Pacific Plastic Surgery - Blog

Realself.com (www.realself.com) is a good website for patients to gather information.  It has a question and answer format, where prospective patients post questions, and plastic surgeons (and dermatologists) answer the questions.  This is an unpaid, voluntary activity, so the answers you get may be from plastic surgeons from anywhere in the country.  I have actualy been impressed that the fromat, along with the guidelines set up by the site, effectively prevent the site from being a big promotional venue for individual practices.  So the information patients get is for the most part is very thoughtful and unbiased. 

I'm sure most patients, rather than posting their own questions, simply find relevant questions already posted, since there are thousands of them for every procedure you can imagine.  There are usually many answers from various surgeons, so you can get many opinions all in one place.

As far as the plastic surgeon responders, I would say that the vast majority give good, solid advice.  Some seem to make a second career out of posting answers (it will show you how many posts a given doctor had put up - total and by the week), and I wonder how much time some of them actually spend doing surgery!  But check it out - it is a good learning tool for patients.

I previously wrote on this blog about Dysport, and it's debut on the market as a competitor for Botox.  I wasn't too thrilled that although it seemed to be very similar to Botox, there was essentially little or no cost difference, and speculated that there were maybe some issues of propping up the price because of third party reimbursement for certain non-cosmetic applications, and that each company wanted to keep that under wraps.

Well, I'll let that line of conspiracy theory go and chalk it up to the unintended consequences and inefficiencies of government's intrusions into health care (imagine any other product coming onto a market, competing head to head with a similar product - the price of both would go down).

Because of patient interest, I decided to get Dysport and have it available along with Botox in my Santa Barbara practice.  So Dysport is now available at Pacific Plastic Surgery with myself or Jessica.  As for the prices of Botox and Dysport...well that hasn't changed, although watch for our occasional specials or events.

I responded to a patient question on the site realself.com wondering what injectable lip options passed the "Kiss" test. 

Yesterday I was contacted by E! News as one of their writers thought Lady Gaga looked different at the Grammy Awards, and thought that maybe she had had a nose job (rhinoplasty) recently.  So I looked at a lot of photos and videos of Lady Gaga going back to 2005, including an amazing video of her (Stefani Germanotta back then) perfoming two of her own songs on piano at a 2005 NYU talent show. 

My conclusion was that she has never had cosmetic nose surgery (rhinoplasty).  There was only one older photo of her which is on all of the "Lady Gaga had a nose job" websites, which when put next to a newer photo, does look very different.  However, the "before" photo is of poor quality and was taken with a wide angle lens from above, which makes it look bigger and wider.  (See my previous blog post on photography and plastic surgery).  Looking at many other older photos and comparing them to newer photos, and trying to correct for the different makeup, costumes, lighting, and angles, I came to the conclusion that there is nothing to the rumor.  Of course, I could be wrong.

But if I'm wrong, it's the most subtle rhinoplasty ever, so why would she have bothered?  She still has a prominent bony cartilaginous dorsum (the hump) and prominent lower lateral cartilages (the sides of the tip).  She has a retrusive (weak) chin on profile as well, which accentuates the prominence of her nose.  This is not to say that I think she needs plastic surgery, and apparently she has denied it in the past and expressed a fear that it could change her voice. 

We are doing Water Assisted Liposuction now with the Body-Jet device, a first for Santa Barbara and the Central Coast.  I'm excited about this technology because it allows for a gentle removal of fat with the assistance of a spray of water at the end of what at first glance looks like a typical liposuction canula (the long metal tube that sucks the fat from your body).  Less energy, or force, needs to be applied during the procedure, and the benefits are seen with less pain, less bruising, less swelling, and a rapid return to normal activities.  It is routinely done under local anesthesia, with minimal pain.  There is some preliminary evidence it can shrink skin up to 8% as well. 

