Dog Bite Prevention Week

It is a pity we do not make prospective animal owners take a test of competency, and an instructional course before they are allowed to own a dog. Then again, most of us would benefit from the very same preparation before raising children- and we don’t make anyone do that either!

One of the saddest complications from the human-canine relationship is the dog-bite. Especially when the victim is a child.

It is especially sad when we consider that a dog’s misbehavior is often the result of our own misunderstanding or mistreatment of that animal.

We can’t always understand what makes a dog tick (or ticked off), nor can we predict when to get out of harms way. What we can do, however, is learn as much as we can about our own dogs, and teach our children how to remain safe around their own and stranger’s dogs.

It is estimated (and I am certain that the number errs on the low side given our propensity to forgive the trespasses of man’s best friend) that there are 4.5 million dog bites a year according to the CDC, and the American Board of Veterinary Medicine. It appears that 60% of these reported incidents involve children.  Of these bites, those requiring medical attention reach 800,000. Dog maulings ending in a human death occur about 16 times a year.

Emergency room visits for dog bite victims which require the help of a plastic surgeon- either because of the location of the bite, or the age of the patient, or the severity of the incident are numbered at 30,000 times a year. Unfortunately, this represents an 8% increase from the previous year (the good news is that this number is down 29% from 9 years ago!).

With numbers like these it is imperative that we take our dog raising skills seriously.

We can certainly put some effort into educating ourselves, and those around us about properly raising our four footed friends, and most of all into teaching our children how to safely and respectfully behave around dogs.

Safety Tips for Dog Owners:

1. Seek a veterinarian’s advice about which dog is right for your family and lifestyle.
2. Socialize your dog so it feels at ease around people and other animals.
3. Don’t put your dog in situations where it may feel threatened.
4. Follow leash laws - don’t let your dog roam free.
5. Keep your dog healthy; Illness and pain can make a dog more likely to bite.
6. Spay/neuter your dog.
7. Confine your dog in a fenced yard when not in the house.
8. Never tether or chain your dog.

Safety Tips for Adults and Children:

1. Never approach an unfamiliar dog.
2. If approached by an unfamiliar dog, stand still like a tree.
3. Never run from a dog and never scream around a dog.
4. If you believe a dog is about to attack you, try to place something between yourself and the dog, such as a backpack or a bicycle.
5. If a dog knocks you over, roll into a ball, cover your face and stay still.
6. Children should never play with dogs unless supervised by an adult.
7. Don’t disturb a dog that is sleeping, eating or caring for puppies.
8. Don’t play with a dog without allowing it to see and sniff you first.
9. Children should never approach a dog unless supervised by an adult.
10. Adults should never leave an infant or young child alone with any dog, not even the family pet.

If Bitten:

1. Seek medical attention immediately.
2. Control bleeding and wash the area of the bite with soap and water.
3. Because serious dog bites can cause scarring, if you are bitten in a location where scarring is of concern, like your face, ask that a board-certified plastic surgeon treat the injury.
4. Report the bite to your local public health department, animal control agency or police.
5. Provide authorities with an accurate description of the dog, the circumstances surrounding the bite, and the dog owner’s identity, if known.

Please find more information on the site links below.                                        -drB

http://www.petconnection.com/blog/2010/05/20/tips-to-remember-during-dog-bite-prevention-week/#comment-487281

http://www.avma.org/animal_health/brochures/dog_bite/dog_bite_brochure.asp

http://www.avma.org/public_health/dogbite/

http://www.avmatv.org/media.cfm?c=381&m=1542&s=64&

http://www.cdc.gov/HomeandRecreationalSafety/Dog-Bites/biteprevention.html

http://www.plasticsurgery.org/Media/Press_Releases/Take_a_Bite_Out_of_Dog_Attacks_Says_ASPS_AVMA_and_CDC.html

http://www.plasticsurgery.org/Documents/Media/statistics/2009-cosmetic-reconstructive-plastic-surgery-minimally-invasive-statistics.pdf

http://www.plasticsurgery.org/Media/Press_Releases/Take_a_Bite_Out_of_Dog_Attacks_Says_ASPS_AVMA_and_CDC.html

http://www.avma.org/products/children/dog_bite_prevention_coloring_book.pdf

Naked Ambition

Last Sunday I came across an article in a New York Times Style Magazine which caught my eye.

