About the Doctor

Dr. Derek Steinbacher: Transforming Lives with Precision and Care

Dr. Derek Steinbacher interview
Embark on a transformative journey with Dr. Derek Steinbacher, a double board-certified plastic surgeon. Witness the artistry of facial refinement, restoring confidence in patients worldwide. Experience the profound impact of precision and compassion in this inspiring video.

My name is Derek Steinbacher. I’m a plastic surgeon and I focus on refinement, function, and aesthetics in the areas that I treat. I’m a double board-certified surgeon, certified both in plastic surgery and oral and maxillofacial surgery. I treat patients coming from all walks of life and from all over the world. We frequently see national and international patients that fly in for treatment. I focus a lot on regions of the face, so this includes rhinoplasty, corrective jaw surgery or orthognathic surgery, facelift, facial rejuvenation, eyelid surgery, and facial sculpting. I also do cosmetic surgery involving the breast and body, again, focusing on refinement, proportions, aesthetics, and restoration. I also work a lot with children who have facial differences, including cleft lip and palate, craniosynostosis or other skull deformities, jaw deformities, or other areas that they’re born with, affecting the face and head and neck region. Going through the entire process of the surgery and then seeing that result and seeing the satisfaction on their face, the smiles on their face when we’re getting to where we want to be, the happiness, the satisfaction, the improved sense of self-confidence and appearance that these patients and their families have is very gratifying.


Dive deep into orthognathic rhinoplasty surgery with Dr. Derek Steinbacher.

The Rhinoplasty Podcast by Dr Derek Steinbacher
"Listen to Dr. Derek Steinbacher explain everything you wanted to know about orthognathic rhinoplasty on The Rhinoplasty Podcast hosted by Dr. Cameron McIntosh. What are orthognathic and rhinoplasty surgeries? What does each procedure involve? Who could benefit from them? What are the technologies utilized? Tune into the podcast to learn all this and more. Dial (203) 453-6635 for a consultation with Dr. Steinbacher.

