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The enclosed letter I received the other day is reminder to me and my staff about how important our relationships that we build we our patients are. We fully understand that patients have many choices in providers of cosmetic services and we try to not only do it better but also do it with passion, caring and compassion for our patients. Today, its not enough to just have the latest and greatest technology or be able to deliver cutting edge procedures, we also have to deliver Ritz Carlton level of service. I have always felt that our practice, having been devoted to 100% cosmetic services for well over 15 years, had a distinct advantage over practices that did not specialize in cosmetic surgery. The relationship of the cosmetic patient and the plastic surgeon just seems different to me than for insurance based physicians. We can take the time to make sure every patient has a clear understanding of the choices, risks, and benefits of everything we do from lasers, injectables to surgical procedures. It’s the thankyou cards like this one that serve as  reminders of our success in that endeavor and that’s what makes it all worthwhile and it’s why we do it every day.

I seem to see a lot of breast implant patients who have had their surgeries done elsewhere who have problems with their breast implants. One of the more common problems is migration of the implant either downward or downward and outward. Often times simple sewing up of the breast implant capsule is first attempted to remedy the situation. This simple approach often fails due to the thin nature of the capsule tissues. I use to fashion flaps of the capsule and the fascia (thick tissue lining the muscles) to help support the new and more pleasing breast implant position. Lots of times this tissue was very thin and would not support the weight of the implant and breast. Now a new product made of pig skin is being used by our office to help repair these misplaced breast implants. The pig skin has been specially treated to remove all of the living cells so that the human body sees it as a template of skin and grows its own cells into it. The Strattice can be sewn into the breast capsule as a hammock support or a barrier to separate the breast implants in cases where the implant capsules are touching (breadloafing or uniboob). Thus far it has been quite successful in our practice. For more information check out the website: http://www.renewingyou.com.

Liteshape Laser Liposuction

Plastic surgery has always been a visual science. Its all about peoples perception of their own visual persona that they feel they represent to those around them. We, as plastic surgeons, provide to our patients the ability to improve that image. We, therefore, at consultation for these visual improvements need to convey to our patients what visual changes they can reasonably expect and provide some information about the risks, benefits as well as other optional treatment choices that exist. We call this process a consultation.

Consults for improvement in breast size, shape or symmetry issues has been dealt with in the past with photographic aids. Beginning about 1996, 2D imaging of breasts with a “Photoshop” like program in which the photo taken at consultation could be manipulated with software tools to depict the possible result. We, as plastic surgeons were kind of guessing as to what the breast would look like with a certain size implant, but with a fair amount of practice, 14 years or so for me, we got pretty good at it. However, the best manipulations were only viewed on a side view of the breasts where the blue background of the image was behind the actual photo. Not infrequently, the patient or her husband or boyfriend present at the consultation would say “can I see what that would look like from the front?” I would replie, “It’s hard to show that since we are manipulating pixels and without the blue in the background it is difficult to show a 3D change from the front. Someday we will have a camera software combination that can interpolate the change seen from the side to that seen from the front.”

Well, that is day is finally here. We have just installed the first Vectra 3D imaging system in the state of  Kentucky. I have watched the introduction of this technology grow over the last year or so and felt that it was  finally good enough to incorporate into our practice. There are only some 40 of these systems around the US now. The Vectra 3D camera takes  a single image of the breasts or face from 6 different 6 megapixel images then stitches them together and using a very sophisticated mathematical model creates a 3D image of the patient that can be moved around on a large screen display in any direction. Both the results of breast augmentation as well as the facial procedures like facelift, nose surgery,(rhinoplasty), chin tucks can be visualized in 3D. For the breast augment patient the choice of the size of the implant was always challenging. I believe that the best, most natural and longest lasting results are achieved when the base diameter of the implant best fits into the natural size of the women’s chest wall. This photo system actually measures in real dimensions those parameters and can display them on the screen. The data of size, width and projection for all of the implants made by Mentor and Allergan are stored on the system.

