In Conjunction with Blepharoplasty (see our previous article)

Patients have the option of having injectable fillers like Juvederm or Restylane to replace volume in the area between the lower eyelid and the cheek to replace the fat from this area that has moved or sunk with age. As newer, longer lasting fillers become available, non-surgical alternatives to blepharoplasty are now possible.  Non-surgical blepharoplasty takes about ten minutes, is relatively painless, and causes little to no bruising. The effects of non-surgical blepharoplasty can last around 18 months. After the procedure it is common to have swelling or bumpiness below the eye. They quickly recede and cause little or no pain.

Blepharoplasty – What You Should Know

Your eyes are the window to your Soul. What do other people think? You look into their eyes… They look back. A person with drooping eyelids, wrinkled, permanently tired hangdog haggered look in his eyes will not be able to communicate the Joy of his or her Soul. Indeed, there will be no joy.  Do people think you are angry or tired when really you are not? Do you look older than you feel? If so, treating the eye area may be your answer.

Dr.Fisher always recommends topical products that are sold at Cosmetic Surgery and Laser Center, Cerritos www.CosmeticSurgeryandLaserCenter.com but only plastic surgery can give you a large-scale, long-lasting new lease on life! You can compare how natural and perfect the results are. The Happiness that we have seen in our patients truly cannot be purchased with money.

Eyelid surgery (blepharoplasty) can correct hollows around the eyes, loose skin, and fine lines and wrinkles. Unlike many other surgeons, who are as yet trying to achieve a natural, “non-pulled” look, Dr. Gregory Fisher has brought this art to perfection. He truly reshapes both the upper and lower eyelid as well as relocates the excess tissue that surrounds the eyeslids. The result is not only obvious and apparent, but also underlying – added strength in the surrounding muscles and tendons.

Blepharoplasty is typically performed to remove excess eyelid skin that causes loss of peripheral vision by blocking a person’s line of sight, causing difficulty with daily activities such as driving and reading. Upper eyelid blepharoplasty can be done both to improve one’s vision or for cosmetic purposes.  Lower eyelid blepharoplasty is always done for cosmetic reasons, since it improves the physical appearance of the eyes by removing the “eye bags” and reduces the wrinkling of the skin in the area.

Many patients are worried excessively about complications. “The only complications I have had,” Dr.Fisher says, “have always been the result of the patient’s not following my instructions. After the surgery, most patients will experience bruising and swelling that lasts about seven to ten days. There is no reason to worry. Patients sometimes call me in the middle of the night, only to find out that they are experiencing a natural healing process. Naturally, after blepharoplasty, patients should have ample time to rest their eyes and should avoid wearing eye makeup and contact lenses during the recovery period.”

”Sometimes,” Dr.Fisher continues, complications may arise from the patient’s concealment of his or her condition. It is very important to disclose any prior surgeries to us, hospitalizations, and, in connection with blepharoplasty any headaches, eye surgeries etc. Patients sometimes do not think that a prior eye surgery they had 2 years ago can have any detrimental effects. Well, it can. In such cases, if you want perfect result, you have to provide your full medical history. It is too late for me to get in touch with your ophthalmologist after the problems arise…”

“One of my patients intentionally did not disclose her eye surgery. Two days after a successful procedure, excessive bleeding occurred, which resulted in abnormal folding of the eyelid skin. It took another surgery to correct the defect. Subsequent healing took five months instead of five days. We are surgeons – doctors, artists in many ways – we are not omnipotent and omniscient. The more open the patient is and the more they confide in me with respect to their past medical history, the better the result will be in the end. A simple breach of the post-operative instructions, such as bending over to put on an item of clothing or – as was the case in one of my patients – to catheterize herself – can ruin a perfect surgical result. It is sad, but it happens.”

That is why we inform you on this blog what you may not be fully aware of, and which will save you a lot of time and money. Only patients who obey the instructions of Dr.Fisher and disclose all their prior medical history can expect a perfect result.

Why Not the Best?

 

In today’s hurried world, you should find some time for yourself and make yourself happy. One of the most obvious choices can be by improving your visage. An experienced, skilled plastic surgeon, such as Dr.Fisher, can take 15-20 years off your face overnight, as if it were the doing of a swift magic wand, not a gentle hand of a mere mortal.

Patients are often surprised how plastic surgery can improve their face – eradicate wrinkles, spots, lines… all those unpleasant signs of aging; and since the outer self molds the inner self equally well as it is often the case the other way round, plastic surgery can add to your mental composure and well being.

Out there, we sometimes see people who did not exercise their choice of a plastic surgeon wisely, and consequently ended up with an equally profound obverse effect: their skin is pulled too tight, unnaturally, ungracefully, or they may even have physical deformities and problems. That is what happens when you do not use your best judgment with respect to your inner satisfaction, but your best judgment with regard to economic concerns. Our advice? If you cannot afford to invest into your well-being and happiness, cannot save a few bucks here, a few bucks there… forget it! Do not give yourself pains. Do not go for the second best – because that might cause just as poor a result as the last – you never know – especially when you have the best one waiting for you.

Dr.Fisher will personally explain to you where the Hollywood starlets – or even erstwhile starlets who, now in their 40s, 50s and 60s, have undergone artful cosmetic procedures to maintain the image of youth – defaulted. Surgery is art – much more than a little nip-and-tuck here and there!

Why, you can see yourself when a facelift goes wrong how even people’s characters alter… Such unfortunate patients will never extol any plastic surgeon. Therefore, ask for the best, look at satisfaction.

During an interview at the 2009 meeting of the American Society of Plastic Surgeons, Dr.Fisher explained the most common pitfalls of facial plastic surgery, and shared some little-known trade secrets for avoiding them.

“During the typical facelift operation, the patient’s ears are subjected to a lot of tension, which causes some drooping of the ear canal,” Dr.Fisher noted. “As the surgeon adjusts the patient’s facial skin and muscle during the face lift, the altered ear drops down, producing extra skin to deal with and dispose of. Patching the patient back up from this usually means producing the ‘pulled’ look. Signs of surgery are conspicuous, as well. If they have a lot more skin to remove, the incision is longer,” he adds emphatically, “and if it’s longer, it is visible.” Shaking his head, Dr.Fisher continues: “We have to do two things: The ear is little higher and there’s more volume. We still do the muscle work, but is there less or more skin? There’s less. And if there’s less skin, the incision is shorter and can be hidden inside the ear.”

Dr.Fisher’s result? A perfectly natural facelift, which will not alter your natural characteristics, will emphasize the beauty of your face, and whose surgical evidence is well concealed. Again: look in the mirror. You deserve better. Why not the best?!

 

“Sad but True,” – Dr.Fisher Responds

“Can the scars from previous my operation be eliminated by a new surgery?” (Fiona B., Montebello)

Perhaps surprisingly, yes. Scars in the abdominal area (and this also applies to stretch marks) can be entirely eliminated by a skilled surgeon. I have done hundreds, if not thousands of operations where the substantial reason the patient expressed for the surgery was that she, in many cases he, wanted to improve the results of a previous surgery.

Usually, the main objective is to be economical while remaining efficient and equally esthetic. This means finding a fair proportion between maximum gain and maximum loss, so to speak. If there is still excess or mal-distributed fat in the area or perhaps lax or over-hanging skin, the main objective is to eradicate those. This objective must be viewed in proportion to the overall bodytype and size of the patient. Sometimes, even a master surgeon, such as myself, finds it almost impossible to remove entirely evidence of an improperly performed surgical procedure.

The tummy tuck operation itself may also be done in such a way as to remove scars or stretch marks. However, the higher the position of the scar, the more difficult it is to deal with it. It is also generally known that scars heal worse in smokers, not to mention people who use drugs. Scars interfere with the blood supply to the skin in general and sometimes may severely complicate a subsequent or reparative tummy tuck. There is no rule of thumb on this issue here.

Every reparative operation is a compromise of esthetic and pragmatic nature. A personal consultation is absolutely necessary. Unfortunately, many people look at cost of the surgery rather than the skills of the surgeon. In most cases, saving $500 or $1,000 in the short run, will cost you ten times that much in the long run. It is sad but – true.

 

Cohesive Breast Implants

In the 1980s, Replicon implants were the most popular. Replicon is an anatomically shaped, polyurethane coated, silicone gel-filled implant. Many surgeons felt that the initial results were very beautiful, but short-lived, because the polyurethane, which was bonded to the surface of the shell helped to maintain the anatomic shape of the implant, eventually deteriorated, and once it was absorbed off of the shell, the remaining thin and pliable shell could not hold the silicone gel in place, and so its shape was lost. Further, gravity forced the gel to the bottom of the shell, collapsing the upper breast, and expanding the lower breast. Folds developed in the collapsed upper pole. The shell was very thin, and with time, the shell weakened along those folds, and eventually could break, allowing the relatively liquid-like contents of the implant to leak outside of the shell. In addition to the effects of gravity, the forces of the breast acted upon the implant, deforming its initial anatomical shape. The implant accommodated to the shape of the breast, rather than the breast taking on the shape of the implant.

Dr.Fisher was directly involved in a long and tedious process – far beyond the scope of this article, or this site, to describe in detail – which involved experimentation with diverse silicone gel fillers. Silicone can be made in virtually any firmness, from a liquid lubricant to almost a rock-hard solid. The aim was achieved in making the filler more stable and avoiding collapse of the shell. Further, the modern cohesive shell can be formed into a particular shape and maintain it.

In the past, shape was of only moderate importance, because the forces of the body and of gravity would shape the implant. However, the modern cohesive filler allows for various ratios of width, height, and projection.

The FDA moratorium on silicone gel filled breast implants in 1992 also contributed to increase in competitiveness and invention in this area. The type of implants that were available before the ban are available today as part of an “adjunct study,” which is open to patients with congenital deformities or having a revision for particular reasons.

What distinguishes the modern cohesive implants is that the silicone gel is firmer, essentially a soft solid. If a cohesive implant is cut in half, there is no gross movement of gel, and the implant maintains its shape. The way these are made is that the company uses more “crosslinker” in the making of the implant. The ingredients are the same, but with more crosslinker added, it makes the gel firmer.

Cohesive breast implants implies form stability, or form retention. That means that in any position, the implant maintains its shape. That is an important distinction, because it means that the shell should not fold, and that it will maintain a particular shape. All breast implants are “cohesive” to a different extent. More cohesive are not necessarily better. The bottom line here is the desirability of shape and firmness, which must be in proportion to the body’s natural qualities.

Facial Implant Surgery

chin osteotomy with lengthening and an interpositional graft preop

 

Be it as a part of reconstructive surgery or an indelible feature of body contouring, Dr.Fisher also performs facial implant including chin implants, jaw implants, or cheek implants, all with the ultimate aim of providing complete rejuvenation, augmentation, and/or reconstruction for patients wishing to improve or repair the appearance of the face.

Chin Implant Procedure is performed either as stand-alone out-patient procedure, or in combination of other surgical procedures. It is an “augmentative” procedure, which means that its goal is either to give accent to the jaw line through the placement of customized implant materials or to achieve chin advancement.  Implants are put in place by means of incision (either under the chin or in the mouth). The surgery is not complicated – but then again – Dr.Fisher is a unique expert in the field…

chin osteotomy with lengthening and an interpositional graft post-op

Jaw Implant Procedure, also referred to as “jaw augmentation” or “mandibular augmentation,” takes within two hours, of course depending on the technique used, the extent of the procedure and its material. Placement of the implant is determined in advance, usually on top of the jaw bone. Once the implant is in place, Dr.Fisher performs a thorough visual examination in order to ensure that it suits the features of the patient. As a sculptor and painter, Dr.Fisher is very well equipped and experienced to assess the propriety, proportionality and perfect fit here. When everything is to his satisfaction, he will use sutures and/or screws to secure the implant in place. Scarring is minimal and invisible to a lay eye.

Cheek Implant Procedure is somewhat more complicated. To provide access for the implant, Dr.Fisher makes an incision either on the outer cheek a little below the lower eyelid, or above the upper lip. This incision creates a fitful “pocket” in the tissue, into which the implant is inserted. The implants may be positioned on or below the cheekbones. To keep them securely attached to the bone, titanium screws are sometimes used. The incisions are then closed with sutures that dissolve in the body.

chin augmentation preop

After surgery, patients often do not feel more than temporary numbness and dull pain, somewhat similar to toothache. The treated area may feel tight and may remain swollen for several days. Naturally, liquid diet is recommended. For any dietetic advice, patients may wish to contact, Dr. Fisher’s daughter, Dr. Sarah Fisher.

Visible effects of face implant surgery typically become evident after 3 or 4 months.  After this time, the implants will be set in place and provide the patient with a lifetime of aesthetic enhancement wherever the implant is placed.

 

chin augmentation postop

Otoplasty

After

 

Before

Many people suffer from protruding or malformed ears, which may have exposed them to ridicule during childhood, severely lowering their self-esteem. Otoplasty, or ear pinning surgery, can effectively eliminate these imperfections and create more aesthetically pleasing ears for the patient.

People with large, malformed or misshaped ears choose to undergo ear pinning surgery. If you have prominent protruding ears, noticeably protruding from the head, if you suffer from the “lop ear” when the tip of your ear appears to fold downward and forward, similar to some dog ears, or if you have cupped ears (disproportionately small), or possibly “shell ears” with the absence of natural ear folds and creases, and no curve in the outer ear rim, you may be the right candidate for otoplasty.

Adults and children alike can receive otoplasty, but the operation is mostly performed on children between 4 to 14 years of age. Although rare, Dr.Fisher performed this surgery many times. “At the age of four,” Dr.Fisher states, “the human ear is nearly fully grown. This is the perfect age for otoplasty.”

Many followers of our site and Dr.Fisher’s blog and website, www.drfisher.com, are full well aware that Dr.Fisher is one of the United States’ foremost experts in reparative surgery and surgery of the hand (carpal tunnel syndrome). He established Marie-Louise Cleft Palate Foundation, and helped many children and adults regain their self-esteem by operating on bodyparts as diverse as you can only imagine – from ears and noses, to feet and genitalia. With his Columbia University background in psychology and physiology, he is also a foremost expert to address when you have any psycho-somatic disorder, such as “outstanding” ears.

How does he perform otoplasty? For adults and older children, the use of local anesthesia and sedatives during the operation is preferable. For young children, however, general anesthesia is recommended. The typical time frame for ear pinning surgery is between 2 to 3 hours. If a particular case is complicated, the operation may take longer.

Before

“It is very easy – if you know how to do it,” says Dr.Fisher with his proverbial good humor and large, welcoming smile. “First, we must expose the ear cartilage by making an incision behind the ear. Then the cartilage must be carved and bent backward, closer to the head. If necessary, superfluous cartilage should be removed, just as we do in nose-shaping. Finally, we apply a few permanent stitches to keep the new shape in place.”

After

To ensure proper healing and molding of the ear after ear pinning surgery, Dr.Fisher uses a bulky bandage around the head of the patient. There may be some aching and throbbing for a few days, which can be relieved and minimized by very effective medication. Dr.Fisher uses self-absorbing stitches, so there is usually no need for a post-op visit for stitch removal. Normal physical activities can be resumed after approximately four to five weeks.

Blepharoplasty

Blepharoplasty is a cosmetic surgical procedure that reshapes both the upper and lower eyelid as well as relocates the excess tissue that surrounds the eyelids and strengthens the surrounding muscles and tendons. Blepharoplasty is typically performed to remove excess eyelid skin that causes loss of peripheral vision by blocking a person’s line of sight, causing difficulty with daily activities such as driving and reading.

Upper eyelid blepharoplasty can be done both to improve one’s vision or for cosmetic purposes.  Lower eyelid blepharoplasty is always done for cosmetic reasons, since it improves the physical appearance of the eyes by removing the “eye bags” and reduces the wrinkling of the skin in the area.

After the surgery, most patients will experience bruising and swelling that lasts about seven to ten days. Patients should have ample time to rest their eyes and should avoid wearing eye makeup and contact lenses during the recovery period.

Although risks and complications are rare for the blepharoplasty procedure, it is still advisable to be aware of possible complications. Complications can include bleeding, which may lead to possible infection. Invariably, such complications are the result of not following Dr.Fisher’s advice on how to avoid them. An insignificant movement can produce very detrimental post-operative complications, such as bending over to pull up an item of clothing within 2-3 days of the operation or trying to take off the bandaged area and conduct a self-inspection at home. All these may cause abnormal folding of the eyelid skin and abnormal discoloration, which may have to be repaired by another surgical procedure. Patients may also experience an inability to fully close their eyes after the procedure.  All side effects should be immediately reported to Dr.Fisher.

Patients also have the option of having injectable fillers like Juvederm or Restylane to replace volume in the area between the lower eyelid and the cheek to replace the fat from this area that has moved or sunk with age. As newer, longer lasting fillers become available, non-surgical alternatives to blepharoplasty are now possible.  Non-surgical blepharoplasty takes about ten minutes, is relatively painless, and causes little to no bruising. The effects of non-surgical blepharoplasty can last around 18 months. After the procedure it is common to have swelling or below the eye. In any case, patients should not be upset and give themselves plenty of time to recover, because each person reacts differently and there are many factors to recovery, such as age or previous stressful environment, which has affected the area etc.

Dr. Fisher will introduce you to critical points you should understand in regard to the expected aesthetic and functional enhancements as well as the possible risks of blepharoplasty surgery.  Always disclose your prior surgeries and/or medical history even if you think it may not be relevant. Dr. Fisher rarely encounters complications, and never does so in patients who diligently and religiously follow his advice and post-operative suggestions.

Calcium Hydroxylapatite

Calcium hydroxylapatite is the heaviest of facial dermal fillers. This substance, which is found naturally in human bones, is a mineral-like compound. It’s often used to fill the moderate-to-severe creases such as nasolabial folds, marionette lines and frown lines. It’s also used to enhance fullness of the cheeks and other facial contours.

Calcium-based microspheres are suspended in a water-based gel to form calcium hydroxylapatite. This dermal filler was first used in dentistry and reconstructive surgery and has a long safety record.

Like some of the other semi-permanent dermal fillers, calcium hydroxylapatite contains small particles that act as a scaffold. Your own collagen then grows on that scaffold. Over time, the particles are slowly dissolved into calcium and phosphate ions through normal metabolic processes.

Calcium hydroxylapatite is biosynthetically produced, which means that no animals or animal products are used. This lowers your risk of an allergic reaction and no skin testing is required.

This type of dermal filler is known to produce a very natural result, doesn’t migrate, and side effects are rare.

