Plastics in Practice (Resident Review)

Plastics in Practice
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A podcast built for plastic surgery trainees. Each episode reviews CME articles and topics from the ASPS Resident Curriculum, breaking them down into core concepts, clinical pearls, and exam-ready takeaways. Listen on your commute, between cases, or while studying—anywhere you want high-yield plastic surgery learning on the go.

  1. 7 HR AGO

    Hair Transplantation Essentials

    Hair restoration is one of the most planning-dependent procedures in plastic surgery — a single wrong call on the hairline or the donor strip can show up for the rest of the patient's life. In this episode of Plastics in Practice we walk through what residents actually need to know about modern hair transplantation: how to evaluate the donor area, how to think about lifetime donor yield, the trade-offs between strip excision and FUE, graft preparation and the out-of-body clock, recipient site design (hairline placement, angle and direction, ethnic and gender variations), postoperative management, and where finasteride, minoxidil, and PRP fit in. Key takeaways: The Safe Donor Area (SDA) defines what is truly permanent — and a 30-year-old destined for Norwood V/VI averages roughly 5,393–6,404 lifetime FUs from average-density donor scalp.¹ Strip excision still dominates (~88.5% of cases) vs. FUE (~11.5%); transection rates can be pushed below 10–15% with tumescent solutions and skin-hook technique.² Graft survival drops about 1% per hour out of body — chilled saline gives ~88% survival at 8 hours; pear-shaped grafts under 6× magnification protect the bulb, sebaceous glands, and dermal papilla.³ Hairline placement: never too low. The mid-frontal point lives where the vertical forehead transitions to the horizontal scalp, ~7–10 cm above the glabella. Build in micro- and macro-irregularities so it never reads as a wall.⁴ Density target for natural long-term coverage in younger patients is 25–30 FU/cm²; high-density "dense packing" >30 FU/cm² is reserved for ideal donor/recipient profiles.⁴ Adjuncts matter: finasteride 1 mg is ~87% effective at slowing AGA progression; topical minoxidil reduces postoperative effluvium and is encouraged 5–12 weeks post-op.⁵,⁶ Cicatricial alopecia (post-facelift, burn, traction): keep recipient density conservative at 15–20 FU/cm² to avoid overwhelming a compromised blood supply.⁷ This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ #PlasticSurgery #Residency #HairTransplantation #FUT #FUE #SurgicalEducation #PlasticsInPractice #HairRestoration #Aesthetic #SurgicalPearls References: 1. Unger W, Unger R, Wesley C. Estimating the number of lifetime follicular units: a survey and comments of experienced hair transplant surgeons. Dermatol Surg. 2012;1-6. 2. Pathomvanich D. Donor harvesting; a new approach to minimize transection of hair follicles. Dermatol Surg. 2000;26:345-348. 3. Limmer R. Micrograft survival. In: Stough D, Haber R, eds. Hair Replacement. St. Louis, MO: Mosby Press; 1996:147-149. 4. Shapiro R. Principles of creating a natural hairline. In: Unger W, Unger R, Unger M, Shapiro R, eds. Hair Transplantation. 5th ed. New York, NY: Marcel Dekker; 2011:374-382. 5. Rossi A. Finasteride, 1 mg daily administration on male androgenetic alopecia and different age groups: 10-year follow up. Dermatol Ther. 2011;24(4):455-461. 6. Bohannon P. Topical minoxidil used before and after hair transplantation. J Dermatol Surg Oncol. 1989;15:50-53. 7. Unger W, Unger R, Wesley C. The surgical treatment of cicatricial alopecia. Dermatol Ther. 2008;21(4):295-311.

