Case Study: Adult Cleft Lip & PalateThe problem: cleft lip and palate in 33 y.o. male.
Case Study: Adult Cleft Lip & PalateJan 11, 2016
Case Study: Adult Cleft Lip & Palate
These days it is uncommon for problems related to a cleft lip and palate to go untreated into adulthood. However in this case, the 33-year-old male patient known as “Kris” was born with a cleft lip and palate but due to personal circumstances in his teens, he was unable to undergo all the corrective surgeries that would typically be performed on a cleft patient.
The Problem: Cleft Lip and Cleft Palate
When Kris first visited our office he presented with history of left-sided cleft lip and palate. He had a dental malocclusion along with insufficient bone in the jaw for tooth implants, poor nasal shape and lip contour. Also, he still had all his wisdom teeth, which were impacted.
The Solution: Orthognathic and Plastic Surgery
Our initial surgical procedure was to remove his wisdom teeth and take a bone graft from his hip to his upper jaw.
We then took him into the operating room again for fat grafting to the upper lip and peri nasal region as well as an open Rhinoplasty with extensive cartilage grafting. The entire surgery was performed through our HappySkulls.org Foundation.
The Results: Patient Testimonial
“I don’t know where to begin with writing this review, so I guess I’ll start by saying that Dr Deschamps-Braly and his entire team are remarkable people. From the moment I walked in the door everyone was so friendly and eager to help. Camille, Betty, Jennifer, Caitlin and Dr. D have all gone above their call of duty to make this chapter in my life one of the best.
I was born with a cleft lip and palate, due to personal circumstances that happened in my teens I wasn’t able to finish all of the corrective surgeries that would typically happen with a cleft patient.
Finally, when I was 33 years old, I decided to consult with a plastic surgeon to see about getting my face corrected. Most doctors I spoke with seemed irritated that I had waited so long and weren’t very enthused about working on someone who had been previously treated by other doctors.
When I met Dr. Deschamps-Braly he was enthusiastic and understanding. The fact that he founded an organization especially for kids with facial anomalies made me feel that much better about choosing him as my doctor.
I have had four surgeries so far with Dr. D. The first was to take out synthetic material a previous doctor put in and was causing infection, the second was to perform a bone graft in my upper gum line, the third was my orthognathic surgery where my upper jaw was moved forward, and my lower jaw backward, and the fourth surgery was a rhinoplasty revision. I have one more to go and that will be a fat graft to my lip to make it look normal.
Each operation he’s done I’ve woke up to very minimal pain in the area where the surgery was performed and he was there telling me how great everything went. I really can’t sing this man and his team enough praises, the amount of work and dedication he’s put into me is insurmountable.
My case was complicated and involved coordination with several other doctors that Dr. Deschamps-Braly organized himself and made sure that everyone was on the same page, and that the direction we were headed in was the best for me, and that I would be happy with my results. I can honestly say that I couldn’t be happier. And even though I had to wait as long as I did, I’m glad that things turned out as they did, and Dr. Deschamps-Braly was the one to perform the final operations on me.
In conclusion, there is no one else I would recommend for craniofacial surgery other than Dr. Deschamps-Braly and his team. And judging from the other reviews on this thread he seems to be just as talented in his other areas of expertise.”
Need more information about cleft lip and cleft palate surgery? Call our San Francisco office.
To make an appointment with please contact our San Francisco office on (415) 624 3922.
Pain Relief After Plastic SurgeryOne of the most frequent questions we get asked is: will it hurt?
Pain Relief After Plastic SurgeryJan 11, 2016
Our approach is to reduce the chances of pain before, during and after your surgical procedure. To do this we utilize the most cutting-edge, non-narcotic painkillers to reduce pain and swelling resulting in faster recovery time and less discomfort.
Why do we choose non-narcotic painkillers?
The problem with narcotics is that they often have significant side effects, such as nausea, vomiting, constipation and even dependence and abuse for some people. All great reasons to avoid their use.
All of our patients receive a regional nerve block injection before surgery begins, which according to the Gate Theory of Pain, prevents pain from taking hold to start with. A nerve block is numbing medication (local anesthetic) injected near specific nerves to decrease pain during, and after, surgery.
Our patients receive a very specific block containing long-acting marcaine analgesics along with injectable steroids. We also provide a number of non-narcotic analgesics that are proven to be more effective than narcotics for our post-op patients.
This approach essentially relieves the majority of the discomfort that patients have after surgery, and limits narcotic use to rare circumstances and also speeds up recovery time.
What to know more? Call our office in Downtown San Francisco:
To make an appointment with Dr. Deschamps-Braly please contact our San Francisco office on (415) 624 3922 during business hours.
The Latest in Facelift TechniquesThe old cliché of the tight-faced facelift is a thing of the past.
The Latest in Facelift TechniquesOct 22, 2015
Many people are hesitant to get a facelift (rhytidectomy) because they are afraid that they will no longer look like themselves. But thankfully, the old Hollywood cliché of the tight-faced, pulled-back, artificial-looking facelift that was your grandmother’s facelift is a thing of the past.
In recent years plastic surgery techniques have evolved rapidly.
Previously, facelifts only pulled back the loose or sagging skin. Today’s facelift techniques work much deeper by actually lifting the underlying tissues and muscles under the skin upwards – rather than just back, resulting in a more natural-looking and longer-lasting result.
Today’s facelift is also as much about restoring lost volume due to aging, as it is about lifting. Fat Transfer or Fat Grafting as it is also known, is a very significant part of today’s facelift procedure and involves harvesting your body’s own fat and using it to restore facial volume while lifting your face.
Today’s facelifts are tailored to your needs and desired results.
One of the most significant improvements in facelift procedures is the understanding that there is no “one size fits all” to having your face lifted. These days we take a completely customized approach to your facelift. Everyone’s face is 100% unique and individual and a facelift must therefore also be fully customized to each individual’s desired results and facial features. Therefore your plastic surgeon needs to be as much an artist with a keen eye for the aesthetic, as he is a surgeon, to ensure that the end result is a natural looking one.
Today’s facelift techniques are a great improvement on the past, with many benefits including:
- Improved recovery and healing
- A more natural-looking result that enhances your existing features
- Significantly longer-lasting results: 10-15 years depending on your procedure
Facelift techniques that we use and recommend:
There are several different types of facelifts available today. A good plastic surgeon will take the time to ask you about your desired results, listen to your concerns, and then make recommendations for a procedure that is right for you.
