Reconstructive Microsurgery in Beverly Hills: The Discipline That Makes the Impossible Possible, and the Surgeon Who Trained at Its Source
What is microsurgery?
Microsurgery is the branch of reconstructive surgery performed under magnification using specialized instruments, sutures finer than a human hair, and a level of technical precision that places it among the most demanding disciplines in all of medicine. It is the technique that allows a surgeon to reconnect arteries and veins measured in millimeters, repair nerves at the level of individual fascicles, and transfer entire blocks of living tissue from one part of the body to another with the vessels sewn together under a microscope, where the anastomosis, the joining of two vessel ends, must be airtight, correctly oriented, and tension-free in a space where a single millimeter of error is the difference between a flap that lives and one that does not.
Microsurgery is what makes replantation possible. It is what allows a hand surgeon to reattach a severed finger. It is what allows a reconstructive surgeon to take a muscle from the back, a piece of intestine, or a skin and fat paddle from the thigh and move it to the chest, the face, or the leg to replace tissue that cancer, trauma, or infection has taken. It is, in the most literal sense, the technique that allows surgeons to restore what would otherwise be permanently lost.
Dr. Daniel Golshani brings master-level reconstructive microsurgery to Beverly Hills, trained in the discipline under the direct influence of Dr. Harry Buncke, the man the surgical world calls the Father of Microsurgery. The precision, the patient selection, and the surgical philosophy that define Dr. Golshani’s reconstructive microsurgery practice are built on that foundational lineage and on the nine years of elite surgical training that produced a surgeon capable of operating at this level.
What is the history of microsurgery and who built the discipline?
Microsurgery as a clinical discipline has a specific, traceable origin, and it begins with a problem that surgeons had been confronting for decades without a reliable solution: how to reconnect blood vessels small enough that suturing them by hand, without magnification, without specialized instruments, and without ultra-fine sutures, was essentially impossible.
The conceptual foundation was laid in 1960, when Jacobson and Suarez published their description of anastomosing small vessels under microscopic magnification in an experimental setting. They demonstrated that magnification made vessel anastomosis technically feasible at sizes that hand technique could not reliably achieve. What remained was the translation of a laboratory technique into a clinical discipline: the development of the instruments, the sutures, the training methods, and the surgical protocols that would allow microsurgery to become reproducible and reliable at the level a patient’s survival could depend on.
Harry J. Buncke, who has been called the Father of Microsurgery for his contributions to the history and development of reconstructive microsurgical procedures, served as a clinical professor of surgery at both Stanford University and the University of California San Francisco, and was the author of four surgical textbooks and more than four hundred peer-reviewed publications. Wikipedia
In 1957, Dr. Buncke was inspired to develop techniques for transplanting blocks of tissue on small vessels of one millimeter. In March of 1964, he reported the first successful rabbit ear replantation to the Plastic Surgical Research Council meeting, having developed special micro instruments, sutures, and hand-made needles to perform these procedures. Microsurgeon
The Davies Medical Center Microsurgery Lab and Replantation Service unit began in 1970. The team performed the first human toe-to-hand transplant, scalp replant, serratus-combined-latissimus microvascular transplant, four-digit replant, tongue replant, and multiple microvascular simultaneous transplant in the United States. Over 250 clinical research fellows and 100 residents trained there, with twenty-seven subsequently becoming department chairmen or co-chairmen. Buncke
Working at first with monkeys in a makeshift operating theater in his garage, Buncke learned to replace lost fingers with toes and helped spark a revolution in microsurgery. He helped develop a two-surgeon microscope that is now standard equipment in microsurgical operating rooms. Aaps1921
What Buncke built was not just a technique. It was a philosophy: that the reconstructive surgeon’s obligation to the patient extends to the most technically demanding intervention available when that intervention is what the anatomy requires. That the question is not what is easy but what is possible. And that what is possible, in the hands of a surgeon trained to the highest level, is considerably more than medicine had previously believed.
What does training under Dr. Harry Buncke mean for a surgeon’s practice?
