Dr. Jennifer W. Robinson

Facial aging is caused by descent and redistribution of skin and fatty tissue, loss of skin elasticity, as well as exposure to the elements, and genetics. Deep wrinkles on your cheeks, creases descending from the nose to the corners of your mouth, and sagging in the middle and lower portion of your face and neck are usually addressed with a facelift and/or necklift. Standard incisions begin at the temples near your hairline, and extending downward along the front of your ear, and they then wrap around below the ear to end near the bottom of your scalp. This enables adjustment of the position of your muscles and the underlying tissues of your face, jowls, and neck. Excess skin is trimmed, and incisions are sewn. It will take you about two weeks to recover fully from a facelift procedure. Conducting a facelift requires a high degree of surgical skill, and the negative effects of a bad one are highly visible. That’s why it’s essential that your facelift be performed by a qualified plastic surgeon. A good one will restore a youthful look without making your skin appear stretched or pulled. Other procedures can be combined including browlift, eyelid lift (blepharoplasty), nose reshaping (rhinoplasty), and fat grafting (lipotransfer). Wrinkles can be further reduced using injections and skin care products. We may recommend that you see a dermatologist for laser resurfacing for finer lines.

Your eyes occupy the focal point of your face, drawing the most attention from others. As you age, skin becomes stretched and wrinkled, and bags can develop beneath your eyes. Your eyelids may begin to droop, appear folded over, or look puffy. You may feel that you appear tired or weary, especially toward the end of each day. Blepharoplasty removes excess skin and sometimes fat from the upper and sometimes lower eyelids. It is done under a local anesthetic while awake, sometimes with anti-anxiety medications. The incisions are hidden within the natural creases of tissue surrounding your eyes, but are sometimes longer depending on the amount of skin to be removed. Blepharoplasty can be combined with other non-surgical and surgical approaches like fillers, browlift, and facelift surgery to achieve a complete overall rejuvenation effect. Eyelid rejuvenation surgery can play a big role in restoring a youthful face, making you appear more alert at first glance, and sculpting a younger contour for your eyes. Malar bags and festoons are more challenging and often genetic manifestations of facial again that may better be treated by fat injection (lipotransfer) techniques. A consultation with Dr. Robinson will determine what the best approach is for you.

A rhinoplasty may be performed to correct a birth defect, to repair an injury, to improve breathing or simply to improve a patient’s appearance. Incisions can be hidden inside the nose (a closed procedure), or across skin between the nostrils (the columella), enabling access to the inner structural tissues of the nose for reshaping. Cartilage is either redistributed within your nose or additional cartilage from either the ear or rib may be required for reshaping. Rhinoplasty may be combined with a septoplasty in patients who suffer from a deviated septum in order to improve breathing. The septum separates your left nostril from your right. When it is displaced to one side, the airflow can be obstructed. A severely displaced septum can block a nostril completely. A septoplasty straightens the septum by aligning the bone and removing portions of cartilage while preserving the structural integrity of your nose. Candidates for rhinoplasty should be at least 16 years old since it is important that patients have finished their facial growth before proceeding with this surgery. Patients considering rhinoplasty should be in overall good health, and should have realistic expectations about the outcome. Immediately after surgery, the patient’s nose and eyes are usually bruised and swollen. Splints and some packing material will remain inside the nose for a few days. Most patients feel like themselves after a week and are able to return to regular activities in 2-3 weeks. One should expect to experience congestion, bruising, some bleeding, and numbness and swelling that improves over months.

Outstanding ears can be corrected in a surgical procedure called an Otoplasty. Dr. Robinson will assess the amount of setback required and tailor the surgical approach accordingly. In children, often suture reshaping of the immature cartilage is sufficient, but in adults, the mature cartilage is less amenable to suture reshaping and sometimes some degree of removal or scoring of the cartilage is necessary. An incision is made behind the ear where it meets your scalp, and a combination of minimal cartilage removal, permanent buried suture placement, and skin removal is performed. Compression dressings are placed and left clean and dry for a few days postoperatively. While the results of the operation are sometimes dramatic, mild asymmetries are expected. Both ears are not alike even in the natural state. Frequently, they are not set at the same distance from the scalp and they sit at different positions on the head. Small differences do not defeat successful improvement since both ears are rarely seen at the same time. Every effort is made to obtain the best possible symmetry. In adults, otoplasty is not covered by the provincial medical insurance plan.