The other thing about this technology that convinced me that it was a significant advancement in the field of liposuction, is that the fat that is removed is very good quality fat that has not been severely traumatized by the procedure, unlike laser liposuction or ultrasonic liposuction, or even conventional liposuction. So what does this mean?  It means that the fat cells that come out (pure yellow, with virtually no blood), are mostly still alive and can be reinjected for those patients who could benefit from fat transfer to rejuvenate an aging face, or to augment body areas such as the buttocks, or even breast augmentation which remians under study in the United States.  The fat even has application in breast reconstruction patients, including patients with radiation changes. 

The cost of the procedure is comparable to conventional liposuction. 

More information can be found at www.mybodyjet.com

Another pop culture comment...What's up with Lady Gaga's "Dance in the Dark" and the intro line of "Silicon, saline, poison inject me..."? Thinking I might have a whole song to comment about, she then digresses, mentioning Jon Benet Ramsey and Stanley Kubrick.  And Jesus and Liberace.  So forget all that - let's just focus on those 5 words... First of all, she means silicone, not silicon.  (She does pronounce it silicone, but the lyrics say silicon - she needs a new writer.  I'm available.)  Silicone is a polymer made up of many molecular groups strung together.  Silicon is an element.  Although there may be some elemental silicon in a breast implant, it's mostly silicone.  Saline - spelled correctly, no comment.  Poison inject me... presumably she's referring to Botox, or perhaps all injectables, where she would be clearly wrong.  But if she is referring to Botox, she's correct in the sense that Botox is a toxin - botulinum toxin.  However, it is a protein that is degraded by the body and goes away.  Like the ethanol in her martini which is also a poison and is degraded by the body and goes away.  Or the cyanide in the nutmeg on her eggnog tomorrow.  Presuming she drinks martinis and switches to eggnog on Christmas.  Botox is unlike a poison like arsenic or mercury, which is not degraded by the body, and can accumulate.  I wish a pop star would decide to write a whole song about plastic surgery, and I could consult on it.  I doubt that will happen, so I may just need to write my own.

 I sent this response a few days ago to the Chairman of the Board of Regents of the American College of Surgeons...

December 4, 2009

Dear Dr. Eastman:

As a Fellow of the American College of Surgeons, thank you for emailing me your letter to Senator Reid announcing the Surgical Coalition’s opposition to the Senate Bill. I certainly agree on the bullet points of opposition laid out in your letter. However, the bulk of what followed was a huge disappointment.  

The debate over health care in this country has brought in many players with skin in the game. Your coalition of surgical organizations is one group among many. These many groups include other physician groups, insurance companies, patient advocacy groups, pharma, and the like. I would bet that the individuals in these groups, including yours, want our country to have the best health care system for themselves, their families, and their patients. But look back to the first line of this paragraph. Did the “players with skin in the game” metaphor rankle you at all? It should have. If it did, maybe there is hope that given enough time you could actually learn enough history and economics to understand what is really wrong with our system. I would submit that we do not have a health care problem in this country, but we do most definitely have a government problem in this country. 

Our health care system is a mess, but few understand why, and most tacitly accept the notion that government can or must provide the solutions. But it needs to be recognized that government encroachment into health care over the decades was the key ingredient in creating the bureaucratic, inefficient morass that is our current system. The logical answer, once this is appreciated, is not to allow the government to fix what it broke in the first place! The answer is to strive to do everything possible toward the goal of getting government out of health care completely. This means less regulation, not more. This means less government/corporate cooperation (collusion), not more. Lobbying for regulations favorable to one group over another is a toxic concept, based on the immorality of the method itself. Yes, I know that is the “way government works” nowadays, and I hear the arguments that we need to have a “seat at the table”, but that doesn’t make it any less wrong. 

We have gotten to the point where we are ready to hand over the last bit of control of our health care system to government bureaucrats, because individuals and groups (like yours), unconsciously through ignorance or consciously through appeasement, have not stood up for sound principles. Is it really so shocking to ask the questions: “Why is the government involved in my health care at all?” Maybe it’s shocking to some to state “Health care is not a right”. But it’s only shocking to someone with no understanding of natural law, rights versus privileges, or why a socialistic system, health care or otherwise, is profoundly immoral. The wealthy will always find a way to skirt such a system while the shrinking middle class pays for it, and the poor, the ones the system claims to benefit, suffer the most.

