New Body Cosmetic Surgery Forum

What Does Dr. Yoho Think About Facial Fat as a Facial Filler?

2007-04-02T17:12:00.000-07:00

Question:
What Does Dr. Yoho Think About Using Fat as a Facial Filler?

Answer:
Dr. Yoho has the experience of fat transplanting hundreds of patients, in faces, buttocks, and elsewhere. He thinks that it can be useful, but there are few problems with it.
1. Sometimes it all goes away.
2. If the patient gains weight, you can end up with a patient with a really fat face.
3. If it is used underneath the lower eyelid in order to fill in the little groove here it can be a real problem because it tends to encapsulate and form a little lump that sometimes grows and sometimes has to be surgically removed through a small incision. Although the cuts in this area heal beautifully in most cases, it is still a hassle to have to remove facial fat that sticks out from the face.

Dr. Yoho also had a large experience using frozen fat but after several case reports of severe infections that occurred with other physicians using this, Dr. Yoho abandoned frozen facial or other frozen fat transplant. Remember that frozen fat is dead material

The best fillers in his opinion as of 2007 are the Restylane, Radiesse, and injectable silicone. All of these provide certain benefits and certain drawbacks which Dr. Yoho can explain at the time of your consultation and which are explained at www.dryoho.com. Most notably, Radiesse frequently causes lumps when placed in the lips and so this is probably not the best use for it.

Dr Yoho feels that facial implants can often solve problems of facial sagging and work better than fillers in many cases. So consider this option also. See http://www.dryoho.com/photo-gallery/results.cfm?Category=41.

Does Botox® Really Work?

2007-03-27T07:38:00.000-07:00

Question:
Does Botox® Really Work?

Answer:
Botox® is the “crack cocaine” of cosmetic surgery. Botox® is just so very addictive because it works so very well. It has also been a great thing for our patients because with Botox®, most people can see the results within a short period of time and sometimes overnight, occasionally it takes as long as a week. We can in many cases erase many years of age from a person’s face. Our new injection technique involves smaller needles than have been available before. These needles are less painful. We can produce nice quality brow lifting, as well as upturning of a person’s mouth and removal of "crow’s feet" and lines under the eye. Additionally, many people can get an improvement in the smoker’s lines around the mouth or the wrinkles around the mouth that a person gets as they mature.

Unfortunately, small doses of Botox® just are not as effective and you should receive about 45 units of Botox® minimum. The results sometimes are disappointing if you get less. Botox® costs between $8 and $15 a unit at the MD's office. It certainly is important who you have injecting your Botox®, because inexperienced or unknowledgeable Botox® injectors can produce effects that can look like Mr. Spock and/or effects that can drop the eyebrow into the eyes and make for a very unattractive look. Generally speaking, the best Botox® practitioners put very little Botox® into the forehead these days, and focus more on other areas.

Understanding TCA (Trichloroacetic Acid) Peel Procedures

2007-03-27T07:28:00.000-07:00

Understanding TCA (Trichloroacetic acid) Peel Procedures

The current cosmetic surgery market is filled with many advertisements for “non-invasive procedures”. These procedures' results are proportional to their inconvenience and recovery time. In other words if you have a tougher recovery, generally speaking, you will have better result. Trichloroacetic acid peeling is the perfect example of this. This can be done in a very non-invasive way with a minimal recovery that involves just a little bit of flaking of your skin. For the right patient, this can produce color improvement and texture improvement. On the other hand if performed in a deep fashion, trichloroacetic acid can produce a tremendous improvement in wrinkling of the whole face. Deep trichloroacetic acid peels unfortunately have a tendency to cause scarring in the area of the jaw and sometimes around the mouth. For this reason, light TCA peels and moderate TCA peels have become the standard and deep TCA peels are practiced only by a few. Dr. Yoho offers light and moderate TCA peels with or without sedation for patients who do not want to come back repeatedly for non-invasive treatments such as FotoFacials®. This can produce a great deal of improvement without all of the driving back and forth and the aggravation in the expense of waiting for your non-invasive treatment to mature.

What is the American Board of Cosmetic Surgery?

