Interview Dr. Yoho on NBC about dangers of plastic surgery

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

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

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

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

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

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

65 Reviews 5 star: (56) 4 star: (7) 3 star: (0) 2 star: (2) 1 star: (0) Average Customer Review 4.8 out of 5 stars (65 customer reviews)		Share your thoughts with other customers: Create your own review
Most Helpful Customer Reviews 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)

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

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)

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

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

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. For Liposuction Fresno visit our office in Visalia, visit our Pasadena location for Liposuction Los Angeles

SERIAL NUMBERS ON BREAST IMPLANTS: LOS ANGELES COSMETIC SURGERY

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?

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:

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 cosmetic surgery patients can come to our Visalia area office and our Los Angeles cosmetic surgery patients can visit us in Pasadena.