Dr. Steinbacher: To not just zoom in a hundred percent on the nose, but to zoom out a little bit and look to see is this the right thing to do the rhinoplasty at this point in time? Or should I do this in conjunction with a genioplasty? Are there things that we can do to alter the balance of the face?
Dr. Cameron: Ladies and gentlemen, welcome to another episode of the Rhinoplasty podcast with me, Dr. Cameron Macintosh. I’m super excited for this month, which is brought to us by Allergan. Thank you. Shout out to them for enabling the podcast for the month of March. The theme is the influences, the reason I’ve named it the influences or the people that are guests on this month have really had a great and a massive influence in the world of rhinoplasty, both from a professional but also from a lay side of things. And kicking this month off all the way from the US of A is no other than Derek Steinbacher. Derek, thank you so much for being on the show with us today.
Dr. Steinbacher: Thank you so much, Cameron. Thanks for having me, and excited to chat a little bit this morning.
Dr. Cameron: So Derek, off air, we were saying how different our geographies at the moment. I’m sitting in South Africa, 30 degrees Celsius, not a cloud in the sky. Tell the listeners where in the world are you at the moment?
Dr. Steinbacher: Yeah, so I’m in Connecticut, which is kind of New England, part of the United States near New York, and it’s snowing. It just snowed this week and so it’s cold and we’re in the thick of winter and I’m definitely envious of your temperature and looking forward to that happening here over the next few months. Cool.
Dr. Cameron: So Derek, we’ve got a really interesting topic that we’re going to chat about is really orthognathic surgery and not just being so focused on the nodes but realizing that there’s so much more involved in the facial skeleton, et cetera, et cetera. But before we climb into that topic, and I know we spoke about it, that you’ll be able to share both for the listeners who are not necessarily surgeons, but also really some key take home messages for the surgeons. Give us a little bit about your history. How did you end up, where you at now? Yeah, for interest’s sake.
Dr. Steinbacher: Yeah, thanks. Yeah, so I started my training began actually going to dental school and I trained in some of the best centers in the US. I think I went to Penn for dental school and then I went on to do some maxillofacial training and I went to Harvard Medical School, finished oral maxillofacial surgery training there. That was at Mass General and Boston Children’s as well. And then went on to plastic surgery, plastic and reconstructive surgery at Johns Hopkins. And there had really the full gamut of learning and training about plastic surgery, not only the face, but breast and body as well. And then finished that off with training in craniofacial and cleft surgery back at 10 and at chop. And then since then I’ve been at Yale for the past 10 or 11 years and have been a full professor here as well. And rhinoplasty I think really has interdigitated with all of these interests and it’s something as a lot of your other guests have shared that you really have to have a passion for and you have to teach yourself in part as well. And so I started getting exposed to rhinoplasty really during my plastic surgery training and just started picking it up and running with it.
Dr. Cameron: Wow, sure. I know two of your colleagues from the Rhinoplasty Society are actually queued up to be for their podcast to go out later this month. Paul Nassif and Jay Calvert, you guys understand, are quite a small society, but goodness me, you guys punch above your weight.
Dr. Steinbacher: Yeah, so it’s the main society in the US plastic surgery sphere that focuses on rhinoplasty and it does incorporate people from ENT otolaryngology, head and neck specialty and facial plastic specialty and also plastic surgery. And it’s really a nice niche group that just gets together and focuses on rhinoplasty research and techniques and ways of furthering the field and specialty.
Dr. Cameron: So one of my best mates is one of the top maxillofacial surgeons in South Africa, Cyrus the virus, I won’t mention his name, but many guys know who I’m talking about. And he trained under one of the profs who was quite instrumental with a sagittal split technique as I understand. And I think that’s quite something that’s come out of South Africa. I know the South African maxillofacial surgeons do a huge amount of work and they’re super skilled in what they do. It’s really nice for me to hear that with your background with that and plastics and rhinoplasty that I hope that for the listeners from a maxillofacial site to realize that they can actually step up to the plate and do the work because they are exceptionally talented surgeons. But sometimes I kind of feel that they don’t quite feel that’s in their field of having to work. I don’t know what your thoughts are on that.
Dr. Steinbacher: Yeah, no, no, I agree. And they’re so interrelated, and firstly, they’re very similar in that it’s kind of modifying bony or cartilaginous skeleton. You’re changing the bones of something to influence the aesthetics or the cosmesis and the function of something. So when you move the jaws around, you’re certainly going to change aspects of the face and function related to the face and breathing and airway. And the same with rhinoplasty, you’re taking down bone or adding grafts and changing the structure underneath to have an influence. The other interesting thing is that one influences the other. So if you’re doing LeFort osteotomies, that’s going to have a major influence on the nose because we’re moving the pyriform and we’re changing septum and it can change how the nose looks. So we have to be able to anticipate that and be able to do things to modify the nose at a later date.
But interestingly, like you’re saying too, I think I’ll go to some maxillofacial meetings or where the focus is heavy on orthognathic surgery and there’s great results that are shown, but there’s such a little influence. There’s sort of less of an emphasis on the nose and how the nose looks and these great results are being shown, but the nose is kind of being ignored. And then conversely to that, I’ll go to rhinoplasty and plastic surgery and facial plastic surgery meetings and present there, and there’s so much emphasis on the nose, but people start forgetting a little bit about the face and miss VME and retrognathia and microgenia and those kinds of things. So they’re really interrelated and I think both of these things together are extremely powerful.
Dr. Cameron: So Derek, you’re kind of in a unique position between the two. What do you think is the way to try and marry them or bring them closer to each other?
Dr. Steinbacher: Yeah, I mean, I don’t know if every specialist wants to get involved in both of them necessarily. I don’t think that’s necessarily the goal. But I think just starting with education and a recognition that somebody’s coming with an airway concern, that to look beyond maybe your own sphere and make sure that you’re at least asking the questions related to how sleep apnea is coming about from maxillofacial discrepancies. And if you’re doing maxillofacial things, making sure you’re focusing on the nose and ensuring that if they have septal deviation or things like that. And from an aesthetic perspective, which is more and more of what I’m kind of focusing on, they’re really very married together. But again, I don’t know if every provider needs to necessarily do both procedures, but just having an awareness or education of them I think is paramount.
Dr. Cameron: Okay. So another question I have for you, which might almost be uncomfortable to answer, but I mean you’re an academic, I mean Yale, you can’t argue that maxillofacial and plastics, where does liquid rhinoplasty fit into the picture?
Dr. Steinbacher: So I still see the whole gamut of cosmetic patients and some patients that want to come with very little intervention and have very little downtime and have a mild deformity. There’s certainly an advantage to doing that, and we certainly offer that. I think one thing I’ve done a lot in my practice too, and we’ve written papers about this, is fat grafting and crushed cartilage and fat for the nose and for some of my primaries or revision rhinoplasties that we’re doing subtle asymmetries or depressions or those kinds of things are certainly can be amenable to aspects of filler based liquid rhinoplasty or sometimes fat injections as well.
Dr. Cameron: Okay, I had a really interesting chat with Alvin de Souza, the president of the EAFPS earlier this week, and he told me that he uses a large amount of Botox during rhinoplasty because he feels that especially on deviated noses or if you’re working in the radix et cetera, the muscles around the nose can have a big impact on the outcome of the rhinoplasty. I found that very interesting.
Dr. Steinbacher: Yeah, no, that’s a great point. I haven’t actually done that in rhinoplasty. I’ve done it for cleft lip for scar, helping mitigate the scar, and I do it in orthognathic to try to help prevent the masseter and temporalis muscle pull at the jaws. But it does make sense. And most of the time I’ll do orthognathic and then rhinoplasty stage, but sometimes we’ll do it together and maybe that’s an advantage because the muscles and the facial drape has all been inserted, which sometimes I think is a disadvantage, but from this perspective of the muscles and the muscles pull, maybe that’s an advantage to a deviated nose and removing some of that muscle pull on the nose. So that’s very interesting. But yeah, I think Botox has more and more applications all across aesthetics, not just aesthetic brow aging and forehead aging. So that’s very interesting.
Dr. Cameron: Oh, maybe there’s a study there, you can get some of your fellows to look into something like that. So obviously it’s been a long road for you to get where you’re at. What is the resilience that you’ve had to rely on to get where you are at, and paired with that is what do you do to be able to survive your off time? Because you can’t be just grafting as a prof at one of the Ivy League universities and working like you do. What do you do when you need the break?
Dr. Steinbacher: Yeah, no, sounds good. So in terms of resilience, I think just having this personal drive or having the interest in the topics and subjects that we’re doing, and a lot of it comes from the patients and we learn so much from the patients. I think we never just want to come in and be cookie cutter in terms of what we’re trying to do. I think especially when you’re combining new and different fields together and you’re trying to push the boundaries and push the envelope of what we’re trying to do and some of the results we’re trying to achieve, I think looking to our patients and really studying our before and afters, and I do a lot of 3D morpho metrics where you could really study results down the line and be critical and try to see what are things we can do or what techniques we’re using to make things better.
So I think I gain a lot of the things that we’re thinking about for the future based on patients and patient results and really just trying to be as good as we can be and better and push the envelope related to rhinoplasty and research related to that as well. And then yeah, certainly downtime is critical and you can’t work 24/7, 7 days a week and expect to not be veering towards burnout at all. So around here in New England, getting outside is good when possible this time of year, obviously skiing and in the summer months, out on the water and boating and out hiking in the spring and fall and those kinds of things. I think similar to you guys, you need to get outdoors and spend time with family and think about things outside of plastic surgery, just try to help refresh us as well and come up with new ideas.
Dr. Cameron: Okay, so before we get into more on the orthognathic side of things, one question in terms of the listeners that for, because actually quite a few lay people listen to the podcast all over the world now. What would your words of caution be to somebody who’s considering a rhinoplasty in terms of what they should be, their homework, they should be thinking about why they want it or who they should have it through, et cetera, for the listeners out there?
Dr. Steinbacher: Yeah, I mean I think one of the things that I’m commonly seeing or have seen to some extent is somebody will come and they’ve had either an incomplete rhinoplasty or they’ve had a full rhinoplasty but still have dysmorphology in their face or they’re unhappy with the cosmetics related to their face. And then it turns out that they’re really a candidate for orthognathic surgery and it’s possible and we have to do it all the time where we do the orthognathic after the rhinoplasty, but then the nose is going to change again and they may need a revision rhinoplasty. So in an ideal world, we would see a patient upfront and you would do the orthognathic surgery first if they’re a candidate for that, then the rhinoplasty as a second stage. So sometimes we’ll do it concurrently, but it’s the second part of the surgery. But most of the time, I’d say 80, 85% of the time I’ll do the rhinoplasty three or four months later.
And not everybody’s a candidate for both of these procedures certainly, but you’d be surprised how interrelated they are. A lot of the jaw deformities come about because of nasal obstruction. There’s a lot of studies from the early eighties and seventies where if there’s nasal obstruction, it leads to this vertical maxillary excess and mandibular lack of growth and those kinds of things. And people have had experience with trauma that have caused their nose to deviate or congenital deviation and they’re really fixated on one element of these things and not always recognizing how interrelated they are. So I would just say just be aware that these are interrelated, it’s all part of your face and that we want to be able to address everything and if it’s an ideal world, we’ll do the jaw surgery and then the rhinoplasty.
Dr. Cameron: Awesome. Okay. Really basic question. What exactly is orthognathic surgery and why would a patient need to have orthognathic surgery?
Dr. Steinbacher: Yeah, so orthognathic surgery, it’s basically movement of the jaws. It’s kind of cuts in the jaws where we reposition them in one place or another in space. And many of the times it’s the upper jaw, lower jaw and chin genioplasty together. And there’s all types of reasons that people want to do it. Most of the time it has to do with their jaw misalignment leads to some malocclusion. But we have some patients with perfect occlusion that want this procedure for strictly aesthetic reasons. And we have some patients that have a perfect occlusion that have both jaws are back and their airway is closed off and they have significant sleep apnea. So the fourth component really is the TMJs and you can have some TMJ issues that can either predispose you to jaw issues or they’re interrelated as well. So it’s those four things that we’re kind of addressing by orthognathic surgery.
