New Body Cosmetic Surgery Los Angeles Blog

The Insanity of the Modern Tummy Tuck

2012-02-10T07:41:00.000-08:00

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

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

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

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

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

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

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

Be careful out there.

______________________

Robert Yoho, M.D.

Fat Transplant Problems and Opportunities

2012-02-04T12:31:00.000-08:00

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

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

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

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

Dr. Yoho's adventure with a horse in Buenos Aires

2011-10-28T12:07:00.000-07:00

Dr. Yoho took a trip to Buenos Aires to attend a medical meeting about cosmetic surgery. During the trip, he went into the countryside and did some touring and jumped on a horse for the first time in 20 years.

He was having a wonderful time until the horse found that he was on his way back to the corral at the end of the ride and began to break into a faster pace. Dr. Yoho was anxious about the horse's speed and was afraid that he'd fall off, so he pulled back on the reins and the horse bucked him right off.

While Dr. Yoho insisted that he fell gracefully, close observers claim that he looked like a sack of potatoes as he flew through the air and hit the ground. Fortunately, very little was bruised except for his right buttock and his ego, and he continued on the sightseeing trip with no further mishaps.

Buttocks Fat transplantation

2010-01-18T16:06:00.000-08:00

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

2010-01-18T15:49:00.000-08:00

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

2010-01-18T15:43:00.000-08:00

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

2010-01-18T15:22:00.000-08:00

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.

THE DEEP OBAGI PEEL AS EXPERIENCED BY THE SURGEON

2009-12-20T18:12:00.000-08:00

During my cosmetic surgery training, one of my mentors was Dr. Obagi, a Los Angeles cosmetic surgeon. Since I had facial acne scars, I asked him to perform a deep T.C.A. peel. I was given Valium and other medications, and the peeling solution was painted on. I had some pain when I woke up, but it was not too bad. The recovery process involved a very swollen face for several weeks, but my skin came out baby-soft and smooth with much improved acne scars.

Peeling does not usually remove all scars, so I didn’t expect perfection. I looked much better after the procedure. I remember thinking as I was standing in my front lawn looking out at Los Angeles that if I had trained anywhere else I probably would not have had this adventure. But the results were delightful and I am now able to tell my patients what the recovery is like from a personal perspective.

Since that time, laser peeling has largely replaced T.C.A. peeling for Los Angeles Cosmetic Surgery patients. It’s a bit more predictable, with easier recovery times. But we still use T.C.A. sometimes, as it’s cheaper and gives nice results for selected patients.

Interview Dr. Yoho on NBC about dangers of plastic surgery

2009-10-30T13:10:00.000-07:00

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

2009-10-29T13:36:00.000-07:00

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

2009-10-27T15:25:00.001-07:00

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

2009-10-09T13:59:00.001-07:00

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

2009-10-09T08:33:00.000-07:00

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

2009-10-07T07:45:00.000-07:00

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)

2009-10-05T15:52:00.000-07:00

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

2009-10-02T16:37:00.000-07:00

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)

2009-10-02T16:31:00.001-07:00

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

2009-10-02T15:48:00.000-07:00

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

2009-10-02T11:02:00.000-07:00

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

2009-10-02T09:08:00.000-07:00

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?

2009-10-01T15:02:00.001-07:00

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:

2009-10-01T14:59:00.000-07:00

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

2009-08-10T12:39:00.001-07:00

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!

2009-08-06T12:07:00.000-07:00

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

2009-07-30T17:38:00.000-07:00

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

2009-07-09T17:57:00.000-07:00

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

2009-07-09T11:59:00.000-07:00

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 / Fresno/ 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.

Cosmetic surgery SEO

Michael Jackson’s death and drugs involved

2009-07-02T13:16:00.000-07:00

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)

2009-06-25T10:55:00.001-07:00

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

2009-06-25T10:00:00.000-07:00

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.

1 6 C C R ß 1 3 5 6 . 6 ( ( C a l . A d m i n . C o d e t i t . 1 6 , ß 1 3 5 6 . 6
B A R C L A Y S O F F I C I A L C A L I F O R N I A C O D E O F R E G U L A T I O N S
T I T L E 1 6 . P R O F E S S I O N A L A N D V O C A T I O N A L R E G U L A T I O N S
D I V I S I O N 1 3 . M E D I C A L B O A R D O F C A L I F O R N I A [ F N A 1 ]
C H A P T E R 2 . D I V I S I O N O F M E D I C A L Q U A L I T Y
A R T I C L E 1 . G E N E R A L P R O V I S I O N S

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

2009-06-19T18:46:00.000-07:00

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

2009-06-19T09:20:00.000-07:00

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

2009-06-17T18:34:00.000-07:00

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.

