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Does My Age Make My Nose Look Big?
Feb 1st
Here’s one from the category of slightly weird science. A study was done by a “facial plastic surgeon” (that would be an ENT surgeon) looking at patients who had had rhinoplasties, or “nose jobs.” So this dude showed photos of people who had rhinoplasties to a bunch of independent observers. He took the feedback and surmised that the procedure makes your face look an average of one and a half years younger. He now touts the rejuvenation as an objective benefit of this operation. Without being overly cynical (who, me?), allow me to inject some common sense (i.e., sanity) into this finding.
Your Nose Knows Your Age?
So, everyone who is planning to have a rhinoplasty to look younger please raise you hand. Anyone…anyone? Thought so. Now, all those who are having a rhinoplasty to improve the appearance of your nose or to improve your breathing, raise you hand. OK, that makes more sense. The concept of selling a rhinoplasty as a way to look younger is just silly.
Beyond this bit of science fiction, how much younger is a year and a half really anyway? Does this actually mean anything? I think not. A good night’s sleep can definitely make me look better. Likewise, coming home from a great vacation I know makes me feel and look better. Conversely, staying awake all night working can definitely make me look terrible, older, crankier…..just fill in the blank.
Happier People Really Do Look Younger
The real point of all this was mentioned by some members of the American Society of Plastic Surgeons who were interviewed in the article. Their take was this: these people were happier with their appearance and the appearance of their nose and thus they looked happier and looking happier made them look younger. With this, I agree. It’s a phenomenon that plastic surgeons see all the time. As one aspect of a patient looks better after surgery or other procedures, other aspects of their appearance look better, making them look even better overall.
The bottom line is this: have a rhinoplasty if you want to change the shape of your nose. When we are happier with how we look, we all look younger. It’s as simple as that.
David B.
Why I Both Love And Hate The FDA
Jan 26th
No arm of the government has had a greater influence on plastic surgery than the FDA, at least during my years of practice. And there is probably not a single plastic surgeon who doesn’t have strong feeling about this. Most of these feelings, I must point out, are negative. I agree with much, well really, almost all of these. However, a recent issue has come to light whereupon the FDA really did come through for us, as plastic surgeons and as patients.
The primary problem is that this branch of the government is political like every other branch, and is expected to make good decisions about the drugs and devices we use. As as physician, I am looking to see decisions made on the basis of science. You can ask anyone in the office about my approach to something new. The first thing I ask for is the science, the studies that have shown effectiveness and safety, not the glitzy marketing pieces. Basically: show me the science! History shows that this has not always been the basis for the FDA’s decisions.
The FDA Got One Wrong
The removal of silicone breast implants from the market is a case in point. In the early 1990′s, plastic surgeons raised some concerns about whether or not silicone implants could be linked to autoimmune disorders. (A good side point is that it was the plastic surgeons who were wanting to understand if there was a problem, not the FDA). They even came up with a name for it: Human Adjuvant Disease. This was shortly followed by a storm of sensational media reports that got everyone whipped up in a frenzy. At that time, the commissioner of the FDA was David A. Kessler, MD, a pediatrician and a lawyer. He was unfavorably disposed towards silicone breast implants and put together a committee to examine the issues around them. In fact, he stacked the committee with people who shared his bias.
However, the recommendations of this committee after they had reviewed the science, was to leave the implants on the market and continue to study them because there was no good scientific evidence that there was a problem. As many of you know, Kessler ignored the advice of his committee and pulled the silicone breast implants from the market in 1992. (They continued to be used in almost every other country in the world). It took until 2006 to get them back on the market. Thankfully we now have them but history will show that this was a poor decision on behalf of the FDA that was politically motivated and not based on science.
The FDA Got One Right
Recently, however, a true success of the FDA’s vigilance has been front page news. Ever heard of the PIP silicone implant? These were manufactured by a French company who produce both silicone and saline breast implants. While the saline implants were approved for use in this country, the silicone implants were not This has proved to have been an excellent decision. The PIP silicone implants were filled with industrial grade silicone (not medical grade) and had a much higher rupture rate. At the preset time the government of France is paying for the removal of these implants. Something that will not be a worry for the USA because they were never used here. Thank you, FDA!
The FDA Still Has A Long Way To Go
The larger problem will be how the FDA amasses the science needed, and the timeliness of this in the approval of new drugs and devices. It takes far longer, and many more dollars to have a new drug or device approved in the company because of the requirements of the FDA. I have listened to FDA members discuss the process, and different devices, and I am left with the conviction that many of the concerns of this bureaucracy are off the mark. But in a recent hearing about silicone breast implants attended by several of my colleagues, it is evident that science is rising above political considerations.