...Perhaps because its title is “Naked Ambition”.

In this piece, the writer, Caroline Weber, examines the current trend of clothing made with sheer, and flesh-tinted materials which blur the distinction between the body and the garment. When the clothing blends into the person wearing them, the result, presumably, is that the garment doesn’t distract the eye from the individual wearing it.

Ms. Weber makes the point that this concept is hardly new, citing, as examples, the diaphanous gowns worn by Cleopatra, and the graceful, loungewear donned by maidens in works by Botticelli.

At the same time, such clothing also does very little to camouflage a particular body’s shape, and age, and level of upkeep. I guess it is easier to have that kind of confidence if you are a young Egyptian queen or Venus.

The idea of clothing being more a window than a curtain seems to be an extreme representation of a more conservative view voiced by Coco Chanel, quoted in the article, who supported the notion that an article of clothing should compliment, and not steal attention from, the wearer.

It was this quote that had me recalling a recent consultation I had with a patient who wished to regain a youthful bust.  This woman told me: “ I do not want my breasts to enter the room before I do, or to scream across the lounge “hey look at me!””. While Ms. Chanel was but referring to clothing, the parallel is clear: A bosom of proportionate size, and youthful shape, can compliment, balance, and complete a body rather than compete with it. It does not need to be an over-inflated, an up-near-the-collar-bone set of golden globes. (Though some of my patients prefer exactly that). A simply feminine, elegant bust is what many more women today are looking for.

This “nude” clothing trend, seems to be in a sense, about honesty, and social transparency (pun intended). Perhaps this style philosophy is the result of a backlash from the recent disheartening national financial masquerade, leaving us all somewhat untrusting. Perhaps we are just tired of false advertising.

This wispy simplicity in clothing is similar to the sense of lightness, of body and spirit that women are seeking when they discuss with me their frustrations with their constant need to wear a supportive garment, and all the limitations in style, and lifestyle that goes with these gel/miracle/wonder-pusher uppers. There is a youthful freedom in not always worrying about how things fit, and how different your body might look in and out of clothing.

Honesty, simplicity, and ease of use, are very liberating elements. Of course, being truthful is easier when we have no secrets.

One might argue, therefore, that with this trend of transparent style, the best accessory is a well-shaped body. Indeed, whether the dress is Chanel-simple or see-through, a proud, proportionate, youthfully-packaged body is the sexiest accessory during any fashion era.

Feeling good about ones' self ultimately shows in the eyes, and voice, and posture. When that ‘look’ and demeanor exists, who needs layers of clothing and  accessories?

-drB

Naples Hooters- Your Top Ten!

Last Saturday, April 17th, the top representatives from the Southwest Florida Hooters Restaurants (by representatives, I mean bikini worthy staff), (and by "top" I mean beauty, poise, sense of fun, and sheer nerve) came to Naples to compete for entry to the nationally televised miss Hooters International Competition finals later this year.  Here are the top ten (out of thirty). Of these, five qualified to go on to the regional finals to be held next month on Boca Raton.  Once again, the job of the judges was a difficult task. Without sounding like a complaint or whine, since I'm sure anyone would take my place in a heartbeat, let me point out that critiquing these wonderful young ladies is difficult, sometimes absurd, and kinda mean. A lot of it is pure gestalt, and evaluating the energy, and poise with which they present themselves. Well, another tough assignment completed.
"Thank you" to the Hooters of Naples for letting me be part of their world for little while.

