New Body Cosmetic Surgery Forum

Interview Dr. Yoho on NBC about dangers of plastic surgery

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 30 Oct 2009 20:10:00 +0000

This video is all about the risks of abdominoplasty or tummy tuck. At Dr. Yoho's office, we are frequently able to do the "no scalpel tummy tuck" to avoid the hazards and difficult recovery of a tummy tuck. This often involves large volume or "megaliposuction". No general anesthesia is involved and for the most part our patients go home that day after the surgery after our technique for sedation. Donda West's mother's Los Angeles Cosmetic Surgery death is commented on.

LASER LIPOSUCTION, WATER PRESSURE LIPOSUCTION, SMART LIPOSUCTION, ULTRASONIC WAVE ASSISTED LIPOSUCTION, ULTRASONIC SUCTION

noreply@blogger.com (Robert A. Yoho, M.D.) — Thu, 29 Oct 2009 20:36:00 +0000

Dr. Yoho recently attended and spoke at a national conference in San Diego devoted entirely to liposuction. His talk was liposuction techniques, complications, and patient management issues. A summary of this should be in this blog soon. The conference was devoted to new methods of liposuction and Dr. Yoho’s conclusion about Los Angeles liposuction was that the new liposuction techniques were very unlikely to offer anything other than an increased complication rate. We do offer Smart Liposuction but think it’s added value is minimal to nonexistant. Laser assisted liposuction of various types were discussed as well as ultrasonic liposuction and a new liposuction method called water pressure spray – assisted liposuction. When you add another energy to the procedure, in an attempt to produce an effect such as skin shrinkage, complication rates may be much higher. NONE of the presentations showed real scientific evidence of improved results. Such science could have been using half the body with the new technique(s) and the other half with traditional technique. Please note that ordinary liposuction causes great skin contraction and check Dr. Yoho’s photographs at DrYoho.com for evidence of this.

FRAXEL VERSUS THE NEWER FRACTIONATED CO2 LASER LOS ANGELES/PASADENA COSMETIC SURGERY

noreply@blogger.com (Robert A. Yoho, M.D.) — Tue, 27 Oct 2009 22:25:00 +0000

This friend is considering having a fractionated CO2 laser treatment. In consideration for letting me use his photo, it's at no charge. This photo was taken in the Sierra.

Fraxel is a laser that delivers very small amounts of energy to the face and has been used for non-invasive treatments to the face for several years. In fact, it has almost been a fad and the name Fraxel has been taken by the laymen to denote many of the popular non-invasive treatments. In fact, for the high expense and the minimal result, it is my opinion after experience with the fractionated CO2 laser that the Fraxel is not worth all the money and height that has been spent on it. The new fractionated CO2 lasers including our new SMARTXIDEDOT®, are more effective and produce very little in the way of long term problems or complications.

The best thing about these lasers is that although a moderate recovery is necessary, the complication rate is very low. In other words, darkening or lightening of the skin is not seen often and it is generally very mild if it occurs. Scarring is almost unheard of when the laser is used properly. And for pigmentary problems, our laser and this group of lasers is excellent. See DrYoho.com for another article about CO2 fractionated laser.
Wrinkles are improved somewhat, but this requires a deep treatment. The most important concept about laser and peels and skin work on the face is that the more aggressive treatments will yield a more aggressive result or a better result and somewhat higher risks for complications. Less aggressive treatments in my opinion do almost nothing and this includes micro-dermabrasion, which has very little to no long-term benefits.

In any case, the fractionated CO2 laser does thousands of tiny treatments to a given surface of the face, spraying the face with laser treatments, leaving bridges in between the treated areas. We use this for both Fresno laser treatments and for Pasadena/Los Angeles laser treatments, as we transport the laser to the Central Valley for cosmetic surgery there. These tiny laser treatments are actually pits or holes in the skin, which will heal and through this healing process improvement occurs. Typically, the patients have a little flaking for 4 to 5 days, some redness, and do not need any time off unless they cannot explain away the redness to their coworkers as a sunburn. We recommend just Cetaphil treatment as the only necessary cream treatment for the face during the first few days. Makeup can likely be reapplied on day 4, although this varies on the depth of the treatment.

Now when you request a fractionated laser treatment at our Pasadena or Fresno/Visalia area office, we are happy to provide a deeper treatment or a more superficial treatment. It does not take much longer and we are happy to not charge any more for a more aggressive fractionated laser treatment. This is certainly much more aggressive than the Fraxel laser in general. You will have a bit of a tougher recovery however so plan accordingly, but there is no extra charge.

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, Visalia, Northridge, and Westlake Village, and Simi Valley to have their appearance 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 is lead by expert Los Angeles Cosmetic Surgeon Dr. Yoho, who has passed the Boards in Cosmetic Surgery and is dedicated to providing high quality yet affordable cosmetic surgery options for his patients and being the best cosmetic surgeon in Los Angeles, Glendale, Pasadena, and Beverly Hills.

EAR COSMETIC SURGERY

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 09 Oct 2009 20:59:00 +0000

The above photo is of Dr. Yoho and some friends and one daughter standing on a rock in the middle of a very cold pool of water at the base of Yosemite Falls this year.

I found a fantastic reference for how ears are taken care of on one of my friend's website.

This shows just how we are able to sew the ears back to make them sit against the head better. We also do the same keloid work that Dr. N so beautifully describes.

FRACTIONATED LASERS AND CO2 LASERS IN PASADENA / LOS ANGELES COSMETIC SURGERY

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 09 Oct 2009 15:33:00 +0000

This photo is unrelated to the post. This is Wesley Harline, MD, who was one of the greatest cosmetic surgeons in the world and one of Dr. Yoho's mentors. He passed away August 2009.

