Every category, rendered.

LinkedIn caption

A section of Dr. Ashford's keynote from the autumn symposium, cut for length and republished here because the argument in it is one every patient considering rhinoplasty should hear. The skin envelope is the variable a surgeon cannot change and frequently the one that determines the outcome. Thin skin shows the framework, which means refinement is visible and so is every irregularity, and grafts have to be smoothed and camouflaged accordingly. Thick, sebaceous skin conceals the framework, which means a surgeon can build definition into the cartilage and the skin will simply not transmit it, and the swelling runs a great deal longer. Neither is better. They are different operations that share a name, and a plan drawn without accounting for the envelope is a plan that will disappoint somebody. This is why the pinch test at your consultation is not a formality, and why the honest projected timeline differs between two patients having what looks like the same procedure.

#plasticsurgery #boston #patienteducation

Draft body, not yet adapted

A section of Dr. Ashford's keynote from the autumn symposium, cut for length and republished here because the argument in it is one every patient considering rhinoplasty should hear. The skin envelope is the variable a surgeon cannot change and frequently the one that determines the outcome. Thin skin shows the framework, which means refinement is visible and so is every irregularity, and grafts have to be smoothed and camouflaged accordingly. Thick, sebaceous skin conceals the framework, which means a surgeon can build definition into the cartilage and the skin will simply not transmit it, and the swelling runs a great deal longer. Neither is better. They are different operations that share a name, and a plan drawn without accounting for the envelope is a plan that will disappoint somebody. This is why the pinch test at your consultation is not a formality, and why the honest projected timeline differs between two patients having what looks like the same procedure.

Draft body, not yet adapted

Mohs fellowship is a year of subspecialty training after a dermatology residency, and the unusual feature of it is that the surgeon and the pathologist are the same person. Most surgical specimens go to a laboratory where a different physician reads the slide and issues a report days later. In Mohs, the person who removed the tissue processes it, orients it against a hand-drawn map, reads the margin under a microscope in the same building, and decides on the spot what happens next. The advantage is that no information is lost between the operating chair and the slide, because the person reading it knows exactly which edge corresponds to which part of the wound. The training is about learning to read frozen sections reliably, which is a genuinely different skill from reading a standard fixed specimen and is where most of the year goes. Dr. Venable completed hers in 2016. It is also why the practice will not run a Mohs day without her present, and why those days are limited to one a week.