As some of you might have heard, one of Santa Barbara’s excellent plastic surgeons, Dr. Russell Stokes, recently relocated to North Carolina. Dr. Stokes is a well respected peer, and I’m sorry to have had him leave town. The North Carolina opportunity is an excellent one, and as an avid golfer, Dr. Stokes is sure to enjoy his new location in Pinehurst- a golf mecca. As Dr. Stokes had a substantial patient population that came from Bakersfield for plastic surgery, we will be happy to provide the same high level of plastic surgery care to Bakersfield patients. In fact, we have seen a gradual increase of patients coming to our practice from the Bakersfield area, and I have very much enjoyed taking care of these very pleasant patients.
The additional advantage that our practice has gained from Dr. Stokes move is that two of his staff have joined ours! As we have become so busy over the past months, we have needed to add two positions- an operating room technician and a patient coordinator.
Our new operating room technician is Nena Santoyo, and she is fantastic. She has extensive experience in plastic surgery from both Dr. Stokes’ operating room and additionally work at the Santa Barbara Surgery Center. Nena is bright and pleasant and we are very fortunate to have her on board. She is a joy to work with and makes my job in the operating room so much easier- she seems to know what I need without me even needing to ask for it.
Our other new addition is Nicole Roden, our new patient coordinator. Nicole worked with Dr. Stokes for several years and comes with rave reviews. In addition to being a quick learner with our advanced MAC based electronic medical record, she is a great “people person” and our patients love her. But there’s more… Nicole is also a registered nurse, and I’m pretty comfortable saying that our staff is now comprised of the most qualified personnel around- With our long time outstanding nurse Susanne, we now have two full time nurses available to help our plastic surgery patients, answer questions, and facilitate an extraordinarily safe, comfortable plastic surgery experience for all of our patients- from Santa Barbara, from Bakersfield, or from overseas!

The nasolabial folds, sometimes called the nasolabial crease, is a highly misunderstood region of the face that gets a lot of attention in facial cosmetic surgery.  Since the increased popularity of soft tissue fillers exploded with the aesthetic enhancement of the lips, many practitioners have taken to injecting the areas of the nasolabial folds in an attempt to make them disappear.

While injection of soft tissue filler into the nasolabial folds can helps soften their depth, it demonstrates a misunderstanding of how the fold develops and what its causes are.  When we “fillâ€� an area with an injectable such as Juviderm or Restylane, we usually do so in an attempt to add volume to an area that is deficient or has shrunk.  In the nasolabial area, however, there is never a loss of volume causing the crease.  In fact, you can see that even babies and children have nasolabial folds…

The nasolabial crease itself is not a sign of aging.  For the same reason, a puffed out, over-filled nasolabial fold that has been treated with excessive injectable does not produce a youthful, or even natural appearance.  Why is this?

In fact, the nasolabial folds appear worse as we age because the cheek above and lateral to the fold falls downward as we get older.  Like the skin and tissue in the area of the jowl and neck sags progressively over time, the cheek tissue falls over the nasolabial region, causing a worsening shadow in the crease.  The fix for this problem is not to fill the area below the fallen tissue, but instead to lift the cheek back to its youthful position.  Just as a Santa Barbara face lift repositions the facial tissue to eliminate excess in the jowl and neck, the cheek lift recreates the natural youthful appearance by returning the cheek tissue to its rightful place.  The cheek lift enhances the soft tissue over the cheek bone, where this tissue was found in youth, and removes the fullness from the lower cheek.  The result is a youthful appearing mid-face with less wrinkling and less shadows in the upper and lower cheek region.  This is why this procedure is often referred to as a mid-face lift.  I will be very pleased to discuss the Santa Barbara cheek lift with any prospective patient- the minimal incisions that are required and the excellent results that are seen make this operation one of my most popular enhancements in facial plastic surgery.

The advantage of the SMAS lift is that as the SMAS is lifted vertically, there is excess that can be manipulated in several ways.  In the full face, this excess is removed so as not to add volume to an already round face.  In the thin or hollowed face, this tissue can be folded on itself to increase volume.  In my Santa Barbara plastic surgery practice, I feel the key to facial plastic surgery, particularly face lifts and rhinoplasty, is to individualize the operation to the patient.  The SMAS lift allow me to do just that.