Nonetheless, the process of approval is long and slow. One of my close friends, at a meeting with FDA representatives said this: “We will come up with a better breast implant. But it will never be developed in the US, because of the approval process by the FDA. This is something that you must deal with if we are to have the best drugs and devices in this country.”
As you can see, my feelings are mixed. We need an FDA but we need it to be driven by good science. The scientifically based approval process must encourage the production of new and effective drugs and devices, not make it an impracticality for them to be developed in this country.
All the best,
David B.
You Decide: Do Silicone Breast Implants Look Different Than Saline?
Jan 19th
When women come in to discuss breast augmentation, one of the big decisions is whether to go with saline or silicone breast implants. This was not always a choice.
As most of you know, silicone implants were taken off the market quite a while ago (a decision most definitely not based on science — but don’t get me going on this!), but were approved for general use in November of 2006. Before I go any further, I must stress that there is nothing wrong with saline implants. If I thought so, I just wouldn’t use them.
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I do like silicone implants, and if pressed I would have to say that they are better than saline. Does this mean that saline implants are a bad, or a poor second choice? Absolutely not, but placed side by side, in most cases I think silicone is a little bit better. And we have seen this with the increased selection of silicone breast implants by women since late 2006. Currently, the majority of implants that my patients choose are silicone.
I believe there are several advantages to silicone. These are generalities and do not apply to all cases, but silicone implants usually last longer, are lighter, softer, and less likely to have rippling.
But, do they look better than saline? Good question.
Here’s my take, and I will ask for your corroboration on this: I would suggest to you that silicone implants look “more natural.” By this I mean saline implants look slightly more obvious (more like implants and not naturally larger breasts). Certainly this is not true in all cases but generally, I think that saline implants look more round and are more visible in the upper portion of the breast, which is not how a natural breast looks. Silicone gives a more normal slope to the upper breast. Also, the rippling can be an issue with saline which you rarely see with silicone. Natural breasts don’t ripple. Right?
Which Looks Better? You Decide.
So should you take my word for which looks better? No. On my website there are about 25 photos of women with saline implants (before and after) and about 19 for silicone. (Watch out saline, here comes silicone.) They all look great. I just have a personal preference and you probably will too.
The great thing is that we have options. Some people only want saline, and others only silicone. Fortunately both are available. Have a look and let me know which you prefer.
By the way, if you or one of your friends are wanting to learn more about breast augmentation, our staff has written an informative and entertaining 33-page eBook called A Girlfriend’s Guide to Breast Augmentation. It’s a free download so you might want to check it out.
All the best,
David B.
New Research Discovers Health Benefit from Liposuction
Jan 5th
Every now and then, we find a real health benefit where we might not expect to see it, like in cosmetic operation. It’s almost like getting a two-for-one. And, in some people, this is the case with liposuction. Recently a fairly large study looked at triglyceride levels in people having liposuction. The study discovered that in patients with elevated triglyceride levels in the blood, there was a significant reduction in these levels. In fact these levels went down over 40%, which is a greater reduction than is usually seen with medications. In people with normal triglyceride levels, there was no significant change seen.
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Understanding Triglycerides
So why is this important and what really is a triglyceride anyway? Let’s take the second question first. We when eat, our bodies take in calories and some are used right away. What we don’t use is stored as fat or lipid and these stored fats are triglycerides which can circulate in our blood and be stored in our fat cells. They will later be released when we need calories between meals or if we don’t need them they just build up and we get fat. However, high levels of triglycerides circulating in our blood will increase our risks of atherosclerosis, which in turn leads to a higher rate of heart disease and stroke. Not good. So the things that reduce triglyceride levels will reduce our risks of these problems.
What does all this mean? Well, first of all, if you have high triglyceride levels and you are on medication for this, keep taking your medication! Is liposuction a substitute for a healthy diet and exercise? Again, no. The benefits of these healthy habits go way beyond triglyceride levels. And liposuction cannot be substituted for them any more than liposuction can be considered a weight loss operation (which it is not.) This study found that if you were having liposuction alone, your weight went down an average of 2.2 pounds and even more if you were having a tummy tuck.
There was also another benefit seen, which was a reduction of the number of white blood cells in the blood. This is thought to mean that there is a lower level of systemic inflammation. Again, this is a good thing. People who are significantly overweight have higher white blood cell counts. Such increased counts and higher levels of systemic inflammation can lead to higher rates of vascular disease, heart disease, and even type 2 diabetes.
These findings are not reasons, by themselves to have liposuction. But if you do have liposuction, these added benefits are sort of a freebie. Just a little something extra from what is already a great operation.
