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Plastic Surgery in Brazil

I recently returned from Brazil, where my father and I did surgery to assist a patient's breathing.  This was a nerve surgery designed to help patients on a ventilator breathe without the external device.  The procedure uses a phrenic nerve pacemaker.  The idea is to allow the breathing muscle or diaphragm to work again.  This allows the lungs to function without using a ventilator.  And this allows patients to do such things as sit up, speak, and in general be much more mobile.

As a California plastic surgeon, I thought doing a procedure in Brazil might be very different from doing surgery here at home.  But I found that surgery is in some respects an international language and we were able to have the procedure go very smoothly even though I do not speak Portuguese and the staff did not speak English.  

Reports are that the patient is doing very well.  He will need some time before he can use the phrenic nerve pacemaker for long periods.  His diaphragm breathing muscle has not been used for a long time, and it will need to be trained and exercised again.  Hopefully in four or five months he will see dramatic improvements in his quality of life.

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An Exciting Skincare Program
We have started using a new skincare regimen on our Los Angeles plastic surgery patients, and we have been impressed with the results.  Below is a summary of some benefits of NIA 24--
This all-in-one cleansing scrub gently removes dead skin cells. Pro-Niasomes™, which are spherical Jojoba Beads infused with Pro-Niacin™, help wash away skin’s visible imperfections.

NIA 24™ Benefits

  • Stimulates cell turnover
  • Improves dry patches
  • Smoothes and evens skin texture
  • Soothes the skin
  • Prepares the skin for maximum absorption of Skin Strengthening Complex.

NIA 24™ Key Ingredients

  • Formulated with Pro-Niasomes, spherical Jojoba Beads encapsulated with Pro-Niacin.
  • Sunflower Oil moisturizes the skin
  • Oat and Sage calm and soothe the skin
  • Chamomile has anti-irritant, soothing and antioxidant properties.

Questions About NIA 24™ Physical Cleansing Scrub

What is the exfoliating ingredient in the NIA 24™ Physical Cleansing Scrub and will it tear my skin?

The exfoliating action comes from the Pro-Niasomes™ which are Jojoba beads encapsulated with Pro-Niacin™. As they exfoliate the skin, they break apart, releasing Pro-Niacin™ for absorption into the skin. The spherical beads found in the NIA 24™ Physical Cleansing Scrub do not have jagged edges and therefore do not tear the skin.

What is the origin of jojoba beads?

Jojoba is a shrub native to the desert and is used fairly frequently in cosmetics as a moisturizer and carrier oil, as it is easily refined to be odorless, colorless, and oxidatively stable. The beads within the Physical Cleansing Scrub are jojoba beads encapsulated with Pro-Niacin™ and thus, are known as Pro-Niasomes™.

Will the particles in the Physical Cleansing Scrub tear down the Skin Barrier that the NIA 24™ products are trying to build?

No, the Physical Cleansing Scrub is washing away dead skin cells, not the skin barrier and the spherical beads do not tear the skin. The mechanical action of this physical scrub is also increasing the cell turnover rate, revealing newer skin.

Can the NIA 24™ Physical Cleansing Scrub be used in combination with chemical exfoliates (AHAs and BHAs)?

Yes. You may find that the efficacy of the NIA 24™ products enables you to reduce the amount of AHA’s or BHA’s that you are using while still achieving the same result and minimizing irritation and potential sensitivity to the sun.

Can you use the Physical Cleansing Scrub immediately after surgeries or skin rejuvenation therapies such as chemical peels or microdermabrasion?

No. Based on the severity of the procedure, allow the skin 2-3 weeks recovery time prior to re-introducing the Physical Cleansing Scrub. Use of the Skin Strengthening Complex and 100% Mineral Sunscreen should be tolerated by the skin. However, should redness occur, apply a cold compress to the skin and reduce application of the NIA 24™ products for several days.

Why do you recommend using the Physical Cleansing Scrub only 2-3 times per week?

The objective of using a scrub or exfoliate is to keep the skin free of dead skin build-up, and prime the skin for more optimal use of other products. Using the Physical Cleansing Scrub 2-3 times per week is all that is necessary.

Will the Physical Cleansing Scrub remove my makeup?