2007-03-27T07:12:00.000-07:00

Question:
What is the American Board of Cosmetic Surgery?

Answer:
The ABCS is an independent private testing organization that gives a 2-day test to physicians who want to be certified or have some demonstration of their knowledge in cosmetic surgery. Cosmetic surgery is the art and science of beautification surgery. It does not include hand reconstruction, cancer surgery, or other skin surgery skills that have to do with diseases. The procedures covered include, but are not limited to liposuction, eyelid lifts, hair transplant, facelifts, forehead lifts, resurfacing procedures of various kinds, insertion of fillers to make the face and other parts of the body fuller and more youthful looking, tummy tucks, and Botox. The doctors are tested on emergency procedures in their office as well, and have to demonstrate good knowledge of cardiopulmonary resuscitation and knowledge of the medications and procedures used in case of emergencies of various types.

Currently, doctors testing for the American Board of Cosmetic Surgery need to have had both a surgical training program and also a fellowship (a year or 2) of specialized training in cosmetic surgery. Dr. Yoho was privileged to take the Cosmetic Surgery Board’s as a “grandfather,” because he had performed over a thousand cosmetic surgery procedures and was considered a very competent individual to join the ranks of the board certified American Board of Cosmetic Surgery members.

This board is the only board that certifies purely cosmetic surgery. The other boards are mixed boards. In other words they certify whole group of other procedures including procedures to treat diseases and injuries. The plastic surgery board, the ear, nose, and throat board and the dermatology board are examples of boards of this type, which include some information and testing about cosmetic surgery procedures, but do not concentrate exclusively on cosmetic surgery.

Note that all of the boards including the American Board of Medical Specialties are private organizations and none has any official status except as granted by medical boards and other organizing bodies. They all have their own board of directors and their own agendas to promote their membership and in many cases advertising budgets.

For complete discussion of board certification and the American Board of Cosmetic Surgery, please see www.dryoho.com under "Meet Dr. Yoho" and then "Understanding Board Certification."

Cosmetic Surgery Procedures After Pregnancy

2007-02-22T06:43:00.000-08:00

Question:
What kind of cosmetic procedures are best for me after a pregnancy?

Answer:
Everyone is an individual and must be evaluated in person; however, many women have deflated and saggy breasts after breastfeeding. Breast implants can restore the original contours or even make a contour that the patient enjoyed during her breastfeeding days. Many times, no cutting is necessary on the skin of the breast and the implant can be inserted through the bellybutton without entering the breast tissue to any significant degree or disturbing the nerves to the breast. Most implants are inserted under the pectoralis muscle. They do well because there is a natural drainage of any slight bleeding into the fat of the abdomen rather than the blood staying in the area around the implant. This bruising on the abdomen rather that around the implant helps decrease the chance of scarring around the implant (capsular contraction). This scarring around the implant can make an implant quite firm and sometimes even painful. For more information, please visit my website at www.dryoho.com.

Another common procedure performed after pregnancy is liposuction. This procedure is very helpful for women who have exercised enough and have had good enough muscle tone of their abdomen. Skin sagging that occurred after the baby was born can often be improved with liposuction alone if it is not too extreme. The liposuction produces an injury to the skin underneath the surface which causes it to contract. As surgeons know, skin contraction occurs in every direction for several weeks after any injury and sometimes for longer. In the case of liposuction the injury is internal and the skin is allowed to contract back towards the muscle wall. In the best case, smooth, tighter, natural-looking skin can be produced by liposuction alone.

For those women whose muscle walls do not recover from the stretch of having that extra 20 to 30 pounds of baby and baby support system, muscle wall tightening can be performed. The “tummy tuck” consists of making an incision from hip to hip and then making a passageway right next to the muscle all the way up to the ribs. In this passageway, the muscle wall is sewn to itself in a sort of pleating process which tightens the muscle. Then the skin is pulled down, extra skin is trimmed away, a new bellybutton is manufactured, and the skin is sewn along the lower abdomen. Unfortunately, this method does produce long scars. Also, unless great care is exercised, some of the belly buttons are not very natural-looking.