Dr. Cameron: Awesome. Okay. So now moving on a little bit more towards our colleagues. Obviously various other people will be listening, but my first kickoff is a cone beam CT scan. So almost every single rhinoplasty I do, I’d insist on a cone beam CT scan. And to me, it’s interesting because a lot of people who say, no, you don’t need a scan, but what you pick up on it is massive. And the majority of my scans, I’ve also asked the maxillofacial just to look if there’s stuff that I might be missing at the same time, I think it’s an essential part of rhinoplasty, what do you think?
Dr. Steinbacher: Yeah, I mean I’m obviously biased towards cone beams as well, and I don’t know if I get it for every single rhinoplasty, cosmetic rhinoplasty, but we have a cone beam kind of in our center, so it makes it very straightforward and easy in the radiation dose is much, much lower and it’s not sending them across somewhere to a radiation or a radiology center for a full CT. It’s very easy. It takes 30 seconds. And I agree if there’s ever any doubt of some issues with their sinuses or if I’m looking at their jaws anyway, we definitely get a lot of cone beam CTs definitely before and after every orthognathic case. And we use this for 3D planning and it’s helpful there to be able to look at their nose and say, look, we’re going to change the position of your LeFort, but you have septal deviation that’s above where we’re going to be operating it. That’s not going to be fixed in this surgery. And that’s something we can do later with a rhinoplasty.
I think the other advantage of cone beam CTs is the research component. If you have before and afters, you can show how the septum is straight, you can show the volume of the nasal cavity, you can show the sinus change in sinus position and all those kinds of things. So I agree, I think there’s great research potential. There’s ability for algorithm construction and things like that when we’re talking about computers and looking at ways that we can predict soft tissue changes and airway changes. So I think it’s a great technology and ancillary really to our procedures.
Dr. Cameron: Yeah, I think you touched on that research. So one of the things that there’s a couple of us doing like international collaboration with Miguel Ferreira on looking at the differences from his side. It’s more in terms of the hump, but we don’t necessarily in South Africa, African humps isn’t really something that we see much of. But to try and look at the relations between the cartilages and the bony septum and how much there’s, because if we are doing an African nose, we need septum and there’s often not enough and the cone beams giving that ability to actually carefully measure that, which I find very interesting. Having said that, I think that there’s possibly, there’s such a discrepancy in reporting on CT scans of the nose with our radiology colleagues. Some guys will give a sentence and some guys can give you a page and I think there needs to possibly be a standardization of this is how a CT should be reported on, I don’t know what you think about that.
Dr. Steinbacher: Yeah, I know, absolutely. I usually don’t even look at the report, I’m just looking at it myself and they focus on the run. They just say the sinuses are aerated or something like that. So don’t, the septum has some deviation or they see a spur, but they don’t really comment on the areas that most of the time we’re really looking at. It’s interesting sometimes I find that it’s hard to distinguish between where the cartilaginous and the bony, where I think we can see the cartilaginous and the bony septum, but in some of these revision rhinoplasties, it’s hard to tell are they going to have any septum, any cartilaginous septum left or is that all just scar tissue there? And they have supposedly a septoplasty in the past and the septum is just so thick and inflamed looking on the cone beam. So sometimes I find it difficult from that perspective to be able to assess if there’s going to be any septum left or not.
Dr. Cameron: Okay. So here’s an interesting question for you. Imagine you’ve got two groups of people listening to you on this podcast. Now there are a whole lot of rhinoplasty surgeons be that plastics or ENT, and then there’s a whole lot of maxillofacial surgeons, the orthognathic side and the rhinoplasty side to try and get these guys to talk to each other. What would your main advice be towards the maxillofacial and then your main advice towards what are call the non-maxillofacial and incorporating some type of orthognathic principles into their surgery?
Dr. Steinbacher: Yeah, no, that’s great. So I think it starts with really if a patient’s presenting for orthognathic at whoever’s providing that a plastic surgeon, maxillofacial surgeon for them to understand what the movements are going to be and how that’s going to change the nose. So many of my patients these days, they want to know exactly how they’re going to look and there’s not really great algorithms related to that yet, but they come for aesthetic optimization and they want these procedures for cosmetic reasons and to look better and to function better. I know some of my colleagues, they’ll see these kinds of patients and they focus just on the occlusion or they don’t really think about the face as a whole. Not everybody obviously, but some people or some providers may do that. And I think it’s incumbent upon them and to give their patients some estimation of how their nose is going to be influenced by this.
And patients always appreciate it if you say, we’re going to do this, your nose is going to look worse and you’re going to need a procedure as opposed to doing the procedure. And then it’s kind of a surprise to everybody. So as much as we can anticipate how that’s going to change and if they’re going to need that procedure in the future, I think would be ideal. And then before even doing any surgery at all, making sure that that provider has seen the patient and says, yes, we’ll be able to take care of any untoward change in your nasal shape or appearance or function. We know with certain movements the alar base is going to widen, the nasal tip might turn up more. There might be worse in septal deviation. The terminates might become close to the maxillary floor and cause more obstruction. So as much as we can or whoever’s doing orthognathic can predict that the better.
And then conversely, on the side of the rhinoplasty side, and we just had a symposium on this, a further rhinoplasty society about genioplasty and facial profile to not just zoom in a hundred percent on the nose, but to zoom out a little bit and look to see is this the right thing to do the rhinoplasty at this point in time or should I do this in conjunction with a genioplasty? Are there things that we can do to alter the balance of the face and if there’s a malocclusion, maybe before jumping into the rhinoplasty, let’s have you see this specialist to at least talk to you about the pros and cons and benefits and risks of undergoing orthognathic surgery first before the rhinoplasty. I think if there’s good communication and with all of our colleagues like this, I think that’ll be the best for the patients.
Dr. Cameron: Sure. Okay. So rule of thumb would be first get the orthognathic surgery sorted out, wait for three or four months and then get the rhinoplasty. You wouldn’t consider doing them both in the same setting?
Dr. Steinbacher: I do do them at the same setting. We wrote a paper about this a few years ago, but I find for a few reasons I prefer to do them staged in about 80% of the cases. The first reason is terms of anesthesia. When you’re undergoing these procedures, you have a nasal ray tube placed by anesthesia to do the jaw surgery. Then on your freshly operated jaws, the anesthesia team needs to come and turn that tube, take that tube out and convert it to an oral tube to do the rhinoplasty. And then secondly, the patients, you’re a little bit, we don’t wire anybody together, but they have pretty tight rubber bands holding their jaws closed. So it can be a little difficult to breathe through the mouth. And I use Doyle splints. I don’t use any packing, but most of the time I’ll use Doyle splints for the rhinoplasty and you can breathe through there, but maybe not as well as you would otherwise.
So I think from a patient comfort perspective too, it’s not always good to do them at the same time. And then really the main reason is when you’re de-gloving the facial tissues and changing the Pyriform and you’re putting plates around where you’re going to be doing your nasal osteotomies are close to that, that can change how you’re going to predict what the nasal form is going to be. We make some osteotomies underneath the anterior nasal spine so that we try to preserve the nasal base, but the nasal base is really weakened when you do a LeFort osteotomy because you don’t have that anterior nasal spine to maxilla to the posterior septal angle connection quite as robust or sturdy. Additionally, all the muscles and the periosteum has been pretty much dissected free, so the nose can be a little bit more difficult to predict what you want to do. So for those three reasons, primarily I like to do it in a staged fashion 80% of the time.
Dr. Cameron: Yeah, you just answered my next question. I want to know what to be careful of if you’re going to be doing a rhinoplasty in someone who’s had orthognathic surgery.
Dr. Steinbacher: Yeah, yeah. So that’s great. And we’ve tried to predict that. And if we think we’re going to need to do a rhinoplasty in this person, I try to make sure that the plates that we place along the pyriform are not quite right up on the nose because if you’re trying to osteotomies or even use a Piezotome to do your osteotomies and you have a titanium plate there, you can’t go through that unless you’re planning to remove those plates at the same time. But repositioning those plates is one thing. Making sure that we save the anterior nasal spine. I mean the conventional way that people do before osteotomies is you totally separate the posterior septal angle from the anterior nasal spine, and then that septum is just kind of flopping in the wind and you reposition the maxilla and maybe the ANS is now over here compared to the septum, and you can end up with septal deviation.
And some colleagues in Europe have written about coming under the anterior nasal spine, leaving that bone preservation. And then I kind of bone graft underneath there. So by the time you come back to the rhinoplasty, this is nice and it’s never been detached. And as you and others and Toriumi have talked about the nasal base is really where it all starts. So that in any way is not stable or it’s deflected. That can be an issue. So the other area would be when we do some impaction, we want to predict how much impaction that’s going to be and if it’s going to come too close to the terminates, usually I don’t like doing full turbinectomy, but we will do maybe some submucosal resection and maybe we’ll take down some of the bone and the nasal floor so that there’s room between the nasal floor and the terminates. Sometimes we’ll widen the nasal cavity as well, that lateral nasal wall will be able to contour that away to help the sinuses drain. But considering all these things for a potential future rhinoplasty. But I think the critical ones are really the plates at the pyriform and the anterior nasal spine.
Dr. Cameron: Okay. So Derek, this is fascinating. It’s so interesting. What I want to ask is what resources are available for the listeners? I mean, obviously you can go and you can do searches and get journal articles and stuff, but there’s not a go-to book on this or perhaps a course or some type of fellowship or something like that that people can try and reach out to increase their knowledge.
Dr. Steinbacher: So we actually have a book that came out that does discuss a lot of these things, nasal considerations in rhinoplasty and rhinoplasty and orthognathic surgery. It’s called Aesthetic Orthognathic Surgery and Rhinoplasty, which really touches on a lot of these types of things. So that’s one resource. And initially when I was starting practice, I was really interested in how the nose changes with jaw surgery. So we wrote about three or four papers about that. I can send you links to those. But I think predicting how the nose is going to change is critical. And then lastly, we wrote a paper where we looked at my experience with doing jaw surgery and rhinoplasty and when to do it concurrently, like we said, and when to do it in a staged fashion. So those are some resources, and I don’t think there’s any particular course. I think it would be a very interesting course though to consider all of these things together. But yeah, I think a course and fellowships and additional resources, maybe I’ll put out some additional YouTube videos as well. But yeah, those journal articles and book I think are great resources.
Dr. Cameron: Just remind listeners how can they get hold of that book
Dr. Steinbacher: Just on Amazon aesthetic with an AES – aesthetic orthognathic surgery and rhinoplasty is probably the easiest way.
Dr. Cameron: Fantastic. And I guess what I’m saying is we’re going to have to come and run that course in South Africa.
Dr. Steinbacher: Yeah, that’d be great. Yeah, see some rugby. And do you play rugby too?
Dr. Cameron: I used to play rugby, but that was when I was a young man. Not anymore, but we can get you to play rugby if you want to. They might even funny enough talking about that. We recently looked at the last 50 nasal injuries, trauma injuries, autonomy as an otolaryngologist, I don’t see the same amount of facial fractures as the maxillofacial surgeon friends in town here. But of the last 50 we looked at that and obviously rugby was the most common injury, but what do you think the second most common sporting injury was? Of the nose that I saw over the last few years?
Dr. Steinbacher: There’s not much basketball there, huh?
Dr. Cameron: No, not much basketball.
Dr. Steinbacher: Maybe surfing or soccer.
Dr. Cameron: Surfing.
Dr. Steinbacher: What is it? Surfing. Okay. Yeah,
Dr. Cameron: We just a near Jay Bay where the Billabong Pro is every year. So people love surfing a lot here in South Africa.
Dr. Steinbacher: And they fall onto their board?
Dr. Cameron: Fall onto the board, back to their nose. These laid back surfers get pissed at each other. They, she stole my wave and they punch each other, whatever. Wow. Sure.
Dr. Steinbacher: That’s great.
Dr. Cameron: Derek, this is a fascinating conversation with you. I think this is an area that is so poorly spoken about at congresses and online and things. So I mean, on behalf of all the listeners around the world, I just want to say thank you so much for sharing this. I mean, what you’re doing is fantastic and guys go out, they find those articles, find the book, and befriend each other. The days of us trying to be in our ivory towers and not working together as different kinds of specialists are over, we’ve got to be working together. So be that the plastic surgeon, the otolaryngologist, the maxillofacial surgeon, we all got to at the end of the day, get the best result for our patient. And it’s not about you anymore, it’s about getting that patient the best result. So that’s why, I mean, being able to sit here and speak to Derek and hear what he has to say is just so inspiring. So thank you very much.
Dr. Steinbacher: Thank you. No, this is great.
Dr. Cameron: Great. Yeah. And finally, just shout out to Allegan again for enabling us to have this podcast. And guys, please come back again next week. Same place, same time for another speaker.