Lest I be dismissed as just a fringe member of the ACS with strange ideas and no solutions, I offer a few things we can do, and would be glad to supply more:

• Recommend to your members that if they are one of the 17% of American physicians that remain members of the AMA, get out. Let’s make it even clearer that the AMA doesn’t represent American physicians and exists solely to feed off its lucrative CPT franchise (merely one example of corporate/government collusion which poisons the system and raises costs).

• Learn what’s really going on with health care in America. A good place to start is the American Association of Physicians and Surgeons and its website, www.takebackmedicine.com.

• Opt-out of Medicare immediately.  Continue to care for seniors, as most physicians who have opted out do, through private contracts with reasonable fees. Refuse to be part of a corrupt and inefficient bureaucracy that threatens its physicians with draconian punishments and fines while paying them a pittance for the privilege. Imagine the signal that would send if a large organization of physicians like yours had the backbone to recommend this. It would force Reid and Pelosi to tender the idea of forced physician labor. That would likely wake up physicians, and indeed the whole of the American people, to just how much power the government craves.

It is only a true free market in health care which will lower costs for all patients, increase availability of care, and spur innovation. Most, unfortunately, have no idea what a true free market looks like. It’s not what we have now, and certainly not what is on the horizon.

Sincerely,

Douglas J. Mackenzie, M.D., F.A.C.S.

cc:

LaMar McGinnis, M.D., FACS, President of the American College of Surgeons
Andrew Warshaw, M.D., FACS, Chair of the ACS Health Policy and Advocacy Group
Thomas R. Russell, M.D., FACS, Executive Director of the American College of Surgeons
Christian Shalgian, ACS Director, Division of Advocacy and Health Policy
 

This is a clipping of a Letter to the Editor that I wrote regarding the healthcare controversy.  It was published in the August 29, 2009 issue of the Santa Barbara Newspress...

NewsPress_29Aug09_letter_publication.pdf

Ahhh… the joys of pregnancy... flawless glowing skin, cute "baby bump" and best of all a darn good excuse to eat that extra chocolate chip cookie. Welcoming your new bundle of joy is definitely the most wonderful and rewarding experience. But you have to admit they have taken a toll on your old bod'. That pregnant glow now is a hyper-pigmented mask of pregnancy. That flawless skin is now ridden with hormonal acne. And that baby bump has transformed to a bulging abdominal wall with stretch marks. How is it that after one burrito, I can easily return to my 5-month pregnancy shape? Now, I am just waiting to be done nursing so I can pose for National Geographic. Don't get me wrong I wouldn't trade any of it for my two sweet children.

While I am a strong advocate of diet, cardiovascular exercise and core strengthening, it is good to know there are other options for helping with my post-baby body. So what can I do and when can I do it safely? I have broken it down into three categories: Immediately following birth (when you are ready to sacrifice a nap for a doctor's visit); Immediately following nursing (when you no longer have to be careful about every thing you ingest or put on your body); 3 months after finishing breastfeeding and/or maximum body achieved by diet of chicken finger scraps and peanut butter and jelly remnants.

Immediately after birth: What is safe?

• IPL (Intense Pulse Light): used to treat melasma (mask of pregnancy), sunspots or hyperpigmented skin.
• Nd:Yag laser: used to all those spider veins that have popped up on your legs.
• Laser Hair Removal: used to treat for area. Most commonly bikini or underarms- who has time to shave at this point anyway?

Immediately after nursing: What can I do?

• Botox: used to relax the frown lines. These have been given a recent workout while overseeing your 3 year old's tantrums and wondering why your husband can't help with the baby's night time feedings.
• Sclerovein: just another option for spider veins. This is an injectable method for reducing of the veins vs. laser.
• Latisse: topical eyelash enhancer. Not that anything really happened to your eyelashes during pregnancy, but this stuff is amazing. And it has been off limits for 9-months plus! So of course, you want to use it even more!
• Retin A: there truly is nothing that is going to get rid of stretch marks. So don't believe anyone that tells you otherwise. (At least as of May 2009) However, if your stretch marks are still purple (and you are not breastfeeding), you can apply topical Retin A that will lighten the color. If they are already silver or white, not much to do but self-tanners or spray tans.
• Obagi Skin Care: this is an amazing line of skin care products with medical grade ingredients like Retin A and hydroquinone. They are perfect for evening coloration and smoothing the skin. They will get you back to about as close as you can get to the glow of pregnancy. Also helpful for active acne or acne scarring.
  
