Welcome to our November NewslinInjectablese

Special Offer on Injectables

Dr. Mohammed, our current Cosmetic Surgical Fellow, comes to us with extensive experience in injecting Restylane and Botox. We have watched his work and find it to be excellent. Many of our patients do prefer to have Dr. Tobin do their injections, and we are happy to comply with their request.

However, with the holidays approaching, we thought we would offer a special, not to fill your stocking, but rather to fill your wrinkles, at a reduced price. Through the end of the year, we are offering a 20% discount on fillers when done by Dr. Mohammed. It’s a chance to save money and also to get to know our Fellow a little better. We are sure you will like him and his work.

Update on Breast AugmentationGel Breast

While winter has just arrived, Spring is not far away and many women will be thinking about breast enlargement surgery. We thought this would be an appropriate time to address some of the major issues related to this very popular operation.

Surgical Approach – For the past twenty years, we have favored the transaxillary (armpit) approach utilizing endoscopic techniques to prepare the pocket for the implant. Admittedly, this is not the most common approach and many patients ask us why we so strongly prefer it.

First of all, endoscopic surgery allows us to be much more precise and to work
through a smaller incision. More importantly, perhaps, is the fact that there is less bleeding with endoscopic surgery. This diminishes the risk of post operative bleeding and bruising and also reduces the risk of subsequent capsular contracture. Why then, do more surgeons not offer this approach? Simply because it carries a steep, lengthy learning curve and the purchase of very expensive equipment which is prone to significant maintenance cost. Simply put, we think it’s worth it and wouldn’t think of going back to simpler techniques.

Gel versus Saline – The past few years have shown a decided shift in the preference of many surgeons toward gel implants. We have had years of experience using both gel and saline, and for most patients we think saline is a wiser choice. There is no question that they are safer. While manufacturers claim that the new technology reduces the chance of gel leakage, these implants have not been around long enough to be sure. As a result, most surgeons recommend replacing them after several years. With saline, there is no reason to replace them unless they leak, and while this certainly can occur, the replacement surgery is safe and does not require a difficult recovery. Sure there is added cost, but for the first several years, much of that is covered by the manufacturer’s warranty, and for those who are concerned about the expense, the manufacturer provides the option of an extended warranty.

There are some cases where using gel does make sense. Women with very thin skin and little natural breast tissue can reduce the risk of rippling by using gel. There’s no question that occasionally, we will have patients with saline implants exchange them for gel, but it doesn’t happen very often.

An added bonus for saline is the fact that the implants are half the cost of gel.

Above or Below the Muscle – This one is getting more difficult to answer. When we first started using saline implants, the recommended procedure was to place them under the muscle to avoid the appearance of rippling in the upper chest area. As it turns out, while rippling is still possible, it’s not nearly as common as we thought it would be.

The only real problem with submuscular augmentation is that slight, but real risk of incomplete settling of the implant. We still have no idea as to why it occurs since we thoroughly detach the lower border of the muscle at the time of surgery. When it occurs, it is usually only one side and it is no more likely to be the right than the left. It’s pretty easy to fix, but does require a second operation which adds cost to the overall expense. While not common, it does occur in about one out of twenty patients. We almost never see it when implants are placed above the muscle.

Another minor concern, occasionally patients are unhappy with the transient distortion of the implant as they flex their muscle. Not really a big problem in most cases as women quickly figure out when not to be flexing.

On the other side of the coin, radiologists tell us that they can do better mammography when the implant is placed below the muscle, so if breast cancer detection is a major concern, it is probably well worth the risk of a second procedure to have the implants placed below the muscle.

As it turns out, most of our patients still prefer going under the muscle, but the trend is slowly changing toward placement above.

Capsular Contracture – No patient is ever happy to discover her implants getting firm. Unfortunately this continues to be a recognized risk following breast augmentation. It’s less likely to occur with saline implants but it can occur at any time with any type of implant or any surgical approach. If it’s not severe, some patients will choose to leave it alone. Treatment is not mandatory. Our endoscopic technique allows correction with only a tiny incision and minimal downtime, but the problem can reoccur.