All the best,
David B.
Plastic Surgery Highlights of 2011: Our Top 5
Dec 30th
Another year is just about in the books, and it’s been quite a nice year for us. I hope it has been a good one for you too.
So, as a final blog post for 2011, I wanted to mention some of what, to us, have been some of the best things over the last year.
The ASPS “Do Your Homework” Campaign.
It seems that not a week goes by without a mention of some injury or calamity that has occurred at the hands of a non-plastic surgeon attempting to do plastic surgery. Some of these are not even doctors, let alone surgeons. This year the American Society of Plastic Surgeons (ASPS) had said enough is enough, and we have started a very aggressive campaign asking patients to do their homework prior to a consultation for plastic surgery. The right questions to ask are listed such as checking on board certification, making sure the doctor has privileges to do this operation in a hospital, and making sure the surgery is done in a licensed facility. We are trying to combat what has become known as “white coat confusion.” Anyone can wear a white coat, but not just anyone is a plastic surgeon. This campaign has been in print, on the radio, online, and on TV. We know it’s working because the non-plastic surgeons whom this is directed at, are all up in arms. Kudos for ASPS!
Greater Use of Silicone Breast Implants
I have been seeing what other plastic surgeons have been seeing nationally: more and more women are choosing silicone breast implants. The “comeback” of silicone has been strong and steady, and now represents about 75 to 80% of all the implants we are using. The reason for this is that women are becoming better educated about the benefits of silicone, and are less concerned with the sensationalism of false claims about their lack of safety. These implants have been studied more that any other implanted devices (like heart valves or replacement joints). And the data is conclusive: silicone is safe. If you have saline implants, don’t worry. These are great implants, too. But silicone implants are just a bit better and more and more women understand this. Way to go, girls — you rock!
Flexible Cannulas for Fillers
Any time I would go to a meeting and attend a session about fillers (like Juvederm, or Radiesse) the topic of using blunt flexible cannulas would come up for safety reasons. When using these, the injector is less likely to inject the filler into a small blood vessel which can be very dangerous (even though it was very rare). So, we — and by that, I mean Jill — started to use these. And they’re great. Certainly they’re safe, but they also make the process much less painful and create much less bruising. Our patients love them. It’s way cool to use something for one reason (like safety) and finds that it’s even better than you expected. Yeah!
Gloss Skin Retexturing Cream by Skinluma
Gloss Cream is hands down the best new thing in skin care. Recently it was featured in the December 2011 Issue of Allure Magazine, so we’re not the only ones who like it. Why is this is so great? Glad you asked. This is the first preparation of TCA (trichloroacetic acid) which is used in many peels, for daily home use. And it’s combined with a powerful retinoid. And it contains our favorite anti-oxidants: Vitamins C and E, and Ferulic acid. And, it’s non-irritating. Pretty much everything but the kitchen sink for your face in a form that you can use without irritating the heck our of your face. This wonderful product by Skinluma, has been brought to us by our good friends at Young Pharmaceuticals (who are rapidly becoming our go-to skin product guys). So Thanks, Young Pharmaceuticals!
Natasha
No, I’m not talking Rocky and Bullwinkle, you know — the wife of Boris Badenoff. I am talking about the newest member of our staff, Natasha. She has been with us only a few months, but you’d never know it. She has picked up the knowledge of the job in no time flat, and is a full-blooded member of our office family. We are really thrilled to have her on board as she is a great addition to a great staff. Three Cheers for Natasha and our staff!
Like I said, it’s been a good year. And as we say goodbye to 2011, we look forward to 2012. For new products or procedures, new patients who will become our friends, and new experiences with our existing friends and patients. We wish you all many blessings in the year ahead.
Happy New Year!
David B.
The Presents That Can’t Be Wrapped
Dec 18th
One of the things that I have always loved about this time of the year is the gathering of friends and families. (I know: you probably thought it was figgy pudding — but what is figgy pudding, anyway?) Reunions and homecomings seem to be the order of the season. It is time when our kids come home and we reunite as a family. As they have grown older and have gone to college and beyond, they are more independent and not around as much. While this is the natural order of things, we miss them when they are not around, and always look forward to their returning home.
We also get to enjoy the homecomings of our friends’ children as well. And, of course, parties and get-togethers abound. There are probably more joyous celebrations and expressions of love in this season than any other. And, being the hopeless romantic that I am (my wife would say “hopeful romantic”), I love it all.
These reunions are not limited to family and friends. But this is also a time of year when we see many people in our office whom we have not seen in a while. Whether its time for a follow-up visit, time for something else, or time to purchase a gift for someone else, we get to see a lot of you. And this is one of the real gifts of the season.
