Rock Climbing for Fitness

Can you get to the top?

Did you know that Dr. Yoho is an avid outdoorsman?

One of his favorite activities is rock climbing. He has been climbing for most of his life, mastering the tough skill during his sabbatical from medical school at age 22. He has climbed many peaks in the western US. But Yosemite is the place he loves most. He has climbed Half Dome (El Capitan) four times. Two of those climbs were: the Northwest Face in 18 hours (2004), and the "Nose” route in less than 24 hours (2005).

Dr.Yoho is interested in more than medical procedures. He has always had an interest in fitness and nutrition. He takes a holistic approach to his own activity and to the health of his patients. He recommends good diet and exercise. He also believes that psychological health is as important as physical health.

Rock climbing is actually great mental exercise, in addition to being great physical exercise. It requires lots of focus to get the techniques right. And for most people, there is an element of fear involved in clinging to a wall high off the ground. Overcoming this fear and literally reaching for the top can be a big mood-booster and confidence-builder.

When people think of rock climbing, they often assume that the activity is all about upper body strength. But in fact, it is one of the best full-body exercises around, requiring lots of involvement of the legs, core, and back in addition to the arms and chest. It is also an accessible activity. Even non-adventure types can take advantage of climbing walls in gyms. Many community centers and sporting stores offer instructions for beginners. Taking classes is a good idea, because rock climbing is intensively technical, although you might be surprised at how quickly you can pick up the basics.

Check out more information about Dr. Yoho here.

The Story of a Free Gynecomastia Case

We met this young patient through his mother, who was also a patient of ours. He had been teased so badly early in his high school years that he had dropped out of sports and withdrawn from many of his peers. We decided that this kind of case deserved pro bono treatment. Dr. Yoho performed gynecomastia surgery. Gynecomastia is more commonly known as "man-boobs" or "moobs". Some males develop breast tissue, typically during puberty. Although this is a pretty common condition, many boys and men who develop it feel self-conscious and isolated.

Boys and men can not only feel as self-conscious as girls and women, young men who develop this condition can even be embarrassed about feeling self-conscious. That very self-consciousness is seen as a weakness in some circles, and we all know how cruel our school peers can be. Many men grow up not wanting to take off their shirts during sports or at the beach. They feel embarrassed around their male peers, and extremely shy around girls or women as well. Even going to the gym can be a source of discomfort, and it's discouraging for these men to discover that no amount of fat-burning exercise can cure their condition.

Gynecomastia surgery is actually fairly simple as far as cosmetic surgeries go, and recoveries are usually relatively quick and uneventful, with excellent results. While nothing in surgery is guaranteed, gynecomastia surgeries have very high satisfaction rates. The process involves liposuction, and sometimes excision of a small amount of breast tissue. Many men are well on their way to surgical recovery within a day.

Post op, he's on his feet and recovering already!

We hope that we have made a difference in this young man's life. We are grateful to him for sharing his story. He agreed to let us publish his interview and photos online, which was very courageous. We hope his story will inspire others as well. While a few people still consider cosmetic surgeries to be for the vain and frivolous, Dr. Yoho has seen many times over what a real difference it makes in people's lives.

Get a Gilt City Deal for Discounts on Injectable Fillers

Look younger with Restylane or related injectable fillers. Purchase a current deal available on Gilt City: pay $49 for a voucher that will get you $100 off of a 1 mL treatment of Restylane (limit 3). Or pay $149 for a $300 voucher toward a 2 mL treatment. Vouchers can be used at participating spas, including the medical spa of Dr. Robert Yoho, located in Pasadena. Dr. Yoho says that the results obtained from noninvasive treatments like fillers are mostly dependent on the skill of the medical aesthetician, rather than the product. So make sure you are using an experienced and highly qualified technician.

These fillers (Restylane and related products) are hyaluronic acid fillers. They are used to fill in and smooth lines and folds of moderate to severe levels. Mainly, they are used around the mouth to fill in the lines that draw down the lower face as we age. For example, many people develop lines that run from each corner of the mouth down to the jaw on either side of the chin. Also known as marionette lines, these can really interrupt the smooth look of the face and are quite aging. The other major use for Restylane is in the lines that curve around the outside of the mouth from nose level almost to the chin. These are the “laugh lines” or “parenthesis” lines. Those with fair skin might notice that these first look red, and then become wrinkles as they age.

Restylane fillers can plump out wrinkles as described above, smoothing the appearance of the skin. In addition, some technicians can use them to fill the cheeks and even in the brow area. The good thing about hyaluronic acid fillers in the hands of a skilled technician is that the filler remains soft and smooth. Older types of fillers such as collagen can appear hard or even form lumps under the skin, so that there is a big tradeoff between getting rid of wrinkles or looking natural. Hyaluronic acid leaves a softer, smoother effect that can last for a year or more. They can even be dissolved if you don’t like the results.

Please call our office to schedule an appointment today. The Gilt City deal must be used by September 30. See the terms in the deal for other specifics.

Is It Important to Wear a Bra With Your Breast Implants?