Because the Physical Cleansing Scrub is an exfoliant that removes dead skin cells and cleanses the skin, it can be used to remove make-up. However, it should not be used around the eye area to remove eye make-up.

Good skincare is important for everyone, including people who had body procedures such as California liposuction and Los Angeles breast augmentation!

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We're Launching Another Blog!

Here at Rodeo Drive Plastic Surgery, we are huge believers in the power of blogs.  They offer the chance to get news out quickly.  They offer the chance to provide thoughts and opinion on all sorts of things regarding plastic surgery.   For example, we have done blog posts about everything from our neighborhood, some interesting patient stories, and safety for such procedures as liposuction.  Moreover, we have different members of our staff writing blogs, so there are diverse points of view coming out from many different directions.  This provides people with a balanced and nuanced understanding of cosmetic surgery and its new trends and various interesting approaches.  

The new blog we started can be found at --

http://californiaplasticsurgery.wordpress.com

So if you have time to do some reading, find some interesting plastic surgery stories and infornation, we hope you will check this new blog out.

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Breast Augmentation and Infections
A recent study found that there is a higher rate of infection after breast augmentation than previously thought.  Their noted rate of infection is higher than we have experienced doing breast augmentation in Los Angeles.  But the study raises important issues.  It is important to have the procedure done in a sterile operating room, best at a fully certified surgery center.  We place patients on a short course of antibiotics after the surgery and give them by vein as part of the actual procedure; this is our protocol for all larger surgeries, such as tummy tuck in California.

Below is a description of the study on this issue, which does have implications for plastic surgery Beverly Hills:

The authors explained that infection rates at the incision site after the surgical removal of a breast (mastectomy) or other breast procedures range from 1% to 28%. "Given the state of fiscal constraints within the U.S. health care system, it is important to calculate the cost-effectiveness of infection control interventions to justify their use from an economic perspective," the authors wrote. "Cost-effectiveness analyses require accurate estimates for the attributable costs of hospital-acquired infections, which are lacking for surgical site infections."

Margaret A. Olsen, Ph.D., M.P.H., Washington University School of Medicine, St. Louis, and team examined 949 hospital admissions for breast reconstruction surgeries or mastectomies at a teaching hospital between 1999 and 2002. The researchers looked at an electronic hospital database, and cross-checked that data with each patient's medical record, in order to identify surgical site infections. They also collected information from the hospital accounting database, which included all costs incurred during their initial hospital stay and surgeries, as well as any further admissions and surgeries which took place within twelve months of the first operation.

The researchers report that 5.3% of the women experienced a surgical site infection within one year of surgery - a total of 50 patients. The risk of infection was highest for breast cancer patients. The risks of infection at the incision site were as follows -

-- 12.4% of patients undergoing a mastectomy with immediate breast reconstruction using an implant

-- 6.2% of patients undergoing of mastectomies with immediate breast reconstruction using abdominal tissue

-- 4.4% of patients undergoing just a mastectomy

-- 1.1% of patients undergoing a breast reduction surgery

On average, those with an incision site infection became infected 46.6 days after surgery.

The researchers explained "Patients with surgical site infections had significantly higher hospital costs associated with surgery and during the one-year period after plastic surgery compared with uninfected patients, and they had a significantly longer total length of hospital stay."

They concluded "Potential interventions to reduce the incidence of surgical site infections in this patient population include strategies to optimize the timing and dosage of prophylactic antibiotics administered before the surgical incision, glucose control in diabetic patients, promotion of meticulous hand hygiene and strategies to promote timely removal of drains, among others. Interventions to reduce the incidence of surgical site infections following breast cancer surgical procedures are essential to reduce not only morbidity in these patient populations but also costs to the individuals and to society."

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Botox for Men

We do as many Botox procedures for men as for women.  A recent study confirmed what we have also seen at our Los Angeles plastic surgery center:  Men need more Botox than women.  In this way, Botox is really just like all other procedures:  plastic surgery for men simply has to do be done differently for men than for women.  Below is a summary of the study--

A review published in Dermatologic Therapy reveals that men can be treated with Botox for cosmetic procedures in the same way as women but require higher doses of Botox in all treatment areas.