We simply click the type and size of the implant and the software applies that to the breast and shows an enhanced version on the screen. We can then rotate that image sideways, vertical, up and down and compare it to the natural untreated image. The view from the top, as the women sees herself is especially compelling. No more guessing, stuffing implants on top inside a bra or adding baggies of rice to estimate the size of the implant is needed to get the job done. We can even adjust for dissimilar size breasts by using different size implants on each side. The look on the few patients faces that have seen this technological advance has been quite satisfying. No you can really “try on” the different implant sizes to get a feel of how you will look after breast augmentation surgery.

Last Friday we had the honor of training plastic surgeons from Japan in the use of lasers for improving the outcomes of liposuction. We developed most of the protocols for safe and effective laser lipolysis that are now used by physicians from around the world. This advanced method of body contouring improves the contour of the body by not only removing unwanted fat but also tightening the overlying skin. It has become an alternative for many of our patients who would like to avoid a general anesthetic and have a single procedure done in an office setting that will produce consistent pleasant outcomes. Like any get together with the Japanese of course there was lots of picture taking so I thought I would include one.

Recently, Lori Lyle was in our office to witness the pain reducing effects of using the Ouchless Needle that I developed to increase the comfort of cosmetic injectables such as Botox and dermal fillers. The piece was seen on Wave 3 here locally the evening before we showed the new device to the public at the American Society of Dermatologic Surgeons meeting held in Phoenix this past October. She told me that this new device was so newsworthy that she would present it to other TV stations across the US. I never gave it another thought until we were actually on our way to Phoenix. I first got an email from my cousin in Toronto, Canada saying congratulations on the developing of the Ouchless Needle. Shortly thereafter, we received phone requests from patients all over the US asking if this technology was available in their hometown or could they come to Louisville for the use of it. Apparently the piece was seen on TV stations all over the US and Canada over a 2 day period. I went to the Internet and googled “ouchless needle” and sure enough there was the video on the websites of television stations in North Dakota, Louisiana, Texas, Florida, California, Tennessee among others. It made the international news and was seen on the MSNBC website. We had a great kick start to the launch of this revolutionary product. It was received with unbelievable fanfare by the dermatologists from around the world in Phoenix. Everyone was excited to finally be able to offer their cosmetic patients a more comfortable and less time consuming facial injectable treatment. We presently are begining to enlist our national and international sales force by the end of this year. You can see the Ouchless Needle and view videos about its use and features at the website www.Ouchlessneedle.com. More than a few patients have expressed concern that I would soon retire based on the anticipated success of this project. I have no plans to retire any time soon. Aesthetic plastic surgery is still my passion and I have fun everyday trying to make a difference in my patient’s lives.

As you may have seen on the facial section of the website, I have developed a mini face-life procedure to specifically address early facial aging, called the Ageless™ Minilift. Below is a video of the procedure being performed at our office in Louisville, KY

As some of you may know, I have designed and patented a new medical device that will aid in the comfort of injectables around the face.  This device, called the Ouchless Needle attaches to the needle syringe combinations that are used by cosmetic providers to place Botox, Dysport, Juvederm and Radiesse into the face.  The injector can, with the push of a button, deliver a short spray of a vapocoolant to the skin’s surface that immediately freezes it thereby reducing the feeling of a needle penetrating the skin and making the injection more comfortable.  This vapocoolant spray freezes above the freezing point of water and therefore does not cause the frostbite pain that ice can cause.  Injectables at present are done with the prior application of a numbing cream to the area to be injected.  The creams take about 40 minutes with a saran wrap type of occlusion over them in order for them to be effective.  Their duration of effect is long after the injectable procedure and can leave a discoloration to the face when adrenalin is added to the mixture.  The vapocoolant, on the other hand, works immediately and its duration is only minutes at most.  Lidocaine can be mixed into the injectable because it is water based.  Lidocaine is a numbing medicine that when injected under the skin will numb the overlying area. Unfortunately, the first needle puncture to introduce the lidocaine will still hurt and every injection thereafter, if done in the same location as before may be more comfortable.  Each injection, however, is usually in an independent area so that this medication may make the injectable hurt less after its in then reducing the actual needle puncture pain.  These devices are disposable and are priced fairly so as not to be much more expensive than the cream often used.  The device will allow for more spontaneity from the patients perspective as after the decision to have an injectable done is made, no longer will they have to wait for 40 minutes to have it be more comfortable.  For the practitioner, this device will speed the delivery of injectables in that the patient will not have to arrive 40 minutes prior to have the numbing cream placed nor will they have to go to a pharmacy and purchase the numbing cream and still place it on the face 40 minutes prior to the injection.  We anticipate beginning to sell this device to physicians in the US starting in October of 2009.  Shortly thereafter worldwide distribution is planned.  It is an exciting time in my professional life as this has been a unique odyssey.  Being an entrepreneur is certainly different and requires a different skill set than doing cosmetic surgery.  I am learning everyday and having fun doing it.

