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Complex Facial Reconstruction: The Miami Face Eating Tragedy (Original Article)

Complex Facial Reconstruction: The Miami Face Eating Tragedy (Original Article)

· Reconstruction · No Comments

            The news media and internet have been buzzing with stories about a recent tragedy in Miami, Florida. A homeless man in Miami Beach, under the influence of a drug-induced high, cannibalized another homeless man. The attacker was eating the victim’s face and was eventually shot and killed by a police officer because he refused to stop.


The bizarre attack generated rumors of zombie behavior and soon gruesome photographs of a faceless victim spread throughout the internet. The victim was taken to a Miami trauma center for treatment and is currently recovering. I have been asked to comment on the reconstructive aspects of such an unusual and complex case.


I recall a very similar patient I personally cared for in New York many years ago. Early one morning I was called to our trauma center emergency department to see a young man with a severe facial injury. He had gotten drunk and argued with his mother. He decided to commit suicide and fired a shotgun under his chin. However, the gun angle was forward and his face took the full effect of the blast injury.


Where Do You Start?


The management of these complex facial injuries is divided into 3 phases. The initial phase is acute resuscitation. Just as with any other trauma patient, the ABC’s of airway, breathing, and circulation, must be followed. Often tissue debris or blood can obstruct the airway and compromise breathing. Lacerations to large arteries can also cause significant blood loss.


Once the patient is deemed stable the initial goal is to surgically clean the tissue and close or cover open wounds in order to allow healing and prevent infection. Wound closure can be difficult if there is a deficiency of tissue. The judicious use of biologic dressings and skin grafts is important. In addition, during the subacute phase, infection is a risk because the human mouth contains a high density of bacteria. Strong antibiotics and vigorous wound care are critical during this period which can last for weeks or months.


The third, or reconstructive, phase will require multiple surgical procedures likely over several years. The principle followed by plastic surgeons in such cases is to give priority to function, such as sight, smell, eating and speech. Cosmetic considerations, although important, are secondary to function. Bony structures, if jaw damage exists, are reconstructed first and then soft tissue is built upon this foundation.


Many options exist for reconstruction, however, the patient’s own tissue will generally be the most compatible. For example, a jaw can be framed from the patient’s own hipbone. If possible, it is preferable to use adjacent facial skin and muscle. If damage is too extensive then soft tissue can be harvested from other body areas such as the arm or even the buttocks and transferred to the face by microscopic attachment. Recently, headlines have been made by full face transplantation. These complex reconstructive cases typically require multiple professionals, including surgeons, dentists, therapists, nurses, social workers and others to work cooperatively.

About the Author:


Dr. Perez is plastic and reconstructive surgeon in Ft. Lauderdale, Florida. He is a graduate of The Albert Einstein College of Medicine in New York. Dr. Perez has been selected among Castle Connolly/U.S. News and World Report’s America’s Top Doctorsevery year since 2000 (again for 2012-2013). He has lectured internationally and been featured as a plastic surgery expert for major media outlets.

New Year, New You: 5 Plastic Surgery Procedures to Start the New Year

            It’s resolution time again. Exercise, weight reduction and improving our appearance are always high on the list of objectives for the new year. Here are 5 popular plastic surgery procedures that produce a valuable, big-bang-for-the-buck change to begin the journey. The procedures featured here are very popular and offer a significant change with a high degree of patient satisfaction.


Eyelid Tuck


            The first place aging becomes evident is around the eyes. If the eyes are the windows of the soul, then the eyelids are the curtains that allow us enjoy the view. The upper lids develop excess skin causing hooding.  The puffy bags on the lower lids create a tired look.


The procedure of choice to correct tired eyelids is the eyelid tuck or blepharoplasty. It is one of my personal favorites to perform and is the most commonly performed aging procedure for men. The procedure takes 45 minutes and patients soon enjoy a refreshed and less tired look.



Face/Neck Lift


Facelift territory includes the area of the cheeks, jawline and neck. As we age the skin and other tissues sag from the underlying bony structures. Although highly advertised under many catchy terms, surgical facelift procedures generally fall into two categories, mini and full. A mini-facelift is best suited for patients in their 40’s or younger who just want to freshen the cheek and jawline.


The patient for traditional face and necklift is in her late 40’s and older with laxity of the jawline and neck, often with turkey-like banding. Combined with eyelid surgery, the procedure often produces dramatic results and can reduce the aging appearance by decades.