Perfection and Cosmetic Surgery

2009-06-17T16:51:00.000-07:00

The above photo is of another surgeon's breast implant which was coming out through the incision that it was placed through. This implant had to be removed a week later after watching and waiting for the hole to close by itself. The lady was to wait for 4 months then have the implant replaced when the healing was complete. Many such problems occur in cosmetic surgery, and this is nothing unusual.

Nothing is perfect! Every face and body is different. Every result depends on the preexisting state of the patient’s skin and underlying structures, and their nutrition as well as the skill of the surgeon. We see imperfections and complications all the time. If we were just to operate on people who looked great and were in perfect health, our results would be nearly perfect too. The following is one “Evaluation” from one of our patients at just a week after the liposuction surgery. Everyone isn’t this happy however. Perfection just doesn’t exist in life or cosmetic surgery…

“Dr. Yoho’s staff is wonderful. They were on top of things. I got a call from his staff every day after my surgery to ensure I was doing well. I felt very comfortable and important. Both Dr. Yoho and Jeremy were wonderful as well. They made me feel relaxed and worry free. I already can see results from my surgery and can’t wait till all the healing process is over to see everything. Thanks you Dr. Yoho and staff for making me feel great and helping me bring my sexy back!!!”

Clint Eastwood is said to have stated, “If you want a guarantee, get a toaster.” We always say there are no guarantees. Our reputation is our guarantee. We promise to do our absolute best to give you the nicest cosmetic result in the safest way we can. For a more definitive article about cosmetic surgery expectations and complications see link. There's a photo here of skin death after liposuction.

The latest on our Fractionated CO2 Laser: the Smart Xide Dot.

2009-06-15T16:55:00.000-07:00

As you may know, a CO2 laser is a stronger laser (see laser results for results)that has to potential in the right patients to erase wrinkles and improve discoloration dramatically. The older CO2 lasers sometimes produced undesirable permanent decrease in pigmentation. This problem has been solved if the new CO2 fractional lasers are used carefully. Patients with the proper (lighter) skin type can be treated more aggressively, and get good results right away. We do treat darker skin types, but it has to be a careful, slow process, over several sessions. The new Smart Xide Dot laser sprays thousands of tiny treated areas on the face or neck and leaves intact bridges of skin that allow for rapid healing.

Where the new laser has come into its own seems to be the neck area. This was formerly impossible to treat without over or under doing it. Now, we seem to often have 50 per cent improvements with just one treatment. We can use just enough treatment power without using too much. Those brown, sun exposed necks that many women in our Pasadena / Los Angeles / or Central Valley / Fresno area have can be successfully and carefully lightened with this laser. And it’s really not painful. If our patients want to take the numbing cream home, they can apply it an hour before they come in to see us and they generally have very little discomfort. Or, if you would rather not have any sensation at all, we offer sedation inexpensively if you have a friend to drive you home. See Lasers at DrYoho.com for more information.

Breast implants: over versus under the muscle?

2009-06-08T13:12:00.000-07:00

The left implant is a saline implant which is deflated. The right implant is a silicone implant.

When breast implants were first invented, silicone fill was always used. During this era, the implants were placed over the muscle. Later, saline implants were developed, but they never felt as natural and they tended to ripple (or scallop along the edges). It was around this time that someone started putting the implants under the muscle, so there would be more body tissue between the implant and the outside, hopefully to make the look and feel of the enlarged breast more natural. The standard practice now is to place just the top part of the implant under the muscle and the lower part of the implant under just the breast tissue and skin. The lowest 20 per cent of the muscle is cut, in order to allow this.

Remember that for a time, there was thinking by regulators in the USA that silicone implants were dangerous, and they were banned from general use for about a decade. Sub-muscular implant placement really gained popularity during this period for the saline implants that were used.

Now, there’s a third way to place the implant, and that’s under the “skin” or “fascia” of the muscle, above the muscle and below the breast tissue. This has some of the advantages of both approaches. This technique has been popularized by one of the busiest breast surgeons in the USA: Dan Metcalf, MD, who frequently performs over 600 breast implant cases a year. Most sub fascial implants are performed through an armpit incision, where the "skin" of the muscle is thick and easily identifiable by the surgeon. Many of these implants were placed as described.

There are surgeons who have been trained that only sub-muscular implants are right and there are surgeons who mostly do sub-glandular (above the muscle) implants and others who believe that sub-muscular implants lead to lots of problems ten years after surgery. Do not believe anyone who tells you that there’s one best way to do this surgery for every patient. Here are some photos of breast implants placed under the muscle.

What does Dr. Yoho do for his Pasadena / Fresno / Visalia cosmetic surgery breast patients? We individualize the approach for each person. The questions we ask are: what do their breasts look like, can they afford and do they want silicone implants, and what sort of incision is desired. For patients who have relatively perky well formed breasts with normal shape and lots of breast tissue, they may get very nice results with a sub-fascial or above the muscle approach with a saline implant and have just as good a result as with a silicone implant. For patients who have odd breasts, such as “tubular” breasts, often a silicone implant above the muscle is recommended because of the surgery needed and the skin stretching that may be needed. If you have very little breast tissue, you likely are a better candidate for sub-muscular implants. These can be silicone or saline depending on the preference. See DrYoho.com for more on silicone versus saline and the style of implants available. We absolutely have to have a look at your breasts and speak to you about your individual preferences to give you the best idea of what is right for you.