Asymmetries of the breast can occur for different reasons during infancy, puberty, or breastfeeding. The specific surgical approach taken depends on the factors causing the asymmetry. Dr. Robinson will do a detailed assessment and together you will choose the option that is best for you. Simple breast asymmetry might be amenable to a single implant or implants on both sides that vary slightly in size. If the smaller breast requires a greater amount of skin to accommodate an implant and/or to level the nipple heights, an expandable breast implant may be used, which may stay in place or be exchanged for a permanent implant at a later date. Expandable breast implants require repeated periods of injection of fluid into the implant to stretch and recreate skin. One breast smaller than the other with or without chest wall and hand anomalies might be an indication of something called Poland’s Syndrome. This is a condition thought to arise from an interruption of the blood supply during embryonic development. A soft tissue flap from your back called a latissimus dorsi flap with or without an implant may address this. Drains may be used that are generally removed after 1-2 weeks. Sometimes breast asymmetry exists as part of a ‘tuberous’ breast appearance, where there is a constriction of the base of the breast with drooping and enlarged areolae. In this scenario, breast tissue expanders and/or implants are used in combination with reducing the size of the areolae and reshaping the breast tissue.

Hypomastia, or small breast volume, is common among women seeking augmentation. Pregnancy, breastfeeding, weight changes, and aging can also result in loss of the volume. The use of breast implants to address these concerns is one of the most commonly-performed cosmetic surgical procedures in the world. Important variables that will be discussed in detail with Dr. Robinson are: Desired size (photographs can serve as a guide, and are encouraged) Implant characteristics (saline vs silicone, textured vs smooth, round vs anatomic) Incision placement (inframammary or peri-areolar) Beneath or above the pectoralis major muscle While breast augmentation will enlarge the breasts, the surgery will not alter underlying basic defects in breast shape and form, or chest wall contour. Asymmetries may be improved but will not be completely corrected with breast enlargement alone. A difference in the size, shape or orientation of the two breasts is considered normal. If breast size and/or nipple position asymmetries are severe, additional procedures to further improve symmetry may be necessary. Sometimes a breast lift of mastopexy either alone or in combination with augmentation will better address your symptoms and Dr. Robinson will discuss with you what your optimal treatment plan will be.

Pregnancy, breastfeeding, weight changes, loss of skin elasticity, aging, and genetics can combine to result in deflation of the breast’s previous volume causing sagging or descent of the overlying skin called ptosis. Mastopexy can be used to remove excess skin and reshape the breast. The extent of the incisions needed to complete the surgery depends on the degree of ptosis that you display. Minor ptosis may be addressed with a simple incision around the areola. More severe cases require longer incisions that may reach both vertically down the lower portion of your breast and even underneath the mammary fold. A well-performed mastopexy will raise and add firmness to your breasts by removing excess skin and tightening the surrounding tissue to support the new breast contour. The incision lines are permanent, but in most cases they will fade and improve in appearance over time. The elasticity of your skin and age will determine how long-lasting the effect of the lift will be. A mastopexy will not significantly change your breast size, or fill out the upper pole of the breast. Breast lift is often performed in conjunction with a breast augmentation procedure to address both shape, size, and upper pole contour simultaneously.

Breast size can increase uncomfortably with weight gain, after pregnancy and breastfeeding, or with menopause. Perhaps you have been large-breasted since puberty. This can cause symptoms of back, neck, and shoulder pain, and cause difficulty with caring for your skin in the folds underneath the breasts. Reduction mammoplasty or breast reduction removes breast skin and glandular tissue to decrease the weight and size of the breasts to a manageable weight that alleviates your symptoms and is in proportion to your body. Anchor-like or vertical-type incisions are marked in the pre-op area by Dr. Robinson. These result in scars around the areola, down the 6 o’clock position of the breast, and often in the inframammary fold. The length of the scars is determined by how large the breast is and how much skin is to be removed. You will notice the change immediately, and may find the change initially very different. We encourage you to be patient with it as it takes some time to adjust. The majority of swelling is resolved by the end of the first week. You can purchase a supportive bra at that time as size will not change appreciably thereafter. It is advised to avoid underwire bras for 3 months after the surgery. Nipple sensation may change and be different between sides. Drains are not used. Think of the breasts as “sisters not twins”, as asymmetries are common both before and after the surgery. Resulting cup size cannot be guaranteed. It is important to note that the purpose of a breast reduction is for medical symptom management and not for cosmetic improvement. A mastopexy or breast lift might be of interest if cosmetic alteration of the breasts is your goal. GYNECOMASTIA (MALE BREAST REDUCTION) Breast tissue can be present to varying degrees in males, resulting in an undesirable appearance. This can occur as a result of hormone changes caused by obesity, aging, drug use, or genetics. Rarely this can be caused by overactive hormone-secreting structures and investigation by your family doctor is recommended. Surgical correction requires removal of fat and/or glandular tissue from the breasts using an incision that follows halfway along the lower border of your areola. Sometimes removal of excess skin requires longer, more visible incisions. Liposuction is commonly used as it improves the overall appearance, but it is not a benefit of the medical services plan. The result is a chest that is flatter, firmer, and more masculine. The best candidates for this surgery have firm, elastic skin that will reshape to the body’s new contour. After the surgery, you’ll need to wear a compression garment for several weeks. Occasionally drains are used. Any discomfort is well-managed with medication, and most men only require this for a few days. We will ask you to decrease your activities significantly for the first two weeks, and then gradually increase them over the following 4 weeks. Major repetitive arm motions should be avoided for 4 to 6 weeks.