The different types of facelifts reflect the type of incision, the level of invasiveness and the area of the face to be lifted. We usually utilize one of the following two facelift techniques:
The SMAS (Superficial Musculo Aponeurotic System) Plication lift works well for people with mild skin laxity, mild jowls and/or mid-face sagging.
The SMAS facial layer consists of the ligaments that hold the cheek fat and the cheeks their normal position. Re-suspending and then re-securing the SMAS layer can rejuvenate the face by counteracting skin laxity caused by aging and gravity.
Your plastic surgeon will create an incision above your hairline at the temple and then extend it downwards to in front, or at the edge of the ear, below the lobe and then behind the ear. The SMAS system is then tightened with sutures, and any excess or redundant skin is removed and remaining skin is stitched closed.
The Deep Plane Lift is ideal for people with severe facial sagging and skin laxity. It is also ideal for those seeking a longer-lasting lift with effects lasting about 10 to 15 years. The Deep Plane Lift has been shown to offer longer-lasting results with fewer revisions.
During the Deep Plane Lift procedure, your plastic surgeon will separate the skin from the Superficial Musculoaponeurotic System (SMAS) layer. He then works in underneath the SMAS layer to release attachments, allowing him to literally “lift” the layer, and accompanying skin, to a more youthful and natural position.
After the SMAS has been repositioned, the excess skin is removed, and the edges are sutured or stapled into place.
What to know more about facelift or necklift procedures? Call our office in Downtown San Francisco:
To make an appointment with Dr. Deschamps-Braly please contact our San Francisco office on (415) 624 3922 or send an email enquiry.
Patient Safetyin Plastic Surgery
Patient SafetyOct 21, 2015
One of our most frequently asked questions is: “Is plastic surgery safe?”
Caitlin Sacher works alongside Dr. Deschamps-Braly as his Surgical Physician Assistant and together they have built a surgical team dedicated to ensuring outstanding excellence in patient-centered care and the utmost patient safety.
While every surgical procedure carries it’s own inherit risks, she explained, certain systems can be set in place to help ensure a safe surgery by minimizing unnecessary surgical complications.
“Much like a pilot running through a “pre-flight checklist” prior to take off, we strictly adhere to the use of a “pre-operative checklist” to ensure all potential complications or difficulties that could arise during your surgery are caught early and addressed appropriately.
“For weeks prior to a patient undergoing surgery, we take all necessary measures to ensure we can perform the safest surgery possible by verifying medications and any allergies, preforming pre-operative testing or work-up, reviewing your prior medical and surgical history, obtaining imaging, and, if necessary, reaching out to other physicians to coordinate additional patient care outside of surgery.
“By starting this pre-surgical preparation process well in advance of your surgery, it allows enough time to obtain any and all information we need in order to proceed with the safest surgery possible.”
Additionally, Caitlin Sacher or Dr. Deschamps-Braly will have a pre-operative meeting with you a few days prior to your surgery to answer any last minute questions you may have, and also to review the surgical ‘game plan’.
We truly pride ourselves on our open and clear communication style and fine attention to detail because this translates into our patients’ knowing they can trust us in delivering not only a beautiful aesthetic outcome, but a safe one as well.
DERMABRASION & TCA CHEMICAL PEELS
Dermabrasion (also known as Dermaplaning) is a safe and effective way to smoothen fine lines and wrinkles, reduce the appearance of acne scarring and alleviate uneven skin pigmentation and sun damage. Dermabrasion is relatively painless and can be performed at our office in downtown San Francisco.
The procedure can also be used in combination with other treatments, such as scar revision, facelift or a chemical peel.
TCA Chemical Peels is a facial skin peel treatment ideal for treating wrinkles and fine lines, acne scarring and other scars, enlarged pores freckles, blemishes and uneven skin pigmentation caused by sun damage.
The TCA peel is much deeper and more powerful than the more common exfoliation peel performed by a beautician or cosmetologist, but it is not as invasive as laser resurfacing resulting in a faster recovery time.
Micro Needling – also known as Skin Needling – involves the use of tiny and very short needles to penetrate the skin. The procedure causes a very mild sensation and only very superficial punctures of the skin.
These “micro-injuries” catalyse the skin’s own natural healing response to produce and rebuild collagen and elastin, which results in a smoother appearance and a reduction of fine wrinkles and lines.
Microneedling is ideal for:
- Reduction of fine wrinkles and lines due to aging or smoking
- Improving skin texture and smoothness
- Evening out colour & skin tone
- Reducing broken capillaries or spider veins
- Large pores, acne or burn scars
- Firms, lifts and sculpts to help tone sagging skin
The aging of the upper lip is influenced by several factors: sun exposure, genetics, cigarette smoking, and natural aging. Wrinkling and flattening of the upper lip causes small vertical cracks and wrinkles to extend outwards into the skin around the lips – causing lipstick to ‘bleed’ into the surrounding skin. Thankfully, there are several surgical – and non-surgical – solutions to rejuvenate and enhance your lips and restore them to a more youthful appearance.
Treatment options for Lip Rejuvenation include:
1. Lip Augmentation using Restylane® Dermal Filler
Lip augmentation is a non-surgical procedure that plumps and “augments” the lips using an injectable dermal filler such as Restylane®. Augmentation especially works for increasing lip volume and reducing lip wrinkles and fine lines.
2. Surgical Lip Augmentation using Dermal Fat Grafts (Fat Transfer)
Fat Grafting is very popular because it uses your body’s own fat rather than any artificial or foreign material that is grown in a lab. Most patients successfully experience permanent results with Fat Grafting and do not require subsequent treatments.
3. Lip Lift or Lip Reduction
This is a surgical procedure that is performed on those who feel that their upper or lower lips are disproportionate or too large. The incisions are hidden in natural creases beneath the nostrils or on the inside of the lip, leaving no obvious scarring.
4. Perioral Dermabrasion for Wrinkles Around the Mouth
Perioral Dermabrasion lessens the appearance of wrinkles around the mouth or “smoker’s lines” to create a youthful appearance. The procedure removes several layers of skin to stimulate collagen production for a permanent improvement.
