Vol. 2, No. 3 – April 2003

Welcome to our April email Update.

Our email newsletter is certainly not intended to be political and I recognize that there are different viewpoints related to the war in Iraq. However, I cannot help but emphasize that regardless of your individual viewpoints, our right to protest was won by the willingness of Americans to fight and die for the principals of freedom.

FlagThere can be no dispute that the current regime in Iraq is as corrupt and inhumane as can be imagined. As in all wars fought by Americans, our goal has been lofty and the present battle is no different. Thirty-four years ago I came to Abilene in the United States Air Force. Dyess AFB in Abilene is, and has been, a source of pride to all of us who live here. All of us at the Cosmetic Surgical Center are proud to voice our support for our President, our nation and especially our valiant troops who are fighting for freedom in the Middle East.

Rhinoplasty (cosmetic nasal surgery)

I am proud of my appointment to the faculty of the University of Texas Southwestern Medical Center. Last week, we went to Dallas to lecture to the Residents in the Department of Surgery, Division of Oral & Maxillofacial Surgery. This is an outstanding training program headed by Drs. Doug Sinn and Ed Ellis, and it is always a pleasure to speak there. My topic this time was on cosmetic nasal surgery, or rhinoplasty. This operation is often considered the “Queen of Cosmetic Surgery,” because it is at the same time the most challenging and satisfying of cosmetic surgical procedures.

A study that was reported years ago in the magazine “Psychology Today,” indicated that 20% of people surveyed didn’t like the appearance of their nose. Additionally, 12% didn’t like their chins. Many studies have confirmed that cosmetic surgery not only makes people feel better about themselves, but it also can contribute to success. Examples include studies that have shown that pretty waitresses get more tips, juries are more lenient on attractive people and better looking people are more likely to get a job. All of this simply serves to confirm that cosmetic surgery is not only elected for reasons of vanity.

Rhinoplasty is one of the operations, often in conjunction with chin augmentation, which can lead to the most striking change. This is certainly not to say that all rhinoplasties lead to drastic change. Many patients are only interested in subtle changes, but the potential for significant change is present.

The really good news about rhinoplasty is that improvements in technique have contributed to making the operation much more precise and easier to undergo. One of the biggest improvements is that packing is no longer needed after the surgery. Just today, I was visiting with a patient who came in to have a secondary rhinoplasty performed. She had had surgery several years ago by another doctor, which, unfortunately, had not corrected all of her problems. When I told her that she would not need packing inside her nose, she breathed a sigh of relief stating that her biggest concern about having a second operation was the discomfort of the gauze that had been in her nose. “I never realized so much gauze would fit in a nose,” she told me.

Another improvement relates to the fact that the old technique of using hammer and chisel to break the nasal bones has been highly refined and is often not even needed. The use of rasps and files can often be used in place of fracture techniques. Even when fracture is required, techniques of micro-fracture make the process much less traumatic.

Finally the use of laser has added greatly to the precision of the operation as well as decreasing operative bleeding and post operative swelling. While there still may be some bruising for a few days after surgery, the swelling and black eyes of the past are quite rare with today’s techniques.

All of the above is not to imply that the surgery is without the risk of problems or complications, but it is a fair statement to say that they are far less common than in years past. Perhaps this why rhinoplasty continues to be one of the most popular and sought after facial cosmetic procedures.

Recent Teaching

A few weeks ago, Gail, our daughter Jill and I had the opportunity to travel to South Lake Tahoe, where I had been invited to speak at a medical seminar. Of course we took advantage of the skiing while we were there, and the conditions were really quite good. It was my first trip to that area and Tahoe really is a beautiful site.

At the meeting, I spoke of our endoscopic technique of breast augmentation as well as our experience with microdroplet silicone injections for lip augmentation. For those of you who get our print edition of the Update, we showed photos of Dena Purvis’ lip augmentation. Dena, our patient coordinator, had a series of three injections. If you wish to see the pictures, you can find them on our website under the link to our print newsletters.

HIPPA The Health Insurance Portability and Accountability Act of 1996

HIPPA goes into effect this month and has already created turmoil and confusion among medical facilities and staffs. At the Cosmetic Surgical Center, we have always placed great emphasis upon protecting the privacy of our patients. In accordance with the new laws, we have summarized our policy in writing and are in the final stages of adopting the new document. As soon as it is finalized, we will publish it on our website as well as making it available to our patients in print. Be assure, however, that there is nothing in the new regulations that have required any change in our overall approach to patient privacy, confidentiality and access to medical information.

That’s all for this edition. As always we appreciate your feedback.
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