Breast Augmentation or Breast Reduction


Breast augmentation surgery is the most commonly performed surgical procedure in plastic surgery. Women choosing breast implant surgery want to achieve greater fullness and cleavage and fit their clothing more naturally. Many implant options exist and attention to detail is important. Breast augmentation is also one of the most commonly re-done procedures so women should carefully choose a compatible surgeon based upon credentials and experience.


Women who experience neck and back pain from heavy pendulous breasts can achieve a significant lifestyle improvement with breast reduction. Breast reduction can improve exercise tolerance, as well as lead to weight reduction and greater overall fitness.


Tummy Tuck



            Pregnancy or weight loss can create changes in a woman’s abdominal skin and muscles. In these cases, the procedure of choice is an abdominoplasty, also known as a tummy tuck. Tummy tuck surgery results in a substantial removal of excess skin and stretch marks, as well as tightening of the muscles. The result is a remarkable improvement in the belly with a very high degree of satisfaction.


Regardless of where you choose to start, these procedures, in the hands of a skilled surgeon, can produce dramatic results and patients who are among the happiest in plastic surgery. Bon voyage.


About the Doctor:


Dr. Perez has been selected among Castle Connolly/U.S. News and World Report’s America’s Top Doctors. He has lectured internationally and been featured as a plastic surgery expert for major news outlets. Dr. Perez is a member of the National Council of Leaders in Breast Aesthetics and was selected as a principal investigator for a national FDA-approved study on abdominoplasty. For more information call (954) 351-2200 or visit


It’s Thanksgiving: Time To Deal With The Turkey…Neck

· Face and Neck, Safety · No Comments

Jorge A. Perez, M.D., F.A.C.S.

            One of the most common areas requested for plastic surgery improvement by both women and men is the neck. Youth and attractiveness are defined by a strong jawline and a firm, clean neckline.


The aging process in the neck usually starts by age 40 and is affected by several components: the skin, bones and cartilage, and the underlying soft tissue, including the muscles and fat. Treatment options will depend upon the correct evaluation of each of these elements.


Jaw surgery or chin implants can help compensate for a bony profile deficiency. These procedures however can be complicated and should be approached cautiously with experienced surgeons.


Younger patients with excess neck fat alone and good skin tone may benefit from liposuction. Ultrasonic lipoplasty is an advanced liposuction technique that will also stimulate neck skin tightening.


The most common aging change affecting the neck is hanging skin, affectionately known as the “turkey neck”. In addition, loose muscles can contribute to the “gobbler” or wattle.


A muscular sling in the neck that is tight in youth but begins to separate as we age is called the platysma. The separation in this muscle causes two ridges that define the neck bands of age. A common treatment to correct this separation is to sew these bands together with a small incision under the chin.


A unique, less invasive, operation performed by our office is to combine neck muscle repair with ultrasonic lipoplasty for skin tightening in carefully selected patients. We were privileged to present this procedure last year to plastic surgeons in the U.S., Europe and Asia.


The gold standard for neck rejuvenation however, continues to be the conventional face and neck lift. The procedure allows for redraping of the cheeks, jawline jowls and neck in a more even and complete fashion. The anatomy of this area is complex, therefore a thorough consultation with a plastic surgeon experienced in face and neck surgery is required.


Many options exist for rejuvenation of the neck and lower face. The procedures can be safe and effective in proper hands. The plastic surgeon, facility and anesthesia all play an important role in the outcome. Cost should never outweigh quality, experience and safety. Happy Thanksgiving.



About the Doctor:


Dr. Perez has been selected among Castle Connolly/U.S. News and World Report’s America’s Top Doctors. He has lectured internationally on face and neck rejuvenation surgery and has been featured as a plastic surgery expert for major media outlets. Surgery is performed at the Broward Health Weston facility with physician anesthesiologists.

To schedule a consultation with Dr. Perez call (954) 351-2200. To learn more about any of these procedures visit


The 5 Steps of Breast Cancer Reconstruction


October is breast cancer awareness month as it continues to be one of the most common disorders affecting women. However, great strides have been made in both cancer diagnosis and treatment. In addition, many options exist for reconstruction following breast lumpectomy or mastectomy that allow these women to enjoy a greater quality of life.


There are several important and timely decisions for women to consider in achieving an optimal outcome. These choices can be overwhelming, though, so here are 5 steps to help women work through this difficult time.


Step 1: The Cancer Operation


Following the diagnosis of breast carcinoma a woman’s first consultation should be with a general surgeon experienced in all of the options for removal of the cancer. Together they should decide upon mastectomy or less radical surgery such as lumpectomy, as well as the role of adjuvant treatment such as chemotherapy and radiation. Based upon these plans a referral to a plastic surgeon with expertise in breast surgery is in order.


