicone breast augmentation, but serves as an alternative for those women who do not want a large volume augmentation and who do not want an implant based augmentation.
Brian P. Dickinson, M.D.
Thursday, February 25, 2010
Family Testimonial
Dr. Dickinson,
I would like to thank you from the bottom of my heart for helping my son through this. You are an extraordinarily skilled surgeon and a very special person. You took the time to help him, not many people do that anymore. I cannot thank you enough or express what your kindness has meant to me enough. My family and I will be forever indebted to you. Please tell your staff that they are the most caring people in the world and thank them for me.
Thank you again,
-------------------
Tuesday, February 23, 2010
Breast Augmentation: Testimonial
"This experience couldn't possibly have been any better, and bless Dr. L for referring me to you! You're the best -- Dr L told me you were going to be the next big bev hills plastic surgeon, and I think he's right.... from the first visit I felt comfortable and am soooooo pleased with my results, you have NO idea!
Every visit has been a true delight, and actually fun and entertaining (not usually the case half naked in a dr office!).... I love that I found a Doc that I didn't feel all weird with, and that I NEVER felt judged, and was always treated with the utmost respect. Thanks!;"
Monday, February 22, 2010
No Touch Teqhnique Breast Implant Delivery
I have been using the Keller Funnel routinely for my periareolar and transaxillary breast augmentation cases. The Keller Funnel allows me to deliver larger implants through a smaller incision without traumatizing the breast implant, the skin, or having the breast implant come into contact with the skin.
I believe strongly that this "no touch technique delivery system" can help reduce the incidence of capsular contracture. It is of paramount importance to me that my patients receive great results and that I try to do everything possible to minimize complications.
Sunday, February 21, 2010
Microsurgery. Nerve Repair
Peripheral nerve injuries in the upper and lower extremity are common with the frequent physical activity in southern California. Activities such as biking, surfing, motorcycles, climbing, as well as occupational hazards can cause peripheral nerve injury.
In the photograph above, the blue background contains a grid with 1 mm squares, allowing the surgeon to assess the dimensions of the injured nerve.
Tuesday, February 16, 2010
Revision Augmentation Mastopexy Surgery
www.drbriandickinson.com
I have found an increasing number of women who present to my office in consultation who had saline breast implants placed ten years ago and who are now requesting removal and replacement of their mammary implants for highly cohesive silicone gel mammary prosthesis.
Often these women underwent reduction mammoplasty with an implant to maintain upper pole fullness, but now want to change to an implant with a slightly higher profile to deliver more breast projection.
We are seeing more women present from out of state who come to
These operations are challenging to preserve the blood supply to the nipple areola complex as previous operations contribute to scarring and necessitate experience with these cases to deliver consistent results.
Bilateral capsulectomies, implant exchange, and mastopexy are commonly performed operations in
Brian P. Dickinson, M.D.
www.drbriandickinson.com
Abdominoplasty & Panniculectomy at RoxBariatric
Patients present to our office and are very excited about having their body contouring procedures done at either the Newport Beach or Beverly Hills, CA surgery centers.
We encourage all patients who desire to have post-bariatric body contouring procedures to bring their insurance cards with them during their consultations. It is a great time to utilize health insurance plans to undergo lap band procedures. Typically after patients undergo their lap band operation they return for their post-bariatric body contouring surgery within 9 months to one year. Patients are very happy after having their panniculectomy and abdominoplasty surgeries and greatly look forward to having their mastopexy, breast reduction, brachioplasty, or medial thigh lift.
Performing post-bariatric plastic surgery is very gratifying for the patient and physician.
Friday, February 12, 2010
Roxbury Clinic & Surgery Center: Orbital Fractures
By nature of the design of the globe and bony orbital frame, the bone tends to fracture first to prevent damage to the eye itself. Repair of the bony defect is often required for greater than 1 square cm defects and/or defects comprising greater than 50% of the floor of the orbit.
Patients who come to the Roxbury Clinic & Surgery Center in Beverly Hills to have their surgery are fortunate to have the expertise of Dr. Kami Parsa. Dr. Kami Parsa is a world renowned ophthalmologist with exceptional talent in oculoplastic and reconstructive surgery of the eye. Smaller orbital floor defects are often repaired with ear cartilage harvested from the ear, while larger defects or defects of the orbital rim often require repair with titanium mesh or porous polyethylene.