Calcium hydroxylapatite has another, special use for HIV-positive people who suffer from facial lipoatrophy, also known as facial wasting, which is a side effect of antiretroviral medications.

This entry was posted on November 18, 2010. 1 Comment

CosmoDerm

 

Many people who choose to make that important step in their lives and undergo cosmetic surgery often tend to do so not because they would be too vain or self-centered, but because they do have a real health issue – be it a matter of body-mind dismorphia, actual physical insufficiency (cleft palate, breathing problems), or they suffer from some lasting consequences of an injury (car accident) or disease (cancer).

Some problems occur naturally, to all of us. Why not help them if we can? Lines, wrinkles and creases in the face are a natural result of sun exposure and aging. Many beauty rejuvenation procedures exist that can help reduce these signs of aging with both surgical and chemical skin treatments. A popular alternative to surgery is CosmoDerm or CosmoPlast, which smoothes out facial wrinkles and irregularities using collagen dermal filler.

 

CosmoDerm CosmoPlast is  offered as an alternative to Botox that reduces wrinkles and fine lines in the face.  CosmoDerm CosmoPlast works by injecting collagen below the surface of the skin, filling in unwanted lines, wrinkles, and other skin flaws.  CosmoDerm CosmoPlast are the only FDA approved dermal fillers that contain natural human collogen.

The CosmoDerm or CosmoPlast procedure normally takes less than an hour, which makes it a convenient treatment for people on the go. CosmoDerm CosmoPlast does not require a pre-treatment skin test. To minimize discomfort, lidocaine is used together with the injection and eventually creates numbing of the skin. Redness and swelling seldom occur after the treatment, but if it does, it usually goes away immediately.

CosmoDerm  is recommended for people who want to reduce the appearance of fine lines , while CosmoPlast  more commonly treats deep wrinkles between the brows or smile lines that form between  the nose and mouth. CosmoPlast also helps treat acne scars.

CosmoDerm and CosmoPlast can correct facial flaws such as:

–    Fine lines on the forehead
–    Frown lines between the eyes
–    Undefined lip borders
–    Deep facial wrinkles
–    Crow’s feet
–    Acne scars
–    Vertical lines above lips

CosmoDerm CosmoPlast can help you smooth away fine lines and wrinkles if you want quick and immediate results.  It is important to stay informed about what ingredients are contained in various facial injections, and which treatment works best to get the results you desire.  For more information about this – indeed, any – treatment, never hesitate to consult Dr.Fisher whose immense knowledge and incredible experience can help you more than hundreds of hours of research on the internet.

One of Dr.Fisher’s specializations when he studied medicine at one of the worlds best and foremost universities, Colubia Medical School, was Dermatology, the science of the skin. He is a veritable expert in the field. Call in at any time, ask about the latest, state-of-the-art methods, ask about the oldest ones, ask about anything! Do not be shy – be Brave, be Bold, be Beautiful!!!

Breast Augmentation

Dr.Fisher is Master of Breast Surgery

 

Some physicians tend to perform breast augmentation only under local anesthesia, performing both sub-glandular and attempting to sub-muscular breast augmentation. However, this approach has a number of potential problems and is not generally recommended by experienced plastic surgeons. There is also the option of intravenous sedation plus local, which is fairly common. The sedation is an important part of such performance.and unless a competent anesthia provider is present,serious complications may occur.

General anesthesia is much safer than people imagine. It is also generally preferred by the patients. Dr.Fisher  routinely performs breast augmentation under general anesthesia.  Local anesthesia requires more monitoring and can be more dangerous (in particular because it requires a certain degree of the patient’s being rendered unresponsive.  Some facilities are not credentialed to provided general anesthesia requiring that the procedures be performed under local anesthesia. We have a fully accredited and credentialed facility that provides both local, regional, and general anesthetic options. Since general anesthesia requires very safe, FDA approved and recognized treatment, it is on the level of state-of-the art technology, often unavailable in unaccredited facilities, and, in particular, outside of the United States, such as Mexico/ Latin American and South American countries. One can also encounter many obsolete, saline implants being used there as well as in Europe.

Breast implants (also known as augmentation mammoplasty, breast augmentation, mammoplasty enlargement, or breast enlargement) come in two primary types:

•    Silicone gel implants — use a silicone rubber shell that is filled with viscous gel. These implants require sub-mammary incision and are more expensive than their saline counterparts. If the patient desires this type of implant, we make it available to them. 

•    Saline implants — use elastic polymer shell made of silicone and is filled with sterilized saline fluid. This implant has relatively little silastic material in contact with the human tissue, compared with other implants. When Dr.Fisher places this implant under the muscle, excellent results are achieved. The Mentor Co., manufacturer of breast implants, will sell the patient a lifetime warranty, should these implants wear out or leak.

 

Both types of implants are approved by the FDA. As a board-certified plastic surgeon with many years of experience, Dr.Fisher rarely encounters problems, e.g. capsular contraction, in less than 5% of all his patients. Such problems can often be solved with non-surgical treatment. In recalcitrant cases, a simple touch-up surgical procedural may be adequate.

Threading Your Purse

Our decisions are directed by economic considerations. When we go shopping for food, buy presents, live in the material world, we decide what to buy by the size of our wallet and how we like the touch, the feel – or how much we need the particular item. Very much the same considerations are taken into account by patients deciding to have plastic surgery. However, a tummy tuck or breast lift is not the same as buying an expensive dress, or a present for your wife. Fundamentally, where you pay for “things” your decision is based on the utility-availability ratio. Where you pay for services, however, the decision factors are many and vary with your experience and knowledge.

As we have emphasized in one of our previous articles, there are simple material costs, which are immutable: you pay for the operating room, you pay for the instruments, and running costs, which are a given in the world of plastic surgery. No surgeon in the United States can, for instance, do a breast-lift under $3,000 without losing money. If he advertises such prices, a yellow light should go on in your head saying: “There is something wrong!”

What your decision should turn on is only the skill and ability of the surgeon, his experience and results. Personal antipathy at the start will not lead to a good end. Neither will the patient’s “cheap” mindset. More often than not, patients return to us asking to re-do or repair some grievous fault that their “economically-chosen” physician made. Such reconstructive surgeries are often more expensive and results far less perfect than if your first decision had been more generous. Generous to whom? To yourself. It does not pay to save on your health and Beauty…

A fine case in point. There is a modern cheap facelift procedure called “thread-lift.” The thread-lift procedure, which makes use of implanted metal barbed threads, may be less costly than standard facelift procedures, but it has never worked well. According to a team of state researchers and independent assessors in New York in a study published in the current issue of The Archives of Facial Plastic Surgery, a survey of three dozen patients who have had either, the thread-lifts alone, or fat injections, or thread-lift surgery plus non-surgical procedures showed that one month into the survey virtually all of them were satisfied and showed noticeable improvement. However, not a single one was when the researchers came back to examine the patients a second time 12 to 31 months later.

The authors concluded that any improvement in skin tightness in thread-lift patients was caused not by the barbed threads but by plain old swelling. As the swelling decreased, so did the tightness, leaving the patient with a face full of “fishhooks,” a lighter wallet and nothing to show for it. The researchers concluded that, given these findings, as well as the risk of adverse events and patient discomfort, use of this procedure for facial rejuvenation simply could not be justified.

Time and again, such research has shown that only a well performed classic procedure, such as the facelift, tummy-tuck, or liposuction – will have lasting results. Your satisfaction is commensurate to your selection of the surgeon – his background, experience, even personal likeness. There is dime a dozen surgeons out there who have come here from diverse countries in the world whose medical expertise, background, and education cannot be ascertained, and if so, only vaguely. Many of them barely speak English… How can someone from an unknown school from India, Indonesia, or a person educated 40 years ago in a former communist country – compare to a Magna Cum Laude Physician from Columbia and Harvard?!

Fat Fads

Dr.Fisher comments on a few latest fads in and around Hollywood that our patients noted and asked about…

 

SmartLipo

During a Smartlipo Laser Body Sculpting Laserlipolysis procedure, a plastic surgeon inserts a lightweight, flexible wand tool into fatty tissue and “melts” the patient’s fat by using a specific laser wavelength. A separate tube sucks away the fat, as with traditional liposuction. Then, the surgeon uses a different laser wavelength to create heat under the dermis, which causes the skin collagen to contract, which ought to eliminate the problem of loose skin after liposuction. The skin contraction process is said to continue over a period of three to six months.

Dr.Fisher:

“However, contouring of the fat while tightening the skin can be achieved by a skilled plastic surgeon without laser. The proponents of this procedure refer to classic surgery as ‘cumbersome’ with allegedly unnecessary complete anesthesia, which can be avoided in so-called ‘SmartLipo.’ There is some strange myth going around that anesthesia will do you harm. Today, anesthesia is safer than sleeping alone at home, in your own bed. Moreover, what is even more precarious here, is the fact that SmarLipo is one of those trend-name procedures administered by amateurs who are often not even Board Certified surgeons.”

 

Fat Zapping

Ultrasound waves can be used in two different ways; to bounce off tissue and show formations inside the body– such as when a pregnant woman gets a prenatal ultrasound—and also to break things apart, such as when a patient suffering from kidney stones undergoes lithotripsy.

Two of the new technologies, Ultrashape and Liposonix, use ultrasound waves to break apart fat. The ultrasound beam is focused into the fatty layer below the skin: one device then causes the fat to blow up while the other heats it to move it out of the body. However, it’s not yet known which technique is better.

The third technology is called Zeltiq, which is a form of fat removal called cryolipolysis. Cryolipolysis is the freezing of fat tissue. With this device fat is cooled to just above freezing, and this causes crystallization in the fat cells, which causes cell death over time. The process takes about 90 days to occur, and the fat layers actually shrink away as the fat tissue dies off.

 

Dr.Fisher:

“Neither Ultrashape nor Liposonix has been approved by the FDA, and there are no credible tests being run. As we have seen with Zelitq, these methods are alternative ways for people who either are not in need of surgery or their medical condition does not permit it. None of them is capable of what the hand of a skilled Board-certified plastic surgeon can do – alter your self-image overnight, follow your dreams, make you feel and look better…”

 

SmoothShapes Cellulite Technology

SSCT uses a combination of suction and laser energy to break up cellulite and give skin a smooth, toned appearance and texture. This treatment bears the FDA approval stamp. However, it is not a typical body contouring procedure. Rather, it is focused on the dermis, the skin itself.

 

Dr.Fisher:

“The treatment depends on the area, 20 min for a thigh, for instance, and ca. 48-hour recovery. The treatment feels like a deep tissue massage, and has to be repeated virtually on a monthly basis. However, for women with lax skin and typical cellulite problem areas, it is a viable solution. I would add that it is a boon where the patient has undergone a classic liposuction in the area, and is still in need of some cosmetic changes.”

Clearly, classic procedures performed by skilled hands of a real expert, such as Dr.Fisher, are irreplaceable and the results unparalleled.

 

 

 

 

 

 

Brachioplasty

 

Brachioplasty, also known as an arm lift, is a surgical procedure to remove skin and fat from the upper arm, reducing skin redundancy, be it from fatty tissue, skin, losing weight or muscle.

Aging, fluctuations in weight, simple forces of gravity… all contribute to the loss of skin elasticity and tone.

Before

Brachioplasty, arm lift or arm tuck, can, and often is, coupled with liposuction. When the excess skin is detached, the remaining skin is stretched and stitched back into place. The surgery often lasts for 2-3 hours, and the patients can be sent home on the same day.

After

Our patients have the advantage of a special arrangement we have with Sheraton Hotel, so even if Dr.Fisher has some prior surgery and the patient is taken into the OR in the afternoon, they can rest comfortably, accompanied by our staff, and transition into a wholesome uninterrupted sleep. Healing time after the surgery will vary between individuals. Dr.Fisher will ask you to avoid engaging in strenuous activities such as lifting heavy objects.

Who are ideal candidates for brachioplasty? Those who have lost weight after a massive surgery (e.g. bariatric surgery or “stomach stapling”), who exceeded their tanning, or even people who find that aging process inflicted unwanted and undesirable effects on their bodies. If a patient has predominantly excess of fatty tissue (all over the body) then liposuction must be performed first (or alongside with brachioplasty). Naturally, people who have some counterindication, such as multiple infections of the sweat glands (Hidradenitis Suppurativa) must be treated appropriately first. In cases of radical mastectomy (extensive breast cancer surgery) swelling of the arms is normal and an added aesthetic procedure may neither achieve the desired effects and/or cause unnecessary complications.

Before deciding on getting an arm lift, one must reflect on the scars that will be permanently found on the side of his or her arms. Depending on the length of the incision, the scar could extend from just within the armpit area or down to the elbow.  Although Dr.Fisher has already hidden these scars at the inner side of the arm, its appearance varies from one patient to the other and you should consult with Dr.Fisher on the issue in detail. What matters here is the extent of the procedure. Minimal skin excess may be treated with an incision in the armpit alone. Moderate laxity is treated with an incision from the armpit to the elbow. Most patients fall into this category. More severe cases are rare and may require extension of the incision past the elbow onto the forearm. Dr.Fisher performed dozens of incisions of all three types and has unparalleled experience in the area.

Finally, if you are planning or anticipate a significant loss of weight in the future, it is probably best to postpone your arm lift until after this has occurred to optimize your results.

Following arm lift surgery, many patients experience an immediate improvement in their self-esteem and discover a greater self-confidence. In addition, many also find greater access to different clothing styles and fashions and are less self-conscious at the gym, around the pool, or at the beach.

More on Microdermabrasion

There are two kinds of microdermabrasion treatments. One approach involves a hand-held device that streams tiny crystals across your skin. An attached vacuum simultaneously suctions those exfoliating crystals back into the machine, along with the dead or loosened skin.

The latest approach uses a diamond-tip wand that is gently moved across your skin to exfoliate. Each treatment will last about a half hour. You may feel a mild scratching as the procedure removes the superficial skin cells. Additionally, you will notice a vibrating sensation akin to a massage. There is also a suction mechanism to lift off the dead skin. Dr.Fisher invariably recommends a special moisturizer or facial product to enhance and prolong your result. You need to consult with Dr.Fisher or our expert nursing staff in person.

Any discomfort experienced as part of microdermabrasion is usually short-lived. This can include redness and swelling, which should subside within a few hours. Later, you can expect the skin to be flaky and dry for several days. Additional rare risks may include bruising, which can occur as a result of the suction, but does not last more than 2-3 days. Post-microdermabrasion, your skin will be more sensitive to sun exposure. Therefore, please use sunscreen, especially immediately following a microdermabrasion session. (viz. Dr.Fisher’s video advice on U-Tube)

Your polished new look should be long-lasting, depending on the severity of your skin damage and the number of treatments that you receive. Many people have two microdermabrasion treatments per month at first and then one per month as part of a maintenance plan. Finally, facial microdermabrasion is sometimes performed with no medical oversight, often in conjunction with facial spa treatments. However, the only way to prevent unwanted, unwarranted complications is to consult with a specialized expert. Dr.Fisher’s focus encompasses all facial and dermal problems, and he is indubitably the authority you need to consult if you have any questions, doubts or worries.

Chemexfoliation and Microdermabrasion

Here, in California, sun exposure is inevitable, and often leaves our skin dry, of uneven, wrinkled tone, perhaps even spotted or scarred. The exposure to UV rays accelerates aging, which many of us, sadly, realize only when it is too late.

If you want your skin to look smoother and younger, consider a chemical peel, which uses a chemical solution to smooth the texture of your skin by removing the damaged outer layers.

A chemical peel, also called chemexfoliation or derma peeling, is one of the least invasive ways to improve the appearance of your skin. Although chemical peels are used mostly on the face, they can also be used to improve the skin on your neck and hands: age and liver spots can be significantly eradicated, acne and acne scars can be smoothened and virtually erased, freckles and irregular skin pigmentation, including rough, scaly patches and scars can be practically removed by repeated chemical peel.

On more sensitive areas of your body, we recommend microdermabrasion, which is a less aggressive approach than dermabrasion, make use of a minimally abrasive instrument to gently sand the skin, removing the thicker, uneven outer layer. This type of skin rejuvenation is used to treat light scarring, discoloration and sun damage and there’s even microdermabrasion for stretch marks.

Microdermabrasion uses microparticles, or a diamond-tipped wand, to slough off the top layer (epidermis) of your skin and stimulate new skin growth. This technique also helps to thicken your collagen, which results in a younger looking complexion.  Collagen is a protein in your skin that’s abundant when you’re a child and makes skin appear taut and smooth. Collagen production declines as we age, resulting in looser, uneven skin.

There is almost no discomfort in microdermabrasion, meaning you won’t need a topical or local anesthetic and there is no recovery or downtime.

More on Microdermabrasion tomorrow…

Minimally Invasive Cosmetic Procedures

 

Several subsequent articles this week will be dedicated to minimally invasive cosmetic procedures, because these non-surgical treatments used to reduce the appearance of facial lines, remove unwanted hair, and even out skin pigmentation, are increasing in popularity every day. Although minimally invasive procedures such as botulinum toxin  injections, microdermabrasion, chemical skin peels, and dermal fillers do not involve surgery, they are not without risk. It is important that you visit the office/hospital and ascertain the conditions, such as the overall demeanor of the personnel, cleanliness and hospitableness of the place. The first impression should be guiding to what comes next. Look around, and do not neglect to notice how modern the equipment is, how embellished and friendly the waiting room and the office itself appears. Usually, this is most telling of the precision and preparation of the surgeon himself.

 

Part I – Botulinum Toxin

 

Adults are living longer than ever before. We feel vital, we’re active and we want our bodies to mirror youthful minds and hearts. Enter botulinum toxin, one of the most important substances to hit the field of facial rejuvenation. Short of a surgical facelift, this substance is the most popular way to reduce facial wrinkles. Botulinum toxin can be used as a wrinkle treatment to smooth:

Frown lines
• Crows feet
Forehead furrows
• Skin bands on the neck

Smiling, frowning, squinting and even chewing – basically any facial movement can eventually lead to one of the most common signs of aging: wrinkles. They can make you appear tired or even angry when you are not. One of the quickest and safest remedies to remove wrinkles is an injection of botulinum toxin.

Botulinum toxin type A and botulinum toxin type B are both purified substances, derived from a bacteria. Injections of this substance blocks muscular nerve signals, which then weakens the muscle so that it can’t contract and diminishes your unwanted facial wrinkles.