What's the Difference Between a Plastic and Cosmetic Surgeon?

2009-05-20T11:59:00.000-07:00

Question:
"What's the difference between a plastic and a cosmetic surgeon?"

Answer:
The best explanation is produced by the American Academy of Cosmetic Surgery. We have reproduced this at DrYoho.com; click here to read more about plastic vs. cosmetic surgeons

Basically, cosmetic surgery is a field of beautification surgery. This includes eyelids, facelifts, breast enhancements including lifts and breast augmentation, and liposuction, among other surgeries. Plastic surgery also includes many other types of surgery, such as hand surgery and complex surgeries cooperating with other surgeons doing reconstruction work. Plastic surgeons typically work closely with other surgeons in hospitals to perform care on sick patients. Some of them also do Los Angeles / Fresno area cosmetic surgery.

If you want to read a comprehensive article about how to choose your surgeon, and understand just how the physician training and experience impacts the performance of various surgeries, refer to this chapter of my book on cosmetic surgery.

This is a pretty complex subject and you need to exercise some judgment and do your homework. Be sure to verify the credentials of your Los Angeles / Fresno area cosmetic surgeon, and research their methods to get a better idea of your options.

Fresno, CA Area Chin Liposuction Improves Sleep Apnea

2009-05-18T12:12:00.000-07:00

We received a thank you letter from a happy patient, part of which follows. I cut out all the detail about our excellent service and so on, but the interesting thing was that the chin liposuction improved her sleep apnea. I have seen this several times, and it seems to be related to our practice of removing fat under the muscle as well as above the muscle of the under-chin area. Here it is.

"Five years ago, I was diagnosed with Sleep Apnea. Every night I was required to sleep with a C Pap machine to assist with my snoring and breathing. This was becoming very cumbersome and uncomfortable, not to mention it's a bulky piece of equipment. My job requires that I travel and carrying this machine was beyond an inconvenience, it was a nightmare. Dr.Yoho suggested that I consider having Chin Lipo to help my sleep apnea. I figured that I had nothing to loose and possibly lots to gain by having my chin done. I also decided to have full torso lipo with fat transfer to my buttocks.

On the morning of the surgery, after a few minor preparations, I met with Dr.Yoho who went over what was going to be done. We chatted for a while which made me feel comfortable and relaxed.

Since my surgery, I have not had the need to use my machine. I recently traveled out of the country for the first time after my surgery and am proud to say there was no need to travel with that extra piece of luggage. "

If you have sleep apnea it may be related to buildup of fat under the muscles of your chin. If so, you might be able to resolve this problem through a Los Angeles / Fresno area cosmetic surgery procedure. This is not a guaranteed outcome of every Fresno, CA facial liposuction procedure, but for certain patients is an added medical benefit.

Fresno Cosmetic Surgery Questions - What is the Liquid Facelift?

2009-05-18T11:42:00.001-07:00

Question:
"What is the 'Liquid Facelift'?"

Answer:
The liquid face lift is a name for non-invasive filling of saggy parts of the maturing face. Fat loss as well as the loss of elasticity is largely responsible for the problems surgeons try to correct with a facelift. In particular, fat loss around the eyes and of the cheekbone area and upper face is responsible for allowing downward movement of the facial skin sometimes producing “jowls.” Near Los Angeles and Fresno, facelift cosmetic surgery is - in simple terms - a way to pull the skin up and trim the extra from around the ears.

However - the original facial contours were influenced very much by the original fat structure. Look at any magazine at photos of younger people: their faces are smoother, more filled out. Facelifts alone can’t produce this effect.

In order to obtain the best results with facelifts, I typically recommend a facial filler of some kind to be done along with the surgery. Fat, JUVÉDERM® Injectable Gel, Restylane® or Perlane®, or other fillers can be used. But this is up to the patient of course. Some people prefer a thinner, more mature look that a facelift alone produces. And of course nothing tightens the neck like a Fresno or Los Angeles facelift cosmetic surgery procedure.

The liquid facelift is an attempt to use the fillers alone to produce the proper effects. This is all about using larger volumes of these fillers to mimic the slightly fatter, more structurally supported faces of youth. Of course, this works best if the skin isn’t too very loose. Sun damage and natural aging processes cause problems that volume correction alone sometimes can’t completely fix.