Pregnancy, weight changes, and aging can result in excess fat and skin around the abdomen. Occasionally this causes rashes and discomfort in the folds beneath excess skin. Generally effective weight loss and exercise do not tighten or remove the skin, and surgery can improve the appearance for you. The ideal patient for abdominoplasty has a body mass index under 30, has excess skin alone, and is healthy and fit. The placement and design of the abdominal incisions vary depending on the looseness and condition of the skin, the amount of fat to be removed, and prior scars. Often there is laxity of the abdominal wall muscles which can also be addressed by tightening this “internal corset” of fascia during the abdominoplasty. The scar runs from hip to hip in the lower abdomen, and one around the umbilicus. Drains are sometimes used, and a compression garment should be worn for 4 weeks after the surgery. Sometimes liposuction is recommended to optimize your result. For those where the sagging skin is mainly in the lower abdomen the mini-abdominoplasty may be an option. This procedure is not as extensive due to a smaller incision that is easily hidden under a two-piece bathing suit. This procedure offers a more rapid recovery and avoid the use of drains.

Loss of skin elasticity in the upper arm can be seen with increasing age, genetic predisposition, or after significant weight loss. An arm lift or brachioplasty can result in thinner, more shapely arms that are more youthful in appearance. Incisions are created that extend from the elbow along the inner arm or on the back of the arm, to the arm pit and even along the chest wall. This technique allows for maximum skin and fat removal. Sometimes it is combined with liposuction to help contour the remaining arm tissues. Sutures used are all dissolving underneath the skin. Drains are sometimes used, and a compression garment will be worn for 4 weeks after the surgery. Scars are an unavoidable part of this surgery, but most brachioplasty patients find this to be an acceptable trade-off to achieve an immediate improvement in their appearance.

Transfer of fat cells from one part of the body to another to address contour irregularities in various parts of the body is called autologous lipotransfer or fat grafting. Dr. Robinson performs liposuction from areas of the body (usually abdomen, flanks, and/or thighs) and processes the fat so that it is injectable. This is used to fill in concavities around breast reconstructions, under depressed surgical and traumatic scars, and restore fat volume loss in the rejuvenation of facial aging. For smaller volumes, injection of the anesthetic fluid used for retrieving the fat through liposuction may be enough anesthetic; for larger volumes, a general anesthetic will be required. One should expect a few days of swelling, a few weeks of bruising and some pain. Pressure on the areas fat grafting should be avoided for 3 months. A variable amount (10-50%) of the injected fat may be reabsorbed by the body over time and the area may lose some volume, particularly in areas of radiation therapy. This is why Dr. Robinson may initially may add more fat than you think you need, and multiple procedures may be required to achieve the desired outcome.

Suction lipectomy removes subcutaneous fat while simultaneously recontouring to create a more aesthetically appealing body. Bothersome fatty deposits that are resistant to diet and exercise can be found in the face, neck, breast, abdomen, upper arm, hips, thighs, knees, and ankles. A thin tube called a cannula is inserted through small, inconspicuous incisions in your skin and loosens the deposits by moving back and forth. The loosened fat is then removed with a surgical vacuum or syringe. Liposuction can be performed on multiple areas at one time – Dr. Robinson will follow accepted guidelines regarding safe volumes which may be removed in one session. While some results are noted immediately, your final shape and form will continue to improve as your swelling subsides. You will be encouraged to be up and about the night of your surgery and progressively increase your activities. Usually light work duties may be resumed within three to five days and vigorous exercise within two to four weeks. You will be required to wear a compression garment for 4 weeks after the procedure to optimize the recontouring of your overlying skin and minimize swelling, bruising, and discomfort. Fat cells is permanently removed with liposuction, but with weight gain, remaining fat cells can enlarge, reversing the benefits of the liposuction. It is important to maintain your weight afterward. It is also important to understand that liposuction is neither a cure for obesity nor a substitute for a healthy lifestyle: the right combination of dietary changes and an exercise plan are ideal to address this. Cellulite is a challenging condition that may require a thighplasty.

