Knoxville Plastic Surgery Insider

Pierced Ear Problems: Prevention, Care & Repair

2012-12-01T16:53:49Z

It may not be the end of the world but problems with ear lobe piercings can be very irritating, not to mention a possible fashion faux pas. While this mainly affects women, some men have issues with this as well. (Always nice to have parity.)

The Problem
Predominantly the problem with the ear lobes is elongation of the piercing hole or, in more severe cases, the hole tearing all the way through the edge of the lobe. Elongated holes make earrings hang somewhat crooked, and the ones that have torn through won’t hold an earring at all. You can take my word on this.

The problem has a couple of causes but the main one is wearing heavy earrings. In addition to gravity being a factor, larger earrings can be more easily caught on things like clothing. Sometimes they are grabbed by babies or young children who just want to do a few pull-ups from the earrings. This was not a problem in my mother’s generation because many earring were clip-ons and pierced earrings were small but it seems to be an issue for women nowadays.

Lobe Wonders Really Help

Prevention Is The Best Solution
So, what to do about this? Well, the first thing is to avoid really heavy earrings. I know this is kind of a no-brainer, but it is something to consider. However, fashion or the most recent gift from your father-in-law (who just came back from Columbia with beautiful amethyst earrings for my wife) can dictate otherwise. But to back up a bit, if you are planning getting your ears pierced, don’t get the hole too low. The more of the earlobe that is below the hole, the better the support will be for the earring.

A $10 Fix
Now, if you are concerned about the weight of your earrings, or if the holes in your ears have begun to elongate and your earrings are hanging all cattywompuss (please forgive the technical term), there is an easy solution: Lobe Wonders. These are little discs that are worn on the back of your ear between the earring back and the lobe. They stabilize your earrings, and take the stress off the tissue of the lobes. And they make your earrings hang straight. They are actually quite good and easy to use. We also carry them in our office….just saying. So, if you are looking for an easy solution or a way of preventing things from getting worse, we got your back, or at least your ear’s back.

Injectable Fillers Work Quite Nicely
The next option for the elongated hole is to add some bulk to the skin beneath the hole. Did I hear someone say fillers? Indeed. The injection of Juvederm or other hyaluronic acids fillers can bulk up this area and give greater support. Now, this is a bit more costly because it will usually take a full syringe to treat both ears. And it may not last forever. However, it can help and it’s easy to do. Just ask Jill in our office.

Repairing a Ripped Earlobe
Once the earlobe is ripped all the way through, you will need to have this repaired. Fortunately this can be done in the office, and it’s not very painful. We just inject a little numbing medicine into the earlobe (no worse than getting the ear pierced originally), and then remove the skin on the inside of the torn hole. Why, you might ask, do we need to do this? Well, if we just put some stitches in, we would be putting the skin or one side against the other and it wouldn’t heal. Just the same way that your fingers won’t grow together at night while you’re sleeping. Skin won’t heal to skin. Once we have “pared” the inside of the hole, so to speak, we just put in a few stitches. These stay in for about 6 days. There will be a little scar there, but it is usually hidden by earrings after the ear is re-pierced, which can be done in about 6 weeks.

Repairing a Gauged Earlobe
Some folks have their ears gauged, which may have seemed like a good idea at one time, but may not be so good if they are looking for employment later in life, or want to enter the military. Repairing a gauged earlobe is a much more difficult problem due to the tremendous stretching and thinning of the tissues. In these cases we really need to reconstruct the earlobe. This is much more involved and I do this as an outpatient operation in a surgery center, although it can still be done under local anesthesia. I think that a reconstructed earlobe will always look better than a gauged earlobe, but it will never look as good as the normal earlobe. Something to think about if you are thinking of gauging your ears, or you’re trying to talk your son or daughter out of doing this. But, it’s good to know that there is a treatment, if you ever want and need it.