5. BOTOX® Cosmetic for Smile Lines
When BOTOX® is injected with the correct skill and aesthetic artistry, it results in a very natural-looking result so others won’t know you have had “work done”. You will still be able to smile naturally without appearing “frozen” or without emotion.
Why Fat May be the Right Filler for YouPossibly the Most Important Surgeons
Why Fat May be the Right Filler for YouFeb 28, 2013
In an age where the predominant health topic seems to revolve around trying to rid ourselves of excess fat, why would anyone want to discuss why adding fat to certain areas may be something to consider?
This discussion is suited to anyone who has ever had fillers injected into their face or considered having such injections. I would like to introduce considerations for when and why someone might consider using their body’s own tissue rather than a pharmaceutical product that comes in a syringe. The takeaway from this article should be for a patient to have a better understanding of fat grafting and to generate awareness of this modality so that patients may ask more informed questions.
Non-surgical treatment to treat wrinkles and signs of aging have rapidly increased over the past five years. In a fast-paced world with shrinking expendable income, people often turn to what are perceived to be less costly alternatives to surgery to address concerns about visible signs of aging. Often, personnel delivering these treatments don’t have the experience and training to offer alternatives which a well informed patient should know about when making important decisions about their care.
Usually, people first turn to fillers and botulinum toxin to treat wrinkles. Botox and similar compounds are used to treat wrinkles that appear when facial muscles contract. These are called “dynamic” wrinkles. However, Botox does not treat wrinkles that are present when you face is relaxed. These wrinkles are called “static” wrinkles. Treatment of “static” wrinkles is why most people first come to use pharmaceutical fillers.
Modest improvement of “static” wrinkles is usually accomplished with fillers, however, that is not where the story ends. As we age, there is more going on than the wrinkles that we see on our face. As we age, there is a general deflation of the deeper layers of fat that defines a youthful face. Take a look at a picture of your yourself 20 years ago. Assuming you are about the same weight, one cannot help but notice that some modest deflation has occurred.
The loss usually first becomes apparent in our mid 40’s and continues throughout our lives. It happens in our temples first, then in our cheeks, our lips, and other places. At the same time we tend to accumulate excessive amounts of fat under our chins, and we see descent of the more superficial layers of fat. It is this progressive shifting of facial fat that leads to very important signs of aging that should be addressed as part of a comprehensive plan to restore youthful features.
Borrowing fat from areas where we have excess accumulation of fat is one way to restore the contour of a youthful face. But why would someone choose to have this “surgical” procedure versus a filler from a pharmaceutical company that can easily be performed in under an hour by a dermatologist or in some offices a nurse?
There are many advantages to using your own fat for restoring volume in the face, however, what if I told you that in some situations it might even be cheaper then all of these “easy” fillers. In an era of people looking for cost effective treatments that is a very important consideration.
The most common fillers are only temporary solutions. Depending on the filler used, they typically last for a period of 6-12 months. These injections need to be periodically repeated to maintain their effect. Fat on the other hand, when injected, tends to shrink a little at first but what remains is with you indefinitely. That is one of the large advantages to using your own fat for this purpose.
When the goal of treatment is to comprehensively treat loss of fullness and volume in the face, the amount of volume needed is often anywhere between 10-30cc. At these volumes the cost benefit of using pharmaceutical filler products tends to disappear and the cost advantage lies with using your own fat. This is especially true when considering the need for periodic repeat treatment with these fillers.
Fat tends to move and feel more natural when injected into areas such as the lip when compared to some of the fillers. For instance, some of the fillers can feel firm when placed into areas such as the lips which should be supple in a youthful individual.
There are other less obvious considerations. Fat is one of the bodies most plentiful sources of “mesenchymal” stem cells. These are the cells that are able to replicate and turn into cells that contribute to improvement in circulation and elasticity in the skin. Though much has been written about these cells, most surgeons who perform fat grafting will tell you that an improvement in skin quality is often seen after performing fat grafting.
Please keep in mind that no matter what filler you choose, trying to fill a face that has lost its elasticity can result in an overly inflated appearance and should be avoided unless also addressing the excess skin and descent of tissues.
So, I hope I have made a strong case for why you as a patient should consider speaking to someone who has experience with fat grafting. However, to be fair, I would like to take a moment and describe when a pharmaceutical filler might be the right choice for you. Pharmaceutical fillers are good for patients who don’t need a lot of volume to accomplish the intended treatment goals. Fillers are also ideal for someone who needs to be ready for an important event or meeting as fast as possible as fat transfers tends to cause relatively more swelling and recovery time.
FaceliftingA Historical Perspective
FaceliftingAug 5, 2013
The facelift has evolved significantly since it was first performed over 100 years ago. The first facelift procedures were simple operations removing of a small piece of skin in front of the ear and then pulling the skin back. This was a novel and exciting idea at the time. The first facelift technique gave people options they never had before to combat the effect of gravity on the soft tissue of the face.
Innovators in the field, however, saw shortcomings with that procedure. The procedure did not drape the skin of the face in a natural way and it did not reposition the sagging tissue of the cheek or jowl. Therefore, additional lifting and re-draping of the skin around the face and neck were introduced in order to make the facelift and necklift procedure more effective. This became the “standard” facelift and necklift operation for the next 50 years. Many surgeons currently still use this technique.
This procedure evolved again in the 1980s to improve upon the necklift and facelift procedures we had at the time. Because skin is an elastic structure, it serves better as a cover for the deeper layers rather than as a structural element. French Surgeons who used deeper layers of the face to reposition sagging tissue led the philosophical shift to approaching this procedure in this manner. Facial structure and shape is now a much more importation issue than skin.
Skin now plays a secondary role to the deep layers of the face. Skin is re-draped gently to cover what we do underneath. In addition, we no longer need to pull tightly on skin because the important part of the operation is the repositioning of sagging cheeks, jowls and neck skin. Necklifts have similarly evolved over time. The necklift no longer uses the skin to reposition the sagging neck. A modern necklift in our practice now focuses on deeper structures to allow the contouring and tightening of the neck.
Fat grafting, which we have written about before, has been the largest advance in treating the aging face since the advances of the deep layer facelift and necklift. Fat grafting has allowed us to contour and finesse our results in cases where we could not otherwise get such a nice result.