Choosing a Plastic Surgeon- SAFELY

Just when I thought I had repeated myself one too many times (..."This is how to pick your Plastic Surgeon"), it becomes apparent to me that the challenge of finding a safe, qualified, and effective plastic surgeon is still a process which often stumps the general public. I continue to be surprised at some of the stories I hear about how intelligent and trusting citizens put their lives and appearances in the hands of practitioners whose only qualifications are that of self-promotion. A recent California survey revealed that the majority of Cosmetic Surgery providers in San Diego are not actual Plastic Surgeons, urges me to re-iterate some fundamental steps to ensuring that your aesthetic concerns are discussed and treated by someone who deserves your trust.
Before reviewing some guidelines to "Finding Dr. Right" let me mention that the study in Southern California (where it was documented that Hyaluronic Acid Gel Fillers are being offered by 1867 'practitioners', and Liposuction is being done by 834 individuals--but only 495 trained Plastic Surgeon exist in the same geographic area) is only putting numbers to what we already know to be the case- not just in San Diego, but all across the country. "Cosmetic" procedures (I place the word cosmetic in quotes because it is a word with no legal meaning) are being offered by many physicians of other specialties, primary care M.D.'s and D.O.'s, Dentists, Oral Surgeons, Nurses, Physician Assistants, Immigrants whose background may have included, unconfirmed, medical background in other countries, and even Salon personnel. These procedures are being done in offices, nail salons, hotel rooms, tanning centers, and ad hoc clinics. "Why?" you might ask. Because they legally can; because they may even think they know how, because it makes them money- being qualified and safe takes a lot of expense which these people do not have. Whether or not these service providers have had any training, have had the right kind of training, can take care of any complications which may arise, use legitimate products, answer to any higher authority, and have the experience and interest in human aesthetics and all its implications-- is up to you to discover before you make a commitment. I would like to help you.

"Finding Dr. Right"
Plastic surgery involves many choices. The first and most important is selecting a surgeon you can trust.
Choosing an ASPS Member Surgeon ensures that you have selected a physician who:

• Has completed at least five years of surgical training with a minimum of two years in plastic surgery.
• Is trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
• Operates only in accredited medical facilities
• Adheres to a strict code of ethics.
• Fulfills continuing medical education requirements, including standards and innovations in patient safety.
• Is certified by The American Board of Plastic Surgery

Questions to ask Before and During the Consultation

• Are you certified by the American Board of Plastic Surgery?
• Were you trained specifically in the field of plastic surgery?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency.
• How many procedures of this type have you performed?
• Am I a good candidate for this procedure?
• Where and how will you perform my procedure?
• How long of a recovery period can I expect, and what kind of help will I need during my recovery?
• What are the risks and potential complications associated with my procedure?
• How are complications handled?
• What are my options if I am dissatisfied with the outcome of my surgery?

Please do you homework. The experience of Plastic Surgery or a non-surgical Aesthetic Procedure, in the right hands, is usually a wonderfully positive, empowering process. This is especially true if you have the confidence - before, during, and after - that you chose your provider well.
There are many wonderfully gifted, compassionate, professional, and experienced, and properly trained Plastic Surgeons out there. Not as many as you would think by just reading the billboards and ads posted by the wanna-bes-- but be patient, use your resources wisely, and you'll find the right one.

Hooters Ft. Myers Annual Swimsuit Pageant

Hooters of Ft. Myers; Saturday March 20th. Well, it was a struggle, but I got through it! Two hours of feigning interest and delight in a parade of bikinis and smiles... How will I ever find someone to take my place?
The Hooters of Ft. Myers Annual Swimsuit Pageant has come and gone. Five lovely ladies will proceed to the regional event, where they may be chosen to go on and represent south Florida at the National level... and then maybe on to the Miss Hooters International Competition.
Seeing these young ladies up on stage, confident, comfortable, smiling, wearing mostly their tan was a very positive experience. I don't mean that as obvious as it sounds. Let me explain.
Each girl was different from the next. They weren't all 5'10", not all were blonde, not all were D-cup, whether natural or enhanced. Some had booty, some were athletic, some had early 'motherly' changes. It was clear that what they did share between them (besides the amazing balance required for 6 inch heels) was a strength in their own body self-image. It was this confidence, the courage, and comfort it takes to get on a stage, that shines through to the audience. This is the basic beauty they all represented. I applaud them for that, and for sharing it with their fans.

As a plastic surgeon I don't have a personal vendetta against wrinkles, asymmetry, or modest curves. What I am here for is to help anyone who has particular body issue-- that certain something which keeps them from standing up proud, from smiling wide, from having that twinkle in their eye-- and modifying it so that they can do all these very things. I had a mentor who would like to say that "Plastic Surgeons may cut on the skin, but they operate on the Soul".
                                                                        more photos of Hooters' Swimsuit pageant

Hooters Annual Swimsuit Pageant

The Ft. Myers' Hooters Restaurant has invited me to be a Judge for the Annual Hooters Swimsuit Pageant. It's a tough job, but someone's got to....