Prior to about the year 1993, we only had acid peels as resurfacing techniques. These peels consisted of the several different acid treatment options. Phenol was the deepest. It has the ability to almost completely remove all the wrinkles on almost anyone’s face. The lightest peels were fruit acids such as glycolic acid. In between, was an agent called trichloracetic acid (TCA), which could remove some wrinkles, but had some potential for problems also. Then around 1992 or 1993, the CO2 lasers became practical for skin resurfacing and a very precise and safe removal of the top layers of the skin was now possible. These lasers, the Coherent UltraPulse® among them, created a very controlled depth of penetration: the top surfaces of skin could be gently removed. Just as in the acid peels from before, the skin regenerated from structures in the deep layers of the skin, which were not damaged, such as sweat glands and hair follicles.Initial healing took a week or so and left the patient with relatively fragile skin for a period of up to several months, sometimes with redness or pigmentary changes just as was seen with the acid peels.

Now, please note that acid peels are still used and are inexpensive. They are effective and although recovery times perhaps are longer for the degree of results obtained, they are still reasonable alternatives.

In any case, in 2008, we had the development of the fractionated CO2 laser, of which which are several models including the one we have, the SmartXide DOT®. This CO2 laser drills thousands of little holes leaving spaces in between with intact skin, so healing time is very rapid from the surrounding skin bridges. This laser allowed us to peel all the different body parts, which was virtually impossible using the older CO2 laser models or even using the lighter acid peels. These methods were either ineffective or caused skin color changes or scarring. The fractionated CO2 laser however is so controlled that we can peel skin that is relatively dark and produce an even result with much less chance of pigmentary changes. It is not the strongest laser, so wrinkle improvement is modest, but for color changes, such as uneven darkening and lightening, it is a wonderful device that is particularly advantageous on the neck and chest, where our other modalities were risky.

This SmartXide DOT and its cousins require, for most people, only anesthesia cream. After about an hour, the area is numb enough to be treated with the laser. There is some discomfort involved, but it should be modest. If requested, we use relaxation medicines at no additional charge. If so a driver should transport our patients home.

See photos for some ideas about what can be accomplished with our fractionated CO2 laser in our Pasadena cosmetic surgery office or Visalia/Fresno office, where we bring the laser as well.

Power Training for Men: Here's my review from Amazon

noreply@blogger.com (Robert A. Yoho, M.D.) — Wed, 07 Oct 2009 14:45:00 +0000

This photo is El Capitan in Yosemite, which Dr. Yoho has climbed six times. The review below is about a book I highly recommend for training. I copied the review from the Amazon.com website, where I had written it.

Customer Reviews

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4.8 out of 5 stars (65 customer reviews)

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94 of 101 people found the following review helpful:

5.0 out of 5 stars this book is changing my life, October 18, 2007

By	Robert A. Yoho MD "reader doc" (Pasadena, CA, USA) - See all my reviews (REAL NAME)

I'm 54 years old and have been lifting since I was 18.

I've read countless weightlifting (mainly bodybuilding)

books starting with Arnold's stuff in the 70's. I'm a physician.

I've been exposed to very little of the material here, but

as I understand it, much of it is used currently for athletic

training such as football. This thing is packed with great

material and I've been working at mastering some of the

ideas for several months. The olympic lifts and compound

(multiple sets together) exercises are just fantastic. I'm no

longer interested in bodybuilding but being strong and healthy

and not wasting a lot of time, and this program seems to

have it all. Buy this book, I think it will change your life.

Be careful with the weight you use, very careful; unless

you are well conditioned already you can easily hurt yourself.

I've never written one of these reviews before but this time

I'm compelled.

Find the book, Power Training for Men by Dos Remedios, at

Amazon.com at the following link:

GUESS THE IMPLANT VOLUME! (PASADENA / VISALIA COSMETIC SURGERY)

noreply@blogger.com (Robert A. Yoho, M.D.) — Mon, 05 Oct 2009 22:52:00 +0000

Now these implants are all the SAME number of cc's or exactly the same volume! However, they are different "profiles". The one on the left is a "low profile" implant, while the one in the middle is a "medium profile" implant, and the one on the right is a "high profile" implant. Generally the "high profile" implants ripple less, or "show" through the skin less. We almost exclusively use "high" profile implants; they are more like a natural breast shape and have a pleasing projection quality. The cost to us is somewhat more, but it's worth it to satisfy our patients. The sample from the far left is a little yellow because it's an old specimen. These are all silicone implants with a smooth surface. See DrYoho.com at the following link for more details. Our office services Pasadena, Fresno, Visalia, and Los Angeles Cosmetic Surgery and Breast Augmentation patients.

DR. YOHO’S CONTINUING MEDICAL EDUCATION FOR HIS LOS ANGELES COSMETIC SURGERY PRACTICE

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 02 Oct 2009 23:37:00 +0000

We'd rather be in Yosemite. This is from the top of North Dome.

Dr. Yoho, in order to stay current needed to re-certify his two major board certifications in August/September 2009. Unfortunately for him, all of this landed in a two and a half week period. First, the American Board of Cosmetic Surgery required a test for him to stay current. It had been 10 years since he passed these boards in cosmetic surgery. Dr. Yoho went to Chicago after studying for about a month every day and successfully passed his test. It covered all kinds of cosmetic surgery, such as liposuction, tummy tucks, eyelid lifts (blepharoplasty), breast implants, and breast reconstruction. The day after this, he had to go to Las Vegas to a boards review course for American Board of Emergency Medicine. This was 12-hours a day for a 4-day course, and then he began to study for the emergency medicine re-certification. Although he does not practice active emergency medicine, keeping current in these subjects is an important process for him. In any case, after he got back from the board review course, he studied 6 to 8 hours a day and listened to audio tapes for another week and a half and then took a 5-hour test on emergency medicine, which he passed. The upshot of all this is that Dr. Yoho realizes that his brain still works. He can still study and learn things but he is happy he is not back in medical school.

