April 10 vol 9 #6

Welcome to our Spring Newsletter.

Welcome to our Spring Update. We are beginning to thaw out from the rather harsh winter. I’m sure all of us are glad to see the cold weather leaving and it won’t be long before we can start complaining about the heat!

A Special Spring Offer – Two for One!2 for 1

Studies have shown that patients usually retain about half of the information they receive during their initial surgical consultation. In order to get the most from your consultation, we’ve always recommended patients bring someone along to listen, help remember and ask questions.

Do your friends or family members talk about having cosmetic surgery but just never get around to making an appointment for consultation? Well, now is the time to spring into the season of savings with our 2 for 1 sale.

For a limited time, we are offering 2 consultations for the price of 1 to new patients considering surgery. Friends or family members can come and sit together during consultation with Dr. Tobin (any necessary exams can be individual) and split the $75.00 fee for the visit.

Considerations in Cosmetic Breast Surgery

It’s coming to that time of year when women begin thinking more about cosmetic breast surgery. Of course breast augmentation is one of the most popular operations in our practice, but many of our patients are concerned not only with volume but with reversal of sag.


While my initial experience with breast implants was with gel filled devices, since the early 1990’s we have come to favor saline filled implants. While we are happy to use gel when patients prefer, our recommendation is to consider saline. I know this is not the recommendation of many surgeons so why do I feel so strongly about this?

The primary reason is safety. Breast implants have now been around for half a century and for as long as they have been available, the biggest concern has been about the possibility of gel leakage into the surrounding tissue. With each new improvement in design, manufacturers claim that the likelihood of leakage is less, but there is no convincing evidence to support the claim that gel implants will last indefinitely, and in fact, most doctors who recommend gel are advising their patients to have them changed every 10 years. The problem is that few women are likely to do that when they see no evidence of any problem. Of course, early leakage is very difficult to detect.

When the FDA released gel implants to the market, it was with the recommendation that patients have an MRI exam every couple of years. Of course, no one is doing that. I’m afraid that down the road, we will see the same problem we saw years ago with many women requiring major surgery to remove leaking gel implants.

Of course, saline implants can also leak, but when they do, there is no risk, since the body quickly absorbs the saline. Replacement, in this case, is relatively simple and safe.

In summary, having many years of experience with this operation, using both gel filled and saline implants, I remain convinced that for most patients, saline is the better option.


Probably a quarter of the patients that come to see us for breast implants are also troubled by sagging of the breast. We have discussed this issue in past newsletters, but it bears repeating.

The older method of addressing the problem was to combine augmentation with a breast lift, or mastopexy. Now a mastopexy is really nothing more that a skin tightening procedure. Excess skin is removed in an effort to tighten the breast and elevate the nipple. The problem is that the operation tends to ignore the issue that caused the problem in the first place. That is a lack of thickness and elasticity in the skin of patients who develop sagging.

In an effort to address this, we would try to over correct which led to early distortion of the breast right after surgery in hopes that ultimately the tissue would adequately hold. Sometimes it did, but often it didn’t and the long term results were disappointing.

Our more modern approach is to combine augmentation with breast reduction. In other words, we not only remove skin but also the sagging breast tissue. What we remove is replaced with the implant that is inserted. By doing this, we also can tighten up the remaining breast tissue allowing more a longer lasting and more natural result.


Our feeling about implant placement has been evolving. Initially, when we started using saline implants in the early 90’s we recommended placing them below the muscle. This was largely based on concerns that rippling of the skin above the implant would be a major problem. This has not proven to be the case very often. It is true that placement below the muscle does tend to give a bit more upper fullness, but the downside is that when the implants are placed below the muscle, we occasionally are faced with the problem of incomplete settling of the implant.

Occasionally, this results in the breast hanging over the implant – a problem that requires further surgery to correct. We almost never see the problem when placing the implant above the muscle.

Currently, the main reason most women choose to have their implants placed below the muscle is the fact that radiologists feel that they can do better mammography when the implant is below the muscle.

There is no set answer to this question and it is one that we discuss in detail with each patient based on their physical findings and individual goals.

Preparing for your surgery – Drugs and supplements to avoid – (Dena Purvis, Patient Coordinator)

At the Facial Plastic & Cosmetic Surgical Center, we take your surgical experience very seriously and do everything we can to make it as safe as possible. Our Center is not only routinely inspected and licensed by the state but we also have staff members who carry multiple certifications to ensure our patients are getting the best possible care. For over 25 years, we have been accredited by the Accreditation Association for Ambulatory Health Care. As a patient undergoing elective surgery, shouldn’t you do anything and everything under your control to reduce surgical risks to a minimum?

Here are some important reminders.

It is common practice to have ALL patients stop aspirin, vitamin E, diet pills as well as any nutritional & herbal supplements for 2 weeks before and after surgery. The reasoning behind this is due to documented adverse effects they can have on bleeding, blood pressure, sedation and medications. There are many products that contain aspirin. Check any over the counter drugs you are taking to see if they contain aspirin.

Along with the most commonly used Aspirin, Vitamin E and Ibuprofen, this is a short list (not complete) of commonly taken supplements that can have adverse effects and should be avoided by surgical patients:

Affects Clotting: Alfalfa, Acetylcysteine, Bee pollen, Capsicum, Celery, Chamomile, Fenugreek, Feverfew, Fish Oil, Garlic, Ginger, Ginko biloba, Ginseng, Guarana, Horseradish, Licorice, Omega-3, Passionflower, Red clover Affects blood pressure: Black cohosh, Creatine, Echinacea, Ephedra, Goldenseal, Hawthorn, Ma huang
Possible adverse drug interactions: Glucosamine-Chondroitin, Kava, Skullcap, St. John’s wort, Valerian

Honestly, no one really knows ALL of the effects that supplements and natural products can have on our bodies. Just because you do not see your supplement on this list doesn’t mean you should continue to take it. Of course, the best policy is to stop taking any over the counter supplements and consult with your physician regarding all prescription medications and how they should be taken prior to and after surgery.

That’s it for now. As always, we welcome your input and suggestions.

We are now available on Facebook: https://www.facebook.com/FacialPlasticAndCosmeticSurgicalCenter and Twitter http://twitter.com/FacialCosmetic


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

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