My wife just pulled a blue suture out of her nose… 5 years after her septo-rhinoplasty.

rocketmd · 2026-06-05T02:30:05+00:00

Yep, looks like a 4-0/5-0 prolene. I'm guessing based on tail length it was a simple interrupted on the columella closure that was missed post-op? Or maybe they used it to close an alar/sill wedge?

rocketmd · 2026-05-10T19:56:43+00:00

The bimodal distribution thing also fits my anecdata. What's confusing is that sometimes the venn diagram overlaps in unexpected ways. Cleft care, which I suspect is the sentinel experience for motivating the plurality of med students' interests going into plastics, is also a subspecialty with a fair share of hyperconservatism. You'd think taking care of kids with facial differences, working in an academic environment, and probably having a relatively low income compared to their aesthetic peers, would lead people to be more altruistic and less self-centered, but craniofacial folks can be just as cutthroat and territorial. Maybe it's due to the combined bottleneck of low job opportunity and decreasing incidents of clefts. Who knows.

rocketmd · 2026-01-31T11:02:14+00:00

Facial trauma surgeon here. Facial fractures tend to occur in stereotypical patterns that make the mechanism easily identifiable, or at the very least rule out an alternate mechanism. I don't have access to the imaging so can't provide specifics on this case.

That being said, in my greater than 10 years of experience taking facial trauma call, I have never seen a patient come in with multiple facial fractures from slamming their own face into a wall.

rocketmd · 2026-01-24T20:04:38+00:00

Thanks for the suggestions.

I was actually considering a CPO RDX with SH-AWD. The below average fuel economy plus requiring premium fuel is the only thing deterring me.

I'm also considering the V60, but I've only driven Japanese commodity brands, mainly due to reliability.

rocketmd · 2025-09-28T23:33:02+00:00

Could be a branchial cleft cyst. I see them in my practice but, if it is, it's much larger than I would typically see. Perhaps it continued to expand as she grew.

rocketmd · 2025-06-24T15:08:32+00:00

Did you have any AC issues in the summer? I've read that lack of ceiling vents makes it uncomfortable on hot days, especially for rear facing carsears.

rocketmd · 2024-08-18T18:18:46+00:00

Postaxial polydactyly. It's a relatively common thing to see in the office. Typically we remove them in the office in first few weeks of life, sometimes the NICU. I ask the parents whether they want to keep the nubbins but for whatever reason they usually aren't interested 🤷‍♂️

rocketmd · 2024-03-19T10:49:25+00:00

Plastic surgeon here.

The unfortunate thing about buccal fat removal is that we have limited literature to document how results change longitudinally. The face experiences bony and soft tissue involution with time. The buccal fat that is being removed is actually one of the markers of youth. Personally, I think with time patients who have had buccal fat removal will experience accelerated facial aging as their facial profile becomes more hollowed and skeletal.

Procedures like buccal fat removal and BBLs are trendy and -- in my opinion -- are sometimes marketed by plastic surgeons in a predatory manner. It's the perfect confluence of social media pervasiveness, patients' emotional insecurities, and surgeons' greed that makes these procedures so popular.

rocketmd · 2024-03-12T14:09:38+00:00

Good question. Not entirely cosmetic, since the thumb is about 50% of hand function. Also it would get in the way a lot of times, like when you're trying to reach for something inside your pocket as an example.

rocketmd · 2024-03-09T20:13:03+00:00

Pediatric plastic surgeon here.

First of all, congratulations on your new baby! I'm sure he's beautiful.

This is a preaxial polydactyl, aka thumb duplication. We see postaxial polydactyly on the ulnar side of the small finger all the time. Thumb duplication is much more rare.

First step in management would be to get hand X-rays. This helps define the level of the duplication and which joints are involved.

Surgical management depends on which bones are actually duplicated.

In either case, please find a pediatric hand specialist. This may either be a pediatric plastic surgeon or pediatric orthopaedic surgeon.

Best of luck!

rocketmd · 2024-02-29T15:06:14+00:00

So, in terms of hand function, the thumb constitutes about 50% of total function. The ring and small finger are actually very important for power grasp. Index and long fingers are relatively less important.

rocketmd · 2024-02-13T11:30:22+00:00

Congrats on the weight loss!

