Monday, January 18, 2010

Buttocks Fat transplantation

LOS ANGELES/PASADENA BUTTOCK FAT TRANSPLANT

More and more patients are opting for a buttock fat transplant when they have their liposuction procedure. It is now almost routine at Dr. Yoho’s office to perform a buttock fat transplant if the person is dissatisfied with their buttock size. In particular, Asians and Latinas often desire a bigger backside and can get great improvement. If the weight returns a bit after the liposuction procedure, often buttocks and breasts benefit the most with a sexier curvier figure. We make an effort to choose just the right amount of fat for each person’s buttocks. If too much fat is transplanted, infections and other problems can result and if too little fat is transplanted, not enough improvement will result. Please call for a complimentary consultation to our Los Angeles, Visalia, or Fresno area cosmetic surgery offices to determine if you are a good candidate for this procedure.

THE 100% REVERSIBLE MID FACELIFT


BY ROBERT YOHO, M.D.

Many methods have been advocated to improve cheek area. Our opinion is that the best methods involve fillers and the best fillers are cheek implants, which hold the mid-face up in an attractive way. These implants are inserted through the mouth using a tiny incision about a third of an inch long. The great thing about this procedure is that the implant can be taken out and thus the procedure is completely reversible. Complications are rare. For example, the infection rate is less than 1%. Results as one of my mentors said “are always better than you think they are going to be.” (RESULTS VARY!) Many times this procedure can replace a facelift or delay a facelift for a middle-aged individual or even an older individual who does not want all the hassle and downtime of a big surgery. It also is complementary with other procedures such as facelifts, peeling, chin implants, eyelid lifts, and chin liposuction. These procedures can be used in combination depending on patient’s desires and how they look.

ALL ABOUT CAPSULAR CONTRACTION

BY ROBERT YOHO, M.D.

Capsular contraction or firming of the breast implant after surgery is the most common problem we face in implant surgery, and many surgeons hardly mention it to their patients. Hopefully, with the counseling prior to the surgery, the patients understand all about it. The Allergan® study, which involved thousands of some of the best surgeons in the country, showed a reoperation rate for silicone breast implants by 5 years of roughly 30% and a capsular contraction rate of over 20%. These figures are perhaps a little better for saline implants, but this is not completely clear based on medical journal articles.


Capsular contraction has several causes. Two that are commonly implicated are: low-grade infection and excess blood in the implant pocket after the surgery. However, many capsules form for unknown reasons. While most capsules occur in the first 6 months after surgery, some form up to many years later.

The classification of capsular contraction consists of:

Grade 1, a completely soft breast and natural implant with no apparent firming

Grade 2 some firming of the implant but no distortion

Grade 3 there is some distortion

Grade 4 where the implant is very hard and there is distortion and pain.


We do not like grade 2 capsules, although many surgeons accept grade 2 capsules and do not treat them. We attempt to treat them medically by prescribing the asthma medicines Accolade and Singular, which are “off-label use” of these medications. Like many medicines, these are being used here for a something not formally approved by the FDA. This is perfectly legal in the United States; many medications are used in this fashion. These medicines are considered very safe although there are very rare cases reported of liver failure for Accolade. This problem, if it really is true, exists on the order of one in a million or 2 million cases.


Another medicine that we have become convinced really helps is fish oil. We recommend all our patients postoperatively take fish oil about 4 grams or 4 rather large pills a day. This can be obtained at Costco or Trader Joe’s. More expensive fish oil, which does not have a fishy taste, can be purchased at vitamin stores. These have been more carefully tested for mercury. Mercury is not good for the human body in high levels and might be concentrated in fish oil. Two brands we recommend are Nordic Naturals or Carlson. Fish oil seems to have an anti-inflammatory effect on tissues and for swollen joints and other problems. Since the capsular contraction seems to be an inflammatory process in some cases, the fish oil may possibly prevent this. Fish oil in all likelihood is very helpful for your heart health as well. Some authorities even recommend higher doses, but we generally stick with the 4 grams or 4 large pills a day.


Another treatment, no longer standard practice, is squeezing or massaging the breast implants aggressively, cracking the implant capsule. Although patients are encouraged to massage breast implants several times a day in order to keep the pockets open, this other massage is a bit rougher and the doctor might do it. This has fallen into disfavor because of a relatively low success rate perhaps 50%, plus a small risk of implant rupture and/or bleeding requiring another surgery. We think that it has some value for select cases, but it does not work for higher-grade capsules.


Note: The “gummy bear” implant has been said to have lower capsular rate. However, this is because the gummy bear implant is firm kind of silicone that does not feel as soft and natural to begin with. It has a feel like a grade 2 capsules when you have the implants placed, right after surgery. Since grade 2 capsules are accepted by majority of surgeons and nothing is done about them, the gummy bear implant in theory would have a lower capsule rate. However, we try to have every patient keep their implants/breasts completely soft, in other words a “grade 1” capsule. This is not always possible of course.

LASER HAIR REDUCTION



BY JEREMY ROMAINE, P.A.
There is no such thing as 100% laser hair removal. “Laser hair reduction” might be more accurate. Depending on the hair color and density of hair growth, 80% reduction may be possible with 8 to 12 treatments. A woman who is shaving her underarms daily may be left with 20% of her original hair growth, and what hair remains would be stunted. She might require shaving only every 3 weeks.

The laser does not hurt much because we use “Numb-n-Number” special cream anesthetic in order to produce anesthesia just in the areas that are worked on. The patients occasionally will ask to be given relaxation medicines but if we do this they need to be driven home. There’s no extra charge for sedation.

Note of importance: the area being treated should not be waxed prior to laser hair removal. Proper preparation would be to just shave. Also, complete back hair removal is not realistic for men. Usually 20 to 30 treatments are required; this is too much for most to tolerate.

We use a frequency of laser that encompasses a spectrum rather than a single isolated frequency. We think this works better for the majority of our laser hair removal patients. The patient's success is based on the contrast between the hair color and the skin color. If the skin color is too dark, it is more difficult to perform laser hair removal. If their skin color is light and they also have white hairs, it is also difficult and usually requires many treatments to obtain an adequate result. For laser hair reduction visit our Los Angeles cosmetic surgeon website with over 1500 pages of information. If you are in the Mid Coastal California area call our Fresno cosmetic surgery office in Visalia.