Caitlyn Jenner’s Surgery:An Inside Look
Caitlyn Jenner’s Surgery:Jun 12, 2015
By Daily Beauty Reporter: allure.com
As we recently learned from Buzz Bissinger’s account in Vanity Fair, Bruce Jenner checked into a Beverly Hills clinic for transformative surgery on March 15th. Ten hours later, Caitlyn Jenner officially emerged. But what exactly is facial feminization surgery—and how difficult was her recovery?
Facial feminization is an aggressive remodelling of every aspect of the facial skeleton. A mere facelift won’t do it—saws are involved, along with burrs to whittle down bones. A typical operation can last up to 12 hours. But for these patients, it’s worth the risks, the pain, and the high five-figure price. “As a transgendered individual, perhaps nothing is more vital to you than having a body that matches how you feel,” wrote Douglas K. Ousterhout in his 2009 book, Facial Feminization Surgery: A Guide for the Transgendered Woman (Addicus Books).
Semi-retired now, Ousterhaut is the San Francisco plastic- and cranio-facial surgeon who pioneered the specialty in 1982, after his first transgender patient asked for help. “Dr. O has done more than 2,000 of these surgeries,” says his associate and hand-picked successor, Jordan Deschamps-Braly, who did not do Jenner’s surgery. It’s been widely reported that two L.A surgeons, Harrison Lee, a maxillo-facial surgeon, and Gary Alter, a urologist and plastic surgeon, together performed Jenner’s facial transformation, breast augmentation, and other unspecified body procedures.
In the 1980s, facial feminization was unchartered territory. To plan his first operation, Ousterhaut, who had devoted 25 years to pediatric birth defects, first studied the 1,500 human crania in the Atkinson Skull Collection at the University of Pacific School of Dentistry, comparing male and female bone structure. His work eventually became the basis of a whole new surgical specialty. We don’t know exactly what procedures Jenner underwent, but the following is Ousterhaut and Deschamps-Braly’s menu of the most important feminization procedures—and a tiny snapshot of what’s involved. (Warning, what follows is not for the squeamish.)
Advancing the Scalp. A high forehead is an instant clue to maleness. Creating a lower hairline and recontouring the brow are procedures that must be done together, says Deschamps-Braly. In a 19-year-old male, the distance from hairline to the center of the eyebrow is 2.6 inches; it’s just two inches in a woman. Lowering the hairline with scalp advancement requires an ear to ear incision across the top of the head. The scalp is then pulled forward and reattached lower down. If the hair in the front section of scalp is thinning, a strip of it is trimmed away. Hair-follicle implants can be done later. Before the scalp is sutured into place at the lover level, the brow is raised lifting the eyebrows to a more feminine position.
Forehead feminization. The skulls of men and women are vastly different. “The foreheads of genetic males slope back—while a female brow is more vertical. Genetic males have a heavy bony ridge protruding above the eye sockets making the sockets deeper than a woman’s,” explains Deschamps-Braly. “We use a saw and remove the ridge carefully, often exposing the sinus cavity which we refill with some of the extra bone.” Males also have bony hoods over their eye sockets. To feminize the eyes, these need to be removed with a 40,000 rpm mechanical burr. A small percentage of facial feminization patients need their brows augmented above the brow ridge with the same synthetic resin used in making dentures. All this bone work can be done through the same long incision created for the brow advancement. “Without feminization, your forehead will always be a giveaway to your birth gender,” wrote Ousterhaut.
Filling temple depressions. Some men also have shallow depressions in the bone beside their eyes. If they’re noticeable, fat can be injected through small entry points in the temple hair.
Rhinoplasty. Jenner had previously had surgery on her nose, which is a common element in the facial feminization process. Male noses are larger and longer, with bulkier tips than a woman’s. They point straight ahead or down, while the ideal female nose is thinner, shorter and sometimes scoops up.The angle at the radix (where the nose meets the forehead) is sharper in males and slopes gently in females. These characteristics can be achieved with surgery.
Changing the shape of the chin. A man’s chin is 17 percent longer than a woman’s and wider as well. A woman’s chin tends to be tapered or oval. Feminization requires taking, on average, a three-eighths-inch horizontal slice out of the chin bone (think of it as removing one book near the bottom of a stack). The bottom piece has to be anchored with plates and screws. If the chin protrudes or is receding, the lowest section can be pushed back or advanced. If the chin needs narrowing, a vertical wedge of bone can be removed at the tip below the tooth roots.
Lower-jaw tapering. The male jaw looks square from the front, but it has a wide, V-shaped bend between the ear and the chin. In contrast, a female jaw has a soft curve from the ear to the chin. The angular male jaw can be rounded by cutting the sharpness from the bend with a right-angle saw and smoothing the edge with a mechanical burr. This is a job for someone very experienced, because running through the jaw are blood vessels and nerves that relay sensation from the lower lip, front teeth, and chin.
Diminishing the Adam’s apple. The Adam’s apple is thyroid cartilage that sits on top of the trachea—the breathing tube—and anchors the vocal cords. Both men and women have one, but a man’s is more prominent. It can be reduced through a small incision under the chin that heals almost invisibly. In 5 percent of cases, male-to-female transgender patients (like Jenner) have it reduced before feminization surgery; Jenner underwent a tracheal reduction in January of 2014.
Raising the cheeks. While rounded cheeks are considered attractive in both men and women, Deschamps-Braly cautions against using cheek implants during the feminization surgery. “I do a cheek lift instead of implants. The cheek looks better. Implants are rarely necessary.”
Shortening lip height. Men typically have a longer upper lip area, averaging 21 millimeters in height compared to 15 millimeters for women. And it gets longer with age. This can be shortened with a short incision right under the nostrils. Lips can then be filled with dermal fat or hyaluronic acid.
Vocal pitch. This is one male trait that isn’t easy to change. Operating on vocal cords to make the voice less husky is risky. It could become deeper and chronically hoarse. “There have been great successes,” says Deschamps-Braly, “but the area is a no-man’s land and complications can’t be corrected.” For this reason, many male-to-female transgender patients skip the surgery and instead hire voice coaches to help them.
Jenner’s surgeon, Harrison Lee, told E! News that his patient had recovered quickly from her March ordeal. “She healed remarkably fast,” Lee said. “Maybe because she’s an Olympic athlete… I mean, at 65, she is in remarkable health.” The full healing process can take up to a year.
