Vol. 4, No. 9 – April 2006

Welcome to our April Newsline.

Sorry we have missed sending out our Newsline for the past few months. Unfortunately our Web Administrator disappeared. We are now under new management and apologize for the interruption.


BackacheMany of you who have been at the Center over the past few months were aware of the severe sciatic pain that began troubling me after our recent hiking trip to The Swag. While I had had some minor back trouble from time to time, this was far more severe than any pain I had previously experienced. While I was able to continue working, I could do little else. I would have to get up at around 4 am just to begin moving about to ease the pain so that I could get to work by eight. Once I got moving, I was usually OK, but really couldn’t sit for more than a few minutes before the pain returned. I had tried the shots but had only achieved short term benefit benefit. Life was truly getting miserable.

Like most people, I was pretty scared of back surgery, but by December, realized that I had no other good options. I had visited with a couple of highly regarded surgeons but ultimately decided to try a rather new and unorthodox surgical technique using endoscopic and laser surgery through a tiny half inch incision. The surgery is performed by Anthony Mork, M.D. at a facility called Microspine in Florida. I had my surgery in early January. A two hour operation was carried out under local anesthesia with heavy sedation in Dr. Mork’s beautifully equipped Center, and I’m pleased to say that the results exceeded my expectations. I am totally free of pain and back to full normal activity. My thanks to Dr. Mork and his wonderful staff; and my sincere appreciation to all of my patients who expressed their concern during this difficult period.


thermageWe are getting an increasing number of calls from individuals asking about facial rejuvenation with Thermage. While we do not offer this service, I thought I might provide some information to help you decide if the procedure is for you.
Thermage, which was approved by the FDA in 2001, uses radiofrequency technology to heat up the tissue cells in the dermis (the second layer of the skin). The outer surface of the skin is cooled to help protect from surface burns. The intent is to produce a contraction of the collagen which will hopefully lead to tightening of the skin. The results are not felt to occur immediately, but rather over a period of several months. While the effect is claimed to last for several months, there is no permanent benefit.

While the procedure is performed with the patient awake, it can still be rather painful and usually either a topical anesthetic or an anesthetic block is used. Patients can expect redness for a while afterwards but you can still return to normal activity following the treatment. In most cases, patients will have more than one treatment.

Does it work? The answer, unfortunately is not clear. Many patients undergoing Thermage treatment also receive Botox of filler injections. It’s hard to know in these cases what is leading to the improvement. It is also a bit confusing when it is said that it takes several months to see the effect but the effect itself only lasts several months! With treatments often costing up to $5000, it can be a difficult decision. Finally, there are potential risks. While uncommon, patients have sustained rather serious burns from Thermage treatment. These are probably related to the skill and the experience of the operator.

The Bottom line: The final answer is not yet in on the effectiveness of Thermage. Like many similar new treatment modalities, there is often an initial unwarranted enthusiasm for these procedures. There are no well controlled studies, of which I am aware, that document the effectiveness of this technique although some patients have spoken highly of the procedure. Remember that FDA approval only relates to relative safety and not effectiveness. Unlike some claims, Thermage is not a substitute for a facelift!


endoscopic_breastWe have previously reported on or unique endoscopic technique of treating firm encapsulated breast implants. Working through a tiny incision made at the junction of the areola and nipple, a special endoscope (or telescope) is inserted which has a built in laser system that is used to cut through the contracted scar tissue that has compressed the implant. The laser allows the surgery to performed in a bloodless manner. Patients can resume normal activity immediately following surgery. While capsular contracture can occur following any procedure, this atraumatic technique appears to significantly minimize recurrence.

Without attempting to publicize the technique, word has spread and we regularly receive inquiries from women throughout the United States. While many wish to come to our Center for the procedure, others ask about availability in their area. Unfortunately, since we designed the equipment ourselves, it has not been available for use outside our Center.
Several instrument manufacturers have shown an interest in making the instrument, but up until now, it has proven to be too difficult a task. I am pleased to announce that this situation may soon change.

This January, I was asked to present our technique at the annual meeting of the American Academy of Cosmetic Surgery. During that presentation, I showed a prototype of the instrument that is being developed by KMI, Inc., a well known manufacturer of endoscopic instruments. While we have not yet carried out testing of the commercial version of the instrument, we hope to soon. I was please to see a great deal of excitement at the vendor’s booth, and many of the surgeons present seemed very interested in the device. Hopefully, in the near future, we will establish training programs in the use of the technique and the procedure will become more widely available.

At the present time, patients still must come to Abilene for the procedure. For patients who may by interested in participating in future training workshops at our Center, there will be a reduction in the fee as an incentive for participation. If interested, please send an email to askdena@newlook.org expressing your interest. Unfortunately, right now, we have no specific information as to when workshops will be offered.

That’s it for this edition. As always your comments and suggestions are always welcome. We will try to address all responses in future Newsline editions.


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

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