And it’s almost always the case that the more filler you use, the better results you get. Nine syringes will obtain a great result in many cases. And our minimum is three. In order to have our patients feel confident that this is worth it, we have cut our price (in Pasadena, Visalia, Fresno areas) to $1000.00 (as of the time of this blog post) for three syringes of JUVÉDERM® Injectable Gel. If you use less than this you may get a result improving your folds around the mouth, for example, but you just can’t get the result you get using more filler.

Fat is just fantastic in some cases, but more swelling usually results and it has to be taken from somewhere on your body with a Fresno or Los Angeles, CA area liposuction procedure.
For more information on fat filling, visit my Los Angeles cosmetic surgery site or see my blog post on fat as a facial filler.

Fresno, CA Area Liposuction for Large-Volume Patients

2009-05-15T16:36:00.000-07:00

In this post I want to comment on a post from MakeMeHeal.com, about a past patient of mine.

This is one of our Los Angeles / Fresno, CA area liposuction patients who had a large volume liposuction and who was full-figured but had VERY satisfactory result. She has posted her photos on the link. If you click through this link using the password yoho, you will find over 20 of her before-and-after photos.

These larger volume liposuctions require special care and experience, and it's my belief that they should not be performed under general anesthesia, which increases the risk of the surgery. Additionally, larger-volume procedures pose increased risks for skin problems. This patient actually had a small area of skin necrosis after her surgery, but was still extremely happy with her result. She lost weight and has a shape she is very proud of, and fits in form-fitting outfits.

meechie

Joined: 10 Dec 2006
Posts: 38

Posted: Sat Oct 25, 2008 5:10 pm Post subject: My one week pics...I am amazed
I went to DR. Yoho in Pasadena on 10/17. I had full torso lipo. I was amazed at the shape and body that he created. I never wanted to be thin, or skinny. I like the thick look. I like small waist, flat tummy, shapely, large thighs and rear...I think that is sexy. My goal is to fit into a 10-12.....I am nearly there now.

my pics are way to big but my pics are here...

http://public.fotki.com/cuteasgirl/dr-yoho/

password is yoho

Nutritional Therapy Before and After Surgery

2009-05-13T18:30:00.001-07:00

Everyone knows that proper nutrition is important. But did you know that nutrition can influence the infection rate? And help healing of open wounds? And make any given patient respond to the stress of surgery better?

I have had many patients who have responded to my nutritional therapy, which I have used to treat complications including large open wounds lasting many months after other physician’s surgical procedures were referred to his clinic. I have cured some of these in just a few weeks using proper nutrition. One of my latest cases involved an infection from a Fresno / Los Angeles area breast augmentation procedure, that was draining - even after the implant was removed - for 8 weeks. I supplied the nutritional therapy described at the above link, and the drainage went away in 3 days and the wound closed soon thereafter.

While proper protein supplementation, vitamin C, Zinc, and other supplements are clearly helpful in some cases of surgical healing, wheat grass pills (usually 5 tablets two times a day, available at wheatgrass.com) may seem like a non-traditional idea. But in my experience they can really help in some cases.

All these therapies must of course be used with good traditional care, such as proper wound care, and possibly antibiotics if infection is demonstrated. If you are not confident that your Los Angeles or Fresno area cosmetic surgeon is offering the quality of nutrition you need, you should contact my Fresno area cosmetic surgery offices and schedule a meeting to talk with me personally.

For more information on healthy nutrition and post-surgical healing, you can also visit my site, www.dryoho.com.

Breast Lifts & Reduction in Fresno

2009-05-13T18:09:00.001-07:00

Question:
Traditional Breast Lifts/reduction versus the new “Vertical Mastopexy/Ice Cream Cone” Breast Lift (with or without implant or reduction) - what's the difference?

Answer:
When you are unhappy with your breasts, there may be three reasons:

volume
shape
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, Fresno, CA breast reduction using liposuction, or a breast 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 its primary function is to shape the breast and re-position the nipple-areola area. If for some reason after this procedure, 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 areolas.

Remember whatever choice you make, if you need a breast augmentation near Fresno, 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: I do not not usually perform the anchor-type scar procedure, the traditional breast lift. However you can view my gallery of past breast lift before and after photos to get a better idea of what the vertical mastopexy can achieve.

Fresno, CA Liposuction - What is the Brazilian Butt Lift?

2009-05-13T18:07:00.001-07:00

Cosmetic Surgery Answers
Question:
What is the "Brazilian Butt Lift"?

The 'Brazilian Butt Lift" consists of Fresno, CA area liposuction of the areas around the buttocks, usually including the area above the butt or “sacral” area and the hips and often the outer thighs. Then, sometimes, fat is transplanted into the buttocks to make them fuller. Contrary to what is said elsewhere, the fat should be transplanted into the lower two-thirds of the buttocks, not the upper two-thirds.