Today we did two breast augmentations and a rhinoplasty at our surgery center. I’m very grateful for the outstanding team we’ve assembled here- everyone got a great operation and should be very pleased with their results. Our newest team member’ Nena Santoyo, is an extraordinary operating room technician who has come to work with us after many years of working with Dr. Russel Stokes, who has recently closed his practice. Nena brings a great energy and abundant plastic surgery experience to the operating room, and we are all very glad to have her on board. She seems to be arriving just in time, as our operating schedule is packed with multiple face lifts, rhinoplasties, and a world of breast surgery. Yesterday’s face lift patient certainly appreciated everyone’s work- she was thanking everyone involved. Every day is rewarding for us all at Montecito Plastic Surgery in Santa Barbara- I’m a very fortunate plastic surgeon!

Yesterday the FDA said in a statement that procedures such as lipodissolve, mesotherapy, lipozap, lipotherapy, and injection lipolysis all involve unproven injections of drugs, and that “We are concerned that these companies are misleading consumers.”  The FDA reports that none of the drugs used in these therapies have been shown to work in clinical trials.

What does this mean for plastic surgery patients?  As most of us plastic surgeons have said all along, there are really only two ways to remove fat- healthy living, and surgery.  I’m a fan of both, and have been doing a lot of body reshaping for my patients recently.  That being said, I emphasize to my patients, as to myself and my family, that eating well with a healthy diet, and a great exercise program is such an important aspect in weight loss and body contouring… so eat your vegetables and get on your bike!  And if persistent areas of fatty deposits still bother you, I will be happy to see you in my office for liposuction or tummy tuck or any one of the many plastic surgery procedures that I perform in Santa Barbara for body contouring.

I’m heading back east today, after another short week of plastic surgery in Santa Barbara.  Last week was a bit of vacation in Aspen, and I was swamped for the short time that I was in Santa Barbara early in the week.  Today, I’m actually running back home to see my mother who is having a bit of surgery tomorrow morning, and will be back on Sunday… for another two whole days before I leave again for Miami.  Next week in Miami is the renowned Baker-Gordon Aesthetic Meeting, which is one of the premier meetings on cosmetic plastic surgery in the world.  While I’m looking forward to exchanging ideas with friends, I’m sorry it is so hard to get in to see me, and I want to apologize to those several patients who are trying to get in for consultations and surgeries. I operated all day yesterday, and squeezed a few new consults between cases- Next week’s Monday and Tuesday are nearly filled, though I’ve asked my staff to try and accommodate patients as much as possible.  I seem to have dozens of new patients to see when I get back, and I want to thank everyone for their patience.

Just wanted to say thanks to everyone for coming out to Float Spa last night- we had a great crowd despite the crazy weather, and a lot of great questions following my talk on minimally invasive plastic surgery in Santa Barbara.  Best of all, it was a great even for Girls Inc.!

Thanks again!!

As many of you know, following Dr. Sheffield’s retirement at the end of last year, some gentle transformations have kept us busy at Montecito Plastic Surgery. New paint adorns the walls, and new furniture can be found throughout the office. This week, the finishing touches will be placed with new flooring in two exam rooms. Several new pieces of art will be received from the framers, and will be heading for our newly painted walls.

The hardest part, and yet the best part, has been that throughout this transition, we have remained clinically as busy as ever. Two and often three operating days per week have been filled through much of February by the ongoing interest in having plastic surgery in Santa Barbara by some old, but many new patients. I will be performing several face lift operations, rhinoplasty operations, liposuction, and breast augmentations in the coming weeks on both men and women from Santa Barbara and beyond.

We are thrilled at the response that patients have given on the new look to the office. It appears lighter, larger, and more aesthetic. Additionally, computers placed in each room allow increased access to the new electronic medial record, as well as plastic surgery imaging programs that aid in patient education. We couldn’t be more pleased with the enhancements to Montecito Plastic Surgery, and we invite you to stop by and see what all of the excitement is about.

Congress is currently debating a 5% federal taxation of users of cosmetic medical treatments like you.  As a plastic surgeon, I urge you to oppose this tax for several reasons outlined here. Please get involved!