As you can see, there are a lot of things that can be done for the problem earlobe. Usually people like simpler things better, and I would agree. However, keeping our earlobe holes from getting too stretched out in the first place may be the best way to go.
All the best,
David B.

5 Tips For Healthy Skin During The Winter

2012-11-30T15:16:41Z

As winter is upon us you have probably noticed that your skin is getting dryer. This is common. Your skin changes throughout the seasons of the year and it requires different care and treatment depending upon the season. So what should you be doing for winter skin? Glad you asked. With the cold of the winter season your skin needs better protection. This means preserving or adding to the natural oils that protect our skin. Here are some tips for you.

1. Ease Up On Exfoliants
Many cleansers and other skin care products we use contain active ingredients such as the alpha hydroxyl acids (think glycolic acid) which promote exfoliation or skin cell turn over. These are great for making your skin look fresher but they also can dry out your skin during the winter months. So you may want to tone it down. If there is a product like this that you use every day, then back off to using it every other day or even once or twice a week.
You may also need to change your facial cleanser or other products. Since you skin’s needs are different with the seasons, you may need to change your products with the seasons as well. Consider moving from your glycolic cleanser to a gentler one, or one which also moisturizes or hydrates. You may also add a hydrating product to your antioxidants. Feel free to play around with things. For instance, if you head to Colorado to ski, know that it may be colder and more arid than your skin is used to, so alter your skin care plan during your trip.

2. Moisturize, Moisturize, Moisturize
You really need to moisturize, but then I may already have said this. Everyone will tell you that it is best to apply moisturizer while your skin is still a little damp. This applies to your face, your hands, and the rest of your body. In addition to keeping in your body’s own oils, the moisturizer will also help to protect you skin as a barrier to the cold.
Incidentally, your hands actually take a bigger hit with the cold than anywhere else on your body so keep a good hand moisturizer around and use it often, especially if you wash your hands a lot during the days. Don’t forget your gloves either. When it’s cold outside, be nice to your hands and protect them from the wind and cold.

3. Long Hot Showers Are Not Good For You
When you’ve been outside and need to warm up, it’s tempting to hop in the shower and turn up the heat. You may even stay there until the hot water heater gives out but this is not good for your skin. The hotter the water, the more it removes you skin’s natural oils and barriers. The longer you are in the shower, the more this happens. Go with warm water not scalding hot (and leave some hot water for everyone else in the house!)

4. Give Your Skin A Treat
While long hot showers are out, a soak in a warm tub can be great, especially if you add something to the bath water. If you have a lot of itching and irritation, try an oatmeal bath. Baking soda can also work. And if you are looking for some added moisture, add a couple tablespoons of olive oil. You can even use olive oil and oatmeal together (but I would leave out the balsamic vinegar…just saying).

5. Continue To Protect
You still need your sunscreen even in the winter. Even though the days are shorter and we are all looking for sun to cure our affective seasonal disorder, the sun’s rays can still damage your skin. One of the easiest ways to remember to wear your sunscreen is to use a skin care product or make ?up with sunscreen in it. If you’re heading up to the mountains to ski or down to the Caribbean to escape the cold, you’ll need a more high-test sunscreen, and remember to reapply it often.

It doesn’t take much to take care of your skin during the winter. Just remember that your body’s natural oils are your friend and what you do for your skin in the summer is not what your skin will need in the winter.

All the best,
David B.

PS. If you haven’t gotten a copy of our practice magazine Your Beauty yet, you should check it out. Just click on the magazine and fill in your address and we’ll mail it to you free!

A Simple Tip to Slow The Appearance of Aging Hands

2012-11-30T15:17:28Z

Our hands are an often overlooked area that show our age. While we my concentrate on our faces, the hands can sometimes tell the tale. There are a growing number of procedures that many of my colleagues are doing to rejuvenate the hands. These range from fillers and fat grafting to IPL (Intense Pulsed Light) and peels. But surely there something more simple we can do to help with the appearance of our hands, right? Yes.