There are some doctors who are spinning the fat, so as to make it denser. In my experience this does not improve the result. The bottom line is that any given butt can take only so much fat in any one operation or the transplanted fat tends to cause problems like infection. Infection is a risk anyway even if everything is done to the best possible standard, but there is no reason to worsen the risk. If you have a big butt this technique can be used to make it much bigger. If you have a small butt, the Brazilian Butt Lift can only do so much.

I have been performing this cosmetic surgery procedure for over a decade. Results vary with the individual, with some people getting almost all the fat to “take,” making the butt more shapely. Others, such as smokers, will have very little retention of the fat. If you are a smoker, it’s probably not worth it.

There are also Fresno, CA liposuction surgeons who are putting implants made of silicone into the buttocks. These implants generally go under the muscle and in my opinion often cause unnatural results, with somewhat strange bulges on top of the butt (see results at other internet sites). Fat transplant methods can be repeated if the patient wants more fullness.

Note that in some cases I can also achieve very good results to lift and shape the buttocks using Fresno, CA area liposuction alone, without transplanting fat to the area. This is because, as noted above, the areas around the butt were shaped beautifully. An additional factor is that slight weight gain, or the patient stabilizing at a similar weight as before a relatively large liposuction, can produce very nice fullness of the breasts and buttocks (whether or not the patient receives a breast augmentation as well), where the remaining fat tissues can grow a little. There may not be any ultimate net weight loss, but the patient sure looks a lot better, and the buttocks specifically may look much more shapely.

I have one additional note about this sort of case. It’s generally a mistake (of course there are exceptions) to liposuction the buttocks themselves. Liposuction of the area around the buttocks is best. This usually produces the most improved shape.

What Does Dr. Yoho Think About Facial Fat as a Facial Filler?

2007-04-02T17:12:00.000-07:00

Question:
What do you Think About Using Fat as a Facial Filler?

Answer:
I have the experience of fat transplanting hundreds of patients, in faces, buttocks, and elsewhere. I think that it can be useful in certain cases, but I do have a few problems with it:

Sometimes it all goes away.

If the patient gains weight, you can end up with a patient with a really fat face.

If it is used underneath the lower eyelid in order to fill in the little groove here it can be a real problem because it tends to encapsulate and form a little lump that sometimes grows and sometimes has to be surgically removed through a small incision. Although the cuts in this area heal beautifully in most cases, it is still a hassle to have to remove facial fat.

I also have extensive experience using frozen fat, but after several case reports of severe infections that occurred with other physicians who were using this, I abandoned frozen facial and other frozen fat transplant approaches. This was not my preferred approach in the first place, because frozen fat is dead material, and is not ideal to create a contour that will last in the long-term.

The best fillers in my opinion as of this post are Restylane®, Radiesse®, and injectable silicone. All of these provide certain benefits and certain drawbacks which your Fresno area cosmetic surgeon can explain at the time of your consultation and which are explained at my cosmetic surgery site. Most notably, Radiesse frequently causes lumps when placed in the lips and so this is probably not the best use for it.

Based on my experience I feel that facial implants can often solve problems of facial sagging and work better than fillers in many cases, so when you meet with your surgeon be sure that he or she clearly explains the benefits and drawbacks of each of these options for you. See my photo gallery of cheek and chin implant before and after photos to get a better idea of the results these can achieve.

Does BOTOX® Cosmetic Really Work?

2007-03-27T07:38:00.000-07:00

Question:
Does BOTOX® Cosmetic Really Work?

Answer:
BOTOX Cosmetic is the “crack cocaine” of cosmetic surgery. BOTOX Cosmetic is just so very attractive because it works so very well. It has also been a great thing for our patients because with BOTOX Cosmetic, most people can see the results within a short period of time and sometimes overnight, occasionally it takes as long as a week. We can in many cases erase many years of age from a person’s face. Our new injection technique involves smaller needles than have been available before. These needles are less painful. We can produce nice quality brow lifting, as well as upturning of a person’s mouth and removal of "crow’s feet" and lines under the eye. Additionally, many people can get an improvement in the smoker’s lines around the mouth or the wrinkles around the mouth that a person gets as they mature.

Unfortunately, small doses of BOTOX Cosmetic just are not as effective and you should receive about 45 units of BOTOX, minimum. The results sometimes are disappointing if you get less. BOTOX Cosmetic costs between $8 and $15 a unit at the MD's office. It certainly is important who you have injecting your BOTOX, because inexperienced or un-knowledgeable BOTOX injectors can produce effects that can look like Mr. Spock and/or effects that can drop the eyebrow into the eyes and make for a very unattractive look. Generally speaking, the best BOTOX practitioners put very little BOTOX Cosmetic into the forehead these days, and focus more on other areas.

It is also important to note that BOTOX is not an effective long-term solution. Near Fresno, face lift cosmetic surgery or other procedures such as brow lift are the "gold standard" for smoothing out problems such as crow's feet and brow furrows in a more permanent way, so be sure to discuss your options with your surgeon beforehand.

