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!
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.
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!
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 surgery”.Dr. Lowenstein comments, “Patients traveling to Santa Barbara for their plastic surgery must understand (more…)
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.
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. (more…)
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.