Jenner did tell Bissinger that her one moment of serious doubt came shortly after the grueling procedure. She had a panic attack—the first of her life—and thought to herself “What did I just do? What did I just do to myself.” A counselor from the Los Angeles Gender Center came to Jenner’s house and explained that such reactions are common and often temporary, induced in part by pain and medication. Deschamps-Braly agrees that few patients regret their surgery in the long run, despite the difficulties involved. “The operation is something they have longed for. In no time at all, they forget what they looked like [before],” he says. “Looking believably female is important. There’s a sense of relief. You can’t hide your face. There is less discrimination. Facial feminization surgery gives them a foundation.”
Bruce Jenner’s Transition:Plastic Surgeons Dispel Common Myths
Bruce Jenner’s Transition:May 29, 2015
Olympic gold medalist and popular TV personality, Bruce Jenner, came out to ABC’s Diane Sawyer on Friday night that he is transgender, confirming years of rumors that he is undergoing a gender transition.
“For all intents and purposes, I am a woman,” Jenner, 65, states. “My heart and soul — everything that I do in life — it is part of me. That female side is part of me. That’s who I am.”
Jenner’s public interview is finally shedding much-needed awareness and education on the topic. But for the general public, gossip, media speculation and overall lack of understanding have led to many harmful misconceptions about transitioning and marginalized the transgender population. We spoke to three plastic surgeons, all who specialize in facial feminization surgeries and see transgender patients, to dispel some of the most common myths.
Myth 1: Transitioning or transgender people are confused.
Transgender people are not confused about their gender — in fact, it’s quite the opposite. “Transgender women or men know of their gender for years — specifically since they’re about the age of 6,” says Boston plastic surgeon Jeffrey Spiegel MD. “The challenge is that while they know their true gender, they are unable to have others recognize them and see them for who they know they are.” Jenner said he was about 8 or 9 when he first knew.
“However, while a person may know for a very long time or their entire lives that they are a trans person, it might take them 40 or 50 years to admit that because of the social implications that may have,” explains San Francisco Plastic and Craniofacial Surgeon Jordan Deschamps-Braly M.D. “It is a very heart-wrenching thing because feeling stuck in one’s own body is one of the most unrelenting psychological forces in someone’s life. Nothing that makes that go away and people bury it for years and years.”
Myth 2: Hormones alone can physically feminize a face or body.
For adult males transitioning to females, hormones alone make little impact on the overall physical feminization of the person, says Dr. Spiegel. “What makes a face appear feminine versus masculine is all in the bone structure, so surgery is required in order to reconstruct the face to eliminate the features that are perceived as masculine and reshape them to feminine.”
“The most feminizing and youth-producing procedures are to move the hairline forward, lift the brows and flatten the supraorbital rims,” explains Beverly Hills surgeon Toby Mayer, MD. “Most patients also undergo rhinoplasty in order to re-sculpt the nose to make the bridge straighter and the tip more refined. Finally the jaw and chin need to be re-contoured and the Adam’s apple removed.”
“Patients can also elect to undergo cheek and lip enhancements to give both a rounder and smoother appearance,” adds Dr. Deschamps-Braly. “Cheek augmentation could entail either inserting implants underneath the skin or volumizing the area with fat injections. Lip work could include either a lip lift, which shortens the upper lid and the use of fillers or fat transfer injections for plumping the lip.”
Myth 3: There’s a fixed medical process and a scientific definition of when transitioning is complete.
“There aren’t any rules around what has to be done in order to transition from a man to a woman,” says Dr. Deschamps-Braly. “One can choose to undergo a number of procedures including hormone therapy, , genital gender reassignment, or facial feminization surgery. However, there are no required procedures. About half of all transitioning patients elect only to undergo facial reconstruction surgery, because that is all that is needed in order for the general public to perceive them the way that they identify themselves.” breast augmentation
Myth 4: A person changes into someone else after transitioning.
“It’s a big misconception that one changes into a completely different person after transitioning,” says Dr. Spiegel. “Instead, what happens is that transitioning allows the person feel whole and finally look the way that they feel inside. It empowers patients to be able to choose how they live the next stage of their lives. It allows people to live their lives successfully as who they actually are.”
Myth 5: Transgender people are mentally unwell or acting out.
“It’s an unfortunate stereotype that trans people live in or come from some sort of underworld or different world than everyone else,” says Dr. Deschamps-Braly. “In reality, the vast majority of patients that we see transitioning are highly educated and highly functioning individuals with enormous amounts of qualities to give to the world. They’re bankers, CEOs, engineers — they come from all walks of being successful.”
“I see about 10 patients a week that are transitioning,” adds Dr. Mayer. “There’s nothing odd or weird about it. One doesn’t choose to be male or female — it chooses them. The bottom line is: Many may look at Bruce Jenner the Olympian who once graced a Wheaties box and ask ‘Why would a guy like him do this?’ And the answer is, because he is not happy and he will only be happy when he’s a woman.”
In Jenner’s own words: “I’m emerging as myself. Isn’t that great?”
From The Office Of Dr. Deschamps-BralyMeet Camille Perez the newest member of our team
From The Office Of Dr. Deschamps-BralyMay 28, 2015
Camille Perez has extensive experience in the plastic surgery industry, and worked for a well-known facial plastic surgeon for over 11 years. “I really love the personal nature of this work, and I enjoy connecting with people. I am dedicated to helping patients achieve their aesthetic goals.”
She is the primary point of contact for consultations, scheduling surgery and guiding patients through the entire surgical process. Patients find her empathetic, attentive and thorough. She will ensure that all of your questions are answered, and your expectations addressed.
Camille is of Spanish descent and speaks Spanish and French. She studied Psychology and French at San Francisco State University. She enjoys traveling, interior design, running, bicycling and yoga.
DR. DESCHAMPS-BRALY TALKS ABOUT THE LATEST 3D
IMAGING TECHNOLOGY IN CRANIOFACIAL SURGERY
One of the biggest new advancements in craniofacial surgery technology is the ability to use 3D CT scan imagery. The CT scan helps surgeons to visually inspect craniofacial deformities and anomalies in high-resolution 3D detail to ensure precise pre-operation planning.
Dr. Deschamps-Braly explains the significance of the newest technology for craniofacial surgery:
“In the past, stereolithographic 3D models were not available and surgeons could only view 3D scans on paper (in 2D). It was helpful, but only as a reference – nothing more.