There has recently become a growing interest in cosmetic procedures by men. Although most practices see a majority of women, the number of male patients who seek treatment is slowly increasing.

Men often require more units of Botox than women which may be because men have a greater muscle mass than women. Similarly, it has been a common clinical observation that larger, stronger men need more units per treatment area than slender, small-boned men. The most common cause of inadequate results in male patients is under-dosing, which may lead to men requiring additional Botox injections.

"Various areas of the male face can be treated with Botox and injections need to keep in mind the greater muscle mass in men," the author notes. 

So whether the procedure is noninvasive like Beverly Hills Botox, or surgical such as Los Angeles liposuction, men need to have procedures customized for them in order to have the best results.

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Assuring Safety of an Outpatient Surgery Center
A surgery center should be among the safest places you can ever go in life.  One way of working toward safety at a surgery center is for it to be carefully inspected and accredited.  There are several organizations that do this.  One such organization is called AAAHC.  You should confirm your outpatient surgery center is certified, for all procedures such as rhinoplasty California.

The Accreditation Association for Ambulatory Health Care (AAAHC/Accreditation Association), founded in 1979, has become the leader in ambulatory health care accreditation with more than 2,800 organizations accredited nationwide. The AAAHC accredits a variety of ambulatory health care organizations including endoscopy centers, ambulatory surgery centers, office-based surgery centers, student health centers, and large medical and dental group practices.

The Accreditation Association serves as an advocate for the provision of high quality health care through the development of nationally recognized standards. It also offers ambulatory health care organizations of all types and specialties, a unique peer-based review system that adopts a collaborative, consultative and educational approach. The AAAHC Certificate of Accreditation demonstrates an organization’s commitment to provide safe, high quality services to patients. It sends signals of confidence to the community it serves and increases an organization’s competitive edge in the marketplace. It is also recognized as a symbol of quality by third party payers, medical organizations, liability insurance companies, state and federal agencies and the public.  This is important if you are having an elective procedure including breast augmentation in California.

AAAHC’s quality efforts seeks to provide standardized, quantifiable metrics for the ASC industry. The aim of quality efforts is to discern how and why higher quality care is delivered with higher cost effectiveness than competing alternatives and with sufficient return on investment to fund growth and continuous improvement.

AAAHC has established a database of meaningful information which includes key industry data elements that are consistently applied. Data Collection has achieved critical mass so that it delivers statistically viable information to help members better manage their centers and achieve better patient outcomes and to support AAASC advocacy, education and payor relations.

Quality and data collection efforts are adequately supported to ensure that the technological infrastructure, expert analysis and business intelligence initiatives are sustained.  When deciding on a cosmetic surgeon in California, be sure this professional uses a certified surgery center for your procedure.

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Saline vs. Silicone: Choosing Breast Implants
Now that is has been a year since silicone breast implants have been approved by the FDA for general usage, there is certainly increased interest in silicone.  More of our patients seeking breast augmentation in Los Angeles are asking about silicone implants.  We still do the majority of our procedures with saline, since most women still prefer these when seeking Beverly Hills breast implants.  However, interest in silicone likely will grow. 

Below is a pretty good comparison of the types of implants, reprinted from an informational organization:

Offering an alternative to silicone, manufacturers chose saline as an implant filler. Saline implants also have a silicone outer shell (the same shell used in silicone gel-filled implants) and contain salt water.

Saline vs. Silicone: Advantages and Disadvantages

Saline breast implants, which were officially approved by the FDA in 2000, have some advantages and disadvantages over silicone breast implants which were FDA-approved November 17, 2006:
All implants carry a risk of rupture. If a saline implant leaks or breaks inside a woman’s body, the salt water is simply absorbed into her tissue.
The size of saline implants can be altered, depending on the aesthetic or physical needs of an implant recipient. This allows women to increase the size of their implants over time, after her skin has expanded. Or if a woman decides that her implanted breasts are bigger than she wanted, she can minimize their size. Saline implants feature small valves in which a doctor can insert a needle and either add or subtract the liquid. The size of silicone implants cannot be changed without actually changing the implant with an operation.
Some patients may find that saline implants do not offer a natural look and feel and that silicone mimics this more effectively.
However, saline implants carry many of the same risks as silicone gel-filled implants, including capsular contracture, infection, pain, and nerve damage. Implants, whether filled with saline or silicone, are not a lifetime device and may need to be replaced.
Advantages of Silicone Implants

Many plastic surgery specialists and patients with breast implants have the opinion that silicone implants have a more natural look and feel than saline implants due to the fact that silicone gel has a texture similar to breast tissue.

