Todd Hanna, MD, DDS, FACS

04/09/2025

The beauty of the deep plane face lift, especially in younger patients, is that you can do a lot without looking like you did a lot.

This is a very beautiful woman, and very young by facelift standards, who was previously highlighted on our page at 9 days post-op. She’s now 10 weeks out from her deep plane facelift. *This was not for aging, but to correct an issue that she had from acne scar treatment several years ago leaving her with prematurely heavy cheeks (see prior post for case details including bilamellar subcision component).

The red and blue circles identify landmark cheek scars that show us the vectors and degree of lifting. We removed almost 2 inches of skin per side in a vertical vector with zero tension, which is more than I would sometimes remove on even older patients with much more loose skin using non-deep plane techniques.

By releasing the facial ligaments within the deep plane, you’re able to passively reposition the facial tissues much more, without things being, or looking, pulled.

This is really the key to the natural esthetic of modern-day face lifting. Very happy for this gorgeous woman.

04/04/2025

1 month post-op custom genioplasty. This is a great example of exploring surgical options because, sometimes, there is more than one right answer.

Classically this would be a jaw surgery plus genioplasty case, which was my recommendation. She wanted the genioplasty only, so we had to find ways to achieve a meaningful projection (~1cm) while avoiding the pitfalls of large isolated chin advancements.

Gladly, we were able to achieve the desired chin projection to balance her lower face with her upper and middle thirds. All while creating elegant curves and angles between the lower lip-chin-neck — especially notable during smile. Sculptural and feminine. Very happy for this beauty ❤️

03/28/2025

It was an honor to share our approach to facial esthetic and orthognathic surgery with the legendary Tim Turvey and the amazing team at UNC . The warmth of this institution reminded me of my own residency days at . Tim is a trailblazer in orthognathic and cleft craniofacial surgery in the states, and grew up just a few miles away from where I grew up in New York. After training with Paul Tessier in Paris, Tim has built an epic career filled with contributions and accolades at UNC. Truly an honor for myself and 🙏 . Special thanks to my tour guides and derricknelson

02/14/2025

Obstructive sleep apnea (OSA) treatment with maxillomandibular advancement (MMA). This is essentially orthognathic (double jaw) surgery and genioplasty using large advancements with the primary focus was on increasing the airway, rather than esthetics or occlusion. Our particular treatment philosophy however, prioritizes esthetics and occlusion, equally with airway.

*Airway volumetrics from CT scans do not diagnose OSA or definitively reflect cure, but they are a very helpful metric to assess progress. A sleep study, specifically AHI (Apnea Hypoxia Index), is needed for diagnosis.

These cases have gotten a bad wrap for undesirable esthetics due to distortion of nose, mouth and chin, but when performed thoughtfully, they can actually make patients look and feel profoundly, younger, healthier, and more attractive. Breathe better, look better, feel better.

Great guy.. very happy for him

02/13/2025

Long term follow up with doublejawsurgery genioplasty and closed rhinoplasty for class 3 underbite, flat labiomental fold, and dorsal hump. The subtleties of this case include, bringing the lower lip back, to the level of (or slightly behind) the upper lip (when looking from side profile), creating a slightly deepened labiomental fold (inward curve between the lower lip and the chin), adding structural support to the upper lip and cheeks, and softening the nasal bridge, and controlling elevation of the nasal tip (supra-tip break) while preventing nasal base widening. Subtle does not always mean simple.

02/02/2025

Bi-lamellar facelift (deep plane and sub-cutaneous plane). Early post op photos at post-op day 9 to highlight what recovery can look like. This is a fix/revision case of a beautiful young woman who had fat grafting and other non-surgical treatments for cheek scars several years ago elsewhere. It left her with premature heaviness and skin laxity in the mid and lower face. “Iatrogenic” doughy cheeks. We needed a deep plane approach to adequately release and elevate the extensive grafted fatty tissue in the cheeks, and we needed a subcutaneous plane approach to sub-incise the cheek scars. The bi-lamellar lift (dual plane) accomplished both objectives, and additionally allows for dual vectors of SMAS and skin (as opposed to composite deep plane lift).