I repeatedly emphasize to our patients that good bras are important or the breasts will sag. If they wear the bras and have support all the time, particularly for the first year when the scar is forming around the breast implant, often the breasts will be just as perky five years later as when the breast implant is placed. However, especially if the breast implant is a large one, the patient will have unpleasant, unnatural, and unsightly sagging of the breast. Here’s an example where the patient, in spite of all my admonitions, is wearing a very lightweight bra, at only two months after breast implant surgery. We recommended to her that she consider a heavier bra like the Bali Minimizer bra, and as always we told her to continue on her fish oil and Vitamin E indefinitely in order to keep her breasts soft.

Liposuction For Men - Six-Pack Abs

Did you know that you could have sculpted abdominal muscles from your liposuction procedure? There are new options available that can give you a chance to look your best. Dr. Yoho specializes in removing all the possible fat from this “six-pack” area of the abdomen and also injecting a little bit of fat in each square of your “six-pack.” This fat tends to be retained and creates a bulging muscular look. While the recovery takes a little longer than with ordinary liposuction, the results can be stunning. Additionally, we make a special effort to suction the fat from the creases of your abdominal muscles, thus creating more definition. Feel free to schedule a complimentary consultation about this exciting new procedure.

Information About Breast Surgery

We require patients to write out the following so they absolutely understand some of the complications of breast implant surgery: “There will be problems.” “We do not know what problems.” “I will feel the implant.” “I will have rippling.” “They will be unequal or asymmetrical.” “I will need to wear a bra to prevent sagging.” “Sometime in the future I may want or need a breast reduction or lift.”

After the patients write this, we discuss with them all the possible complications of breast surgery. Breast surgery has one of the highest satisfaction rates in our practice, and breast augmentation has been a mainstream procedure in America, with about 10% of women here having breast implants (at least in California). However, there are some problems. In the Allergan® implant study, a re-operation rate of 1 in 3 patients was found after 5 years for silicone implants. It is likely that the saline breast implants have a high re-operation rate also. The biggest problem is capsular contracture, which is a firming or hardening of the implants. This may occur in 5% to 10% of the patients who have breast implants. Fortunately, there are now some medical treatments for capsular contracture including fish oil, which I believe is an anti-inflammatory. We recommend a dose of 4 grams a day. Also, we have a medication called Accolate, which is FDA-approved for asthma. It is not FDA-approved for treatment of other conditions, and so this is an “off-label use of an on-label drug.” Doctors are allowed by law to use drugs that are approved for one disease to treat other conditions. Unfortunately, for Accolate, there have been a few reported instances of liver failure. The chance of liver failure seems to be one in several million per patient. By comparison, every person in America has approximately a one in 8,000 chance of dying in an automobile accident each year. In any case, we want our patients to understand that breast implants are not perfect.

One of the other complications we see, if the patients do not wear good bras, is a “rock in the sock” problem. That is when the skin envelope or the breast itself sags, and the implant sags down with it until you get a very saggy breast with an implant resting at the bottom of it. This can be prevented if a good bra is worn. We recommend wearing a bra at least during the day and, better yet, 24 hours a day for the first 7 to 8 months while the tissues are healing properly. We show our patients that a bra should put pressure on their shoulders and should lift their breasts. This is part of the advice we regularly provide during our complimentary consultation and during the postoperative process as well.


_______________________

Robert Yoho, M.D.

Advances in Breast Augmentation

Belly button breast augmentation or "TUBA" is one of the innovative techniques in breast augmentation surgery that has rendered obsolete many of the surgeries that leave scars on the breast, such as the through-the-areola approach. While some patients need to be treated by the through-the-areola approach because of odd-shaped breasts or other problems, the TUBA approach can put the implant in through the belly button without any scars anywhere near the breasts.

In experienced hands, this technique works wonders for many patients. It seems to have a lower rate of complications, such as capsular contracture, which is firming of the breasts. This complication accounts for the highest of all of the problem rates in breast augmentation surgery.

Dr. Peter Cheski pioneered and invented this technique, and Dr. Yoho learned his technique right from Dr. Cheski, working closely alongside him in his office over the years. Dr. Cheski was at the point where he could perform one of these surgeries in 10 to 15 minutes with virtually no help outside of a scrub tech and a sedation person who watched the monitor. He performed many tens of thousands of these surgeries over the years, and Dr. Cheski is regarded as one of the pioneers in breast augmentation.

Please come in for a look to see whether this procedure is appropriate for you. We love its results, but you must be evaluated before having the procedure.

Sculpting a Six-Pack

Did you know that there are new liposuction techniques that can get you more definition of your abdominal muscles than ever before? These new techniques include special aggressive suction of the fat in between the muscles, which can be done with ordinary liposuction or with other types of liposuction machines. Dr. Yoho’s belief is these new machines don’t yield any significant advantage. However, the real news is that a tiny bit of fat injected into the muscles of the abdominal area makes for greater definition and a much better result. This has to be done carefully and with experience, to ensure that the muscle squares are enhanced and improved. It helps to have good muscle tone before the procedure, but you don’t have to be slender. The liposuction itself can do that.

The Avelar Tummy Tuck

A relatively new procedure that we have performed is the Avelar tummy tuck. This form of tummy tuck provides a significant decrease in discomfort and/or complications experienced after the procedure. The incision used is similar to an ordinary tummy tuck, but in this new technique, sewing together the muscles is usually not done or not done as aggressively. First we use liposuction to thin the area prior to the removal of the skin, so as to loosen the skin, rather than just making a large hole between the muscle and fat and pulling the skin above the navel down. By using liposuction before the procedure, attachments to the skin are largely left intact, so blood circulation is in theory preserved, despite the removal of a large amount of skin from the lower abdomen.

