Increasing volume in the cheek area with an implant can help this a bit, and alternatively fillers placed to the crease can bulk it up and reduce shadowing. Unfortunately, while both of these procedures improve the symptom of the shadows at the nasolabial fold, neither looks natural or mimics the look of youth.

Literally yesterday I saw two sisters who both came in for Restylane in their nasolabial creases. Both had previously had this procedure performed by another surgeon, and complained of a firm ridge at their nasolabial area. I explained that further injection of filler to this area is certainly possible and popular these days, but it does not tend to look youthful or natural. I can spot a woman who has had soft tissue fillers from across the room- it rarely makes a woman look more like she did at a younger age.

For these women, I instead showed them the effects of a cheek lift on the mid-face and nasolabial folds. When a lifting of the soft tissue of the cheek back to its proper position over the natural cheekbone is performed, the entire mid-face is rejuvenated, and the shadows of the nasolabial fold are improved in a natural appearing manner. Instead of placing bulk into the crease (where it does not belong in the first place), the shadow is eliminated by rejuvenating the entire cheek structure. This can be mimicked by gentle traction on the cheek area in the direction of the temple- the fold is greatly improved, and the volume of the full and youthful cheek is restored. Both women decided against further injectables and are planning on getting this more natural appearing, more permanent solution.

My reputation for natural appearing plastic surgery in Santa Barbara depends on my honest assessment and recommendation for my patients. While many women come to the office for fillers and it remains a large part of my practice, I recommend injection of the nasolabial folds in only a limited fashion. When limited to the upper fold and a subtle injection of the lower aspects of the nasolabial crease, soft tissue fillers such as Restylane and Juvederm can be great. For women who have significant shadows in this region, however, I routinely discuss the more permanent option of the cheek lift- I have never had a patient undergo this procedure who was disappointed with the outcome.

Thanks again!!

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

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.

Yesterday the United States Preventive Services Task Force released new guidelines for recommended breast cancer screenings in women, revising the suggested age for mammograms to 50 from 40 and decreasing the frequency of such tests to every two years rather than the previous annual exam. This government-appointed panel of medical experts, which provides guidance on public health concerns to both doctors and insurance companies, found there was sufficient new data to warrant the changes in policy. These new guidelines do not apply to women who are considered to be at higher risk for breast cancer than the general population, such as those with previous chest radiation or a family history of cancer.

At the forefront of the new guidelines was data collected from studies conducted in England and Sweden, which indicated there was little increased benefit in yearly screening versus screening every two years. Meanwhile, multiple cancer-oriented organizations, such as the American Cancer Society, are strongly opposing these new recommendations.  As technology evolves, what is clear is that screening recommendations will continue to evolve.  New studies such as precision ultrasound and MRI are becoming increasingly frequent modalities for breast cancer detection, and this is particularly true in our local community where our breast screening radiologists are so well regarded.  As for my own recommendations, I feel that the needs for various screening techniques and protocols are specific enough from patient to patient that each individual should discuss the pros and cons of early mammography screening with their primary care doctor, and proceed in the manner that makes them most comfortable. My practice will continue to remain very involved in breast reconstruction until the day that we all hope comes, when those services are no longer needed.

As many of you have heard, Dr. Sheffield is planning on retiring at the end of the year. His presence will, of course, be missed by all of us in the office, as well as so many of his patients who have worked with him here in Santa Barbara for over 15 years. Dr. Lowenstein will certainly be looking forward to providing ongoing plastic surgery care for all patients in Santa Barbara, and we anticipate that there will be a seamless transition at Montecito Plastic Surgery. We have hired some new staff (like me!) to aid in patient coordination, and many of our staff, like our outstanding nurse, Susanne, will remain with us (forever, we hope!). We are also not letting our front desk receptionist, Hayden, leave as we are unsure how we would cope without her!

We do want to remind our plastic surgery patients that as the end of the year approaches, both Dr. Sheffield and Dr. Lowenstein are trying to accommodate all of the patient requests for surgery that we can. The schedule is filling up, however, and so we encourage our plastic surgery patients to plan ahead and accordingly, especially if you are looking to have your plastic surgery before the end of the year. In fact, as January is a popular month for plastic surgery in Santa Barbara, Dr. Lowenstein’s plastic surgery schedule is getting filled already.

Please feel free to call us with any questions or requests and we will do our best to accommodate you!

-Alexandra Essex

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!