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!

I’m seeing more and more “procedures� associated with dissolving fat: Zerona, Lipodissolve, and other fat injections. There are concerns about these procedures, and so I want to make sure that my patients understand why the controversy exists. Most physicians agree that many of these procedures do indeed dissolve fat away. The problem that many responsible doctors are concerned about is what happens to that fat once it dissolves?
Fat is held in fat cells, called adipose cells, and we see this fat as an accumulation of excess tissue in regions of the body that we don’t like- the abdomen, the hips, the love handles, etc… The fat dissolving procedures claim to melt away the fat deposits- further reading on the Zerona website states that “The laser causes the fat cell membrane to become temporarily porous, allowing the liquefied fat to leave the cell and accumulate in the interstitial space around the cells. There is no damage to the cell membrane and after 48 hours the pores close up. Once the fat is in the interstitial space, the body via the lymphatic system naturally removes it.� Similarly, the lipodissolve procedure is thought to dissolve the fat into the areas outside of the fat cells, the interstitial space, where it is taken away from the site of excess.
In each case, the question remains… where does the fat go? Thoughtful medical professionals are concerned that the fat may be brought to the liver, which acts as a filter for the blood and is a site of metabolism for much of the fat in our bodies. If this is so, the treated, “melted� fat might overwhelm the liver causing fatty liver or and significant liver disease or possibly liver failure. Another concern is that the fat could get picked up by the lymphatics or directly by the blood, and end up increasing deposits in the blood vessels themselves, worsening atherosclerosis and/or blockage of the coronary arteries. This might cause subsequent heart disease or heart attacks.
It must be understood how these procedures differ from liposuction. Remember that liposuction is a fat REMOVAL process, where the excess fat is removed from the body by the suction of the liposuction machine. Your physician can show you the collected fat in special canisters after your procedure if you like- it’s no longer in your body at all.
The significant questions and concerns with Lipodissolve and Zerona and similar fat dissolving procedures are principle reasons behind the fact that the Food and Drug Administration has not approved these types of procedures for the indications of cosmetic improvement of fat deposits. Until the understanding of the metabolism of the dissolved fat is better understood, it is thought to be an unknown with such severe possible side effects that it is not recommended.
My philosophy as a plastic surgeon in Santa Barbara is that while I want my patients to look great and feel fantastic about themselves, the health and safety of my patients comes before all else. Until I’m convinced of the science of the safety of the fat dissolving procedures, I am going to join my plastic surgery colleagues in recommending against this procedure. As always, when getting information about new and exciting procedures, it is vital that patients are well educated. I encourage all prospective plastic surgery patients in Santa Barbara and elsewhere to make sure your physician is a real plastic surgeon, and make sure that she or he is certified by the American Board of Plastic Surgery. See more on the importance of Board Certification here.

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.  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.  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.   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.  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.  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.  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!!!!!

JUST SAY NO TO SKIN CANCER!

With hopes of the economic recovery on the horizon, more and more people are once again considering plastic surgery as a means of self-improvement. From breast augmentation to facial rejuvenation, patients are looking to their plastic surgeon for the means to make a change. Not all patients seem to be looking locally, however.

Santa Barbara plastic surgeon Dr. Adam Lowenstein reports that increasing numbers of patients are traveling from their distant homes to have plastic surgery in Santa Barbara. “I’m seeing more and more people who are interested in traveling to Santa Barbara for their plastic surgery. This week alone we’ve made arrangements to see women from Alaska and Colorado. Last week I saw a woman from New York. We’ve dealt with patients from Europe recently as well.�

Dr. Lowenstein is insisting on proper postoperative planning when seeing patients traveling from far away, and has specific thoughts on what he terms “destination plastic surgeryâ€�. Dr. Lowenstein comments, “Patients traveling to Santa Barbara for their plastic surgery must understand Read the rest of this entry »

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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!

With every breast augmentation patient in Santa Barbara, I go over the various types of breast implants, the various pockets that breast implants can be placed in, and additionally the different incisions that can be used to place the breast implant into the breast pocket.  With respect to this last issue, I think there is some helpful information that has recently been published.  Read the rest of this entry »