Vol. 2, No. 1 – January 2003

Welcome to our January email Update.

A note from Dr. Tobin

Each year, the governing body of the Cosmetic Surgical Center meets for an annual Board meeting. This year, we were fortunate to have the meeting at the beautiful Chama Lodge in Chama, New Mexico. The Lodge had recently undergone a major renovation and we couldn’t have been more pleased with the facility or the service. There was a little snow on the ground, but not too much to prevent us from doing a little hiking to see the Elk early in the morning. Our thanks to the Lodge for their wonderful hospitality.

It seems like these days the major emphasis in cosmetic surgery is along the lines of more simple surgical procedures. We are constantly getting inquiries about mini facelifts, mini tummy tucks and mini breast lifts to mention only a few. I guess the simplest answer to the question is to mention the oft-repeated quote: “there is no free lunch.” First of all let’s not confuse the issue by ignoring the fact that there have been many advances and innovations in cosmetic surgery that have simplified or refined standard cosmetic procedures.

A good example of refined procedure are the endoscopic techniques that are used in breast augmentation surgery. The transaxillary endoscopic submuscular technique of breast augmentation has greatly simplified this operation by allowing the surgery to be carried out through minimal incisions with much greater precision and reduced blood loss. But the important fact is that the same thing is accomplished through this operation as through the older techniques.

The same is true of our innovative endoscopic technique of treating capsular contracture (scar tissue hardening) which can complicate breast augmentation. Instead of the older techniques which required removal of the implant, we are now able to use a laser connected to a very small endoscope which is inserted into the fibrous capsule that surrounds the implant. By this means, we can break up the scar tissue that is compressing the prosthesis and causing the firmness. Even though we now need only a tiny half inch incision, we accomplish the same thing that formerly required longer incisions and removal of the implant.

Unfortunately this is not true of many of the newer minimizing procedures. The best example that I can think of relates to some of the newer facelift procedures. In the lay press as well as the trade cosmetic journals we see constant reference to new simplified facelifting operations. They often go under catchy phrases such as the “weekend facelift,” the “lunchtime facelift,” or the “S lift. – S is less.” In general they are characterized by techniques that depend more on sutures than on dissection.

The sad but true fact is that lifting procedures that depend only on sutures often continually slip resulting in only short term benefit. These techniques were tried years ago and ultimately abandoned because of their limited effectiveness. Many of these newer operations seem to be nothing more than an attempt to reinvent the wheel. The longest lasting facelifting techniques appear to be those that result in development of a network of deep scar tissue that serves to hold the relocated tissue in position. Unfortunately, there is no simple way to produce this layer other than by a more extensive dissection.

To be sure, newer techniques have simplified the recovery process. There is far less risk of bleeding or bruising. The bulky dressings and drains of the past are no longer required, but these represent improvements in surgical technique rather than short cuts in the process.

The moral of the story is simple. Don’t fall for gimmicks. If a new procedure seems attractive, do your homework. Discuss it with a reputable cosmetic surgeon. Make sure the procedure has been around long enough to have been evaluated by many surgeons. Remember that most of the new procedures that you read about in the lay press are there because of effective public relations persons who are working for the doctor who developed the technique. Many, or most, of them will be forgotten within a year or so to be replaced by the next vogue technique.

This past year was the busiest year that the Center has experienced. We are appreciative of the confidence you have placed in us. While we cannot expect to fully satisfy every patient’s surgical expectations, you can be assured that we will always try our best. All of us at the Cosmetic Surgical Center wish all of our patients and friends a wonderful New Year.
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