Quite an honor indeed!
Considering how far many of our local young ladies have risen in the ranks of Hooters' national and international contests, not to mention their national Hooters Calendar, and television show- "Hooters Dream Girl" contest - it is quite exciting to be at the start of it all at this local 'home-grown' event.

I have been so impressed (this will be my third or fourth honorary judicial appointment) with all the girls who compete- it's just a wonder (and a wonderful thing) that they have the nerve to share their beauty with the rest of the world. The confidence it takes to get up there on stage--that in itself is a beautiful thing. They should all win.
Competition and careers aside- the day's event is quite a hoot (sorry about the pun). Between the live music, food, drink and very colorful crowds, its all quite an experience. I recommend it for anyone who is within driving distance. So, now you know where I'll be on Saturday night from five to ten. Perhaps I'll see you there.

Mini Facelift - Mini Results

I was asked the other day: "A mini-facelift sounds sooo much more appealing; less downtime, faster, less expensive. Why would I want a normal facelift to remove my jowls and wrinkles?"

Well, I'm glad you asked.

Of course a Mini Facelift sounds more appealing. It is faster, cheaper, quicker to recover from, and wait for it.... it is a smaller, less powerful procedure!

Understand this and your confusion will clear: Many "Mini facelifts" are not being advertised by surgeons directly. Most of the current hype and enthusiasm surrounding this mini- technique has been propagated by marketing-oriented businesses. The advertisements are misleading the "consumer" (you are not a  'patient' to them) into thinking that you are comparing apples to apples. This is not so. Because this campaign is lead by a business, you need to keep your "smart-consumer" hat on--and be skeptical, and read the fine print, like any other thing you might consider buying. When you think about it that way it will be obvious to you that it make no sense that you could get the same product for that much less investment.

INSTEAD,  I URGE ALL THOSE CONSIDERING A 'MINI' PROCEDURE to disregard the business trying to sway you, and listen to a fine surgeon whose primary goal is to educate you, and help you. If what you require to get the results you want is an abbreviated version of the classic facelift, then he will tell you so, and your experience will be a bit easier. If the "mini" is not the right choice, then you will be glad you didn't waste the time, money, and risk.

There are no shortcuts:

• Find a surgeon - qualified, experienced, pleasant, and communicative
• Meet with them- be evaluated- listen to their recommendations
• Learn what to expect, the risks, limitations, and downtime involved
• The right decision yes or no should be clear by then.

For Perkier Breasts... a New "Skin Bra"

   Think of the skin of the breast and chest as a bra for your breast tissue.
   Originally your "skin bra" fits snugly. It holds all of your new breast volume in a firm shape, and high position. As the breasts undergo the changes of life: adolescence, weight gains and losses, pregnancies, gravity, and menopause, they stretch and deform the internal and external materials holding their position and shape.
   A Mastopexy, or breast lift, is really just a tailoring procedure. And there are many different techniques. The concept behind all the different approaches to breast tailoring is to remove any unnecessary weight (if any), re-shape and position the breast substance, and tailor the breast skin covering it all. The scar pattern left behind any of these procedures is directly related to how much tailoring needs to be done.
   When the breast need tailoring, or lifting, but can also use a little extra volume, then the first step is to add an implant. This will give you larger cup volume, and add firmness, and definition in the cleavage area and upper pole of the breasts. It also decreases the amount of tailoring that is required, and therefore the extent of the scar pattern.
   The important point here, is that if your breast size and shape is not to your liking, and doesn't fit in well with your lifestyle or personality, then you should visit with a plastic surgeon. I recommend one who is board-certified by the ASPS, and has a lot of experience with breast restoration. They should listen to what your goals are, then help you through the decision making process. The solution should make sense to you, and should deliver a result that appeals.
   Breast lifting is a wonderful procedure which not only helps create a more youthful, prettier breast, but also frees the patient from  the day in-day -out requirements of  heavy breast support, and narrowed clothing choices. That kind of comfort, and freedom, and perkiness is quite empowering indeed!

Easy Beauty Mondays!

