Ep. 127 In-Office Facelifts with Dr. Demetri Arnaoutakis

09/05/23 • 53 min

In this episode of BackTable ENT, Dr. Demetri Arnaoutakis, a facial plastic surgeon, and host Dr. Gopi Shah discuss planning and execution of in-office facelifts.

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SHOW NOTES

First, Demetri and Gopi begin with discussion of the clinic intake visit. During a first visit, Demetri takes time to understand each patient’s goals and priorities as they relate to their appearances. Using this knowledge, he walks each patient through all possible treatment choices, then helps the patient decide the best path forward. He takes a detailed procedural/surgical history and performs a top-down examination of the patient’s face.

Then, Demetri describes different surgical and non-surgical options to improve facial aesthetics. He divides these options into non-invasive (micro-needling, fillers, Botox), minimally invasive (radiofrequency-assisted lipolysis), and surgical (facelift). Demetri explains multiple approaches to facelift, noting that he tends to prefer a deep-plane approach that mobilizes the superficial musculoaponeurotic system (SMAS). Demetri then shares pearls from his practice about optimal incision sites, the importance of acquiring the right instruments, and the addition of tranexamic acid to tumescent anesthesia to reduce risk of hematoma.

Finally, Demetri outlines his post-operative management. In addition to standard post-operative protocols, his patients undergo hyperbaric oxygen treatment to increase oxygen delivery to tissues and lymphatic massage to aid lymph drainage. The episode wraps up with Demetri’s advice to listeners wanting to improve their cosmetic surgical skills.

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RESOURCES

Dr. Arnaoutakis’ website:

https://www.drdemetrimd.com/

In this episode of BackTable ENT, Dr. Demetri Arnaoutakis, a facial plastic surgeon, and host Dr. Gopi Shah discuss planning and execution of in-office facelifts.

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SHOW NOTES

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RESOURCES

Dr. Arnaoutakis’ website:

https://www.drdemetrimd.com/

Previous Episode

Ep. 126 Odontogenic Sinusitis with Dr. John Craig

In this week’s episode of Backtable ENT, Dr. Ashley Agan and Dr. Gopi Shah talk with Dr. John Craig, chief of Rhinology and co-director of the Skull Base Center at Henry Ford Health in Detroit, about odontogenic sinusitis (ODS).

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SHOW NOTES

The episode begins by hearing about John’s path to rhinology and his work and research interests in ODS. First, John defines ODS and contrasts it with chronic rhinosinusitis (CRS). He notes that the cardinal symptoms of CRS are the same as ODS but for ODS, these symptoms are unilateral, such as unilateral nasal obstruction, unilateral nasal drainage and unilateral facial pressure. Also, a foul smell is a very common symptom of ODS.

The conversation then transitions to discussing the role of dental history in ruling in ODS. John explains his oral exam process and questions he asks related to a patient’s dental history such as upper dental pain, root canals, extractions, dental implants and dental bridges. Interestingly, current research has shown only 20-40% of patients have dental symptoms such as dental pain. The group discusses how insurance coverage plays a role in the treatment management patients with ODS may undergo, and John notes the importance of collaborating with dental providers for endodontic testing and imaging that includes dental roots.

John further delves into what he is looking for on an endoscopy exam including unilateral purulent drainage from the middle meatus, edema and polyps. CT sinus usually shows unilateral maxillary sinus opacification.

Then, John explains how he groups patients in two groups, treatable and untreatable dental pathologies, to help in deciding management of patients with ODS. Treating the sinus and the treatable dental pathology (i.e.-closure of oroantral fistula) will help the condition resolve in the majority of cases. Timing of treating the dental pathology and sinus surgery is complicated, but taking into account the patient’s symptom burden can help decide timing of these procedures. When there is no treatable dental pathology, management options include antibiotics (to temporize symptoms) and endoscopic sinus surgery (ESS) with 98% success. The episode concludes with the group discussing the role of ESS for ODS.

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RESOURCES

PubMed (Link to John’s list of Publications):

https://pubmed.ncbi.nlm.nih.gov/?term=Craig%20JR&cauthor_id=32656998

Next Episode

Ep. 128 Free Flaps 101 with Dr. Eli Gordin

In this episode of BackTable ENT, Dr. Eli Gordin, microvascular surgeon at UT Southwestern, joins hosts Dr. Gopi Shah and Dr. Ashley Agan to discuss free flap surgery. This high-yield episode walks listeners through the basics of microvascular surgery, from indications to management of surgical complications.

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CHECK OUT OUR SPONSOR

Cook Medical Otolaryngology

https://www.cookmedical.com/otolaryngology

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SHOW NOTES

First, the surgeons discuss pre-operative management of free flap patients. The most common indications for microvascular surgery in otolaryngology include head & neck cancers. In his pre-operative clinic visits with free flap patients, Eli answers questions about surgery, hospital stay, and recovery. In his experience, patients often don’t understand the extensive nature of these surgeries prior to this visit, so he spends time explaining what a flap is and what the hospital course will look like.

Then, Eli speaks about his experience with virtual surgical planning, which entails remote meetings with engineers. He admits that the learning curve to virtual surgical planning is steep, but that contemplating reconstruction with the help of virtual planning helps him better account for details at the time of surgery. Gopi and Ashley then inquire about surgery and peri-operative management of these patients. Eli addresses vital topics including surgical technique, fluid management, and thrombosis risk.

Finally, the podcast addresses post-operative management of free flap patients. Eli briefly outlines his free flap protocol, emphasizing physical exam signs that indicate need for an OR takeback. He leaves listeners with an important insight: when surgeons have any doubts regarding the viability of a flap, they must return to the OR quickly: the best look they can get at a troubled flap is the one obtained in the OR.