Dr. Darryl Hodgkinson

Over a 5-year period, my technique of approaching and modifying the aging neck has changed from direct suturing of the medial platysma bands and strong posterior traction of the platysma to superior elevation of the posterior platysma and strong fixation to the tympanoparotid fascia. When indicated, redundant anterior platysmal bands are resected instead of approximated. Evaluation of these anterior bands preoperatively for thickness and degree of descent allows more precise decision-making… Show more

Over a 5-year period, my technique of approaching and modifying the aging neck has changed from direct suturing of the medial platysma bands and strong posterior traction of the platysma to superior elevation of the posterior platysma and strong fixation to the tympanoparotid fascia. When indicated, redundant anterior platysmal bands are resected instead of approximated. Evaluation of these anterior bands preoperatively for thickness and degree of descent allows more precise decision-making regarding the need to resect redundant and excessively thick or long anterior platysmal bands. The added advantage of the strong fixation of the platysma in a vertical fashion to Loré’s fascia (the tympanoparotid fascia) leads not only to an improvement in the contour of the jawline and submental area but also to the undervalued aesthetic feature of a defined contour and visually increased length of the sternomastoid muscle Show less

Thermage is a nonsurgical treatment for sagging skin in the jowl, neck, and eyelids. Abdominal striae, loose upper arm skin and buttock sagging, and improvement of the appearance of cellulite have become amenable to the radiofrequency treatment. Radiofrequency passed through cooled epidermis allows for radiofrequency-induced thermal damage to the dermis and deep dermal collagen (fibrous septae). The remodeling of the collagen leads to clinically discernible improvement in the sagging skin and… Show more

Thermage is a nonsurgical treatment for sagging skin in the jowl, neck, and eyelids. Abdominal striae, loose upper arm skin and buttock sagging, and improvement of the appearance of cellulite have become amenable to the radiofrequency treatment. Radiofrequency passed through cooled epidermis allows for radiofrequency-induced thermal damage to the dermis and deep dermal collagen (fibrous septae). The remodeling of the collagen leads to clinically discernible improvement in the sagging skin and skin quality; the remodeling of deep dermal collagen (fibrous septae) allows modeling of contours and improvement of the cellulite appearance.

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Nasal augmentation is a highly popular technique used among Asian patients to change the characteristic flat Asian nose to a more prominent nose. The extent of augmentation is determined by the aesthetic desires of the patient, and the method of augmentation is provided by the surgeon, who takes into account the technical limitations of his or her preferred technique and the proposed surgical result. Although a silicone prosthesis is the most common implant used to improve the nasal appearance,… Show more

Nasal augmentation is a highly popular technique used among Asian patients to change the characteristic flat Asian nose to a more prominent nose. The extent of augmentation is determined by the aesthetic desires of the patient, and the method of augmentation is provided by the surgeon, who takes into account the technical limitations of his or her preferred technique and the proposed surgical result. Although a silicone prosthesis is the most common implant used to improve the nasal appearance, the author prefers an autogenous approach with the olecranon bone used as a dorsal implant and conchal cartilages used to improve nasal tip projection because of the long-term stable results. A series of 31 cases over 15 years is reviewed. The technique varies little from that described for saddle nose by Hodgkinson in 1992 [5]. The procedure is a variation of the ulnar donor site originally described by Antia et al. [1].
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Augmentation of the upper limb, except for the pectoralis major using pectoral implants, has been somewhat taboo for plastic surgeons. Deformities of the upper limb and muscular deficiencies, however, are aesthetically unattractive or result in unacceptable asymmetries. The following implants have been used for reconstruction of the upper limb after trauma: deltoid, triceps, and biceps. Following the dictum that the implant needs to be placed beneath the muscle (i.e., on the humerus for the… Show more

Augmentation of the upper limb, except for the pectoralis major using pectoral implants, has been somewhat taboo for plastic surgeons. Deformities of the upper limb and muscular deficiencies, however, are aesthetically unattractive or result in unacceptable asymmetries. The following implants have been used for reconstruction of the upper limb after trauma: deltoid, triceps, and biceps. Following the dictum that the implant needs to be placed beneath the muscle (i.e., on the humerus for the deltoid and the triceps, and underneath the brachialis for the biceps muscles), these implants are deep and act as spacers affording the establishment of more volume and symmetry. Access incisions make use of incisions previously placed for the repair of previous trauma, fractures of the upper limb, or the repair of muscle. Most aesthetic surgeons are not familiar with this anatomy, and revision for the morbid anatomy of the upper limb is important. Familiarity with the major nerves of the upper limb is paramount, particularly familiarity with the radial, ulnar, median, and circumflex humeral nerves. Show less

Body dysmorphophobia (BDD) is a psychiatric illness experienced by up to 20% of patients requesting cosmetic surgery. Because of its diverse presentations, BDD should be searched out and recognized by the plastic surgeon. Otherwise, the unwary operator will invariably have to deal with a profoundly dissatisfied patient. Patients with BDD hate their bodies and may seek out cosmetic surgery as a solution. However, they invariably are not satisfied despite the objective result. Many eventually… Show more

Body dysmorphophobia (BDD) is a psychiatric illness experienced by up to 20% of patients requesting cosmetic surgery. Because of its diverse presentations, BDD should be searched out and recognized by the plastic surgeon. Otherwise, the unwary operator will invariably have to deal with a profoundly dissatisfied patient. Patients with BDD hate their bodies and may seek out cosmetic surgery as a solution. However, they invariably are not satisfied despite the objective result. Many eventually fall into the cosmetic surgical victim category of “overoperation.” These patients need psychological counseling and referral to psychiatrists with a special interest in body image. Recognition and deferral of surgery for BDD patients is advised because findings have shown the propensity of these patients to litigate, threaten, and even harm or kill their surgeon.

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Background Skin lifting alone in face-lifting surgery is limited to minor lifts in younger patients. The extent of skin undermining depends on the operative plan.

Aims An optimal aim is to minimize the amount of undermining to achieve a pleasing, natural rejuvenated result.

Results By respecting the extensive network of the dermal vascular plexus and by good surgical technique, ischaemia of the elevated skin may be minimized.

Conclusion Moderate to maximal lifting, however,… Show more

Background Skin lifting alone in face-lifting surgery is limited to minor lifts in younger patients. The extent of skin undermining depends on the operative plan.

Aims An optimal aim is to minimize the amount of undermining to achieve a pleasing, natural rejuvenated result.

Results By respecting the extensive network of the dermal vascular plexus and by good surgical technique, ischaemia of the elevated skin may be minimized.

Conclusion Moderate to maximal lifting, however, has proven to be anatomically sound in over 1500 cases operated on over the last 20 years using classical face-lift techniques to correct the pathoanatomy of the ageing face.
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