01/11/2025

HFJ family (missing Keldsy and Lis). 2024 was an incredible year for us filled with growth and milestones. We have grown this practice from a single operatory and a coat closet for an admin office, to a state-of-the-art multi-unit surgical facility. Ever-growing.

This growth is possible because of the dedication and efforts of the truly superb people within our little work family, and within our network of colleagues and trusted patients—I am grateful for each of you and our growth is a reflection of that gratitude.

The most important skill, as a surgeon or anything else, is being able to attract superb human beings. Set the bar high and the superb ones will find to you. Those not up for it will w**d themselves out. Our people are our greatest success.

Wishing each of you a healthy prosperous and joyful 2025! May your dreams become a reality ❤️

12/21/2024

Post-Op Day 5 from subnasal lip lift. Close up high definition photos taken immediately after suture removal, hence the red spots. This incision will flatten, pink will fade, and it will be near invisible, even close up, in weeks to months.

Factors that influence how a scar heals can be grouped into 3 categories:

1. Technical elements such as carefully designing making and closing the incision, and handling the soft tissue gently. This includes suture choice and closure techniques. These are things the surgeon and team can control.

2. Genetic or systemic elements including tendencies towards hypertrophic scars or keloids, certain medications, hormonal imbalances, and infections can all affect scars. These are things that may or may not be in the control of the patient or the surgeon.

3. Postoperative and environmental elements. How the wound is cared for after surgery. Using silicone and sunblock are the two most widely accepted methods to encourage a well-healed scar. Avoidance of sun is probably the most critical. These are things that patient can control.

12/18/2024

Complex facial restructuring with upper and lower orthognathic surgery and genioplasty for correction of a class 3 skeletal deformity (underbite), lip incompetence, anterior open bite, bilateral posterior cross bite, and facial asymmetry at all levels. The upper jaw was sectioned into 3 pieces and repositioned. The lower jaw utilized the HSSO technique on the left side to level the jawline (down and in) and oblique BSSO on the left. His chin was centered leveled and shortened. Superb orthodontic work by . The HSSO technique continues to be an invaluable technique for complex cases such as this. For technical notes, see the journal article by myself and .science.enjoyinglife with contributions by the entire and teams.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11204967/

12/13/2024

One for the young surgeons: Nuances of lip lift incision design.. simple, but critical. 1. Marking the upper margin. If there is not an existing well delineated subnasal groove or sill, as in this patient, you will create one with your incision. Look for where the thick shiny dermis of the ala fades into the thin duller dermis of the upper lip, and follow the curvature of the ala. If a natural groove exists, stay a blades-width (~0.5mm) shy of its depth to avoid webbing. 2. The columella and medial crura footplate rarely have an existing groove. As you create one, respect a curvilinear design and avoid making a straight line across which will catch the eye. 3. Extension into the alar-facial groove is dependent on extent of lift needed, but it helps to mark the light reflex of the alar rim and not go above this point for a more harmonious scar. 4, 5, 6. Keeping the angles within the inferior margin obtuse allows for better matching of surface area/length between upper and lower margins (red and blue lines) which produces a cleaner closure without dog-ears or pleats. *It is important to take initial measurements, but avoid the pitfalls of “treating to millimeters” despite what is in literature as “norms”. Everyone’s anatomy is different. What’s important is tooth display, arch-form of upper lip, raitios and proportions, passive closure of lips at rest, avoiding recruitment of peri-oral accessory muscles during speech, and a well placed scar—not how many millimeters it is.

09/12/2024

doctor.hanna Total full-thickness cheek defect and reconstruction at 1 year with thigh transplant. This individual had an extensive late stage sarcoma/cancer requiring removal of the entire cheek (full-thickness defect). I was able to reconstruct him with an ALT Microvascular free flap using a vastus lateralis muscle and fascia (TFL) for internal lining inside the mouth, and thigh skin for external lining on the face. He had radiation after surgery, which causes the loss of beard hair, and darkening and stiffening of the skin, but has remained cancer-free. Over the course of 1 year we did a series of recontouring, debulking, circumferential tissue recruitment, and commissure-plasty to reconstruct the mouth corner. Great team work by@mountsinai_omfs and teams . Very happy to see this guy thriving. ❤️

07/31/2024