Welcome to our November Newsline.


As has been my habit recently, this newsletter will be written in bits and pieces over the next week as Gail and I are on a special journey. The trip is a reward for Gail’s hard work and a job so well done in her capacity as Chairman of the Festival of the Trees, an annual fundraiser for the Windcrest Alzheimer Care Center in Abilene. Before describing our journey, a bit of information about Windcrest is in order. We became introduced about four years ago when we brought my Mom from California, where she was entering the end stage of Alzheimer’s. The Sears Methodist Retirement System, in Abilene, had built Windcrest which has become recognized and one of the nation’s outstanding Alzheimer care centers. Mom spent her last year there and we were so impressed with the Center and its care that we have continued to become more and more involved. Gail had served as Auction Chair for the fundraiser in the past and had been asked to be Chairman this year and next. The event was outstanding, highlighted by a return visit of Michael Regan as our special guest speaker. His talk was outstanding and the whole evening was a grand success.


As a reward to Gail for her hard work, we are traveling to London on a luxurious Boeing 777- first class, no less (thanks to hard earned frequent flyer points!); and in a few days will be returning on the Queen Mary 2. I’ll have more to write about that next week. At any rate, at this moment we are about a quarter into our flight. A great dinner has been served and the lights are out. Most people are asleep as I begin writing, but I wanted to at least start the newsletter, realizing that I have been a bit delinquent in my writing over the past several months. I usually write it in my spare time at the office, but frankly we have been so busy, that spare time never seems to materialize.


New Orleans

Two weeks ago, I traveled to New Orleans to lecture at a Cosmetic Surgery course put on by the Department of Oral and Maxillofacial Surgery at the Louisiana State University Medical Center. On arrival, I was shocked at the continued devastation that I saw just driving in from the airport. My cab driver told me that he and his family of five were living in a camper for the past year while he tried to work and rebuild his home. Things seemed far worse than I had imagined.

At any rate, the meeting was a great success and I was especially proud because it was being run by one of my former Fellows, Dr. Jon Perenack. Jon has done a fantastic job of holding the department together through such adversity, while at the same time building a very successful private practice. On top of that, he recently married Cherie, whom we had first met during his year of Fellowship training.


Lip Lift

At the meeting, Dr Perenack spoke of his experience with a lip lifting operation that he had actually learned during his Fellowship. He also demonstrated the procedure in the anatomy lab. He must see quite a few patients with long upper lips, because he has built up quite an experience with the operation, in addition to publishing his experience in the medical scientific literature. The operation is a relatively simple and straight forward procedure that involved an incision made at the base of the nose and which leaves an almost imperceptible scar. It raises the central portion of the upper lip a few millimeters which can make a very favorable improvement in the appearance of patients with an abnormally long upper lip. It can also be used to enhance the effect of lip enlargement. As I listened to his presentation, I realized that we probably should be offering the procedure to more of our own patients.



One of my topics at the meeting, and one that I will again be presenting at a meeting in Hilton Head, SC this spring relates to our experience with the Extended Subperiosteal Coronal Lift. In this operation, a long, hidden incision is made across the top of the head. It is hidden entirely in the hair and does not require any shaving of the scalp. Through this incision, we are able to approach the forehead, brow area as well as the entire upper and mid face. The lifting is done through elevation and suspension of deeper tissues with no stretch or pull on the skin.

No other operation is as effective at rejuvenation of the mid and upper face, nor does any other procedure, in our experience, offer the long lasting results. It is truly one of the most powerful facelifting operations in our armamentarium.

Since our exposure to the mid face is so great, we can also do bone contouring and enhancement. This includes such options as cheek bone augmentation or reduction of an over prominent forehead or brow. The Subperiosteal Lift is not effective in the neck, but can, in selected cases, be combined with a neck lift or a neck suspension procedure.

Recovery from the procedure is similar to recovery from a standard facelift. No dressings or drains are required and most patients find themselves quite presentable to appear in public in a week to ten days, although, as is always the case, bruising and swelling are quite individual. More information about this procedure can be found on our general website, and, of course, through personal consultation either in Abilene at our Center or during one of our scheduled consultation visits throughout Texas.



It’s hard to believe that a week has gone by on board the Queen Mary 2. From Southampton to Fort Lauderdale FL, we spent seven days on board and the time just flew by. It sure isn’t hard to understand why cruises have become so popular! The crossing was a delight with mostly good weather, although one day was rather stormy with rough seas. Still, it was amazing how stable this ship is. While quite chilly on the first part of the voyage, the last couple of days were quite warm allowing some sun bathing on the deck. All in all, a very relaxing vacation, although one which required quite a few hours in the gym to work off the calories from all the great food.

Gail and Howard Tobin visit with famed singer, composer, musician Lenny Kravitz on board the Queen Mary 2

Lenny Kravitz


While on board the Queen Mary, I saw the news that the FDA had decided to release silicone gel breast implants with some warnings and restrictions. I also received several email messages from the implant manufacturers about the availability. While we certainly plan to make these devices available to those patients who wish them, I personally anticipate that, at least for now, the majority of patients will wish to remain with saline filled implants. There is no question that saline offers greater safety and can be inserted through a smaller incision. Additionally, I remain convinced that saline implants are far less likely to induce capsular contracture leading to firmness of the implant. We will certainly have more information in the next several weeks.

Right now, we are going through all of the information and paperwork required for the use of these implants. Surgeons will have to be certified to use the devices and patients will have to agree to mandatory follow-up requirements including rather expensive periodic MRI examinations. Additionally, there is no question that the cost will be higher. How much higher? We are not certain at this point.


Along with the entire staff of our Center, we wish all of you a very joyous and peaceful Holiday Season. We wish to thank all of our patients who have allowed us to have such a wonderful year. It is our privilege to serve you, and, as I’m flying home on American Airlines, I will borrow a slogan from them. We know you have a choice in selecting a Center for Cosmetic Surgery, and we deeply and humbly appreciate the fact that so many of you, from so many places, have selected us. We will always do everything we can to continue to justify that confidence.

That’s it for this month.  That’s it for this edition. As always your comments and suggestions are always welcome.

Facial Plastic Surgery


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

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