Don’t Waste The Leftovers

If you are using skin products to help the skin of your face, then you’re down with this! We are using a lot of alpha-hydroxy acids, anti-oxidants and retinols for our faces and generally you have a little left over after putting these on your face so put it on the back of your hands, not the towel.
We have a great new exfoliating cleanser. I use this in the shower and after rubbing it into my face and neck I put it on my hands. Then the products I use on my face when I get out of the shower (Intense Firming Complex, and Anti-oxidant serum) are put on my hands as well.
You will not see a difference in a day, or even a week. But as the months and years go by, your hand will look great. As they say, this is easy peasy. Give it a try!
All the best,
David B.

PS. If you haven’t gotten a copy of our practice magazine Your Beauty yet, you should check it out. There’s information about the products I mentioned and a lot more. Just click on the magazine and fill in your address and we’ll mail it to you free!

4 Factors That Determine When Breast Implants Feel Normal

2012-11-06T20:15:40Z

One of the questions on the mind of women undergoing breast enlargement is “when will my new breasts with implants feel normal?” I actually ask my patients in follow-up visits when they feel that their implants are a part of their body. This is the time when they stop thinking about them as new implants, and start thinking about them as their breasts. There are a lot of factors that can impact this. And there is a certain psychological aspect as well, which deals with changes in body image and how quickly someone will adapt to this. But, since I am not a psychologist (even though my staff thinks I’m mental ? is the same thing?) let me talk about some of the physical factors that can affect this.

1. Silicone vs. Saline
As silicone implants are inherently softer, they will tend to feel more “normal” sooner that saline. This is not to say that saline implants won’t feel normal, but it may take a little longer, especially if the implants are riding a bit high, as saline implants often do. The viscosity of the silicone implants is what really makes the difference, and I might venture to say that silicone implants will always feel more normal than saline implants. When you hold each implant in your hand, you can really appreciate the difference. This is why over 80% of my patients choose silicone.

2. Over the Muscle vs. Under the Muscle
Not everyone is a candidate to have implants placed on top of the chest muscle. But for those who have enough natural breast tissue to cover the implants and not require the muscle as soft tissue coverage, the implants will feel more normal sooner. This is because the muscle does not need to be stretched out. Also, you will be less aware of the implants when you contract your chest muscles if they are on top. Because when you do flex your pectoral muscles, they will slightly change the shape of the implant/breast as the muscle presses down on them. This goes away immediately when the muscle is relaxed and does not pose a long term problem, but some women may notice this.
When I talk with patients about placing the implants on top of the muscle, many are surprised and thought that implants should always be sub-muscular. But when the balance is right between the amount of natural breast tissue, and the size of the breast implant (usually these will be silicone), this can be an excellent way to go, and sometimes gives the most natural results.

3. Smaller Implants vs. Larger Implants
The size of the implants also makes a difference. And, larger implants take longer to feel natural. In fact, overly large implants may never feel as natural as I would like them to, particularly in the case of saline. How large is too large? Well, that?s tough question. But when we consult with people and work with sizers, we can find a good size that makes enough of a difference without going over the edge. There are, however, some women who want to go larger than I would recommend, and we always tell them that the implants will not feel (or look) as natural. But, then, this is what some women are going for.

4. Smaller Normal Breast Tissue vs. Larger Normal Breast Tissue
The amount of your natural breast tissue can also be a factor. With more tissue, the implants will be more quickly assimilated into the look and the feel of the breast. Breasts will feel more natural, sooner, going from a full B cup to a small D cup, than going from a small A cup to a small D cup. This again has to do with the amount of tissue covering the implant. As I tell women, if you have almost no breast tissue at all, it will be hard to make the augmented breast not look and feel somewhat like an implant. Still, this is better than being so small that clothing and bathing suit tops won?t fit.
All these things make a difference, and this is why it is difficult for anyone to give you an absolute of when things will feel normal, or feel like a natural part of your body. The other thing that no one can control is how your body makes scar tissue, and how it makes the capsule around the implants. If your body makes thicker scars and a thicker capsule, it will take longer. But, if you were to pin me down on how long this whole process takes, I would give you are range of anywhere from two to nine months until your breasts feel normal.

