Every category, rendered.

Draft body, not yet adapted

Dr. Ashford teaches a rhinoplasty anatomy session for residents twice a year, and the recurring question from the room is about septal extension grafts: when to use one, how to size it, and how to judge how much support it is actually providing under load. It is an unglamorous piece of the operation. It does not appear in any photograph a patient will ever look at, and it is a substantial part of why a tip is in the same place at year five as it was at year one. Publishing a section of the teaching session is deliberate. If the material is good enough for surgeons in training then it is good enough for a patient who wants to understand what they are consenting to, and this audience has repeatedly demonstrated that it prefers the version that has not been simplified for it. The full session is not published; this is one segment, recorded with the residents' agreement and with nothing identifiable in frame.

Draft body, not yet adapted

Post-operative anxiety is mostly an information problem, and the fix is a clear division between what is expected and what is not. Expected: swelling that is worse on waking and improves through the day, asymmetric swelling where one side settles faster than the other, and numbness in the tip or the cheek skin that resolves over weeks to months. None of those require a call, though you are welcome to make one. Call the office the same day for: pain that is escalating rather than settling, particularly if it is one-sided; fever; a sudden change in swelling rather than a gradual one; or any bleeding that does not stop with fifteen minutes of pressure. The reason for writing this down is that the two categories feel identical at two in the morning, and a patient who cannot tell them apart either calls about everything or, much worse, waits on the one thing that mattered. Every patient here leaves with this list on paper and the after-hours number on the same page.

Draft body, not yet adapted

Post-operative anxiety is mostly an information problem, and the fix is a clear division between what is expected and what is not. Expected: swelling that is worse on waking and improves through the day, asymmetric swelling where one side settles faster than the other, and numbness in the tip or the cheek skin that resolves over weeks to months. None of those require a call, though you are welcome to make one. Call the office the same day for: pain that is escalating rather than settling, particularly if it is one-sided; fever; a sudden change in swelling rather than a gradual one; or any bleeding that does not stop with fifteen minutes of pressure. The reason for writing this down is that the two categories feel identical at two in the morning, and a patient who cannot tell them apart either calls about everything or, much worse, waits on the one thing that mattered. Every patient here leaves with this list on paper and the after-hours number on the same page.

Draft body, not yet adapted

Hyaluronic acid fillers are usually described as lasting six to eighteen months depending on the product. That range is real but it hides most of the story. Longevity depends on where the material sits, how much movement that area sees, how much was placed, the individual rate of turnover, and, at deeper planes, the fact that some products integrate rather than simply degrade. Filler placed on bone in a low-movement area routinely outlasts the same product placed superficially in a mobile one, sometimes by a year. Imaging studies have found material still present well beyond the quoted duration in some patients, which is one reason the honest answer to how long will this last is a range and a shrug rather than a figure. Claire's practice is to treat conservatively, reassess at four weeks, and let the individual pattern of longevity emerge over the first two treatments rather than promise a schedule. If a provider gives you a confident single number, they are quoting a brochure.

Draft body, not yet adapted

Hyaluronic acid fillers are usually described as lasting six to eighteen months depending on the product. That range is real but it hides most of the story. Longevity depends on where the material sits, how much movement that area sees, how much was placed, the individual rate of turnover, and, at deeper planes, the fact that some products integrate rather than simply degrade. Filler placed on bone in a low-movement area routinely outlasts the same product placed superficially in a mobile one, sometimes by a year. Imaging studies have found material still present well beyond the quoted duration in some patients, which is one reason the honest answer to how long will this last is a range and a shrug rather than a figure. Claire's practice is to treat conservatively, reassess at four weeks, and let the individual pattern of longevity emerge over the first two treatments rather than promise a schedule. If a provider gives you a confident single number, they are quoting a brochure.

Draft body, not yet adapted

The exam is more thorough and less uncomfortable than most people expect. You change into a gown. Dr. Venable starts at the scalp and parts the hair in sections, then works down the face, behind and inside the ears, the neck, and along the hairline at the back. Arms including the underside, between the fingers, and the nail beds. Torso, front and back. Legs, then the soles of the feet and between the toes. A dermatoscope, which is a lit magnifier held against the skin, comes out for anything she wants a closer look at, and using it is not a signal that something is wrong. You are welcome to keep a gown on throughout and to say no to any part of it. Anything suspicious is photographed with your permission, measured, and either biopsied that visit or scheduled for a short interval recheck. The whole thing takes about thirty-five minutes. The single most common reason people delay is not fear of the result, it is not knowing what happens in the room, which is a solvable problem and the reason this exists.

Draft body, not yet adapted

The exam is more thorough and less uncomfortable than most people expect. You change into a gown. Dr. Venable starts at the scalp and parts the hair in sections, then works down the face, behind and inside the ears, the neck, and along the hairline at the back. Arms including the underside, between the fingers, and the nail beds. Torso, front and back. Legs, then the soles of the feet and between the toes. A dermatoscope, which is a lit magnifier held against the skin, comes out for anything she wants a closer look at, and using it is not a signal that something is wrong. You are welcome to keep a gown on throughout and to say no to any part of it. Anything suspicious is photographed with your permission, measured, and either biopsied that visit or scheduled for a short interval recheck. The whole thing takes about thirty-five minutes. The single most common reason people delay is not fear of the result, it is not knowing what happens in the room, which is a solvable problem and the reason this exists.

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.