The Buncke Clinic at Davies Medical Center in San Francisco became, over the decades following its founding, one of the most important microsurgical training centers in the world. Its fellowship program trained surgeons who went on to become department chairmen, program directors, and the leading reconstructive microsurgeons of their generation across the United States and internationally.
To train under Dr. Buncke, or under the surgeons whose training and philosophy Buncke directly shaped, is to receive microsurgical education at its source. The principles instilled are not simply technical, though the technical demands of microsurgery are extraordinary. They are philosophical: a commitment to the most precise and most complete reconstruction available, a respect for the tissue being operated on, and an understanding that the patient in front of you has entrusted the outcome to a surgeon who must be capable of performing at the highest level when the anatomy demands it.
Dr. Golshani had the privilege of training under the direct influence of Dr. Harry Buncke, an experience that shaped both the technical precision and the reconstructive philosophy that define his approach to complex tissue transfer and microsurgical reconstruction. The influence of Buncke’s standard, that precision at the microscopic level is the foundation of every successful reconstructive outcome, is evident in every microsurgical procedure Dr. Golshani performs today.
What procedures does reconstructive microsurgery make possible?
Microsurgery is the enabling technology for a category of reconstructive procedures that would be impossible without it. Understanding what these procedures are helps clarify both the scope of what microsurgery offers and why the level of training behind it matters so significantly.
Free flap tissue transfer. A free flap is a block of tissue, consisting of skin, fat, muscle, or bone, taken from a donor site on the body and transferred to a recipient site where the blood supply is disconnected during the transfer and reconnected at the new location using microsurgical anastomosis of the feeding artery and draining vein. The tissue survives because the surgeon re-establishes its blood supply at the new location with a precision that allows the vessels to carry blood through the anastomosis without leaking, clotting, or kinking.
Free flap tissue transfer is the technique that allows a surgeon to reconstruct a breast using the patient’s own abdominal tissue following mastectomy, to resurface a leg wound following trauma or tumor resection, to fill a defect in the face or skull following cancer surgery, or to replace a missing segment of the jaw following oncological resection. It provides living tissue, with its own blood supply, in situations where local tissue options are insufficient.
Replantation. Replantation is the reattachment of a completely amputated body part, most commonly a finger, thumb, hand, or arm. The severed part is brought to the operating room, the anatomical structures are identified and prepared under magnification, the bone is fixed, the tendons are repaired, and the vessels and nerves are joined under the microscope. The outcome depends on the quality of the microsurgical anastomosis, the viability of the amputated tissue, the ischemia time, and the overall condition of the patient.
Replantation is among the most demanding emergency microsurgical procedures, performed under time pressure with anatomy that has been traumatically disrupted rather than surgically prepared. It is a procedure that requires not only microsurgical technical mastery but the clinical judgment to determine, rapidly and accurately, which amputations are replantable and which are not.
Nerve repair and reconstruction. Peripheral nerve injuries, whether from trauma, tumor resection, or surgical complication, produce functional deficits that range from numbness and weakness to complete paralysis of the affected extremity or facial zone. Microsurgery allows nerves to be repaired at the level of individual fascicles, the bundles of nerve fibers that carry specific functions, with an alignment precision that gives the regenerating nerve fibers the best possible path to reach their target organs.
When the nerve gap is too large for primary repair, nerve grafting using segments of sensory nerve from elsewhere in the body bridges the gap under magnification. In selected cases, nerve transfers, in which a functioning nerve branch is redirected to reinnervate a denervated muscle, produce functional recovery in situations where direct nerve repair or grafting is not possible.
Vascular reconstruction. Microsurgical anastomosis of small vessels is the technique underlying not only free flap transfer and replantation but a range of reconstructive vascular procedures that address trauma-related vessel injuries, tumor involvement of named vessels, and the vascular complications of prior surgery or radiation.
Lymphatic surgery. Lymphedema, the chronic swelling that results from lymphatic system damage following cancer surgery, radiation, or trauma, can be addressed through microsurgical procedures that create new connections between the lymphatic vessels and the venous system, bypassing the damaged lymphatic channels and reducing the chronic swelling that otherwise persists indefinitely.