An alternative to the Avelar tummy tuck is a simple dermolipectomy. This is a fancy name for removal of much of the skin of the lower abdomen without interference with the belly button area or the upper abdomen. These areas can then be reshaped with liposuction. The Avelar tummy tuck, on the other hand, does involve manufacture of a new belly button and stretching the upper abdominal skin all the way down to the upper groin area.

Latina patients benefit greatly from these procedures, because their skin often tends to be thinner, which can result in a less-than-perfect skin recovery after childbirth, with some stretch marks and looseness. We prefer to recommend the more conservative or less invasive procedures rather than more invasive, more risky, and more costly procedures, which can also involve more scarring. For example, we usually recommend the dermolipectomy more than the Avelar tummy tuck, and recommend the Avelar tummy tuck more than a normal tummy tuck. The risks, the scars, the cost, and the other problems are just not worth the extra investment of time and the more difficult recovery for these more complicated procedures, even if they are considered the “traditional approach.”

In fact, Dr. Yoho often recommends simple liposuction, and with his technique, the “no scalpel tummy tuck,” in many cases no skin removal is necessary at all, and the skin will shrink to fit. Sometimes a little loose skin is left above the belly button, but this is a small price to pay for not having a scar that extends from hip to hip and avoiding a very difficult recovery of perhaps a month or more, the pain and aggravation of more anesthesia and more surgery, and a higher price.

_______________________

Robert Yoho, M.D.

What's the Difference Between Juvederm and Restylane, and What's the Difference Between Botox and Dysport?

Hut at Baldy-Nothing to Do With Injectables

The two companies that manufacture these products are in direct competition, and they have done a great deal to confuse the value of their products in order to try to increase sales and compete with each other. The fact remains that in my opinion there is no substantial difference between Botox and Dysport. Dysport is measured in a slightly different unit measurement, but when all is said and done we mix it the same way and we deliver it the same way, and the costs are very close to Botox, although Dysport is a little cheaper for us. The chemical natures of the two products both produce the same wrinkle relief if administered in the same way, and the side-effect profile is almost the same (which is almost nothing).

As for Juvederm and Restylane, these are both hyaluronic acid products, and this certainly doesn’t mean that they burn! They are both reconstituted or mixed with a tiny bit of numbing medicine called lidocaine, which aids in the less painful (or virtually pain-free, in some cases) injection. They probably last a similar length of time in the body, which is perhaps a year. It’s our belief that these products last two years if delivered in larger quantity because the body’s natural mechanisms to break them down are slower when a larger quantity is used. They both stay soft in the face, and don’t generally produce any lumps, and both can be dissolved very easily with another injectable if you don’t like the results. While chemically a little bit distinct, they are essentially in the same class of usefulness, and both produce beautiful plumping effects of the face when used properly in the cheeks, lips, the folds around the mouth, and sometimes even the brows. The expertise of the person injecting is the critical factor, rather than the product.

I hope this clears up some confusion, but remember when reading anything from a manufacturer: it’s all about marketing. Get the straight scoop from your health-care provider.

The Biggest Issue in Breast Implants Part 3: Breast Implantation Issues

Judy in Trinidad

How is capsular contracture or hardening of the breast implants treated?

First, as mentioned in the past essay, we attempt to prevent this by encouraging the consumption of fish oil and Vitamin E. These home remedies are not clearly established to prevent capsules, but there is a lot of circumstantial evidence suggesting that they do.

Second, if you have a capsule, there are various remedies, and one of the things that has been thought to work is a medicine for lung disease called Accolate, or another related medicine called Singulair. These brand-name medicines are commonly used by lung doctors to improve lung functioning in certain kinds of asthmatic and other conditions. They have a very small statistical rate of some serious problem, so be sure to talk to your doctor about these before taking the medicines. In any case, they're expensive and they need to be taken for four to six months in order to be effective. The earlier you catch your capsule, in other words, the softer the breast is before starting the medicine, the better chance you have of correcting the problem with a medication.

We also increase the fish oil to a higher dose, although as stated before, this is not clearly known to be effective. We have seen interesting cases in which a person who stops taking their Vitamin E or fish oil and develops a capsule within a month, but of course, this doesn't prove anything for sure.

Surgery for capsular contracture is problematic, because the chances of the problem coming back are very, very high after most any surgery. The traditional approaches include removal of the capsule, which sometimes is difficult, especially under the muscle, and replacement of the implant in a different plane. This means that if the implant was above the muscle, you put it below the muscle; and if it was below the muscle, you put it above the muscle in the secondary operation. The chances of a return of the hardening of the breast after these surgeries is a disappointing nearly 50 percent.

Unfortunately, the Allergan study, which encompassed many, many thousands of women with breast implants and silicone gel implants, had a secondary operation rate of about one in three after seven years. This means that you must not view these things as a permanent solution to small breasts unless you're lucky.

Judy, my wife, has had her implants for about 15 years and has never had any problem except for a slight firming on one side, so she might be the exception rather than the rule.

Best of luck, and if you get breast implants, be sure you have a good surgeon who will be happy to follow you for any problems afterwards.