    22 min

  2. 21 HR AGO

    Osseous Genioplasty

    Osseous genioplasty is the most versatile tool the plastic surgeon has for the lower face — and the most commonly mis-planned. In this episode of Plastics in Practice, we review the basics of chin surgery: when to pick the osteotomy over an implant, the five-pillar physical exam, the technical steps that decide your aesthetic result, and the pitfalls that cause the bizarre "overadvanced" chin we've all seen on revision.Key takeaways:• The lower lip rule: never advance the chin past a vertical line dropped from the lower lip. Cross it, and the result looks artificial every time.¹• 3-D versatility: implants only correct mild sagittal deficiency. Vertical excess, asymmetry, deep folds, or revisions belong to osseous genioplasty.²• Soft-tissue ratios: ~1:1 for advancement and lengthening; only ~0.5:1 for posterior repositioning.³• The 4 mm rule: keep the horizontal cut ≥ 4 mm below the mental foramina to protect the inferior alveolar nerve.⁴• Carry the cut posteriorly to the molars — the most common technical error is too short a cut, which produces an hourglass deformity.⁴• Mentalis discipline at closure prevents witch's chin (soft-tissue ptosis).⁵Disclaimer: This content is for educational purposes only and is not medical advice.🎧 Full episodes available now:Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ#PlasticSurgery #Residency #Genioplasty #Craniofacial #SurgicalEducation #PlasticsInPractice #FacialAesthetics #ChinSurgeryReferences (AMA):1. Rosen HM. Aesthetic guidelines in genioplasty: the role of facial disproportion. Plast Reconstr Surg. 1995;95(3):463-469.2. Converse JM, Wood-Smith D. Horizontal osteotomy of the mandible. Plast Reconstr Surg. 1964;34:464.3. Rosen HM. Aesthetic refinements in genioplasty: the role of the labiomental fold. Plast Reconstr Surg. 1991;88(5):760-767.4. Spear SL, Mausner ME, Kawamoto HK. Sliding genioplasty as a local aesthetic outpatient procedure: a prospective two center trial. Plast Reconstr Surg. 1987;80(1):55-59.5. Zide BM, McCarthy JG. The mentalis muscle: an associated component of chin and lower lip position. Plast Reconstr Surg. 1989;83(3):413-420.

    18 min

  3. 8 APR

    Facial Implants

    Facial implants can dramatically change facial balance, but the difference between a natural result and an operated look comes down to planning, positioning, and fixation. In this episode, we break down the core principles of facial skeletal augmentation with implants for the plastic surgery resident. We review the major implant materials, the anatomic targets across the midface and mandible, and the operative concepts that matter most in real cases. This includes why subperiosteal placement is preferred, why screw fixation remains a key technical principle, and how to think through chin augmentation versus sliding genioplasty. We also cover common causes of poor outcomes, including malposition, asymmetry, poor transition zones, and technique-related complications rather than material toxicity. Key takeaways: Facial skeletal morphology is a major determinant of facial aestheticsAnthropometric normals are more useful than rigid neoclassical canons for planning Subperiosteal dissection improves visualization, precision, and safety during implant placement Screw fixation helps eliminate implant-bone gaps and reduces migration risk Infraorbital rim and paranasal implants can be powerful tools in midface deficiency Chin implants and sliding genioplasty each have distinct advantages and tradeoffs 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ    References Farkas LG, Hreczko TA, Kolar JC, Munro IR. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg. 1985;75(3):328-338. doi:10.1097/00006534-198503000-00005. PMID: 3883374. Rubin JP, Yaremchuk MJ. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg. 1997;100(5):1336-1353. doi:10.1097/00006534-199710000-00043. PMID: 9326803. Yaremchuk MJ, Israeli D. Paranasal implants for correction of midface concavity. Plast Reconstr Surg. 1998;102(5):1676-1684. doi:10.1097/00006534-199810000-00055. PMID: 9774030. Yaremchuk MJ. Infraorbital rim augmentation. Plast Reconstr Surg. 2001;107(6):1585-1592. doi:10.1097/00006534-200105000-00047. PMID: 11335841. Disclaimer: This content is for educational purposes only and is not medical advice.#PlasticSurgery #PRS #FacialImplants #FacialSkeletalAugmentation #Craniofacial #Aesthetics #ResidentEducation #PlasticsInPractice