Either after bariatric surgery or self-directed large-volume weight loss, undesirable excess skin can be found to sag, limiting the gratification of your weight loss. This can be remedied by surgery consisting of one or more of the following procedures: Abdominoplasty (tummy tuck) Brachioplasty (arm lift) Thighplasty (thigh lift) Buttockplasty (buttock lift) Monsplasty (pubis lift) Upper Body Lift (+ Mastopexy in Women) A lower body lift is most often performed on the lower half of the torso and the thighs, addressing the loose skin of the stomach, back, hips, thighs, and buttocks. It combines buttockplasty, thighplasty and abdominoplasty done on the same day. This results in circumferential scars around the lower torso, around the mons pubis, and along the inner thighs. At a separate stage, an upper body lift is performed, combining brachioplasty, reverse abdominoplasty, lateral chest and back lift, and in breast lift in women. Combined procedures are longer and more complex and patients must understand the potential for risks and complications. The recovery period is considerably longer than when the procedures are done in isolation. Blood thinners are often required around the time of surgery. A period of 3 months is required for recovery between procedures.

Excess skin and fat can be removed from your thighs in this operation. Many individuals choosing a thighplasty procedure have excess skin as a result of weight loss, or simply because of the natural effects of aging. Thighplasty removes excess fat and skin from the inner thighs resulting in a tighter, firmer, more toned thigh appearance. Cellulite can be improved somewhat with this procedure. A thigh lift usually lasts several hours. The surgery begins with an incision in the groin area that usually extends down the inner thighs. Dr. Robinson separates the skin on your thighs from the fat and muscle below by moving the flap of skin upwards. Then, the excess skin is removed and the remaining skin lifted and closed. The length of incisions we make will depend on the extent of operation you require. Similar to a brachioplasty, the scars are long and visible, but most patients find this an acceptable trade-off for a better thigh contour. Drains are often used and removed 1-2 weeks afterward. A compression garment is worn for 4 weeks postoperatively to minimize the risks of fluid collections (seroma), bleeding (hematoma), and to improve the overall result.

Carpal Tunnel Syndrome Numbness and tingling in the hands, particularly involving the thumb, index finger, long finger, and part of the ring finger can be a symptom of carpal tunnel syndrome. It can also manifest itself as pain in the hands and forearms that wakes one at night, or as weakness when handling small objects. Individuals with hypothyroidism, diabetes, peripheral edema, and pregnant women are predisposed to developing this condition. Carpal tunnel syndrome results from compression of the median nerve. This nerve travels from its origin in the cervical spinal cord, through the neck and arm, entering the hand through the carpal tunnel at the wrist. The tendons to the fingers also travel through this tunnel. A band of connective tissue at the base of the palm called the deep transverse carpal ligament, forms the roof of the carpal tunnel. This structure can compress the median nerve. Surgical release of the ligament relieves the compression on the nerve, allowing it to recover. The procedure is performed under local anesthetic as an outpatient procedure. If compression has been longstanding, sometimes irreversible nerve damage may have occurred which limits how much return of function or sensation can be realized. Other Nerve Compression Syndromes Numbness, tingling, weakness, and pain can result from nerve compression in other areas of the upper extremity or elsewhere in the body. A few examples are: Cubital Tunnel Syndrome (ulnar nerve) Wartenberg’s Sydrome (radial nerve) Tarsal Tunnel Syndrome (tibial nerve) It is important to recognize that nerves can be compressed or injured at any point along their path, from the neck to the end target. Please contact our office for more information about the diagnosis and treatment of these conditions.

Microsurgery is a general term used for surgery of sufficiently small structures to require the use of an operating microscope. In plastic surgery, this involves the repair of microscopic structures including nerves and blood vessels. This approach is used when such structures have been injured, when performing replantation of limbs and portions of limbs that have been traumatically amputated, and when performing ‘free tissue transfer’ for reconstructive purposes. Dr. Robinson has a special interest in the microsurgical technique of ‘Free’ or ‘autologous’ tissue transfer. A region of “donor” tissue is selected that can be isolated on a feeding artery and vein; this tissue is usually a composite of several tissue types (e.g., skin, fascia, muscle, fat, bone). The procedure was first done in the early 1970s and has become a popular “one-stage” (single operation) procedure for many surgical reconstructive applications. Scenarios in which Dr. Robinson performs this technique are: Breast cancer surgery Head and neck cancer surgery Sarcoma surgery Traumatic injury Burn reconstruction Congenital defects Facial reanimation Lymphedema management Impaired and prolonged wound healing Dr. Robinson’s training both during her residency at the University of Western Ontario and her fellowship and the University of Texas M.D. Anderson Cancer Center, as well as extensive operative experience in this field have contributed to her expertise on this topic both in British Columbia and in Canada.