The tax is punitive and places an additional burden on the middle class – According to the American Society of Plastic Surgeons (ASPS), sixty percent of patients considering a cosmetic medical procedure are squarely in the middle class, earning between $30,000 and $90,000 per year.  This tax would come on top of increased payroll and income taxes sure to result from health reform’s $849 billion cost, and would penalize those who have made a well-educated and informed decision in consultation with a specialized physician to opt for cosmetic medical treatments.

The tax discriminates predominantly against women – Data from the ASPS shows that 91 percent of patients seeking cosmetic medical procedures are women.[1] And many of these women are seeking treatment to improve their appearance to enhance their self-image and self-confidence which helps them succeed at work and in other areas of their lives.

The tax does not serve the goals of health reform – President Obama has stated that the goal of health reform is “to enact legislation that offers stability and security to those who have insurance and affordable coverage to those who don’t, and that lowers costs for families, businesses and governments across the country.�  Since these procedures are generally not covered by insurance, the proposed tax will not reduce the cost of health care nor will it reduce insurance premiums.  Further, it will increase administrative costs for physician offices.

The tax puts cosmetic procedures in the same category as cigarettes and alcohol – So called “sin taxes� on cigarettes and alcohol were imposed to try to change unhealthy behavior and cover the significant costs that these products placed on the health care system.  This is logical.  But a tax on cosmetic medical procedures is illogical because they are healthy and merely a responsible form of self-improvement.  Furthermore, these procedures do not impact the heath care system since patients pay for these procedures themselves and they are not covered by insurance.  People should have the freedom to decide what is best for their personal health care, including their own aesthetic appearance and therefore be free to correct, alter or enhance their appearance responsibly, in consultation with a physician, without being forced to pay an extra tax.

The tax will be impossible to effectively and equitably administer – It is not clear which procedures will be subject to the tax and which will not.   The line between “cosmetic� and “reconstructive� surgery is not always clear and leaves the decision of medical necessity up to tax auditors- a completely inappropriate proposition.  Further, the same procedure performed on two different patients could lead to different conclusions concerning application of the tax.

The tax discourages innovation and promotes dangerous and unregulated alternatives – Because only drugs and procedures regulated and approved by the Food and Drug Administration (FDA) will be subject to the tax, manufacturers may choose to circumvent FDA regulation to avoid the tax. Further, patients may seek untested and potentially dangerous treatments from unlicensed practitioners to avoid the tax, including seeking treatment across our borders and overseas.

For all these compelling reasons, I urge you to help stop the cosmetic tax.

You can express your opposition to this tax proposal by reaching out to your local Senator by calling 1-877-221-8207 or visiting the American Society of Plastic Surgeons website at www.plasticsurgery.org.  The time to act is now– the Senate is currently debating the bill, so please voice your concerns today.

[1] American Society of Plastic Surgeons Annual Report; http://www.plasticsurgery.org/Media/stats/2008-quick-facts-cosmetic-surgery-minimally-invasive-statistics.pdf

Help fight a bad idea!!  Congress is soon to debate the Health Care Reform Bill, which is a great move towards increasing the number of insured Americans.  Unfortunately, it is filled with several bad ideas, like a taxation on patients who undergo cosmetic surgery.

This has been attempted previously in New Jersey, and has failed miserably- A government auditor will be the one to decide whether your surgery is cosmetic or reconstructive, a necessity or a luxury.  This tax additionally discriminates against women and the middle class, who are the two groups most likely to undergo aesthetic surgery.  Finally and most concerning, this taxation will encourage more patients to go overseas for their plastic surgery, inevitably resulting in more complications in patients returning to the US.  With treatment of these medical and surgical complications, health care spending with respect to these botched plastic surgeries is likely to INCREASE, rather than decrease.

Please- email and call your congressional representatives and Senators, and encourage them to oppose this taxation- it’s not only unfair, but unsafe for Americans.

Effective ways to reach your Members of Congress include:

1. Call your Senators and Representative’s District Office this week. Most legislators are home this week for the holiday break.
2. Call Your Senator and Representative’s Washington, DC Office (early and often).
3. E-Mail Your Senators and E-Mail your Congressperson.
4. For Patients: The U.S. Capitol switchboard is 202-225-3121 where your patients can be connected to their Senators and Representatives. NOTE: The patient must know the name of their Senator prior to calling the switchboard; this information can be found at www.senate.gov (scroll by state). They can determine the name of their representative by going to www.house.gov where they can enter their zip code.