The Biggest Issue in Breast Implants Part 2: The Advantages and Disadvantages of Various Breast Implant Techniques

Seattle Port at Night 2

Part 1 covered some of the aspects of above versus below-the-muscle implant placement. One more note about this issue: There was a large-scale study over 20 years ago that showed that with silicone implants that there was a higher capsule or hardening rate with over-the-muscle implants. Subsequent studies have not shown this to be true, so even though this remains as an urban legend, it probably has not been verified. It probably isn't the case.

This brings us to the subject of this essay, hardening or firming of the breast implants or "capsular contracture." Capsular contracture is the most likely complication after breast implantation, and many studies show that rates are about 5 percent or 1 in 20. When capsular contracture occurs, the breast implants become hard and sometimes progressively so, to such an extent that the women can't stand it and want them removed. Most capsules have no significant health impact, but they can be uncomfortable and be cosmetically unacceptable.

The things we try to do to avoid a capsule after the breast implant surgery are threefold.

First, we encourage the use of good-fitting bras (this also helps decrease problems with the implants descending).

Second, we encourage postoperative patients to take fish oil. Fish oil is an anti-inflammatory and we think that it decreases the capsule formation, although this has never been formally studied and may be another urban legend.

Third, Vitamin E at doses of 400/800 International Units a day also helps decrease the chance of a capsule formation.

No one really knows what causes these complications, but certainly if you have some inflammation or an infection or extra blood around the implant, these all typically do increase the risk of capsule formation. But most capsules are of unknown cause, and some women just seem to be capsule-formers. It's possible that the breast ducts which connect with the outside in some women are colonized or infected with bacteria and this may contribute to capsule formation, but this is unclear.

Certainly if you're lactating, your chances of a capsule are much higher, and so for this reason we recommend that you not consider breast implantation for a full three months after having your baby (if you do not breast feed) or after stopping breast-feeding.

The Biggest Issue in Breast Implants: A 3-Part Series

Pasadena's Natural Beauty

 Part 1: By far the most important choice you will make in your pursuit of bigger breasts is whether to put the implant above or below the muscle. The muscle is a wildcard that produces many effects, not all of them good. Understanding all of these options and possibilities is very important. 

We recently took the Sports Illustrated swimwear, swimsuit model edition, and analyzed the problems with the women's breast implants. Many of the under-the-muscle placements had resulted in the implant being pushed out toward the side and down. The girls in the Sports Illustrated photographs were often holding their breasts toward the middle, and many times the implant had dropped or been forced down lower than it might naturally have done so by the muscle action. 

Under-the-muscle implants are supposed to produce a more natural curve in the upper part of the breast area, and perhaps they do for a while. However, eventually most "under the muscle" implants get pushed down so the muscle is no longer really covering them. 

Of course, it's possible and even likely that over-the-muscle implants droop also, unless they're protected by a good-quality bra most of the time. These implants, however, tend to sag straight down. 

Efforts to repair problems like these are relatively hazardous compared to the initial implant surgery. The medical journals are full of reports of nipple areolar area death and a higher infection rate and other problems due to attempts to improve breast implants. 

One particular article I show the patients who want surgery because their breasts have stretched out, and this article shows in living color nipple areolar complex or nipple areolar area skin death and loss of the nipple and areola. 

Even though breast implants have problems, they are still the most popular and the highest satisfaction cosmetic surgery we have. Women who improve their bustline often feel much more confident and are able to perform at a higher level in many ways. 

Fish Oil Is Just Fantastic Stuff, or: Everything You Wanted To Know About Fish Oil but Were Afraid To Ask

Fish oil has been shown in studies to be an excellent anti-inflammatory. It actually has been used for rheumatoid arthritis to decrease inflammation and pain, and it really works as been proved by scientific study. We use it to attempt to decrease breast firmness after breast implantation, which is the most common complication. Capsular contracture or breast firmness occurs in at least 5% of all breast implants and it is a very aggravating problem for both surgeon and patient. It’s our belief that taking fish oil in reasonably large doses, perhaps a teaspoon a day or more of the liquid fish oil (the equivalent of five of those large 1g pills) can be very useful. The best fish oil is refined fish oil which has had the mercury removed. We recommend Nordic Naturals, Carlson, or Eskimo brand fish oil. Nordic Naturals has the biggest reputation, but it may be more expensive. Buy oils online because they are costly. Nordic Naturals is available in several grades. It is important to become knowledgeable about active components in the fish oil and consider buying the more expensive types. We use larger doses at times to combat capsular contracture.

Fish oil is also good for certain kinds of heart problems, and is heavily recommended for people with high triglycerides, which is part of the cholesterol problem. Dr. Yoho takes fish oil every day for an arthritic ankle and so he is certainly an advocate himself.

Aftercare - Emotional Reactions to Facial Surgery

Dr. Yoho's vacation tent at night

A significant number of people have a very strong emotional reaction to the change in their appearance. Depression is common, and this sometimes lasts for months. If you have a history of depression or other psychological problems in the past, this can even last longer (please inform the doctor before the surgery). Many people have problems adjusting to any new appearance, even if it is better! We recommend that you brace yourself for a rough psychological recovery. If you have an easy time, you will be pleasantly surprised. And brace yourself for reactions from your friends and acquaintances: they will vary from jealousy to supportive behavior. Some will nit-pick any flaw, despite an overall good result.