Thursday, February 11, 2010
Revision Breast Augmentation Surgery for Saline Implant Deflation
The leak of saline into the body is not harmful to the patient, but is nonetheless, psycholocially distressing. These patients have been coming to our office with an increasing frequency and request the removal of their saline implants for silicone implants. Often patients who have a deflation of their saline implants have had their devices for over 8-10 years.
These patients who have undergone removal and replacement of their saline implants for silicone gel implants are starting to tell their friends how happy they are with the improvement in the shape and feel of their breasts. As a result, I am seeing an increase in the number of patients who present to the office requesting their saline implants to be exchanged for silicone implants.
Brian P. Dickinson, M.D.
www.drbriandickinson.com
Tuesday, February 9, 2010
Strattice in Aesthetic Breast Surgery. Self-Study. Conference. LifeCell-Strattice
This conference came at a timely fashion for me as it reinforced my educational experience on the use of Strattice for revision aesthetic breast surgery in women with thinning tissues.
I have seen many women in consultation recently with fitness model physiques and a history of recurrent capsular contracture and severe thinning tissues.
As was taught to me by my mentor, the reinforcement of the thin lower pole skin with Strattice can help visible and palpable ripping in this population. The Strattice held in by marionette sutures and then sutured with long-acting absorbable will decrease the incidence of palpable rippling and may reduce the rate of capsular contracture.
Brian P. Dickinson, M.D.
www.drbriandickinson.com
Thursday, February 4, 2010
Breast Implants. Saline Implant Valve Failure with Capsular Contracture
I am seeing more and more women in consultation in my office with deflation of their saline breast implants. In fact, twice this month we had women who presented with the development of pain around their breast implant with an associated distortion of the breast shape secondary to breast implant valve failure.
It has been my experience that the development of a capsular contracture around the breast implant changes not only the shape of the breast implant capsule complex, but may incorporate around the valve of the saline implant (as shown in the image above).
Either continued contraction of the breast capsule resulting in a change in the surface area to volume ratio and/or ingrowth of the capsule to the valve disrupts the valve and allows the saline to extravasate. These women often present with continued pain and the apparent deflation of the implant can be distressing to the patient.
In these cases I recommend that women undergo removal and replacement of their breast implants and capsulectomy. Many women are opting now to exchange their saline implants for silicone gel breast implants.After these surgeries, patients are very happy with the new contour of their implants and their pain is often markedly improved.
Brian P. Dickinson, M.D.
www.drbriandickinson.com
Wednesday, February 3, 2010
Rox Bariatric: A Team Effort
The Rox Bariatric program continues to grow. I was very fortunate today to hear some excellent feedback from one of our patients who is recently post-op from her panniculectomy and medial thigh lift.
She was very thankful for her results as well as to have had an excellent team of surgeons tend to her care. This group of surgeons not only pays close attention during her surgery, but also to the post-operative care that is so important to ensure proper healing.
I was truly thankful to hear how highly our patient spoke of our team of doctors. Specifically, the patient expressed her gratitude to Dr. Jay Calvert, Dr. Anita Patel, as well as the USC plastic surgery resident Dr. Joe Carey was so helpful during our case.
Dr. Patel has been taking a great interest in post-bariatric body contouring surgery and post-bariatric patients. Together with Dr. Patel, Dr. Shafipour, and the help of the USC residents we are able to provide complete and excellent care to these great patients who have lost massive amounts of weight. I am very proud of how hard our patients work to achieve their goals.
Brian P. Dickinson, M.D.
Tuesday, February 2, 2010
RoxBariatric. More Body Contouring. More Patients Enroll for Lap Band.
Not only does the removal of the abdominal pannus seem to allow patients the ability to workout and exercise, but also significantly motivates them to loose weight through appropriate dietary measures.
Today in the operating room I was truly impressed with a patient who returned for her bilateral mastopexy and bilateral brachioplasty after she continued to loose weight after her panniculectomy a few months ago. I continue to be very proud of how hard our patients work to improve themselves and their health.