Fresno Cosmetic Surgery vs. Noninvasive Treatments - Understanding TCA Peel Procedures

2007-03-27T07:28:00.000-07:00

The current Fresno area cosmetic surgery market is filled with many advertisements for "non-invasive procedures." These procedures' results are proportional to their inconvenience and recovery time. In other words, if you have a tougher recovery, generally speaking, you will have better result. Trichloroacetic acid peeling is the perfect example of this.

This treatment can be performed in a very non-invasive way with a minimal recovery that involves just a little bit of flaking of your skin. For the right patient, this can produce color improvement and texture improvement. On the other hand, if performed in a deep fashion, trichloroacetic acid can produce a tremendous improvement in wrinkling of the whole face. Deep trichloroacetic acid peels unfortunately have a tendency to cause scarring in the area of the jaw and sometimes around the mouth. For this reason, light TCA peels and moderate TCA peels have become the standard and deep TCA peels are practiced only by a few.

At my Fresno area cosmetic surgery offices, I offer both light and moderate TCA peels with or without sedation for patients who do not want to come back repeatedly for non-invasive treatments such as FotoFacials®. These peels can produce a great deal of improvement without all of the driving back and forth and the aggravation in the expense of waiting for your non-invasive treatment to mature.

What is the American Board of Cosmetic Surgery?

2007-03-27T07:12:00.000-07:00

Question:
What is the American Board of Cosmetic Surgery?

Answer:
The ABCS is an independent private testing organization that gives an intensive 2-day test to physicians who want to be certified or have some demonstration of their knowledge in cosmetic surgery. Cosmetic surgery is the art and science of beautification surgery. It does not include hand reconstruction, cancer surgery, or other skin surgery skills that have to do with diseases. The procedures covered include, but are not limited to, liposuction, eyelid lifts, hair transplant, facelifts, forehead lifts, resurfacing procedures of various kinds, insertion of fillers to make the face and other parts of the body fuller and more youthful looking, tummy tucks, and BOTOX® Cosmetic. The doctors are tested on emergency procedures in their office as well, and have to demonstrate good knowledge of cardiopulmonary resuscitation and knowledge of the medications and procedures used in case of emergencies of various types.

Currently, doctors testing for the American Board of Cosmetic Surgery need to have had both a surgical training program and also a fellowship (a year or 2) of specialized training in cosmetic surgery. Fresno area cosmetic surgeon Dr. Yoho was privileged to take the Cosmetic Surgery Board’s as a "grandfather," because he had performed over a thousand cosmetic surgery procedures and was considered a very competent individual to join the ranks of the board certified American Board of Cosmetic Surgery members.

This board is the only board that certifies Fresno area cosmetic surgeons purely in cosmetic surgery. The other boards are mixed boards. In other words, they certify surgeons in a whole group of other procedures including procedures to treat diseases and injuries. The plastic surgery board, the ear, nose, and throat board, and the dermatology board are examples of boards of this type, which include some information and testing about cosmetic surgery procedures, but do not concentrate exclusively on cosmetic surgery.

Note that all of the boards including the American Board of Medical Specialties are private organizations and none has any official status except as granted by medical boards and other organizing bodies. They all have their own board of directors and their own agendas to promote their membership and, in many cases, their own advertising budgets.

For a complete discussion of board certification and the American Board of Cosmetic Surgery, please see www.dryoho.com under "Meet Dr. Yoho" and then "Understanding Board Certification."

Cosmetic Surgery Procedures After Pregnancy

2007-02-22T06:43:00.000-08:00

Question:
What kind of cosmetic procedures are best for me after a pregnancy?

Answer:
Everyone is an individual and must be evaluated in person; however, many women have deflated and saggy breasts after breastfeeding. Breast augmentation for Fresno-area women can restore the original contours or even create a contour that the patient enjoyed during her breastfeeding days. Many times, no cutting is necessary on the skin of the breast, and the implant can be inserted through the bellybutton without cutting the surface breast tissue to any significant degree or disturbing the nerves to the breast.

Most implants are inserted under the pectoralis muscle. They do well because there is a natural drainage of any slight bleeding into the fat of the abdomen rather than the blood staying in the area around the implant. This bruising on the abdomen rather that around the implant helps decrease the chance of scarring around the implant (capsular contracture). This scarring around the implant can make an implant quite firm and sometimes even painful, but a qualified surgeon will be able to explain what techniques he or she will use to minimize this risk.
For more information, please visit my website at www.dryoho.com.

Another common procedure performed after pregnancy is Fresno, CA area liposuction. This procedure is very helpful for women who have exercised enough and have had good enough muscle tone of their abdomen. Skin sagging that occurred after the baby was born can often be improved with liposuction alone if it is not too extreme. The liposuction disrupts the skin tissues underneath the surface, which causes them to contract. As surgeons know, skin contraction occurs in every direction for several weeks after any injury and sometimes for longer. In the case of liposuction the damage is minimal and internal, and the skin is allowed to contract back towards the muscle wall. In the best case, smooth, tighter, natural-looking skin can be produced by liposuction alone.