Botulinum toxin can be combined with other cosmetic skin procedures such as chemical peels, dermal fillers or microdermabrasion to further improve your results. This combination of therapies can even help to prevent the formation of new lines and wrinkles.

Dr.Fisher’s Surgery and Laser Center of Cerritos Towne Center offers a gamut of modern procedures, and botulinum rejuvenation is one of the most frequently desired non-invasive procedures.

Is Plastic Surgery Covered by Your Insurance?

Derived from the Greek word “plastikos,” meaning to mold or give form, the specialty of plastic surgery encompasses two general categories:

  • Reconstructive surgery, which is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.

  • Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient’s appearance and self-esteem.

Your insurance policy is an agreement (contract) between you and your insurance company, which covers listed procedures. The agreement (contract) for services between you and your plastic surgeon is a different, wholly separate legal arrangement. When you have surgery, you become responsible for payment of the surgeon’s fees. Coverage for services and levels of payment by your insurance company depend on the terms of the contract between you and your insurance company. You are responsible for any amounts not covered by your plan and/or otherwise not included or expressly stated to be covered by you in your contract with your surgeon.

What is interesting is that reconstructive surgery is generally covered by most health insurance policies, although coverage for specific procedures and levels of coverage may vary greatly. Reconstructive, as stated above, means corrective of some unnatural deformity.

Cosmetic surgery, however, is usually not covered by health insurance because it is elective. Cosmetic surgery is your choice and not considered a medical necessity.

There are a number of “gray areas” in coverage for plastic surgery that sometimes require special consideration by an insurance carrier. These areas usually involve surgical operations which may be reconstructive or cosmetic, depending on each patient’s situation. For example, eyelid surgery (blepharoplasty) – a procedure normally performed to achieve cosmetic improvement – may be covered if the eyelids are drooping severely and obscuring a patient’s vision. Or, nose surgery (rhinoplasty and/or septoplasty) may be covered if it will correct a defect that causes breathing difficulties.

In assessing whether the procedure will be covered by the patient’s insurance contract, the carrier looks at the primary reason the procedure is being performed: is it for relief of symptoms or for cosmetic improvement? If a procedure is within these “gray areas,” insurance companies often require prior authorization or approval before the surgery is performed and/or extra documentation after surgery to determine how much of the cost of your care they will cover.

It’s important to understand what’s included in your policy before you advance too far in planning surgery. Some policies provide coverage for many plastic surgery procedures while others are more limited in coverage. Read your policy and benefits manual carefully and discuss any questions you may have with your insurance plan manager.

There are three typical cost sharing options:

  • A deductible, is the total amount of covered medical expenses that must be paid by the patient before the insurance company begins paying benefits. Examples of standard deductibles are $100, $250, or $500. After this requirement is reached, the insurer will begin paying according to terms of the contract-often 75%-85% – of covered medical costs. The patient is responsible for any remaining balance.

  • A flat-rate copayment, reflects a defined share of covered medical costs that the patient pays, with the insurance carrier paying an amount based on the patient’s policy. For example, when the patient pays $15 of any office visit charge or $3 for any prescription, the insurance carrier is responsible for the balance.

  • A percentage-based copayment, reflects a percentage share of covered medical costs that the patient pays, with the insurance company paying an amount based on the patient’s policy. Examples are: 20% of the office visit charge – $10 of a $50 charge, $12 of a $60 charge, etc. Typically, this copayment arrangement includes a deductible and may have other variations.

 

Example One

A woman is planning to undergo hand surgery, the surgical fee will be $2,000. Her plan has a $250 annual deductible, and will cover 80% of her covered medical costs. Because she has paid only $70 so far this year in covered medical expenses, she must pay the first $180 of the covered costs of the hand surgery to satisfy her plan’s $250 deductible. If her plan cost’s share is a percentage-based copayment of 80%-20%, the carrier will pay 80% of the covered costs of the procedure. Once that is settled, she must pay for 20% of the covered costs, plus any costs for which the insurance plan denies coverage.

If the patient’s insurance plan covered the full surgical fee, the cost sharing would look like this:

 

Reconstructive Hand Surgery: $2,000

Balance of deductible: $180 ($250 – $70) = $1,820

Insurance coverage: $1,820 x 80% = $1,456

Patient payment: $2,000 – $1,456 = $544

The $544 is the patient’s responsibility under the percentage-based copayment arrangement.

 

Example Two

A different scenario occurs if the patient has met the deductible and the plan covers the full surgical fee, e.g.:

 

Reconstructive Hand Surgery: $2,000

Percentage-based agreement: $1,600 (80%)

Patient payment: $400

The patient’s responsibility is, in this example, $400.

 

Example Three

If the patient’s insurance has a flat-rate copayment plan for covered medical services with no other limiting conditions and the copayment rate is $15, then the surgical cost might be paid as follows:

 

Reconstructive Hand Surgery: $2,000

Contracted patient copayment: $15

Balance paid by insurance: $1,985

 

Example Four

With a coordination of benefits or dual coverage, the hand surgery patient is also covered under her spouse’s insurance, and the benefits of both plans may be coordinated to cover more of the cost of the surgery. With dual coverage, the patient’s carrier is considered the primary insurer. Coverage under a percentage-based copayment is 80% of the cost of surgery. The secondary insurer, her spouse’s plan, may cover the remaining 20% depending on the specific terms of the spouse’s policy.

After the primary insurer has paid its share, it will send the patient an “explanation of benefits” statement, including the date of service, the doctor’s charges and/or hospital covered charges, the amounts and payment dispersal dates. If the patient is covered under only one plan, she must pay the unpaid balance. With dual coverage, the secondary insurer may pay some or all of the remaining balance. Usually, the secondary insurer will not pay for any portion of the remaining balance until a copy of the primary insurer’s benefits statement is received.

The above illustrate examples of coverage. The amount billed to your insurance by your physician may not be the actual amount on which reimbursement is calculated; your insurance plan may assign a lesser fee for the procedure. Where a physician has agreed to be a contracted provider, these illustrations will not necessarily apply.

Your particular situation will:

  • Reflect the coverage and cost-sharing agreement of your insurance plan;

  • The deductible and any amount of the deductible that you have already met;

  • And any dual coverage available if you are also carried on your spouse’s or another secondary plan.

Understanding your policy and your responsibility for payment is essential. Securing approval of medical services and fees by your insurance carrier prior to surgery will prevent any misunderstanding of coverage and responsibility for payment after your care is complete.

If you have any genetic deficiencies, which require reconstructive surgery, or have suffered some grave accident, Dr.Fisher is here to help you. Dr.Gregory Fisher of Cerritos Surgery and Laser Center is an expert in reconstructive surgery and has great experience in the field. Please carry your insurance card and find out all about your insurance policy before you visit us.

 

What a Waste in the Waist!

On Monday, Archives of Internal Medicine reported, that both men and women with bigger waists ”carry a greater risk of death” even though their weight may be “normal” as measured by the body mass index, or BMI, a standard measure based on weight and height (see the BMI article on this blog). Eric Jacobs, strategic director of pharmacoepidemiology at the American Cancer Society, which funded the study, stated that regardless of weight, if your waistline is larger than it should be,  the risk of death from causes including respiratory illnesses, heart disease and cancer is greatly increased. Other studies linked waist size to dementia, heart disease, asthma and breast cancer.

Current estimates show that over 50% of men and more than 70% of women over 50 have waistlines that are larger than would be healthy for their size and age. Average waistlines have expanded by about one inch per decade since the 1960s. The report concludes that men should not exceed 40 inches, and  women 35 inches in circumference.

The study also found that BMI was misleading, because irrelevant to symptoms associated with overweight. The study used more than 100,000 subjects, in the period lasting from 1997 to 2006. About 15,000 of them died during this decade. All the measurements summed up, four extra inches around the waist increase the risk of dying from between 15% to 25%. The latter, 25%, was in women with normal BMI. Stop worrying about your BMI, and take a measuring tape or mirror instead! Remember, 1 inch extra around your waist can mean 1 or 2 years of life less. Thus, if Dr.Fisher takes 4 pounds of your fatty waste, thus taking 2-4 inches off of your waistline, he most probably extended your life by 4-5 years! That is about $1,200 a year, or, if you will, $3.28 a day. Now, can you go to the supermarket and purchase one day of your life for that price?

 What a waste in the waist!

Bigger is Better?

 

Although many women generally agree with this proposition, the heading above had better have a bigger question mark after it. On the one hand, women who opt for implants that are too small, even though they are advised otherwise, end up regretting their choice, wishing they had “gone bigger.”  – on the other, there are those who like the glitz-and-glitter of a new image. The latter  may disregard their Surgeon’s advice as to optimum results and how to achieve them entirely, and may end up with back pain, premature descent and possibly skin damage.

Around the country, the largest breast implants are currently being given in Miami and in Hollywood. Reportedly, the motto is: “Go big or go home.”

An experienced surgeon, such as Dr.Fisher, who performed several thousand of breast implant surgeries, will tell you that there are several decisive points to consider:

First, the base width of the patient’s breasts and the distance between them.

Second, the amount of tissue needed to accommodate the implants.

Third, balance between desires and expectations of the patient and what is physically possible and still safe.

Fourth, skin laxity, relevant to age and bodytype.

Bottom line for Dr.Fisher? “Happy patients – both immediately and in the years to come,” he says.

Is Beauty Science or Art? Beauty is as Beauty does...

Vascular Health

There can be a real difference between how old you are and how old your blood vessels are.  For instance, the vascular age of a 30-year-old woman who is a smoker, overeats (thus has higher blood pressure and cholesterol level) could be as high as 55 years old. Some studies show that the comparison is not misleading to a healthy 80-year-old woman! – this, according to Donald Lloyd-Jones, a preventive cardiologist at Northwestern University, Chicago, who co-authored the recent study, which appeared in the journal Circulation last August.

The first step is to stop smoking (if you do) and adjust your lifestyle. Pursuant to the Northwestern University study, a 42-year-old man who smokes and has total cholesterol of 180, good cholesterol (HDL) of 45 and systolic blood pressure of 125, has a vascular age of a 54-year-old. If he quits smoking, his vascular age could drop to 42, the same as his chronological age.

A 52-year-old nonsmoking woman, who has total cholesterol of 220, HDL of 44 and systolic blood pressure of 135, has a vascular age of a 68-year-old. If the woman reduces her cholesterol below 200, her vascular age could drop to 59 years old.

With optimal cholesterol and blood pressure and no diabetes, the vascular age of a 74-year-old non-smoking man could be as low as 60, according to the report by Dr. Lloyd-Jones. A similarly healthy 74-year-old woman could have arteries as young as 53, or 21 years less than her chronological age.

While the main problem behind this finding is clearly lifestyle and exercise, cosmetic surgery can set you on the right track. We invariably recommend that our patients change their lifestyle after liposuction, at least in part, so that the immediately apparent visual effect is reinforced by the positive mental attitude and internal changes. In fact, although not all our patients immediately sign up for a major surgical procedure, all come to us for Dr. Fisher’s advice and consultation on how to improve their body image.

BMI

 

By now, everyone following our blog knows  that the BMI is a grossly inaccurate, simplistic way to tell you that you are obese. Your mirror is a better coach in this respect. Diverse impact journal studies of association between obesity and mortality were inconclusive whenever based on the BMI, precisely because of the BMI measurements. There is a slight relevance to your cardiovascular health, but even that is, to a much larger degree, the result of your genetic predispositions.

Second, BMI attempts to account not only for you subcutaneous fat cells but also for the visceral, or inter-organ fat. Most of your body is water and not fat. Inner fat is difficult to measure, but some techniques are more successful than others. The most accurate is probably Dual Energy X-ray Absorptiometry (DEXA) which is a similar device to the airport body-scan – painless, and precise. Many of you have probably purchased BI scales, which work on “Bioelectric Impedance,” wherein your body functions as a conductor-resistor. These are not terribly accurate, unless you preserve the same conditions every time: the same body temperature, empty stomach, i.e. no drink or meal several hours prior to the measurement. The oldest, most accessible and accurate is the measurement via the skinfold calipers.

The areas for measurement by calipers are the same you have to look at when considering your bodyfat in the mirror: the abdomen (around the navel), the upper arm (triceps area), the inner thigh (pelvic area), the lower back, and the top of the kneecap. You can always conduct a little “caliper test” with your thumb and index finger. If you cannot, you probably need to see me. (please consult my article on liposuction in the SCIENCE section of this BLOG)

What surprised me today was how many of the famous Hollywood stars are on a permanent road to starvation. Starvation is the road to destruction. Many so-called “diets” walk around the news and food journals, fluffing their skinny feathers. You should know that once you reach the point of no return, when your caliper just will not do, liposuction is the only alternative to a strenuous training routine combined with a scientific diet (not starvation!). Why? Liposuction actually takes away the fat cells out of your body. No diet will do that. You have a certain number of fat cells. They may shrink as a result of your diet, but they will be there, and when your diet days are over, your hungry fat cells will want their share back…

That is not to say that healthy eating and moderate exercise are not helpful. Even if you decide not to have liposuction, you can significantly improve your cardiovascular health, gain some muscle and lose some fat, you have time and determination, and are willing to put in the effort and expense requisite for such adventure. However, they will be much more helpful after you have had the liposuction from the most problematic areas: your heart will not be stressed, your body will adjust faster, you will not regain fat in the area, and, most importantly, the most problematic of these problematic areas are usually the places where you started to put on fat first. By a quirk of nature, these are precisely the places where you are going to lose it last – without liposuction. Why? Your body-type and structure, which boils down to your genes, has it so. Some of us put more fat on their buttocks, some on their thighs, some on their abdomen. Fat is very important as a storage of energy and insulation (more on this topic later) and depending on where the ancestors of our ancestors lived (i.e Sweden v. Italy; India v. Korea; Canada v. Mexico) our bodies needed to preserve either fat for energy or fat for insulation or both…

 Today, when you embark on an exercise program, you will not lose fat “topically.” You can swathe your body around your arms, put rubber and plastic bands around your torso – this will not make you lose fat topically. If it seems so, such a loss is visually apparent because of the loss of water in the area. Fat will be re-distributed proportionately, and in concurrence with your genetic information. The only way to fight your genes is to have liposuction.

…from Cyrano to Star Trek…

 

Cyrano the Man

The latest video series produced by Dr.Fisher points at and emphasizes our preoccupation with our Self-Image, our plight to achieve Perfection, and, to some degree, equalize the differences that we sometimes tend to see as insurmountable obstacles to our Success in the modern world. Not by coincidence did Dr.Fisher discuss one of his favorite plays, Cyrano de Bergerac. There, the topic is clear – Cyrano is the epitome of malformation, his nose is an obvious obstacle to his very survival. True, he attempts to bring it to his advantage. He is a strong knight, a magnificent figure… Yet, in real life, he was hardly so.

The real Cyrano died at the age of 36 of unspecified causes. He was noble, he was strong, but not strong enough to overcome his deformities… which eventually befell him in his personal life, and his career. That is the real story.

The extent to which this story concerns us all is apparent from the dozens of screen adaptations, T.V., stage, radio even… all focused on one fateful feature or other, not necessarily represented by the nose. The entire series of Star Trek: The Next Generation, and several chapters of this script in particular, were inspired by Edmond Rostand’s play. In Star Trek, we meet different civilizations, their representatives, who are variously distorted, as we all know. The primary purpose is to show them as different, somehow non-human.

When you get up in the morning and look in the mirror, your main features are the same as those of all other human beings. The particularities distinguish us. However, distinguish too much, and you are ostracized. That is what we all fear.

The beauty of the art of plastic surgery is not in that modern science can make you look better, more amiable, in certain ways more “human” but, above all, in that it adjusts your self-image and aspirations to your internal needs. Needs, not desires. We need certain part of ourselves to conform, a certain other part to stand out. Why? In order to move ahead in life, to succeed, to overcome, to conquer – just like the Cyrano of the olden days.

Body image is our innermost sensation. Yet, it becomes public by our everyday contact with other human beings. There are two sides to the story, somewhat like Dr.Jeckyll and Mr.Hyde; yet – it is one story. We cannot live with the black veil upon the feature we do not like, be it on our face or our soul, as the proverbial Minister in the famous story by Nathaniel Hawthorne… Whom would we be veiling ourselves from? Ourselves. Do we really want to do that? –

We live in the world where we can visit a plastic surgeon – artist of the sculpting of Human Self par excellence – and be happy forever after…

As Indiana Jones would say, some of us choose wisely, some poorly – but: choose, we all have to.

Nipple Inversion

 

Before

In most women, nipples stand out from 0.2-0.4 inches from the lobe. Their size alters with sexual arousal to a different extent and, as many women know, also with cold or heat. However, the (colloquially) so-called inverted nipples, i.e. nipples that are turned inward, become erect in another way during sexual arousal. Paradoxically, the nipple does not become erect on the outside, but even more on the inside. Inverted nipples may thus look even more like a dimple than normally.

Both men and women have inverted nipples. They are more often found in overweight people, although it is not a rule of thumb. If you think that the phenomenon of nipple inversion is very rare, you are mistaken. 10 per cent of all women have this deformation. It can also occur only one nipple. Since the cause underlying this phenomenon lies in overly short and rather tight connective tissue in the region of the lobe, it can be permanently operatively altered.

After

Many women notice inverted nipples in puberty when their bodies start developing into adult bodies. This often detracts from their self-confidence and self-image. However, no consternation is necessary, because, as Dr.Fisher says, “There is no place on the surface of the human body, which, once neglected by Mother Nature, could not be revived, reinstated, embellished or perfected by a skilled plastic surgeon.”

Further, nipple inversion is a natural phenomenon and the natural state of your breasts, which is not immediately dangerous, does not cause you to be more prone to cancer, and does not cause problems during lactation. If your nipples become erect outward despite being generally inverted, breastfeeding is not a problem. Even if your nipples do not become erect at all, it is only slightly harder for the baby to take the nipple into the mouth. “Patience and love cures every imperfection,” as Dr.Fisher stated during our interview. However, if you are not willing to wait or have more audacious intentions in mind – after or before pregnancy – come to us for a free consultation.

This entry was posted on October 7, 2010. 2 Comments

Facts about Breasts

 

The skin surrounding the breasts is thin and sensitive.  Female breasts consist of fat, milk glands and collagen. Milk glands and collagen are replaced by the fat as part of the aging process. That doesn’t mean, however, that breasts necessarily become bigger  (although sometimes they do) and inevitably start  to sag/droop.

 Women also have “hairy” breasts. There’s around 15 long and straight pieces of hair, which can also be quite dark, growing around the nipples of every woman. The hair is not hard to control, either with  depilation, which must be repeated, or laser, which lasts permanently after two or three treatments.