  Later: While we may wish we had all the trainers, nutritionists, and nannies it took to get Heidi Klum on the runway at 6-weeks post baby…that is not reality. So if you have given it your best effort with the time and resources available to you, but are seeking some additional intervention here are your options:
• Liposuction: removing unwanted fat most commonly from abdomen and thighs. Often this can be enough for managing problem areas that don't come off with diet and exercise
• Tummy tuck: there are mini and full options- if your abdominal wall is too stretched for just liposuction, this might be an alternative. The full will tighten the abdominal wall, and get rid of stretch marks from the belly button down. And both full and mini will get rid of stretched out abdominal skin.
• Breast augmentation/lift: who knew??? Who knew what breastfeeding does to your boobs? Just remind yourself of all the diseases you have saved your child from contracting and that will make you feel better. And if it doesn't just insert a small implant and remove excess skin.

I might mention… it is good to wait at least 3 months after childbirth to do a tummy tuck. Even without a lick of exercise, your body will still change. And wait at least a couple months after nursing and until you are no longer producing milk or your breasts seem to be done changing size and shape. Also… you may as well wait until you are done with having kids before you invest in any of the surgical procedures unless you want to visit our office again in a few years. Which is fine too, you are always welcome.

Jessica Barker, P.A.
Pacific Plastic Surgery

We had a great turnout Tuesday at Derma Spa Med (www.dermaspamed.com) in Santa Maria for the evening event that I announced in a previous blog post. Dr. Labrecque discussed cosmetic dermatology with several of the attendees, while I discussed plastic surgery procedures. It was a nice, mingly kind of atmosphere, which I much prefer to getting up and putting on a Powerpoint presentation! Plus, it allowed prospective patients to have a "mini-consult" with myself or Dr. Labrecque, which is often not possible with these kinds of events.& In fact, I was there the next day, where I saw several people from the night before to complete a more formal consultation.

Most were women seeking improvement in their abdominal contour, or breast enhancement with implants and mastopexy.  Two women were interested in improving the results of previous blepharoplasty and facelift.  This kind of venue also appeals to the patient who may have some early interest in plastic surgery, or maybe just has a few questions about a procedure they've already had, but would rather avoid the formality of office consult.

All the attendees were offered special discounts on plastic surgical procedures and cosmetic dermatological procedures and products. Nurses Heather and Tui were there to discuss procedures, particularly Fraxel, and there were product representatives from Glytone and Radiesse. The most popular, however, seemed to be the two make-up artists that came to promote Colorescience!

If you'd like to attend a future event like this in Santa Maria or Santa Barbara, either keep checking this blog, or call my office in Santa Barbara and ask to be put on our email list.

Douglas J. Mackenzie, M.D., F.A.C.S.

This is the title of a recent Santa Barbara Newspress article which featured me and discussed how the economy has impacted the job market. It featured several Santa Barbara clothing experts and wardrobe consultants discussing how to dress for success. I was quoted as to the effect that both surgical and non-surgical rejuvenation procedures can have on self-esteem, and on the competitive edge that someone may gain who is trying to get or keep a job in this market. After all, age discrimination is a fact of life, but you can do something about it!

The article reflects a recent blog post that I wrote with the idea of "Invest in Yourself". With the uncertainty of the economy, the instability of the dollar, the crash of the stock and real estate markets, people are understandably worried about what to do with their money and where to put it. Investing in oneself seems to me like a great way to use your hard earned dollars now, when they will still buy something useful at a good price (before the inflation that is likely coming soon!). The results may intangible, but they can be huge! Supplementing your education has always been a great way to invest in yourself, or maybe buying a bicycle or gym membership and committing to getting in shape. Cosmetic surgery and nonsurgical cosmetic procedures are just another way to consider investing in yourself to gain a return on investment that may not be easily measured, but can have a significant effect.