Your face is the first thing that people see when they meet you and the first thing that people respond to. For many people, their face represents their identity. Therefore having facial surgery may bring along with it some emotional readjustment. In this post are detailed some of the possible emotional reactions to your surgery.

In the first days after your procedure you may find that you are sleepy or tired. This is a normal physiological reaction to surgery and indulging in it and resting may help you heal faster. By contrast, some people find themselves feeling unusually energetic and may require less sleep than usual. Excitement at having done something very special for yourself and/or your loved ones -- improving your physical appearance through facial surgery -- may have provided you with this extra boost of energy. The prednisone we gave you may have helped, too.

At the same time, it is important to acknowledge that you may go through several different stages during your recovery -- not all of them easy.
If you are wearing a full-face bandage, you may find the bandage cumbersome, and it may affect your ability to do the things that you normally do for yourself. Some people find that their peripheral vision is affected. People wearing contact lenses will be unable to wear them for a few days. Those wearing glasses may find it difficult to put on the glasses over the bandages and/or may have difficulty retaining the glasses in place because of the cream or Vaseline on their nose. The net result will be greater difficulty accomplishing many of the tasks we all take for granted and a decreased feeling of competence. You may find yourself becoming more dependent on people around you and if you live alone, you may need to seek out others' help for a few days until you are able to accomplish things on your own. Hopefully you have made arrangements for friends or family members to help you as you begin your recovery.

Because it is likely that your eyes, face and lips may be swollen and may continue to be swollen for some days and possibly weeks, you may find yourself self-conscious about your appearance. Once your bandage has been removed and your facial skin continues to be red and to peel, your self-consciousness may increase. Well-meaning strangers may ask you what happened to you. In addition, it is likely that family members and friends may have some difficulty with the changes in your appearance during the healing period. In particular, young children may be frightened by your bandage and by your appearance during the early days. It is important to prepare them (and yourself) for these changes and to reassure them that you will eventually look much more attractive. You may also want to prepare yourself for the physical discomforts of the bandages, the necessary applications of ice, Vaseline, and creams and the sensitivity of the new skin which the laser peel has revealed (if this is the type of surgery you had).

Patients who are very invested in their appearance (and who isn't?) may become impatient with the length of the healing process. For some, the redness of the skin is a very temporary thing. For others it may last some weeks to even months for about 20% of patients. Since everyone heals at his or her own pace, it is impossible to predict for any given individual how long the healing process will take. Fortunately, make-up can cover the redness. For some, however, foundation make-up will be an imperfect cover-up especially when the new skin is still peeling or very dry. Patience is critical during this period and the knowledge that the end product will be worth it may help the individual make it through discouraging periods.

Why You May Not Need That Lower Eyelid Bag Removal or Blepharoplasty After All

Luxury camping!

The removal of the fat from the lower eyelid has fallen more and more into disrepute. This fat supports the eyeball, and even if it's sticking out a little bit, there may be other solutions to improve the appearance that are better than its removal. In fact, the problem is likely to be more a shrinkage of fat in the cheek rather than an excess fat in the lower eyelid. This cheek fat shrinkage can be improved with a number of methods, including injection of fillers and insertion of cheek implants. 

The fillers are primarily hyaluronic acid these days, which is a natural substance existing in the human body. Contrary to how it may sound, it's not a burning acid. It's simply a biosynthesized component of human tissue which has no allergenicity, or potential to cause allergy. This substance is injected nearly painlessly into areas of deficiency of fat and soft tissue in the face. Common brands include Juvederm and Restylane.

On the other hand, a more permanent solution and possibly a more aesthetic solution are cheek implants. Did you know that Dr. Yoho has cheek implants? You can check him out when you come in for your consultation. These are inserted through the mouth and can be easily taken out in less than five minutes if you decide you don't like the effect. Please be aware that some swelling occurs after the procedure, and you should wait for at least a month or two before you make a decision to take out the implant. 

In any case, consult with your surgeon before "ordering up" your lower lid fat removal. Your surgeon can sometimes direct you to more aesthetic or beautifying options, which may flatter your face a great deal more than simple "bag removal" of the lower lids. 

Now, most people have wrinkles of the lower lid area and this can be improved with either removal of a little strip of skin or laser resurfacing, depending on your skin type and desires. Consult with Dr. Yoho about this at the time of your consultation.

Dr. Yoho's Recent Experiences with Athletics

Dr. Yoho and Judy Yoho enjoying the great outdoors

Dr. Yoho was an enthusiastic amateur athlete who did a lot of climbing, biking, and other activities in the outdoors. However, with a rock-climbing fall in 2008, he's had some pain in his left foot when he walks. For this reason, he has cut his training down to conditioning level, and although he does exercise every day, unfortunately he can't look forward to all of the outdoor activities that he used to do. 

 Currently he's very interested in kettlebell training, and is being trained by a registered kettlebell instructor. The kettlebell exercises are limited to only four main types; a sort of a swing between the legs and up in front of your body, an Olympic-style clean and jerk and Olympic-style snatch, and finally a special exercise called Turkish getup. This odd and slow exercise that was mentioned last can be looked up on the Internet and observed, and it is a very powerful exercise for strengthening the core muscles, including the low back and the abdominals. Dr. Yoho is able to do this exercise with 55 pounds several times. 