The skin surrounding the breasts is thin and sensitive and you have to use a quality moisturizing cream which makes the skin more firm. The skin around the nipples can become dry really quickly so you have to use a special moisturizing cream or olive oil, which has been used since ancient times to provide lubrication and protection to the skin of the breast. 

Every woman’s nipples are of different shape and size. They can also be inverted on the inside or in different directions (we will have an article on this phenomenon tomorrow).

Hormonal changes in the body have a great influence on breasts. After the period breasts are more smooth and therefore this is the most appropriate time for self-examination. In the middle of the cycle the nipples are very sensitive to touch, which is the consequence of a high level of estrogen in the body. During the period breasts can be swollen and painful because of a high level of progesterone.

The breast surgeons in the United States have performed 8,5 million cosmetic surgeries in 2010 and 17 percent of them were surgeries where breast implants were inserted.

A sensitive skin on the breasts can be sunburned even if you wear a bra or swimming suit in one piece. That’s why it is always advisable to protect your breasts with a sun lotion. Further, during physical activity, e.g. aerobics or running, your breasts will jump up and down, which can be unpleasant or even painful. It is advisable to wear a sports bra that offers enough of support. Also make sure you wash the bra regularly, otherwise an inflammation of the nipples could occur because of perspiration.

The area under the breasts, especially if they are large and the skin under them is wrinkled, is very sensitive to various infections. It is advisable to protect the area with baby powder which prevents and absorbs the extra moisture caused by perspiration.

 If you have breast implants, there’s nothing to worry about: they will not “burst” if you sleep on the belly.  However your post-op treatment of yourself and your attitude to your new assets can significantly support, or undermine – as the case may be, Dr.Fisher’s work. Please, if you are uncertain about something, do not hesitate to always ask.

 During physical activity, e.g. aerobics or running, your breasts will jump up and down, which can be unpleasant or even painful. It is advisable to wear a sports bra that offers enough of support. Make sure you wash the bra regularly, otherwise an inflammation of the nipples could occur because of perspiration.

This entry was posted on October 4, 2010. 1 Comment

Ab Etching

 

In Los Angeles, we have summer virtually all year round and many bikini-loving beachcombers love to reveal their physical assets. Weight loss and toning is not all diet and exercise. From the breasts and buttocks to the waist and arms… your whole body is “suctionable,” as Dr.Fisher says. “What an ugly word,” he adds. “It is one of those flash-in-the-pan expressions I commented on in my last interview for Facebook and U-Tube.  One should not be susceptible to new-fangled terms in science or art, terms that drive the banner of some lowest common denominator – spaghetti universe, Twiggi body… and such. ‘Suctionable’ seems to be one such term. It is, though, very descriptive. It says what we do in helping people feel better about themselves: we separate the chaff from the grain, so to speak. You see, it does not have to be on the beach – it can be in the privacy of your own home, while you are stepping out of the shower looking at yourself in your bathroom mirror. No-one can see you then – only you. However, how you look is how you feel, and that reflects and bears on your self-esteem when you are fully clothed among other people.”

Dr.Fisher wrote a whole book on the subject, aptly titled “Body Image.” He is currently preparing a second edition. He would welcome any reflections on liposuction that his former patients may have.

For those who have not yet had any cosmetic surgery done and are contemplating getting rid of love handles, hip rolls, muffin tops or whatever other part of your body, which you do not like, “suctionable,” albeit ugly-sounding, is a very descriptive term: we can simply “suck it off.” For example, “abdominal etching” involves the removal of excess fat in between the abdominal muscles, and in doing so creates indentations that give the appearance of a defined stomach. You may have seen this on some of our models on Facebook (all product of Dr. Gregory Fisher’s work). Think six-pack abs? Why not?

 

 

 

Now, as you are, touch yourself on the abdomen. You are sitting? Stand up, lean backward. Now, touch yourself on the abdomen. Can you feel the “sixpack” hiding below? A good surgeon-sculptor, such as Dr.Fisher, can touch you exactly the same way in the operating room, while you are under anaesthesia. He can follow your muscles, and feel where the indentations are. Then, he can suction off the exact amount of fat needed for your muscles to stand out. Of course, you do have to exercise a little and not be a total couch potato. “Abdominal etching” is an option only for individuals in whom total body fat is less than 18 percent. However, it is just as successful, if not more, as a stringent diet and hard exercise, much harder than you would have to exert without ab etching.

Bring Us Your Wedding Dress – We Will Make It Fit!

 

Of course, you want to look the best in your family heirloom scrapbook… No, this is not about winning your beloved’s heart – but about preserving the Beauty you have now!

Many brides and grooms visit our office, in plain attire, quite blaze, asking what we could do for them. First of all, surgery is not always the best option. Perhaps, you do not have enough time or are, as is generally the case, under stress from all the arrangements and expectations. Simple Botox uplift to your face may be the thing to go for. Two weeks before the D-day you may realize that a little touch-up would add to your lasting beauty. This may not even be a noticeable change at first sight – but, to be sure, you will be noticed. Those pictures will look just a little better. That is what we do, make things better for you: a couple of Botox injections, no swelling, no bruising…

Perhaps, you also did not know that Botox is approved for severe underarm sweating. Many a nervous bride and groom will experience that uncanny rivulet of perspiration running down their sides, gluing their silk underwear to the skin or soaking up into a brand new shirt. Did you not want to pass down that wedding dress to your daughter? Why! With us, you can!

If you are older, you may opt for a full facelift or eyelid surgery (blepharoplasty), which will tighten your skin, remove excess fat from the upper and lower eyelids, improve any “baggy” skin under the eyes or sinking upper eyelids. These are among the so-called “invasive” procedures, and so you should contemplate these several months before the wedding.

Liposuction will do away with those pockets of excess fat, which can be visible in your dress, no matter what you do. Progressively, with age, these pockets are larger, as we all know, and you may have tried low-carb, no-carb, liquid diets, pills, “pre-wedding specials” (diets)… Oh, do not despair! We have a cure! Come to us 9 months before your wedding, bring your dress – and see what happens. We will make your body fit your dress!

Remember, liposuction can be done on any area: abdomen, hips, buttocks, back, thighs, knees, calves, ankles, upper arms, jowls, cheeks and neck… Its wonder is that it lasts and is immediate – local! No diet can do that for you!

Several months ago, we had a case when a desperate lady, 29, came in: “Dr.Fisher, my bridegroom asked me if we could take our wedding pictures on the  shore, me wearing just bikini and him with the surfing board and all…” Well, after Dr.Fisher took care of her hips, calves and breasts – we heard no more of this person… – until last week when her wedding pictures came in with a Great Thank You to Dr.Fisher and his staff!

So, do not despair, take Heart, muster the courage, and come to us – bring that sleeveless wedding dress along, and we will make it fit!

Natural or Supernatural? – Breast Augmentation by Dr.Gregory Fisher

 

Many people are adverse to cosmetic surgery, because they do not believe in what they call “artificial” breasts.

They want a woman to look natural.

Or – is it supernatural?

Let us see.

This is an internationally known figure model with natural breasts:

 

And this is one of Dr.Fisher’s results:

What was the original natural pre-operative condition of this patient?

Brazilian Buttocks?

There are many new “trends” in plastic surgery, which may be viewed favorably by a non-expert, or even a surgeon who does not find sufficient acumen and capacity to perform what we consider “classic” surgery. Let us preface that a buttocks lift operation is performed in our hospital with marvellous results, but we strenuously avoid any suspect procedures, which involve high risk of infection, hundreds of injections, and pain.

Over the last few years the buttocks and abdomen have received more press coverage than ever before. The “Brazilian butt lift” is slowly becoming just as popular (if not more) in Mexico as other types of plastic surgery. We must not forget that the tolerance for malpractice in Latin American countries is much less than in the United States, and patients do not have the same legal recourse against doctor-charlatans.

The “Brazilian butt lift” is a type of augmentation procedure which results in more prominent buttocks and, possibly, a more sensual body profile.  The procedure itself, however, is not that simple. Fat is removed fat from selected areas of your body, purified, and then re-injected into the desired area. The process of fat reinjection may involve hundreds of injections. The procedure is designed to fill the upper quadrant of your buttocks so that the overall impression is that of a more lifted and “perky” behind. 

Apart from the “Brazilian butt lift” (fat injections or fat transfer to the buttocks), there is a classic implant option, i.e. the insertion of silicone implants. Naturally, if you are petite and store fat mostly in the abdominal area, this latter procedure is preferable. Brazilian butt lift became so popular precisely because it can be “tailor-made” by many injections to suit precisely the requirements of the patient. It is also more demanding on the surgeon’s ability and artistic acumen.  We must emphasize, however, that the same, if not better – and more lasting! – results can be achieved by the classic liposuction utilized by Dr.Fisher.

Even in the so-called “Brazilian butt lift” the surgeon must always start with liposuction and contouring. However,  in order to obtain sufficient amount of fat for processing, the liposuctioned areas include the lower back directly above the buttocks, the stomach, and the thighs. Often, this procedure in itself gives the patient a more attractive appearance. Since there is not enough source of “raw” fat from any single area, at least three areas are usually used as a source for the fat  to be purified and re-injected. Once purified, special cannulas are used to inject the fat in small amounts in different areas and at different depth. The procedure usually involves hundreds of such fat injections.

This procedure is performed mostly outside the United States, where the tolerance for malpractice and poor results is much higher. There is a risk of possible contamination if the personnel and the physician do not keep up standard medical procedures. The fat melts away in time, because the body naturally tends to keep its own fat distribution. Further, due to infection, the pressure of sitting, and other factors, extrusions are very frequent and problematic to resolve. Therefore, we do not perform this type of surgery in our Cosmetic Surgery and Laser Center.  However, Dr.Fisher can body-sculpt your buttocks to perfection, lift and elevate your self-image and self-esteem via liposuction and buttock-scupting without virtually any pain – and with results that will last!

Liposuction Boosts Body Immunity

In the late 1970s, I started  research on the impact of genetic transcription of adenovirus 36 on the development of fat cells in the human body. Obesity rates among children and adults have skyrocketed lately, and virus research appears to be one avenue that research into the environmental impact on obesity could take.

There are more than 50 types of adenovirus, which cause respiratory infections or gastrointestinal tract infections. Research confirmed that AD-36 is the most likely to infect fat cells. Consequently, fat cells grow and multiply. A strange vicious circle is thus triggered because the body immunity decreases in proportion to this multiplication. This decrease is inversely proportionate to the multiplication of AD-36 and thus directly geometrically proportionate to obesity. The latest study of adenovirus 36 was conducted on 300 U.S. military personnel. It was released recently and confirms what my study at St.Luke’s hospital had predicted years ago (and many studies confirmed since): there is a direct link between your genetic information and your BMI.

A similar study was conducted recently by our colleague, Dr.Jeffrey Schwimmer, a pediatric gastroenterologist at Rady Children’s Hospital and the University of California. This study involved 124 children aged 8-18. Their BIM index was taken and children divided into obese and non-obese groups. Their blood was tested to the presence of antibodies to AD-36. These antibodies were found in 19 children, 15 of which were in the obese group. This means that 24% of all subjects were found with AD-36 present in their system, while 19% out of these 24% were obese, which means ca.76% of those affected were obese. Obese children who tested positive weighed about 36 pounds more than obese children who tested negative.

Considering that obesity is the impacting factor as well as causal factor here, it is safe to conclude that tummy tuck or liposuction can not only extend your life, but help prevent many diseases.

Pre-Mummy Tummy Makeover?

Are you overweight? Considering pregnancy? While we do not recommend liposuction or tummy tuck during pregnancy, we certainly do recommend it before you decide to become pregnant. The popular philosophy of “mummy makeover” should be altered to “pre-mummy tummy makeover” – altered now! – altered forever!

Pursuant to the latest results reported the American Journal of Epidemiology, women who do not limit their weight gain during pregnancy are indirectly exposing their children to higher risks of obesity, diabetes and high blood pressure. Women who gain more than 52 pounds are 2.3 times as likely to have a high-birth-weight baby as women who gained 18 to 22 pounds.

The study examined the birth records of more than one million full-term births over a 15-year period ended in 2003 in two states, Michigan and New Jersey. Researchers focused on women who had more than one child to separate out the effects of genetics.

They found that if the same woman gained roughly double the weight during one pregnancy compared with another, her baby was on average half a pound, or 200 grams, heavier than its sibling, a large difference for newborns.

The more weight the women gained, the higher the risk of having a high-birth-weight baby, defined as 8 pounds, 13 ounces. Women who gained more than 52 pounds, for instance, were 2.3 times as likely to have a high-birth-weight baby as women who gained 18 to 22 pounds, within the recommended range of gain for overweight women.

Other evidence suggests less conclusively that high birth weight is also related to increased risk of developing asthma, allergies and cancer.

For women, substantial weight gain raises the chance for gestational diabetes and pre-eclampsia, a dangerous condition involving high blood pressure, as well as the need for Cesarean sections.

Although not all, many of these problems can be substantially, if not completely, prevented by a timely liposuction, which will rid you of those “problem fat cells” forrever!

Most Popular Non-Surgical Procedures

 

BOTOX ® consists of botulinum toxin Type A which when injected into muscles can temporarily paralyze them for 3-6 months. BOTOX® can target the muscles that create wrinkles on your forehead, around the corner of your eyes, and between your eyebrows. In addition, with the proper injection of BOTOX®, a brow lift can also be achieved.

BOTOX® is also used for the bands along your neck as well as for the treatment of migraines. Dr.Fisher’s staff has significant experience with the injection of BOTOX® and will perform the service for you in such a manner as to minimize complications and pain and to ensure you have a result that will last as long as feasibly possible.

Our BOTOX® Patients can return to their normal activities the same day following BOTOX® Injections. Some topical numbing cream is applied prior to injection to ensure your comfort and minimize any pain associated with the injections. Some minor swelling or bruising resolves quickly.

BOTOX® is extremely popular in treatment of the wrinkles on your forehead, around the corners of your eyes, and between your eyebrows.

 

Both Juvederm and Restylane are hyaluronic acid fillers used for non-surgical rejuvenation of the face. These fillers are temporary and are the ideal fillers for patients wanting to soften the folds around your mouth, lines from your upper lip, or wrinkles around your eyes. These fillers generally last between 6 – 9 months. We employ several highly professional certified nurses who can perform the injections of both Restylane and Juvederm for you to minimize complications and pain and to ensure you have a result that will last as long as feasibly possible.

Some topical numbing cream or nerve blocks are performed prior to injection to ensure your comfort and minimize any pain associated with the injections. Patients can return to their normal activities the day following filler injections. Some minor swelling or bruising resolves quickly.

 

Radiesse is smooth calcium hydroxyapatite (CaHA) microspheres that are suspended in a water-based gel that stimulates the body to produce collagen. Radiesse must be injected carefully to prevent clumping or abnormal deposits. The results last for over one year and can be truly dramatic.

In all of the above-mentioned procedures, some topical numbing cream or nerve blocks are performed prior to injection to ensure your comfort and minimize any pain associated with the injections. Patients can return to their normal activities the same day following filler injections. Some minor swelling or bruising resolves quickly.

Cleft Lip and Palate

Not many people know that Dr.Fisher established a foundation for helping children born with lip deformities. Cleft lip (cheiloschisis) and cleft palate (palatoschisis) are among the most common birth defects affecting children in North America. The incomplete formation of the upper lip (cleft lip) or roof of the mouth (cleft palate) can occur individually, or both defects may occur together. The conditions can vary in severity and may involve one or both sides of the face.

A cleft, or separation of the upper lip and/or the roof of the mouth, occurs very early in the development of your unborn child. During fetal development, certain components of the upper lip and roof of the mouth fail to form normally. Cleft lip and cleft palate repair is a type of plastic surgery to correct this abnormal development both to restore function and to restore a more normal appearance.

Many children are grateful to Dr.Fisher for being able to eat, speak, hear and breathe normally today.

 

Surgery to repair a cleft of any kind is a highly individualized procedure that’s intended to not only close the defect, but also to insure your child’s ability to function and grow normally.

Cleft lip repair, also called cheiloplasty, includes reconstruction of a more normal appearance, namely:

  • Closure of the cleft resulting in a scar located in the normal structures of the upper lip
  • Formation of a cupid’s bow (the curve at the center of the upper lip)
  • Considerations for adequate distance between the upper lip and nose

Because the palate creates the floor of the nasal cavity, considerations in repairing a cleft palate include:

  • Allowing for normal growth, function and speech development
  • Relation of the palate to the auditory canal and hearing
  • Development of the teeth and jaw alignment

Where the cleft also affects the shape of the nose, additional procedures may be recommended to:

  • Achieve symmetry between the nostrils
  • Create adequate length of the columella (the tissue that separates the nostrils)
  • Increase the angle of the nasal tip, to avoid a flattened nasal tip or one that pulls downward

 

The timing of the cleft repairs depend on the individual circumstances of your child. Cleft lip repairs are initially performed when a child is at least 10 weeks of age and 10 pounds in weight and has a hemoglobin (or blood count) of at least 10. Cleft palate repairs are generally performed when a child is somewhat older, from 9 to 18 months of age. Cleft repair may be delayed in order to treat other, more life-threatening problems that may be present such as a heart or lung disorder.

If your child suffers from a similar deformity, you may wish to visit Dr.Fisher and discuss with him what options are available for cleft lip and/or cleft palate repair, and what are possible outcomes of surgery and the potential risks and complications associated with the procedure. Dr.Fisher will recommend the most suitable course of treatment for your child.

This entry was posted on September 18, 2010. 1 Comment

World Trends in Plastic Surgery III

In view of what we have stated in our prior two postings, it is no surprise that even patients are more educated and knowledgeable about the procedures, prices, what they want… “When we go to a conference these days,” Dr.Fisher says, “you will find only 1 or 2 booths selling surgical instruments. The rest are selling – advertising, rather – the dream of looking younger and looking better. Unfortunately, it is often misplaced and misstated, because many of these new techniques and procedures stand on very shaky scientific ground, and the doctors who perform them have little or no experience in the world of real cosmetic surgery.”

The fact is that to keep pace, aesthetic surgery groups are building upscale health spas and combining them with their surgical practices. Thus, sole practitioners are increasingly rare. Since surgeons also operate less, as people ask for more non-invasive procedures, they do not have the opportunity to sufficiently perfect their techniques, in particular the new “kids on the block” – surgeons with an i-pod in one pocket, mobile phone in the other, scheduling Botox and laser instead of operating. “When I finished my medical training,” Dr.Fisher stated, “there were no creams [botulinum], or dermal fillers. Back then, we were just surgeons.”

