We are seeing more and more women come from Beverly Hills and Hollywood to have their plastic surgery in Santa Barbara.  I find this a very interesting phenomenon.  I’ve never been one to gawk at celebrities- I see them as people just like you and I, with very interesting careers.  (I have some friends, whoever, that I’m convinced only visit me both here in Santa Barbara and also at my home in Aspen because they like to see and be seen with the rich and famous.)  Personally, I feel that privacy issues are of ultimate importance, and as I refuse to divulge anything about my patients Read the rest of this entry »

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!!!!

Recently, our entire Santa Barbara community was affected by the Jesusita fire, from Goleta to Montecito.  Personally, my wife and I hosted evacuees from the foothills, and my wife additionally volunteered at the call center to help provide information regarding the Jesusita Fire.  Only by the outstanding work of the firefighters was the home of our nurse, Suzanne, spared.  Homes all around hers were unfortunately destroyed, and despite the fire burning down the tool shed in the back yard, and even charring the house itself, the firefighters were able to save her home and we are all so very grateful to them.

Although I’ve been buying dinners for firefighters at any restaurant that I see them at, I’m hoping to do more for the brave men and women that fought the Jesusita fire here in Santa Barbara.  I am going to be donating 100% of our profit from all injectables- fillers and additionally BOTOX® as well, from now to the end of June, to the Santa Barbara Fire Department.  I’m calling the event, “FILLERS FOR FIREFIGHTING�.
Soft tissue fillers including Retylane®, Juviderm™, and Evolence™ will be available, as well as BOTOX® used to treat dynamic wrinkles.  I hope that our patients will enjoy not only the outstanding results obtained from getting their fillers and BOTOX® performed by a plastic surgeon himself, but also receive a sense of pride that the means to enhance their beauty will additionally be going to a good cause.  We are expecting to raise several thousands of dollars to donate to the Santa Barbara Fire Department as a thank you for their skill and valor fighting the Jesusita Fire.

I’m posting this on our “What’s New� page of this website as well, and I hope you will tell your friends and spread the word as much as possible.  I’m hoping to raise as much as possible by donating the entire profit from our medical injectables for the next 6 weeks.

A friend showed me an article in a recent edition of Forbes Magazine about a New York plastic surgeon that is performing something he calls a Y-lift.  This is apparently an outpatient procedure with minimal recovery and patients “look amazing immediately afterward, and in a day or two they look even better.�
After I read the article, I was very excited to learn more about this technique, and in order to see the results, I checked out his website.