Easy Beauty Mondays
Monday, March 1st
Monday, March 8th
Monday, March 15th

BOTOX® price: $10/unit !
JUVEDERM® price: $400/syringe !
Microdermabrasion price: $90
Express Facial price: $45
Call our office to secure one of the remaining spots for Easy Beauty Mondays:
239-514-8777

Filler with "Less Feel"

Juvederm Ultra XC®  has just been released!
The newest rendition of a the popular Hyaluronic Acid Gel filler, Juvederm, now has local anesthetic mixed within it.
While some of us were hand mixing Lidocaine, a liquid local anesthetic, into the gel just before application, this new product allows anyone who hadn't thought of doing so to administer comfortably, this very safe and predictable sub-dermal filler.
To the surgeon, or injector (always ask, before you go, who actually does the injections), this eliminates the step of hand mixing the material.
To the patient it means very quick, relieving, comfort as the local anesthetic starts to kick in moments after the first 'pin prick'. When the application is over, the patient walks out comfortable and without the awkward numbness, and inarticulate period associated with the "oral block". This is primarily helpful when using the fillers in and around the lips.


Juvederm Ultra and Ultra Plus XC® are not the only, or the first, fillers with local anesthetic built in. We have been using Prevelle Silk ® for a few years now. Prevelle has been very popular with my patients who need to go back to work the same day of their injections, or out to dinner with friends. They didn't want to put up with the few hours of recovery from the oral block, but didn't want to sweat out the procedure with no form of  relief. There are a few other characteristics which make Prevelle preferable for the immediate- need filler. The company's tag line is "Today for Tonight". I like to reach for it when we have a "Plumper Emergency"


However, I am happy to have Juvederm in this new format, since I can expect predictably long results with this filler as compared to most of the other hyaluronic products available.


-drB

Bo-Tax Defeated!

   In case there are some of you who were not aware of the political craziness that went on just before the holidays, let me summarize.
   Under the guise of fixing America's heath care "crisis" the government added, at the last minute, a tax on Cosmetic Surgery, in an effort to fund all the costly, poorly planned changes they proposed for the health system. See Below:

Surprise Addition to Healthcare Bill is Arbitrary, Difficult to Administer

For Immediate Release: November 19, 2009

Arlington Heights, IL and New York, NY - Late yesterday, democratic leaders in the Senate unveiled their proposal for overhauling the health care system, which included a new 5% tax on elective cosmetic procedures. Senate Democrats argue that the tax, which was a surprise addition to the sweeping 2,074-page bill, will generate $5.8 billion over the next 10 years to be put towards the bill's estimated $849 billion price tag. However, the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) oppose this tax as discriminatory, arbitrary and ineffective.

  Well, it turns out that this idea was unconstitutional, or at least unfair since Cosmetic Surgery patients, as it turns out, are neither rich, nor evenly distributed in terms of gender, or nationality. A tax would have discriminated against middle income females.

A letter to our local paper's editor follows:

Letter of the Day: An ugly prospect 
Editor, Daily News:
   As you are aware, as part of the national health-care reform solution there is a proposed tax on aesthetic surgery procedures.
   I truly hope that I am not alone in vehemently objecting to such a preposterous concept. I can only imagine that the idea to tax aesthetic procedures was born in some brainstorming session and was immediately, though incorrectly, thought of as a form of luxury tax.
   In this desperate economic climate nobody dared to analyze the idea any further.
   If one took the time to do so they would realize that this tax would penalize women (90 percent of aesthetic patients) and the middle class (90 percent have an income under $90,000 a year).
   This tax is not based on the logic of penalizing an activity which costs the country money, such as smoking. Instead it is a penalty on a random spending habit — an intrusion on a private use of discretionary funds.
   This tax furthermore imposes a new role upon the medical caregiver — that of tax collector. This is a role which will only hurt the patient-doctor relationship.
   The goal to improve the U.S. health-care delivery system is a respectable aspiration. However, let’s not let this goal turn into a one-man or a one-administration crusade.
   To use fear tactics, loosely controlled statistics and popular sound bites is marketing propaganda, which should not be allowed in the election process, let alone in critical policymaking.

— Andrea Basile, M.D., Naples, board-certified plastic surgeon

Naples Daily News Letter to Editor

Fortunately reason won out this time and the tax was removed from the health care reform proposal-at least for now....