See http://www.dryoho.com/dr-yoho/cv.cfm for Dr. Yoho's professional resume and http://www.dryoho.com/dr-yoho/bio.cfm for his personal biography.

HOW DO I TREAT KELOIDS AND HYPERTROPHIC SCARS (SCARS THAT STICK UP FROM THE SKIN SURFACE)

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 02 Oct 2009 23:31:00 +0000

This photo is unrelated to the post. It's my friend Reid on the trip of a lifetime in Patagonia, at the tip of South America, where he went to climb a difficult mountain.

Everyone skin has a different degree of reactivity, and if your skin is darker, sometimes its reactivity is such that any surgery produces a lump of scar. In the area where a necklace would hang on your neck, scars are particularly common and active. Scars are almost always treatable with injection therapy, although some “keloid” scars are almost like tumors that need to be cut out and then treated with injections aggressively afterwards. The public and many surgeons know all about silicon sheeting therapy, which entails silicon material placed over the scar for most of the day in order to flatten the scar. No one is quite sure how this works, but it is moderately effective.

Our patients are often ethnic individuals who have trouble with scarring and we treat this routinely in follow up with injections and silicon sheeting. We use several medications. One, a cortisone agent called triamcinolone is used in varying amounts or concentrations. These concentrations vary from a very weak concentration which is used to inject acne pimples. Higher concentrations are used to inject scars and make them shrink. If the acne pimple were to be injected with high concentrations of triamcinolone, an indented area would occur and this is certainly not desirable. The art of the process is to determine the concentration or quantity of the triamcinolone that is required to produce proper shrinkage with any given skin problem.

We offer injections of two other agents for the most difficult scars. These are “off label use of on-label products” in other words, the FDA has approved these medications for use in other conditions but not for scarring. In the quantities used for scarring, very small quantities, no side effects or problems are to be expected except for treatment of scar area. These other medications are 5-flourourecil (5-FU) and bleomycin. These agents are quite effective in shrinking scars.

The side effect of cortisone injection or injection of these other agents, sometimes (rarely) involves lightening of the skin or too much shrinkage—formation of a sort of depression of the skin. Both side effects usually go away on their own within 6 to 12 months, or can be corrected by a minor procedure or sun exposure.

Cosmetic surgery patients, breast lift and implant patients, facelift patients, and even occasionally blepharoplasty patients from Fresno to Pasadena to Los Angeles all sometimes need scar treatment, and we include it at no charge after any surgery. Even liposuction patients have scar problems and may need treatment, and sometimes even revision of their incision scars.

FACIAL FAT TRANSFER: PASADENA/LOS ANGELES AND FRESNO/VISALIA

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 02 Oct 2009 22:48:00 +0000

Notice the fat loss in my "mature" 55 year old face compared to my 12 year old daughter's face, which is full and round. This fat loss gradually contributes to sagging and aging. In many cases, we can produce excellent improvement often when combining fat transfer with other facial cosmetic surgery techniques in our Pasadena/Los Angeles or Fresno area cosmetic surgery office.

Facial fat transfer has evolved into an excellent improvement technique to help saggy aging faces restore some of the lost volume. Over about the last 10 years, two famous physicians have developed their techniques and have taught the rest of the cosmetic surgery community their methods.

Dr. Sydney Coleman of New York City has performed many cases using his fat transfer method, which involves putting the fat on multiple different levels and doing tiny amounts of fat with each insertion of the blunt needle that he uses. He particularly likes to put the fat right on the skin of the bone or “periosteum” and also in the layers of the superficial fat on the face. A good deal of swelling, tissue reaction and bruising occur with this technique because so many strokes of the insertion device are necessary and so much tissue disruption occurs. Dr. Coleman’s spins his fat to produce a denser part of the original harvested fat for insertion into the face. Up to 100 cc or a cup of fat is used on the whole face. The faces typically are distorted for up to several months before the final result is seen.

Dr. Amar uses larger quantities of fat in each insertion, and typically his trainees produce less swelling and a quicker return to work. He also uses large quantities of fat and often touch-ups for both of these procedures are necessary at 6 months to 1 year. The general rule of thumb is that the fat that is present at 4 to 6 months is relatively permanent and has been taken up by the body in a way such that the body can support it and retain it. He attempts to place the fat into the muscles of the face, and his technique is called “FAMI” or “Facial Autologous Mesenchymal injection.”

Dr. Yoho’s experience with these techniques is extensive. Generally, his patients are not willing to put up with months of downtime, so he recommends doing fat transplant to the face in stages, using moderate quantities into the muscles. A week or two off is about all that his patients usually tolerate. For this technique, spinning is not necessary and he inserts the fat into both the muscle and the superficial fatty layers and the periosteal areas of the upper and mid face to produce the lift. Often, this is done in conjunction with skin resurfacing procedure and/or conservative facelift procedure. These procedures in combination, each of which is relatively noninvasive and has a relatively reasonable recovery profile, is a modern way to improve faces without all of the downtime and all of the unnatural looks that large procedures with invasive techniques entail.

Dr. Yoho always notes to his patients that for facial fat transplant, if a lot of weight is gained, the weight can definitely go on the face and this is important if you have gained and lost weight over your lifetime.

MARKETING WORDS TO UNDERSTAND LIPOSUCTION: VISALIA, LOS ANGELES, PASADENA, AND FRESNO

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 02 Oct 2009 18:02:00 +0000

The photo above is of the fat output from a large volume liposuction case. Notice that the yellow material on the top of the five containers is the fat. The material on the bottom is local anesthetic fluid with a tiny amount of blood in it. The amount of blood loss with liposuction cases is generally minimal. In this case, the fat represents about 6 quarts, roughly 60 per cent of the 10 quarts removed.

Many words are used by physicians to advertise their services in liposuction in Los Angeles, and the Central Valley. See below for explanations.

1. Liposculpture versus liposuction – This does not mean much of anything. Every surgeon doing liposuction aspires to sculpt the bodies of their patients and this is almost a word that stands for itself.