What conditions are treated with reconstructive microsurgery?
Microsurgical reconstruction is indicated when the defect or injury requiring reconstruction cannot be adequately addressed through simpler, local tissue options. The conditions most commonly treated include:
Breast reconstruction following mastectomy. For patients who have undergone mastectomy for breast cancer and who want autologous tissue reconstruction, free flap breast reconstruction, using tissue from the abdomen, thigh, or back, provides a result that looks and feels more like natural breast tissue than implant-based reconstruction, ages naturally alongside the patient’s body, and in many cases produces the most aesthetically complete breast reconstruction available. See the Breast Reconstruction page for a detailed discussion.
Head and neck reconstruction. Following the surgical resection of tumors of the oral cavity, pharynx, larynx, and facial skeleton, the defects produced can involve multiple tissue types simultaneously: skin, mucosa, muscle, and bone. Free flap reconstruction allows the reconstructive surgeon to bring composite tissue from a distant site to restore both the form and the function of the head and neck region in a way that no local tissue option can achieve.
Lower extremity reconstruction. Traumatic injuries, diabetic wounds, and tumor resections of the leg can produce defects that expose bone, tendon, or hardware and that local tissue cannot cover. Free flap transfer brings well-vascularized tissue to these wounds, providing coverage that heals reliably and restores the functional integrity of the extremity.
Hand surgery and replantation. The hand is one of the most functionally complex and most surgically demanding anatomical zones in the body. Trauma to the hand, whether by amputation, crush injury, nerve laceration, or vascular disruption, requires a level of microsurgical precision that reflects the complexity of the structure being repaired. Dr. Golshani’s training at the Buncke Clinic places his hand and replantation microsurgery within a direct lineage of the surgeons who established the technical and clinical standards for this work.
Facial reanimation. Facial nerve paralysis, whether from tumor resection, trauma, or congenital absence, produces one of the most functionally and psychologically impactful deficits in reconstructive surgery. Microsurgical nerve repair, nerve grafting, and free muscle transfer for facial reanimation address this directly, restoring the dynamic facial movement that static procedures cannot provide.
How does microsurgery relate to Dr. Golshani’s cosmetic practice?
The connection between reconstructive microsurgery and cosmetic surgery is one that is not always apparent to patients, but it is foundational to understanding why a surgeon with Dr. Golshani’s reconstructive training produces cosmetic results of the quality he does.
Microsurgery requires the deepest possible understanding of vascular anatomy. To move tissue from one part of the body to another and expect it to survive, a surgeon must understand, at a precise and granular level, where the blood supply comes from, how the vessels behave under dissection, and how anastomosed vessels respond to the physiological environment of the recipient site. That understanding of vascular anatomy informs every cosmetic procedure Dr. Golshani performs.
The deep plane facelift requires a precise understanding of the facial vascular anatomy to protect it during deep dissection. The G-Stem fat grafting technique requires an understanding of how transferred fat establishes its blood supply, which is the same physiological process that determines free flap survival. The breast reconstruction patient and the breast augmentation patient are both operated on by the same surgeon, whose knowledge of breast vascular anatomy informs every incision in both contexts.
Reconstructive training does not make a surgeon more conservative in cosmetic surgery. It makes them more anatomically precise. And anatomical precision is what produces naturally beautiful cosmetic results that hold up over time.
When microsurgery is part of a complete reconstructive plan
Reconstructive microsurgery is rarely the only component of a comprehensive reconstructive plan. It sits within a broader context of procedures that address the full picture of what the patient needs:
- Breast Reconstruction where microsurgical free flap reconstruction is the most sophisticated and most natural-appearing option for patients who want autologous tissue breast restoration following mastectomy
- Plastic and Reconstructive Surgery as the broader disciplinary context within which microsurgery sits alongside the full range of reconstructive and cosmetic procedures available at this practice
- Post-Weight Loss Face and Body Rejuvenation where the tissue transfer principles of microsurgery inform the fat grafting and body contouring work that addresses the full scope of post-weight loss changes
- Eyelid Reconstruction where reconstructive principles including local flap design, skin grafting, and tissue rearrangement address the functional and aesthetic consequences of eyelid defects
- Facial Autologous Fat Grafting with G-Stem where the biological principles of tissue transfer that microsurgery has refined are applied to the precision fat grafting technique that defines Dr. Golshani’s regenerative facial work
Why Patients Choose Dr. Golshani for Reconstructive Microsurgery in Beverly Hills
Reconstructive microsurgery is the most technically demanding discipline in plastic surgery. The patients who require it are not choosing between aesthetic options. They are entrusting the restoration of function, form, and in some cases the viability of a body part or the outcome of cancer treatment, to a surgeon whose technical capability must be equal to what the anatomy demands.