Comprehensive Review of the Steinbacher Rhinoplasty Set

Explore the precision of the Steinbacher Rhinoplasty Set with Derek Steinbacher in this revealing video. Discover the specialized instruments, from guarded nasal osteotomes to delicate needle holders, meticulously designed for rhinoplasty perfection. Derek showcases each tool's role, demonstrating their function in achieving finesse and accuracy in nasal surgery.

Hey everyone. So today I’m excited to start unpackaging and reviewing the instruments in my Steinbacher rhinoplasty set. The first thing we’re looking at here is what’s called the double guarded nasal osteotome. This helps smooth the bump, so we’ve got a small single skin hook, and now we’re moving to a beautiful slender speculum to help us access the septum and inside the nose. For rhinoplasty, you need a very fine, small, a traumatic needle holder, which we have here, which is beautiful. Very nice. The next thing I’m opening is what’s called a coddle elevator. It has a spoon like end, as well as a blunter end that helps us with dissection and along the septum. This next instrument is Ron jour, which allows us to nibble away at things. And now another speculum enabling us to get inside the nose and along the nostrils. The next things here we’re going to open are called nasal rasp, and this is a surface that’s like a nail file and it helps us to smooth the bone of the bridge of the nose and the grits on the surface here are graduated to help smooth these in a progressive manner.
This next item is a very fine guarded osteotome. This next instrument is a long contra angle scissor that helps us or enables us to trim cartilage. This is a wire loop retractor called an Eva retractor that works beautifully. Here’s another dissector or elevator. This is a freer elevator with a significant curve, and now another coddle elevator. This next instrument enables us to get to the back of the septum and remove spurs. It’s called a Takahashi. Here’s what we refer to as a baby Ron Jaw with a fine tip in another Takahashi like instrument that enables us to get to the back of the septum. This is a baby fine, two-millimeter osteotome. This next instrument I’m really excited about, it’s the Steinbacher version of the Converse scissor, which is a contra angle sharp tipped scissor, helping us with rhinoplasty dissection. See those tips closely here, and this will have a black handle. Here’s the pair of different sized, double guarded osteotomes, and now a Joseph elevator. Now this is an awesome Ferrari, red guarded bipolar, and now finishing with that smooth Webster needle driver that helps us suture. So, this gives you a sneak peek at this awesome Steinbacher rhinoplasty septoplasty set. Now check out some case examples where we achieve these results using my rhinoplasty set. Thanks again. This is Derek Steinbacher.

Rhinoplasty Magic: From C-Shaped Deformity to Perfect Symmetry!

In this video, Dr. Derek Steinbacher describes the 24-year-old patient's nasal deformities. He discusses using three-dimensional analysis and planning to address these issues, such as adjusting the tip position, creating a super tip break, and narrowing the tip. He also mentions using techniques like spreader grafts and septal extension grafts and shows before and after simulated views to demonstrate the expected results.