Well, its been about 6 months in search of the Holy Grail of fractional lasers for the removal of wrinkles and discolorations of the face and neck.  The laser story starts in 1995.  At that time, CO2 laser was the rage and I embarked on a course of lasering quite a few people with weathered and wrinkled skin.  There was tremendous healing times attendant to this treatment with a pink hue to the skin that could last several months.  We also noticed that sometime later, the skin could be lighter in color and there would be a line of demarcation at the jawline.  The Fraxel® laser was introduced with the hope of less downtime but similar results to CO2.  We tried the first version of Fraxel® when it was first introduced several years ago.  We found that it hurt too much and wasn’t all that effective.  I introduced fractional lasers to our office with the Affirm® laser.  This laser uses a combination of laser wavelengths that we call non-ablative.  By that we mean that the skin is not removed only “injured” by the laser so the downtime consists of only redness for a few hours.  Like everything in life, you get what you pay for.  With limited downtime’s, multiple treatments are necessary and the results are more subtle.  For mild wrinkles and coarse facial texture the Affirm® laser is great.  Some patients wanted more results for deeper wrinkles and were OK with more downtime.  In the search for a new laser, most companies were using CO2 but in a fractional mode.  I tried several of these and found that CO2, because of the heat it produces can still have some of the unwanted healing characteristics from the early CO2 lasers of the mid 1990’s.  Along comes the Sciton Joule® using a different Erbium wavelength.  Erbium it turns out is more gentle than CO2 and heals more quickly.  However, it is the heat of the CO2 that may tighten the skin and lead to a better result.  With the Joule®, we can actually dial in as much or as little heat as we need and customize for each patient the downtime and the result.  We can mimic the characteristics of three different lasers in one machine. For instance, the Pearl® settings can be simulated on this new laser.  It’s been a few weeks now and our patients have been thrilled with the results.  We can even combine IPL treatments for color with this fractional laser in one session.  We also have combined the effects of both the Affirm® and the Joule® into one treatment package to maximize the benefits of each laser.  Slow or fast results, little or minimal downtimes: we have all the choices to make our patient’s skin look its best.

Theses days I’m seeing more and more outrageous claims for cosmetic improvements mostly by non traditional aesthetic services providers.  By that I mean practitioners other than board certified plastic surgeons and dermatologists.  Injectable concoctions such as “lipodissolve” that can reduce the patient by several dress sizes and non invasive massage using ultrasound that removes inches of fat over 6 to 8 treatment sessions have both been recently touted in the media.  While our office has had some experience using Lipodissolve, our outcomes have been very modest and we use this method in a very few selected fashions for very small areas.  Focused high energy ultrasound is presently being evaluated in clinical trials here in the US.  Early reports have shown some fat reduction after 2 to 3 treatments.  No one in the Kentuckiana region has either of these experimental machines. We as board certified plastic surgeons, evaluate all new technologies very carefully.  Sometimes, the early claims of improvement can not be repeated by subsequent physicians.  New treatment modalities are tried and compared to the already existing standards and these outcomes are presented at our meetings and reported in peer reviewed journals. Not until the safety and efficacy (they work) are proven can these new breakthroughs be utilized by all physicians.  I have trouble with physicians who are new to the aesthetic arena recommending the newest technologies as being the greatest thing since sliced bread when they have had little or no experience in what this new technique will supposedly replace.  Unfortunately, it is a case of buyer beware.  Ask yourselves why, if this new machine, concoction, technique is sooo much better than the standard method that everyone doesn’t have it or do it.  Sometimes, when it sounds to good to be true maybe getting the opinion of an expert in the field would be prudent.  As it stands today, there is no machine that tightens skin like a facelift, no fat treatment that equals liposuction results and nothing that has been shown to be effective long term in treating cellulite.