How can you affect this whole process?
Massage. Actively massaging your implants will help with the formation of a capsule which is soft and allows normal movement and a natural feel to your implants. If the implants are beneath the chest muscles, this will help the muscles relax and stretch out. So, really working with massage, especially early on when it may be uncomfortable is important. Think of it as a short time discomfort for a long term gain.
All the best,

David B.

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.

Sandy’s Aftermath, Medicine, and Plastic Surgery: First Things First

2012-11-03T15:48:29Z

It is hard for any of us to not be touched by the destruction that was left in the wake of Hurricane Sandy. As some of you may know, I was brought up in Philadelphia, and I have traveled to the Jersey Shore several times with friends for visits during the summer. Most recently I was there about twelve or thirteen years ago for a conference, and I had a good early morning run with some colleagues along the boardwalk. And my mother has a picture of her and her twin sister as children with their Grandfather Wayne dressed in their Sunday best, walking hand in hand along that very same boardwalk in Atlantic City. It is going to be a long time before any such photo opportunities will be possible again, if ever.

Most of us have visited New York City. Does anyone have a burning desire to visit right now? I am sure that my two cousins and their families who are there without water, power, or heat would rather be somewhere else. And, with the difficulties of travel, getting around the city, and hotel and restaurant services aside, will visitors to the Big Apple right now really help the city recover?

Obviously this had been the subject of the debate surrounding the New York City Marathon. Now, I love sporting events as much as the next guy, particularly if I can participate (and for me that would need to be a regatta, not a street race). But when I heard that the NYC Marathon was still a go, I was astounded. In fact, when one of my staff told me that it had finally been cancelled, I was glad that wiser heads had prevailed (actually what I think I said was that I was glad someone had grown a brain).

Certainly the economic infusion that comes with this event will help New York City. But at what cost in terms of services diverted from recovery and rebuilding, to put on such a massive event. And what is the emotional cost to the citizens of Staten Island whose homes have been devastated to see thousands of people running through their streets in a leisure activity (albeit strenuous), when they may have neither food or water?

For me this was an issue of first things first. What is the highest priority? What should be addressed first? In my opinion it should be the restoration of basic services and meeting the needs of those who have lost so much. But, clearly — as much as I seem to think this is a straight forward decision � this was a difficult decision for the leadership of NYC to make. And I do not mean to belittle the tasks and decisions they are confronted with. None of us want to be in their shoes.

In medicine, and in plastic surgery, we are frequently confronted with difficult decisions. Most people in medicine understand the Latin phrase “Primum non nocere” which means “first do no harm.” This is such a basic tenet of the practice of medicine that I am reminded of it almost every day. And it puts the health and safety of the patient before all other priorities.

And it is true of plastic surgery as well. I frequently have this conversation with the anesthesiologist caring for my patient. If they are concerned about something, what I’m doing comes to a halt. Because the consequences of a problem with what they are doing has the potential to have a much greater effect on the health of my patient than what I am doing. And, when I have a tough surgical problem, I must always approach it with care and common sense taking care of the major issue first, and then dealing with the other issues. At times this is difficult for some of my patients to understand. Because sometimes we forget that cosmetic plastic surgery is real medicine and real surgery, requiring the same level of care as open heart surgery. Patient safety will always be first.

New York, New Jersey, and the other places that were affected by Sandy need all the help we can give them. I hope the telethon last night will raise a lot of money to help the Red Cross meet their needs. And all the people affected need our prayers. We wish them well. We know that services will be restored and that the Jersey Shore will be back. But it’s going to take some time. In the meantime, first things first.

All the best,

David B.