Another way to tighten the muscle wall - if the skin is not tremendously loose - is to do it through the bellybutton. In this method, a bit of liposuction might be performed on the front of the abdomen, and then a little circular cut is made around the bellybutton. After this, passageways are made in the midline above and below the bellybutton and again the muscle covering is stitched to itself with permanent sutures. This procedure cannot tighten the skin, but the skin often will shrink fairly well later on if the muscle wall is tightened. This avoids the long scar of the tummy tuck, but again care must be taken with the bellybutton or unnatural bellybuttons with scarring right on the surface can result. Please visit www.dryoho.com for before and after photos and information about these and other cosmetic surgery procedures.

Common Cosmetic Surgery Questions

2007-02-05T15:02:00.000-08:00

Question:
What procedures are new in cosmetic surgery?

Answer:
Two procedures are now gaining popularity and we will have to wait and see just how popular they become. The first is revision of the bellybutton as a sole procedure. This can be done by removing a little bit of skin around the belly button and then carefully stitching inside the bellybutton in order to hide the scar. This produces tightening. It is an excellent procedure as a stand-alone bellybutton improvement surgery, or can be done after liposuction or tummy tuck.

The second set of procedures, which are becoming more common are nipple revision procedures for women. Some women have large droopy nipples and this can be revised. The best way to revise these is to carefully remove a cuff of skin from the base of the nipple. This pulls the nipple up and makes it perkier and preserves the nipple sensation. Older methods such as cutting off the top of the nipple work as well but have more chance of significant problems and of course entail a much longer healing process. Inverted nipples can bother women for a lifetime. The revision can be done by pulling the nipple out after the area has been injected with local anesthetic. After the nipple is pulled out, a small incision is made in the side of the nipple and the fibrous bands, which held the nipple down in to the breast are cut, and the incision is stitched. After this, no special care is needed. Bruising is frequent, but this should go away within a week to 3 weeks. This can be done at the same time as the breast implant procedure and greatly enhances the results for those women who have inverted or “sucked-in” nipples. For more information, please visit www.dryoho.com.

Question:
What procedures may be wrong for most patients?

Answer:
Thigh lifts are often problematic. This procedure causes scarring, and sometimes the scar will pull in unnatural fashion on the area around the private parts of a woman. Additionally, the scar tends to migrate or move down the leg as the tissues mature. While there are ways to cope with each of these problems, overall this is not generally a good procedure in younger women. Exceptions may be individuals after massive weight loss. We offer liposuction in this area and the skin will shrink adequately in many cases. In an older woman with exceedingly loose skin, occasionally a thigh-lift is an acceptable alternative, but only if the patient understands the potential problems. Additionally, thigh-lifts place the scar in a moist area that is somewhat difficult to keep clean and infections are probably more frequent in this area than other types of surgery in other areas. When an infection happens, the scars become even more spread than is ordinarily the case with case with body surgery. For all these reasons, thigh-lifts are not popular with the cosmetic surgery community and not all surgeons perform these procedures and they are generally unacceptable for younger patients.

Another procedure that is performed by only a few is artificial pectoral implants in males (in the breast area). There are some hard silicone implants that are designed for placement underneath the muscle to simulate a body builder’s chest, but these implants sometimes are mobile, and you can often feel the edges of them, creating a very unnatural result. While it may be possible that someone somewhere is doing a good quality pectoral implant and getting results that are acceptable, I do not know of any.

Calf implants are another procedure that is not performed very often and in my opinion has unacceptable healing times and questionable risk-to-benefit ratio. The hard plastic implant (polymerized silicone) is placed through a slit in the back of the knee into the area underneath the muscles of the calf. The patients have to walk around on their tiptoes for weeks to months in order to get the muscle tissue to stretch out around the implant, and this is very uncomfortable. The incision is not insignificant in this area and frequently will spread, producing a scar that may often be unacceptable.