The other thing he is still able to do is ordinary weight-lifting and Bikram Yoga. With the Bikram Yoga, he is able to stay flexible and although he suffers in that heat, he thinks it's good for him. 

If you have questions about diet and exercise and you are Dr. Yoho's patient, feel free to ask them at your follow-up visit or your consultation visit.

 Dr. Yoho's Background 

Did you know that 2011 represented the 20th year that Dr. Yoho has been practicing cosmetic surgery? 

He has earned various awards and passed many tests in his progress towards his current level of expertise. He passed the boards in the American Board of Laser, and also is Board-certified in Emergency Medicine, the American Society of Medical Specialties. This last certification is an extra safety factor for his patients. He additionally passed the boards in cosmetic surgery, and is one of only two surgeons in the country who passed both the cosmetic surgery boards and is also Board-certified in emergency medicine.   

Dr. Yoho has trained over 50 physicians who have observed him in his office and given preceptorships for them and is currently and will be the president in 2012 for the American Society of Cosmetic Breast Surgery. 

He has presented over 20 times at national meetings, most recently in 2011, and also has published in scientific journals for cosmetic surgery over 20 times. He attends between four and ten cosmetic surgery educational meetings every year. 

His office experience encompasses more than 10,000 surgeries, and we think that our best recommendation is that over 95 percent our patients are either return patients or referrals from other cosmetic surgery patients. 

What is Body Dysmorphic Disorder (BDD) and Do You Have It?

True body dysmorphic disorder has to do with people thinking that one particular part of their anatomy is exceedingly deformed or completely incompatible with their happiness. We do see people with problems and do make great improvements in their looks and self-esteem. Most people don’t have this BDD diagnosis. This sort of person would be obsessed about something that to others looks like a minor issue. People suffering from BDD will insist over and over that their problem needs to be corrected. When a surgeon operates on an individual like this, sometimes they end up performing multiple operations, trying to make the patient happy, and no one, surgeon or patient, is satisfied.

This does not mean that we consider you to have body dysmorphic disorder if you think you need a touchup. The fact is that most individuals who want touchups are quite reasonable in their requests and have completely clear expectations about what to expect. They just need our advice about what is possible with touchup procedures. Please don’t hesitate to ask for improvement surgery after your initial surgery, because this often can effect a much more satisfied patient with improved results. As long as you are not obsessed with details, and can objectively listen to the surgeon’s opinion on what’s possible and what isn’t possible, BDD is very unlikely to be an issue.

All the best,

__________________________________


Robert Yoho, M.D.


You Are Always Welcome in Our Office, No Matter How Long it’s Been

We have patients who are embarrassed to come back and see us, even ten years after the procedure, because they’ve gained weight or they haven’t taken care of themselves or they’re afraid there’s going to be some sort of charge.

Consultations are always free, and we particularly love to see our established patients back years after the event to see how they’ve done, see what’s happened in their lives, and let them know what’s happened in our lives. Our door is always open to any of our friends who just want to drop by and say hello and/or discuss another cosmetic issue or ask us what’s new. Visit my Los Angeles cosmetic surgery website for Liposuction Los Angeles and information about all the procedures available.

I don’t like to call these people “old patients” because it’s getting so I’m the “old doctor” and they’re the “young patient.” I like to call them established patients!

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Robert Yoho, M.D.

Did You Get Too Much Sun This Summer?

Surgeons take nights off too!

We have a lot of patients who forget to use their sunscreen during the hottest part of the year, when the sun’s rays are most direct. They forget that between 11:00 a.m. and 2:00 p.m. 80% of the sun’s rays are cast on the Earth, and the advice of the dermatologist is to be very careful during this time. Wearing a hat and using your sunscreen is the best way to protect yourself from conditions ranging from brown spots to wrinkles to skin cancer, but this advice is often ignored. Our dark-skinned patients in particular sometimes forget that they would benefit from sunscreen too, because their skin doesn’t usually get burned, but their pigment problems can actually become worse than a light-skinned person and they can have a lot of dark and lights spots that affect their looks and perceptions of their own attractiveness. 

We recommend Fallene sunscreen, which can be obtained at drugstore.com or at many pharmacies. This is a stronger sunscreen which has both chemical and physical sun blockers. A physical sun blocker is the addition of tiny little particles of metallic substance into the base of the sunscreen, and if you rub it in, it rubs in clear but protects the skin. 

The good news is that if you’ve forgotten your sunscreen this summer and have some areas that look dark or sun-damaged, or your complexion is a bit muddy, you can come in for our fractionated laser treatment and have your problems improved. This treatment is partway between an invasive and a non-invasive procedure, and is a little bit rougher on the recovery side than other less effective treatments such as photofacials. We really love our results, and have had a wonderful experience even with dark-skinned individuals who would react badly to ordinary laser treatments. This can be done with either just a cream anesthetic or the use of sedation, which is performed at no extra charge at Dr. Yoho’s office. Our charge for a full-face laser is $800 we can include your neck and chest area for just a bit more. 

Please call for a complimentary consultation.