Advantages of Saline Implants

Saline implants have some advantages over silicone implants for breast enlargement. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are usually seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.

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Plastic Surgery Around the Holidays

The holiday season starting last week is always one of our busiest seasons for plastic surgery.  We do a great many procedures during this six week period from Thanksgiving to New Year’s Day. 

There are several reasons why people come in for Los Angeles plastic surgery during the holiday season.  People have time off from work or school and they find it convenient to take time out to have procedures such as Beverly Hills breast augmentation.  They have time to make a leisurely recovery, with less pressure from work and other issues.  This is an important issue.  We find that people recover more quickly and easily and enjoy the overall process more if they go into it with the best possible mental attitude.  

The holiday period also means that family and other caregivers have free time.  This helps with recovery as well, since there are people to lend a hand and make the process smooth and worry-free.  Good care also leads to good mental attitude and helps with recovery.

Because this season is so busy for us, we add on extra days when we do surgery.  This allows us to accommodate people who seek plastic surgery during the holidays and creates the freedom to schedule people more closely to their desired time.

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Our New Plastic Surgery Gift Card
We are pleased to introduce our new Rodeo Drive Plastic Surgery Gift Card.  The card allows people to purchase services for someone they care about and does make a unique Christmas present.  So far, we have received great feedback on the gift card.

Our gift card is in keeping with national trends for holiday gift giving.  Below is an article about the national move toward using them around the holidays a interesting presents.

Gift cards continue to jump to the top of many people's wish lists. As the holiday shopping season gets underway, retail experts expect another huge gift card sales boost.

Gift cards come in all shapes and sizes and now some even play music or light up. The cards are evolving as fast as the popularity continues to soar.

"A good part of it from a gift-giving perspective is it's great for people to be able to purchase whatever item they want to, and it kind of takes away that stress factor of what item would be best for a particular person," said David Alligood, a store manager at Target.

"Its good if you don't know what to buy somebody or you don't want to make the choice for them to let them go out and get what they want," added Chris Cartano.

The rising popularity is evident in the sales reports by the National Retail Federation. In 2003, shoppers bought about $17 billion in gift cards. Last year, that number jumped to nearly $25 billion.

Now buying those gift cards is even getting easier. You can buy gift cards to places like Best Buy, Circuit City, and a number of major retailers all in one place at grocery stores all across the state.

While clothing and video games remain top sellers with roughly 57 percent buying both, gift cards are barely behind in third with more than 56 percent of shoppers buying at least one gift card.

The National Retail Federation reports 92 percent of retailers now offer cards without expiration dates or fees. That allows more time to purchase, but many shoppers spend it pretty fast.

For more information on our plastic surgery gift card, and how it can be used for such procedures as Botox in Beverly Hills, please contact us.

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Rodeo Drive Mommy Makeover Continues to Make News

Our Mommy Makeover is getting a lot of attention recently.  Within the last few weeks, we have done interviews about the procedure with local newspapers such as The Los Angeles Daily News.  We also have done several interviews with the international media.  We spoke with London's Sunday Express and Daily Mail newspapers.  We also did interviews with German and French television.  For most of these interviews, some of our patients also participated.  We also had a mention in the New York Times about the topic.  Previously our approach to the procedure was featured in popular a Japanese magazine.

The Mommy Makeover topic garners interest because it does speak to larger trends in society.  Women want to have work, family, and the shape they always wanted.  In many ways, the procedure is reconstructive.  People come in and they want to have the body they used to have, and to wear the clothes they used to wear.  The procedure is often not about changing appearance per se, but rather about restoring what people used to have.  This allows women to have the lifestyle they are most comfortable with.