This 24-year-old woman presents for rhinoplasty. You can appreciate the dorsal hump blending with the tip. On lateral view, you can see a deep nasal frontal recess with good projection and rotation. The submental view, the hump looks more obvious than the tip and the zoomed in you can see a broad boxy tip with irregularities. Frontal view shows a C-shaped deformity with the light reflex irregularities of the alar, especially on the right-hand side. This rotating image is useful to communicate with the patient and determine problems and goals. Here you can see that prominent dorsal hump and no super tip break. We use 3D analysis and planning using the rhinoplasty tool. Again, a CS shaped deformity, a prominent dorsal hump, deep nasal frontal recess. We can adjust the tip position, create a super tip break, bring down the dorsum, augment the radix area here too we’re adjusting the alar. On frontal view we can narrow the tip. We can simulate placing a spreader graft to widen the mid vault and address this C-shape in irregular light reflex. Next, we can look at the before and after simulated view. Communicate this with the patient and ensure that we’re on the same page for goals. This is the rhinoplasty diagram showing the spreader graft, septal extension, graft, fat rafting. Here you see correction on frontal of the C shaped deformity. Better tip definition in a better equilateral triangle. Better support at the alar base.
Gentle dorsal lines, blending to the tip with a very subtle and gentle super tip. Break on the lateral view. Again, good dorsal definition smoothing to a super tip break. 3D image shows correction of that C-shaped deformity, smoothing of the dorsum, correction of the deep nasal frontal recess, better tip projection definition, and a small super tip break.

How to Speed Up Your Rhinoplasty Recovery: Tips & Postoperative Care Guide!

Join Dr. Derek Steinbacher as he unveils essential postoperative tips for a seamless rhinoplasty recovery. From bruising remedies to proper cleaning techniques, this comprehensive guide ensures optimal healing and stunning results. Discover the secrets to a smooth recuperation journey!

Hey, how’s it going? This is Derek Steinbacher and I’d like to discuss your postoperative rhinoplasty course today. So first off, you will have a splint in place that we put on postoperatively. There will be no packing and there will be a couple tubes inside the nose that keep the septum straight, but you’ll be able to breathe through these if you can keep them clean. There can be a variable amount of bruising postoperatively and we take steps to try to minimize or avoid these steps so that there’s no nausea and vomiting, but we want you to avoid strenuous lifting or exercise. No hanging the head low. Also, applying ice, especially to the lower eyelids is helpful. We like and recommend using green tea bags, steeping these, and then keeping several in the freezer, placing them to the lower eyelids. There’s also a few dietary and topical considerations.
Pineapple juice has an enzyme bromelain that seems to block and lessen bruising. Arnicare as well is an herbal supplement that you can place topically in the lower eyelids as well as dissolve a tablet under the tongue and doing all these things leading up to and after surgery has a positive effect. Vitamin K ointment on the lower eyelids after surgery too will help limit or lessen bruising. In terms of medications and keeping the area clean, we want no water on or underneath the splint because we want this to stay in place. We would like for you to clean the nostrils in the area of blue sutures. In doing this, we’d like for you to use a Q-tip with hydrogen peroxide or soap and water and gently curl this back and forth to clean any debris as shown here on this gag gift pillow with my rendering.
We also will give you nasal sprays. We’ll give you either Afrin or Neo-Synephrine and would like for you to use two sprays per nostril, three to four times per day, stopping after the third day. Additionally, we’ll give you a saline nasal spray. Frequently, Ocean spray nasal spray for this, please use it four times per day and each nostril and continue this until we see you. A few other things to consider. Please keep your head elevated while sleeping on two to three pillows. Take it easy. As mentioned, no exercise. Glasses are okay while the splint is in place, but once we remove the splint, no glasses for at least four to five weeks and this includes sunglasses. Flying is okay if you’re traveling for surgery, you may want to stay nearby for one day postoperatively, depending on the time we finish the case. If you were more local or regional and flying at some point postoperatively, that’s fine too. We may just want to give you some Sudafed to help with any ear or sinus pressure before and during the flight. We typically will see you back at about seven to ten days following surgery at which point we will remove the splint tubes and sutures.
This image shows a young woman at about the eight-day post-op mark just having those things removed. We actually studied over a hundred of my own patients and showed looking at edema or swelling, that 70% of it goes down by about four to six weeks postoperative, but the remaining 30% takes the better part of a year to completely go away. And these images are from our study showing at various time points how the nose takes shape as the edema comes down with time. So, we’ll finish off this short video just showing a couple postoperative results. This is about one year postoperative and showing that when you adhere to the recommendations that we describe, this will help your recovery go smoothly and we can both look forward to your final results. Remember, every case is different, and please discuss with us in person for any specific situation and contact us anytime during your recovery phase. See you soon and looking forward to your results in your rhinoplasty. This is Derek Steinbacher.

A 3D Journey Through Rhinoplasty Transformation with Derek Steinbacher

Dr. Derek Steinbacher is explaining the use of a three-dimensional rhinoplasty tool in this video. He discusses how they can make changes to the nose that align with the patient's goals and what is biologically possible. He demonstrates adjusting the tip and profile of the nose using the tool and compare it to the patient's preexisting nose, and shows simulated and actual results before and after the rhinoplasty.

So, this is the 3D rhinoplasty tool that we use. First, we look at your nose together and we can make changes that adhere to your goals and our goals. We want to try to do this in the confines of what we can really achieve and what is biologically possible. Here you can see we’re adjusting the tip in the profile of the nose on the lateral view. We can then compare with your preoperative or your preexisting nose to see how close this looks. We can rotate this in multiple directions. Again, this is a 3D image, and this gives us an idea of what we’re shooting for and trying to achieve with your rhinoplasty. So, on the bottom panel here in the middle is the simulated result, and on the far right is the actual result. Here is the before and the actual after result, and we’ll finish up with the rotating 3D view of the before and the actual after result. Thanks for watching. This is Derek Steinbacher.


Mastering Jaw Surgery Recovery: Tips for Rapid Healing and Stunning Results!

In this video, you can discover expert guidance on jaw surgery recovery and post-operative care from Dr. Derek Steinbacher. Learn about managing swelling, dietary tips, and essential practices for optimal healing. Witness jaw-transforming before-and-after results, promising improved function and aesthetics. Join us for a journey towards exceptional orthognathic results!

Hey, how’s it going? This is Derek Steinbacher and I’m going to talk to you today about jaw surgery recovery and post-operative instructions. Typically, you stay in the hospital for one or two nights following this procedure. The bruising and swelling tend to peak at the third post-operative day, so when you’re at home, but there are things that we will do to try to minimize this, including medications we give you and having ice applied. Your teeth are not wired together, but we do place rubber bands that are tight for the first week or so. We then loosen them at the first post-operative visit to enable you to open and close your mouth a bit better. If you happen to have Invisalign, we place small screws in the gum tissue that help hold the rubber bands. Feeding for the first several days or week is facilitated by using a small syringe with a catheter.
We will want you on blenderize no-chew food for at least the first three weeks. It will be normal to have some nasal secretions for the first several days or week following surgery. To help control this, we will give you neo synephrine. Please take this only for two days. Then utilize saline nasal sprays, several sprays per nostril several times a day, and you’ll continue this for several weeks after surgery. Ice will be important to help keep down the bruising and swelling, especially the first three to five days. We also recommend the use of green tea bags that have been steeped and then frozen as this help cut down bruising and swelling very effectively. At day five, you can buy a small child’s toothbrush and gently brush the teeth and braces only, not the gum tissue. Immediately after surgery and going on for several weeks. We’ll want you to use a parodontax type mouth rinse several times per day.
It also is important to rinse with saline or salt water several times a day, especially before and after meals. Pineapple juice is good to ingest or drink, and it helps cut down bruising and swelling, but make sure to rinse with water and saline afterwards. Taking bromelain as well as applying or taking arnica is also helpful. Some patients will find comfort in managing secretions by using a home suction machine. We will show you where to purchase this. The day after surgery while still in the hospital. We’ll obtain a cone beam scan depicting the new jaw position. Ask us more specifics about activity levels, but basically no hardcore intense or contact sports for six weeks post-op. Also, you can resume a normal diet at six weeks, including hard, chewy things, but take it slow at first.
We are always available to help you post-operatively as well. Please call or contact us and we’ll be seeing you at regular intervals to make sure the process is going smoothly for you and your family. To finish off, I’d like to show you some actual before and after orthognathic or jaw results. In each case, you can see the improved balance, aesthetics, and appearance, as well as function is improved in all of these patients. We look forward to shepherding you through this process in obtaining the best possible results we can together. Thanks for listening, and we look forward to your great orthognathic results.