The Bo-Tax Defeated!

WRITTEN BY MYCOSMETICPROCEDURES | 19 DECEMBER 2009
POSTED IN ARTICLES

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The "Bo-Tax" has been officially defeated and removed from Senate bill on Health Care Reform. Senate Majority Leader Harry Reid, amidst organized pressure from the medical community, lobbyists and various women's groups, decided to remove the proposed 5% tax on elective cosmetic procedures. While the proposed Bo-Tax was estimated to raise $3.7 billion over the course of 10 years, it was argued that the tax discriminated against middle-class women.

I'll keep you posted about any flip-flopping on this in the future...

-drB

Adios Miami...

More from Miami-the Yummy Mummy Tummy!

   Today we had the pleasure of listening and watching two Brazilian Plastic Surgeons on the topic of LipoAbdominoplasty, or Tummy Tuck. These two well-known surgeons were very thorough in their explanations on how they decrease risks, and improve their results. Excellent results indeed! Judging by the photographs presented, it appears that in Brazil the women are very demanding of their figures. Let me explain.

   The preoperative pix of these surgeons’ patients were on average in fantastic shape. These were not women who had let themselves go, or who had lost massive amounts of weight. These were well cared-for, in-shape bodies; women who demanded to feel good about the bodies they carried around the beaches of Rio. It was a pleasure to see them find a way to polish up, in the hands of these experts, small amounts of fat, and segments of loose skin.

   When I visited Brazil, for fellowship in Cosmetic Surgery, I observed first-hand what an active, sporting culture it was. I remember finishing up at the clinic, during the week, at about 8pm, and after returning to my apartment, cleaning up, and changing I’d head out about 9:30, to dinner, since my American stomach couldn’t hold out much longer. Not only would I still be the first one to arrive at any of the restaurants I’d choose, but on the way I would see leagues of soccer teams along the beach, groups of volleyballers practicing, marshall artists, and runners; All ages; Sweating, Laughing; Keeping their bodies in shape; The same bodies I’d see on the beach during the day. Mind you- I’m not talking about a “south beach” location- just a beach- and it was always filled with women and men wearing very little, to cover bodies of all dimensions, from grandmothers to little tots, and even expectant mothers. They were all confident and comfortable with themselves. They weren’t all model perfect- far from it- but they all showed effort- and from this effort came the attitude. They were beautiful because they wanted to be and because they worked at it. It is no wonder that in South America Aesthetic Surgery is ubiquitous, so accepted, and so much part of the culture.

   We are gaining more of this physical and aesthetic awareness in the States. We go through phases; In my opinion, we are poised for a resurgence of interest in being physically fit. It cannot come too soon- considering we are the most obese country in the world. We are also realizing that looking good and feeling good about it is not an impulse of which to be ashamed. Rather, we are beginning to embrace in America that taking care of ourselves is not selfish, but just.

More on this issue some other time.

-drB

Welcome to MIAMI- Beauty in Paradise

Day 2 Baker Gordon Surgery Conference:
Today we covered many topics. More live surgery. More videos.
More experts getting up and telling us how it is, to be then contradicted by the next speaker.
Some of the interesting topics covered include:
   Issue: Capsular contracture
   What is it: Hardening of scar tissue around a breast implant causing tightness, and distortion of shape.
   Points made: Do not yet know why it happens. Do not have way to avoid it. Not related to implant fill type, implant texture, or implant position relative to the chest muscle.
  
   Issue: Fat grafting
   What is it: Collecting fat from one part of the body and placing it another, in order to make that recipient site fuller.
   Points made: Increasing in popularity. Used in face, buttocks and now, breast. Don't yet know best way to harvest the fat, best donor site, fat preparation, or injection technique--we need some scientific research on this issue. We need to know these things to get the best "take" of the transposed fat. There may even be some positive skin quality effects from this transferred fat. In the meantime we can use lessons learned, and the artistic sensibility we have developed, from the injection-sculpting the use of nonpermanent fillers to the face.

   Issue: Fat graft breast augmentation
   What is it: Transfer of patients own fat from elsewhere on body to the breasts in order to make them bigger.
   Points made: Controversial, limited in effectiveness, legally tenuous, not yet ready for prime-time.