Step 2: Immediate vs. Delayed Reconstruction


The initial consultation with a plastic surgeon includes a thorough medical history and directed physical examination. The first decision will be whether to delay the breast reconstruction or begin at the time of mastectomy. The latter is regarded as an “immediate” reconstruction. Coordinated surgery offers the advantage of a single operation and fresh tissue planes for a cleaner and faster reconstruction, although delayed breast reconstruction can also be safely performed years after a mastectomy.


Step 3: Autologous Tissue vs. Prosthesis Reconstruction


The detailed plastic surgery discussion should include the types of reconstruction. There are several procedures available for creation of a new breast mound ranging from simple implant placement to microsurgery. The choice will depend upon several variables including the patient’s desires and body type. Autologous reconstruction is performed using the woman’s own body fat from the belly, back or buttocks. These can be lengthy and more complicated procedures. Breast implants, with or without expansion of the chest skin is called prosthesis reconstruction.


Step 4: The Other Breast


The opposite, healthy breast can be reshaped as well. Breast augmentation, lift or reduction for the purpose of achieving symmetry to the reconstructed breast may be necessary and should be included in the reconstructive planning.


Step 5: Nipple and Areolar Reconstruction


Once a new breast mound has been formed the final phase is the optional creation of a nipple and/or areola. Many procedures exist for this purpose. Although these are not mandatory, the results can be amazing.


Finally, and fortunately, laws exist to protect women from insurance companies during this vulnerable time. Florida law mandates coverage for both the reconstructed breast as well as the other healthy breast, if necessary, to achieve symmetry.


About the Author:


Dr. Perez is a member of the NOVO National Council of Leaders in Breast Aesthetics. He has served as a consultant for both Mentor (J&J) and Inamed (Allergan), leading breast implant manufacturers. Dr. Perez has lectured internationally on the subject of breast surgery and has been selected among the Castle Connolly (U.S. News & World Report) America’s Top Doctors. Our office aggressively advocates only on behalf of patients, not insurance plans. More information is available at or call (954) 351-2200. Visit our website blog to learn about The 10 Questions Every Plastic Surgery Should Ask.

Sientra: The New FDA-Approved Shaped Gel Breast Implant

Breast augmentation surgery is the most commonly performed surgical procedure in plastic surgery. Following the breast implant lawsuit crisis of the early 1990’s most silicone gel manufacturers fled the U.S. market. Only two companies, Allergan (formerly McGhan/Inamed) and Mentor/J&J, remained and have dominated the market for the past 20 years. One consequence of this implant duopoly is that the cost of breast implants increased from hundreds to thousands of dollars since the 1980’s.


Earlier this year the U.S. F.D.A. which regulates medical devices approved a third breast implant manufacturer. Santa Barbara based Sientra was approved to offer silicone gel prostheses for sale in the U.S.  Allergan and Mentor are also based in Santa Barbara, leading to the affectionate term of “Silicone Alley” for the Southern California region.


Dozens of breast implant companies exist throughout the world. Many of these brands are sold in Latin America. Sientra’s parent manufacturer has sold implants internationally, but of course U.S. approval is a highly coveted achievement.


A Good Thing…and a New Thing


The arrival of a third player to the U.S. breast implant market is expected to be a good thing for American women. In addition to providing greater competition, Sientra offers a unique line of shaped gel implants. These “teardrop” or “anatomical” breast prostheses are commonly used in Europe and Latin America. A saline-water filled version has been available for years in the U.S. However, Sientra is the only manufacturer granted F.D.A approval for the gel filled type.

Shaped implants offer greater options for both cosmetic and reconstructive breast surgery. The prostheses come in a variety of shapes, sizes, base diameters and projections giving both the patient and surgeon greater versatility in body contouring.


The augmentation procedure using shaped implants is different from the traditional round prosthesis insertion. Therefore it is advisable that patients choosing these implants consult with experienced breast plastic surgeons. As a corporate philosophy, Sientra will only sell and warranty implants placed by plastic surgeons recognized by the American Board of Plastic Surgery.


Editor’s Note: Dr. Perez can be seen on ABC News in Miami discussing the Sientra implant at:



About the Author:


Dr. Perez is a member of the NOVO National Council of Leaders in Breast Aesthetics. He has served as a consultant for both Mentor (J&J) and Inamed (Allergan). Dr. Perez has lectured internationally on the subject of breast surgery and has been selected among the Castle Connolly (U.S. News & World Report) America’s Top Doctors. More information is available at