Orthognathic Jaw Surgery: 10 Vital Insights You Need!

Derek Steinberger shares crucial insights on Orthognathic Jaw Surgery in this comprehensive guide. Covering everything from pre-surgery preparations to potential nose changes and nerve recovery, Derek's breakdown of these 10 key aspects demystifies the procedure.

Hey everyone, this is Derek Steinberger and today I want to review with you 10 things that you should know before undergoing Orthognathic Jaw surgery. Number one, orthodontics or having an orthodontist. Yes, it’s true conventionally, you do need an orthodontist before surgery and typically orthodontic treatment for 6 to 12 months surgery and then a few more months of orthodontics after surgery. However, that paradigm has shifted to some extent in certain cases or patients where you can be a surgery first candidate. That means most of the orthodontics is done after surgery. Additionally, in some cases you may be a candidate for Invisalign or clear aligner therapy in place of conventional metal braces. And lastly, some aesthetic cases or sleep apnea patients may have a perfect bite or occlusion ahead of time, but yes, we still typically want you to have an orthodontist to be part of the team to prepare for surgery.
Number two, what’s the definition of orthognathic jaw surgery in general? This refers to a series of different procedures that affects the upper jaw here, a LeFort osteotomy where we’ll typically move this through the sinuses into the appropriate position. The lower jaw, typically a sagittal split osteotomy where we move this part with the teeth and reposition it and or a genioplasty, a chin procedure where we change the position of your chin. So orthognathic surgery refers to usually some combination of those three procedures. Number three, what are the planning and records that we need to prepare for this surgery? These days we do a lot of 3D planning, and this entails getting a CT scan from which we’re able to print these types of models. Additionally, we have dental models that we obtain either with typical molds or more often with scans. These days, we can then virtually and digitally reposition your jaws to achieve the best result we possibly can. From 3D planning we produce or print splints that help us reposition your jaws as well as sometimes we can use 3D titanium printing for actual plates that we’re able to use customized to you.
Number four, what is the surgery length and hospital stay? Typically, these surgeries take anywhere from two to four hours, a little bit longer to go to sleep, a little bit longer to wake up, and it depends on how complex and how many of the jaws we’re moving and in what position or magnitude we’re moving them. And in terms of hospital stay, typically one night in the hospital, sometimes more, but we’re actually moving in the direction of trying to have enhanced recovery where you can almost go home the same day or within 23 hours. Number five, a lot of people ask this, but you’re not wired together. 99% of the cases you’re not wired together. Sometimes you do have tight rubber bands that are holding your teeth together, but we do not. I repeat. We do not wire your jaws together.
Number six, we can remove your wisdom teeth at the same time. Traditionally, you needed to have these removed ahead of time, but these days, and we’ll show you a reference to one of our papers, we can remove these at the same time and this saves you an additional procedure ahead of time and you recover just fine having them removed at the time of jaw surgery. Number seven, there are a lot of ancillary or additional procedures that we do at the same time or concurrently with jaw surgery. These include, as mentioned, the genioplasty where we can move the chin, fat grafting where we liposuction fat from other parts and inject it to help with contours and the aesthetics of your case, submental liposuction, or lipectomy where we remove areas of fat underneath your chin to help crispen and define that area. And we can also do skeletal augmentation where we add implants to your cheekbones or other parts of your jaw or face to enhance symmetry and the aesthetic result.
Number eight, your nose and jaw surgery. Most of the time, especially if we’re doing a LeFort or the upper jaw procedure, your nose is going to change as a result of jaw surgery. Typically, the function will improve and the appearance may get better, stay about the same or get worse. So, we really want to think about the nasal changes, anticipate how it’s going to change, and if a rhinoplasty is needed, we want to plan that from the outset. Typically, that can be done three to six months later. Number nine, titanium plates. Yes, we do use titanium plates that hold the bones together. This is the reason we don’t need to wire you together and these plates can stay forever in about 95, 98% of cases, they don’t set off any issues at airports or with metal detectors, and you can have MRIs without issue if needed in the future.
In some cases, you’ll elect to have them removed. Either people want them out or in some rare cases there can be inflammation associated with them and you don’t really need them after three or six months and we can remove them then if you wish, or it’s determined to be necessary. In number 10, nerve or sensibility recovery. So, it’s true, you will have some numbness after jaw surgery. The upper lip and cheeks usually come back in six weeks or two months. The lower lip and chin, because of the inferior velar nerve or the nerve that comes through your lower jaw to the lip and chin, that can take longer to come back. It can be six months or a year, but in most cases, 98% of cases. This does return factors that can help with this younger age under about age 40 or so correlates with improved return of sensation. Additionally, some instrumentation that we use these days, a Piezoelectric for instance, and some medications that we give you also correlate with nerve recovery. Thanks again for tuning in to hear about these 10 things before having orthognathic jaw surgery. Please comment any ideas or other future videos below and remember too that this is general advice, for specifics regarding your case please consult with your physician or your doctor in your area. Thanks again.

Revolutionizing Nasal Maxillary Hypoplasia with Orthognathic Surgery and Staged Rhinoplasty

Dr. Steinbacher discusses the treatment of a patient with nasal maxillary hypoplasia, specifically a bender type patient. The patient has various facial asymmetries and dental issues. He explains the preoperative state and the planned procedures, including mandible repositioning, maxilla advancement, genioplasty, and rhinoplasty. Postoperative images show improvements in lip projection and support, but the nasal profile remains unchanged. Dr. Steinbacher describes the techniques used in the rhinoplasty procedure, including cartilage grafts and alar base reduction. He concludes by showing before and after photos, highlighting the improved tip definition, narrowed alar base, and better nasal projection and support. The combination of orthognathic surgery and staged rhinoplasty has enhanced the patient's profile.