A skilled artist-surgeon might draw a heavy sigh of despondent air here, but breast augmentation and liposuction are still extremely popular in all the countries stated in our previous posting. In fact, around the world. Cosmetic preferences are generally based on a Western standard of beauty, with small modifications to fit the population’s ethnic inclinations. Eyelid alterations and nose implants are performed throughout Asia. Surgical upper lip augmentation is popular in Thailand, and Iran has succumbed to rhinoplasty boom over the past two years.

Overall results (published in our two prior postings) were compiled by Industry Insights, a private research firm in Columbia, Ohio. They are accurate within a range of ±4.24% at the 95% level of confidence. The confidence intervals for individual countries vary.

Surveys were initially sent to 20,000 plastic surgeons in an ISAPS database. National professional societies representing plastic surgeons provided data accounting for 31,000 practicing plastic surgeons around the world. When the total number of plastic surgeons in a given country was not known, an estimate was supplied by an international organization that maintains a list of surgeons by country.

For nonreporting countries, a regression analysis was performed to estimate the number of plastic surgeons and procedures on the basis of population and economic statistics. This method accounted for less than 2.5% of the global totals, according to the ISAPS.

Plastic Surgery Trends – continued

 

You may have read in our previous blog that despite widespread poverty, Brazil has historically been a center for aesthetic augmentation (currently second behind the United States with aver 2.5mil surgeries each year). This is due in part to a strong cultural association between body image and self-esteem. More liposuction is performed in Brazil than in any country in the world, according to the ISAPS survey.

The number of procedures and the number of physicians practicing plastic surgery in a particular country were strongly correlated. The survey identified 30,817 aesthetic plastic surgeries worldwide. Of that total, 5700 physicians worked in the United States. China was second, with 4250 surgeons; Brazil and India followed with 3824 and 2000, respectively.

On a per capita base, cosmetic procedures were most popular in South Korea. According to the survey, 13.5 procedures per 1000 population were performed in that country of 48.8 million.

Although worldwide use is about evenly split between surgical and nonsurgical augmentation, 57% of the procedures performed in the United States are noninvasive. Survey results indicated that more than 498,000 botulinum and nearly 312,000 laser hair removal procedures were performed there last year. Other high-use procedures include hyaluronic acid (a dermal cream), sclerotherapy, and laser vascular treatments.

The ISAPS survey totals for the United States — limited to aesthetic plastic surgeons — are substantially smaller than figures published by the American Society of Plastic Surgeons (ASPS) in June. By including all providers, the ASPS survey uncovered a 1% decline — to 12.5 million procedures. That survey found that minimally invasive procedures accounted for 88% of total volume. They rose just 1% in 2009, but have nearly doubled since 2000.

World-Wide Interest in Cosmetic Surgery

 

The Miss Universe pageant, held on Monday in Las Vegas, has awarded two consecutive titles to contestants from Venezuela, reinforcing the Latin American country’s reputation for beauty pageant winners. In a culture which places a high premium on physical appearance, cosmetic surgery has become commonplace with Venezuelan women at younger ages than ever before.

19-year old Laura, being interviewed after the beauty pageant, admitted she already had two plastic surgeries, and was going for a third one upon her arrival back in Venezuela. “There is a great pressure on young girls to look beautiful, which, however, means also to feel beautiful, because one does not happen without the other,” she stated in a T.V. interview.

Venezuela has become one of the most popular “cosmetic surgery” destinations lately. Average breast augmentation in Venezuela costs $2,500, which is much more than in the United States, in comparison to our average salary. Yet, the interest is growing – and not only there.

Pursuant to the survey was sponsored by the 2000-member International Society of Aesthetic Plastic Surgery (ISAPS) and released to coincide with the ISAPS 20th Biennial Congress in San Francisco this year, nonsurgical procedures, such as botulinum-A (Botox) and laser hair removal, were actually performed more frequently in the United States last year than invasive plastic surgery. The trend is leading aesthetic plastic surgeons in the United States to modify their practices to adjust to shifting demand. 

The survey found that 17.1 million cosmetic plastic surgery procedures were performed worldwide in 2009, and 3 million of those were in the United States. The top-5 countries were:

the United States with 3,031,146 procedures

Brazil with 2,475,237

China with 2,193,945

India with 894,700

Mexico with 835,280.

China and India’s prominence can be explained by rapid economic growth, which necessarily puts pressure on appearance in contesting for higher paid positions. A recent Wall Street Journal report revealed that China’s $4 trillion gross domestic product has surpassed that of Japan…

As there are rapidly growing middle classes in China and India, their disposable incomes are likewise increasing. Plastic surgery is extremely popular in China, about as much as it is in Western Europe and the United States. The media interest, celebrities, even bad publicity adds to the overall popularity of cosmetic-plastic surgery.

(to be continued…)

Congratulations to ZELTIQ!

We have just been informed by our friends at Zeltiq® that their new “coolsculpting” device received the craved-for FDA approval on Sept.8. Congratulations! This indicates not only that there are some credible scientific studies to support the new method of non-invasive liposuction, but also that there is a parallel market, which needs to be satisfied. This should be good news for everyone: the proponents of non-invasive, mild, slow, repeated method of “sculpting,” as well as the surgeons who can offer an alternative treatment at a larger profit margin, and less legal accountability, being shielded under Zeltiq’s strict liability in tort for any potential injury flowing from the treatment.

The approval of Zeltiq by the FDA signals a major step forward for patients seeking a safe, non-surgical fat reduction option. A latest survey of over 1200 potential patients revealed that most consumers are primarily interested in results when considering a body contouring/sculpting (48%), than in cost (21%), safety (11%), and length of recovery (10%).

Since most potential patients are interested predominantly in results, we believe that this device will only improve the ever-growing popularity of plastic-reconstructive surgery. Patients will benefit by using this device not only as a parallel treatment or an alternative to surgery, but as an added boon to the work of an expert cosmetic surgeon; for no machine can substitute the hands of a skilled surgeon, in particular where the case is complicated, reconstructive surgery is needed, or the patient wants to see an immediate effect, such as the loss of several pounds of fat cells over several hours of pleasant anesthesia-induced sleep, while she is being taken care of by professional, considerate, concerned surgical staff. The Art of Surgery will always remain what it is, Art wedded to Science.

Breast Reconstruction

Men

 

Abnormally-enlarged breasts in men, known as Gynecomastia, can usually be corrected through a simple procedure using a specialized form of liposuctioning known as the “ultrasonic method” or “liposelection.” There are many possible reasons for male breast growth, and each patient must discuss his specific needs with Dr.Fisher, who will ask about your medical record, your physical and emotional health, as well as examine your skin quality. A more expert surgical operation may be required if your problem is a result of abuse of performance enhancing drugs. In such cases, gynecomastia usually affects only the area around the nipple. Only an artistically-minded, patient surgeon, such as Dr.Fisher, using a very detailed and precise technique, will accomplish an impeccable result.

Women

 

In our hospital, we also perform breast reconstruction surgeries, which may have been produced by a former unskilled surgical procedure, or resulted from cancer treatment, i.e. mastectomy. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearing to matching a natural breast. Post-mastectomy breast reconstruction is not a simple procedure, but ought to follow – upon successful completion of cancer treatment – your physical and psychological healing. You should not be shy if something so excruciating in your life as mastectomy has occurred. Dr.Fisher has extensive experience in reconstructive surgery and will be able to help you.

Hard Times – Hard Costs – Hard Labor

 

Dr.Fisher with his surgical assistant, anesthetist Sarah Collins, C.R.N.A.

Many surgical centers are closing their doors during these hard times. You may ask why – are the doctors not rich enough? Some are and do operate at a loss, hoping for better times to come. Others, usually smaller and less successful outpatient centers are left with no choice vis-à-vis the dearth of patients – in the world of ever-rising expenses.

Operating room (OR) charges are perhaps the most important singular charge any hospital has to consider. In larger hospitals, it is scheduled into “blocks” to be used by particular surgeons and their teams. Larger hospitals also have so-called “overflow” block time for a surgical group’s cases that cannot be completed in the regular block time allocated to each surgeon in the surgical group. Having such overflow block time increases OR utilization. The optimal way to schedule patients into a surgical group’s overflow block time is unknown. Hospitals constantly strive to maximize the efficiency. Current strategy focuses on: (i) 2 week advance scheduling into any overflow block; (ii) a “first case of the day” start time and priority; (iii) maximum scheduling not exceeding 4 weeks; and (iv) encouraging the surgeons to perform the cases on the earliest possible date(s). This can be difficult because the whole surgical team must be in place on scheduled time.

 In a smaller hospital, such as the Surgery and Laser Center at Center Court Drive, scheduling surgery is very similar. Although we do not perform as many surgeries as larger hospitals, our OR expenses are equal, if not greater, because we provide equal care and conditions, which means not only the necessary scheduling, staffing, pre- and post-operative care, but also the supplies and maintenance, which the patients do not see. These entail not only running costs for anesthesia equipment, vital signs monitors, vaporizers, respiratory aids and ventilators, electrocautery, medical warmers, infusion pumps, surgical lights with special halogen lights etc. but also simple replacement of oxygen tanks, sterilization of instruments, light handles, machines, disposal of medical refuse, as well as cleaning of the room pre- and post-surgery can be extremely costly. Naturally, labor time for highly-skilled and well-trained staff is comparably high. Even the most economical OR cannot be operated at less than $1,500/hour – plus labor time for the surgeon, anesthetist, 1-2 skilled surgical assistants, and a scrub tech…

Thus, it is usually more economical on the part of the patients to opt for several procedures at the same time, such as liposuction and breast augmentation, because this reduces the maintenance costs for the above-stated backup and equipment: where the performance of liposuction on one patient, and breast augmentation on a different patient would require post- and pre-operative maintenance, this gap-time is eliminated if the patient chooses to undergo several procedures.

A Picture Speaks a Thousand Words…

 

So the old saying goes. Therefore, here are a few pictures of “successful” Hollywood breast implants – on unnamed stars we do not want to embarrass:

Here, for comparison, is a sample of Dr.Fisher’s everyday work:

BEFORE:

AFTER:

BEFORE:

AFTER:

The average cost of breast augmentation in Hollywood exceeds $10,000.

The average cost of breast augmentation performed by Dr.Fisher is less than half of the sum above.

We provide complete care with a professional staff both pre and post-surgery – including special lodgings and care in the Sheraton Hotel in the neighboring building.

How much is accommodation in Hollywood? We do not know.

What we do know is that Hollywood will not accommodate your personal needs as we will – on any level, in any respect, at any cost.

Scar Treatment: Laser AND Non-Laser

 

Regardless of the type of scar you have, we understand that scars can have an affect on the clothes you wear or even the way you see yourself. Scars come in all shapes, sizes and colors, but the thing that is consistent is that they can be difficult to treat. There are several scar treatment options, including surgery, laser treatments, and injections. In our Laser and Surgery Center we provide all of these.

Scars can be difficult to treat. If you have used some ointment in the past, it may have been effective in the brief period after you have suffered the injury causing the scar. Such crèmes are based on natural moisturizers and softeners, such as  rosemary, ginseng, nettle, figwort, watercress, sorrel, fumitory, focus, sometimes onion or Allatonin. They are effective in softening the skin and perhaps also supporting the natural recovery process. They do work but they are only collateral aid to more effective procedures such as we perform in our Laser and Surgery Center in Cerritos, which include not only laser treatment but also complete removal of scars. Of course, we do believe in natural healing and healing aids, such as beeswax, cocoa butter, sesame, royal jelly in combination with Octyl palmitate, cyclomethicone, mixed ethylene copolymer, and often also Retinyl Palmitate, which is Vitamin A – probably the most important vitamin for the appearance of the skin. All vitamins are important, in particular A and D. Vitamin A is essential for normal growth, regulation of metabolism , cell structure and healthy skin.  Vitamin E is also one of the most important vitamins needed by the body. It has been shown to supply oxygen to the heart and all other muscles while promoting healthy skin and hair. Further, there is Coenzyme Q-10, which plays a role in the body’s production of adenosine triphosphate, the basic energy component of the cell, thus aiding in cell rejuvenation. Some of the crèmes also contain Pycnogenol, a unique and powerful natural plant extract made from the bark of the European coastal pine, pinus maritama. Pycnogenol possesses antioxidant properties that help protect against free-radicals. It enhances the ability of collagen to repair itself, thereby protecting against age-related and degenerative processes. Pycnogenol also inhibits swelling (edema) and inflammation. Improves skin health by reducing damage, increasing nutrient supply and improving elasticity. Naturally, oral supplements can also help. Many people for instance believe strongly in the use of Glucosamine to help rebuild damaged joints, tendons, cartilage and soft tissue. All of these have been proven effective in practice.

 

None of these, however, has the immediate power of a laser treatment or surgical removal, as the pictures above show. Some scars are more difficult to remove than others, depending on your skin type, body type, and the extent of the scar in width, length, and depth. Not all scars will disappear instantly with one wave of our magic laser wand.  This is because in many cases it is difficult to know exactly how a particular scar will respond to the treatment. However, with all scars, we can revise and improve the texture and color of many different scars, including keloid, surgical and pigmented scars. Depending on the type of mark, scar removal options can be limited because in some cases, removing one scar can create another. It is difficult if not impossible to say whether or not your scar is a good candidate for laser treatments until we see it and understand what you would like to change about it. We have lasers specifically designed to revise the color and texture of scars, and/or possible surgical removal. There is not one treatment, but a whole plethora of different highly effective expert methods of attacking those nasty marks that bother you so much, which you are trying to cover, and which may even be carcinogenic. The answer is not to eliminate laser, or some other treatment, but to combine them, thus multiplying and enforcing their effects under the guidance of our chief surgeon Dr.Fisher and his courteous, professional staff, who perform such procedures on all parts of the human body every day.

This entry was posted on September 9, 2010. 2 Comments

Laser Treatment

We often receive inquiries about our laser. We use several lasers. The most favorite and frequently exploited is perhaps our latest state-of-the-art Candella YAG type laser, which effectively treats all skin types, including tanned skin, offering unmatched treatment capabilities in permanent hair reduction, leg veins, facial veins, wrinkles and skin tightening. This GentleYAG’s 1064 nm wavelength effectively impacts multiple spot sizes using variable pulse durations and Candela’s patented cryogen cooling system (DCD™) for maximum patient comfort and safety. What is more, with unprecedented 18 mm spot size and repetition rates up to 2 Hz, the GentleYAG offers fast treatment with fewer laser pulses.

26,333 watts of peak power and capable of delivering fluences up to 600 J/cm2 for vascular applications, and hair removal energies in pulse durations as short as 3ms for unparalleled treatment efficacies, especially finer hairs.

Non-ablative treatment, including fine lines and wrinkles, and for pseudofolliculitis barbae (PFB), or beard bumps, leg and facial veins, and skin tightening are among the most frequently desired types of treatment. Finally, deep penetration with minimal scattering of laser energy makes the GentleYAG ideal for all skin types.

Using Urine for Your Skin?

 

Last week, you may have come across a cable T.V. program in the Taboo series on urpohagia. Urophagia is beside the point of this article, because such use is outside the scope of any cosmetic considerations. However, you may have noticed that some products do contain urine, or the substances, which urine itself contains. Urine is 95% water. NASA experiments have proven that water can be extracted from urine for drinking. Urine as such can be used to sustain the human functions for a limited period of time, e.g. when buried after an earthquake. It is slightly acidic (PH depends on what you eat/drink, thus a diet high in citrus, vegetables, or dairy can increase urine pH. Some drugs also can increase urine pH, including acetazolamide, potassium citrate, and sodium bicarbonate; while a diet high in meat or cranberries can decrease urine pH, i.e. more acidic. Drugs that can decrease urine pH include ammonium chloride, chlorothiazide diuretics, and methenamine mandelate.) Urine consists of what your body does not need, because it carries waste from the kidneys out of your system. The kidneys contain millions of nephrons which filter toxins, waste, ingested water and mineral salts out of the bloodstream. The kidneys regulate blood acidity by excreting excessive alkaline salts when necessary. The chief constituent of the nitrogenous wastes in urine is urea, a product of protein decomposition. Urea is, among other things, a diuretic.

NASA [CR-1802, D. F. Putnam, July 1971] determined that, apart from water, urine contains, in order of decreasing concentration: urea 9.3 g/l, chloride 1.87 g/l, sodium 1.17 g/l, potassium 0.750 g/l, creatinine 0.670 g/l and other dissolved ions, inorganic and organic compounds. Urine is sterile until it reaches the urethra where the epithelial cells lining the urethra are colonized by anaerobic Gram negative rods and cocci. Subsequent to elimination from the body, urine can acquire strong odors due to bacterial action. Most noticeably, the asphyxiating ammonia is produced by breakdown of urea. Some diseases alter the quantity and consistency of the urine, such as sugar as a consequence of diabetes.

You may “read” a lot from your urine, its smell and color. Darker and thicker urine shows dehydration. Too much yellow equals overabundance of B vitamins in your bloodstream. Certain medication, e.g. rifampin and pyridium, can turn your urine orange. When it is deep dark orange to brown, you may have jaundice, rhabdomyolysis, or Gilbert’s syndrome. Black or dark-colored urine is referred to as melanuria and may be caused by a melanoma. Interestingly, beets can cause a pinkish tint, while asparagus consumption can turn urine greenish. Eating asparagus is also known to cause a strong odor in human urine. This is due to the body’s breakdown of asparagusic acid. Other foods (and beverages) that contribute to odor include curry, alcohol, coffee, turkey, and onion.

Attempted medicinal use of urine is nothing new. Aztec physicians used urine to clean external wounds to prevent infection, and administered it as a drink to relieve stomach and intestinal problems. In India, the ancient Ayurvedic medicinal system calls urine Shivambu (you can find links to this therapy on the web). Chinese folk medicine also documents use of urine as remedy to various ailments – always secondary, however, to herbal medication. Ancient Romans used human urine to cleanse grease stains from their clothing, before acquiring soap from the Germans during the first century AD. Urine that has been fermented for the purposes of cleaning is referred to as lant. Emperor Nero instituted a tax (Latin: vectigal urinae) on the urine industry, largely because of the envy of the profit that one of his rivals made on this “industry”. The tax, however, was continued by Nero’s successor, Vespasian, to whom is attributed the Latin saying Pecunia non olet (“money doesn’t smell”) – this is said to have been Vespasian’s reply to a complaint from his son about the disgusting nature of the tax. Vespasian’s name is still attached to public urinals in France (vespasiennes), Italy (vespasiani), and Romania (vespasiene). Alchemists spent much time trying to extract gold from urine, and this effort led to discoveries such as white phosphorus, which was discovered by the German alchemist Hennig Brand in 1669 when he was distilling fermented urine. In 1773 the French chemist Hilaire Rouelle discovered the organic compound urea by boiling urine dry.