2. Microliposuction and microcannula liposuction – These marketing terms refer to use of smaller cannulas for liposuction than were used in the past. The general evolution of Los Angeles liposuction has been towards smaller and smaller cannulas. Some surgeons use cannulas as small as 2.5 mm in diameter (we do occasionally). Originally, in the 1990s, cannulas as large as 6-10 mm in diameter were used frequently. In 2009, most of us are using 4 mm or smaller cannulas. Delicate areas such as arms and faces and calves often are treated entirely with 3 mm or even the 2.5 mm cannulas with delicate tips. They harvest fat surprisingly well although they certainly are slower than larger ones and prolonging the operation is a disadvantage. The structure of the tissue around the fat can be better preserved with the smaller instruments and generally a smoother result is obtained, although this also has great a deal to do with the surgeon’s skill. In any case, if you are quite overweight and need a lot of fat removal to produce a more shapely body, you do not want your surgeon using the smallest cannula and taking 12 hours to do your procedure. Not only is the anesthetic necessary for such a procedure possibly a bit much for your system (and even have bad effects on your health) but you might have more discomfort.

3. Tumescent liposuction – Refers to putting local anesthetic in the tissues before the procedure in large quantities. The idea is to accomplish as little discomfort as possible and thus require less sedating medications. This stretches the fat in such a way that makes the removal of it more effective and probably less painful. This term was invented by Dr. Jeffrey Klein, who did some of the pioneering work with local anesthetic liposuction. If you Goggle tumescent: definition, there are also sexy overtones to the meanings so this too is marketing term.

4. “Liposuction totally by local anesthetic” – This is the liposuction that dermatologists are promoting. Some of them do not even use intravenous safety catheters and this may be reasonable for some cases, although it’s against California Law currently. The number of areas that are treated by these surgeons are by necessity limited because the patient does not take other medications besides local anesthetic. Dr. Yoho has had a lot of experience with the use of pure local anesthetic liposuction; he thinks that the fear factor and the anxiety factor can be countered easily by modern light anesthetic methods and that this much more humane. After all, we have cars now, you don’t have to ride a bicycle! Occasionally the patient has very limited areas that are going to be operated on, and pure local anesthetic is reasonable.

5. “Large volume liposuction” generally refers to liposuction of total fat output of over 5 liters. This does not include the fluid that is placed in the fat and then partially removed again. This is actually more of a medical distinction than a marketing distinction

6. "Adit" – This is a term for a kind of incision made with a punch instead of a slit with a scalpel. The theory is that the round hole heals better than a slit hole made by a scalpel. This is dermatologist term invented by Dr. Klein and is not used by the plastic surgeons or other cosmetic surgeons. Dr. Yoho does not like to use this technique, because he feels that the healing is not better.

6. “Ultrasonic” or “laser” or “vibrating cannula” liposuction – There are liposuction, vibrating instrument liposuction rotating instrument liposuction; these are all technologies which have been developed in an attempt to make either the operating time shorter or the experience by the surgeon easier or perhaps the result better. I think that none of these aims have been clearly achieved and there are no good studies that show that any of these techniques are superior to the liposuction we use which varies the cannula size based on the case and uses relatively large volumes of local anesthetic. We do have access to various technologies of these types if you want us to use them; just ask. There is a small extra charge.

SERIAL NUMBERS ON BREAST IMPLANTS: LOS ANGELES COSMETIC SURGERY

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 02 Oct 2009 16:08:00 +0000

These are photos of three silicone breast implants: all the same volume, but different “profiles”. The “high profile” implants are generally the best, they do not ripple as much and usually are more natural for most patients.

There is a fairly recent story in the news about Los Angeles cosmetic surgery patient Jasmine Fiore’s body being identified from the serial numbers on her breast implants. The murderer apparently had destroyed the woman’s fingertips, so she could not be identified from this and otherwise she was mutilated beyond recognition and supposedly she had been identified by checking the numbers on her breast implants. This would work only for silicone breast implants, which have individual numbers on the implants.

There are no serial numbers on saline or salt water implant implants: there’s only a “lot” number. The number of saline implants manufactured together is about 10,000 and in this 10,000 group all of the implants are identical. Now if a woman was carrying her card, that she got from her doctor, in her pocket and there was a serial number on the card, even if the name was not on the card, she could be identified. The breast implant companies keep track of what is going on and if a certain group of breast implants was having a certain kind of failure pattern, or leakage pattern, this could be identified.

So we know that Jasmine Fiore, Los Angeles breast augmentation patient, allegedly murdered by her husband Ryan Jenkins (if the news story is true) most likely had silicone implants!

CAN BOTOX BE USED FOR ARMPIT SWEATING?

noreply@blogger.com (Robert A. Yoho, M.D.) — Thu, 01 Oct 2009 22:02:00 +0000

And the answer is yes indeed, it can. It does take quite a quantity of Botox but the effects of the Botox in shutting down the armpit sweat glands usually last about 200 days or 2/3 of a year. Costs in Dr. Yoho’s Pasadena or Visalia cosmetic surgery office: The costs of injection of Botox into the armpits are about a thousand dollars. The majority of patients are very happy.

This is Fort Lauderdale, FLA.

ARM-LIFTS: DR. YOHO’S PHILOSOPHY FOR LOS ANGELES COSMETIC SURGERY:

noreply@blogger.com (Robert A. Yoho, M.D.) — Thu, 01 Oct 2009 21:59:00 +0000

The traditional teaching about loose skin removal and arm lifting is that if the patient has just a little fat and very little loose skin, liposuction alone is reasonable. This makes sense. For our Visalia/Los Angeles cosmetic surgery patient who has a little more loose skin, an incision and tuck in the armpit might be necessary, and for a person who has a lot of loose skin and/or fat an incision all the way down the arm might be best. For patients who has had “stomach stapling” surgery of some kind, an incision might be necessary all the way down the arm, sometimes onto the forearm and then down onto the front side of the chest.

