In this week's edition
- ✍️ Letter from P'Fella
Are we treating birthdays or bodies? - 🤓 The Sunday Quiz
*Drumroll🥁* announcing the winners! - 🖼️ Image of the Week
Sagittal craniosynostosis - preoperative 3D CT. - 🚑 Technique Tip
Recreating the levator sling in cleft palate repair. - 🎈 Upcoming Events
Newly added craniofacial & cleft conferences. - 🔥 Articles of the Week
Cleft lip/palate evaluation parameters, Pittsburgh fistula classification, & pharyngeal flap outcomes: With 1-sentence summaries. - 💕 Feedback
Suggest ideas & give feedback!
A Letter from P'Fella
Are We Treating Birthdays or Bodies?
Teens: Breast Reduction Rules the Roost
If you’ve ever treated a teenager with symptomatic macromastia, none of this is surprising. Back pain, shoulder grooves, embarrassment in school, PE avoidance — it’s heavy stuff for a young person. So yes, this is the decade where reduction surgery sits comfortably at the top. And honestly? It’s one of the most instantly gratifying procedures in the whole specialty.
20s & 30s: The Breast Augmentation Years
This group is classic:
- In your 20s, you finally have independence and can act on an insecurity you might have carried for years.
- In your 30s, pregnancy and breastfeeding have done their thing, and patients want a return to their pre-baby shape.
The overall vibe? Natural, proportionate, athletic. Even in Texas, apparently. And with new implants like Motiva pushing surgeons to rethink submuscular vs subglandular placement, this space is evolving fast.
40-55: Liposuction Steps Into the Spotlight
This is the decade where metabolism slows, hormones shift, and weight redistributes… often in the most inconvenient places. So liposuction becomes the go-to move, especially for people who genuinely take care of themselves but still have the stubborn flank/saddlebag/bra-roll areas that literally laugh at diet and exercise.
Add in how common it is to pair lipo with tummy tucks and lifts, and it’s no surprise this age group accounts for nearly half of all lipo procedures.
55+: Eyelids Take Centre Stage
Blepharoplasty becomes the star attraction here, and for good reason.
Patients hit the point where hooding, puffiness and the “I slept eight hours but still look tired” look finally pushes them toward something more durable than Botox and filler.
Fast recovery, discreet scars and a huge payoff? No wonder it’s popular.
The Real Takeaway
Zoom out and the pattern is crystal clear:
- Teens: Remove the burden
- 20s-30s: Add volume
- 40-55: Shape the contour
- 55+: Brighten the eyes
It’s not dramatic. It’s not philosophical. It’s simply how our bodies change and how people choose to keep up.
With love,
P’Fella ❤️
The Sunday Quiz
*Drumroll🥁* Announcing the Winners!
We're thrilled to announce the winners of this edition's quiz. After seven rounds of questions on plastic surgery, we have our top scorers! The winners will receive a copy of our textbook, Foundations, at a discount.
We truly appreciate everyone who took part, and we wish you the best of luck for the next round!
Image of the Week
Sagittal Craniosynostosis - Preoperative 3D CT
This week’s image is a preoperative 3D CT of sagittal craniosynostosis, showing a classic scaphocephalic skull and a fused sagittal suture. Early diagnosis on imaging opens the door to endoscopic strip craniectomy with postoperative helmet therapy when the child presents before 3-4 months.
Takeaway: Don’t just recognise the scaphocephalic shape. Use the 3D CT to decide if your patient still qualifies for a less invasive, growth‑friendly endoscopic option.
Technique Tip
Recreating the Levator Sling in Cleft Palate Repair
In a Furlow double-opposing Z-plasty, the levator repair is the operation, not an add-on. Treat the levator as a mislocated muscle: dissect it off the posterior hard palate, retroposition the bellies onto the posteriorly based soft palate, and re-approximate them in a transverse sling within the opposing oral and nasal Z-flaps.
The Z-plasty both lengthens the palate and hides your intravelar veloplasty inside well-vascularised, interdigitating flaps, improving velopharyngeal closure while keeping tension off the midline.
Don’t start closing until you can see the full levator bellies and the reconstructed sling sitting at the hard-soft palate junction where it actually belongs.
Upcoming Events
Newly Added Craniofacial & Cleft Conferences
Articles of the Week
3 Interesting Articles with One-Sentence Summaries
US multidisciplinary guidance emphasizing SLP-led perceptual evaluation, nasopharyngoscopy for suspected VPI, and coordinated timing of secondary procedures with orthodontics and alveolar bone grafting.
A standardized, location-based system that improves reporting, communication, and selection of repair strategy from local two-layer closure to buccal/tongue flaps for wide anterior defects.
Matched to closure pattern, pharyngeal flap and sphincter pharyngoplasty yield comparable resonance outcomes, with measurable OSA risk for both, reinforcing endoscopy-led selection and careful port sizing especially in syndromic or obese children.
