Archive for the ‘Surgical Technique’ Category

Long Face Syndrome and Facial Feminization Surgery (FFS)

January 13, 2018

What is Vertical Maxillary Excess? How can it be Corrected within the Context of Facial Feminization?

When a transgender person is seeking to undertake facial feminization surgery there are several relevant FFS procedures that may be recommended depending on existing facial structure and aesthetic goals. Some FFS procedures fall under the category of plastic surgery (soft tissues), others under craniofacial surgery (the underlying facial skeleton), and others yet under orthognathic surgery (surgery of upper and lower jaws).

One of the lesser utilized FFS procedures is the surgical correction of long face syndrome or vertical maxillary excess. This condition is a facial deformity caused by a disproportionately grown upper or lower jaw making the face appear overly long. Depending on the individual, the vertical maxillary excess may result in a very “gummy” smile and a thin, over-elongated face.

Surgical Correction of Vertical Maxillary Excess within the Context of FFS

Vertical maxillary excess is easily correctable with orthognathic (jaw) surgery and is ideal for transgender individuals who are transitioning into females and have an excessively long face relative to their gender-adjusted soft tissue envelope (the skin, subcutaneous tissue, and deep fascia). The surgery is often used in the setting of a staged procedure. For instance, depending on the individual’s existing features, we usually prefer to complete the maxillary impaction prior to doing a rhinoplasty, unless there is to be a long course of orthodontic treatment involved. This procedure should also be done before an upper lip lift is performed because the lip lift is a finishing touch based on balanced proportions of the facial skeleton. Otherwise, the rest of the surgical procedures follow the same long format surgical session within the cluster of procedures that make up FFS.

Reducing the height of the face significantly adds to the outcome of facial feminization because shortening the face creates a more feminine appearance. Typically men’s faces are longer or taller, more angular, with higher foreheads and hairlines than women. And women’s faces are typically rounder, shorter in height, and less angular particularly around the chin and jaw area — amongst other differences.

Other related procedures that may be recommended regarding the lower half of the face to enhance feminization may include upper lip lift surgery, chin recontouring, “Asian” V-Line surgery, or chin reduction surgery.

How is the Surgery Performed?

The mechanics of surgically reducing the length of the face are essentially identical as those used in the Le Fort Osteotomy – an orthognathic (jaw surgery) procedure. Known as the “workhorse” of jaw surgery, this procedure is typically used in non-FFS patients for the treatment of upper jaw malocclusion and cleft palate.

In FFS patients, the Le Fort Osteotomy I maxillary intrusion involves the cutting of the jaw in the area between the nose and teeth to shorten the maxillary bone. Then reattaching the bone to bring the upper half of the face more harmoniously in balance with the bottom half in order to shorten the length of the face to a more feminine aspect.

Read more about the Le Fort Osteotomy I here.

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Virtual Surgical Planning (VSP)

October 16, 2016


Virtual Surgical Planning (VSP)

What is Virtual Surgical Planning?

Virtual Surgical Planning (VSP) is a pre-operative planning method that involves the visualization of a surgical procedure using 3D imaging computer software. The central patient benefit of using VSP is that it assists your surgeon in predefining each step of the surgical procedure including goal planning, bone segment navigation, and ensuring facial symmetry.

VSP utilizes medical image data to accurately plan the surgery so that the surgeon can then transfer that plan to the patient using customized 3D printed surgical guides.

VSP is used in several plastic and craniofacial surgical procedures.

Virtual surgical planning is quickly becoming a best practice standard of care for orthognathics and reconstructive craniofacial (maxillofacial) surgeries. Dr. Deschamps-Braly commonly uses Virtual Surgical Planning to plan the following procedures:

VSP ensures that the customized treatment plan we create for our patients is highly accurate, and results in the best possible patient outcome.

The benefits of VSP for patients.

VSP helps the patient by giving them a means to visualize exactly what the surgeon will be doing in the operating room, resulting in clarity of communication and increased peace-of-mind. Our patients are typically quite fascinated by viewing a 3D rendering of their own jaw or skull, and knowing exactly how the procedure will work.

Other patient benefits include:

  • Fewer ”surprises” and clearer expectations
  • Better outcomes – VSP makes it easier for your surgeon to reconfirm planned operative movements
  • Reduced surgery time – VSP can eliminate hours of orthognathic pre-op planning

What to expect at your VSP imaging session.

If you are a candidate for VSP the first step will be to undertake a comprehensive initial workup session. This session will include taking all 3D facial and intraoral images, measurements, plain films, study models, midline notations, occlusion class notation, a bite registration, and a cone beam CT scan. A cephalometric analysis is then performed to show the spatial relationships between dental and skeletal elements.

How we build your treatment plan using VSP.

The data collection is then digitized and virtual 3D models are created to simulate the planned surgical movements and outlined patient goals based on the pre-op analysis. The VSP software shows different colors for different sections of the skull, making it easy to see what goes where and in what order.

Plastic surgical guides are then fabricated using a 3D printer, allowing your surgeon to perform the virtual plan in the operating room to ensure precise repositioning of the jaw and other skeletal features.

Want to know more about Virtual Surgical Planning and how it may affect your surgical procedure? Please ask your surgeon during your session or call our office on +1.415.624.3922.

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Pain Relief After Plastic Surgery

January 5, 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 +1.415.624.3922.

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Stille Ambassador

February 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 “feel driven” 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.

To read the full article

To make an appointment with Dr. Deschamps-Braly, please contact our San Francisco office +1.415.624.3922.

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