NASA satellite photo of Hurricane Sandy

Coolsculpting: Yes It Really Works

2012-10-25T14:01:32Z

CoolSculpting Update
We’ve had our CoolSculpting machines for three months now, and it’s time to step back and look some of our results to see just how well this is doing. And, to cut to the chase, we are delighted with the results. Certainly there are some types of fat that respond better than other, and some areas may do better. But overall we are very pleased with the results.

I have had this done myself, as I had demonstrated in a video which we posted to Facebook. My hip rolls (that’s doctor speak for love handles) have had an impressive result. Just one hour of treatment has given a major reduction. And, voila! Have a look at my before and after photos below.

We have other before and after photos on our website. Many people are seeing great results in a month, but the best time frame to evaluate the results is three months.

We have not had major problems with pain after the procedure. One person did have some major discomfort that resolved in about a week. We are also finding that people are truly having just about no downtime. You may not hit the gym the day of the treatment, but you should be fine the next day.

Our status report is that all systems are “go!” We are quite pleased with our investment into this technology and are having a lot of fun with our patients. If you are interested give us a call. If you have a special outfit you want to wear for New Year’s, now is the time to have this done.
All the best,
David B.

Dr. Reath Before and After Coolsculpting of his Hip Rolls

NECC Recall: What My Patients Should Know

2012-10-18T13:19:05Z

I suspect that most of you have heard about the severe fungal infections and deaths that have resulted from steroid injections, many of which have been in Tennessee. We are fortunate that the CDC has done such a good job of isolating the cause of these, in an effort to make sure no other infections happen. And, believe it or not, the fallout from this has even affected our practice, although none of our patients are at risk.

Let me explain. The steroids in question are compounded (that is to say made or mixed) by NECC, the New England Compounding Center. The CDC was able to track the infections to these drugs made by NECC after May 21, 2012. This company is a very large pharmaceutical company that produces hundreds of different drugs. However, out of an abundance of caution, the FDA had recalled all drugs made by NECC that were manufactured after May 21. These drugs are being “quarantined.” I suspect they will need a big warehouse, and this pretty much the end of the road for NECC.

Again, why am I even writing about this, you might ask? Well, like many plastic surgeons, we have on a very few occasions used a drug compounded by NECC, Hyaluronidase. This can be used to dissolve the hyaluronic acid fillers such and Juvederm or Restylane. Like most plastic surgeons we will on rare occasions use this. In fact, we have a vial that was produced after May 21. But guess what? It’s unopened and on the way to the CDC.

Tomorrow, the Tennessee Hospital Association will publish a list of all Tennessee physicians who have received any products from NECC, and my name will be there (along with other plastic surgeons in Tennessee). We just wanted to give you a heads up.
Bottom line:

Infections have occurred only with the steroids compounded by NECC after May 21, 2112.

There have been no infections reported with NECC’s hyaluronidase.

We have not used any hyaluronidase produced after May 21, 2112

Since we have been shipped an NECC product in the past, our name will be on the list THA publishes on October 18.

We wanted to let you know that even though our name may be on this list, none of our patients have been affected by this. And that’s exactly the way we want it to be.
All the best,
David B.

From Collagen to Radiesse: A Brief History of Fillers

2012-10-04T21:38:38Z

Anyone remember the movie First Wives Club? Or, more to the point, the image of Goldie Hawn after having collagen injected into her lips? She really did a pretty good imitation of a duck billed platypus with swollen lips to the max. Truly this was a parody of the earlier days of injectable fillers, but we’ve come a long way since then. Let’s have a look back.

In The Beginning
First came Zyderm and Zplast (this is what Goldie got). This was actually first used in the late 1970′s. It is collagen from a bovine origin (you know, beef, what’s for dinner). The products were the first widely used and well tolerated products to be used as fillers. However, since they were a foreign protein (foreign to the human body, that is) you needed a skin test to make sure you weren’t allergic. And they did have a lot of swelling associated with them. Also, they didn’t last all that long.

