Welcome to our November email Update.

A note from Dr. Tobin

Gail & I just returned from a weekend spent in Taos, New Mexico. The weather looked threatening for the entire weekend, but fortunately turned out fine. There was already snow in the mountains and there was still time to see the beautiful Fall foliage. The crisp cold evenings made it delightful to sit by the fire. We stayed at the wonderful Casa de las Chimeneas on Cordoba Road. If you are looking for a delightful getaway, you won’t go wrong giving them a try. For more information, their website is http://VisitTaos.com. All in all it was a perfect weekend.

With Thanksgiving just around the corner, we decided to devote this issue of our Update to Thanksgiving topics. Today at our office meeting, the staff racked their brains for pertinent topics and we came up with the following ideas:

1. Turkey Wattles
2. Stuffing
3. Drumsticks, and
4. Holiday shopping


Turkey Wattles

We have often talked about our neck suspension operation using Alloderm. The operation was really proving to be an excellent conservative approach to correcting neck laxity without resorting to a more complex facelift or necklift. In spite of our good success with the operation, it pretty much has fallen by the wayside. This is not because our patients and we were not satisfied. The problem was related to the escalating cost of the material and the unavailability.

In fact, in reviewing our experience, the results with the Alloderm neck support seemed superior to the more complex open neck lift operation that we have been offering lately.

Now we think we may have found a solution. There is another grafting material that seems well suited to the procedure. It is called Surgisis Gold. It is a porcine graft material that has been shown to be very effective in the repair of large hernias. Only recently have cosmetic surgeons been exposed to the material. It looks like it should be just as effective for the neck support operation as was Alloderm.

The procedure is quite straightforward. First we remove excess fatty tissue with standard microliposuction techniques. Then through small incisions placed behind the ear and under the chin, the graft material is placed across the neck and tightened by suturing to the neck muscles in back of the ear.

We plan to start using it and will keep you posted as we gain more experience.


Of course it is natural to put on a few pounds during the holidays and this brings up our next topic – the role of liposuction in the treatment of obesity. First of all, it practically goes without saying that liposuction surgery is not a very effective means of losing weight. Even a major procedure is unlikely to lead to a loss of more that a few pounds. It seems surprising, but even a quart of fat weighs less than a pound. Still we continue to see many patients who come in seeking surgery with an expectation of losing significant weight. Does this mean that no one who is overweight is a suitable candidate for liposuction? Of course not. The important issue is what you are trying to accomplish through the surgery.

Many overweight people can accept their general stature but are troubled by certain aspects of their build. It may be the abdomen, the love handles or the thighs. Regardless of how much they realize that a general weight loss program would be ideal, they know that they will not be able to achieve their goal. Patients like this can benefit greatly from liposuction, so long as they realize that the goal of surgery is simply to give them a more proportional shape. Dr. Pierre Fournier, one of the early pioneers in the field of liposuction expressed this concept ably when he said that “liposuction is not a treatment for obesity, but it can be useful in the treatment of obese patients.”

We have had quite a few patients who were 30 to 40 pounds overweight who significantly benefited through reduction of certain troublesome areas like the abdomen, hips or back.

Treatment of the back has become a very popular option for patients considering liposuction. This is an area that was not normally treated years ago, but with new techniques and refinement, it works quite well, as seen in this example.

In fact, one of the most satisfying aspects of liposuction surgery is the possibility of effectively treating areas that were considered unsuitable in years past. Another example is the treatment of the breast with liposuction. While male breast enlargement has always been effectively treated in this way, it is only recently that liposuction is being used for limited breast reductions in women.


We had to scratch our heads a bit to come up with this topic, but once we thought of it, it was obvious: CALF AUGMENTATION!

This has really become one of our specialties and it is an operation that is not widely offered. Perhaps that is one of the reasons we get so many patients from long distances. It’s simply remarkable how many people – both men and women- who are unhappy with thin calves. Unfortunately, it can be almost impossible to bulk up the calf muscles with exercise. We also see quite a few patients who have calf atrophy as a result of polio or other conditions that interfered with normal development in either one or both of their lower legs.

The operation involves the insertion and placement of a soft but solid silicone implant through a small incision behind the knee. The implant is placed above the muscle but within the muscle sheath. The implants come in a variety of sizes, and we are further able to customize the implant for the best possible fit in any given patient. Although it is physically difficult to place the implant through a small incision, the results are worthwhile and it is an operation that has given many patients and us a great deal of satisfaction.

You can find more information about this surgery on our website by using the following link: http://www.newlook.org/facts/25.html

Holiday Shopping

Seems like everyone gets pretty price conscious during the holiday shopping season. That’s only reasonable. We have quite a few patients and prospective patients that contact us by phone or email asking for prices. While in many cases we can accommodate these requests it’s not always possible for several reasons. First of all, it may be impossible to determine the exact procedure that will be indicated without carrying out a consultation. Secondly, often patients are considering more that one procedure, in which case fees are often discounted for combinations. For these reasons, I hope you will understand why we can’t always provide fee quotes without seeing a patient. We do try to give fee ranges but it is important to understand that these are subject to wide variation.

Unfortunately, it is not uncommon for patients to ask for the fee for a specific procedure only to come in and find that the operation for which they were quoted is not the one indicated for their condition.

Of one thing you can be certain, when you come for a consultation at our Center, we will strive to provide you with honest, unbiased information that will take into consideration all factors involved in choosing cosmetic surgery. That includes cost as well as all of the other factors that go into making such an important decision. You will always be provided with a complete and accurate fee quote before your surgery is scheduled.

That’s it for this month. Please keep your questions and comments coming. We want this to be as informative as possible and your input surely helps.


Howard A. Tobin, M.D., F. A. C. S.

For general information: askdena@newlook.org or n41gt@newlook.org