The Issues About General Anesthesia Sedation versus Local Anesthesia

Falls in Argentina photo by Dr. Robert Yoho

 We have many times emphasized in our information on our website and to our patients that we think that the light sedation that we use, which does leave the patient without any memory of the procedure, is by far the best way to go. Confusion arises with this because using pure local anesthetic the way a lot of people do, including the rapid facelift and the weekend facelift surgeons, often leaves the patients terrified and there is some pain involved. Our anesthetic, on the other hand, leaves the perception of general anesthetic, with no memory of the procedure in 99.9% of the cases, and we feel the risks are minimized and the discomfort is also minimized. Very little post anesthetic reaction occurs, with the chance of nausea, vomiting, and other bad feelings from the anesthetic being minimized.

General anesthetic is used by many well-meaning and well-trained surgeons who just haven’t found out just how to achieve good sedation without using all those heavy drugs. General sedation also requires an anesthesiologist to put the tube in the throat, and the attendant risks of general anesthesia. These surgeons generally have been trained in a hospital and are used to doing things just one way. They don’t understand and haven’t taken responsibility for the anesthesia care of their patients.

Dr. Yoho, on the other hand, as a Board-certified emergency room physician, is confident about his ability to manage patients who are sedated and his ability to give them a comfortable experience. This has been well-established after tens of thousands of cases of experience. Dr. Yoho gets as many cases as a lot of anesthesiologists get each year. We do use local anesthetic if the patient requests it as a sole or single agent for the pain relief, but we don’t usually recommend it. We recommend at least a touch of relaxation medicine and more likely our version of the single medication sedation technique that we advocate, have perfected, and have published articles in medical literature about. You can read more at DrYoho.com. You can read Dr. Yoho’s original article about this technique, which has been adopted by many surgeons across the country.

An additional advantage of your anesthesia at Dr. Yoho’s office is that you save money. Not only are the medications much less expensive than medications used for general anesthetic, but the extra expense of an anesthesiologist is avoided. Instead of an anesthesiologist, we have a fully licensed physician’s assistant who is competent to administer this medication and has been doing it for many thousands of cases. Dr. Yoho is also involved and we watch you very carefully with the standard monitoring technique that’s used in a surgery. The very cheapest of these medications, which are the Morphine/Demerol class drugs, are not used, and our technique does cost us a little more than this, but it’s much cheaper to make you comfortable using these modern medications than it is to have the anesthesiologist use a gas anesthesia or the many different drugs that are typically administered in general anesthesia.

All About The Total Makeover

Robert Yoho, MD playing with his daughter

Generally, facial procedures are done “all in one.” In other words, facelifts, eyelids, cheek implants, chin implants, noses, and laser resurfacing are often performed at the same time. This has been the traditional approach and is felt to be reasonable by the medical community. 

 However, the “total body makeover” where all this facial work is done and then breasts and liposuction are all performed together we think represents an extreme risk. One of the problems with this involves anesthesia time, which increases the problems with blood clotting and other medical issues related to the anesthesia. Surgeries over a couple of hours to us seem relatively unreasonable, although sometimes our facial surgery or breast lift will extend three hours or a little more.

So beware of the “total makeover.” We think that it’s easier for you and makes more sense to approach these things stepwise, thus getting to know the quality of your surgeon and the quality of the results bit by bit.

Am I A Surgical Candidate?

Dr. Yoho and friends in Argentina.

You are a surgical candidate if a number of things come together. First of all, you have to be psychologically ready for a surgery. Sometimes these things are stressful and sometimes they’re not, but you have to be willing to undergo the stresses of the possible complications for any of these given surgeries, however unlikely they are. Most cosmetic surgeries are comfortable and their post-operative recovery for most people is very modest, however. 

Second, you need to have good physical characteristics for the surgery that you desire. The doctor will help you understand just what kind of result you are likely to expect. For example, a woman with medium-sized breasts and a lot of breast tissue can get spectacular results with breast implants in most cases. A woman with long, skinny breasts sometimes needs reconstructive surgery and some of these surgeries come out better than others. Liposuction works very well for people with a lot of fat just under the skin surface, but doesn’t work at all for people with fat underneath the muscle wall. 

Of course, you need to be able to afford the procedure, and you need to be able to take the time off. If you are too busy to take the time off, many of the noninvasive procedures we do can, over time, make improvements that are as significant or nearly as significant as the invasive procedures. For example, our fractionated laser repeated several times can produce a fantastic result, and if you stay out of the sun and use Fallene sunscreen from drugstore.com (for example) and Retin-A over a year or two, you can get a fantastic result that rids you of wrinkles and really in many ways is as good as the invasive procedure which requires the two-week recovery and the possibility of more complications. 

Fillers can approximate a facelift for the right individual, replacing the fat and restoring the contours and form of the aging face to a younger contour, and when performed in conjunction with Botox and the resurfacing modalities, can be spectacular indeed. But the noninvasive procedures, remember, can be easily as expensive as the invasive procedures and require coming back to the office a lot.

The Insanity of the Modern Tummy Tuck

Trinidad beach scene-by Dr. Yoho. Nothing to do with tummy tucks.

I am concerned about the fact that the Los Angeles tummy tuck has become synonymous with plastic and cosmetic surgery in some contexts. The fact is that this operation is not indicated in most cases. A tummy tuck or abdominoplasty is a major surgery which has a fatality rate of one in 3,000, according to the best medical literature we have. Older studies had a fatality or death rate of one in 625 surgeries. The patient is cut all the way from hip to hip. The fat and skin is separated from the muscle. The muscle is usually tightened, and a large portion of skin and excess fat is removed and then the patient endures a recovery which can last for many months.

