Real Patient Stories: Journeys Through Plastic Surgery

Dr. Earl Stephenson Jr., MD, DDS – Plastic Surgery TNA (Talk and Advice)

Dr. Earl Stephenson Jr. introduces himself as a board-certified Atlanta plastic surgeon with over 20 years of experience. He explains that while his practice focuses primarily on cosmetic surgery, he occasionally performs reconstructive surgery. In this episode, he wants to share some reconstructive cases to demonstrate why plastic and reconstructive surgeons are uniquely qualified to perform cosmetic procedures.

He notes that some surgeons who only perform cosmetic procedures may dismiss reconstructive surgery, but Dr. Stephenson believes that having plastic and reconstructive training makes them the “surgeon’s surgeon.” He explains that he’ll share cases that demonstrate why he feels confident in his cosmetic surgery skills.

• Learn more about Dr. Stephenson 

Housekeeping and Content Warning

Dr. Stephenson thanks returning viewers and welcomes new ones, asking them to like, subscribe, and share his content. He warns viewers that the episode contains graphic surgical images that might be disturbing but reassures them that no patients were harmed.

Case #1: Vascular Malformation of the Lip

A man came to Dr. Stephenson’s office with a bluish area on his lip, which was identified as a venous malformation (a tangled mass of veins). Dr. Stephenson explains the difference between arteries (carry blood to organs) and veins (carry blood away from organs). The patient had been dealing with this condition since childhood.

Dr. Stephenson chose not to surgically remove the malformation as it would disfigure the patient. Instead, he used a 1064 nanometer laser combined with steroid treatment to target the veins while preventing aggressive regrowth. After three rounds of treatment spaced 4-6 weeks apart, the malformation was significantly reduced.

He notes that this treatment was both cosmetic and prophylactic, preventing potential future complications like bleeding, infection, or breathing problems if the malformation had continued to grow.

Fun fact: 4% of newborns present with vascular lesions.

Case #2: Arteriovenous Malformation of the Chin

A nurse was referred to Dr. Stephenson with a painful, throbbing swelling on her chin that kept growing. It was diagnosed as an arteriovenous malformation (containing both arterial and venous blood vessels).

Dr. Stephenson developed a two-stage treatment plan:

1. First, an interventional radiologist identified and blocked the feeder blood vessel to shrink the malformation
2. Then, Dr. Stephenson surgically removed the mass before the body could create new blood vessels to feed it

He designed a zigzag incision rather than a straight line to create a less noticeable scar. The patient’s recovery was successful with complete function of her lip, no loss of sensation, and minimal scarring.

Case #3: Elbow Fracture with Exposed Hardware

An orthopedic surgeon referred a woman in her 60s-70s who had fallen and fractured her elbow. The orthopedic team fixed the fracture with a plate and screws, but the wound didn’t heal properly, leaving the hardware exposed.

Dr. Stephenson performed a radial artery forearm flap:

1. He created a “sausage patty” of skin from the wrist with its blood vessel (the radial artery)
2. He verified blood flow would still reach the hand through alternate vessels
3. He traced and dissected the artery up the forearm
4. He pivoted the flap to cover the exposed hardware at the elbow
5. He used a dermal matrix to cover the donor site on the wrist, which would later receive a skin graft

The procedure successfully covered the hardware while preserving arm function. Dr. Stephenson notes that while the result isn’t cosmetically perfect, it’s functionally successful, which was the primary goal.

Fun fact: 5-10% of orthopedic implants suffer from exposure and require complex reconstruction.

Case #4: Dog Bite to Corner of Mouth

A young woman suffered a dog bite that damaged the corner of her mouth (the commissure), which Dr. Stephenson describes as a complex structure formed by multiple muscles.

For this case, Dr. Stephenson decided that direct closure with minor rearrangement of local tissue was the best solution. He cleaned the wound and closed it, restoring both function and reasonable aesthetics. The scar will continue to improve with time, especially since she’s young (in her 20s).

Fun fact: There are 4.5 million dog bites annually, some causing severe facial injuries requiring complex reconstruction.

Conclusion

Dr. Stephenson uses these cases to argue that plastic and reconstructive surgical training provides crucial knowledge and experience that makes board-certified plastic surgeons uniquely qualified for cosmetic procedures.

He emphasizes that this background gives him both the confidence to perform aesthetic procedures and the judgment to know when not to. He advocates for patients to seek board-certified plastic surgeons (specifically by the American Board of Plastic Surgery) for all cosmetic procedures.

He concludes by inviting viewers to contact his practice for consultations and to follow him on various social media platforms.