Welcome to our September email update.

This month’s newsletter doesn’t have much new information on cosmetic surgery. I thought with so much available on television and in the magazines we might keep this issue a little lighter.


Speaking of light, light peels have become quite popular. Skin resurfacing is certainly a very popular option. There’s no question that the best modality is to use a C02 laser. Of course, not everybody wants to go through the significant recovery that is involved with laser resurfacing. There are a host of alternatives available and one that we have found to be very satisfactory has been the TCA Peel. The procedure is easily accomplished without anesthesia or sedation, and requires very little in the way of recovery. The skin is thoroughly cleansed and a solution of TCA ranging from 15% to 30% is carefully applied with a small cotton swab until there is obvious frosting on the skin. At that point, the TCA is neutralized and iced compresses are applied. No further care is required. Recovery is simple.

The skin is red for several hours and there may be some light peeling over the next few days. Patients return to normal activity immediately and complications are very rare. The biggest risk seems to be post treatment hyper-pigmentation which is almost always the result of sun exposure. The best treatment, of course, is prevention, but it can also be effectively treated with bleaching agents.

Most patients who undergo a TCA peel choose to repeat the procedure every four to six months. We tend to treat on the light side the very first time, using a stronger concentration for subsequent treatments according to skin tolerance. Patients can expect to see a significant decrease in very fine lines in the skin and a marked improvement in skin texture. While certainly not as effective as a CO2 laser treatment, a TCA peel is an excellent intermediate measure that has proven quite popular among our patients.


Gail & Howard Tobin with Swag
owner & manager Deener Matthews

September tends to be on the slow side at the Center, and so we have been taking advantage of the lull. Gail and I spent a long weekend at a wonderful retreat in North Carolina, called The Swag. Deener Mathews, owner and host, welcomed us personally. Our accommodations were in a beautifully restored cabin and we could not have been more comfortable. A large bedroom hosted a huge fireplace well stocked with wood. The small living area next door was always well supplied with snacks, fresh coffee beans and fresh fruit. The resort is located adjacent to the Great Smoky Mountain National Park at an elevation of 5000ft. The main activity is hiking and there is great variety of trails both in and out of the Park.

The food was truly outstanding. Not only was it plentiful but it was absolutely delicious. Fortunately, by hiking a good deal of the day, we were able to burn off the extra calories so that our weight gain during the trip was reasonable. The service was absolutely impeccable. The trip was so wonderful that when we were ready to leave, we were already planning a return visit for next year.


Almost all of our patients know Amelia, our Doberman. Amelia has become a wonderful friend to patients and staff alike. Last week she celebrated her tenth birthday. The past few years she’s been having more difficulty getting around. Since she was a puppy, she and I would regularly run together. I always felt that she would probably out last me in the ability to run, but it hasn’t worked out that way. This year, she was reduced to walking and has developed a considerable limp because of a swelling in her left front paw. Last week, we flew her in to see an orthopedic veterinary surgeon in Dallas. It seems that sometime in the past, she may have injured herself. She had a good bit of swelling and calcification in the joint but fortunately no evidence of any malignancy. The good news was that there was nothing too serious but the bad news was that there was nothing much that could be done to help her. She certainly was a wonderful patient and impressed all of the doctors and the staff at the clinic. We’re going to try splinting the limb and treat her with medication. Of course, she will continue to come to work everyday, so those of you who are coming to the Center can wish her well.


Last weekend I traveled to Tulsa, Oklahoma. One of my former Fellows, Dr. Angelo Cuzalina, was putting on a live surgery teaching course and invited me to come up and lecture. The course focused on all aspects of facial cosmetic surgery. About 30 doctors from all over the world came to attend. It was an excellent course and I was very proud to see the progress that one of my former Fellows had made. He has an absolutely magnificent clinic and is proving to be an excellent surgeon. It really is a great source of pride for me to see my fellows doing well on their own.

The trip was especially fun for me because instead of flying, I decided to ride my motorcycle. It was a delightful ride on the Gold Wing. On Friday afternoon I rode half away, stopping in Lawton, OK. The next day I finished the ride up to Tulsa. On Sunday, I rode straight through from Tulsa to Abilene, making the 400 mile trip in about six and a half hours. The weather was perfect, and except for quite a bit of sunburn on my face and my lips, it couldn’t have been more pleasant. Gail says I should never have been riding without sunscreen. My Gold Wing performed beautifully and I couldn’t have been more comfortable.

That’s it for this month. As always, we appreciate your interest and welcome your suggestions.


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

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