Dr. Daniel Golshani, MD, FACS is a double-board-certified plastic and reconstructive surgeon whose nine years of elite post-medical school training encompassed two full surgical residencies, two subspecialty fellowships, and direct training under the influence of Dr. Harry Buncke, the Father of Microsurgery. His reconstructive microsurgery practice at his Beverly Hills office brings the most demanding level of surgical precision in the specialty to a practice that serves patients across the full spectrum from complex reconstruction to refined cosmetic surgery.
The surgeon who can operate at the microsurgical level brings a depth of anatomical knowledge and technical discipline to every other procedure they perform. This is the foundation on which Dr. Golshani’s Beverly Hills practice is built, and it is why patients with the most complex reconstructive needs, and the highest cosmetic standards, consistently arrive at the same consultation room.
His practice at 9301 Wilshire Blvd., Suite 410 in Beverly Hills serves patients from Beverly Hills, Bel Air, Brentwood, West Hollywood, Pacific Palisades, Santa Monica, and internationally. Surgical procedures are performed at the Rexford Surgical Institute, an AAAHC-accredited surgical center on the same floor as the office.
Your Microsurgery Journey: Step-by-Step
Step 1 — The Consultation
Reconstructive microsurgery consultations begin with a comprehensive review of the clinical situation: the nature of the defect or injury, the prior surgical history, imaging and pathology where relevant, the functional and aesthetic goals, and the full range of reconstructive options available for this specific presentation. Dr. Golshani explains the role of microsurgical reconstruction within the overall plan, the donor site options and their implications, the realistic outcome, and the recovery expectations. A patient coordinator attends every consultation, recording everything discussed so nothing is lost between your visit and your surgery date.
Step 2 — Pre-Surgical Planning and Coordination
Complex reconstructive microsurgery frequently requires coordinated planning with oncological, orthopedic, or other surgical teams. Dr. Golshani participates directly in multidisciplinary planning when the reconstructive procedure is part of a larger oncological or trauma care plan, ensuring the reconstructive timing and approach are optimized within the full context of the patient’s treatment.
Step 3 — The Procedure
Reconstructive microsurgery is performed under general anesthesia at the Rexford Surgical Institute or at a hospital facility as required by the complexity of the case. Free flap procedures are performed with microsurgical anastomosis of the flap’s vessels to recipient vessels at the defect site, confirmed by intraoperative monitoring of flap perfusion. Replantation procedures follow the systematic repair sequence of bone, tendon, vessel, and nerve under magnification. Operative time varies considerably based on the scope of the reconstruction.
Step 4 — Recovery and Monitoring
Recovery from microsurgical procedures requires close post-operative monitoring of the reconstructed tissue, particularly in the first forty-eight to seventy-two hours when the risk of vascular compromise is highest. Dr. Golshani’s team provides detailed post-operative monitoring protocols and ensures that the early recovery period is managed with the vigilance that microsurgical outcomes require. Long-term recovery varies by procedure, from weeks for simpler reconstructions to months for complex free flap cases requiring secondary refinement procedures.
Microsurgery FAQs -Beverly Hills, CA
What is microsurgery in Beverly Hills?