While this procedure does have very nice results in some patients, it has significant limitations and is a poor substitute for a true facelift to which the article seems to claim comparison.
While I have not actually seen Dr. Yan Trokel’s procedure personally, the description sounds like a particular  application of soft tissue injectables to sculpt the face and re-create the fullness of a youthful appearance.  This concept is not new – dramatic effects have been accomplished in patients with “wasting� syndromes such as AIDS in which excessive hollowing in the face have been treated with soft tissue fillers.  Dr. Trokel seems to be utilizing similar concepts in different planes of the face – closer to the bones – in order to provide plumping.  His argument for this is a very valid one:  “As people age, they don’t grow extra skin…�
In fact, the concept that I believe he is getting at is that as patients age, there is a loss of apparent volume in the face – some of this is perceived, and some of this is real.  As the natural fat in the face atrophies with age, some volume is actually lost.  Additionally, the ligaments that hold the youthful volume in place over the cheekbones and jaw line atrophy with age as well.  Sagging below the cheekbone causes these areas of youthful definition to diminish.  Sagging below the jaw line causes jowls.  Re-filling these areas with soft tissue filler should then provide volume in the areas where there is loss, and the skin, which appears wrinkled and deflated over the lost volume, should again appear rejuvenated as it re-drapes over the new volume.  Liken this to a balloon where the rubber that appears dull and wrinkled when deflated appears smooth and shiny once volume (air) is used to inflate it.
And all of this is true.  Unfortunately, fillers alone have limitations to a very specific group of patients.  The Y-lift (and many other uses of soft tissue fillers) addresses volume loss without necessarily addressing volume droop.  If you examine the before and after photos closely, you will see that the best results are seen in women who are actually rather young.  These women are beginning to experience some volume loss, and have not yet had significant atrophy of their facial ligaments.  All of the women who have after photos of their full face (not profile) are marginal candidates for facelifts in the first place, and have great results from this application of filler.  In several of the older women you can see the persistent aging in the neck, and the uneven contour of the remaining facial skin outside of the injected areas.  The droop has not been addressed.
Please do not take this as a criticism of Dr. Trokel – I think his technique is a good one and I would like to hear more about it.  In properly selected patients, I think the Y-lift concepts are sound, and I think Dr. Trokel deserves praise for his work there.  I think that the Forbes article paints his procedure as a substitute for a face lift, which I do not believe it is.
In Dr. Trokel’s own words, “You can’t just throw on the duvet.  You have to do all the layers to make it look really nice.�  He also says, “So we really don’t need to be cutting the excess skin, because there is no such thing.�  Both statements are (almost) completely true, and to a point, I agree.  The misunderstanding is that a facelift is not about cutting off excess skin.  That would be a face-tightening, not a face “lift�.
When I do a face lift, the majority of the work is addressing the layers of the face- particularly the youthful volume and connective tissue that has dropped because of the aging ligaments.  This is addressed in the LIFTING of the SMAS layer underneath the skin, and you can read about that here.  Often, minimal amounts of skin are actually cut off.  The SMAS layer is elevated and replaced into a more youthful position, and often it can be sculpted in the area of the cheekbone to produce enhanced volume here as well.  The skin is re-draped over the newly lifted underlying soft tissue, and if any excess is apparent (usually because of laxity and stretching as aging skin looses youthful elasticity as it ages), this is removed to allow a natural closure to the skin incision.
In addition, the platysma layer of the neck is addressed in most facelift procedures.  Here again, the skin is not the focus – the banding and blunting of the angle between the jawline and neck are addressed by sculpting the aging layers lying underneath the skin.  The aging muscle here is tightened and shaped in order to re-create the youthful shape of a more defined angle here.  Again Dr. Trokel is right:  “You can’t just throw on the duvet.�
An alternative to a full face lift in some patients who have only early volume sagging is a cheek lift.  In this procedure, the layers under the skin are lifted back over the cheek bone, called the malar eminence, through a lower eyelid incision.  This smaller procedure, like the Y-lift, gives great results in properly selected, usually younger patients.  In combination with a lower facelift, many patients can get outstanding outcomes.  Unlike the Y-lift, however, the results are much longer lasting and use only your own tissues and dissolvable sutures.
So again, kudos to Dr. Trokel for his fine work with soft tissue fillers.  I will look forward to continuing my use of these tools in patients who benefit from them.  In the right patient, I think this is a commendable short-term solution for early volume loss.  A face-lift, as I’m sure Dr. Trokel will agree, it is not.
One last comment- as always, it is important to  be comfortable with your surgeon’s training and credentials before undergoing any plastic surgery procedure.  In accordance with the American Society of Plastic Surgery, we suggest that patients find a plastic surgeon that is certified by the American Board of Plastic Surgery.  Remember that any physician can call himself or herself a cosmetic surgeon.  It is up to the patient to ensure that their plastic surgeon is well trained and certified in his or her field of practice.

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!

Best wishes from all of us!

The other day I was riding my bike through the beautiful Carpentaria country side, and met a fellow rider with whom I began to chat.  We discussed bikes (of course), and then ventured into a discussion of plastic surgery in Santa Barbara.  She asked some excellent questions about facial anatomy and the changes that come along with the aging process.  She also had questions about specific areas, and in particular the vertical lines on the forehead which we call “glabellar frown lines�.   I explained that the quick and easy way to treat these were with Botox and this was done very commonly.  I was interested to hear her response, however, which was concern about Botox as a “poison� that would make you sick.
It is not infrequently that I have this type of conversation in both the professional plastic surgery as well as the casual setting, as classic teaching is that botulism toxin, which Botox is made from, is poisonous when ingested in large doses (as from bad food).   This substance is poisonous because it paralyzes many muscles in your body when ingested in large quantities.  When refined and used in minuscule amounts with specific placement, as we do with injections of Botox in my plastic surgery office, this toxin does not affect the entire body- only the individual muscle that it is applied to. By paralyzing the very small muscle that contracts just under the skin, the Botox injection prevents the contraction of that muscle and therefore prevents the wrinkle in the skin overlying that muscle from appearing.  In this application, Botox is therapeutic, and not poisonous at all.
Lots of research has gone into development and purification and safety of Botox.  I would not use it on my patients if I had reservations about it, and it ranks highly as one of the most satisfying patient therapies short of surgery.  We must remember that like so many of the medications and even vitamins that we take, the proper dosing of the therapy is key.  Too much vitamin A can kill someone if taken in overdose amounts. Similarly with Botox, the right dose, indication, and application by a certified professional are key to a safe, youthful appearance.

