Welcome to our November email update.

It is hard to believe that Thanksgiving is right around the corner. We at the Center certainly have a lot to be thankful for. This has been a wonderful year for our practice and we are very appreciative of the wonderful comments and support we have received from our patients. The majority of our practice now consists of former patients, their families and friends and other direct referrals from patients. We want you to know that we work hard to earn your confidence and trust, and sincerely appreciate it.

Since our last newsletter, Gail and I spent another wonderful few days in the Smokey Mountains. We stayed at one of our favorite lodges called The Swag. It is a beautiful rustic retreat adjacent to The Smokey Mountains National Park and features great hiking, fantastic accommodations and wonderful food. See our September 2004 edition for some more info on The Swag, or you can check it out directly at www.theswag.com.

Our favorite room at the Swag


In the past, surgeons resisted operating on seniors unless something was broken, blocked or bleeding. Problems related to anesthesia and long operating times often outweighed the advantages of looking better. All of that has changed now. Improvements in anesthesia coupled with advances in surgical technique that allow shorter operating times with minimal bleeding have made age much less of a factor in whether patients are suitable candidates for surgery.

Not only are people living longer, but they feel younger and, as a result, want to look younger. According the American Society of Plastic Surgeons, In 2000, 244 patients older than 65 got breast implants, while in 2004, that rose to 2,640. At our Center, we recently did a facelift on a patient 95 years old, and several years ago a patient of 100.

“We, as doctors, do a better job of helping people get to an older age, and they come to the operating room in better shape,” said Paul Curcillo, vice chairman of surgery at Drexel University College of Medicine.

“It used to be that if you had an 88-year-old with a bad hip, the cardiologists would keep them out of the operating room, but now they are the ones saying that the best thing for them is often to keep walking.”

Surprisingly, in many ways, older patients heal better. While healing time may not be as fast, scars tend to be thinner and less noticeable. Many of our senior patients seem to tolerate the pain and stress of surgery much better than younger patients. When patients come in for consultation and ask if they are too old for surgery, my usual response is that you are only too old if you feel too old.


Laser resurfacing is commonly requested to help diminish the fine lines that develop in the skin from aging, sun exposure, smoking or just plain heredity. In our practice, it has replaced the older deep phenol peels. The reason we now use laser isn’t because it is more effective. On the contrary, nothing is more powerful than the Baker’s solution that has been used for many years. Baker’s solution is a combination of phenol, croton oil, Septisol and water. It is an extremely powerful peeling solution. The problem with the old phenol peels rested with the difficulty of controlling the depth. Patients often noted loss of pigmentation following treatment. There was no certain way to control the depth of peeling.

With laser resurfacing, we do have control since we can control pulse duration and strength. It is possible to over-treat with the laser, but it is much less likely than with phenol.

Our philosophy has always been to remain on the conservative side. Granted this may not produce quite as dramatic an improvement in some cases, but we do not feel that the added recovery time and risk of complications justifies an overaggressive approach.

More conservative treatment assures that nearly all patients will be healed in eight to ten days. Hypo-pigmentation is rarely seen and we have yet to produce any scaring. An additional benefit of more conservative treatment is that we can safely combine laser resurfacing with a facelift allowing us to combine the benefits of both modalities. This is an important advantage. Facelifting elevates and supports sagging skin and tissues, but it is ineffective in reducing fine to medium lines in the skin. Laser resurfacing is helpful for the lines but does nothing for the sag. Since so many patients are troubled by both problems, we can achieve much better overall improvement by combining resurfacing with facelifting.

Another issue to be considered is the type of laser used. We use a carbon dioxide (CO2) laser which is indisputably the gold standard of laser resurfacing. A lot of new devices have come on the market which claim to resurface and rejuvenate the skin. Do not confuse these with the laser resurfacing achieved with the CO2 laser. Most of these new products achieve only temporary results at best and are more properly considered as skin care devices. CO2 laser resurfacing is a surgical procedure that should only be offered by surgeons trained and skilled in its use.


So many people look to the internet for information about cosmetic surgery, and much of it is quite helpful. Of course a lot of what you see in promotional or advertising, and one of the common forms of advertising is for surgery abroad. I am amazed to see how much of this is available. Many surgeons and clinics abroad have US consultants who promise to facilitate the entire experience. In fact, it often sounds more like a vacation than a surgical experience. Of course the big lure is the price.

Sure, there are many good cosmetic surgeons outside of the United States, and many patients come home describing good results. But there is also a dark side. First of all, marketing can present a very deceptive picture. Often the surgery carried out in countries other than the U.S. can be performed in facilities that are woefully below the standards in this country. I have personally visited quite a few colleagues in Mexico, Central and South America who I felt were perfectly adequate surgeons, but practicing in facilities that I considered inadequate. Another important issue relates to the management of complications. Does the surgeon have facilities to manage these problems? Do you really want to remain in a foreign country for an extended period of time if your surgery does not work out the way you hoped? Are you prepared to return for the necessary follow-up? All of these issues are vitally important and need to be considered before deciding if you want to leave home for surgery abroad.

We have seen a number of patients who have come to us with problems related to surgery abroad. Invariably, by the time they paid to have these problems corrected, their total cost was greater than if they had stayed home to start with. The following link is only one example of how bad things can go. http://www.cosmeticsurgerydisasters.com Of course, cost is important, but it should never be the only issue. Naturally, we are not opposed to patients traveling for cosmetic surgery if traveling affords them better care – especially if that traveling takes them to Abilene!

That’s all for this month. As always, we welcome comments and suggestions.


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

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