So remember, when you are thinking about cosmetic surgery, you do not have to get everything on the menu. Just as when you go to a good restaurant, you should try to eat everything that is there. There are procedures that are appropriate for your particular body and you should consult with your surgeon about what is most reasonable. For more information, read "Doctor, What Else Do I Need?" If you are considering cosmetic surgery and live in the Los Angeles/Pasadena area, please visit www.dryoho.com for before and after photos and procedural information.

Question:
What kinds of cosmetic surgery procedures produce the most lawsuits against surgeons?

Answer:
The answer to this question reflects several factors. First, it reflects possibly the kind of patients and the perfectionism of the patients who are interested in each procedure. Second, it may represent the difficulty of performing a given procedure well. Third, it may reflect the complication rate of the procedure. If the procedure has many complications, possibly, there might be more lawsuits.

The number one litigation or lawsuit risk for the cosmetic surgeon is nose surgery. This procedure represents less than 10% of the cosmetic surgery cases performed and about 1/3 of the lawsuits. Nose-improvement surgery is highly specialized and complex and probably should be performed by surgeons with ear, nose, and throat (facial plastic) background or maxillofacial background only, unless the cosmetic surgeon takes a lot of time to learn the procedure “hands-on” from a reputable training facility. The standard joke among cosmetic surgeons is that you should pay the first 100 patients for performing their nose surgery and after that, the patients can pay you. Nose surgery’s healing process is different than any other cosmetic surgery, and that it may take a full year for the final result to be seen. A nose that might look good at 3 months might not look good in a year. Experience is everything, or almost everything. An experienced nose surgeon who has the artistic feel for what he is doing can produce beautiful changes and a nose that does not look “done”. There is nothing worse than a bad nose job and problems are so obvious right in the middle of a person’s face.

Liposuction on the other hand has relatively few lawsuits, only about 3% of the total lawsuits against cosmetic surgeons, but it must be about 1/3 to 1/2 of all the surgeries done. However, the problems with liposuction when they occur, are sometimes severe and might require hospitalization.

Breast reconstruction, especially when an implant is placed at the same time, requires a great deal of experience and nipple loss is a possibility with some of the surgeries. This is obviously problematic. These cases have a disproportionately higher litigation rate. Ordinary breast augmentation, however, has one of the highest satisfaction rates in cosmetic surgery and has some problems, but no more than the average cosmetic surgery.

The most important take-home message from all this is if you want your nose done, get it with the most experienced surgeon, and choose your surgeon wisely in any case. Look at the list at http://www.dryoho.com/dr-yoho-book/chapter2-6.cfm#checklist for further information about how to choose your surgeon.

Question:
I have dark skin. How can cosmetic surgery help my scars?

Answer:
We see many patients with dark skin: Filipinos, Hispanics, African Americans and others. These skin types do not do well with aggressive peeling procedures because this can lighten or darken the skin, sometimes for lengthy periods or even permanently. However, with special treatment, this skin types can respond beautifully to our skin care programs. The first step in treatment of a person with irregular pigment problems of their face is generally to use bleaching agents. We often include Retin-A® for better penetration to lighten their entire complexion. After a month or so of this, frequently, light treatments with slightly destructive methods such as electrical burning may be indicated for problem areas. Then, the patient might be instructed to use the bleaching and penetrating agents some more or they may be allowed to back off and use only a mild treatment regimen and allow their pigment to return to the skin.

Acne scars and wrinkles are particularly difficult to treat in these skin types. The peeling procedures and the deeper laser procedures are just not appropriate for darker skins because of pigment change. The good news is that wrinkles are not usually as much of a problem as in light complexions where the sun exposure has to some extent aged the skin. Darker skins are just protected better from the sun because of the natural pigment. We can effectively treat dark skinned patients who have even darker areas due to their acne. Acne can be treated with a variety of prescription and over-the-counter medications and there is a cure for it called Accutane®, which generally results in long-term improvement or complete cure of acne. After these treatments are used, the bleaching creams and the smoothing creams can be employed to produce a complexion that is even and attractive. The ultimate goal for complexion treatments of any kind is to produce a smooth even-colored look without the color irregularities that are present with some kinds of skin growths and/or skin irritations such as acne. We will individualize our approach to your skin type by evaluating you carefully and using our best judgment about what would help the most.