We still use urine today. Urine contains proteins and other substances that are useful for medical therapy and are ingredients in many prescription drugs (e.g., Ureacin, Urecholine, Urowave). Urine from postmenopausal women is rich in gonadotropins that can yield follicle stimulating hormone and luteinizing hormone for fertility therapy (see our previous posting). The first such commercial product was Pergonal. Urine also contains antibodies, which can be used in diagnostic antibody tests for a range of pathogens, including HIV-1.

However, its acidity makes it largely unusable for self-medication of any skin diseases. What you find in skin products is a specifically refined and purified type of “urine,” which is not of natural (human or animal) origin, but was synthesized artificially (e.g. La Roche-Posay Laboratories http://www.laroche-posay.com/international/beauty/home-h.aspx). Further, purchasing such a product gives you the assurances of FDA and the manufacturer that it is safe for the intended purpose. We offer some of these products, and are able to obtain others, should you desire. Please do not hesitate to consult with any of our specialists.

Facial Exercise or Facelift?

 

Your face has more than ten bones and 12 muscles, with numerous branches of nerves, arteries, and veins. Facial exercise can help in all of these areas. It is typically used to stimulate blood flow and circulation, to better prepare skin for a facial treatment, relieve tension, or assist in treating medical conditions.

It is important to realize that the face often ages more rapidly than other parts of the body, because facial skin is exposed to the environment virtually all the time. Exposure to sun, wind, excessive heat, and cold, as well as chemical and biological pollutants… not to mention hormonal changes, depleted collagen production, thinning of the skin due to free radical damage, slacked facial ligaments, genetic disposition, and poor diet – all gradually produce an appearance of sagging, discolored, dull skin. What can you do?

Dr.Fisher suggests facial exercise prior to facials, microdermabrasion, and chemical peel. Sometimes, TMJ, i.e. temporomandibular joint, produces facial pain, headaches, and other uncomfortable symptoms. Therefore, facial exercise is not only a matter of surface but also the substance. As we smile, laugh, speak, and frown our faces do a lot of muscle work, 12-16 hours a day, sometimes even in our sleep. Tensed facial muscles can inhibit blood flow and circulation.

You do not have to be a licensed massage therapist to perform a simple facial exercise in the form of a massage at home. It can help blood circulation, which aids detoxification. Detoxification produced by lymphatic drainage occurs when lymph fluid, containing bacteria and debris, is transported through the lymph vessels in the body tissue. As lymph fluid is carried through the bloodstream, the bacteria and debris is sieved by lymph nodes. During a facial, facial exercise can help facilitate lymphatic drainage.

Facial exercise is often performed by moving the pads of the fingers in an upward, outward motion over different areas of the face. Practitioners may massage areas or slightly pinch around the brow where facial tension is concentrated. This may depend on your individual need. Generally, you want to be tender and gentle, in particular around your eyes. Usually, therapists will massage along the jaw line or at the hinges of the jaw and cheekbone to help manage TMJ.

If you decide to implement a daily facial exercise plan and want to take wrinkle prevention seriously, Dr.Fisher recommends that you avoid the following:

Scrubbing your face too strenuously

  • Using a downward scrubbing motion during cleansing
  • Squinting your eyes
  • Leaning your chin or cheek on the telephone or on your hand
  • Sleeping with your hand lodged between your chin, cheek, or pillow

However, if you do have a particularly sturdy, sagging or wrinkled area, facelift will do the job overnight.

Facial Hair Can Be a Pest…

Facial hair can be a pest, which many women abhor and are reluctant to talk about. It can plague you privately, because you are the only one who really knows or notices… Many people who suffer from much more grave and serious cosmetic problems will simply wave their hand at a “hair-raising” issue.

However, unwanted facial hair on women may imply some deeper underlying hormonal condition. Since many times the nurses who operate the hair-removal laser do not know this, they will not be the best “specialists” to consult with.

If you do not have any underlying condition, then simple hair removal is, indeed, simple. However, it requires several sessions and its efficiency is not the same for everybody. Darker skinned women will find laser removal less effective than fair-skinned patients. Further, the hair permanently renews itself and thus the laser may only “catch it” in a certain period in the cycle renewal. Not every time is thus the laser equally effective with respect to each and every hair you may have.

It is not necessary to shave your hair either before or after the treatment. After the treatment, the hair falls out by itself. Before the treatment, complete shaving prevents the laser beam from “catching” the root of the hair because it is not detected. All in all, the treatment efficiency ranges from 50 to 70 per-cent after three treatments, ca. six weeks apart. Some maintenance is usually necessary, either once or twice a year, in particular in blond, fair-skinned women, where hairs are generally lighter, thus more difficult to detect and can often be persistent.

Laser treatment is much less damaging for the skin than tweezers and does not leave any marks or imperfections. In fact, the laser beam has a rejuvenating effect even on the skin which is not in need of hair removal. Thus, you will not suffer any “collateral damage” to your skin. Some people experience pigmentary changes, either lightening of the skin or darkening of skin, following the procedure. This is not scarring. All such alterations are temporary and will disappear over several weeks following the procedure.

In our Surgical Center, we have several lasers with different capacities and focus to match your needs and desires. It is a wise choice to always consult Dr.Fisher prior to the procedure, but need not be necessary because all the nurses on our staff are qualified to answer questions relating to hair removal, and have been expertly tutored in operating all our devices by the manufacturer.

Fads You Do Not Need

Three new cosmetic procedures have recently appeared on the market. First, so-called “awake” breast augmentation, which is a heavily marketed procedure, mainly due to the interest of the media. During this procedure, patients undergo breast enlargement while under sedation rather than a general anesthetic. Some patients feel more comfortable knowing what the surgeon is doing, some surgeons feel that they need patient’s cooperation during the surgery. We feel that neither is necessary and both may lead to complications.

Second, a “Botox breast lift,” another-flash-in-the-pan of a Hollywood OR man: Botox is injected into the chest muscle wall with the intention of lifting the breasts. However, what current results show is that the only lasting effect this potentially expensive alternative to a traditional breast lift has is the lasting effect on your wallet.

Finally, some plastic surgeons have begun using the injectable filler known as Sculptra to provide patients with “cleavage rejuvenation.” Side effects of Sculptra may include injection site discomfort, redness, bruising, bleeding, itching, and swelling. Other side effects may include small lumps under the skin that are sometimes noticeable when pressing on the treated area. Larger lumps, some with delayed onset with or without inflammation or skin discoloration, have also been reported. In a key clinical study the numbers of small and larger lumps were low and most resolved without treatment. Sculptra is used as a modern anti-aging treatment, but is also applied to correct the signs of facial fat loss in patients with HIV-associated facial lipoatrophy.

Pass on that Gastric Bypass!

We had an inquiry about the gastric bypass surgery today. Gastric bypass, Lap Band or sleeve gastrectomy is more popular than ever. These surgeries, however, are extremely invasive and may cause unforeseeable complications. They are not what would be medically categorized as “cosmetic.”

What you should know prior to undergoing any such surgical procedure is that it is not a cure. You may suffer from a psychological problem, some debilitating condition, which can be cured by a skilled psychologist or psychiatrist. You may also have some genetic problem. In any case, you have tried to “treat” yourself – and it did not work. It is high time to see a specialist.

While an expert, proficient surgeon, Dr.Fisher does not perform gastric bypass surgery because such a surgical procedure requires an in-patient long-term observation and hospitalization. While often successful, the surgery itself is not a cure-all and many people persist in poor eating habits. It is almost impossible to succeed and achieve what you want without altering your eating habits.

It is also important for you to realize that gastric bypass does not diminish the number of fat cells in your body, as liposuction does. It makes you starve. But the fat cells remain in your body. Also, you have to be in the heavily overweight category, ca.300lbs+ to qualify. Unlike in normal, average population, the BMI is relevant here. Anyone above 35 is likely to succeed in applying for a gastric bypass.

One more unpleasant feature of this type of weight loss surgery is that you have to stick with liquid diet for 2 weeks after the surgery and be very careful about consuming “heavy” food even after this period of time. As a practical matter, the surgeon will recommend 2 weeks of liquid diet prior to the surgery, so as to shrink your liver. This makes the operation easier. In total, it means ca.4 months of liquid diet.

One positive feature is that there is no need for a large incision. Modernly, the majority of weight loss surgeries are now carried out laparoscopically. You will be left with a very small scar (which, however, cannot be hidden in any abdominal fold, as can a very thin scar left after tummy tuck or liposuction).

Finally, many potential patients are concerned about the so-called “dumping syndrome. Dumping syndrome is commonly caused by the rapid entry of undigested food products from the stomach into the small intestine where your body is not prepared for the concentration and rushes to dilute it by “dumping” fluid and electrolytes rapidly into the contents of the intestines. This is also why your diet has to be very restrictive and limited, without excessively fatty foods, or simple carbohydrates with high sugar content.

Since insurance does not cover this surgery either, you might be left  in the lurch, longing for a real treat, with a lien on your house… Perhaps it is better to discipline your eating habits now, pass on that gastric bypass, and visit Dr.Fisher now. He may be able to help you at much less expense and pain –  to much more satisfactory results.

CoolSculpting™ by ZELTIQ™

 

We would like to inform our patients that we have been trying to clarify technical details, availability of the device on the U.S. market, and its general potential for non-invasive targeted fat reduction.

Unfortunately, there are no credible studies of veritable peer review available at this point, which would clarify potential harmful effects of this device. The technical features are unavailable at this point, and the device has not been approved in the United States either on a federal or state level.

Therefore, any surgical center, which would venture upon the unapproved unknown, would risk strict scrutiny by the Medical Board, and potential suspension of license in case of any complications.

In our close communication with Zelteq, we were interested in the effect of cryolipolisys on the liver,  because its proposed function is based on “detoxification” of fat cells, its potential carcinogenic impact on the human body in general, and other long-term complications, which would include damage to the skin, its subcutaneous as well as surface levels, and unwanted reversal of the former condition, i.e. natural regrouping of fat cells in the area, which is a result of the apostatic distribution given to each of us genetically.

None of these issues have so far been elucidated in either medical or lay terms by the company. We have therefore decided to abandon this novelty.

“An ounce of prevention is worth a pound of cure,” as Dr.Fisher points out. A safe well-established method of fat removal through liposuction will cost you 1/3 of the price for the uncertain, unapproved cryolipolisys. The results you receive from liposuction are permanent. There is no such guarantee in cryolipolisys. Further, in Dr.Fisher’s Surgical Center, you will receive protection of the Federal Government, California Medical Board, and 35+ years of experience, skill and acumen of a man-artist who stood at the very cradle of modern liposuction.

Fighting the Clock – Antiaging Treatments Popular

Pursuant to the American Society of Plastic Surgeons (ASPS), minimally invasive procedures like Botox and wrinkle fillers are up 99 percent since 2000. The survey by RealSelf backs this anti-aging trend, especially among women aged 55+: of those who would choose cosmetic work if money was not an issue, one third (33 percent) would opt for wrinkle filler and 14 percent would choose Botox.

Facelift surgery is of high interest by baby boomers:  among those 55-years and older, 36%, and one in 10 (11 percent) of men, would choose a facelift in an effort to retain their youth – again, if money was not an issue. Yet, among men aged 35-44 interest is also high – one in five (16 percent) would choose a face lift if money was not an issue, compared to just 6 percent of men aged 45-54.

The survey also looked at which treatments people planned to undergo within the next 12 months, providing insight into what types of procedures will be popular in the months ahead. More than 50 percent of those who are planning to undergo a minimally invasive procedure plan to get their teeth whitened, and one in five (23 percent) will go through a hair removal procedure. One in 10 (11 percent) will have a wrinkle filler injection (e.g., Juvederm, Restylane), while only 3 percent noted they will have Botox injections.

Among cosmetic surgical procedures, one in four (27 percent) will have eyelid surgery and 18 percent will undergo hair replacement. Facelift (13 percent), tummy tuck (12 percent) and breast lift (12 percent) round out the top five procedures people have planned for the next 12 months. Tummy tuck and facelift are also among the top five Worth It procedures on RealSelf.com. The RealSelf Worth It Index measures levels of satisfaction with procedures from actual patients, noting whether or not the results were “worth it.”

The Worth It Index ratings and average costs for treatments in the survey include:

Procedure % Planning to Undergo in 20102 RealSelf Worth It Index Average Cost
Mommy Makeover 7 97 $12,532
Tummy tuck 12 85 $8,722
Vision correction N/A 83 $3,139
Breast implants 8 77 $6,591
Facelift 13 73 $11,471
Hair removal N/A 68 $1,520
Botox 3 64 $475
Teeth whitening 50 63 $380
Wrinkle filler (Juvederm) 11 59 $743
Liposuction 8 58 $5,660
Laser skin treatment 9 51 $2,443
Hair replacement 18 45 $17,390
Cellulite treatment 6 32 $2,271

 1 Harris Interactive® fielded the survey on behalf of RealSelf.com from March 23-25, 2010 via its QuickQuerySM online omnibus service, interviewing a nationwide sample of 2,148 U.S. adults aged 18 years and older. Data were weighted using propensity score weighting to be representative of the total U.S. adult population on the basis of region, age within gender, education, household income, race/ethnicity, and propensity to be online. No estimates of theoretical sampling error can be calculated.

2 Results associated with the surgical procedures planned for next 12 months should be interpreted with caution due to small sample base size.

About ASPS

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

Interest in Cosmetic Surgery Increases

The American Society of Plastic Surgeons (ASPS) reported a decline in cosmetic surgery and treatments during the first half of this year.

However, according to a new online survey by Harris Interactive of 2,148 adults on behalf of cosmetic treatment community, consumer interest in cosmetic procedures is up – way up, in many cases. More than two-thirds (69 percent) would choose to have cosmetic work done if money was not an issue, up 15 points from November 2009 (54 percent), indicating that interest is constantly climbing.

Additionally, the desire for invasive plastic surgery procedures, even those requiring extended recovery time, suggests people want big changes, not just minor nips and tucks. Of those who would get cosmetic work done, almost one in three (29 percent) would choose a tummy tuck, 23 percent would want liposuction, and 13 percent would opt for a facelift.

Interest in other treatments includes:

Procedure % of Total % Female

  

% Male

  

Cosmetic Minimally Invasive  
Teeth Whitening 48 46 51
Hair Removal 27 35 18
Cellulite Treatment 14 21 3
Wrinkle Filler (e.g., Juvederm, Restylane) 12 15 7
Microdermabrasion 10 14 4
Hair Replacement 9 5 16
Botox 7 9 4
Cosmetic Surgical  
Tummy Tuck 29 40 15
Liposuction 23 26 18
Face Lift 13 17 8
Breast Lift 15 26 1
Breast Augmentation (i.e., implants) 6 10 2
Breast Reduction 6 8 2
Rhinoplasty 4 5 4

 

Tummy tucks are most popular among women aged 35-44 – almost half (46 percent) would choose to tone their midsection if money wasn’t an issue, compared to 34 percent of women 18-34. More than one-third (34%) of women aged 35-44 would undergo a breast lift, and 28 percent would opt for liposuction, possibly thinking ahead to swimsuit season. Liposuction is also popular among men 35-44: 29 percent would undergo this fat removal procedure. These three procedures are most often associated with “Mommy Makeovers.”

Seven Tips for Successful Recovery

Although we have a very hands-on skilled and experienced nursing staff, there are some things you should know about your post-op recovery.

Depending on the extent and difficulty of your procedure, pursuant to Dr.Fisher’s instructions, you may feel more comfortable taking a few days off and modify your bedrest. Organize yourself prior to surgery. Do not do your shopping and heavy household chores and activities that might aggravate your recovery (washing, cleaning). Have some help around the house so that you can relax and allow your body to recuperate.

After the night of fasting prior to the surgery and a day of not eating anything following the surgery, your body will be dehydrated and depleted – the feeling is somewhat similar to that of having a hard workout.

Here is the crucial Seven you need for recovery:

  1. Drink + fruit and soft food
  2. Cold Compress to reduce inflammation (only in blepharoplasty)
  3. Natural sleeping aids (tea, milk)
  4. Soft and comfortable bed
  5. Disposable washcloths
  6. Handheld showerhead
  7. Mild laxative (if needed)

 

Dr.Fisher and his staff will answer all your questions and will provide you with more information.

Plastic Surgery in a Bottle?

The Journal of Health and Longevity (Vol 1., Issue 2, 2010) published an article called the “Fountain of Youth Rediscovered!” – with a would-like-to-be medical analysis of how the human growth hormone can help you lose fat and stay healthy. It touts HCG as “Plastic Surgery in a Bottle.” Not only is this grossly misleading, because the only effect of ECG which might be tangentially connected to what a skilled plastic surgeon can do, would be excessive growth of cartilage – i.e. perhaps lengthening of your nose, your ears, and your chin; but some of the “facts” the article states are simply wrong: HCG cannot “prevent osteoporosis” or “revitalize your immune system” or “restore your sexual vitality” including “hair color” etc. etc.

Not only is this not true, but it is the very opposite of what the HCG will do for you. First of all, HCG  (human chorionic gonadotropin) is not for you at all. Its main purpose in nature is to promote the maintenance of new life in the mother during the first trimester, which means: 1) triggering the production of progesterone, which in turn enhances the lining of the uterus and protects the growing fetus by 2) repelling bacteria and even the immune cells of the mother, and even enhancing the mother’s immunity system. You might think: right, that’s why it is good for my immunity system. Wrong!

Like every hormone in your body, HCG has its precise functions, which are connected to the functions of other hormones. Synthetic hormones were develop to help those who do not have their own hormones (hypogonadism) or suffer from hormonal dysbalance. HCG was first used by Russian athletes. There was no artificial HCG yet, so any HCG had to be taken from the pituitary gland of corpses. It is not so revolting if you realize, for example, that even today there are organizations, which help hospitals collect urine from pregnant women for extraction of HCG for use in fertility treatment.