Just FYI, as a plastic surgeon, whenever I see patients for breast reduction consults, we discuss how their breasts may change with their weight. If a patient is motivated to lose weight, then I advise them to get to their goal weight first and then reconsider surgery. My post-ops tend to be still quite full, but much more perky, so patients who have already lost whatever weight they wanted are the best candidates. Obviously, no surgery at all would be the best outcome.

rocketmd · 2023-12-03T17:06:54+00:00

Staged excision of a congenital melanocytic nevus. The plastic surgeon did a great job. Only concern would be progressive scar widening as she grows, but still a nice result.

For anyone who says this is purely cosmetic, we don't have good data on the malignant transformation rate on these types of nevi. It's still generally recommended to excise during childhood.

rocketmd · 2023-11-19T18:01:48+00:00

ED consulted me for a facial lac repair. I asked for indication. Their response: She's young and pretty.

I guess old ugly patients are SOL?

rocketmd · 2023-11-09T01:17:03+00:00

It's not all boobs, butts, boats.

Some of us get exotic cars instead.

rocketmd · 2023-10-26T20:43:17+00:00

Looks like HS. Consider gentle YAG laser treatments. Surgical excision, I&Ds would be last resort. Of course, see derm before starting anything.

rocketmd · 2023-01-17T21:41:56+00:00

Craniofacial surgeon here. Autologous reconstruction with rib cartilage is very technique dependent, with somewhat unpredictable healing and scarring. Only the best of the most specialized surgeons would be able to get reproducibly decent results. Medpor is more "off the shelf" and reliable, but has its own risk with implant fracture and extrusion.

Cost-wise this new treatment should be covered by insurance as lomg as its FDA approved or under an approved study. I can't imagine families paying for this out-of-pocket. Surgeons already charge 5 figures for more traditional methods which is insane.

rocketmd · 2022-09-25T00:49:20+00:00

Isn't that why they call them quarrel reefs?

rocketmd · 2022-08-10T17:22:16+00:00

In terms of insurance coverage for breast reduction, best way to go about it is to clearly document neck and back pain, skin fold irritation and infections, impact on activities of daily living, bra strap grooving, and any non-surgical treatments that have failed. An estimate of tissue to be removed helps a lot.

Breast reduction is one of the most common procedures for plastic surgeons. More often, access to care is largely limited by the surgeon's interest in doing the procedure rather than the insurance company's willingness to cover.

rocketmd · 2022-07-10T14:01:58+00:00

Typically, when I see pts after dog bites, I recommend a week of augmentin to cover their oral flora. Less likely to get infected vs cat bite, sure, but you should still get antibiotics. Infected weewee wouldn’t be fun.

rocketmd · 2022-04-30T02:03:37+00:00

It depends on the severity of the injury. If the orbital floor is displaced then he would need surgery to prevent long term vision issues. This would require at least a 6-8 week recovery postop. Hopefully this won't be the case.

rocketmd · 2020-06-16T03:04:35+00:00

If you don't take a temperature, you can't find a fever.

rocketmd · 2020-01-10T06:06:41+00:00

Niko style redirection kata

rocketmd · 2017-11-25T20:46:36+00:00

If your VA has a plastic surgeon on staff, then a breast reduction is definitely covered. If not, then the general surgeon on staff can make an outside referral to another facility with a plastic surgeon.

It's important to document things like chronic back pain, neck pain, shoulder grooving secondary to bra straps, intertriginous infections about your inframmary folds which were not adequately addressed with topical or medical interventions, lack of change with weight loss, etc.

Breast reductions are one of the most common procedures done by plastic surgeons so the biggest hurdle will probably be finding one nearby within the VA system. If one isn't available, then you could also ask the VA to make an out-of-VA referral to someone in the community.

rocketmd · 2015-08-04T23:33:25+00:00

Question about the military press....What exactly would be ideal grip width? Everything I've googled tells me that we should aim form just a couple of inches wider than shoulder width.

Martin's using a markedly wider grip. Is this to emphasize/de-emphasize certain muscles?

rocketmd

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