Nicholas Haddock, M.D. Answers Questions On: Plastic Surgery and Orthopaedic Surgery

Microsurgery is the process of moving tissue – with its blood supply – from one part of the body to another. We have to use a microscope for the procedure because these blood vessels can be as small as 1.5 millimeters in size.

Microsurgery allows me to work in multiple areas of the body and solve problems with many different options. It is also very precision-oriented, and I enjoy the technically challenging nature of it.

There are many options in breast reconstruction: tissue expander/implant-based reconstruction; immediate implant reconstruction; combined autologous flap and implant reconstruction, and autologous flap microsurgery. I have experience in all of these options, so I can offer my patients the full spectrum of breast reconstruction.

I’m skilled in the DIEP (deep inferior epigastric artery perforator) flap procedure, which allows me to use the patient’s own abdominal tissue to reconstruct the breast. I also perform the PAP (profunda artery perforator) flap procedure, where I use posterior thigh tissue to build the breast. Patients who have had previous abdominal surgery, or those who do not have enough abdominal tissue, would be the prime candidates for this type of surgery.

I worked with Bob Allen, M.D., the pioneer of the DIEP flap and PAP flap procedures, at New York University’s Langone Medical Center. In fact, I was involved in writing the sentinel paper about the PAP flap. I also worked on the first 20 cases in New York. Not many surgeons have this particular type of experience. 

I’m seeing a lot of patients with carpal tunnel and cubital tunnel syndrome. Most people have heard of carpal tunnel syndrome, which is compression of a nerve in the wrist. Cubital tunnel syndrome is also a nerve compression, but it is located near the elbow. The most common symptom for these syndromes is numbness of the fingers. It often wakes you at night. The first line of treatment is often splinting; however, if unsuccessful, a short outpatient procedure is often required.

It is almost exactly what it sounds like – when you bend your finger, it gets caught, or locks, in the position of pulling a trigger and will not extend very easily.

The fingers work by a tendon gliding through a pulley system. An imbalance in these structures causes this condition. There are different grades of trigger finger. In some situations your finger simply hurts and in more advanced cases your finger locks.

I can treat trigger finger with steroid injections, which generally work well. If they are unsuccessful, a straightforward procedure can be performed in which the pulley is opened to allow the tendon to glide freely.

In situations of acute trauma or in chronic injuries, I will coordinate an individualized treatment plan. In some situations I can use local tissue, but in other cases these reconstructive efforts require the use of distant tissue. With microsurgery experience, I can offer both soft tissue reconstruction or bone reconstruction.

The body changes significantly with pregnancy, and unfortunately it doesn’t automatically spring back into pre-baby shape. The Mommy Makeover can help, and it often includes a tummy tuck, breast lift, breast augmentation, or breast lift with augmentation.

In most situations, results are optimized if you wait until after all pregnancies are completed. In addition, before having any Mommy Makeover or body contouring procedure, if the patient smokes, he or she should stop. Smoking can significantly raise the risk of complications, especially when an abdominoplasty is part of the surgical plan.

To help rejuvenate the periorbital area, there are a number of options. An upper eyelid blepharoplasty helps rejuvenate the upper eyelid and often involves removal of skin and some fat. A lower eyelid blepharoplasty often involves removal of skin, repositioning or removal of fat, and potentially redraping of eyelid muscles.  In some patients, other areas of the face and brow should also be addressed to optimize the overall result. 

The movement of surgery in general, especially plastic surgery, is toward more minimally invasive procedures. For instance, we are often able to delay cosmetic surgeries, such as a face lift, sometimes for years, because patients have options such as Botox and fillers to help create a look that is more youthful. They are not substitutes. However, nonsurgical options can camouflage the signs of aging for some patients.