Modern liposuction can accomplish many of these goals and for most patients it is the preferred alternative, even for very overweight patients. Recovery from liposuction is very modest compared to a tummy tuck. The death rate for liposuction may be as low as one in 50,000. Although after a liposuction with a large patient, some saggy irregular skin is to be expected, the skin shrinks to a much greater degree than most people would expect. It’s not like cutting and pasting a paper bag. The skin is the magic organ of the body, and just like after a pregnancy, after a liposuction the skin shrinks a great deal. Particularly helpful in this regard is the irritation that is produced by the liposuction process itself. This irritation or injury process accelerates and helps the shrinkage of the skin.

Nothing is perfect. Liposuction can produce irregularities, and just like abdominoplasty, major complications can occur. However, let the reader imagine the number of hospitalizations, major blood losses, and blood clots to the lungs and legs that occur with tummy tucks versus liposuction. It’s a ratio of ten to one or greater with the much safer procedure being liposuction.

Large-volume liposuction, or removal of more than five liters of fat, has become a standard and much safer procedure for the modern surgeon and the contemporary patient. We believe that this can be accomplished safely and efficiently in our hands, using our techniques, with a very modest risk. These surgeries result in very gratifying results, and if extra skin remains after the procedure and the patient is willing to have a secondary touch-up procedure, this can be removed much more easily than when the patient presents with all the fat to begin with. In other words, a second relatively inexpensive surgery can make a result with a smaller scar and less risk of major problems after a liposuction than trying to do it all at once. Particularly risky is the practice of doing a large liposuction and cutting skin out at the same time. This procedure can result in areas of skin death or problems of other kinds, including infection or sometimes other problems.

My firm belief is that liposuction under general anesthesia, particularly large-volume liposuction under general anesthesia, is connected with a much higher risk. My technique involves sedation and local anesthetic combined with two operating professionals who remove the fat rapidly and expose the patient to a much shorter operating time and less medication.

So if your surgeon recommends a tummy tuck, shop this around and be sure this is what you want. Look at pictures online and see Los Angeles cosmetic surgery website in particular to see if there is another part to this story that you haven’t heard.

 Be careful out there.

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Robert Yoho, M.D.

Fat Transplant Problems and Opportunities

Fat transplant has become an increasing trend in the last few years. Transplantations can be performed on various areas, including to buttocks, face, and breast. Buttocks fat transplant is done in Dr. Yoho’s office almost every week. We’ve had experience that may extend to a thousand patients. We have seen very few complications with it because the fat is sterile. It’s kept sterile through the use of enclosed containers and is transplanted almost immediately back into the patient’s own tissues. However, when the volume of fat is increased to large quantities, the risks of problems become higher and higher because the buttocks’ blood vessels and supporting structure can only take so much of the new material before areas of fat become isolated and susceptible to infection. We have seen this in several cases where very large quantities of fat were used. The result is a prolonged recovery and an unhappy patient, intravenous antibiotics and procedures to wash whatever fat we can out of the buttocks. For this reason, we’ve limited our volume to a sensible amount and don’t claim to produce very full buttocks with one procedure. That said, repeat procedures can be done and improvement is progressive.

Facial fat transplant, of course, has been of great interest to the cosmetic surgeon for at least 15 years. Transplant of tiny amounts of fat to the cheek areas around the brow, the lips and chin, and even the muscles of the jaw produce very pleasing results if done carefully and by an experienced surgeon. It’s a bit tedious, but the tiny amounts of fat transplanted make for very smooth results. The problem here is that in the case of massive weight gain later, sometimes the patient ends up with a very fat face. This fat transplant to the face, if done properly, is permanent or at least very, very long-lasting. The general rule of thumb is that what you see is what you get after about three to four months.

Breast fat transplant is a very different kind of procedure. We do perform breast fat transplant and have experience with hundreds of cases, but it basically doesn’t work in breasts that are very, very small, because the breast can’t support and give nutrition to the new fat if there’s not much breast to begin with. For larger breasts, breast fat transplant is successful and can make them even larger. The most important point for the potential patient is to understand that they’ll never get an increase in size anything like a breast implant. However, if this is successful, breast fat transplant produces natural results and rarely any mammogram changes. The fear of the mammogram changes looking like breast cancer is generally misplaced, although I suppose it’s possible. The mammogram changes that show breast cancer are relatively characteristic of breast cancer, and any breast surgery can produce calcification and scarring that is visible on a mammogram that doesn’t look like breast cancer. That said, the small possibility of a biopsy for breast fat transplant in the future mistaken for breast cancer must be factored in by the potential patient. We’ve actually never seen, in our practice, abnormal mammograms after breast fat transplant. They always seem to come back “interval increase in breast size with no apparent other change.” 

In any case, there are risks and the patient should be aware of it all before fat transplant. This article isn’t complete and you need to speak with Dr. Yoho about your specific situation and he can tell you what to expect and what the potential problems are for your case and your body type. Please visit Dr. Yoho's main website for more information on many types of cosmetic procedures. Here, you can also find contact information to make an appointment for your complimentary consultation.