Microsurgery is reconstructive surgery performed under magnification using specialized instruments and ultra-fine sutures to repair or reconstruct blood vessels, nerves, and complex tissue at a scale invisible to the naked eye. It enables free flap tissue transfer, replantation of amputated parts, nerve repair and reconstruction, and vascular reconstruction in situations where simpler techniques are insufficient. Dr. Daniel Golshani performs reconstructive microsurgery in Beverly Hills, trained under the direct influence of Dr. Harry Buncke, the Father of Microsurgery.
Who is Dr. Harry Buncke and why does training under him matter?
Dr. Harry J. Buncke was an American plastic surgeon and clinical professor at Stanford and UCSF who is universally recognized as the Father of Microsurgery. Beginning in the late 1950s, he developed the instruments, sutures, and techniques that made clinical microsurgery possible, performing the first rabbit ear replantation in 1964 and founding the Buncke Clinic, which became one of the most important microsurgical training centers in the world. The clinic trained over 250 clinical research fellows and residents, with twenty-seven subsequently becoming department chairmen. Training under his direct influence means having received microsurgical education at its foundational source.
What is a free flap and how does it work?
A free flap is a block of living tissue, which may include skin, fat, muscle, or bone, removed from a donor site on the body and transplanted to a recipient site where the tissue’s blood supply vessels are surgically disconnected and then reconnected using microsurgical anastomosis at the new location. The tissue survives because the surgeon re-establishes its blood supply at the recipient site with vessel anastomoses performed under magnification. Free flap transfer is the technique that makes complex breast reconstruction, head and neck reconstruction, and lower extremity wound coverage possible when local tissue options are insufficient.
What is replantation surgery?
Replantation is the microsurgical reattachment of a completely amputated body part, most commonly a finger, thumb, hand, or arm. The amputated part is brought to the operating room, the bone is fixed, the tendons are repaired, and the vessels and nerves are joined under the microscope. The outcome depends on the quality of the microsurgical anastomosis, the viability of the amputated tissue, and the ischemia time. Replantation is among the most demanding emergency microsurgical procedures and requires immediate access to a surgeon trained at the highest level of the specialty.
How does reconstructive microsurgery training improve cosmetic surgery outcomes?
Microsurgery requires the deepest possible understanding of vascular anatomy, tissue viability, and the physiological behavior of transferred tissue. This knowledge directly informs cosmetic procedures: the vascular anatomy understanding that protects vessels during deep plane facelift dissection, the tissue transfer principles that underlie fat grafting survival, and the technical precision at the level of individual anatomical structures that defines excellent outcomes in both reconstructive and cosmetic surgery. A surgeon trained in microsurgery brings a depth of anatomical knowledge to every cosmetic procedure that training limited to cosmetic surgery alone cannot produce.
What conditions are treated with reconstructive microsurgery?
Reconstructive microsurgery addresses breast reconstruction following mastectomy using free flap autologous tissue, head and neck reconstruction following oncological resection, lower extremity wound coverage following trauma or tumor resection, hand surgery and replantation following amputation or crush injury, peripheral nerve repair and reconstruction following trauma or tumor resection, facial reanimation following facial nerve paralysis, and lymphedema treatment through lymphovenous anastomosis.
How does microsurgery relate to breast reconstruction after cancer?
Microsurgical free flap breast reconstruction uses the patient’s own tissue, most commonly from the abdomen, thigh, or back, to reconstruct the breast following mastectomy. The flap is transferred with its blood supply disconnected and reconnected at the chest using microsurgical anastomosis, creating a breast mound from living tissue that ages naturally, feels like native tissue, and produces the most aesthetically complete autologous reconstruction available. It is the most technically demanding form of breast reconstruction and the one that, for appropriate patients, most completely restores the natural breast appearance and feel.
When preparing for a facelift consultation, it’s essential to gather I nformation about your medical history, current medications, and desired outcomes. Additionally, bring along any questions and photos of your ideal to discuss with Dr. Golshani and his surgical coordinators. Additionally, its always important to be open about your expectations and concerns.
Before your facelift surgery, follow Dr. Golshani’s pre-operative instructions carefully, which will include fasting before the procedure, avoiding certain medications that can increase bleeding risk, and arranging for transportation to and from the surgical facility. It is also important to make sure that you have a comfortable recovery area at home with necessary supplies following your facelift procedure.
