As many of you know, following Dr. Sheffield’s retirement at the end of last year, some gentle transformations have kept us busy at Montecito Plastic Surgery. New paint adorns the walls, and new furniture can be found throughout the office. This week, the finishing touches will be placed with new flooring in two exam rooms. Several new pieces of art will be received from the framers, and will be heading for our newly painted walls.

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

Help fight a bad idea!!  Congress is soon to debate the Health Care Reform Bill, which is a great move towards increasing the number of insured Americans.  Unfortunately, it is filled with several bad ideas, like a taxation on patients who undergo cosmetic surgery.

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!

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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