    23 min

  4. 6 APR

    Otoplasty Essentials

    Prominent ears are not one deformity. They are usually a combination problem involving the antihelix, concha, and lobule. In this episode, we break down a practical, anatomy-first approach to otoplasty that helps you create a natural setback without a sharp, overdone, or obviously operated appearance. We review the major causes of auricular prominence, the aesthetic goals of correction, and the core maneuvers every plastic surgery resident should know. The focus is on reliable, cartilage-sparing principles: Mustarde sutures for antihelical recreation, Furnas sutures and selective conchal reduction for conchal excess, and deliberate management of the lobule so you do not leave behind a hockey-stick deformity. We also cover timing, infant ear molding, postoperative care, and complications worth respecting. Key Takeaways Prominent ears usually reflect a combination of underdeveloped antihelical fold, conchal excess, and lobule prominence. The goal is a soft, natural, harmonious setback with visible helical rim from the front and a straight helical contour from behind. Mustarde mattress sutures remain a foundational technique for recreating the antihelix. Furnas concha-mastoid sutures help address middle-third prominence by reducing the concha-mastoid angle. Lobule correction matters; ignoring it can leave a disharmonious result despite an otherwise good otoplasty. Early neonatal ear molding can permanently improve selected deformities without surgery. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ    References Thorne CH, Wilkes G. Ear deformities, otoplasty, and ear reconstruction. Plast Reconstr Surg. 2012;129(4):701e-716e. doi:10.1097/PRS.0b013e3182450d9f. PMID: 22456385. Mustardé JC. Correction of prominent ears using buried mattress sutures. Clin Plast Surg. 1978;5(3):459-464. PMID: 359224. Furnas DW. Correction of prominent ears by conchamastoid sutures. Plast Reconstr Surg. 1968;42(3):189-193. doi:10.1097/00006534-196809000-00001. PMID: 4878456. Gosain AK, Recinos RF. A novel approach to correction of the prominent lobule during otoplasty. Plast Reconstr Surg. 2003;112(2):575-583. doi:10.1097/01.PRS.0000071000.80092.2A. PMID: 12900617. Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #Otoplasty #ProminentEar #AuricularDeformity #PlasticSurgeryResident #ResidentEducation #PRS #FacialPlasticSurgery #PediatricPlasticSurgery #SurgicalPearls

    18 min

  5. 31 MAR

    Rhinoplasty Fundamentals

    Rhinoplasty is not a reductive operation anymore. Modern rhinoplasty is about precision, preservation, and structure. In this episode, we break down a practical framework for analyzing the rhinoplasty patient, protecting the airway, and executing reproducible tip and dorsal maneuvers with fewer long-term problems. We cover the anatomy that actually matters in the OR: skin/soft tissue envelope behavior, the bony and cartilaginous vaults, the internal nasal valve, and the ligamentous support structures that determine projection, rotation, and long-term stability. We also walk through systematic nasofacial analysis, component dorsal hump reduction, algorithmic tip refinement, spreader graft logic, osteotomy planning, and why revision rhinoplasty remains so technically unforgiving. Key Takeaways Modern rhinoplasty favors conservative, structure-sparing techniques over aggressive resection. Component dorsal hump reduction helps preserve dorsal aesthetic lines and reduce midvault complications. Tip work should follow an algorithmic progression: cephalic trim, sutures, strut support, then grafting as needed. The internal nasal valve is a major determinant of airflow and must be protected throughout dorsal and septal work. Strong outcomes depend on methodical preoperative analysis and matching technique to deformity. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ    References Ghavami A, Janis JE, Acikel C, Rohrich RJ. Tip shaping in primary rhinoplasty: an algorithmic approach. Plast Reconstr Surg. 2008;122(4):1229-1241. doi:10.1097/PRS.0b013e31817d5f7d. PMID: 18827660. Howard BK, Rohrich RJ. Understanding the nasal airway: principles and practice. Plast Reconstr Surg. 2002;109(3):1128-1146. doi:10.1097/00006534-200203000-00054. PMID: 11884847. Rohrich RJ, Ahmad J. Rhinoplasty. Plast Reconstr Surg. 2011;128(2):49e-73e. doi:10.1097/PRS.0b013e31821e7191. PMID: 21788798. Rohrich RJ, Muzaffar AR, Janis JE. Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg. 2004;114(5):1298-1308. doi:10.1097/01.PRS.0000135861.45986.CF. PMID: 15457053. Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #Rhinoplasty #NoseJob #PlasticSurgeryResident #PRS #FacialAesthetics #SurgicalEducation #Residency #MedicalEducation #ENT #AestheticSurgery