Douglas J. Mackenzie, M.D., F.A.C.S.

On May 5th I'll be at Dr. Pierre Lebrecque's Derma Spa Med in Santa Maria for an event promoting aesthetic dermatology and plastic surgery in Santa Maria. He has a beautiful facility where I see patients two days a month, as well as a state of the art surgery center next door where I do surgery (Santa Maria Ambulatory Laser and Surgery Center).

The event will have refreshments, gifts and prizes, and there will be representatives highlighting Radiesse and Fraxel, along with makeup artists from Colorescience. Dr. Labrecque and I will also be offering special pricing for attendees who schedule aesthetic plastic surgical and dermatologic procedures.

The event will be from 5 to 8 pm, Tuesday May 5th, but please RSVP if you plan to attend. Here's the info: Derma Spa Med, 120 North Miller Street, Building C, Santa Maria, California. Telephone 805-739-0033. Website: www.dermaspamed.com

See you there, bring your Mom, or bring a friend!

Douglas J. Mackenzie, M.D., F.A.C.S.

I just got the latest software update installed for my AxisThree breast augmentation simulation system (www.myportrait3d.com) which I have had about a year now and used on over 100 patients. If you've never heard of this before, it is a 3-D camera system that takes your photo and allows me to morph your photos with different implant sizes. The latest software update actually has a database of all the implants from Mentor and Allergan, so I can choose the implant and the system knows its dimensions and applies them to the image. The images can then be moved in three axes, compared to the "pre-op" image, and adjusted as necessary. The patient and I can then change the implant size or type in the system to see a simulation of the desired result. This is a great help to my patients, who have a much better idea of what to expect regarding size and appearance after surgery. Although there is no exact way to predict which implant will give a certain size after surgery, this comes close. I still take measurements at the time of the consultation, and many patients still like to try on implants in a bra, but these methods are somewhat imprecise.

Douglas J. Mackenzie, M.D., F.A.C.S.

Now is the time to get serious about doing body contouring and breast enhancement surgery! Surgery now through May will allow you to have some time to recover before beach season, and with the economy the way it is, prices have never been better (see my previous post regarding the economy and plastic surgery). You may be getting a tax refund soon, and what better way to spend it than investing in yourself! At some point, inflation will hit and prices for everything including plastic surgery are likely to rise given the massive expansion of the money supply by our government. But right now we're still in a somewhat deflationary situation, and that's why it's a good opportunity to take advantage of the lower prices.

Right now is still a good time to address previous sundamage on your face and neck, and even your chest or hands. The treatments, whether just with topical products like Obagi, or more aggressive with an office Obagi Blue Peel or Photodynamic Therapy, are safe with minimal downtime and cost. You should avoid the sun when undergoing these treatments, so now is a good time to do it before summer comes.

Douglas Mackenzie, M.D., F.A.C.S.

Today the FoxNews website had an article speculating whether Paris Hilton got her lips enhanced recently while in Australia. As is typical with these stories, a couple New York and Beverly Hills plastic surgeons were quoted, and based on the recent photos, opined in the affirmative. So that prompted me to write this…

Lip Enhancement, or Lip Augmentation, is the second most common procedure that plastic surgeons perform behind breast augmentation. There are certainly some very common concerns I hear when I see patients interested in improving their lips. But before I go into that I’ll start with the basics. Lips can be enhanced to correct the effects of aging, or just provide sexier lips to someone whose lips may be thinner than they would like. Let’s discuss the aging lip first…

As a person ages, their lips, along with the rest of their facial tissues, tend to atrophy, or shrink. The deflation from the plump lips of their youth causes the lips to lose the crisp edge between the skin and vermilion (the red part), roll inward, and to develop lines and wrinkles radiating outward. The philtral columns are the two ridges going up from the upper lip towards the nose – they tend to flatten with age. As you can imagine, besides aging, smoking and sun exposure also play a roll in the aging lip.