When we plan orthognathic surgery, we use models of the patient’s teeth and from these we generate surgical guides to ensure precise results. However, for other types of craniofacial surgery we make a plan, and then essentially “eyeball” the result from an experienced aesthetic viewpoint and voilà that was it. Although results are commonly good, it’s not very scientific and reproducibility is not ensured.
We wanted more than just using the judgement of the eye.
We wanted to know how to use CT data to ensure that patients undergoing surgery for craniofacial anomalies would receive the most precise and accurate result that matched our pre-operative plan for the patient.
It’s now possible to create actual 3D digital surgical guides so that we can accurately produce the same surgery that we intended with extreme accuracy on the actual patient.
This has been a great advance in forehead surgery for infants and we are also looking at it’s applications for adult forehead contouring.”
NON-SURGICAL JAW CONTOURING & FACIAL THINNING
The “masseter” is one of the facial muscles that we use for chewing. However, for some, it is also the muscle that is engaged when one, often subconsciously, grinds or clenches the teeth, or ‘holds tension’ in the jaws.
This tension essentially overworks the muscle causing it to become hypertrophied (enlarged) which can result in one’s face appearing ‘angular’ or ‘full’, especially in the lower face along the posterior portion of the jaw.
While some patients may want to surgically reduce the angles and width of their mandible (jaw bone), others may not be candidates for such an operation due to their facial fullness being the result of prominent soft tissue
such as enlarged masseter muscles rather than a prominent jaw bone.
Luckily, there is a non-surgical option involving Botox® injections in multiple sites directly into the masseter muscle. This helps to atrophy (shrink) the muscle, which in turns makes the face appear less angular and ‘thinner’.
BOTOX TO ALLEVIATE SEVERE UNDERARM SWEATING (HYPERHIDROSIS)
Approximately 2.8% of people suffer from Primary hyperhidrosis, or “excessive sweating” that exceeds the body’s requirements for thermoregulation. Stress, anxiety, physical activity or other triggers can cause Hyperhidrosis.
Men and women are equally affected and the condition can be inherited. It affects the underarm (axillary) area most frequently. But it can also affect the palms of the hands, soles of the feet, face and scalp. It is often very disruptive and humiliating to those who suffer from it, causing adaptive behaviors such as slouching or avoiding raising the arms to disguise damp areas on clothing.
Botox® and Dysport® are well established for the treatment of hyperhidrosis, as they provide quick, non-invasive relief that can last 6-12 months or more. The treatment is well tolerated, and patients tend to be very satisfied with the results, repeating sessions depending upon individual needs. There are some medical contraindications to Botox® and Dysport®, so a physical exam and a knowledge of your medical history is required for treatment.
A starch-iodine test is performed to identify areas of excessive sweating. Botox® and Dysport® are then injected with a very fine needle into the affected area at specific intervals to target the sweat glands. In the same way Botox® and Dysport® can inhibit muscle contraction, they can also inhibit sweat gland production by inhibiting acetylcholine, a messenger neurotransmitter. Since the glands do not receive the “message” to release sweat, the skin remains dry.
The axillary (underarm) region is the most common area treated, but other areas may be treated as well. However, care must be taken to avoid functional changes during treatment of the hands since Botox® and Dysport® can affect muscle function as well.
Both Botox® and Dysport® are FDA-approved for the treatment of hyperhidrosis and have been used extensively over many years, with an excellent safety profile.
Patients who have failed using other treatments have a safe, efficacious, and long-lasting treatment option that allows them to confidently approach stressful or anxious situations and exercise without fear.
NEED A SPRING BOOST? TRY A MIC SUPER B INJECTION
Ready to leap into spring but lacking your usual joie de vivre?
The MIC Super B injection is an affordable, non-surgical treatment that contains a pharmaceutical blend of B-complex vitamins and other non-essential amino acids that support liver function, detoxification and regulate metabolism.
The injection contains vital nutrients and can potentially boost energy and vitality. It may also reduce anxiety due to vitamin B’s ability to improve the resilience of the nervous system.
The treatment takes only a few minutes in our downtown San Francisco office. Make an appointment by calling 415 624.3922.
UPCOMING INTERNATIONAL & US CONFERENCES
Dr. Deschamps-Braly and his team regularly attend local and international seminars, meetings and conferences. Here are a few that we’ll be attending this year:
ASAPS (Aesthetic Society of Plastic Surgeons) The Aesthetic Meeting
(Attending: Dr. Deschamps-Braly, Caitlin Sacher & Jennifer Fick)
May 14th – May 19th, 2015
The Palais des Congres de Montreal
Montreal, QC, Canada
ISCFS (International Society of Craniofacial Surgeons)
(Attending: Dr. Deschamps-Braly)
September 14-18th, 2015
Hilton Tokyo Bay Hotel, Maihama
25th Annual Southern Comfort Conference (Transgender)
(Attending: Dr. Deschamps-Braly, Caitlin Sacher & Camille Perez)
Dates: September 29th – October 3rd, 2015
Fort Lauderdale Premier Spa & Gold Resort
Fort Lauderdale, FL
(Attending: Dr. Deschamps-Braly, Caitlin Sacher & Jennifer Fick)
October 16-20th, 2015
Conference Location TBA
LATISSE® AND RETIN-A NOW AVAILABLE
We now sell Latisse® and Retin-A directly from our downtown office near San Francisco’s Union Square. Latisse® is an FDA-approved prescription treatment for hypotrichosis (inadequate or thin eyelashes) that helps eyelashes grow longer, fuller and darker. Retin-A (tretinoin) is a form of vitamin A that helps the skin renew itself especially in cases of acne, reducing the appearance of fine lines, wrinkles and mottled skin.Want to know more about the products we sell? Call our San Francisco office on 415 624.3922.
Jennifer Fick Joins OfficeMeet Jennifer Fick the newest member of our team
Jennifer Fick Joins OfficeApr 20, 2015
We’re proud to announce Jennifer Fick, RN, as the newest addition to our clinical team. Jennifer has been a registered nurse for over 20 years with previous experience in cardiology, geriatrics and medical detox services.
She has provided personalised and successful cosmetic procedures to thousands of patients across the Bay Area.