Dr. Yoho has had an extensive experience using liposuction alone to improve people with hanging skin and excess fat together. His conclusion is that in the vast majority of the cases, liposuction alone is the best procedure. In the literature (the medical journals) and in the real experience of Dr. Yoho and his colleagues, scarring from arm lifts on the inside of the arm or in the armpit is unacceptable. The scars often open up or spread in the post-operative period, and may become hypertrophic, which means that it raises and you can feel it. These require injection or other therapy.

There are some people, of course, who have so much loose skin and have lost so much weight that some sort of a cutting procedure is the only way to get rid of their lower arm “wings”. But in the vast majority of cases, liposuction irritates the skin from underneath, causes contraction and produces an effect that may not be super tight, but is a big improvement and better in almost every case than the cutting procedures. With the cutting procedures, multiple injections may need to be performed into the scars to get them to “calm down” and even many months later, there is evidence of scarring.

For arm liposuction, small cannulas are necessary; 3 mm in diameter or smaller are the usual preferred instrument. This is because the skin is delicate and larger cannulas cause more rippling. Most of the fat can be removed successfully and when only a relatively thin skin layer is left, this skin layer is able to shrink successfully to a minimum 50% of its prior “droop.”

Every patient needs to be evaluated individually, and we hope if you are interested in arm improvement of either the skin or the fat or both, that you are willing to come in and have a complimentary consultation to see what the best procedure is for you to meet your needs. Our Visalia/Fresno area cosmetic surgery patients can come to our Visalia area office and our Pasadena cosmetic surgery patients can visit us in Pasadena.

Book Review: The End of Overeating, by David A. Kessler

noreply@blogger.com (Robert A. Yoho, M.D.) — Mon, 10 Aug 2009 19:39:00 +0000

We don’t write much at DrYoho.com about diet and exercise: this is a whole specialty field. But obviously I’m concerned about health; we do a lot of liposuction. I thought our patients from Los Angeles to Fresno would be interested in the following summary.

The most important point of this book is that the eating-out industry, which now takes 50 per cent of the dollars spent on food in the USA, is all about making money and has little interest in your health, perhaps an obvious point—but look below. This has been a progressively worse problem over the past 4 decades. The trend toward (massive) US citizen weight gain was confirmed in the scientific journals about 1970. “Food scientists” working for the restaurant industry are interested in getting you to spend as much as possible, so they try to make the experience as exotic and sensual as possible. While this may seem like it’s all in good fun, it turns out to be the cause of many of our health problems. All successful chain restaurants, with the fast food restaurants leading the pack, have designed the material you are eating to be the most palatable treat they can. And in doing this, they emphasize consumption of what some of the scientists call “the three points of the compass”: fat, sugar, and salt. When they can combine these in ways that are appealing, consumption—and profits—go up. While it’s widely known that the “chicken” in a Macdonald’s chicken product is part beef, part sugar, part other things, and has the nutritional composition more like beef than chicken, it’s not widely known that most of the sit-down chains manufacture their foods also. The emphasis of course is maximum consumption. There are other factors which are used: texture and color considerations and food additives come to mind, but the three unhealthy additives above have come to represent such a major portion of the diet that we all are gaining weight. These designers even make the food softer in some cases in order to make more of it go down faster.

So I don’t trust Appleby’s, for example, any more than MacDonald’s or Jack in the Box now. They are not generally serving real components of what’s grown on the land or taken from the animals, just manufactured mixtures that might look like it’s natural but which are often unhealthy.

One of the sad but I suppose funny insights was thinking about one of our local franchises which sell deep fried chicken and waffles, together! It’s all there: fat, salt and sugar (the syrup of course). And the people going in and out all day are universally obese. The rumor is that the combination is an aphrodisiac… But we don’t have to explain the appeal after reading Dr. Kessler’s book.

The solution to the obesity problem isn’t easy. We have to eat what we cook ourselves, and not give in to the temptation to eat out often. Japanese restaurant cuisine seems healthy to me (what can they do to these ingredients if you stay away from California rolls, mayonnaise, and deep-fried selections?). Portion control seems to be almost more important than ingredients for weight control as shown in some recent studies. This may explain why the French seem to stay thin and healthy despite a high fat composition in their diet and cigarette use. There are various behavior solutions to help your attitude toward food that may help, which Dr. Kessler describes.

I highly recommend this book, available at Costco, where I stumbled across it this last Saturday.

The Shape of Buttocks to Come!

noreply@blogger.com (Robert A. Yoho, M.D.) — Thu, 06 Aug 2009 19:07:00 +0000

What is an attractive buttock? How do I improve my buttocks? How much is too much? What’s best for Pasadena / Visalia / Bakersfield / Fresno / Los Angeles areas? (Hint: this is a trick question and will be answered at the end of the article.)

Cultural norms vary for how big buttocks should be for a given figure, but generally in America the preferred look is getting bigger, and coming closer to ethnic black buttocks than ever before. At our office, where at least 25 per cent of our patients are pretty dark skinned, we can really appreciate what buttocks should look like and have had a tremendous experience shaping buttocks and the area around the buttocks.

The first idea is that just adding volume does not do it for the vast majority of women. Sculpting the fat around the buttocks, particularly the outer thigh, the lower back, and the waist and lower waist area is critical. While we often add fat to the buttocks themselves, the shaping process is at least as important. Most attractive is what’s under the fat: the natural female form. We should be able to see sacral dimples if possible, and removal of the fat from the lower back and upper buttocks sometimes reveals them. And while some women view their outer thighs as part of their buttocks and don’t want to have them slenderized, usually if these are thinned a bit the whole “rear-end” looks much better. The hip, particularly the lower hip, is too large in many women and detracts from the picture also. When all these areas around the buttocks are treated, you can see improvements that are profound and not related to just putting some fat into the buttocks. There’s an area under the buttocks called the “banana-fold” which is sometimes has extra fat too. This area must be treated with care, because it actually supports the buttock. If it’s suctioned too aggressively, the buttocks can fall and creases will appear under the butt.