Today we’re sharing a video encompassing the treatment of a patient with nasal maxillary hypoplasia, a bender type patient. Here on the frontal view, you see that her forehead and orbits are symmetric. She has nasal dorsal deviation a wide alar basin, asymmetric alar. She has a short upper lip and a rolled out prominent lower lip. Looking at her chin point, it’s deviated to the right here. On the smiling view, you see that she has prominent nasal labial folds. The nasal tip and upper lip come in close proximity to one another with a short upper tip and a derotated nasal tip. Her smile is a reverse smile showing mostly mandibular teeth with a little or no upper incisor tooth display. Also, her mandibular midline is seen as deviated to the right several millimeters. In the submental view, she’s got peri alar hollowing, she has a wide alar base, asymmetric nostril display con melo deviation, poorly supported upper lip, and again her chin is deviated to the right.
On the three quarters view on the left, she has again poor nasal maxillary support. She has mid vault and tip loss of projection. Her upper lip is pulled back and she has the prominent lower lip that’s rolled out. On the left lateral view, you can see the absolute and relative nasal hump and it’s relative as it’s worsened due to the mid vault and tip depression. She has an acute nasal labial angle, a short, poorly supported upper lip and a rolled out lower lip. On the right lateral view again, that decreased nasal tip projection and rotation in the pulled back upper lip. On the frontal occlusal picture, you can see that she has a negative overjet, an anterior crossbite, and a posterior crossbite on the left-hand side. Both midlines are coincident but deviated over to her right on the lateral occlusal pictures. You can see that she has an anterior crossbite and class three molar and canine relationships.
Here on clinical exam, you can see when we ask her to smile that she shows only mandibular teeth. She has buried maxillary teeth, a very short upper lip and a very short maxilla. Here our preoperative lateral cephalogram showing both the vertical position of the maxilla, the poor lip support. The 3D plan shows first the preoperative state, second this is a mandible first plan where the mandibles moved into position mostly using rotation. Next, the maxilla is advanced and lengthen in a vertical plane, steepening the occlusal plane, and finally the genioplasty with advancement and lengthening. Here you can see the amount of maxillary repositioning with the midline moving to the left and disimpaction of seven millimeters. On the final occlusal models, the red ink indicates areas of an AMLO plasty that’s required.
Here you can see the before and after CT scans on a frontal view with a plate fixation and position. On lateral, you can see the steepened occlusal plane, the genioplasty sagittal split, and LeFort. Here’s her postoperative images where her lip projection in fullness is improved, but her nose is not improved on three quarter and lateral as well. You can see the improvement of her upper lip and lip support, but the nasal profile remains with a depressed tip projection. So here is the rhinoplasty diagram demonstrating the procedures and techniques that we perform. This includes crust cartilage to the dorsum component, dorsal reduction hilo to high osteotomies cephalic trim, alar batten grafts, caudal septal extension graft, infra lobular tip graft and maneuvers to increase both tip projection and tip rotation. And finally, alar base reduction in seal excisions to narrow the alar base and reduce the alar flare.
So here is the pre and post zoomed in frontal photo before orthognathic surgery and after orthognathic surgery and rhinoplasty. You can see the improved tip definition as well as the narrowed alar base width. The intra lobular dimensions are improved as is the upper lip support. On the worm’s eye, you can see the improved lip projection, more of an equilateral triangle on the nasal base, a narrow alar base and better nasal tip and base support, as well as an improved upper lip support. Moving to the pre and post three quarter views, you can see an improved contour of the middle third of the face with better nasal maxillary projection and support. On the lateral view, you can see improved nasal projection at the mid vault and tip, as well as increased tip rotation, upper lip support and length, and a more orthognathic profile. In the zoomed in lateral 3D images, you can appreciate the smooth dorsal contours, transitioning gently to the nasal tip with a super tip break, increased tip projection and rotation, increased upper lip length and support. On the shadow overlay, you can see how the nasal tip and chin profile changed following surgery.
And finally in the animation, this puts it all together in this bender type patient where we’ve enhanced her profile by combining treatment first by orthognathic surgery, focusing on maxillary advancement and vertical lengthening with increase of the occlusal plane, and then by a staged rhinoplasty to improve the dorsal contours, increasing the tip projection and rotation, and narrowing the alar base. Thank you.


How to Eliminate Your Double Chin and Turkey Waddle: Transformative Solutions Revealed by Derek Steinbacher

Dive into Derek Steinbacher's insightful guide on banishing the double chin and Turkey waddle! Discover diverse solutions for every age, from submental lipectomy to advanced jawline procedures. Witness dramatic before-and-after transformations and learn how to redefine your jawline. Don't miss this ultimate guide to a sculpted profile!

Hey guys, this is Derek Steinbacher, and today I want to talk to you about how you can get rid of your double chin. Now this is often described as a Turkey neck or a waddle, as you can see here. So, the age of the patient can have an influence on both the cause and how we treat this condition. On the left, you can see a younger patient has good quality skin, but poor support from the jaw. The patient on the right is older with good jaw position, but draping excess skin and muscle problems. This next patient is in between or early middle age, and you can see that she has loss of definition from the chin to the neck with a waddle. So, the point I want to get across is that there are multiple factors that contribute to having a double chin. This includes the bone position and support, the skin itself, and the fat, the underlying fat and the muscle or platysma.
This young woman obviously has a small or weak lower jaw as well as some excess fatty tissue. One option for younger patients to remove the fat between the chin and the neck is submental lipectomy. You can see the improvement in definition from the chin to the neck here. However, in some cases, the jaw bone or chin itself needs to be augmented or advanced. As you can see here. There’s another case where the double chin has been eliminated and the jawline is more defined. I’d like to use a 3D camera to depict actual before and after changes. As in this case where the double chin has been addressed. The profile is significantly improved with definition of the jawline, the position under the neck, as well as the nose and the lips on profile. Moving to a few older patients, we obviously need to address not only the jaw, bone and chin, but also the skin, muscle and fat.
This woman in her fifties underwent face and neck lift as well as tightening of the muscle underneath the neck. Here’s another example of a neck and face lift with elimination of that waddle. In some older patients, a small jaw or chin has never been addressed, and a facelift or neck lift alone will never achieve the result or crispness of the neck that you desire. So, in this patient, both the lower jaw chin was advanced and repositioned. The neckline was made crisp by tightening the skin, removing fat, tightening the muscle to really eliminate that Turkey aspect, waddle or double chin. So, here’s another older woman who’s had her double chin nicely addressed, and this was done both by advancing and repositioning the chin and lower jaw tightening the skin, removing fat and tightening the muscle. You can see this well in our 3D image that’s rotating.
We’ve recently published about addressing not only the skin, the soft tissue, the fat, the platysma muscle, but paying attention to the jawline and the chin to help smooth the jowls to give you crispness between your chin and your neck to eliminate the Turkey waddle and get rid of your double chin. So that about sums up my philosophy in giving you a crisp jawline and chin neck definition to eliminate your double chin and Turkey waddle. There’s some other surface treatments to the skin, including nano fat and laser and chemical resurfacing. Please check out some of my other videos as well and look at some before and afters on our Instagram. Thank you very much for listening. This is Derek Steinbacher.


Metopic Craniosynostosis Correction in a 6-Month-Old Baby Girl

Witness the incredible transformation of a 6-month-old baby girl with Metopic Craniosynostosis. Using 3D planning and cranial vault remodeling, follow her journey from triangular head shape to improved forehead dimensions, roundness expansion, and corrected craniosynostosis. Experience the remarkable changes in her appearance and life post-surgery.

This is a six-month-old baby girl with Metopic Craniosynostosis. You can see on CT, the few sutures in the triangular head shape with bitemporal narrowing. We use 3D planning to help round and understand the amount of expansion we need at the forehead and temporal regions. You can see the different colors on the right panel. We use a cradle to help open that endocranial frontal angle and achieve the temporal expansion required. All the roundness, the improved forehead dimensions. CT shows the expansion, improved contour and clinical images. Six months later show that she has improved forehead dimensions, roundness expansion, medial scleral show, correction of this metopic craniosynostosis using cranial vault remodeling and peri cranial flaps. Thank you very much.