It seems that more and more and more surgeons are performing breast augmentation in the same techniques that Dr. Sheffield and I have been proponents of for quite some time.  The dual plane breast augmentation seems to be gaining favor by many plastic surgeons around the country.  On of the most respected breast surgeons in the world, Dr. Dennis Hammond, is a friend who has been kind enough to participate on my panel at the ASPS meeting for two years running.  He and I additionally share responsibility for much of the educational program at the ASPS meeting pertaining to surgery of the breast, and I have the highest opinion of Dennis as a great, thoughtful surgeon and educator.  He is also a proponent of the dual plane approach for many patients, and like me, believes in an individualistic approach to breast augmentation and breast lifts.  Breast implants should be chosen on the basis of individual patient anatomy, including length and width of the chest wall and torso, as well as specific patient expectations. Read the rest of this entry »

I’ve just returned from the 2008 meeting of the ASPS- thousands of plastic surgeons converged in Chicago last weekend to discuss the latest trends in plastic surgery, as well as issues of patient safety and improving plastic surgery outcomes for patients around the country and the world. I had the pleasure of being involved with two of the most popular programs, one of which I’ve been asked to put together now for I think the 6th year running. We discussed issues ranging from wound care to breast augmentation, breast lifts, breast implants, body contouring, facelifts, and eyelid surgery. I had the opportunity to teach by sharing my thoughts, while hearing from some of the world’s experts about their recommendations and experiences. Having previously served on the Board of Directors of the American Society of Plastic Surgeons, I also had the great opportunity to see many of my friends from around the country, and help mentor some of the younger, up and coming plastic surgeons. On top of that, I got to do some shopping on Michigan Avenue, and have some fantastic Italian food. And then there was that amazing Chicago style hot dog at O’Hare airport….. ☺ I’ll try to include some of my thoughts about some of our discussions over the next few blog entries, and I’ll limit my thoughts to plastic surgery instead of pasta and hot dogs.

Next week is the national meeting of the American Society of Plastic Surgeons which is in Chicago this year.  This is the largest national forum for plastic surgery, and a great educational opportunity for everyone who comes.  I haven’t missed one of these meetings in nearly 10 years, and every time I learn something new.  As I’ve matured in my practice, I’ve had the opportunity to go from student to teacher in various forums, and I’m very much looking forward to this year’s programs.  I’ve been asked to once again present a panel that I’ve been doing now for 6 years, called “Fresh Faces, Real Cases”- this is one of the most popular events of the meeting, and as director and moderator for this panel, I’ve put together a great program that should produce some very good discussion on breast augmentation, breast lift, body contouring, lower extremity reconstruction, breast reconstruction, and neck lifting.  The breadth of the subject matter makes this one of the most enjoyable parts of the week for me, and the opportunity to interact with hundreds of plastic sugeons at one setting is a real highlight.  Additionally I will be involved with another aesthetic panel, as well as several of the events involving the YPS (Young Plastic Surgeons) Forum- a subdivision of the ASPS which I used to head up when I was younger….  oh well.  As the grey creeps into my head of hair, I’m less eligible to be seen as one of the young crowd.

Beauty for Life is a fantastic source of plastic surgery information, developed by the ASPS/ASAPS joint Cosmetic Medicine Task Force. This program has been designed to help you learn about procedures that can help you meet your personal beauty needs, at any age.  By clicking on the link above, you can download the information to review on your computer, and feel free to discuss your thoughts with me during your appointment in Santa Barbara.