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 “fill” 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.
I’m heading back east today, after another short week of plastic surgery in Santa Barbara. Â 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. Â 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. Â 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. Â 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. Â I seem to have dozens of new patients to see when I get back, and I want to thank everyone for their patience.
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, IÂ 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.
We at Montecito Plastic Surgery are very excited about the changes that we are implementing around the office- new art on the walls, new staff additions, and new technology that is going to help us to provide state of the art services to our plastic surgery patients here in Santa Barbara.
As we move the office to an Apple-Mac based facility, we are bringing in the most comprehensive new medical software available. One of the most significant transitions that we are making is an implementation of a program called MacPractice- a scheduling and patient management software package that additionally has an electronic medical record (EMR).This will allow patient records to be stored on our secure server and viewed at each of the computers in the Montecito Plastic Surgery facility.No more tracking down paper charts, or struggling to find a piece of information buried on one of the pages therein.With the EMR software, each visit is categorized and easily accessible, and each data point about a patient, such as a medication list, is easily retrievable anywhere in the facility.
Additionally, we will be adding imaging software that will categorize patient photos with each chart, making reference to them easy for all of our staff, as well as patients who want to see what they used to look like before their plastic surgery procedure in Santa Barbara.All information is totally secure, with a multiple password encryption system to and redundant computer backups to ensure that our patient information is safe.This software package is being customized to Dr. Lowenstein’s specifications at Montecito Plastic Surgery in Santa Barbara- no other facility in the world has this specifically exclusive level of technology.
How else can this program help?For those patients who require correspondence between our plastic surgery facility and other physicians, doctors’ notes can easily and quickly be generated and sent to other physicians through the mail or electronically.Information from previous surgeries, other doctor’s notes and letters, and previous tests that our plastic surgery patients have undergone will be easily and quickly scanned into our server at Montecito Plastic Surgery, allowing easy reference and access to them.And as a further bonus, the electronic medical record will allow us to rid ourselves of the ugly mass of current paper charts, as well as our file cabinets, leaving more room for some of the outstanding original artwork that Dr. Lowenstein is moving into the facility!
This morning I had the pleasure of listening to two lectures by Fred Menick, MD, from Tuscon, AZ. Fred is one of the true masters of plastic surgery of the nose, and I’m feeling very fortunate that he and I were visiting my alma matter, the University of North Carolina Medical school, on the same weekend. Some of my best friends run the outstanding residency here, and I was so pleased that they invited me to their residents’ conference.
Fred gave two outstanding discussions about total nasal reconstruction, as well as partial nasal reconstruction. Of course, references to cosmetic nose surgery and rhinoplasty were multiple- the best of the aesthetic surgeons are well versed in reconstructive plastic surgery.
I was very happy to hear him discuss some of the principles that I have been following for years. His examples of complex nasal wounds following MOHS surgery were terrific, and his multi-staged approach to reconstruction yielded fantastic results. My own passion for plastic surgery of the nose and rhinoplasty allowed me to really enjoy his presentation, and I hope that the residents came away from our subsequent discussion with some great “pearls” on plastic surgery of the nose- both reconstructive nose surgery and cosmetic plastic surgery of these areas.
“Tanning beds have been ranked alongside cigarettes, arsenic and asbestos as posing the greatest threat of cancer to humans by an international cancer research group.”- from a Reuter’s news article last week.
Skin cancer is finally being recognized as the significant cancer that has significant morbidity and even mortality. Â The chief culprit to cause this problem is radiation from the sun, but for those that just can’t get enough sun in the outdoors, the tanning booth has been the go-to option. Â Finally reports are surfacing that have tagged the dangers of this increased radiation exposure.
Many plastic surgery patients, particularly here in California, and PARTICULARLY here in Santa Barbara, are sun worshippers. No doubt that the sun in moderation is a good thing- even psychiatrists have reported that the sun is the general basis for light therapy and is good for both the mood, as well as converting precursors to Vitamin D which helps your bones with calcium. Â BUT, too much of a good thing is a bad thing, and excessive exposure to the radiation of the sun, which is really what a tanning bed emulates, provides a high risk for skin cancer.
Such radiation can be a causal factor in basal cell cancer, as well as squamous cell cancer, and additionally the more deadly melanoma. Â But for those more aesthetically inclined, I remind them that even the conditions that are pre-cancerous, such as actinic keratosis, are sun related, and these spots need to be treated too. Â The treatment for the minor cancers, as well as many of the pre-cancers, may be invasive enough to cause permanent scarring, and nobody wants extra scars on their face. Â Since the face is one of the most exposed areas on the body- this is often where the lesions manifest themselves.
The take home message- we are gifted in Santa Barbara and most of the rest of California to see the sun in the sky so much of the year, but SUN SCREEN IS A MUST!!!! and….. TANNING BOOTHS ARE A MUST NOT!!!!!
Evolence, the soft tissue collagen filler that everyone is talking about, just got FDA approval for labelling thier product as lasting 12 months! This means that long term results have held up to the rigorous standards of the FDA. I love using this product because of its lack of swelling, ease of precise placement, and long term results! Because this is not the run-of-the-mill soft tissue filler, only trained, endorsed physicians have access to this product. It’s use in treatment of lines and wrinkles such as the nasolabial fold area is outstanding- see the Evolence website for details, or call Dr. Lowenstein to find out more information about Evolence!
I’ve finally been persuaded to put up a Facebook page for our office, which you can find HERE. I’m seeing more and more questionable information out there, and so I think that the tools of social networking may be an excellent way for patients to have access to us, and additionally allow patients to be made aware of things going on in the world of plastic surgery in Santa Barbara and Montecito. Through Facebook, I’m hoping to be able to make people aware of things going on at the office, and special situations such as our “Fillers for Firefighters” event which you can read about below. So visit our Facebook page, become a fan, and keep up to date!!!!
Everyone here at the Montecito Center for Aesthetic Plastic Surgery would like to wish all of our patients and friends a very happy holiday season, and a fantastic 2009. Be safe, be happy, and be healthy!
