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KYBELLA® Now Available In Our Office!

KYBELLA® is the first and only injectable drug approved by the FDA (in 2015) “for the treatment of moderate to severe convexity or fullness associated with submental fat in adults”.  In lay terms, this drug improves the appearance and profile of moderate to severe fat below the chin, or “the double chin”.  KYBELLA® is deoxycholic acid (DOCA), a cytolytic drug, which, when injected into the tissue,  physically destroys the cell membrane causing lysis, i.e., permanent death to the fat cell so it can no longer store or accumulate fat, regardless if the origin of fat is genetic, weight gain or aging.

This is an office procedure involving multiple injections with a very tiny needle into the fatty area below the chin.  A topical anesthetic is applied beforehand for comfort.  Afterwards, an ice pack is placed to reduce swelling.  While normal activities may be resumed, because of the likelihood of swelling, social downtime for a few days is recommended.  The average treatment uses 2 to 4 vials, and the average patient requires 2-4 treatments at monthly intervals.  Once the result is achieved, further treatment is not necessary. This is a non-surgical alternative to liposuction in this area of the body!

The most common adverse reactions (>20%) include injection site edema/swelling, bruising/hematoma, pain, numbness, erythema/redness and induration/firmness.  Edema/swelling was reported as mild in 79.5%, moderate in 19%, and severe in 1.5%.  Ice packs, head elevation and time resolve this reaction.  Risks include frequent bruising/hematoma reported in 72%.  Marginal mandibular nerve injury resulting in an asymmetric smile was reported in 4%; spontaneous resolution occurred in a range of 1-298 days, median 44 days.  Dysphagia (difficulty swallowing) was reported in 2%; spontaneous resolution occurred in a range of 1-81 days, median 3 days.

Deoxycholic acid (DOCA) is a naturally occurring molecule in the body that aids in the breakdown and absorption of dietary fat.  Endogenous DOCA (that which normally circulates in the body) is a product of cholesterol metabolism and is excreted intact in the feces.  DOCA from KYBELLA® joins the endogenous bile acid pool in the liver circulation and is excreted along with the endogenous DOCA.

Before and after photos can be viewed at MyKybella.com .

Castle Connolly’s “Top Docs” 2016 Recognition

Once again, I am honored to be selected as Castle Connolly’s “Top Doctors” in Plastic Surgery for 2016, as published in the Gulfstream Media Group’s publications (Jupiter Magazine, The Palm Beacher). Castle Connolly Medical Ltd. is a health care research and information company recognized for their established survey and research process.  Their team of researchers follow a rigorous screening process of doctors’ educational and professional experience to make selections.  Doctors do not and cannot pay to be selected and profiled as “Top Doctors”. This is my seventh consecutive year for this selection and I am humbled to be recognized. My goal has always been to provide exceptional, individualized care to improve the health and well being of my patients, both reconstructive and cosmetic.

Radiesse First Filler FDA Approved For Hands

       RADIESSE® is the first and only dermal filler approved by the FDA for correction of volume loss in the aging hands. Our office is pleased to be one of the first in the Palm Beach County area to offer RADIESSE® for hand rejuvenation. RADIESSE® provides an immediate volumizing effect and can help to reduce the prominence of tendons and veins in the hands, delivering smooth, natural-looking results that can last up to 1 year.  Treating the hands with RADIESSE® is a quick in-office procedure that can usually be completed in 30 minutes.
       In recent years, I’ve seen an increase in the number of patients who are seeking aesthetic treatments for their hands. The hands don’t lie- so even after providing a more youthful appearance of the face, a patient’s age can easily be given away by the appearance of his/her hands.  RADIESSE® allows me to restore the volume in the back of the hands, enhancing the appearance and the filler also provides the opportunity to treat both their hands and their face. With RADIESSE® for hands, I am able to provide an FDA-approved treatment for patients in my practice who are ready for this next step in their aesthetic regimen.
       In a randomized, controlled US trial, blinded evaluators reported that RADIESSE® improved the appearance of both hands in 75% of treated patients at 3 months. Importantly, 98% of treated patients also reported improvement in the appearance of their hands at 3 months. Improved aesthetic outcomes as measured on the Global Aesthetic Improvement Scale (GAIS) after initial and repeat treatments correlating with clinical improvement were demonstrated in this study, with all primary and secondary endpoints being met. Most adverse events were injection site reactions such as swelling, redness, pain and bruising, which were usually mild to moderate, short in duration (lasting about 1 week), and required no treatment. No severe device-related adverse events were reported that required treatment.

Plastic Surgery Medical Tourism

Plastic Surgery medical tourism is becoming more frequent.  In South Florida, I  hear of patients going to Costa Rico or other places outside of the United States for “cheaper” procedures.  Unfortunately, not infrequently, this can result in complications with which the patients find themselves facing the dilemma: who will treat the complication?  Typically, it is the local plastic surgeons who take on that responsibility, but not without cost to the patients.  I assume most Plastic Surgeons have a policy similar to mine, i.e., in the unlikely event that a post operative complication requires treatment, or when a result deemed unsatisfactory by both the patient and surgeon requires revision, surgical fees (not facility or anesthesia) are waived.  Patients who have their plastic surgery performed out of the country don’t benefit from this professional commitment to exceptional individualized care by their foreign surgeons.  The link below is an interesting example of Plastic Surgery medical tourism gone wrong in China.  Once again, the lesson learned is “cheaper is not always better“… or in other words, “you get what you pay for”.  http://shanghaiist.com/2015/09/30/chinese_victims_of_failed_plastic_surgery_protest_in_seoul.php.