Before we go on, here is a couple of other hormones also produced by the pituitary gland: Adrenocoricotropic hormone (ACTH), Thyroid-Stimulating hormone (TSH), Prolactin (PRL), Lutropin or Lutenizing hormone (LH), Follicle Stimulating hormone (FSH), Melanocyte-Stimulating hormone (MSH), and beta endorphin. Do you really think that a tiny pea-sized area in your brain can handle releasing one without curbing the release of another hormone? No-one knows precisely how these hormones interact and we are still learning mostly by experiment. Further, most studies cannot even be conducted because they are too dangerous, and those that are being “conducted” are so outside of the approved medical milieu (often in the gym, or the changing room, rather) because if something goes wrong – the results may be fatal.

Every time you place an artificial hormone into your body, the body suppresses the same. There is an inner immunity. Some gurus (not necessarily physicians) call this an “apostasis.” They are not incorrect.

For example, in professional sport, the world where “performance enhancing drugs” such as anabolic androgenic steroids (AAS) and HCG and LH are most common, athletes who do not want to destroy their career by self-destruction from within and/or embarrass themselves in public by some undesirable anti-doping scandal, must know more about this part of medical science than physicians themselves: half-time of each drug in the body, their interaction, how to prevent side effects, and how to restore the inner balance. This is a tedious process, only for the most dedicated and its results are proportionately very small.

All positive effects (notice: not almost all, but all) of the use of artificial hormones are temporary. They are most prominent during the cycle and for several weeks after the use. All negative effects, unfortunately, remain. All hormones injected into the human body artificially are a time-bomb, which will quicken the pre-programmed clock in your genes. Did your mother die of cancer? If you use HCG, the chances that you will die of cancer sooner than she did increase geometrically, i.e. by the square of the dose you use multiplied by the length of use. HCG testing is actually used to ascertain how far your cancer, if you have been diagnosed with one, has already advanced: the more HCG present in your body, the further beyond the point of no return you are. You may have lost 5% of bodyfat and gained 5% of muscle over the two months you have been using HCG, but not only will you be just the same as before in 6-8 months, you will have accelerated all genetic disorders in your body and, paradoxically, will also have grown twice as old in the process as you would have otherwise.

Hormones are drugs. As any drugs, they are addictive. Placebo effect studies show that it is a psychological addiction, rather than a physiological one. Psychologically, you are addicted the day you first inject yourself. Psycho-somatic addiction follows soon thereafter. Why do people who have taken HCG advertise it as a miracle drug? I believe it was the same with Coca-Cola when it first appeared on the market, containing cocaine. Perhaps if cocaine were not illegal, the users of cocaine would do the same today: “Miracle drug! Come and buy! Grow 10 years younger overnight!”

Unfortunately, I have seen the dire and dismal consequences of such miracle drugs: be it (from AAS) female breasts (gynecomastia) in men, acne the size and extent of leprosy, disintegrated liver (not unlike that of a destroyed alcoholic), and 20-years-old bold men with scrawny-looking 45-year-old wrinkled faces and rhoid rage in their eyes; or (as is the case in HCG) elongated chins and cheek-bones, cancer of the bone, the skin, ovular dysfunction in women, or (the more common) headaches, irritability, restlessness, slight water retention, tenderness of breast tissue, swelling of the injection sight, and depression. There are some rare, severe side effects as well which include the development of ovarian hyperstimulation in females.

Please note also that none of the HCG reports or articles will actually point at any scientifically recognized study, which would receive acclaim and credible peer review. All such studies invariably show that the positive effects of HCG, if any, are fleeting and temporary, while the negative ones persist. Indeed, the bottle of HCG may lead to many surgeries but, at the end of the day, none will restore your youthful look and feel like a skilled plastic surgeon, who can rid you of your fat permanently and erase your wrinkles for the next ten to fifteen years – in 4-6 hours of wholesome sleep.

Smiling Buttocks

Most surveys indicate that after the eyes and the mouth, the breasts and the buttocks are the area men most often look at (or for?) in women. While liposuction makes it possible for surgeons to change corporal proportions and selectively contour arms and buttocks, abdominal bulges, and many other body parts, the desire to have “smiling buttocks” if one was not given to you by God is a very painful procedure, which can be extremely complicated. Buttock creases can be re-carved to create “smiles” under the buttocks, no doubt, but few patients are aware of the risks, because they are not often spoken about – even by the surgeons who perform such procedures.

As you may read in our “science” part (of this blog), Dr.Fisher stood at the cradle of liposuction. While today it is perhaps the most popular procedure performed by cosmetic surgeons, fat transfer and shape modification are still lagging behind. For one, the interest is overall much less than in the other procedures; for another, the procedure of recontouring and restructuring is much more complicated and not many surgeons are willing to undergo the risk of complications. If a general risk of breast implant rejection is ca.1%, in breast reconstruction, the risk may reach 5% or more, and when we speak of the buttocks area, the risk is 20% to 30%.

The risk of what? Infection, dissatisfaction, prolonged healing, often painful consequences, such as another surgery. Superficial surface irregularities are extremely difficult to deal with and unless you encounter some surgeon who is really experienced and has had 30+ years of experience, you do not want to be the one on whom the surgeon gains his experience. A little cellulite, a “placid” instead of “smiling” buttocks – might then be the least of your problems.

Post-liposuction iatrogenic deformities are not just limited to surface irregularities. Changing the relationship between your thighs, your abdomen, and your buttocks can result in unnatural disposition, out of proportion, even physically cumbersome, preventing you from running as you used to and doing other activities you enjoyed so much before…  A good surgeon has to be an artist, has to keep in mind overall proportions of the body, like a sculptor. Flattening the lower abdomen without attention to the upper abdomen can lead to strange appearance, and deformities, which are too obvious to cover. The same disproportionate result can be created by interrupting the continuous flow of the lateral and posterolateral thigh into the buttock while performing liposuction or restructuring of the area.

Dr.Fisher began performing liposuction at St.Lukes in the early 1970s and has gained immense knowledge and experience in treating iatrogenic liposuction deformities with fat grafting, primarily focusing on the surface irregularities, while addressing the overall corporal proportion to restore a more natural aesthetic look and proportionality between the waist, hips, and thighs. “You have to trust a doctor like Dr.Fisher,” as one of our patients (Taiana K.) stated recently. “If he says it is too dangerous, then I will rather go to the gym than waste time and money on some other, second-rate advice.”

So, remember, your craving for “smiling buttocks” might erase the smile from your face forever.

C-Section or C++?

Let us preface that although Dr.Fisher does not perform vaginal tightening or other reparative surgeries in the area, he has performed such operations in the past and has more experience in this respect than many of our patients might surmise. How does this connect to the latest news on the growing number of caesarian sections (currently over 30% of all births) in the United States?

We are excitedly awaiting the publication of the September issue of Obstetrics and Gynecology, where the conclusions of the latest studies on caesarian section procedures will be qualified for a larger public. In order to minimize the risk of infection in mothers, women giving birth to babies by caesarean section should routinely receive antibiotics an hour before the surgery, according to a new recommendation issued Monday by a national doctor group. Currently, women who undergo caesareans often receive antibiotics as a precaution against infection to the abdomen and uterus—but usually only after the delivery, when the umbilical cord is clamped, because of concern for the baby’s safety. Some pediatricians worry that antibiotics administered to the mother will reach the newborn and suppress the baby’s blood bacterial count, potentially masking a serious infection in the baby unrelated to the caesarean section. However, such worries might be untimely and unwarranted.

Dr.Fisher recommends taking antibiotics as preventative measure. “It is not the antibiotics that may cause problems, but the doctors who administer them,” he says. “A physician must be absolutely certain what the impact of a particular antibiotic is going to be, and what the appropriate dosage should be. It is also critical that each patient be completely honest with the physician about her diseases, past and present, and any ailments or maladies she may have had recently. A surgery is a surgery. We know that some 8% to 10% of women who have a scheduled caesarean will acquire an infection, as will about 30% of women who have a caesarean delivery after labor has begun, because of greater exposure of the inside of the uterus to bacteria from the vagina.”

Although the prevalence rates for sepsis do not appear to be significant in newborns, during plastic, and, in particular, reconstructive surgery, any “unaccounted for” bacteria may cause adverse reaction of the patient’s immune system to the implant. “There are no reliable studies on the subject out there,” says Dr.Fisher, “but, from my own experience – it is better to be safe than be sorry. If the implant is rejected, we have to wait for the body to recuperate, re-acquire full immunity, before we set things right… and this may be very traumatic for both the patient and the surgeon.”

Five Top Plastic Surgery Procedures

 

BREAST ENLARGEMENT

Having children, losing large amounts of weight or simply old-age can take their toll on our bodies and a breast enlargement, or boob job as they are more commonly known, can really help people regain their confidence and feel better about their selves.  Enlargement implants vary in size, texture and shape and thus your surgeon will be able to work with you to gain a result which is best for your individual case and looks natural as well.  For more information, check out the related page on www.cosmeticsurgeryandlasercenter.com

 

 

BREAST UPLIFT

If you don’t feel like you need larger breasts, but would just rather they didn’t sag so much, then breast uplift is another extremely popular procedure which could be right for you.  Many people are feeling that they can recapture their youth by reshaping either their nipples or the full breast.  Again, you can find out more information about whether this procedure is right for you by visiting the relevant link on our website or by directly making an appointment with Dr.Fisher.

 

 

BREAST REDUCTION

There are just as many people who wish to reduce the size of their breasts as want to augment their assets.  Breast reduction surgery removes excess fatty tissue and breast tissue from the area around the nipple and then the breast is lifted. This can, for many women, result in a more manageable cup-size and can often help women get their body in better proportion which can help with everything from getting clothes to fit properly to having more general confidence.  If you feel like this procedure may be right for you then head on over to the relevant page on www.drfisher.com  and take the first step to getting the weight off your mind, and your body as well. Since this is a very demanding and difficult surgery, a thorough personal exam with Dr.Fisher is necessary before taking any decisive steps. Please disclose all your former procedures and any materials or medical history papers you may have. This will decrease the risk of complications and proportionately increase your satisfaction with the result.

 

 

LIPOSUCTION

 

Probably one of the most well-known cosmetic procedures, liposuction has become hugely popular in the last few years.  In layman’s terms, it is the removal of excess fat from areas such as the ‘love-handles’ or the thighs. It is so popular because it is a procedure which is not simply for those people who are overweight or obese. Many of us, after dramatic weight loss, or simply as our bodies change as we get older, can find that our skin loses its natural elasticity and that we have stubborn pockets of fat in places which we would rather we didn’t.  Liposuction is a remarkably quick and simple procedure which can help banish such confidence-sapping excess weight from parts of our bodies. It is not a substitute for a healthy diet and regular exercise, but it is a way of sculpting yourself in a way which no amount of exercise would achieve.

Please visit the liposuction article on this blog (science) to find out more about how Dr.Fisher helped invent and originate this procedure.

 

 

EYELID SURGERY

Widely known as Blepharoplasty, this procedure increases in popularity by the day. If you ever wondered about its origins, it is derived from the Latin word “blephar,” which means simply the “eyelid.” It traces its origins to the Greeek “blepharon,” and occurs in such connections as *blepharitis* or *blepharospasm* or even  *blepharoconjunctivitis*

The eyes are really the most prominent feature of a person and, whether in business or social situation, eye contact can be crucial. If you’re not confident about your eyes, this can be hard but eyelid surgery can help by removing excess eye-lid skin, taking away excess fat or removing prominent bags which may appear underneath the eye itself. The process can not only give you increased confidence but can take years off how old you appear as well and this is why the procedure is so popular. Become more confident today and check out your future better, more beautiful Self with Dr.Fisher by making a personal appointment.

Congratulations!

Congratulations to all the patient and caring nurses, skillful and painstaking technicions and scrub-techs – all the members  of our staff! As you know, our last year’s success of 99.3% of satisfied patients, calculated by the total number of surgeries over the complete satisfaction rate, i.e. 612 over 608 is hard to beat (four patients were reportedly not fully satisfied but were offered additional post-operative treatment which they gratefully accepted). Nonetheless, we have only had one complaint this year, and that was resolved by a reparative surgery to a complete satisfaction.

For all my patients, I would like to state that capsular contracture  is one of the most common problems caused by breast implants. It occurs when scar tissue around the implant hardens and begins to squeeze the implant. It can cause hardening of the breast tissue, rippling in the skin of the breast, and changes in the shape of the breast. It may also be painful. Surgery is sometimes needed to remove the scar tissue or replace the implant when capsular contracture develops.

Good news – it can be prevented. In our experience, all patients (without any exceptions) who follow Dr.Fisher’s advice and massage the incriminated location per his directions come out without any contractions. This prevents further surgery or uncleared hemorrhage. Some women have higher risk of complications. These include: BMI over 35 (heavily obese), high blood pressure, diabetes, smoke, other diseases. It is imperative that all diseases or conditions known to the patient must be revealed to the surgeon prior to surgery. We have had some cases where the patient concealed her medical condition (such as a disease or prior surgery), thus causing extra consternation and worry during the procedure. Nothing remains concealed when you are in the OR. Only then, – quite frankly – , it might be too late to comply with safe disclosure.

Remember, our hospital is certified and federally approved.  In trying to accommodate all your wishes, Dr.Fisher will always proceed pursuant to his own best judgment as to what is safe for you, from what you will benefit the most. This may not always perfectly and in all respect correspond to your wildest dreams and your imagination. However, you will  end up being safe, healthy, and happy – along with other 600+ patients who entrust their selves to Dr.Fisher’s skillful hands every and each year.

Bigger is Better

 

Although many women generally agree with this proposition, the heading above had better have a bigger question mark after it. On the one hand, women who opt for implants that are too small, even though they are advised otherwise, end up regretting their choice, wishing they had “gone bigger.”  – on the other, there are those who like the glitz-and-glitter of a new image. The latter  may disregard their Surgeon’s advice as to optimum results and how to achieve them entirely, and may end up with back pain, premature descent and possibly skin damage.

Around the country, the largest breast implants are currently being given in Miami and in Hollywood. Reportedly, the motto is: “Go big or go home.”

An experienced surgeon, such as Dr.Fisher, who performed several thousand of breast implant surgeries, will tell you that there are several decisive points to consider:

First, the base width of the patient’s breasts and the distance between them.

Second, the amount of tissue needed to accommodate the implants.

Third, balance between desires and expectations of the patient and what is physically possible and still safe.

Fourth, skin laxity, relevant to age and bodytype.

Bottom line for Dr.Fisher? “Happy patients – both immediately and in the years to come,” he says.

Adhere to the Instructions!

A breast implant is a soft silicone shell filled with saline (salt water) or silicone gel.  Botth kinds are equally good to  create a more natural-looking breast, because their weight and texture in all respects resembles breast tissue.

The implant may be placed directly under the skin, or, more commonly, under the chest muscle. Individual bodytype and form are decisive here. After the implant has been carefully adjusted to the correct shape and position, the incision is closed. However, it is not like going shopping – every surgery is a procedure, which requires utmost skill and expertise of a knowledgeable and experienced surgeon.

Breast reconstruction usually takes more than one surgery.

Many of the risks associated with breast reconstruction are the same as those with any surgery: infection, poor wound healing, bleeding, or a reaction to the anesthesia used in surgery.

Many, if not all, of these complications can be prevented by the patient herself if she religiously adheres to the advice of Dr.Fisher, which means: no shower or water contact for 8-10 days, and slight massage of the area pursuant to Dr.Fisher’s instructions, once the incision is firmly closed.

Do Derma Rollers Really Work?

 

Derma Rollers are supported by clinical studies to be effective in non-surgical and non-ablative treatment for a variety of skin conditions. These include aging, (wrinkles, fine lines, and stretch marks), scarring (acne and breast augmentation), as well as cellulite and hyperpigmentation.

Studies have also shown that derma rollers are often preferable to dermabrasion, chemical peels, and laser resurfacing. They are proven to be just effective in their ability to stimulate collagen and elastin production. Regular use of derma roller can thicken skin, smooth scars of all sizes, and erase wrinkles. 

The treatment itself is not painful at all. The device produces a slight, tickling feeling as the roller touches the skin and its extremely fine needles (microneedles) penetrate into the dermis, in order to push the pores open. Just like destruction of muscle during exercise stimulates the body to hypertrophy, so is this “needling” perceived by the body as slight damage, which requires that collagen and elastin be generated to repair the skin.

The human body reacts to any injury by initiating the healing process, but usually it will only heal as far as it must to keep you healthy – which is different to healing to a cosmetic level. By persistently triggering the healing process, you encourage your body to continue healing until the task is done and completed, and your skin has rejuvenated entirely.

Cryolipolysis

 

CoolSculpting™ by ZELTIQ™ is a new, non-invasive way to gently and effectively reduce fat in targeted areas of the body that results in a natural-looking fat reduction in the treated areas. What makes the CoolSculpting procedure different is that it uses a “cooling technology” to selectively target fat bulges and eliminate fat cells through a gradual process that does not harm the surrounding tissues. This procedure can reduce unwanted abdominal fat, love handles (flanks), and back fat.

The CoolSculpting procedure is non-invasive, without any surgery at all, it does not have the same results. During the procedure, a non-invasive applicator is applied to the skin surface to deliver precisely controlled cooling to target and eliminate fat cells in specific areas of the body. As they are exposed to cooling, the fat cells begin a process of “natural cell removal.” The fat cells in the treated area are gradually eliminated through the body’s normal metabolic processes, similar to how fat from food is eliminated. The result is a reduction in fat bulges that is visible in most patients in about two to four months.

We have not as yet had any candidates. The procedure is fairly new and although FDA approved, compared to classic liposuction, it has two significant drawbacks: the results are not immediate, and the procedure itself has to take place over several hours and be repeated to be effective. Since one sitting is ca.$2,500, overall cost is 2-3 times more than that of classic liposuction. However, if you are interested, please let us know.

DYSPORT

How Does It Work

DYSPORT™ inhibits release of the neurotransmitter, acetylcholine, from peripheral cholinergic nerve endings. Toxin activity occurs in the following sequence: Toxin heavy chain mediated binding to specific surface receptors on nerve endings, internalization of the toxin by receptor mediated endocytosis, pH-induced translocation of the toxin light chain to the cell cytosol and cleavage of SNAP25 leading to intracellular blockage of neurotransmitter exocytosis into the neuromuscular junction. This accounts for the therapeutic utility of the toxin in diseases characterized by excessive efferent activity in motor nerves.

Recovery of transmission occurs gradually as the neuromuscular junction recovers from SNAP25 cleavage and as new nerve endings are formed.

