Dr. Paul Nassif shares more information about Estella's facelift.

Editor's note: After Monday's episode, which included Estella's facelift, we wanted to share more information about the process. Dr. Paul Nassif has also included a photo diary, to take you through the entire process.

I've had a lot of conversations since the show aired about the operating room scenes, and I thought I'd give some insight about what it's like for a surgeon behind those scenes.

Obviously, a surgeon has to have the technique, the know-how. I'd compare it to a golf swing, honestly. Both are crucial parts of things I enjoy doing, and once you have that technique down, you can rest assured that the follow-through is there. A surgeon has to maintain a certain relaxed confidence in order to be efficient. It's wasteful for a surgeon to channel their energy into unnecessary tension.

Inside the O.R., it's a very unique atmosphere, there has to be confidence and precision alongside that relaxation. It's a very sane room, a very focused room. And it has to be sane for up to eight hours at a time, which means bathroom breaks, snack breaks, and even simple "breathers" are crucial. An experienced surgeon knows exactly when these breaks can be taken -- and how necessary they are. The specifics of operating room behavior vary widely, like the superstitions of pro athletes. I know some surgeons who have music playing in the operating room, some who chat back and forth, and some who just work in total silence. It's the surgeon's choice, but you can be sure of one thing: a patient's safety is always paramount.

As an experienced facial plastic and reconstructive surgeon, I know when to allow moments of calm versus moments of heightened awareness. No matter what else is going on in the O.R., my first and foremost concern is for the safety of my patient. Since I got my start as a head and neck surgeon, I have this grounding of experience in a more typically "serious" field, which I bring to what people sometimes (incorrectly) regard as a frivolous one. My ear is always attuned to the audio monitors (that monitor the patient’s vital signs) in the room and if there's even the slightest change, absolutely everything refocuses on the reasons for that change and an examination of the patient's vital signs ensues.

The sequence featuring Estella's surgery in last week's episode is actually from the final moments of the procedure when I was putting in the last sutures. Even though I must remain focused until the very end -- when we reach that point in the process I know how to lighten the mood with the O.R. team and start releasing the tension.