Visalia / Fresno / Hanford / Porterville report

Since opening his Visalia cosmetic surgery office, Dr. Yoho has been very pleased by the response of his patients. He now serves the area between Los Angeles (Pasadena) and Fresno and draws some patients from Bakersfield area.

Although he’s done just a bit of print advertising, his practice is now primarily word of mouth, even though he’s only been practicing in Visalia for two years. He has mainly attracted liposuction and breast augmentation and breast lift patients, although some blepharoplasty and face-lift patients have also had surgery in Visalia. His surgical center there is accredited by AAAHC (Accreditation Association for Ambulatory Health Care), and has one operating room.

Botox, fractionated laser (SmartXide dot) and fillers with Juvederm® Restylene® Radiesse® and others are offered as well. Dr. Yoho attends his Visalia / Fresno area clinic almost every Tuesday plus one Saturday a month for surgery, follow ups, and consultations. Consultations are available within a week at our new patients’ convenience. Call the main number (626) 585 0800, and we will schedule you.

Surgical Healing Times

This photo is a classic view of Yosemite with El Capitan on the left (north) and Half Dome peeking over the right upper corner.

How long do my breast implants, liposuction, facelift, or other surgeries take to heal?

I’ve just had liposuction in Dr. Yoho’s Los Angeles office, how long do I have to wait to be “normal” again?

The answer: Los Angeles liposuction is no different than anywhere, and while things can look great right away, there’s a rule of thumb that soft tissue takes at LEAST four months to soften, improve and normalize. Darker skin types--which may be stronger incidentally--also have a tendency to complete the healing cycle over a longer period, and possibly scar more. We have treatments for this. TRY to be patient. Despite all the warnings and disclaimers and education we try to provide for our patients in Visalia / Fresno / Los Angeles getting liposuction and other types of procedures, we always have people who think their result should be perfect RIGHT NOW. This is one of my biggest frustrations as a surgeon. Cosmetic surgeries are often a work in progress. Complications happen (see “What’s the worst that can happen” chapter on Dr. Yoho’s book at http://www.dryoho.com/dr-yoho-book/chapter14-1.cfm). We don’t have a magic wand! We promise to work with you until we are satisfied that we have the best result we think is possible. Again, be patient… Don’t panic when things aren’t just right. We do not desert our patients!

I learned about healing the hard way. I broke my ankle trying to climb El Capitan in a day. See ** below for the story about how a 55 year old man (me) was trying to recover his lost youth by climbing things he should leave to the young dudes. That was June 2008, and it still hurts in July 2009. I found out that for bony injuries, it can take TWO YEARS for things to be the best they will be. Soft tissue surgical recovery doesn’t take as long but it can be many months.



**Dr. Yoho Breaks His Ankle Trying to Climb El Capitan in 24 hours
In June 2008, Dr. Yoho tried to climb El Capitan in Yosemite (3300 feet high and nearly vertical) with his friend Chris Gonzalez, MD. About 15 per cent of the way into the climb, he took an unexpected swing into a corner and broke his left talus (ankle) bone. Chris (52 years old at the time; Dr. Yoho was 55) helped Dr. Yoho slide down the ropes to the ground and then assisted as he crawled to the road, a half mile away.
Dr. Yoho and Dr. Gonzalez have climbed El Capitan before in 27 hours in 2007, but they were trying to beat the 24-hour mark. If they do, they would be the oldest climbing team ever to do this. For more information at DrYoho.com, see http://www.dryoho.com/dr-yoho/yogo-method.cfm.

Why Discount Breast Implants Are a Bad Deal in Los Angeles

This is a cliff known as Tahquitz in the mountains near Palm Springs.

Did you know that implants of different shapes have different costs to the doctor? And did you know that the discount Los Angeles breast implant surgeons generally use only the cheapest breast implants?

Implants made by the two major manufacturers approved for USA use have almost identical shapes. There are three types: flatter (the oldest and cheapest), intermediate, and “high profile.” The high profile implant, for the same volume, has a narrower base diameter and has a bit higher “projection” or distance out from the body when placed under a breast. This is the best implant for most people, but it’s significantly more expensive. In order to visualize this better, the lower or flatter profile implant is shaped more like a Frisbee (not this flat, but you get the idea), while the higher implant looks more like a real breast. The higher profile implants ripple less, a significant consideration especially when saline implants are used.

Now, base diameters must match the patient’s chest. If you have a larger chest, maybe the flatter implant is OK for you to help your cleavage, but for implants over about 350 cc volume, we use almost exclusively the more expensive high profile implants because they look better and the base diameters are usually fine for even a bigger chest. We won’t compromise the result by spending less on the implant. And the wholesale cost of the implant from the manufacturer is a significant part of your breast implant expense.

The Los Angeles breast implant field is an art, because women’s breasts are all different and we have to match your psychological needs for size and shape with both your breast type and the implant choices. We also use different approaches—over versus under the muscle and the different surgical approaches—to try for the best result for you. For example, with relatively large breasts that do not sag, there are many options. Many times, patients like this get the best results with a through-the-armpit approach over the muscle, but under the “fascia” or skin of the muscle. This has many advantages of If you have saggy breasts, many times just an implant will be enough. You may not need a lift, which puts scars on the exterior breast. But some breasts need a lift to get the right result. And if you have very little breast tissue, through the belly button under the muscle may be best. And the “peri-areolar” approach, given careful closure of the incision, gives the best control of the breast pocket and the incision usually almost vanishes. The areolar skin is sort of like lip skin, it hides scars well if the surgeon does his or her job well.