A Big Advance
The next advance didn’t come until 2003, when Inamed (what McGhan became before they were acquired by Allergan) developed a human form of collagen, Cosmoplast and Cosmoderm. These were great products and a real advance over the bovine collagen because no skin test was required. Although these are not used as much these days, they still are very good fillers. They just don’t last as long as we would like.

The Game Changer
Enter Hyaluronic acid. This is a natural polysaccharide that is a part of our bodies. Hyaluronic acid fillers are produced in the lab and are compatible with all of us. No skin testing is needed, and it lasts longer than collagen. Much longer. Medicis corporation was the first kid on the block in this country with Restylane which debuted in 2003. It became pretty big in a hurry because of it’s longevity when compared to collagen.

Allergan was once again heavily in the game with the introduction of Juvederm in 2007. Juvederm, like other hyaluronic acid (HA) fillers, is available in different thicknesses to work better in certain areas and perhaps last a little longer (i.e. Juvederm Ultra, Juvederm Ultra Plus).

Currently we are using several different HA fillers as some are better in some areas for some people. The latest improvement on this has been to add lidocaine, or a local anesthetic to the filler, as in Juvederm XC. This happened in 2010 and has made the whole process easier.

A Different Kind Of Filler For Certain Areas
There is also another class of fillers which are considered semi-synthetic. These contain synthetic (non-organic) materials mixed with an organic matrix. We use Radiesse, which contains micro sphere of hydroxyapatite in a gel carrier. Radiesse has the advantage of lasting longer than the HA’s. However, it is thicker and must be used in areas where the tissue is thicker (never the lips). Semi-synthetic fillers are not for everyone, in the right places they’re great.

Another Big (and Recent) Advance
One of the greatest advances with fillers in terms of both safety and comfort has had nothing to do with the injected product, but what we inject it through. Formerly we all used needles. However, there has been a move to use blunt flexible cannulas because they are safer, and we have found them to be much more comfortable and to have less bruising. Yes, they may cost a bit more but, boy, are they worth it.

What comes next? Don’t really know. But the products that we now have are quite good and quite easy to access. Anything that will receive as wide acceptance as these will need to be as easily used and as easily accessed. We’ll keep our eyes open and let you know what we come across.

All the best,

David B.

Sex After Plastic Surgery- Glad You Asked

2012-09-14T21:08:35Z

Before you read any further, let me tell you that this post is PG rated at the very least. This will either set you at ease or disappoint you. In either case, read on!

From time to time during my post-operative consultations, a patient or spouse will ask me when they can resume normal sexual activity. Sometimes I am asked this before surgery. And if there is any surprise in this, it would be that I am not asked this more often. However, I am always gratified when a patient, or a couple will be honest enough about their concerns to ask what might be considered by some an embarrassing question.

So, when can you resume normal sexual activities after plastic surgery? This is not a question you will find an answer to in a text book. But, the answer in many cases would be sooner than you think. It really depends upon a couple of things: the surgery you have had, how much discomfort you are in, and when you as the patient feel ready for this.

Few people will be ready for sexual activity the day after surgery. And if there are drains involved, or special positioning after surgery is indicated, this probably is not the right time for physical romance. The time you will need to wait will be longer for more involved operations. For instance, you may want to wait several weeks after a tummy tuck, but probably not as long after breast enlargement. In fact, women who have had breast enlargement may feel much better about themselves in bed and want to get back into the saddle sooner.

Pain can be a real turn off. If you’re hurting, or needing narcotic pain medication, making love to your partner may not feel too good. And, after all, you want to enjoy your sexual activity. So, wait until you’re not hurting. In many cases you may need to be somewhat inventive with positioning to enjoy sex. Having someone’s body weight on an area that is healing may be uncomfortable. But, if you can position yourselves to prevent this, all systems may be go.