   Issue: Sub-Fascial Breast Augmentation
   What is it: Placement of a breast implant above the chest muscle, but below the thin, tough layer of muscle fascia covering the muscle.
   Points Made: Demonstrated by Dr. Ruth Graf of Brazil. Benefits of technique not obvious. Technique tedious.

Reception at the Vizcaya Museum and Gardens tonight. Maybe I'll find Dr Graf and ask her more about her technique. It wont be in Portuguese however, since when I did an Aesthetic Surgery Fellowship in Rio De Janeiro with Dr.  Ivo Pitanguy I was unable to learn any permanent Portuguese at all! Tough language!
-drB

Minimally Invasive Surgery -"The Non-Cutting Edge"

   Day 1 of the 44th Annual Baker Gordon Aesthetic Surgery Symposium!
   The theme this year is "Agility in Minimally Invasive Plastic Surgery Techniques".
   That which distinguishes this particular conference from most of the other surgery conferences is that it presents live, simultaneously broadcasted surgery to an auditorium, from where we can interact with the surgeon and operating room through two way audio. Though technically marvelous forty years ago---today--- still pretty cool! Most other conference formats involve 5 to 10 minute keynote/powerpoint presentations which are great to reveal research data, or show long-term results. But nothing beats watching one of these "luminaries" in the academic plastic surgery world deal with real life variables, in real time, all the while answering our questions, and colleagues' challenges. Oh, while staying out of the camera's way... Awesome.
   The day started at 8am with Dr. James Stuzin performing an isolated Neck Lift. This procedure highlighted an issue which I have long argued- namely that the neck can and often should be treated in isolation from the rest of the face. Many younger patients present with a full, blunted neck angle which stems from a hereditary propensity to have a thick inelegant neck, or from weight fluctuations early in life. Sometimes simple liposuction is the solution. Sometimes we need to tighten the neck muscles- much like you might lace up a corset to help define the midriff. Yet other times we need to tailor the neck from multiple directions at once. Either way, we needn't do anything to the face when the neck is misbehaving all by itself. Lately, I have seen some older patients who had their face and neck addressed many years ago. Either because their face has withstood the passing years better than their neck, or because perhaps the neck hadn't been treated thoroughly enough at that time, they present with isolated neck issues- usually loose skin and draping, and unkempt neck muscles creating vertical bands spanning from their chin to the collar bone. In these patients, as well, there may be no reason at all to fift their faces again if the neck is out of proportion all by itself. Sure, sometimes its just easier to do both procedures at once.       My father once told me - "Doing what is easy is rarely the right choice". 
   Treat what needs it. Do as little as possible to make the face beautiful and the soul happy. Dr Stuzin showed excellent results, technical efficiency, and an aesthetic sensibility. Bravo.
   The middle part of the day dealt with (appropriately) the Mid-Face Lift. Presentations, surgical videos, and live surgery by three different surgeons showed us their three different approaches to the mid-face. They each had different philosophies on treating the mid-face, different sets of indications and goals, and different techniques. The bottom line here is that the Mid-face Lift has very specific benefits, significant limitations, and more downtime than average. It should not be used on just anyone- certainly it should not be a standard part of every Facelift. Amen to that.
   At the end of the day we were shown some live non-invasive procedures (needles instead of blades) with neurotoxins (BOTOX and Dysport), and Injectable Fillers (Restylane, Juvederm, Radiesse). Didn't discover anything new here. The point was made that we practitioners of aesthetic medicine more often than not use neurotoxins and fillers in "off-label"ways, considering that the FDA's approval of these agents is very specific and limited. Perhaps we should mention this more clearly to our patients. Then again the FDA is often behind the curve of actual practices.
   I thought a nice analogy for this branch of non-surgical aesthetics is to compare our techniques and choice of products, to the palette of an artist, and their use of light, and choice of brush stroke to obtain a pleasing result both to the artist and the patron.
   All in all an exciting first day.
-drB

Miami Plastic Surgery Conference!

Hello from Miami! I am attending the 44th annual Baker-Gordon Aesthetic Surgery Symposium. The theme this year is "Minimally Invasive Techniques". That means better results with less downtime! Stay tuned for updates and summaries of this wonderful conference ...
-drB