Full Transcript for EP 29: Same Patient, Two Surgeries, One Wild Coincidence | OR DIARIES

00:02:16.000 --> 00:02:25.680 And he happened to be at her first surgery 18 months ago on the other side of the country, uh, which is very like serendipitous. 00:02:25.759 --> 00:02:26.479 What are the odds? 00:02:26.560 --> 00:02:52.240 He was working with that surgeon and literally happened to be there that day, to the point of pulled up his notes because in the learning stage, he's I love this, taking notes about every single day that he's in the operating room, and pulled up his notes from the exact day that she had surgery and was able to tell me exactly what they did in surgery that day, like better than the OR note, because it was a student's eyes, a white belt mentality, like looking at everything anew. 00:02:52.560 --> 00:03:00.240 And so I learned that she had a brow procedure with her face that had failed and had bad kind of scarring with hair loss. 00:03:00.319 --> 00:03:09.439 And he showed me where the endotines, these like absorbable carpet tacks, were put in her scalp, something I don't use, but um, where they had been put in her scalp. 00:03:09.520 --> 00:03:15.840 And so I knew actually to go around them, if you will, because of his notes from being in the surgery that day. 00:03:15.919 --> 00:03:18.960 So it was pretty wild um to see that. 00:03:19.280 --> 00:03:24.879 And you know, it was interesting because as you know, he sort of sees the difference. 00:03:25.039 --> 00:03:32.960 He, you know, his first deep plane facelift with me is his whole comment was, This is so different than uh what I saw before. 00:03:33.120 --> 00:03:45.599 And the surgeon he was working with before also has some great results and and um is you know a very great, you know, plastic surgeon, facial plastic surgeon, board certified in their specialty. 00:03:45.680 --> 00:03:49.439 Um, but not all of those things mean what we think they mean all the time. 00:03:49.680 --> 00:03:51.759 And it was very obvious to him. 00:03:51.840 --> 00:04:05.280 Uh, the seconds having seen a lot of other procedures to what sort of I'm gonna call like the modern era or the the new frontier of a deep plane facelift is, and this idea that not all deep plane facelifts are created equal. 00:04:05.439 --> 00:04:12.400 Just because someone's calling it a deep plane, is it a deep plane from 10 years ago or from five years ago, or honestly, even from two or three years ago? 00:04:12.479 --> 00:04:14.879 It's totally different than what's happening now. 00:04:14.960 --> 00:04:20.399 Um, nothing that I'm doing now is the same as it was when I was in fellowship, let alone 10 or five years ago. 00:04:20.480 --> 00:04:27.680 I mean, there's probably aspects that have some overlap now, but it's a rapid evolution driven by my obsession with my results and wanting to get better. 00:04:27.759 --> 00:04:28.800 And that was very apparent. 00:04:28.879 --> 00:04:39.759 It was interesting to see, just very apparent to um somebody who's been in the field, had a lot of exposure, then kind of coming for their first procedure here, and just like again, what are the odds that it was literally on a patient? 00:04:39.839 --> 00:04:44.560 It was a direct comparison present for both surgeries to get to see that. 00:04:44.720 --> 00:04:59.600 And so, you know, it illustrates some of the changes that uh this person had in their face, some of the static changes that we were working to correct, um, you know, re-elevating things that weren't elevated, taking dehissed areas that had pulled apart and trying to put them back together. 00:04:59.759 --> 00:05:08.800 So I think the really interesting part for my fellow to see was um the different approaches, even just visualizing and understanding what was going on. 00:05:08.959 --> 00:05:23.040 For example, this patient with their previous surgeon, that surgeon didn't even know where their results had failed or why their results had failed, recognized that something was off, but didn't exactly uh put together why that failure had happened. 00:05:23.120 --> 00:05:32.399 And, you know, the second I saw it, I knew exactly, okay, you know, your zygomaticus complex is disconnected from its deep connection, layer three to layer four, um, and what's happening there. 00:05:32.480 --> 00:05:39.600 And there's you know a septum underneath that muscle that connects it to the deeper, you know, levels underneath or the different layers that we call them. 00:05:39.680 --> 00:05:56.240 Um and so an immediate recognition on one end versus really not understanding, which I think she very wisely kind of picked up on when she didn't proceed to do the revision offered to her, knowing that it was sort of just kind of like flying blind a little bit, not understanding. 