Too Complicated?

The primary pharmacodynamic effect of DYSPORT™ is due to chemical denervation of the treated muscle resulting in a measurable decrease of the compound muscle action potential, causing a localized reduction of muscle activity.

Using currently available analytical technology, it is not possible to detect DYSPORT™ in the peripheral blood following intramuscular injection at the recommended doses.

Still Too Complicated?

It is similar to Botox. Made by a different company.

Come to our office, we will explain to you how it works.

Bid Your Acne GOOD-BYE!

A generic BPO does not work the same way as the novel solubilized BPO applied in Obagi medications. This 5% BPO gel in conjunction with a salicylic acid-based toner resulted in a greater reduction in the non-inflammatory lesion count than twice-daily applications of a prescription 5% benzoyl peroxide/antibiotic product (34% v. 21% after 2 weeks). Although these results are not groundbreaking, the study conducted by Mary C. Spellman, MD (San Francisco, CA) and Jose Ramirez, PhD (JR Chemical, Milford, CT) shows that the solution is especially potent against Propionibacterium acnes and its comedolytic activity.

Nevertheless, physicochemical challenges in the formulation of BPO products mean that the bioavailability of BPO and its ability to enter follicles (and so act directly at the pathogenic source of acne) may be significantly compromised. For example, it is thought that only a very small proportion of available BPO molecules in commercially successful BPO formulations are actually delivered to the follicles. It is possible therefore that improving the bioavailability of BPO, and improving delivery to the follicles, could enhance the clinical efficacy of BPO still further.

A number of factors are believed to hinder the delivery of BPO to the follicles. First, BPO molecules are poorly soluble. Second, they aggregate into clusters that may be large enough to prevent them even entering the follicles—an evaluation of three commercially available BPO products showed that the BPO clusters in the formulations had diameters of 5-50 μm, 10-100 μm, and 50-100 μm, respectively, whereas an average hair follicle has a diameter of approximately 50 μm.

Clustering also inhibits the action of the BPO because most of the BPO molecules become trapped in the interior of a cluster, hindering their ability to interact with P. acnes. A third factor that can impact the delivery of BPO to the follicles is the vehicle—for example, BPO formulations may be oil in water emulsions and these do not readily flow into follicles.

In the past, attempts to use various solvents to improve the solubility of BPO were thwarted because increasing the solubility of BPO was found to negatively impact its stability.  However, more recently, a novel solubilized 5% BPO gel has been developed that is designed to deliver superior BPO solubility without any such stability problems. Based on the results of comparative trials [Erianne J, Prince DL, Ramirez J, Wilson D, Zeichner J., “The pharmacologic science of a novel benzoyl peroxide formulation and the implications for clinical effects,” presented at the 25th Anniversary Fall Clinical Dermatology® Conference, October 6-9, 2006, Las Vegas, NV.] the bioavailability of BPO in this novel solubilized BPO gel is thought to be substantially higher than that in other commercially available formulations. In addition, the vehicle is designed to allow the passage of BPO into the follicles.

The latest Obagi Formula is available in our Laser and Surgery Center!

Do not hesitate!

BID YOUR ACNE GOOD BYE!

Botox on the Rise

Pursuant to Marketwatch.com, the manufacturer of BOTOX, Allergan, Inc. reported  36% increase in revenue for the second quarter of this year. Botox appears to be its biggest product, somewhat like an i-Pod for Apple. Cosmetic surgery candidates who shy away from a procedure performed under general anaesthesia, such as liposuction or facelift (“Rhytidectomy” which literally means “wrinkle-smoothening” in Latin), opt for a more affordable chemical peel or Botox or Thermage. This is not to say that the result is the same – far from that. However, the fact that the sales of the antiwrinkle treatment rose 7% in the second quarter indicate that even under poor economic conditions, many people think of their wealth in terms of Beauty.

In the latest quarter, Botox sales, which account for about a third of Allergan’s revenue, grew 7% to $360.5 million. Allergan’s results, following a strong first quarter, suggested that the cosmetic-procedures market—at the more affordable end, at least—has turned a corner.

The Irvine, CA, company reported a second-quarter profit of $240.1 million, or 78 cents a share, up from $176.1 million, or 58 cents, a year earlier.

In comparison, according to the American Society for Aesthetic Plastic Surgery, the number of surgical cosmetic procedures fell to 10 million last year, after reaching 11.7 million in 2007. The reports indicates that potential patients are having second thoughts, holding off on treatments, while regular patients are spacing out their sessions.

Therefore surgical centers very often focus on offering more affordable procedures, i.e. Botox and its rival Dysport. Patients appear to be thrilled by large mail-in rebates and discounts (such as a $75 mail-in rebate from Dysport’s marketer, Medicis Pharmaceutical Corp.).

While the sales of Latisse dropped to between $90 million and $100 million today from February’s $140 million target, Dysport and Botox are still on the rise.

This entry was posted on August 14, 2010. 1 Comment

Acne Comes in Many Forms…

When many people think of ACNE, they envision the unhappy adolescent whose once smooth skin has been blighted by clusters of draining cysts forming whiteheads, which have left the skin pock-marked, red, and embarrassing.

However, acne has many gradations in severity, and many causes, which may be hormonal, dietary, hygienic, or even that extra glass of wine no-one was meant to notice…

These are some of the factors that lead to the eruption of isolated pimples, red-colored skin, widening of the skin pores, especially in the nasal and cheek areas, which steal attention away from the valuable image that you wish to communicate.

Self-treatment in the form of attempted exfoliation by digital [Lat. “finger”] pressure generally makes things worse. Other treatments, such as drying agents, creams or antibiotics, do not have a lasting success.

While not every busy person may wish to come to our plastic surgery and laser center for a special treatment and lotions, Dr.Fisher’s evaluation can save you valuable time and agony.

Once your skin is in a condition to use the Obagi CLENSderm-MD system, you will be amazingly satisfied with your results. Obagi CLENSderm-MD system is the only treatment with the liquid form of Benzol Peroxide, and the prescription strength therapeutic system has been reported to have clinically proven to produce visibly clearer skin in as few as 2 weeks, although we have seen improvement even more rapid that this.

This medication consists of a three-gel regimen in topical use and does not require taking oral antibiotics.

If you start to feel the pimples about to sprout before your big events, join dozens of our clients who have benefitted from our Finest of products.

Reversing the Irreversible

As a follow-up to the posting published on August 10, there are a few more facts we have omitted to look at. In 1998, the American Journal of Epidemiology published a study of more than 100,000 women, which showed association between fewer menstrual cycles and a reduced risk of breast cancer. Girls who began to menstruate before 12 years of age, have been shown to have a slightly increased risk of breast cancer, according to the National Cancer Institute.

This is due to estrogen, which facilitates pubertal development and is necessary to the menstrual process. Although the evidence that the onset of menarche has shifted to a lower age has not been decisive, the risk tied to estrogen levels has.

On an even more negative side, the increase in body weight and obesity rates has also been provably connected to the levels of estrogen. Current studies focus on a possible impact of environmental chemicals and hormones that girls may be exposed to in foods and packaging (plastics etc.) as well as some plant hormones and pesticides, which may all significantly influence the body’s endocrine system.

How is this connection established? Fat cells produce hormones, and once a critical mass of fat tissue is reached, the hormone leptin is released to trigger puberty. The opposite effect can be noticed during the life of a woman, when bodyfat levels drop below a certain per-cent point (usually between 12-10%) the menstrual cycle stops. Many professional athletes can testify to that.

However, if you are neither a professional athlete nor a successful Weight-Watcher, you will probably not be very pleased with the scientific findings. On top of it all, a separate study in the Journal of Pediatrics found a direct link between the rate of  weight increase during infancy and the accelerated onset of puberty. Once the changes have begun, they are irreversible.

That is to say, they were irreversible until the 1974 when we began to experiment with liposuction.

Since then, we have advanced so much that even most seemingly irreversible changes caused in part by poor habits, in part by Mother Nature, can be reversed by a skilled, qualified, Board-certified surgeon.

Tummy Tuckers Will Live Longer!!!

On Monday, Archives of Internal Medicine reported, that both men and women with bigger waists ”carry a greater risk of death” even though their weight may be “normal” as measured by the body mass index, or BMI, a standard measure based on weight and height (see the BMI article on this blog). Eric Jacobs, strategic director of pharmacoepidemiology at the American Cancer Society, which funded the study, stated that regardless of weight, if your wasteline is larger than it should be,  the risk of death from causes including respiratory illnesses, heart disease and cancer is greatly increased. Other studies linked waist size to dementia, heart disease, asthma and breast cancer.

Current estimates show that over 50% of men and more than 70% of women over 50 have waistlines that are larger than would be healthy for their size and age. Average waistlines have expanded by about one inch per decade since the 1960s. The report concludes that men should not exceed 40 inches, and  women 35 inches in circumference.

The study also found that BMI was misleading, because irrelevant to symptoms associated with overweight. The study used more than 100,000 subjects, in the period lasting from 1997 to 2006. About 15,000 of them died during this decade. All the measurements summed up, four extra inches around the waist increase the risk of dying from between 15% to 25%. The latter, 25%, was in women with normal BMI. Stop worrying about your BMI, and take a measuring tape or mirror instead! Remember, 1 inch extra around your waste can mean 1 or 2 years of life less. Thus, if Dr.Fisher takes 4 pounds of your fat, thus taking 2-4 inches off of your wasteline, he most probably extended your life by 4-5 years! That is about $1,200 a year, or, if you will, $3.28 a day. Now, can you go to the supermarket and purchase one day of your life for that price?

Girls Hit Puberty at Younger Ages

Shirley S. Wang ( shirley.wang@wsj.com) a Wall Street Journal correspondednt, reported on Monday the results of a research pointing at the  implications for the girls’ physical and mental health of the fact stated above. “By 8-years-old,” she stated, “more than 1-in-10 girls have already begun developing breasts, which marks the technical start of puberty for girls.” Her article is founded on a latest report in the Journal of Pediatrics. Although the findings varied by race (among 7-year-olds, about 10% of whites, 15% of Hispanics and 23% of blacks have some breast tissue) the conclusion is clear.

The study, conducted by the researchers from the University of Cincinnati College of Medicine, Mount Sinai School of Medicine in New York, and Kaiser Permanente in San Francisco, included  1,239 girls. The results were compared with a similar study conducted in Denmark, 15 years ago, which concluded the same results for ages  between 10 and 11 years.

Frank Biro, the director of adolescent medicine at the Cincinnati Children’s Hospital Medical Center and first author on the study, which was funded by several federal grants, was unable to conclusively state what factors contributed to this change. However, the doctors’ concern is mainly that of inadequate mental development compared to the physical advance, and  a possible greater risk of breast cancer – shifted to younger ages.

What we may derive from the study is that  lower self-esteem and poorer body image goes hand in hand with breast development in girls. On the one hand, greater demands are posed on girls who are perceived as  more mature, due in part to increased attention, teasing from peers, and sexual and emotional expectations incommensurate to their mental ripening.

Conversely, we conclude that insufficient breast development is the obverse side of the coin, in girls who are either less “fortunate” in this respect, where the peer pressure is from the other side,  or who are more mature mentally and their slower physical development does not correspond to their mental body image.

Needless to say that corrective cosmetic surgery in the latter case is much more than mere “cosmetics” and can have significant beneficial effects on the self-awareness, self-respect and thus also respect of the society to the individual – and her success in personal and professional life.

Fighting the Genes?

Today, I have had the pleasure to meet some famous Hollywood stars on the occasion of a private Health Club meeting in Burbank, and have been asked several questions about the Body Mass Index.

First, everyone should know that the BMI is a grossly inaccurate, simplistic way to tell you that you are obese. Your mirror is a better coach in this respect. Diverse impact journal studies of association between obesity and mortality were inconclusive whenever based on the BMI, precisely because of the BMI measurements. There is a slight relevance to your cardiovascular health, but even that is, to a much larger degree, the result of your genetic predispositions.

Second, BMI attempts to account not only for you subcutaneous fat cells but also for the visceral, or inter-organ fat. Most of your body is water and not fat. Inner fat is difficult to measure, but some techniques are more successful than others. The most accurate is probably Dual Energy X-ray Absorptiometry (DEXA) which is a similar device to the airport body-scan – painless, and precise. Many of you have probably purchased BI scales, which work on “Bioelectric Impedance,” wherein your body functions as a conductor-resistor. These are not terribly accurate, unless you preserve the same conditions every time: the same body temperature, empty stomach, i.e. no drink or meal several hours prior to the measurement. The oldest, most accessible and accurate is the measurement via the skinfold calipers.

The areas for measurement by calipers are the same you have to look at when considering your bodyfat in the mirror: the abdomen (around the navel), the upper arm (triceps area), the inner thigh (pelvic area), the lower back, and the top of the kneecap. You can always conduct a little “caliper test” with your thumb and index finger. If you cannot, you probably need to see me. (please consult my article on liposuction in the SCIENCE section of this BLOG)

What surprised me today was how many of the famous Hollywood stars are on a permanent road to starvation. Starvation is the road to destruction. Many so-called “diets” walk around the news and food journals, fluffing their skinny feathers. You should know that once you reach the point of no return, when your caliper just will not do, liposuction is the only alternative to a strenuous training routine combined with a scientific diet (not starvation!). Why? Liposuction actually takes away the fat cells out of your body. No diet will do that. You have a certain number of fat cells. They may shrink as a result of your diet, but they will be there, and when your diet days are over, your hungry fat cells will want their share back…

That is not to say that healthy eating and moderate exercise are not helpful. Even if you decide not to have liposuction, you can significantly improve your cardiovascular health, gain some muscle and lose some fat, you have time and determination, and are willing to put in the effort and expense requisite for such adventure. However, they will be much more helpful after you have had the liposuction from the most problematic areas: your heart will not be stressed, your body will adjust faster, you will not regain fat in the area, and, most importantly, the most problematic of these problematic areas are usually the places where you started to put on fat first. By a quirk of nature, these are precisely the places where you are going to lose it last – without liposuction. Why? Your body-type and structure, which boils down to your genes, has it so. Some of us put more fat on their buttocks, some on their thighs, some on their abdomen. Fat is very important as a storage of energy and insulation (more on this topic later) and depending on where the ancestors of our ancestors lived (i.e Sweden v. Italy; India v. Korea; Canada v. Mexico) our bodies needed to preserve either fat for energy or fat for insulation or both…

 Today, when you embark on an exercise program, you will not lose fat “topically.” You can swathe your body around your arms, put rubber and plastic bands around your torso – this will not make you lose fat topically. If it seems so, such a loss is visually apparent because of the loss of water in the area. Fat will be re-distributed proportionately, and in concurrence with your genetic information. The only way to fight your genes is to have liposuction.

Skin Types?

Today, I have been asked about “skin types” and whether a particular “skin type” is better or worse for surgery.

Many commercially oriented sites will tell you that there is a “normal skin,” or “dry skin,” etc. This might be relevant for your choice of makeup. However, it has little or no bearing on how we perform a particular surgical procedure. Dermatology was one of my specializations at Columbia. Let me preface, for your benefit: the skin is a most miraculous organ, and we cannot do it justice in a brief answer or posting. I believe what my concerned patient, Mrs. T, had in mind was whether a particular kind of skin may cause particular problems. Indeed, it may, but it has very little to do with a “skin type.”

What is most relevant is the age of the patient, genetic factors, and overall exposure to the sun. Natural aging causes wrinkles and sagging, the skin is less flexible, if you will, and heals longer. Sun exposure causes a different type of wrinkles (somewhat deeper) and destroys a specific type of collagen in the dermis. Generally, aging of the skin can be decreased, if not averted, by topical application of creams containing estradiol, and collagen. It is therefore a sound choice to avoid exposure to the sun and use such creams. These should be accompanied with vitamins, mainly of the B-group, vitamin A and E, and oral collagen.

Exposure to the sun causes irreversible changes in the dermis and the skin stops reacting to artificially supplied collagen and estradiol. Studies have shown that this cuts across skin colors, types, and even sexes (men benefit from the topical use of the same creams). Pre-operation, we have to clean and dry your skin. Post-operation, it has to remain dry until the sutures are stabilized and firm (usually 7-10 days, but, depending on your age and quality, rather than “type” of the skin, it can be 2-3 weeks). That is why is it absolutely essential not to take a shower or be in any contact with moisture in the affected area. I could not emphasize this more.

After the stabilizing period, when the sutures are sufficiently firm (following my post-op examination) you should apply the above-stated topical crèmes to facilitate healing and minimize scarring. Again, vitamin and mineral supplements are also beneficial.

What makes us different – what makes us better

Unlike other doctors you may have encountered browsing the web, I am not concerned with celebrities, fame, or money for that matter. What interests me is the structrue of the human mind, the body, its beauties, functions, and shortcomings. My aim is the Ultimate Beauty. I am an artist, I paint, I sing, I act. I apply my artistic acumen when I operate. I do not use pure knowledge – I apply the Arts…

 I want my patients to benefit the most from any experience they may have with me, and, gain the most from my skills, which I have gathered over the past 35 years, from my scholarly beginnings at Columbia and Harvard, to my professorship at University of Colorado Medical School, to my beautiful practice down here in Cerritos, of which I am extremely proud.

We have the latest state-of-the-art technology, most modern Candella lasers, microscopes, and highly skilled professional staff of international stock. We serve all to the best of our abilities, and we are extremely proud of our results. Yet, we do not crave fame. We crave but satisfaction of an ordinary man or woman who wants to improve his or her life, who wants to make it more beautiful, smooth, satisfactory, and, ultimately, successful.

Ultimately, what makes us different, is precisely this aim – not some grand images from Hollywood that anyone can upload on their site – not some reports of what we have seen or experienced – but our own work, and the reports of our happy patients…

Hello, and Good Morning to All My Patients!

 

Gregory T.Fisher, MD, F.A.C.S.

Welcome to the world-wide blog of

The Plastic Surgery and Laser Center of Cerritos, CA.

This site is intended to help my preoperative, as well as  postoperative patients accommodate  to the great and significant changes that they have had the courage to make in their lives.

Plastic surgery is a choice unlike any other – a decision that many are afraid to make, and many more are even afraid to think about, lest they should commit some eternal heresy and perdition against human nature and God.

I am a religious person myself, and what I gathered through the years of my faith, humility, and spiritual guidance is that the closer to God we are, in image, Soul, sense, Beauty, and our Spirit – the better for us, and, ultimately, for all around us…