“With over 16 years of experience in the medical cosmetic industry, my approach continues to be driven by the unique needs and wishes of each person I work with. Developing a treatment plan together, that considers the natural balance and proportion of your face, ensures a desired outcome that best enhances the distinctive facial features”
Jennifer has extensive experience in injectable cosmetic procedures such as:
Botox Cosmetic Treatment to smooth and soften lines and wrinkles for a rejuvenated appearance
Restylane Facial Filler to replace lost facial volume due to aging, and restore the skin to a more youthful glow
Lip Fillers (Augmentation and Rejuvenation) Plump and rejuvenate the appearance of your lips with Fat Transfer, Restylane®, Juvederm®. Reduce the appearance of the lines above and below the lips with Botox® Cosmetic or Dysport®
Sclerotherapy for Varicose Veins Reduce the appearance of varicose and “spider” veins in the legs with minimal discomfort
MIC Super B Injection Vitamin B injections to boost energy and improve the resilience of the nervous system
By prescription only:
- Latisse®: longer, fuller lashes – clinically proven and FDA-approved
- Retin-A®: reduce the appearance of fine lines, sun damage and improve overall skin texture
Touch of the winter blues? Try a MIC Super B injection for a vitamin boost!
If you’ve still got a touch of the winter blues, you might be interested in one of Jennifer’s most popular non-surgical offerings: the MIC Super B injection.
The MIC Super B consists of a pharmaceutical blend of B-complex vitamins and other non-essential amino acids that support liver function, detoxification and regulate metabolism.
Because the injection contains vital nutrients required for ATP production (mandatory for every cell in your body!) it can potentially boost energy and vitality. Some patients also report that it reduces anxiety due to vitamin B’s ability to improve the resilience of the nervous system.
Saturday appointments available from 10am to 7pm
Due to popular demand, we’re continuing our Saturday office hours from 10am to 7pm. Jennifer Fick and Caitlin Sacher are both available on Saturdays for injectable facial treatments and other non-surgical procedures. Make your Saturday appointment by calling us directly on (415)624.3922.
COMING SOON: PLATELET-RICH PLASMA (PRP) TREATMENTS
As we grow, we are continually expanding our scope of non-surgical aesthetic procedures. Platelet-Rich Plasma (PRP) treatments are just one of the many new procedures we have in store for you in 2015.
Platelet-rich plasma (PRP) is your very own blood plasma that has been enriched with platelets – blood cells whose function is to stop bleeding, promote faster healing with less swelling and bruising. Known to some as the “vampire facelift”, PRP is much less invasive than plastic surgery.
Platelet Rich Plasma harnesses your own biological nutrient-rich cells to stimulate the regeneration of the underlying structural integrity of your skin. PRP treatments are commonly used for the treatment of wrinkles or scars in the face, neck and hands.
It is now becoming possible to harness and use PRP in an office based setting. This is a new field that our office is embracing. Please call our office and speak to Jennifer to obtain more details at (415)624.3922.
A FRESH APPROACH TO AESTHETIC SURGERY
While we offer a wide range of aesthetic procedures – both surgical and non-surgical – you will discover that our approach to plastic surgery is methodical.
We understand that aging is an overall process that happens to all the structures of the face. And although we do not intend to promote procedures that you do not bring to our attention, we also believe that evaluating isolated features out of context to other facial structures does not always lead to the most harmonious results. That’s why we believe in evaluating the entire face when making a recommendation. Then, together, we decide on what makes the most sense for you.
Our most popular aesthetic procedures include:
- Facelift (Rhytidectomy)
- Neck Lift
- Eyelid Surgery (Blepharoplasty)
- Brow / Forehead Lift
- Fat Transfer (Fat Grafting)
- Restylane® Facial Filler
- Botox® Cosmetic
- Ear Surgery (Otoplasty)
- Rhinoplasty (Nasal Surgery / “Nose Job”)
- Lip Fillers (Peri Oral Rejuvenation)
Regardless of your specific concern, when you visit our office in San Francisco we evaluate your unique facial features, and formulate a treatment plan that is consistent with your goals and our abilities. Make an appointment by calling (415)624.3922.
Stille AmbassadorSurgical Perfection at Its Best
Stille AmbassadorFeb 3, 2015
Talking instruments and plastic surgery procedures with Dr. Jordan Deschamps-Braly, one of the most uniquely and broadly trained plastic surgeons in the world, as well as a true STILLE Ambassador.
Dr. Jordan Deschamps-Braly is a leading plastic surgeon with offices in San Francisco conducting specialized facial aesthetic, craniofacial and orthognathic surgery. In this interview Dr. Deschamps-Braly talks about his experiences with the STILLE instruments that he uses as part of his practice.
Dr. Deschamps-Braly, what do you appreciate most by using STILLE instruments?
I appreciate that they are so light in my hand. They don’t just seem lighter and sharper than other instruments, they just are. I do most of my work at the scissors tips and I don’t want a scissor that chews on the tissue, that’s a key element in creating perfection. Using other scissors, I have noticed that they compensate somehow by overly forcing the blade crossover, and in the process of doing this you get a lot of resistance and grind at the tips. This is a key element to avoid and you never get that with a STILLE scissor.
How would you describe STILLE to another Surgeon?
I would use the word “Boutique” or “Boutique-y”, meaning a highly specialized and high quality manufacturer. When you perform a procedure where the feel and enhanced performance of the instrument is important to you and the results for your patient, STILLE is your go-to instrument. In my experience, instruments that provide a more “feeldriven” experience for the surgeon tend to include forceps, needle drivers, and scissors. Those are all “feel driven”. They have movement and tactile feedback in a different way than a static instrument does.
What are the clinical advantages of using STILLE instruments?
It decreases the surgeon’s fatigue. Holding a lighter instrument that requires less force when dissecting tissue is a key element to success. I think fatigue and frustration are two things that a great surgical instrument removes. Good instruments can’t make a surgeon good, but they can definitely make a good surgeon’s life easier. Fatigue and frustration are two things that quality instruments, such as STILLE’s, sure can help to minimize. If you do not have a scissor that cuts properly it is very frustrating when trying to accurately inset the skin flaps on a facelift along the edge of the ear. If the scissor does not cut properly it can chew on tissue, it can destroy a good flap, and it can be frustrating at the end of a long day when you are 6 hours into an operation.
The last thing you need is more frustration because your instruments are not doing their job.