We are doing the procedure on a lot of Southern California plastic surgery patients.  Many are from the immediate Los Angeles area and many others are from more distant Southwest locales.  And as all of the international attention shows, we are getting quite a few patients from around the country and around the world who come for the procedure.  We enjoy meeting people from far away.  It is important, however, to do careful and thorough planning prior to the procedure so everything goes smoothly both during the procedure and thereafter.

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Nip/Tuck Joins Us On Rodeo Drive
The famous plastic surgeons from Nip/Tuck will be joining us here on Rodeo Drive.  The television show will premiere this week and their new location will be right here on our shopping street.  We'll be watching closely since in real life we are the only plastic surgery center on the boulevard.  It will be interesting what sort of stories they come up with, they tend to have interesting plotlines involving celebrity plastic surgery and other interesting ideas.  For now we will stick with our usual Mommy Makeover and rhinoplasty procedures, though.

Here is how the media is reporting the move:

Viewers will see for themselves when FX’s “Nip/Tuck” shifts locales for its fifth season, beginning Tuesday at 10 p.m. on FX.

Julian McMahon, who plays randy plastic surgeon Christian Troy, welcomes the change.

“We did four seasons in one city,” he said. “Now we have the injection of energy from a new city. It’s kind of opened up the box a little bit.”

Series making such changes usually do so out of a last-ditch attempt to save a sinking ship. “Nip/Tuck,” however, has consistently been among FX’s top-rated shows.

Moving to Hollywood will make the drama a bit more comedic, McMahon said.

The show will parody itself in a story line in which Dr. Troy and Dr. Sean McNamara (Dylan Walsh) work as consultants on a TV drama set in a hospital - think “Grey’s Anatomy” as done through the eyes of “Nip/Tuck.”

Along the way the two men will find new loves and even crazier patients. Sean’s ex-wife, Julia (Joely Richardson), will pop up - with a girlfriend (Portia de Rossi).

“The show has a completely new look,” said creator Ryan Murphy. “Everything, I think, is shinier and bigger. But we do tackle pretty much the hot-button topics. The show is still as sexy as it’s ever been, maybe more so.”

FX has poured millions into the new sets, located on a soundstage on the Warner Bros. lot. The new digs are expansive, taking up the length of a football field. New offices and apartments retain the show’s signature flair for sleekness and classiness but with less flamboyance.

Look through a window on one of the set’s faux apartments and you’ll see a tarp with a beach scene on it. Stand a few feet back and that same tarp looks eerily realistic.

Tricks with lighting and distance will give the tarp the look of a real beach as seen through a window.

Murphy says this move to Hollywood isn’t just an excuse to get new sets.

“One of the things that we wanted to do by moving this show to L.A. is to explore the theme of L.A., which is people who come to this city to reinvent themselves and go after their dreams,” he said.

When he created the show more than five years ago, Murphy was adamant about it being set in Miami and not Tinseltown, which, at the time, seemed cliched to him.

“Miami has got it all,” Murphy said then. “It’s got the crime, the lifestyle, the skin, the Latin-American influx, everything that I wanted to deal with.

“Really, the only other place to do the show would be Beverly Hills and actresses who need boob jobs. I don’t care about them. I didn’t think anyone would like those people.”

So what changed?

The show needed to be shaken up, Murphy said. The characters had played out Miami. Though the entire cast is returning (the stories will work them all into the California move), he wants “Nip/Tuck” to take advantage of fresh terrain.

In the end, though, McMahon says the change is all about taking another risk and seeing where it leads the stories and its characters.

“Look, man, this is TV,” he said. “After four seasons, you have to be willing to give something else a try.”
 

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Our Philosophy of Plastic Surgery

People often ask us, "What is your approach to plastic surgery?" or "What is your philosophy?"  We believe plastic surgery is about improving lifestyle.  Of course on the most superficial level it is about changing aspects of appearance -- looking fresher or more shapely.  But on a deeper level it is about feeling good about yourself, and being able to do things you might not have been comfortable doing without plastic surgery.  

People tend to be happiest when they have a good understanding of what role plastic surgery will make in their lifestyle.  Before going through with a procedure, ask yourself why you really want the procedure.  Is it to wear different typles of clothes?  Is it about looking younger?  People who have asked themselves these sorts of questions, and have come up with answers that satisf