Draft body, not yet adapted

Skin cycling describes rotating active ingredients across a four-night schedule with recovery nights built in. It is worth being clear about what it is and is not. It is not a treatment or a mechanism; it is a scheduling structure, and the structure encodes advice dermatologists have given for decades, which is that layering multiple actives nightly causes barrier irritation and that irritation is the most common reason people abandon an otherwise reasonable routine. Framed that way it is genuinely useful, particularly for people starting a retinoid. What it will not do is change what the ingredients themselves are capable of, and the specific four-night pattern is not evidence based against any other spacing. If your skin tolerates a nightly retinoid, cycling offers you nothing. If it does not, spacing works and the name attached to the spacing is irrelevant. Dr. Venable's view is that the trend is harmless, occasionally helpful, and considerably less important than whether the routine gets followed at all.

Draft body, not yet adapted

Skin cycling describes rotating active ingredients across a four-night schedule with recovery nights built in. It is worth being clear about what it is and is not. It is not a treatment or a mechanism; it is a scheduling structure, and the structure encodes advice dermatologists have given for decades, which is that layering multiple actives nightly causes barrier irritation and that irritation is the most common reason people abandon an otherwise reasonable routine. Framed that way it is genuinely useful, particularly for people starting a retinoid. What it will not do is change what the ingredients themselves are capable of, and the specific four-night pattern is not evidence based against any other spacing. If your skin tolerates a nightly retinoid, cycling offers you nothing. If it does not, spacing works and the name attached to the spacing is irrelevant. Dr. Venable's view is that the trend is harmless, occasionally helpful, and considerably less important than whether the routine gets followed at all.

Draft body, not yet adapted

Twenty two seconds of unedited macro footage of a donor area at working magnification. Follicular units of one, two, three and four hairs are visible and countable. This is the view a density measurement is taken from, and it is the reason a photograph from across a room cannot substitute for it.

Instagram caption

Transplanted hairs commonly shed in the second to fourth week after placement while the follicle beneath stays where it was put. The follicle then re-enters a growth phase on its own schedule. Patients who were not told this in advance conclude the procedure failed. Telling people before they book is part of the job.

#hairrestoration #scottsdale #patienteducation #askthedoctor #consultfirst

Draft body, not yet adapted

Transplanted hairs commonly shed in the second to fourth week after placement while the follicle beneath stays where it was put. The follicle then re-enters a growth phase on its own schedule. Patients who were not told this in advance conclude the procedure failed. Telling people before they book is part of the job.

Draft body, not yet adapted

The procedure itself is not painful because the scalp is fully anesthetized. The injections that produce that anesthesia are uncomfortable for a few minutes, and the donor area is sore for several days afterward. Anyone who answers this question with the word painless has skipped two of the three parts.

Instagram caption

The procedure itself is not painful because the scalp is fully anesthetized. The injections that produce that anesthesia are uncomfortable for a few minutes, and the donor area is sore for several days afterward. Anyone who answers this question with the word painless has skipped two of the three parts.

#hairrestoration #scottsdale #patienteducation #askthedoctor #consultfirst

Draft body, not yet adapted

A meaningful share of our patients fly for a living, which makes scheduling a clinical question rather than an administrative one. The recipient area needs about ten days without headset pressure or a tight hat. We build the date backward from the roster instead of asking anyone to rearrange it.

Draft body, not yet adapted

A meaningful share of our patients fly for a living, which makes scheduling a clinical question rather than an administrative one. The recipient area needs about ten days without headset pressure or a tight hat. We build the date backward from the roster instead of asking anyone to rearrange it.

Draft body, not yet adapted

Growth is uneven for the first two seasons and comparing month four to month five tells you almost nothing. Month nine is the first point where a density count means something, and month twelve to fourteen is when the result is fair to judge. We book the month nine appointment on the day of surgery.

Draft body, not yet adapted

Between leaving the donor area and being placed, a graft is out of the body. Temperature, holding solution and time out are all controlled, and they are the variables that most affect whether a follicle survives the move. It is the least photogenic part of the procedure and one of the most consequential.

Instagram caption

Between leaving the donor area and being placed, a graft is out of the body. Temperature, holding solution and time out are all controlled, and they are the variables that most affect whether a follicle survives the move. It is the least photogenic part of the procedure and one of the most consequential.

#hairrestoration #scottsdale #patienteducation #askthedoctor #consultfirst

Instagram caption

Abdominoplasty is discussed as if it were about skin, and the skin is only half of it. Beneath it, the two vertical bands of the abdominal wall can separate during pregnancy and stay separated afterward, which is why some women find that no amount of training changes the shape of the midline. Board-certified Dr. Elise Rowan repairs that separation with internal sutures before any skin is removed. It is the part of the operation you cannot see in a photograph and the part that determines whether the result holds. Recovery is significant and restrictions on lifting last several weeks.

#plasticsurgery #nashville #patienteducation #askthedoctor #consultfirst

Draft body, not yet adapted

Abdominoplasty is discussed as if it were about skin, and the skin is only half of it. Beneath it, the two vertical bands of the abdominal wall can separate during pregnancy and stay separated afterward, which is why some women find that no amount of training changes the shape of the midline. Board-certified Dr. Elise Rowan repairs that separation with internal sutures before any skin is removed. It is the part of the operation you cannot see in a photograph and the part that determines whether the result holds. Recovery is significant and restrictions on lifting last several weeks.