Welcome to our September Newsline.

It’s been some time since our last Newsline, and I hope at least a few of you have missed it. It’s not that there hasn’t been anything to write about, rather there simply hasn’t been the time. I’m writing this now in Monterrey, Mexico where I was honored by being invited to be the keynote speaker at the annual meeting of the Mexican Academy of Cosmetic Surgery. The meeting has actually been superb and I have enjoyed being a part of it. I was recognized by being named an honorary member of the Academy. Gail and I have also appreciated the splendid hospitality shown by our Mexican hosts. It is interesting to note that the popularity of Cosmetic Surgery is increasing here in Mexico at the same rate it is increasing at home.

Just prior to coming to Mexico, Gail and I spent a wonderful week in Nova Scotia on a walking and hiking trip. We were on Cape Breton. Cape Breton Island is part of the province of Nova Scotia, Canada, although physically separated from the Nova Scotia peninsula. It is bounded on the west by the Gulf of St. Lawrence and on the east by the Atlantic Ocean. The country is quite mountainous with excellent hiking trails and spectacular scenery on both land and water. We also enjoyed superb food, getting our fill of lobster and other seafood. The photos attached will give you some idea of the beautiful scenery and wildlife we saw.

Combining facelift with laser resurfacing

Facial rejuvenation can take several forms. For patients who are showing early signs of aging, upper facial rejuvenation may be the procedure of choice. This might involve some form of brow or forehead lifting, eyelid surgery or combinations of both. In some cases, patients may opt for the more extensive extended subperiosteal coronal lift. As patients continue to age, attention seems more directed toward the mid and lower face. At this stage, patients are more apt to consider the traditional facelift which also nicely rejuvenates the neck. Patients frequently combine this procedure with eyelid surgery as well as considering chin or cheekbone implants.

All of these procedures do a fine job of reversing the signs of aging caused by sagging tissue. What they don’t do very well is treat the effects of aging on the skin. So often patients come in seeking consultation about facelifting when their primary concern is deep etched lines in the skin along with skin laxity.

For these patients, we recommend a combination of facial rejuvenation procedures combined with laser resurfacing of the facial skin. The laser beam destroys the outer layer of skin (epidermis). At the same time the laser heats the underlying skin (dermis), that stimulates the growth of new collagen fibers. As the wound heals, new skin forms that’s smoother and tighter. Generally complete healing takes about 8 to 10 days and requires fairly constant attention in the form of frequent washing and application of lubricating medications. Patients who are diligent about their post op care usually heal three or four days quicker than those who are not as attentive.

Patients can expect a significant reduction in moderate to superficial lines in the face, and although deeper lines cannot be eliminated, the improvement is often substantial.

It is important for patients to protect their skin from the sun after treatment. We also recommend a skin care program using glycolics to enhance the result of the laser resurfacing. While there are a number of newer devices on the market that use light sources and low power lasers to improve skin texture, none of these devices come close to providing the result that one achieves from carbon dioxide laser resurfacing.

Combining resurfacing with various lifting procedures produces a complementary improvement by reducing laxity at the same time as it firms and smoothes the skin.


Adjustable Breast Implants – are they worth the expense?

There has been an increase in interest in the use of adjustable implants recently. These are saline filled implants in which the filling valve is left buried under the skin for a period of time allowing the surgeon to add more saline or reduce it. They come in two varieties. One is filled entirely with saline, while the other has an inner layer of silicone gel. The adjustment is carried out by inserting a needle through the skin into a small filling reservoir and either adding more saline or removing some. This, in turn, can allow for a variation of about 20% in the size of the implant. When the final choice of size is established, the filling valve is removed through a second relatively minor operation.

The down side is that the implants are much more expensive, not to mention the added cost of the filling and final removal of the valve. Our experience with adjustable implants has primarily been in the area of breast reconstruction following mastectomy where we have found them to be very useful. For cosmetic augmentation, we still recommend that patients carry out preoperative sizing and stick to the standard techniques of augmentation.

Nevertheless, it remains an option for patients who are uncertain about the size they are trying to achieve.

Gel or silicone – the debate on breast implants continues

While most physicians have praised the FDA’s decisions to release gel filled implants for general use, consumers remain justifiably apprehensive. Forgotten by many is the FDA’s conditional approval of gel implants which requires periodic MRI examination of patients to determine leakage. It seems highly unrealistic to expect patients to undergo the cost of thousands of dollars every two years, on top of the fact that manufacturers charge more than twice as much for gel devices as for saline. Also often overlooked is the fact that gel implants are much more likely to produce capsular contracture leading to hardening and the requirement for additional corrective surgery. Finally, gel implants require a larger incision resulting in a longer scar.

In our practice, while we offer both options, our patients continue to choose saline – a decision that we heartily endorse. With our long-term experience with both gel and saline implants, at the present time, our recommendation remains on the side of saline filled implants.

In Memory of Amelia

It is with great sadness that I report the loss of Amelia, our wonderful Doberman, who passed away a few weeks ago, She would have been 13 years old on September 16th. Many of you who have recently been at the clinic have already asked about her and we have received quite a few notes from those of you who knew of her death. These are much appreciated. For those of you who didn’t know her, until a few months ago, Amelia came to work with me every day. She was our constant companion. She had a remarkably soothing effect on nearly all of our patients who were often seen petting her during their consultation. In the evening, she would come with me as we checked on the patients in our overnight suites and always brought a smile to everyone’s face. She was the kindest, sweetest dog I have ever known. We miss her greatly.


Facial Plastic Surgery


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

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