Welcome to our September Newsline.


According to a recent article in Cosmetic Surgery Times, liposuction is more popular than ever and has proven very satisfactory to patients.  The article refers to a study carried out by the Accreditation Association for Ambulatory Healthcare’s Institute for Quality Assessment, which recently carried out a study that revealed that more than 80% of patients undergoing liposuction were pleased with the results.  Only 5% reported that they were not satisfied with the results.  While more than half of the patients were of normal weight, simply seeking contouring, 14% were obese.  Many of the patients had liposuction of multiple areas of the body. Sixty four percent had treatment of two to four areas of the body.

The most common areas treated were the abdomen (61%), flank and waist (50%) and hips (35%).  While the overall rate of complications was low, the most common were severe bruising, blood or fluid accumulation beneath the tissues, excessive bleeding or pigmentation changes of the skin.  We are pleased to report that in our personal experience with several thousand patients, we have had no major complications and specifically no cases of excessive bleeding or blood or fluid accumulation in the body.  While we recognize the risk of complications and always discuss them with our patients, so far we have not had a single patient with a major complication or a complication that did not resolve favorably.

One of the most pleasing aspects of liposuction surgery is the fact that patients have relatively short downtime, with nearly all resuming light activity within a day or so, and full activity within a week to ten days.  As our experience continues to grow, we find the procedure applicable to more and more areas of the body.  From chin to ankles, liposuction can be a helpful contouring tool.


Triple Creek

Gail and I recently returned from a long weekend spent at the Triple Creek Ranch in the Bitterroot  Mountain Range of the Montana Rockies near Darby, Montana. This is one of our favorite getaways.  Lodging is in individual luxury cabins but the service is the outstanding feature.  This year we were pleased to find a new chef that had brought about a major improvement in the food (which had always been good but now is great!)  While there were forest fires in the area, none were close to the ranch.  Altogether it was a perfect long weekend, and we look forward to returning.


An article appearing the the journal, Dermatological Surgery, reported that in a small series of patients, injections of Botox into glabellar frown lines relieved clinical depression.  The authors reported that nine of the ten patients reported that they no longer suffered from depression.  The authors offered no explanation as to why they felt the Botox was effective.  Certainly this small study does not contain enough evidence to even suggest treating depression with Botox injections.  However, one cannot help but consider the fact that the improvement in appearance may have boosted the patients’ self esteem enough to have made a difference in their depression.  Only time will tell.  Until then, we are only recommending Botox to eliminate the wrinkle.  Any other effects, although welcome, should not be expected!


Teaching activities have occupied a significant portion of the last few weeks.  This month, I first traveled to Tulsa, Oklahoma, where I served on the faculty of a live surgery workshop put on by one of my former Fellows, Dr. Angelo Cuzalina.  This was also an opportunity for me to ride my motorcycle and fortunately the weather turned out great.  A little rain fell on the way home through Wichita Falls, but otherwise, the sun shined the whole way.


This was not the case, however, during my most recent trip.  I was invited to serve as an Honored Speaker at the first annual meeting of the Mexican Academy of Cosmetic Surgery held in Ixtapa.  This is a beautiful location and we were looking forward to a few days in the sun.  Unfortunately, it rained the whole four days we were there.  Not that it mattered that much, since I was kept busy lecturing with talks on facelifting, rhinoplasty, breast lifting, endoscopic breast augmentation, tummy tuck, neck rejuvenation and silicone lip augmentation.  The talks were well received and I was asked to return next year to speak at their meeting in Monterey.

The meeting was excellent and this new Society seems to be off to a very good start.  I certainly was honored to be asked to serve as principal speaker at their first convention.


One of our patients recently asked about the use of injectable fillers for cheekbone augmentation.   While I have heard of this technique, using either temporary fillers, such as Restylane, or permanent fillers like silicone, I feel that it is far more desirable to use soft solid silicone implants inserted through a tiny incision in the mouth.  This operation, which we have been performing for years, offers a permanent correction which, if desired, can be reversed.  I personally feel that two much volume would be required for injection augmentation which could lead to complications if a permanent  filler such as silicone were used. The solid silicone implants that we use result in a very natural feel and appearance which is far more satisfactory in the long run, compared to injection treatment.  The implants come in a variety of sizes which can be further customized to provide a very subtle but real enhancement.



For years, there has been  confusion in the minds of the public regarding the distinction between plastic surgery and cosmetic surgery.  Part of this results from the fact that so many plastic surgeons now refer to themselves as cosmetic surgeons, when often, they have no specific extra training in the field.  Those of us who limit our practice to cosmetic surgery feel that the distinction is very important.  We are proud of our Board Certification in Cosmetic Surgery, which we feel sets us above and apart from others who may legitimately engage in various aspects of cosmetic surgery but are not true specialists in the field.

This week, the California courts recognized this distinction in a ruling which instructed the Medical Board of California to recognize the American Board of Cosmetic Surgery as equivalent to a Board recognized by the American Board of Medical Specialties. This followed a similar ruling by the Texas Medical Board several years ago.

ABCS President, Robert Jackson, MD applauded the Court’s decision: “This Board has spent several years and taken every step to assure its certification requirements meet or exceed the requirements maintained by the American Board of Medical Specialties. The Court was apparently the first to actually review and consider ABCS’s certification requirements. The California Medical Board certainly did not.  I believe, and hope, this decision, and the recognition that ABCS’s certification requirements meet or exceed those of other ABMS boards, will raise the bar for physicians seeking to perform cosmetic surgery.  I believe, and hope, patients seeking  cosmetic surgery will ask about, and look for, physicians certified by the American Board of Cosmetic Surgery.  This can only lead to higher quality health care and greater patient safety.”

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


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

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