Do you see any benefits to patients by using STILLE instruments?
Well, a happy surgeon leads to a happy patient! If a case is shorter and the surgeon is more focused on the operation than his malfunctioning or low quality instruments, I’d say you perform better and create better results. The instrument is not the make-it-or-break-it for the patient, but a happier and more comfortable surgeon will create better results. If you get frustrated halfway through the case because instruments are not optimal for the task, then things can go downhill very fast. It’s all about fatigue and frustration, and anything you can do to keep a surgeon sharp is always good.
How do you justify the investment in a STILLE instrument?
Good question, I justify it as a long term investment. Getting tactile feedback from the hand as you cut is worth the money to me. But it may not be worth it to everybody. An investment in a STILLE instrument is an investment that will last throughout your career. You should never compare a STILLE instrument with a standard $50 instrument. For a surgeon whose accuracy in dissection is important, a quality instrument is definitely worth the investment.
So how do you get STILLE instruments to the trays?
I’m an active surgeon. I do surgery at the California Pacific Med Center as well as the Children’s hospital of Oakland. At my center, I made the personal decision to fill the trays I use with STILLE. When I head out for surgery at hospitals, I take my own face and eyelid set with me to procedures. I drag it with me, and yes it is a pain to do, but I have tight control of what I use. The OR staff notices that enhanced level of attention by the surgeon to the details that go into a good surgical outcome, and they respond accordingly.
Eyelid SurgeryA New Paradigm
Eyelid SurgerySep 30, 2013
Eyelid surgery has evolved and become better in the last decade. A modern blepharoplasty reshapes the eyelids in an artistic way that does not compromise the way your eyes look in ten years. Traditional blepharoplasty removes fat from around the eyes. A modern blepharoplasty takes a different approach. It reshapes the fat so that we don’t produce the hollow look that is the hallmark of the way blepharoplasty used to be performed. It also takes into account the position and shape of the brow as these is very important when considering eyelid rejuvenation. A modern blepharoplasty produces a refreshed appearance that smoothens the contours of the eyes and refreshes the skin while maintaining a natural look. If you have questions or concerns regarding how to improve your eyelids, please give us a call.
Healing after a faceliftWhat is it and how do we treat it?
Healing after a faceliftSep 16, 2013
One of the most often asked questions when visiting with a prospective patient is, “how long will it take to recover from my facelift?” The length of recovery can be a source of apprehension and fear. This fear often drives people to seek non-invasive treatments as an alternative. Though non-invasive treatments have their place, it has to be clearly understood what the expectations of those treatments are. There simply is no laser or filler that will give you the same youthful result that a well-performed surgical facelift can offer. Therefore, I feel compelled to post about the topic to dispel some of the fear.
Pain: All patients ask me if it will hurt. The answer is: rarely ever. I have occasional patients report to me that their neck feels somewhat tight. This makes sense since we tighten the muscles around the neck. However, I’ve yet to have a patient tell me that they had significant pain after surgery.
Anesthesia: There is often fear of being put under anesthesia and going to “sleep”. Anesthesiologists and the art and practice of anesthesiology have made great strides in the last two decades in terms of patient safety. From patient selection, to their methods and monitoring, anesthesia has become incredibly safe over the last two decades through data driven scientific rigor. I usually make an analogy to flying. It is usually safer to either have anesthesia, or fly somewhere on an airplane, than it was to drive to your appointment. We are also trending towards performing more and more of our surgery under a deep sedation administered by an anesthesiologist, than having a patient be fully “asleep”. This allows our patients to feel better and recover more quickly.
Time Off: I tell people to take two weeks after a facelift, or one week after eyelids. Some people need a little less time. However, to be on the safe side, this is a realistic number. The two weeks usually provides enough time for most of the bruising to dissipate, so that makeup will hide any traces of surgery. Often, some slight swelling will still be present, but it’s usually not significant enough that others notice. Most of my patients are comfortable enough to be out in public after one week with the help of cover-up makeup, but keep in mind that everyone heals at their own pace. We don’t want patients to feel pressure to “recover” faster than their body allows.
Please contact our office to request an appointment, or please call for further information.
Cleft Lip and PalateWhat is it and how do we treat it?
Cleft Lip and PalateAug 16, 2013
Cleft lip and palate is a spectrum or disorders based around the term orofacial clefting. The majority of cleft lip and palate patients do not have any genetic basis for the disease, and instead represent an anomaly during the developmental part of pregnancy not related to a gene or mutation in the genetic code.
Therefore, it should be well understood that the vast majority of children with cleft lip and palate might grow up with normal intelligence and ultimately lead productive and happy lives. Cleft lip and palate patients are cared for with a dedicated team of specialists, including a craniofacial surgeon in order to make sure that we attend to every detail of your child’s care.
Most children with cleft lip and palate undergo most of their reconstructive procedures before school age, which has benefits for their psychosocial health. However, some reconstructive procedures such as corrective jaw surgery may be delayed until your child has attained their teenage years.
A detailed consultation is required to give a more adequate assessment of your child’s treatment plan.
Please contact our office to request an appointment, or please call for further information.
CraniofacialContouring and the Necklift
CraniofacialAug 16, 2013
Craniofacial contouring entails altering the shape of the facial skeleton to achieve an improvement in contour in either aesthetic/cosmetic surgery, or in congenital malformations. One common adjunct to the necklift that often goes unrecognized by surgeons is the role of the diminutive chin on facial harmony and aesthetics. A weak chin can nearly ruin the aesthetics of an otherwise good result when it comes to achieving neck rejuvenation.
Consideration to augmenting the chin when it is found to be weak is a very important part of the evaluation for facial rejuvenation. Additionally, chin ptosis or a drooping chin needs to be discussed, as there are a variety of methods to improve chin ptosis depending on the cause and severity. The decision on whether the chin needs to be addressed comes from the physical examination and very careful evaluation of the facial profile. Occasionally, a special x-ray of the facial skeleton may be performed to verify the underlying proportions of the face.
When it comes to craniofacial contouring we have two options. We can place facial implants, or we can actually move the bone in many cases, or add layers of bone or cartilage to achieve the same effect. The best option will depend on a variety of factors.
Please contact our office to request an appointment, or to find out further information.
“We are fanatical about the finer details and how we care for you - our patient.
Understanding your expectations and exceeding them in every way is how we have made our name.”