I can’t help but share this great commercial involving gynecomastia. Any sports fan should love this. We are seeing more and more gynecomastia patients, and more male patients in general here in our Santa Barbara plastic surgery practice. Treatment of gynecomastia with liposuction can be very successful, with or without the addition of an excision of some tissue when needed. I’m happy to answer any questions that any of you may have about this very treatable cosmetic condition.
In the course of my discussions about creating the most natural appearing breast augmentations, I always review the reasoning that I use the dual plane technique with my patients. A lot of information about breast implants can be found on the breast pages of my website, but I want to reiterate why this technique seems to give the best and most natural breast contour.
The pectoralis muslce is a broad, flat muscle that extends from the proximal humerus, at the top of the arm near the shoulder, down to the breast bone and central rib cage. Classically, breast implants have been placed either above or below this muscle. Most often breast implants are currently placed under this pectoralis muscle because it tends to have a lower rate of complications. This is called the sub-muscular position. The disadvantage to putting the breast implant in this position is that the attachment of the pectoralis muscle to the rib cage and the breast tissue can tend to hold the implant in a relatively high position, giving the un-natural appearance of excess fullness, or a shelf, in the upper portion of the breast.
While some plastic surgeons will release the lower portions of the muscle in order to aid in preventing the breast implant from remaining high, the dual plane technique adds a further dissection releasing the lower portions of the breast from the muscle. This allows the implant to fall into the relaxed breast tissue behind the nipple. With the implant in this position, the apex of the breast implant lies where the best projection of the breast should be- at the region of the nipple. The muscle remains to cover the upper portion of the breast implant, and creates a lovely transition from the breast apex to the upper chest wall. The resulting tear drop form allows a very natural appearing breast augmentation, and a very happy patient. Best of all, this dual plane technique retains a very low complication rate.
Feel free to come and have some further discussion on this breast augmentation technique, and be sure to review our photo gallery for some examples of woman who have had natural appearing breast augmentation with me in Santa Barbara.
There was a lot of coverage today of the news that a certain type of lymphoma has been found in a relative few women with breast implants. Much of the coverage, as expected, lacked the actual information put out by the FDA. My particular interest is in doing the right thing for my patients, and additionally making sure that my patients are well educated.
Please feel free to follow this link to FDA white paper that was released, which has an excellent explanation of the information that is currently available. Some key points taken from the FDA report:
”According to the American Society of Plastic Surgeons, nearly four million breast implant procedures were performed in the United States from 1998 – 2009. The total number of implants worldwide is estimated to be between 5-10 million.”
”In total, the FDA is aware of approximately 60 case reports of ALCL in women with breast implants worldwide. The exact number is difficult to verify because reports from regulatory agencies and scientific experts often duplicate those found in the scientific literature.”
“Health care providers should be aware ALCL in women with breast implants is a very rare condition; when it occurs, it has been identified most frequently in patients undergoing implant revision operations for late onset, persistent seroma. The FDA does not recommend prophylactic breast implant removal in patients without symptoms or other abnormalities.”
”Because the risk of ALCL appears very small, FDA believes that the totality of evidence continues to support a reasonable assurance that FDA-approved breast implants are safe and effective when used as labeled.”
I encourage my patients and the general public to become as educated as possible on this as well as all aspects of any plastic surgery procedure that they are considering. I am happy to review the pros and cons of any and all of the plastic surgery procedures that I perform in Santa Barbara. If you are planning or considering plastic surgery, please feel free to come and have an educational, complementary aesthetic plastic surgery consultation with me to discuss any questions or concerns.
Having just come across the show called Bridalplasty, I’m so thoroughly disgusted that I felt I had to write about it. It seems that Dr. Terry Dubrow has involved himself in this television show in which women will compete for the opportunity to have a plastic surgery makeover. I fully agree with the opinion of my friend, Dr. Mike McGuire, the former president of the American Society of Plastic Surgery. In an article by ABC news, Dr. McGuire calls the show embarrassing to the field, and says the American Society of Plastic Surgery frowns upon taking a “well-recognized specialty down into this level of entertainment.”
As a plastic surgeon that takes my practice extraordinarily seriously, I find it very disappointing that any one of my “peers” would think it was in a patient’s best interest to encourage her to compete against others for a plastic surgery procedure. I feel that this show devalues the doctor-patient relationship, and is at best marginal in its ethics.
As a consumer and prospective patient, I sincerely hope you do not associate my practice with this type of sensationalist “entertainment.” My patients are carefully evaluated, thoroughly educated, and meticulously cared for in a manner that is in their best interest. I will continue to do my best to provide patients with aesthetic and reconstructive surgical care that emphasizes the best in plastic surgery and leave the “entertainment” to those more interested in entertaining.
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 “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.
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!
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.!
