Welcome to our June Newsline.

Fish Flying
Two expert anglers fishing at Nemacolin

June has been a busy travel month with two trips to Ohio and one to Atlanta.  The first Ohio trip was very special.  Our son, Evan was celebrating his fortieth birthday.  He lives in Columbus, Ohio where he practices medicine specializing in Ear Nose and Throat Surgery (Otolaryngology).  Following a tradition that my wife, Gail, started with our oldest daughter, Tracy, I took Evan on a little vacation.

Taos, NM
The Doctors Tobin at Gettysburg

We went to a wonderful resort in western Pennsylvania called Nemacolin where we enjoyed fly fishing and shooting sporting clays. Evan out-shined me in both endeavors! We also took a side trip to Gettysburg where we toured the Civil War battle fields.  Finally we visited “Falling Waters,” the beautiful and widely acclaimed home built by Frank Lloyd Wright over a waterfall.  The whole trip was very special.

Falling Waters
Frank Lloyd Wright famous architectural masterpiece:
Falling Waters.
Built over an active waterfall.

Two weeks later, we returned to Cincinnati where I was honored by being invited to be the keynote speaker for the graduation of  Residents at the University of Cincinnati, in the department where I completed my Fellowship Training.  It was the fortieth anniversary of the training program and I was asked to speak on “Developing a Facial Plastic Surgery Practice.”  We stayed at the home of my mentor, Dr. Donald Shumrick and his lovely wife, Nora, with whom we have maintained a wonderful friendship since my training in 1972.

Finally, my last June trip will be to Atlanta to carry out an Accreditation Survey of a surgical center.  I have previously written about my volunteer activities as an accreditation surveyor.  It always proves educational to visit other surgeons, and although my primary responsibility is to be certain that the facility is operating up to standards, I never fail to learn something new on these inspection visits.


In a May article by the Knight Ridder News Service, author Katherine Spitz points out that, “When it comes to recovering from surgery, some patients seem to be superstars, while others take a much longer time to heal.”  She cites that recovery from knee replacement can vary from as little as two weeks to months.  While complete healing takes several months, most people resume normal activity in far less time than that.  This is especially true following cosmetic surgery.
Certainly, attitude has a great deal to do with it.  We have long noticed that patients who expect to recover quickly are much more likely to do so.  Those that expect difficulty often find it. A lot also depends on support from family and friends.  Mary Ann Stephens, a psychology professor at Kent State University, found that if relatives of a loved one were critical or dismissive, patients did not do as well in recovery compared to those that received positive support.  There is a natural period of depression following surgery and certainly those who are already suffering from depression will likely be hit much harder.
She also found that those who were willing to undergo painful rehabilitation were more likely to recover quicker. This corresponds with our own observations.  After submuscular breast augmentation there is always a good deal of muscle soreness.  Patients who force themselves to move and elevate their arms always seem to have a much quicker recovery compared to those that do not.


Another finding that is not surprising – women seem to recover quicker than men.  Most older women have experienced far more pain in their lives than men. For many men, the operation they are undergoing is the most painful thing that has ever happened to them.  This may also help to explain why older patients in general tolerate the pain of surgery better, and often recover quicker.
Sometimes, there simply is no explanation for why recovery times vary.  In the article cited, the author describes a lady who simply breezed through one knee replacement, only to find that her recovery after the second operation was much longer.  Healing and scaring can vary.  This can also explain why patients may find that one side of a bilateral operation does much better than the other.
Scientists are taking greater interest in this subject, and hopefully will come up with some answers that may reduce the variability in recovery.  In the mean time, it is something that we simply must accept as normal.



Restylane is one of the newer injectable hyaluronic acid fillers.  It is used to treat facial lines and depressions, and can also be used for lip enlargement.  In our experience, it has almost entirely replaced the older collagen injections.  While not permanent, experience is showing that results often last six to eight months, and sometimes even longer. We still feel that silicone microdroplet injections work better in the lip, but Restylane can be used initially to get an idea of what the long term result will be with silicone.  One area in which we have found Restylane to be particularly useful is in the “tear trough deformity”  (see picture).  This depression which often exists between the nasal bone and the cheek is difficult to correct surgically, but responds very nicely to injections of Restylane.  While not permanent, it does seem to last six to eight months in most cases.  Patients have been very pleased with the results.  Several of our patients have asked about silicone injections in this area but we feel that the skin is too thin and could possibly result in some unevenness.

That’s it for this month.  I had hoped to write an article about brow lifting, but somehow never got to it.  Hopefully, next month……. 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