6-Month-Old's Craniosynostosis Journey

Witness a remarkable journey of a 6-month-old battling craniosynostosis. Innovative 3D planning and posterior vault distraction bring improved skull dimension, shape, and volume. Follow her consolidation phase and witness the incredible clinical and developmental transformation post-treatment.

This is a six-month-old girl with multi suture craniosynostosis. You can see the (unclear) sutures. We use 3D planning for posterior vault distraction. Here she is in the consolidation phase with the activation arms being removed. Here’s the normal cephalic final postop CT with improved dimension, shape and volume. Note the clinical improvement in skull shape. Very normal appearing post-treatment photos doing well developmentally and appearance wise. Thank you.


Mastering Cleft Palate Repair: A Comprehensive Guide to Double Opposing Z Plasty Techniques with Dr. Derek Steinbacher

Join Dr. Derek Steinbacher in this detailed walkthrough of a cleft palate repair using a modified double opposing Z plasty technique. Witness the step-by-step process, from raising flaps to complete closure, showcasing before-and-after results in a simulated model and an actual patient case.

Hey guys. Today we’re going to do a cleft palate repair. So, this is a cleft of the soft and hard palate. I’d like to do a modified double opposing Z plasty repair. We’ve drawn the Z limbs here and I began by removing sagittal mucosa from the uvula. Next, we score and raise the triangular flaps on the left side this is Musculo mucosal on the oral side. We then raise the nasal flap on the opposite side. It’s Musculo mucosal on the nasal side. I then begin scoring the vomer flap in the midline. I then in size and raise Von Langenbeck flaps at the hard palate. Next, we transpose the nasal side Z plasty and close this with buried sutures. Here we’re using Vicryl, but in real life we would use four chromic sutures with a tapered needle.
We then move anteriorly raising the vomer flap and securing this to the nasal mucosa on the hard palate on either side. Here’s the fully closed nasal mucosa from the hard palate to the uvula. We next are moving around from the nasal side to the tip of the uvula, making sure that this is completely closed. Here I’m demonstrating the complete closure of that nasal side. Next, we’ll place horizontal mattress sutures in the hard palate or Von Langenbeck flaps. Now we will transpose and secure the soft palate Z plasty flaps going base to base, placing these into position all the way to the tip of the uvula. Some settings I would place the complete Von Langenbeck flap closure first to take off the tension from the Z plasty. But here we’re able to close the Z plasty first and then move back to the hard palate to completely finish these horizontal mattresses for the Von Langenbeck flaps.
Now you can see the complete closure of the hard palate all the way back to the soft palate. These are relaxing incisions on the side, and I like to place fibrin here. Now going anterior to posterior, and we can actually open this up to look at our complete closure. Now this shows the before and after using the simulator model. Look at this nice before and after with closure of the palate using a double opposing Z plasty. Here is a similar example in an actual patient showing that transposition and beautiful closure. Here I am of Dr. Furlow who came up with this type of repair as well as with Dr. Summer Ladd written several papers characterizing the benefits and influence of this type of repair and cleft palate in general. Thanks so much for listening and watching. This is Derek Steinbacher, and hope to see you soon.

3D Planning

Transforming Healthcare: The Precision of 3D Printing in Medical Care

Discover the impact of 3D printing on healthcare in this insightful video. Witness firsthand how doctors at Yale Medicine employ detailed 3D models to enhance surgical precision and improve patient outcomes. From facial procedures to kneecap reconstructions, discover the revolutionary advancements shaping modern medical care.

>> Jocelyn: In your health, can 3D printing improve your medical care? I’m Jocelyn Mamenta. More and more doctors are using the high-tech approach so that you, the patient will benefit a three-dimensional approach to medical care becoming more the norm. 3D printing painted a clearer picture for college student Emma Fuchs.
>> Emma: You weren’t going into it blindly.
>> Jocelyn: Who had three facial procedures since she was 15 years old.
>> Emma: I was very nervous before the jaw surgery, especially because it’s a lot happening, a long surgery, but it definitely gave me insight into what exactly they’re doing and how it would turn out.
>> Jocelyn: Plastic surgeon, Dr. Derek Steinbacher at Yale Medicine relies on 3D models like this one.
>> Dr. Steinbacher: So, based on this, we can really appreciate the anatomy. You can see the nerve coming through the lower jaw. You can see the position of the teeth and the roots.
>> Jocelyn: Details for a virtual run-through
>> Dr. Steinbacher: Gives us a chance to think about the procedure and go through a series of steps in advance prior to doing the surgery.
>> Jocelyn: So, what happens in the operating room is streamlined and more efficient.
>> Dr. Steinbacher: Really helps us be more precise. It helps us understand the anatomy. It helps us get the best results we possibly can.
>> Jocelyn: The 3D structures
>> Antonio: Here we have a 3D model of a kneecap
>> Jocelyn: Are produced from 3D scans here at the Yale Center for Engineering Innovation and Design. Design Fellow Antonio Medina.
>> Antonio: It can get down to a 10th of a millimeter, which is pretty precise.
>> Jocelyn: It can take up to 20 hours to build
>> Antonio: So that they can take this and say, we’re going to operate in certain locations. This is what your kneecap currently looks like.
>> Jocelyn: A more accurate view that can lead to better results and potentially shorter recovery time. Dr. Steinbacher says before three D printing, most of the decisions were done in the operating room with a little less planning in advance. News 8 is on call for you. Do you have a health question? Send it to News 8 on call@wtnh.com. Jocelyn Mamenta – News 8.

Revolutionizing Facial Reconstruction: The Artistry of 3D Precision

Discover the intricate fusion of artistry and technology in facial reconstruction with Dr. Derek Steinbacher. Explore how cutting-edge computer-assisted design and 3D modeling reshape surgical outcomes, offering a glimpse into a future where precision and aesthetics converge for personalized, life-changing transformations.

There’s so many functional considerations that go along with the face. This is what somebody is wearing front and center, and this is what everybody sees. This is how they’re interacting at school, at work, when social engagement, so it’s vitally important to somebody. It’s an important to their identity. Most of the time it’s this form function following one another similar to architecture where if something is not well proportioned or doesn’t look right or is imbalanced, then most often there’s a functional component that goes along with that. In the head and face and neck area that we deal with that’s frequently being able to eat and speak and chew or breathe. I’m very interested in computer assisted design and how we can manipulate patient data in the 3D space to better understand their preexisting or preoperative diagnoses or situations, manipulating that in a way that will help us reposition tissues and structures to help us get the best result that we can. We start with the patient, their own data, their customized data that represents their facial bones. Then we take those images, we’re able to digitally render them, and then we can manipulate them, basically performing the surgery in digital space. Then from that virtual space, we can generate 3D prints that we can either utilize in the operating room to help us manipulate and reposition structures or that are sometimes part of the actual reconstruction themselves.
We have a machine learning model now that’s based on about 4,000 normal individuals, so this has come about from some of our collaborations with people nationally and internationally that are all interested in 3D morphometrics or 3D shapes of faces. I contributed over a hundred of my actual before and after orthognathic jaw surgery patients to look at how we can better model based on normals and based on after the postoperative scans, how we can achieve that ultimate endpoint based on large amounts of data sets. This will help minimize the number of variables that we have to think about intraoperatively or that we’re eyeballing based mostly on subjective criteria. We don’t want to leave it to the hands of a computer to make every single decision as to how we’re going to move bone and what the end result will be, but we can use this model to get us three quarters of the way in terms of what the bone relationship will be and how we need to move the bone to achieve what our facial result is. I think incorporating this model into our planning process is going to help us get reproducible, high fidelity, accurate, very aesthetic results.