The most common, and as a stand-alone procedure, the most effective, way of improving the aging lip is by adding a filler – something that will re-inflate the deflated lip. This will restore volume, smooth lip lines, and if done with an artistic eye, give better and more youthful definition to the edges of the lip and philtral columns. Other procedures may be considered as well, such as lasering or peels, but filling the lips is usually the best tool for restoring youthful lips. So what are they filled with?

There are basically two broad categories of fillers: off-the-shelf products and autologous (your own) tissue. The most common off-the-shelf products are Juvederm and Restylane. In my opinion, these outshine the other products for reliability, ease of injection, lower risk, and the fact that they’re not permanent. That’s right, in my opinion the fact that the product is not permanent is an advantage when considering lip augmentation. A permanent implant, whether an injectable (silicone) or an implant (PTFE), can cause a myriad of problems as the patient ages and the surrounding tissues change, and can be difficult or impossible to remove.

As far as autologous fillers go, the main sources are your own fat, harvested elsewhere and injected into the lips, or a fascial graft, which is tissue harvested from elsewhere and threaded through the lips via tiny incisions. These are obviously more involved procedures than injecting a syringe of Juvederm. They can be done under local anesthesia, but often are done under general, and often as an adjunct to another procedure like a facelift. In fact, during a facelift I’ll often use the SMAS layer of tissue from the cheek as graft material for the lip, since I have it exposed and elevated already. This compliments a facelift nicely, as a facelift alone does nothing for the lips.

For a younger person who just wants bigger, sexier lips, the off-the-shelf products are by far the most common. These are quick office procedures, although they do need an anesthetic block to numb the lips as otherwise it would be extremely painful. Some swelling and occasionally some bruising may happen, but the pain tends to be minimal after the anesthetic wears off. Juvederm can last up to a year or more, but sometimes just a few months.

The biggest concern I hear, which tends to be more of a concern the older the patient, is going too big. I constantly hear “I don’t want to have duck lips”, or “I don’t want to look like ____” (fill in the blank with any number of balloon-lipped celebrities). A syringe of Juvederm in a young woman, or even two in an older woman is not going to look ridiculous as long as it is injected skillfully. The overdone celebrities either had too much to begin with, or more likely, they did a little and liked it and went back for more…and more.

Paris looks good, but I would have liked a little more definition of the philtral columns and the cupid’s bow contour of her upper lip. Maybe she’ll come up to Santa Barbara the next time she needs her lips done…

Douglas J. Mackenzie, M.D.

OK, this starts out glum but there is a silver lining at the end…

I am really trying to wean myself off of television news and especially business news. It’s so distorted and inaccurate! The collapse of the markets in real estate, stocks, and commodities was forecast by some, but certainly not by the majority of the talking heads and business “experts” we see on CNBC, Fox, or CNN (Larry Kudlow, Ben Stein, Stuart Varney, and so many more). As I’ve listened to their Pollyanna pronouncements over the last few years (actually, since before the tech bubble) and seen them proven wrong over and over again, it seems logical that the ones to listen to now are the ones that were, instead, right over the last few years (here’s a few: Jim Rogers, Ron Paul, Nouriel Roubini, Peter Schiff). These folks were often the ones sidelined and ridiculed. These are the guys that would deserve the last laugh now, if there was anything to laugh about.

Bernanke and Paulson are in a desperate scramble to prop up the economy by bailing out the banking system, big industry, and whoever else may come along telling tales of fiscal doom and carrying gullible politicians in their back pocket. The next beggars may be the state governments - California comes to mind. But their Keynesian cure-all of monetary expansion seems to have run out of air. The increase in GDP per dollar of debt is heading towards zero.

Are we headed toward a deflationary depression? Followed by inflation, maybe even hyper-inflation? Well, I don’t know, but in the mean time, what does one do with his/her money? We hear of a “flight to cash”. Treasuries are sporting nearly zero percent interest. Yikes. Some crafty folks are looking at putting their money into gold again, if they can get it. Seems smart. But I have a different suggestion, and so this is the segue into my shameless pitch for plastic surgery…

That’s right, spend the dollars you have now on plastic surgery. You’ve been thinking about it for months, maybe years. You’re feeling miserable about the money you’ve lost in your 401k. Every time you check your home value on zillow.com it’s down. Except for maybe a brief Obama rally, the stock market will likely be down or flat for a long time. The dollars you have now will almost surely be worth less, maybe much less, in the not-to-distant future.