Perhaps the most important consideration is when you, as the patient, feel ready for this. You are the only one who can determine this. At times this may call for patience. At other times, you may find physical closeness (even if it does not involve sex) is comforting and something that really makes you feel better. On the other hand if you are completely healed, and you are in doubt about how you feel about yourself due to scars, or changes in your body, be honest with you lover and work through this together. Understanding and reassurances can go a long way here. And once you have taken the plunge — so to speak, you may feel much better about some of these concerns.

There is no right or wrong answer to the question of when to resume sexual activity after plastic surgery. Many people are thrilled with the appearance of their body and want to get back at it pronto. Others take longer to feel ready. But common sense will often rule the day: if it doesn’t feel good, don’t do it. But the most important thing to remember is that you can always ask your plastic surgeon. He or she probably enjoys sex as much as you do, and will be very understanding of your concerns. Like I said, I welcome this question, because it shows me how honest and healthy my patient is.

All the best,

David B.

Figuring Out What’s Cool in Plastic Surgery: 4 Questions To Ask

2012-08-30T19:13:28Z

In the world of plastic surgery, we are continuously being offered new technologies, new products, or new applications for existing technologies. And these run the gamut from snake oil to something that is very effective. The hard part with all this is trying to figure out what makes sense and what does not. Over the years I have developed a mindset that helps me figure out just how good something is. Because if you listen to the manufacturers’ hype, apparently there is no way we can survive without everything new trick that come down the pike.

So to figure out what’s for real and what isn’t, I ask myself these four questions:

Does this make sense? So, Joe laser dude comes in telling me that his machine will remove all stretch marks -make the skin look like they were never there (I’m making a bit of an exaggeration here). Well, stretch marks are scars in the skin. And there is no way to remove a scar. You can replace them with other, better looking scars, but you cannot zap them away with a laser as if they were never there at all. So, no go for Joe.

Where is the science? And by this I mean what is the scientific basis for this new technology: proof that this works and lives up to it’s hype. This can be kind of interesting. Because sometimes you can show that scientifically this technology is making a change. You can measure it and prove it. However, in terms of how things look, or what patients will see, the change just isn’t that great. Take laser liposuction (sorry to keep picking on lasers). You can show statistically that there is some tightening to the skin, but if you look at the before and after photos you can barely notice a difference. For other technologies, the science is sound and the results look good. These are the ones I’m interested in. There should always been some good scientific studies that show that this new thing really works.

Who’s using it? Is this new fangled machine being used only by the people who invented it, or are other plastic surgeons using it? For this I call up some of my colleagues around the country and get the straight scoop. We did this with CoolSculpting. I spoke with Dr. Joe Hunstad, a friend in Charlotte, and well as Dr. Grant Stevens in California. Both said it was the real deal. But Joe also told me what it could do (abdomen, hip rolls, bra line and muffin tops), and what it could not do (thighs). And this is really valuable information. To me this says that Joe is giving me a very honest assessment of the machine, pointing our where it works, and where it may not. Because not everything works everywhere. If the only people using this new invention are the people who developed it, time to proceed with caution.

Is this right for us? Does this add something that we want to our practice? And can we all make this work? This part is always a team discussion where I get input from everyone in the office.

So how have I done? Well, not perfectly, but pretty well. This is usually obvious by what machines or other things we have sold or gotten rid of. And there has only been one thing that really didn’t work out. But in recent years the biggest hits have been: CoolSculpting, Cutera Laser Applications (Pearl Fractional, Limelight IPL, Laser hair removal, etc), Reveal Camera, and a host of skin care products that we all use. Also, Ultrasound Assisted Liposuction has survived the test of time.

In about two months, we will have our national meeting in New Orleans (assuming it dries out),and any number of the latest and greatest will be on display. I’ll look them over and find out if there’s something new that will make a difference for you. But, as a general rule, I don’t want to be the first person in the county using a new gadget; and I don’t want to the the last person, either.

Be well,

David B.