Lumps and bumps on the face or in other areas of the body that are bothersome are usually amenable to surgical removal. A thin, linear scar that is usually slightly longer that the length of the lesion itself results. In some areas of the body, this scar has the tendency to widen or thicken, requiring treatment with steroid injections or other methods. In most cases, a scar is favourable to the contour irregularity caused by the lesion as it can be masked by makeup, can be hidden within natural skin creases, and does not cause shadowing. Sunscreen is recommended for a year after lesion removal to avoid darkening of the scar. The removal of these lesions is NOT covered by your provincial insurance plan: Benign nevi (moles) Cysts Seborrheic keratosis (rough wart-like dark spots, more common with age) Common warts Lipomata (fat lump) Uncomplicated benign dermal and/or epidermal cysts Telangiectasias and angiomata of the skin (i.e. dilated blood vessels, spider veins, red spots) Skin tags and polyps Papillomata (wart like growth) Neurofibromata (nerve tumour) Dermatofibromata (skin nodule) Dr. Robinson may recommend that you see a dermatologist if laser removal may better address your concerns.

If you have excessive scarring from prior surgery or trauma, you may benefit from scar correction surgery. While it’s not possible to remove a scar completely, surgery can frequently minimize the appearance or negative impact of a thick, tight, bothersome scar. Steroid injections can decrease the thickness and inflammation of scars. Dr. Robinson may refer you to a dermatologist for laser treatment if this might better address your symptoms.

Please contact Dr. Robinson’s office to access the Cutaneous Surgery Clinical Referral Line, ensuring expedited service. Basal Cell & Squamous Cell Carcinoma Basal cell skin cancer is only locally invasive and only in very rare cases has the capacity to metastasize or spread elsewhere in the body. Squamous cell skin cancer has a greater chance of growing more rapidly and more deeply as well as metastasizing. Surgical removal is curative, although liquid nitrogen, topical chemotherapy creams, and radiation can also be used to treat these cancers. Dr. Robinson offers traditional plastic surgical removal, but also a Mohs-like Total Margin Control (TOMAC) technique that has a lower risk of recurrence than with traditional techniques. Melanoma Malignant melanoma is the most worrisome of the skin cancers, and has the capacity to metastasize to other organs in the body and cause death. Treatment depends on the tumour’s thickness, microscopic characteristics, location on the body, and patient factors such as age and medical condition. Surgical removal of the tumour is combined with some or all of the following: wound closure techniques (direct closure, skin flaps, skin grafts) sampling the lymph nodes (sentinel lymph node biopsy) chemotherapy immune therapy medications targeted therapy medications radiotherapy

Large wounds that struggle to heal on their own are frequently treated by plastic and reconstructive surgeons. Such wounds can develop as a result of prolonged pressure, major trauma, or even minor trauma in individuals with: Spinal cord injuries Impaired cognition Immobility Diabetes Medical conditions requiring immune suppression therapies Areas of radiation therapy Treatment For more superficial wounds, a regimen of dressings and supportive wound care may be prescribed for nurses to perform. This may also require surgical removal of non-viable or unhealthy tissue called debridement. If the wound is sufficiently large or slow to heal, a combination of surgical strategies can be employed to replace deficient tissue: Skin Grafts Heal by adhering to and being supported by the blood supply of the underlying wound. Local Skin Flaps Rearrangements of adjacent skin and fat which carry its own blood supply to cover the wound. Regional Or Distant Pedicled Tissue Flaps Using a combination of tissues which carry their own blood supply over a distance to fill the wound. “Free” Or Autologous (Within The Same Body) Tissue Transfer Disconnecting a tissue system and its feeding blood vessels from one part of the body and transplanting it to the area requiring reconstruction, using microsurgical techniques to connect the blood supplies.

Dr. Robinson treats bony injuries of the hand and craniofacial skeleton, as well as injuries of the soft tissues of the entire body. This is both in the initial fixation of these injuries, and also later on in the context of scar management and restoration of form and function. The full range of techniques in plastic and recognitive surgery can be performed.