The Yoho method technique for adding fat to the buttocks follows. First, we suction the fat into a sterile container using sterile instruments and sterile tubing. We are able to sterilize all of this conveniently because we have a “gas sterilizer” (in addition to steam sterilizers) which is a hospital-standard machine. Next, the fat is allowed to sit (“decant”) so the fluid and other unwanted parts of the fat are partly eliminated. Some doctors use a sterile centrifuge in order to concentrate the fat more, but the value of this has never been clearly proven and we think it leaves room for more bacterial contamination. Then, still sterile, we take the fat and pour it into 60 cc syringes and then streak it through the buttocks with a screw-on “leur-lock” cannula or tube with a hole in the tip that fits the syringe. The better the fat can be evenly spread through both the muscle and the fat of the buttocks, the more likely it’s going to “take,” or stay long-term. The fat has to find new blood supply from the tissue it’s injected into and this is impossible if large quantities of fat are injected into one spot.

What about buttocks implants with hard silicone? Dr. Yoho thinks this makes an unnatural figure, and buttocks are often too big on the top. Recoveries and pain are prolonged and surgical complications are unacceptable. He does not recommend it.

How much is enough and how much is too much? Each patient has to be evaluated very carefully. The amount of fat has to be determined individually, based on needs and body type. There’s a limit on how much fat can be added because if too much is used, infection can occur. Generally, the bigger your buttocks are already, the more fat can be added. There are some surgeons making claims that they can add a liter (about a quart) of fat per side of the buttock BUT we feel the risks of big problems are high when this is done. When fat gets infected, it all gets infected and such a patient can have drainage problems and need to be on antibiotics for over a month. ALSO there’s no need to go absolutely crazy with the volumes of fat added because the buttocks will grow naturally after liposuction when the weight stabilizes. That is: a naturally sexier and more appealing figure emerges after liposuction of the torso and legs, with some growth of the buttocks and breasts.

What about buttocks liposuction? Generally speaking, unless you are referring to sculpting the curve of the upper buttock into the lower back, it shouldn’t be done. There are some exceptions, but if the areas around the buttocks are properly shaped by the surgeon, the (lower) buttocks shouldn’t be suctioned.

And finally, what’s best for Pasadena / Visalia / Bakersfield / Fresno / Los Angeles areas? The trick answer to the trick question is that it’s your ethnicity rather than your location that determines just what is right for you. See an article on this question of ethnic approaches to beauty at DrYoho.com at http://www.dryoho.com/dr-yoho-book/appendix-a-1.cfm. Hispanic and Asian patients are more and more choosing buttocks enhancements.

(Also see DrYoho.com photo section at http://www.dryoho.com/photo-gallery/)

FAQ’s
1) Q Can I use someone else’s fat?
A Only if you have an identical twin.
2) Q Can I have silicone or other synthetic filler injected into my buttocks?
A Silicone can be a disaster. There are some people using this for post HIV wasting, however.
We don’t do this.
3) Q Does the fat go away?
A Sometimes. If you are a smoker fat transplant does not work very well. Generally
expect to retain 1/3 of the injected fat. Weight gain in the areas that are
not liposuctioned (see above) will sometimes help your appearance of
retention.
4) Q If I gain/lose weight what will happen?

A The fat in the areas that are left will gain or lose weight proportionately. Note that weight
loss will usually make you look better and isn’t much of a problem for most people.

Visalia / Fresno / Hanford / Porterville report

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 31 Jul 2009 00:38:00 +0000

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

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 10 Jul 2009 00:57:00 +0000

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

noreply@blogger.com (Robert A. Yoho, M.D.) — Thu, 09 Jul 2009 18:59:00 +0000

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 / 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.

Michael Jackson’s death and drugs involved

noreply@blogger.com (Robert A. Yoho, M.D.) — Thu, 02 Jul 2009 20:16:00 +0000

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.

Traditional Breast Lifts/reduction versus the new “Vertical Mastopexy/Ice Cream Cone” Breast Lift (with or without implant or reduction)

noreply@blogger.com (Robert A. Yoho, M.D.) — Thu, 25 Jun 2009 17:55:00 +0000

When you are unhappy with your breasts, there may be three reasons:
1) volume
2) shape
3) positioning

Positioning really refers to how saggy the breasts are. If your only concern is volume, and you don’t have a problem with the shape or positioning or , breast liposuction or an implant may be the best choice. Most patients can achieve a one to two cup size reduction with liposuction, and a 1 to 2 inch nipple elevation with liposuction alone.

If you are concerned with the shape but you generally like the size of your breasts, then the “Ice Cream Cone/Vertical Mastopexy” may be the procedure of choice for you. This procedure can provide a volume reduction if necessary but it’s primary function is to shape the breast and re-position the nipple areolar area. If for some reason after this procedudre, you decide you want a bit more volume, it’s not a problem to place an implant 4 to 6 months later. About 50 per cent of patients choose to put an implant and 50 per cent are happy with the lift only without implant.

Note that the traditional “anchor” scar procedure is generally regarded as not as satisfactory as the vertical mastopexy. This older procedure needs a scar all around the bottom of your breasts plus a scar up the middle plus a scar around the areola as well. It does not hold up as well as the vertical mastopexy, and tends to sag sooner. Also, the newer procedure needs only a scar down the middle of the front of the breast and around the areolae.

Remember whatever choice you make, if you need an implant, it’s always better to do this procedure in two surgeries. This is because if you have the implant put in and reduce the breast as well, the forces on the breast tend to pull the scars apart. When you do the lift first, then put the implant in later, the breast tissues hold up better and there’s less risk of sag and other unsatisfactory results. .