Think about it! Cosmetic surgery can be a real boon to self esteem. Age discrimination is a fact of life for many in the workforce, and rejuvenation surgery such as a facelift or blepharoplasty may give you back your edge. You might need whatever edge you can get as unemployment rises. Also, now is a good time to begin the process of getting beach-ready, and that may mean a breast augmentation or tummy tuck. An investment in yourself can pay huge and long-lasting dividends! If surgery is not a consideration, Botox and fillers are great options, at a fraction of the cost and down-time.

You do need to be prudent, and I’m not a financial adviser. You certainly want to make sure you are secure in your job. But if you have the money to spend, or can get a fixed rate loan (we suggest www.carecredit.com) with reasonable terms, consider plastic surgery. You might just be happier, maybe a lot happier, than if you put your money somewhere else!

Douglas J. Mackenzie, M.D., F.A.C.S.

Let's face it, pretty much every business is getting hit by this recession, and plastic surgery practices are no exception. I was at the recent annual meeting of the American Society of Plastic Surgeons (ASPS -www.plasticsurgery.org) in Chicago and there was much talk about the impact of the financial crisis on the plastic surgery industry in general, as well as individual practices. Some practice activity is down 30%! (That made me feel like I was doing fairly well!). Pretty much gone are the days (not too long ago) when patients could get an equity line on their home to pay for things like cars, boats, and...plastic surgery. The news isn't all gloomy - the downturn in the economy will provide opportunities for patients who still want plastic surgery procedures.

Many people use financing for plastic surgery, and the group I have been using is CareCredit (www.carecredit.com) In my experience, (and I have used about five other companies over the years) they have been the most reliable as far as approving most patients for financing and providing a streamlined process for the patient and for my office. It seems as though they are still able to approve most patients since the financial meltdown began, and I was curious to get their take on the situation. I talked to them in Chicago, and they told me that they are still well capitalized and don't anticipate a dramatic change in their lending practices.

With declining patient traffic to plastic surgeon's offices, surgeons will be more willing to come down on price. If they are adamant on their price and don't negotiate, perhaps they will include another treatment for free, or at a discount. It never hurts to ask. If it's a surgery you're interested in, offering to pay in full immediately (even if your surgery is scheduled 3 months later) will almost always get you a nice discount off the surgeon's fee. Remember however, there are some costs your surgeon has little if any control over, including anesthesia fees, OR fees, and implants.

Minimize or eliminate the cash cost of the procedure by offering something in return - old fashioned barter. How about that old guitar collecting dust in the basement, or the Warhol print in the hall? Gold and other precious metals, especially in uncertain financial times like this, are also in demand and could be used for payment.

Consider less expensive procedures, like injectibles. Again, many offices including our own will be offering discounts and specials, especially this time of year. We are offering Botox at $10 per unit, which is comparable to spa prices, in our office on Wednesdays through the end of the year.

Douglas J. Mackenzie, M.D., F.A.C.S.

Our office is pleased to announce the arrival of our brand new laser system, Lumenis One Multi-technology Platform. The Lumenis One is able to treat unwanted hair, leg veins, sun spots and broken capillaries. One feature of the Lumenis One is a fourth generation Intense Pulse Light System which provides maximum results and ensures safety and comfort for our patients.

Photorejuvenation is the term used for treating the skin with an Intense Pulse Light (IPL) to get rid of brown pigmentation such as sun spots, melasma, freckles or age spots. The intense pulse light can also treat broken capillaries and help to stimulate your skin’s own collagen. New collagen can help the skin to feel and look smoother. The IPL can be used on the face, neck, chest or hands.