00:05:56.480 --> 00:06:06.160 Um, but you know, again, for my fellow to sort of see, oh my goodness, like this, it's just a different approach and a different mindset and a different level of understanding uh that goes into this. 00:06:06.319 --> 00:06:12.240 And again, uh I'll beat this horse to death, but you know, not all D-plane facelifts are created equal. 00:06:12.399 --> 00:06:16.959 Um, you see a lot of people they get a D-plane facelift and they get an improvement and they're thrilled with it. 00:06:17.040 --> 00:06:19.040 You know, it's that six out of ten result. 00:06:19.120 --> 00:06:20.000 It is what it is. 00:06:20.079 --> 00:06:22.160 Um, it's better, and that's all that they know. 00:06:22.240 --> 00:06:25.279 They didn't even know that there was a seven, eight, nine, ten type of result. 00:06:25.519 --> 00:06:27.360 Um, and that's where the new level lives. 00:06:27.439 --> 00:06:29.600 That's where the next level is, that's where we're getting better. 00:06:29.680 --> 00:06:32.000 And it's a it's a pretty progressive evolution. 00:06:32.079 --> 00:06:44.480 Um, probably something I should talk more about, actually, in and of itself, is like how deep lane facelifting and necklifting have advanced so much, even in the past year, two, three

years, uh, even out to four and five years. 00:06:44.639 --> 00:06:46.959 When before that it just hadn't been changing as much. 00:06:47.120 --> 00:06:53.279 So a lot going on, a very interesting day in the operating room from a revision standpoint. 00:06:53.360 --> 00:06:54.639 I love revision surgeries. 00:06:54.720 --> 00:06:58.720 They're challenging, they're a different, um, a different level. 00:06:58.800 --> 00:07:05.600 When I'm visualizing through before revision surgery, there are a lot more avenues to go down because I don't exactly know what I'm gonna come across. 00:07:05.839 --> 00:07:07.360 It's a little bit of choose your old adventure. 00:07:07.439 --> 00:07:14.000 I don't know what type of old permanent sutures I'm gonna find or what type of fixation devices, or where there's scarring, or in her case, hair loss and things like that. 00:07:14.160 --> 00:07:17.199 So uh it was really helpful to have my fellows' previous notes. 00:07:17.279 --> 00:07:30.560 Um, but you know, it it there's a lot more uh problem solving, which is like honestly my main job when I'm rolling along, is I'm so locked in, hyper-focused, inflow, and I'm problem solving the entire way along. 00:07:30.720 --> 00:07:34.720 And these are what this is one of my strengths in life, and as an athlete was my ability to do that. 00:07:34.800 --> 00:07:37.519 And a revision surgery really uh highlights that. 00:07:37.600 --> 00:07:40.160 It it plays to my strengths very much to be able to do that. 00:07:40.319 --> 00:07:43.680 When I do a primary surgery, I'm doing the same thing, I'm locked in. 00:07:43.759 --> 00:07:54.079 Um, but that's a there's a lot less variability in those types of procedures to go through until I come across old filler or an old device or old threads or something that the person had forgotten about. 00:07:54.160 --> 00:07:56.639 There's a little bit of choose your own adventure there sometimes too. 00:07:56.800 --> 00:07:59.360 But um, you know, I love these types of revision procedures. 00:07:59.439 --> 00:08:16.480 It was really great to be able to share that with my fellow and a really interesting, again, what are the odds type of situation to be involved with both of those and get to see the differences directly, same patient, same tissue, same approach, same um, in this case, sort of like issue afterwards, how to fix it. 00:08:16.800 --> 00:08:22.480 And um, this is you know just highlighting the modern era of facelifting, which again, something I should talk more about. 00:08:22.639 --> 00:08:23.759 Maybe I'll do that next. 00:08:24.319 --> 00:08:31.600 Um thanks for tuning in, and I hope you enjoyed this diary of random things on my mind coming out of the operating room. 00:08:31.680 --> 00:08:34.799 I thought today was a pretty fun one and a bit of an eye-opener. 00:08:35.039 --> 00:08:36.720 And again, just what what are the odds? 00:08:36.879 --> 00:08:41.679 But if you have any questions or topics you would like me to explore further, please leave them in the comments. 00:08:41.840 --> 00:08:45.039 I read them all and they often help shape the future conversations here. 00:08:45.360 --> 00:08:58.480 I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine, nor should this be taken as individual medical advice. 00:08:58.720 --> 00:09:00.000 Thank you for spending your time with me. 00:09:00.159 --> 00:09:03.039 I appreciate you being here, and I will see you on the next episode.