Note: Dr. Yoho does not usually perform the anchor-type scar procedure, the traditional breast lift. However photographs of the other procedure both with and without implants are available at DrYoho.com.

CALIFORNIA LIPOSUCTION LEGAL STANDARDS

noreply@blogger.com (Robert A. Yoho, M.D.) — Thu, 25 Jun 2009 17:00:00 +0000

Weight Loss with Liposuction: Some patients get drama! This is 6 weeks after surgery.

I’ve reprinted the law regarding liposuction standards in California, below. I was involved in developing these standards. I testified several times before the California Medical Board and supplied them with materials and documentation to aid them in their decision-making process. I believe that these rules are important and necessary for safety. I want to make several points.
1) If you are seeing someone who does not start an intravenous line, they are violating the surgeon’s “standard of care” and also California law.
2) The other requirements that are seen below include blood oxygen and blood pressure monitoring, which are simple, modern devices to see how well you are breathing and how well your heart is working.
3) Modern liposuction is a very, very safe procedure in experienced hands. However, there are risks and if you find someone who says that it is risk free, you should look elsewhere. Common surgical complications such as infection are unlikely but possible.
4) If your surgeon uses no relaxation medicines at all, some sort of liposuction may be performed and the risks may be lower. However, like anything in life, there are trade-offs, in other words you have to accept possibly a lower standard of results—in particular less fat removal--in exchange for not going to sleep. Additionally, we have found that many of our patients find the option of having nothing but local anesthetic frightening and sometimes quite uncomfortable. This is not to say that I approve of general anesthesia for liposuction, I don’t. I think this compounds the risk.
5) For individuals who need significant amounts of fat removed, California law requires a certified surgical center, such as a hospital would have. Ask to see the certificate if this is the case.

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ß 1 3 5 6 . 6 . L i p o s u c t i o n E x t r a c t i o n a n d P o s t o p e r a t i v e C a r e S t a n d a r d s .

( a ) A l i p o s u c t i o n p r o c e d u r e t h a t i s p e r f o r m e d u n d e r g e n e r a l a n e s t h e s i a o r i n t r a v e n o u s s e d a t i o n o r t h a t r e s u l t s i n t h e e x t r a c t i o n o f 5 , 0 0 0 o r m o r e c u b i c c e n t i m e t e r s o f t o t a l a s p i r a t e s h a l l b e p e r f o r m e d i n a g e n e r a l a c u t e - c a r e h o s p i t a l o r i n a s e t t i n g s p e c i f i e d i n H e a l t h a n d S a f e t y C o d e S e c t i o n 1 2 4 8 . 1 .
( b ) T h e f o l l o w i n g s t a n d a r d s a p p l y t o a n y l i p o s u c t i o n p r o c e d u r e n o t r e q u i r e d b y s u b s e c t i o n ( a ) t o b e p e r f o r m e d i n a g e n e r a l a c u t e - c a r e h o s p i t a l o r a s e t t i n g s p e c i f i e d i n H e a l t h a n d S a f e t y C o d e S e c t i o n 1 2 4 8 . 1 :

( 1 ) I n t r a v e n o u s A c c e s s a n d E m e r g e n c y P l a n . I n t r a v e n o u s a c c e s s s h a l l b e a v a i l a b l e f o r p r o c e d u r e s t h a t r e s u l t i n t h e e x t r a c t i o n o f l e s s t h a n 2 , 0 0 0 c u b i c c e n t i m e t e r s o f t o t a l a s p i r a t e a n d s h a l l b e r e q u i r e d f o r p r o c e d u r e s t h a t r e s u l t i n t h e e x t r a c t i o n o f 2 , 0 0 0 o r m o r e c u b i c c e n t i m e t e r s o f t o t a l a s p i r a t e . T h e r e s h a l l b e a w r i t t e n d e t a i l e d p l a n f o r h a n d l i n g m e d i c a l e m e r g e n c i e s a n d a l l s t a f f s h a l l b e i n f o r m e d o f t h a t p l a n . T h e p h y s i c i a n s h a l l e n s u r e t h a t t r a i n e d p e r s o n n e l , t o g e t h e r w i t h a d e q u a t e a n d a p p r o p r i a t e e q u i p m e n t , o x y g e n , a n d m e d i c a t i o n , a r e o n s i t e a n d a v a i l a b l e t o h a n d l e t h e p r o c e d u r e b e i n g p e r f o r m e d a n d a n y m e d i c a l e m e r g e n c y t h a t m a y a r i s e i n c o n n e c t i o n w i t h t h a t p r o c e d u r e . T h e p h y s i c i a n s h a l l e i t h e r h a v e a d m i t t i n g p r i v i l e g e s a t a l o c a l g e n e r a l a c u t e - c a r e h o s p i t a l o r h a v e a w r i t t e n t r a n s f e r a g r e e m e n t w i t h s u c h a h o s p i t a l o r w i t h a l i c e n s e d p h y s i c i a n w h o h a s a d m i t t i n g p r i v i l e g e s a t s u c h a h o s p i t a l .

( 2 ) A n e s t h e s i a . A n e s t h e s i a s h a l l b e p r o v i d e d b y a q u a l i f i e d l i c e n s e d p r a c t i t i o n e r . T h e p h y s i c i a n w h o i s p e r f o r m i n g t h e p r o c e d u r e s h a l l n o t a l s o a d m i n i s t e r o r m a i n t a i n t h e a n e s t h e s i a o r s e d a t i o n u n l e s s a l i c e n s e d p e r s o n c e r t i f i e d i n a d v a n c e d c a r d i a c l i f e s u p p o r t i s p r e s e n t a n d i s m o n i t o r i n g t h e p a t i e n t .