Winter months are the best time to think about starting an IPL series. Generally, most people require 3 treatments with the IPL. These treatments should be spaced out about every 3-4 weeks. There is limited down time between sessions: you leave the office looking slightly pink and feeling like you have a mild sunburn. On day #2, you may see your brown spots coming to the surface. On day #3, these spots will start to flake or peel off. You are still able to wash your face regularly and apply sunscreen and makeup, if you like. It is preferable to avoid a lot of sun exposure just following a treatment, which is why the winter months are a perfect time to complete your treatments.

The benefits of this treatment can be enhanced by adding Levulan or photodynamic therapy. Levulan improves the cosmetic results of the IPL and also tackles pre-cancerous spots called “actinic keratosis”. Levulan is a solution that is painted on the skin approximately 3 hours prior to your IPL session. It does cause a little more redness and peeling, but the results are well worth it. We usually like to do the Levulan treatment during the second or third treatment in your series.

In addition, for anyone that decides to purchase a series of three IPL treatments, we will include a skin care system that will complement your skin type. This skin care will prepare your skin for the sessions as well as enhance your overall results. Ideally, you should start the skin care at lest 2 weeks prior to your first session.

Photorejuvenation or IPL is a perfect way to get rid of unwanted age spots, sun spots, melasma, and broken capillaries with a minimal amount of down time. Your skin will look smooth, even and glowing for the New Year. Please take a look at some of our before and after photos on the website to see the results of an IPL treatment.

Jessica Barker
Physician Assistant
Pacific Plastic Surgery

I just finished reading a new book about skin care that anyone should read who wants to learn more about their skin and sort through the confusion about skin care. That’s pretty much everyone, so go out and get this book! …

“The New Science of Perfect Skin” by Daniel Yarosh, PH.D., Broadway Books, New York, 2008.

The author, Daniel Yarosh, is the brains behind AGI Dermatics, a company that makes a high-end line of skin care products that goes by the name of Remergent (No , I don’t carry this product line, but dermatologist Gary Novatt, M.D. here in Santa Barbara does). Although understandably supportive of his own line of products, and others containing AGI Dermatic’s compounds, Yarosh is not over the top about it, and has good (and bad) things to say about many other competing products as well. He explains the science of skin care well, on a level that is easily understandable, and pulls no punches when commenting on many of the too-good-to-be-true youth-in-a-bottle products and ingredients. This is a refreshing change from another well-known skin care book that came out a few years ago (“The Wrinkle Cure” by Nicholas Perricone, M.D.) which had a tiny bit of science and a whole lot of hype. Perricone has a new book out, which seems to be more of a wholistic health book, but I haven’t read that one yet so I can’t comment on it.

One of the most useful things you will learn after reading Yarosh’s book is to dissect a skin care product’s ingredient list and have a pretty good idea of what you will be putting on your skin. (You read the ingredient list off the food packages you buy, don’t you? Why not for that skin moisturizer, too?). He also tells you how to avoid spending exorbitant amounts of money on ridiculous products that do nothing, and how to find good products that are reasonably priced.

He thankfully puts to rest the idea that topical potions can do what Botox does, and describes both Botox and dermal fillers in the context of an overall skin rejuvenation plan. Some of this information is already a little dated, but that speaks to how quickly the non-surgical rejuvenation options are expanding and changing.

He goes into a good amount of detail on how the sun damages skin, how sunscreens work, and why no one uses sunscreens properly. I wish he would have gone into more detail on smoking’s harmful effects and pathological changes on skin. This is something I see in my practice frequently, and it seems patients aren’t always that knowledgeable about it. I can tell the facial “signature” of a smoker who has smoked for at least 10 or 15 years. The look is different from that of photoaging (sun damage), although often occur together. It’s no mystery how to stop the harmful effects of smoking, but we could all do better with sun protection. He tells how the Australians, with the highest rate of skin cancer, are emphasizing more physical sun protection (wide brimmed hats, long sleeved shirts, etc) in addition to sunscreens, as they’ve probably got all the benefits they can out of their current use of sunscreen. Here in Southern California, we should be doing the same. So buy a beach umbrella and use it while you read this book!

Douglas J. Mackenzie, M.D., F.A.C.S.
Pacific Plastic Surgery