My hope for you is that this is, among other things, a season of wonderful reunions and homecomings with families, friends, and those you have not seen in a while.
Merry Christmas!
David B.
P.S. Can you feel the love?
5 Reasons Why It’s Hard To Buy Gifts For Men
Dec 12th
As the season of Christmas rolls on (it’s actually Advent, but that another blog), it’s that time of year when the lucky ladies try to figure out what to get for the men in their lives. I am told this is not always an easy task. And, alas, I believe this to be so. In order to help the shoppers, and to add introspection for us guys, allow me to provide you with some insight into why men are hard to buy for.
1. There is no “go to” gift for men. While there are some men who are passionate about a gift associated endeavor, we aren’t like women (duh, I know, but stick with me). At the risk of sounding flippant, men have an easier time. If nothing else comes to mind, a trip to the jewelry store rarely bombs. To wit: for one of my wife’s birthdays, she requested that we row our double shell in a marathon regatta in Natchitoches, Louisiana, and that’s what we did. All 26.2 miles of it. Remember, she asked to do this. At about mile 22 she said that if she ever suggested that we do this again, I should just buy her a piece of jewelry. I rest my case.
2. We are very particular. When we have something in mind, we want the exact thing we are thinking of, even if there is a better item. Creativity here is not always rewarded and when it come to clothes this is especially true. Shirts are pretty easy, but not jeans. Some fit us better than others, and these are the ones we want. And forget about our remembering what size we wear. We just want ones that we are currently wearing to threads. We know what we want.
3. We don’t know what we want. I would like to wax eloquent about this but suffice it to say that this is pretty much on the mark. No one every accused us of being self aware. We’re men after all.
4. When we want something we get it for ourselves. Delayed gratification is not our strong suit. As we are cruising the internet, we generally buy something that strikes our fancy in the space of a few clicks, forgetting that it is December the 15th, and we have yet to help out by producing a wish list.
5. Men don’t accessorize. Candles, scarves, and knick knaks just don’t do it for us. Again, we’re men: pass us the remote.
Fear not! All is not lost. I have two stocking-stuffer suggestions for the guys in your life (this is when I will crassly advertise). There are some other things, but these two are dead solid hits: like jewelry for men.
Medishave Shaving Cream
Young Pharmaceutical Medi-Shave: This is simply the best shaving cream I have ever used. When my sons come home for Christmas they steal it and actually shave. In addition to being a great lubricant for a super-close shave, it also contains alpha hydroxy acids which help to exfoliate and keep us looking our best.
Colorescience SunForgettable in All Clear- Hands down the best sunscreen ever, and even better for men. This has an SPF 50 and goes on as a powder. It’s not a heavy lotion, it’s light and very waterproof. You don’t sweat this stuff off into your eyes. So it’s perfect to wear when you’re exercising and easy to slip into your golf bag or gym bag where you’ll actually use it. Before we brought this product into the office 8 years ago my family test drove it in Hilton Head in June. No one got sunburned. It is approved by the Skin Cancer Foundation. This really works.
Sunforgettable Sunscreen SPF 50
Whoever you are thinking about this season, and no matter what you are getting them, this is a wonderful time of the year. So amid the business and goings on, always pause to enjoy this time.
I wish you all the best!
David B.
Our Most Fun Holiday Promotion….Ever!
Nov 27th
Now that Thanksgiving is over, and — for the most part — the turkey dinners are digested, our thoughts move on to Christmas. And, what my office staff and I enjoy most about this season is giving. I am sure that I get as much joy out of finding and giving a present to someone as they get when they receive it.
So for this Christmas season, we have a real treat for you in our office: Reath Reward-O-Ments. This is a mix of our Reath Rewards program, the holiday spirit, and Christmas tree ornaments. And the office staff is about as excited with this as they are with anything we’ve come up with lately.
Introducing Reath Reward-O-Ments
The Christmas tree in our office is decorated with a variety of eight different ornaments. (Hopefully they will still be there, because the staff really think they’re cute, and I can just see one of them sneaking in over the weekend to “borrow” a few for their trees!) Inside each of these is surprise — anything from free movie tickets to a gift certificate to a local restaurant, to something from our store. Once you pick an ornament from the tree, you check what’s inside, and you get to keep the ornament. Cool, right? We’ll have them until Christmas as long as the supplies last. Theresa and Natasha show you what they look like on this video.
Here’s how it works:
Reath Reward-O-Ments are a gift with any non-surgical purchase of $250 or more which includes products, skin care procedures, most laser treatments and all injectable wrinkle treatments and fillers (including Botox, Dysport, Juvederm and Radiesse.)