( 3 ) M o n i t o r i n g . T h e f o l l o w i n g m o n i t o r i n g s h a l l b e a v a i l a b l e f o r v o l u m e s g r e a t e r t h a n 1 5 0 a n d l e s s t h a n 2 , 0 0 0 c u b i c c e n t i m e t e r s o f t o t a l a s p i r a t e a n d s h a l l b e r e q u i r e d f o r v o l u m e s b e t w e e n 2 , 0 0 0 a n d 5 , 0 0 0 c u b i c c e n t i m e t e r s o f t o t a l a s p i r a t e :

( A ) P u l s e o x i m e t e r

( B ) B l o o d p r e s s u r e ( b y m a n u a l o r a u t o m a t i c m e a n s )

( C ) F l u i d l o s s a n d r e p l a c e m e n t m o n i t o r i n g a n d r e c o r d i n g

( D ) E l e c t r o c a r d i o g r a m

( 4 ) R e c o r d s . R e c o r d s s h a l l b e m a i n t a i n e d i n t h e m a n n e r n e c e s s a r y t o m e e t t h e s t a n d a r d o f p r a c t i c e a n d s h a l l i n c l u d e s u f f i c i e n t i n f o r m a t i o n t o d e t e r m i n e t h e q u a n t i t i e s o f d r u g s a n d f l u i d s i n f u s e d a n d t h e v o l u m e o f f a t , f l u i d a n d s u p r a n a t a n t e x t r a c t e d a n d t h e n a t u r e a n d d u r a t i o n o f a n y o t h e r s u r g i c a l p r o c e d u r e s p e r f o r m e d d u r i n g t h e s a m e s e s s i o n a s t h e l i p o s u c t i o n p r o c e d u r e .

( 5 ) D i s c h a r g e a n d P o s t o p e r a t i v e - c a r e S t a n d a r d s .

( A ) A p a t i e n t w h o u n d e r g o e s a n y l i p o s u c t i o n p r o c e d u r e , r e g a r d l e s s o f t h e a m o u n t o f t o t a l a s p i r a t e e x t r a c t e d , s h a l l n o t b e d i s c h a r g e d f r o m p r o f e s s i o n a l l y s u p e r v i s e d c a r e u n l e s s t h e p a t i e n t m e e t s t h e d i s c h a r g e c r i t e r i a d e s c r i b e d i n e i t h e r t h e A l d r e t e S c a l e o r t h e W h i t e S c a l e . U n t i l t h e p a t i e n t i s d i s c h a r g e d , a t l e a s t o n e s t a f f p e r s o n w h o h o l d s a c u r r e n t c e r t i f i c a t i o n i n a d v a n c e d c a r d i a c l i f e s u p p o r t s h a l l b e p r e s e n t i n t h e f a c i l i t y .

( B ) T h e p a t i e n t s h a l l o n l y b e d i s c h a r g e d t o a r e s p o n s i b l e a d u l t c a p a b l e o f u n d e r s t a n d i n g p o s t o p e r a t i v e i n s t r u c t i o n s .

Dr. Yoho's Chapter published in a Breast Augmentation Book

noreply@blogger.com (Robert A. Yoho, M.D.) — Sat, 20 Jun 2009 01:46:00 +0000

See

(link)
for a large sample of this book. Dr. Yoho's article was about how to alter the implant pocket without going into the implant space. The ideas it contained were originated by Dan Metcalf and Roy Morgan MDs. The technique consists of suturing the skin to the underlying tissues to make a breast implant pocket smaller.

Complications of Breast Implant Surgery: Hematoma

noreply@blogger.com (Robert A. Yoho, M.D.) — Fri, 19 Jun 2009 16:20:00 +0000

The photo above is of my son having his first haircut and has nothing to do with the article below.

One of the common problems with breast implant surgery is bleeding around the implant right after the surgery. When the pocket for the breast implant is placed, it’s sometimes impossible to do this in a way that produces no bleeding, though we try as hard as we can. Additionally, after the surgery, a compressive wrap is often placed in the hope that this will help. Sometimes however the area surrounding the implant will end up with significant blood in it within a few hours and other times it will even fill up with blood. This space is closed and sealed, so the pressure that develops in the cavity will generally stop any bleeding before it becomes dangerous to your health but it can be uncomfortable. The tip-off is usually that one breast becomes much bigger, more swollen, and more bruised than the other one. We can look at the breasts with a bright light in a dark room and this can help distinguish whether the area is just swollen or contains blood.

The blood should be taken out by returning the patient to surgery, opening the incision, taking the implant out, washing the area with a few quarts of sterile salt water solution, putting the implant back, and then sewing up the incision. Sometimes if bleeding vessels are found, they are “cauterized” or burned with the special device used for this purpose. This procedure is usually done at 24 to 48 hours after the original surgery. Only rarely does bleeding become apparent after this time.

Why is this important, and why can’t we just depend on the body to clean up the blood on it’s own? Well, “capsular contraction” or firm to hard scarring around the implant (later) is much more common when there’s blood surrounding the implant initially that the body has to remove. Recovery time is also much longer when there’s a “hematoma” or blood in this area. This complication happens in perhaps a few percent of all breast cases, and is probably more common in secondary cases, in other words in cases where the breast has been operated on before.

See also link for a discussion of other breast implant risks and second link for a general discussion of complications in cosmetic surgery risks.

Dr. Yoho used to be a real climber

noreply@blogger.com (Robert A. Yoho, M.D.) — Thu, 18 Jun 2009 01:34:00 +0000

Photo above was taken during an ascent by Dr. Yoho of El Capitan's Nose route in Yosemite. An article was published in Alpinist magazine (April 18, 2007) about Dr. Yoho's "first ascent" in Zion National Park, which he did in 1987 with his friend Dave Jones. This climb has recently been climbed "free" by another set of climbers. This means that at no point was it necessary to use gear placed in the rock to advance up the climb. There are some photos and a nice story. See link for photos and article.

Dr. Yoho has climbed the Nose Route of El Capitan in less than 24 hours, see chart. See Biography for Dr. Yoho's personal biography.