A “one size fits all” approach just won’t give the best results for every person. For example, one surgeon we know only performs his breast implants as over the muscle through the crease at the bottom of the breast. I can’t believe his results are consistently the best. And because his prices are so cheap, I’m sure he’s using only the low profile implants, which aren’t optimal in most cases.

We like silicone implants, but it’s of course your choice if you can’t afford the silicone implants (wholesale cost roughly $2000 to the doctor), or have concerns about silicone. And while we are on the subject, I want to mention the “gummy bear” implant. It’s great marketing, but these implants are hard and unnatural. Too hard for my preference. And they are touted to have a thicker silicone that won’t migrate or run into other tissues if the implant shell ruptures or breaks. I don’t think this is true based on what I have seen when the implants are cut. The silicone in these implants runs and is just as sticky and has characteristics just like the silicone which is used in ordinary implants.

Check out three implants of the same volume, with the three profiles to show the three profiles we use for our Los Angeles / Fresno/ Visalia area patients, here. Remember the high profile implant, the more expensive one, is usually best for implant sizes above 350 cc. You get what you pay for. And you will have a really hard time making decisions about all this complex stuff by yourself, no matter how much reading you do. Try to keep an open mind when you come in for your consultation(s). Choose a surgeon who’s willing to carefully select a size, style, and surgical approach that has the best chance of working, and who is experienced with all four surgical approaches to breast augmentation. And be patient if you don’t get what you want right away. Implants often need to settle into place, and sometimes months of treatment with oral medicines can help this, rather than insisting on an immediate secondary surgery. Much more information is available at DrYoho.com, in particular see this link.

Dr. Yoho has patients come from Glendale, Burbank,

Pasadena, Los Angeles, Encino, Huntington Park, Studio City,

Arcadia, Montrose, Hollywood, La Crescenta, La Canada

Flintridge, Valencia, Monrovia, Eagle Rock, Altadena, San

Marino, Sherman Oaks, Thousand Oaks, North Hollywood,

Long Beach, Beverly Hills, Van Nuys, Santa Monica,

Calabasas, Palmdale, Fresno, Northridge, and Westlake

Village, and Simi Valley to have their “man boobs” or

gynecomastia improved with our special surgical technique.

Our Cosmetic Surgery center in Pasadena, California

specializes primarily in Cosmetic Surgery including

breast augmentation, liposuction, tummy tuck,

cosmetic facelifts, Forehead Lift, Chin and jowl liposuction,

Eyelid Surgery and other body contouring procedures.

The center led by an expert Los Angeles Cosmetic

Surgeon. Dr. Yoho has passed the

boards in Cosmetic Surgery and is dedicated to providing

high quality yet affordable cosmetic surgery options

to his patients and being the best cosmetic surgeon in Los Angeles 

  Glendale, Pasadena, and Beverly Hills.

Cosmetic surgery SEO

Michael Jackson’s death and drugs involved

Recent news reports have said Michael Jackson was using a variety of opiate narcotics, including oxycontin, Demerol shots, and was sleeping using an intravenous Propofol drip, just like the patients do in the intensive care unit. Patients who are as wealthy as Jackson can easily find an unscrupulous physician to give them whatever they want, for a price.

The dangerous thing here is the use of the opiate narcotics, and the drug combinations, which lead to unpredictable consequences. The common end point is difficulty breathing, and stopped breathing. If Jackson were in an intensive care unit or under the immediate supervision of an anesthesiologist, alarms would go off when he stopped breathing and simple measures to start him breathing again would be undertaken.

While it’s possible that Jackson suffered a heart attack or had some other cause of death—and we will know for sure only after the autopsy—it’s unlikely. Physicians are trained to think first of the obvious things, and of course it’s obvious that Michael Jackson died of a drug overdose.

We use propofol (Diprovan) as the only medication for our procedures. Our sedation isn’t general anesthetic, it’s “sedation” or “twilight sleep”. We also dilute Propofol about ten to one in sterile salt water and use a special micro-dripper to be sure it isn’t used very quickly and the patient is safe. The typical general anesthetic, on the other hand, employs on average 10 drugs under the supervision of an anesthesiologist. These medications additionally require a sophisticated post-operative care unit including monitoring for hours in order to safely recover. And many times nausea, vomiting, and bad feelings result during hours to days after the general anesthesia procedure is over, when so many drugs are used. We hate to see Diprovan getting a bad name because it was associated with Michael Jackson. It’s a fantastic medication for our patients and very safe when used by itself in the manner we employ it. More information is available at DrYoho.com. See particularly http://www.dryoho.com/dr-yoho-book/chapter13-1.cfm. A medical journal article Dr. Yoho wrote about his technique is at http://www.dryoho.com/dr-yoho/anesthesia.cfm. We no longer use ketamine, incidentally, just Diprovan.