The improvements made with a facelift last for years. Your face will continue to age naturally, but you’ll always look younger than you would have without the surgery. You can extend the results and slow the effects of aging by maintaining a stable weight and taking good care of your skin, especially by protecting it from excessive exposure to the sun. If, after a few years, you’re bothered by the effects of aging, you might choose to have a refresher facelift. Nonsurgical treatments can also complement the improvements made with a facelift.
There is no right age for facelift surgery. Timing depends on the changes to your face over time and your readiness for surgery. The surgery is simpler and results last longer for younger patients (in their early 40s, for example) because of the elasticity and resilience of younger skin. But we have had facelift patients in their 70s and 80s who have been delighted with their results. A one-on-one consultation is the best way to determine if you are a good candidate.
Only a surgical facelift can make the comprehensive and long-lasting enhancements to an aging face you see in the before and after pictures on this site. That’s not to say that everyone who’s bothered by the signs of aging needs a facelift. Positive improvements can be made with non-surgical and minimally invasive treatment. Options include chemical peels, microdermabrasion, laser skin resurfacing, dermal fillers, Botox®, and endoscopic procedures. We can combine a customized series of non-surgical treatments to give you a personalized minimally invasive facelift.
The duration of a facelift procedure can vary depending on the extent of the surgery and the particular techniques used by Dr. Golshani. On average, a traditional facelift may take several hours, while a mini-facelift may have shorter operating times.
Typically, a traditional facelift is a more comprehensive procedure that addresses sagging skin, muscle laxity, and excess fat in the face and neck area. In contrast, a mini-facelift, also known as a limited incision facelift, focuses on targeting specific signs of aging in a more limited area with a shorter recovery time and less dramatic results.
A non-surgical facelift typically involves minimally invasive treatments like injectables, laser therapy, or skin tightening procedures to improve facial contours and reduce signs of aging without surgery. In comparison, a traditional facelift is a surgical procedure that involves lifting and repositioning facial tissues for more significant and long-lasting results.
To prolong facelift results, maintain a healthy lifestyle with a balanced diet, regular exercise, and proper skincare routine. Protect your skin from sun exposure, avoid smoking, and follow Dr. Golshani’s post-operative instructions for optimal healing and long-term outcomes.
Swelling, bruising, and initial healing after a facelift may vary, but most of our patients feel comfortable going out in public within 1-2 weeks after surgery. Additionally, makeup can help conceal any residual bruising or redness during the early stages of recovery.
Strenuous exercise and activities should be avoided for several weeks after a facelift to allow for proper healing and minimize the risk of complications. Dr. Golshani and his surgical team will provide guidelines on when you can gradually resume physical activities based on your individual recovery progress.
Generally speaking, the timing of returning to work after a facelift depends on the extent of the surgery, individual healing process, and the nature of your job. Most patients can expect to return to work within 1-2 weeks, but it may vary for each person.
Smoking can have detrimental effects on the healing process and outcomes of a facelift. It is advisable to quit smoking before undergoing a facelift to reduce the risk of complications, improve circulation, and promote optimal wound healing. If you are a smoker, being transparent with Dr. Golshani is incredibly important so that, together, you can come up with the best course of action prior to your facelilft surgery.
A deep plane facelift is a surgical technique that involves lifting and repositioning deeper facial tissues, specifically the SMAS (superficial musculoaponeurotic system). This technique can provide more significant and longer-lasting results compared to a traditional facelift by addressing sagging tissues in a more comprehensive manner. Dr. Golshani is incredibly skilled and experienced with performing deep plan facelifts and uses this technique very often.
On the other hand, a hybrid facelift combines surgical and non-surgical techniques to address facial rejuvenation tailored to each patient. This approach may involve a combination of facelift surgery with injectables, laser treatments, or other minimally invasive procedures to enhance facial contours and address multiple signs of aging. Consulting with a board-certified plastic surgeon, such as Dr. Golshani, can help you determine the most suitable facelift approach based on your goals and anatomy.