For those women whose muscle walls do not recover from the stretch of having that extra 20 to 30 pounds of baby and baby support system, muscle wall tightening can be performed. The “tummy tuck” consists of making an incision from hip to hip and then making a passageway right next to the muscle all the way up to the ribs. In this passageway, the muscle wall is sewn to itself in a sort of pleating process which tightens the muscle. Then the skin is pulled down, extra skin is trimmed away, a new bellybutton is shaped, and the skin is sewn along the lower abdomen. Unfortunately, this method does produce long scars. Also, unless great care is exercised, some of the belly buttons are not very natural-looking. However, a qualified Fresno area cosmetic surgeon should be able to create a result that looks and feels natural.

Another way to tighten the muscle wall - if the skin is not tremendously loose - is to do it through the bellybutton. In this method, a bit of liposuction might be performed on the front of the abdomen, and then a little circular cut is made around the bellybutton. After this, passageways are made in the midline above and below the bellybutton and again the muscle covering is stitched to itself with permanent sutures. This procedure cannot tighten the skin, but the skin often will shrink fairly well later on if the muscle wall is tightened. This avoids the long scar of the tummy tuck, but again care must be taken with the bellybutton or unnatural bellybuttons with scarring right on the surface can result.

Please visit www.dryoho.com for before and after photos and information about these and other cosmetic surgery procedures.

Common Cosmetic Surgery Questions

2007-02-05T15:02:00.000-08:00

Question:
What procedures are new in Los Angeles / Fresno area cosmetic surgery?

Answer:
Two procedures are now gaining popularity and we will have to wait and see just how popular they become. The first is revision of the bellybutton as a sole procedure. This can be done by removing a little bit of skin around the belly button and then carefully stitching inside the bellybutton in order to hide the scar. This produces tightening. It is an excellent procedure as a stand-alone bellybutton improvement surgery, or can be done after a Los Angeles liposuction or tummy tuck procedure.

The second set of procedures, which are becoming more common are nipple revision procedures for women.

Some women have large, droopy nipples, but these can be revised surgically at my Los Angeles / Fresno area cosmetic surgery practice. In my opinion, the best way to revise these is to carefully remove a cuff of skin from the base of the nipple. This pulls the nipple up and makes it perkier while still preserving nipple sensation.

Older methods such as cutting off the top of the nipple can often produce attractive results, but have more chance of significant problems and of course entail a much longer healing process.

Inverted or "sucked-in"nipples can bother women for a lifetime. The revision can be done by pulling the nipple tissues outward after the area has been injected with local anesthetic. After the nipple is pulled outward, a small incision is made in the side of the nipple and the fibrous bands, which held the nipple down toward the inside of the breast are cut, and the incision is stitched. After this, no special care is needed. Bruising is typical immediately after surgery, but this should go away within 1 to 3 weeks. This procedure be performed at the same time as a Fresno-area breast augmentation cosmetic surgery and greatly enhances the results for those women who have inverted nipples.

For more information on nipple and belly button cosmetic surgery, please visit www.dryoho.com.

Question:
What Fresno cosmetic surgery procedures may be "wrong" for most patients?

Answer:

Thigh lifts are often problematic, and generally unacceptable for younger patients. This procedure causes scarring, and sometimes the scar will pull in unnatural fashion on the area around the private parts of a woman. Additionally, the scar tends to migrate or move down the leg as the tissues mature. While there are ways to help prevent or correct each of these problems, overall this is not generally a good procedure in younger women.

Typical exceptions include individuals who have lost massive amounts of weight. At my cosmetic surgery practice near Fresno I offer liposuction in this area, and in many cases the skin will shrink adequately afterward. In an older woman with exceedingly loose skin, occasionally a thigh lift is an acceptable alternative, but only if the patient understands the potential problems.

Additionally, thigh-lifts place the scar in a moist area that is somewhat difficult to keep clean, so infections are probably more frequent in this area than for other types of surgery in other areas. When an infection happens, the scars become even more spread than is ordinarily the case with case with body surgery. For all these reasons, thigh-lifts are not popular with the cosmetic surgery community and not all surgeons perform these procedures.

Another procedure that is performed by only a few is artificial pectoral implants in males (in the breast area). There are some hard silicone implants that are designed for placement underneath the muscle to simulate a body builder’s chest, but these implants sometimes are mobile, and you can often feel the edges of them, creating a very unnatural result. While it may be possible that someone somewhere is doing a good quality pectoral implant and getting results that are acceptable, I do not know of any.

