Welcome to our May email update.


The number of individuals deciding to have cosmetic surgery resumes a growth spurt after a slight decline in 2002. According to statistics compiled by the American Society for Aesthetic Plastic Surgery, the number of both surgical and non-surgical cosmetic procedures peaked in 2001 at 8,470,363. In 2003, the number declined to under eight million and in 2003 again rose to eight and a quarter million.

Of course much of this growth has been in non-surgical procedures such as injections of Botox and other fillers. These accounted for over 75% of the total number of procedures tracked by the survey. Nevertheless, the number of surgical procedures was still found to have doubled since 1997. All of this growth has resulted in a dramatic change in how cosmetic surgery and cosmetic procedures are promoted and provided.

No longer is the Cosmetic Surgeon the sole source of information regarding cosmetic surgery. More and more, aestheticians, dermatologists and other health care providers are becoming the first source of information for patients considering surgery. This has both positive and negative aspects.

The option of more conservative procedures can be very useful for patients who wish some improvement without undergoing major surgery. The drawback is that patients may not be advised of the temporary nature of the treatment or the overall long-term expense of repeated injections. Often, non surgeons will fail to inform their clients or patients of the surgical alternatives for fear of “losing the business.”

While we recognize that many of these non-surgeon entities have a valuable role to play in assisting patients to look their best, we still feel that a well trained, experienced Cosmetic Surgeon is the best source of information regarding the myriad of choices now available. With a full understanding of the advantages and disadvantages, as well as the potential risks, a Cosmetic Surgeon can help a patient make the important choices as to what treatment program will best serve that individual’s wants and needs.


In a rather surprising move, and FDA advisory panel recommended in favor of releasing gel implants manufactured by Mentor Corp. while recommending against those of rival Inamed. This was especially unexpected since the panel had recommended in favor of Inamed’s application at the last session.

It’s still way too early to know whether the FDA will accept the recommendation of the panel. Our bet is that it won’t. Even if it is approved, it will probably be quite some time until the final terms of the approval is worked out.

Regardless of the final decision, we will continue to recommend saline implants until we become convinced that the gel offers equal safety. Of course, if approved, we will offer our patients the option of gel, but it appears that not only will gel be significantly more expensive, but will also carry a recommendation of periodic MRI evaluation and replacement after a certain time. All of this will significantly increase expense. We remain convinced that at least for the present, saline filled implants are a better choice for most patients.

By: Babak Farzaneh M.D., D.D.S.

Wrinkles around the mouth speak of years of sun exposure, smoking, laughing or just the result of genetics and natural aging.

Some may view these as signs of character or aging gracefully but you may think of your wrinkles as imperfections.

“What can you do for these lines around my mouth?” Or, “My lips seem to be thinning.” These are questions and comments I hear commonly at consultation appointments. So you are not alone.

Loss of full youthful lips, vertical wrinkles around the lips (deep or fine lines), and pronounced nasolabial folds (lines running from the nose to the corner of the lips): are addressed collectively as “perioral rejuvenation.”

There are many rejuvenation techniques, each with their own advantages and drawbacks.

This modality is, in essence, the exfoliation of skin and has been in use for centuries. In Indian societies, pumice was used to abrade the skin to bring a youthful glow. Royalties in France bathed in red wine, which now is known to contain tartaric acid.

Modern science, now using medications with adjusted strength and potency, allows a more predictable and controlled method of skin rejuvenation.

TCA peels, which are performed at our Center, can address fine lines. The perioral area can be treated alone or, to allow a more uniform blending. the entire face can be treated. The procedure is simple and recovery is rapid. But TCA peels although, a great option, are a superficial treatment for fine lines and need to be repeated in about 6 months.

The advent of laser skin treatments in the 1980s allowed a new tool for surgeons to restore a youthful look to the aging face. Laser resurfacing is the workhorse in skin rejuvenation as “surface surgery,” Alone or in combination with facelifts and eyelid surgery, laser resurfacing can produce dramatic results.

Laser resurfacing provides a predictable depth of penetration with each pass of the laser. The new advent in laser technology utilizing computer scanning as used at our Center allows precise regulation of duration and amount of energy produced therefore providing a uniform result with less risk of any complications.

The laser has an effect on the deeper dermal layer of skin by vaporizing the outer damaged layer of skin and allows for new collagen formation and remodeling which translates into healthier, firmer and youthful skin.

Fat transplantation, collagen and Restylane injections are used to address moderate to severe facial wrinkles and folds.

Works by using donor fat from thigh, abdomen or buttocks, which is then reinjected into the wrinkles and folds to restore the lost volume. Although a relatively simple procedure, it does carry a risk of unpredictable reabsorption of the transplanted fat. While there are many positive reports regarding the effectiveness of fat injections, our experience has been that much or most is absorbed within a few months of treatment.

Approved by the FDA in November 2003 for treatment of facial wrinkles and folds. It is a clear, colorless gel that consists of non-animal derived hyaluronic acid. In contrast to Collagen, no skin testing is necessary. Therefore, treatment is possible at the initial consultation appointment.

The ability of Restylane to hold water allows for the plumping away of the wrinkles and folds. The results are variable but generally last around 4 to 6 months.

Last but not least, is the option of using silicone in microdroplet fashion as a permanent filler. This is most commonly used for lip enlargement. As the lip volume is restored and enhanced, the wrinkles and lines around the lips become less noticeable.

At our Center, with over 25 years of experience with the liquid silicone microdroplet technique to augment lips and to fill other depressions, we have found this modality very satisfactory. The tiny particles of silicone injected are surrounded by the body’s own collagen. The filling effect is almost entirely the results of collagen formation which is a gradual process. While not FDA approved, microdroplet silicone injections can be carried out as an off label use of an approved device.

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