Fine Print (and there’s always fine print): There is a one ornament limit per person per day. Supplies are very limited (no kidding, here) so don’t leave this to the last minute.
Also…. you will still earn Reath Rewards points on your purchase, (but you may not use Reath Rewards to get your Reward-O-Ment).
But don’t worry about the rules, we’ll explain them to you when you come in. This is just our way of having some fun, and sharing our Christmas spirit with you.
All the best, and Ho, Ho, Ho!
David B. (And, no — I do not look like Santa Claus!)
The Other Boost You Get From Breast Augmentation
Nov 16th
The most common operation that I do is breast augmentation, and there are a lot of reasons for this. When I first start doing this operation over 25 years ago, I thought about it a lot differently than I do now. Back then is all seemed extremely simplified. A patient comes in, we put in the implants, and the breasts get bigger. Bathing suits look better, the beach is a more fun place to be and everyone goes home happy. End of story. Right? Well, not so much.
The more I do this operation, the more I realize its importance to the women who choose to have it (dare I say, need it?). And, not to put too fine an edge on this, it’s not about getting big boobs. It really is about making the patient’s quality of life better. Let me explain.
How Our Bodies Impact Us
Our bodies in many ways define us. They certainly affect everything we do. If you don’t buy this, talk to someone who has had a injury or surgery and can’t use a part of their body. It affects everything! The same can be true if there is a part of our body that is not the way we want it to be. And this is the case with breasts that are too small (or overly large, for that matter).
Women who have very small or almost no breasts, have trouble with just about every type of clothing. Bathing suits don’t fit, tops don’t stay up, and strapless is out of the question. And each time they find a dress that fits their hips, they are swimming in the top. So how would it be for you if you looked in your closet each morning, and knew that there was nothing that you really felt you would look great in? Not only that, but you can’t even buy clothes that will fit your shape. It can begin to get to you.
Confidence And Body Image
Self esteem and confidence are also very closely tied to our bodies and our body images. I cannot tell you the number of women who tell me how much more confident they feel after this surgery. In the world in which we live, we are all trying to look our best. That’s why women put on make-up and men shave in the morning. That’s why we pay attention to the clothes we wear and how we look in clothes. It may also be why we hit the gym or work out. But short of wearing a thickly padded bra, women who are small-breasted have no other way to deal with this other than through the use of breast implants.
If you are concerned about the size of your breasts, you may be a bit nervous about talking to someone about this. Don’t be. Most plastic surgeons you will see understand where you are coming from, and do not believe that your concerns are trivial. Some of my most happy patients are women who have had this done. (I just got a hug from one!) This is great operation, with very high patient satisfaction. If it’s right for you, we would love to help you out with this. And we know, that it’s not just about size.
If you are wanting to learn more about breast augmentation, our staff has written an informative and entertaining eBook called A Girlfriend’s Guide to Breast Augmentation. It’s a free download so you might want to check it out.
All the best,
David B.
We’re “Stuck” on a Better, Safer Way To Inject Fillers
Nov 4th
One of the things that I like about plastic surgery is that we are always trying to improve the things we do. I think it’s part of our culture or the way plastic surgeons are wired (no comments from the peanut gallery, please!). Usually the goal is to have a better result or make something as safe as possible. And the latest upgrade in what we are doing has to do with the way we inject fillers, like Juvederm and Radiesse.
Jill can't stop talking about how much she loves her new flexible cannulas!
Most injections are done with needles — I know, duh. However, there are other ways to do this that can be both more comfortable and safer. The problem with needles is that they are sharp — yes, I know, duh again. While the sharp end allows them to go through the skin easily, it also allows them to puncture very small blood vessels which causes bruising and can hurt.
There have even been reports of times when the filler has actually gotten inside the blood vessel and traveled to an adjacent area causing a problem. This was actually the impetus to find a better, safer method of injecting fillers.
Enter the flexible cannula.
A flexible cannula differs from a needle in that the end is blunt and the hole through which the filler is injected is on the side of the tip, rather than right at the end. Since the cannula is blunt, it more or less pushes the tissue aside as it is advanced rather than puncturing or cutting the tissue as a needle would do. Otherwise it works just like a needle and everyone agrees it’s safer too.
But guess what: it is also a much more comfortable way to have the injections. So, in our quest to do this better, we ended up doing this with less pain, and less bruising. Not bad. And it’s something that our patients are noticing and commenting on.
So next time you are in for your fillers, Jill will probably be using her flexible blunt cannulas rather than a needle and you will find that your experience with these wonderful little fillers just got a lot better!
Hope to see you soon,
David B.
