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.

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

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 contact our San Francisco office +1.415.624.3922.

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.

For further information or to request an appointment, please contact our San Francisco office +1.415.624.3922.

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.

For more information, or to make an appointment with Dr. Deschamps-Braly, please contact our San Francisco office +1.415.624.3922.

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” 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.

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