We do not believe that post operative massage or any known drug therapy has proven effective, although massage may be worth a try if you notice your implants starting to get firm. We still advise our patients to simply live a normal life and not be obsessed by the need to carry out daily exercises that have not been proven to be effective. Our patients have no higher incidence of firmness than is generally reported, and in fact, it seems to be lower.


We feel very privileged to have such wonderful patients. Forgive us for bragging, but we thought we might share some of the comments we receive with you. Of course the names have been omitted except for one that asked us to include her name.

“My family and I would like to extend our deepest appreciation for your
thoughtfulness and superior care in what would normally be an uncharted and frightful situation. Your attention to detail and thoughtful concern was well noted. From the first consultation to the follow-up visit and every step in between we could not have asked for better care.
Sincerely, J”

“What a wonderful experience this has been – even for a surgery. I would do it
again. I have the feeling that everyone here cares about me (me the person) not just a patient! Thank you for making me feel totally comfortable and not embarrassed. You all will have a special place in my heart forever. I will recommend you all to everyone wanting or needing to take this “step” in their life. D”

“Our experience here has been excellent. You have this down to a fine art. The
suite was great & you furnished anything anyone could possibly need or want. It is easy to see why you are well recommended & loved. It is good to know that West Texans have you available so near home. Keep up the good work & all the excellent care. You will be highly recommended by me & my family.
Thank you, J”

“Ya’ll are a wonderful group of medical professionals. Your friendliness & hospitality are wonderful additions to your expertise. You all made it a great experience.

The suite was an added bonus & reflects your care & concern for your patients’ needs& comfort. Our dog loved playing with yours!
Many, many thanks for everything. D”

“Ya’ll were great!! No wonder everyone comes to you. Ya’ll were over the top – I knew you were a good person when I saw you brought your dog to work.
Ya’ll are the best!! M”

“You are truly a blessing. I felt like you did your best and took your time with me. Thank you for giving me the time to make me understand everything that you were doing. After our 1st consultation I was 100% sure and comfortable with you and your staff. I feel like you don’t have to do this job, but you do it because you absolutely love it. Thank you for performing everything I asked for and making sure I had as least pain as possible. I enjoyed staying at your suite to make the first night easier. I have struggled with my stomach for years and this is a special day for me because now I’m excited about my body not ashamed. I hope you continue loving & helping people because you’re amazing and I’m honored to know you and your great staff.
Thank you, B”

“I feel so confident in your work & staff, I have brought both of my daughters to see you. A mother cannot give a higher compliment than to trust someone with their child. God bless you all. S”

And finally, from Sabra Cowan, who asked that we include her name

“Hello Dena!
It has been three years since Dr. Tobin performed my breast reduction surgery on 9/25/2009.

I moved from Abilene back to my hometown of Glen Rose in May 2011 and my life is the best that it has ever been. Not a day goes by that I do not look in the mirror at my still new, wonderful and perfectly small breasts and say thank you Lord for this amazing gift.

I am still so touched thinking of your kindness and genuine concern for my well being.

I very often tell people about Dr. Tobin and what a gracious man he truly is. he has performed surgery on many VIPs such as Miss Universe, and here I was a recovering drug addict who’s grandmother was paying. He treated me as if I were Miss Universe. I was then, and remain today in such respectful awe of his kindness and compassion. I know nothing about surgeons, however, I know that Dr. Tobin is one of the best in the world. I had no pain, complications, or problems. My scars are almost completely faded and I can wear every type of top. And I no longer have to put my boobs in the pockets of my pants! ha! ha!

I hope all is well with everyone!

Be Blessed,
Sabra Cowan”

We thank all of you for all your kind words and positive reviews. YOU are the reason we consider this not just a job but a true joy.

That’s it for now. All of us wish you and yours a very happy and healthy Holiday Season and a wonderful New Year. As always, we appreciate your comments and questions.


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

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