    19 min

  6. 27 MAR

    Facelift Core Principles

    Master the principles behind modern facelifting. This episode breaks down the core concepts of rhytidectomy, focusing on high-yield surgical principles, SMAS manipulation, and complication avoidance. We move beyond outdated skin-tension techniques and focus on what truly matters: volume restoration, anatomic precision, and hemodynamic control. You’ll learn how to think about facelifts like a surgeon—not just perform steps. From SMAS strategies to neck management and hematoma prevention, this is a practical, resident-level deep dive. Volume > tension: Excess skin tension leads to distortion and poor aestheticsSMAS is everything: Extended SMAS provides superior midface + neck correctionHematoma = #1 complication: Strongly linked to perioperative hypertensionAnatomy dictates safety: Stay superficial to the transparent fascia to protect CN VIINeck defines outcome: Platysma management is critical for cervicomental angleLess is more: Over-aggressive surgery → “operated” appearance🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ    BibliographyThorne CH. Facelift. Grabb and Smith’s Plastic Surgery. This content is for educational purposes only and is not medical advice. #PlasticSurgery #Facelift #SMAS #SurgicalEducation #PRS #Residency #Aesthetics #MedEd

    23 min

  7. 26 MAR

    Blepharoplasty High-Yield Principles

    Blepharoplasty looks simple—but it’s one of the easiest ways to create devastating complications if you don’t respect the anatomy. This episode breaks down the high-yield principles of modern blepharoplasty, focusing on what actually prevents bad outcomes: proper evaluation, conservative technique, and understanding lid support. We cover upper and lower lid strategy, when to preserve vs remove fat, and how to avoid classic complications like ectropion, scleral show, and retrobulbar hematoma. Evaluation is everything: vector analysis, lid laxity, and Schirmer’s test predict complicationsVolume preservation > aggressive excision to avoid hollow “A-frame” deformity Lower lid support is critical: canthopexy/canthoplasty reduces malposition risk Orbitomalar ligament release + fat redraping improves lid–cheek junctionRetrobulbar hematoma = emergency → immediate canthotomy/cantholysisTransconjunctival approach preferred in select patients to minimize complications🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ    Codner MA, Burke RM. Blepharoplasty. In: Plastic Surgery Text. Comprehensive Analysis of Modern Blepharoplasty. Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #Blepharoplasty #Aesthetics #SurgicalPearls #PRS #Residency #Oculoplastics #FacialRejuvenation

    23 min

  8. 24 MAR

    Forehead and Brow Lift

    The brow lift has evolved. What used to rely on long coronal incisions has shifted toward anatomically precise, minimally invasive endoscopic approaches designed to restore brow position while avoiding the over-elevated, unnatural “surprised” look. In this episode of Plastics in Practice, we break down the modern principles of forehead and brow rejuvenation with a resident-focused review of upper facial aging, brow aesthetics, relevant anatomy, retaining ligaments, and operative strategy. We cover how the frontalis acts as the sole brow elevator, why the corrugator, procerus, orbicularis, and depressor supercilii matter clinically, and how selective ligament release with controlled fixation helps produce more natural results. The frontalis is the only true brow elevator; the corrugator, procerus, orbicularis oculi, and depressor supercilii act as brow depressors.Female brows generally favor lateral elevation and arch, whereas the male brow should remain flatter and closer to the superior orbital rim.Over-elevating the medial brow creates the classic “surprised look” and should usually be avoided.The lateral retinacular ligament must be adequately released for effective lateral brow elevation.Modern endoscopic techniques reduce morbidity associated with traditional coronal approaches, including alopecia and paresthesia.Unicortical bone tunnel fixation provides durable suspension in endoscopic brow rejuvenation. 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/   Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA  Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216  YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO  Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/  📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ    #PlasticSurgery #BrowLift #ForeheadRejuvenation #EndoscopicBrowLift #AestheticSurgery #PlasticSurgeryResidency #FacialAesthetics #SurgicalEducation Phillips BZ, Hoy EA, Chang JT, Salomon JA, Sullivan PK. Forehead and brow rejuvenation. In: Thorne CH, ed. Grabb and Smith’s Plastic Surgery. 7th ed. Philadelphia, PA: Wolters Kluwer; chapter 45. Sullivan PK, Salomon JA, Woo AS, Freeman MB. The importance of the retaining ligamentous attachments of the forehead for selective eyebrow reshaping and forehead rejuvenation. Plast Reconstr Surg. 2006;117(1):95-104. doi:10.1097/01.prs.0000194904.27418.a0. PMID: 16404232. Disclaimer: This content is for educational purposes only and is not medical advice.

    19 min
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A podcast built for plastic surgery trainees. Each episode reviews CME articles and topics from the ASPS Resident Curriculum, breaking them down into core concepts, clinical pearls, and exam-ready takeaways. Listen on your commute, between cases, or while studying—anywhere you want high-yield plastic surgery learning on the go.

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