Calf implants are another procedure that is not performed very often and that, in my opinion has unacceptable healing times and a questionable risk-to-benefit ratio. The hard plastic implant (polymerized silicone) is placed through a slit in the back of the knee into the area underneath the muscles of the calf. The patients have to walk around on their tiptoes for weeks to months in order to get the muscle tissue to stretch out around the implant, and this is very uncomfortable. The incision is not insignificant in this area and frequently will spread, producing a scar that may often be unacceptable.

So remember, when you are thinking about cosmetic surgery, you do not have to get "everything on the menu" - just as when you go to a good restaurant, you should not try to eat everything that is there. There are procedures that are appropriate for your particular body and those that are not, and you should consult with your surgeon about what is most reasonable.

For more information, read "Doctor, What Else Do I Need?"
If you are considering cosmetic surgery and live in the Los Angeles / Pasadena area, please visit www.dryoho.com for before and after photos and procedural information.

Question:
What kinds of cosmetic surgery procedures produce the most lawsuits against surgeons?

Answer:
The answer to this question reflects several factors. First, it can reflect the kind of patients and the perfectionism of the patients who are interested in each procedure. Second, it may represent the difficulty of performing a given procedure well. Third, it may reflect the complication rate of the procedure. If the procedure has many complications, possibly there might be more lawsuits.

The number-one litigation or lawsuit risk for the cosmetic surgeon is nose surgery. This procedure represents less than 10% of the cosmetic surgery cases performed and about 1/3 of the lawsuits. Nose-improvement surgery is highly specialized and complex and probably should be performed by surgeons with ear, nose, and throat (facial plastic) background or maxillofacial background only, unless the cosmetic surgeon takes a lot of time to learn the procedure “hands-on” from a reputable training facility.

The standard joke among cosmetic surgeons is that you should pay the first 100 patients for performing their nose surgery and after that, the patients can pay you. Nose surgery’s healing process is different than any other >Fresno area cosmetic surgery, and it may take a full year for the final result to be seen. A nose that might look good at 3 months might not look good in a year. Experience is everything, or almost everything. An experienced nose surgeon who has the artistic feel for whether what he is doing can produce beautiful changes and a nose that does not look “done.” There is nothing worse than a bad nose job and problems are so obvious right in the middle of a person’s face.

Liposuction cosmetic surgery in Fresno, on the other hand, has relatively few lawsuits, only about 3% of the total lawsuits against cosmetic surgeons, although it must be about 1/3 to 1/2 of all the surgeries done. However, the problems with liposuction when they occur, are sometimes severe and might require hospitalization.

Breast reconstruction, especially when an implant is placed at the same time, requires a great deal of experience, and nipple loss is a possibility with some of the surgeries. This is obviously problematic. These cases have a disproportionately higher litigation rate. Ordinary breast augmentation, however, has one of the highest satisfaction rates in cosmetic surgery and has some problems, but no more than the average cosmetic surgery.

The most important message to take home from all this is if you want your nose done, get it with the most experienced surgeon, and choose your surgeon wisely in any case. Look at this plastic surgeon qualifications checklist for further information about how to choose your surgeon.

Question:
I have dark skin. How can cosmetic surgery help my scars?

Answer:
At my Fresno area cosmetic surgery office I see many patients with dark skin: Filipinos, Hispanics, African Americans and others. These skin types do not do well with aggressive peeling procedures because these can lighten or darken the skin, sometimes for lengthy periods or even permanently. However, with special treatment, this skin types can respond beautifully to our skin care programs.

The first step in treatment of a person with irregular pigment problems of their face is generally to use bleaching agents. We often include Retin-A® for better penetration to lighten their entire complexion. After a month or so of this, frequently, light treatments with slightly destructive methods such as electrical burning may be indicated for problem areas. Then, the patient might be instructed to use the bleaching and penetrating agents some more or they may be allowed to back off and use only a mild treatment regimen and allow their pigment to return to the skin.

Acne scars and wrinkles are particularly difficult to treat in these skin types. The peeling procedures and the deeper laser procedures are just not appropriate for darker skins because of pigment change. The good news is that wrinkles are not usually as much of a problem as in light complexions where the sun exposure has to some extent aged the skin. Darker skins are just protected better from the sun because of the natural pigment.

We can effectively treat dark skinned patients who have even darker areas due to their acne. Acne can be treated with a variety of prescription and over-the-counter medications and there is a cure for it called Accutane®, which generally results in long-term improvement or complete cure of acne.

After these treatments are used, the bleaching creams and the smoothing creams can be employed to produce a complexion that is even and attractive. For some patients in Fresno, more intensive cosmetic surgery may be appropriate, but in general a carefully chosen regimen of laser resurfacing and/or other nonsurgical skin treatments is sufficient. The ultimate goal for complexion treatments of any kind is to produce a smooth even-colored look without the color irregularities that are present with some kinds of skin growths and/or skin irritations such as acne. We will individualize our approach to your skin type by evaluating you carefully and using our best judgment about what would help the most.