“Top Doctors” Recognition By Castle Connolly!

Once again, I am honored to be selected as Castle Connolly’s “Top Doctors” in Plastic Surgery for 2015, as published in the Gulfstream Media Group’s publications (Gold Coast Magazine, Jupiter Magazine, The Palm Beacher, Boca Life Magazine). Castle Connolly Medical Ltd. is a health care research and information company recognized for their established survey and research process.  Their team of researchers follow a rigorous screening process of doctors’ educational and professional experience to make selections.  Doctors do not and cannot pay to be selected and profiled as “Top Doctors”. This is my sixth consecutive year for this selection and I am humbled to be recognized. My goal has always been to provide exceptional, individualized care to improve the health and well being of my patients, both reconstructive and cosmetic.

Lifestyle Lift No Longer Lighting Up Your Life……. Or Your Face

Nationwide cosmetic surgery chain Lifestyle Lift apparently has closed at least 40% of its clinics and may file for bankruptcy.  The corporation treats plastic surgery more like a commodity…the model is based on selling trademarked cosmetic procedures to physicians in return for patient referrals, marketing, and training.  They claim to offer less invasive, cheaper facelifts and a shorter recovery. “Real” Plastic Surgeons do similar procedures, but call them “mini-facelifts”.  Because “real” plastic surgeons have extensive training, their results are usually better with less scarring and longer lasting. This is just another example that “Cheaper is not always better!” See more information on the following links:

From Plastic Surgery SmartBrief (03/10/15):  Fast Face-Lift Firm Closes Clinics

Nationwide cosmetic surgery chain Lifestyle Lift has shuttered clinics and might file for bankruptcy. Office staff at a North Carolina clinic that closed said they are working for free to ensure patients get necessary follow-up care. WCNC-TV (Charlotte, N.C.) (3/5), WWSB-TV (Sarasota, Fla.) (3/6)

 

 

 

Cheaper Is Not Always Better!

If you think the cost of good Plastic Surgery is expensive, consider the cost of bad Plastic Surgery! This woman who was interested in enlarging her breasts opted against traditional breast augmentation surgery for a cheaper procedure….she choose silicone injections.  Cheap ended up costing the woman her breasts.  The old saying, “You get what you pay for” still rings true! Click on the following link for the story http://www.foxnews.com/health/2015/01/05/botched-breast-enhancement-performed-by-non-certified-plastic-surgeons-leads/

Memorial Day Weekend…Honor Those Who Gave Their Lives For Our Freedom

Memorial Day Weekend is considered by many to be the kickoff to Summer. Before we start the celebrations, backyard barbecues and beach side picnics, I have 2 serious points to consider. One, let us remember to honor those who died to preserve our freedom. And the second, choose the right sunscreen.

Summer is right around the corner. And while you should use sunscreen every day of the year, it’s even more important during summertime, when the days are longer, the sun is stronger, and it’s easier to spend more time outdoors. When choosing sunscreen, be sure to read the label before you buy. US Food and Drug Administration regulations that went into effect in 2012 require the labels to follow certain guidelines. The guide below can help you understand the terminology.

Choose a sunscreen with “broad spectrum” protection. Sunscreens with this label protect against both UVA and UVB rays. All sunscreen products protect against UVB rays, which are the main cause of sunburn. But UVA rays also contribute to skin cancer and premature aging. Only products that pass a test can be labeled “broad spectrum.” Products that aren’t broad spectrum must carry a warning that they only protect against sunburn, not skin cancer or skin aging.
Make sure your sunscreen has a sun protection factor (SPF) 30 or higher. The SPF number is the level of protection the sunscreen provides against UVB rays. Higher SPF numbers do mean more protection, but the higher you go, the smaller the difference becomes. SPF 15 sunscreens filter out about 93% of UVB rays, while SPF 30 sunscreens filter out about 97%, SPF 50 sunscreens about 98%, and SPF 100 about 99%. No sunscreen protects you completely. The FDA requires any sunscreen with SPF below 15 to carry a warning that it only protects against sunburn, not skin cancer or skin aging.
“Water resistant” does not mean “waterproof.” No sunscreens are waterproof or “sweatproof,” and manufacturers are no longer allowed to claim that they are. If a product’s front label makes claims of being water resistant, it must specify whether it lasts for 40 minutes or 80 minutes while swimming or sweating. For best results, reapply sunscreen at least every 2 hours and even more often if you are swimming or sweating. Sunscreen usually rubs off when you towel yourself dry, so you will need to put more on.

Other ways to stay sun-safe

In addition to choosing the right sunscreen and using it correctly, follow these steps to help protect your skin from sun damage that can cause premature aging and skin cancer:

Cover up. When you are out in the sun, wear clothing and a wide-brimmed hat to protect as much skin as possible. Protect your eyes with sunglasses that block at least 99 percent of UV light.
Seek shade. Limit your direct exposure to the sun, especially between the hours of 10 a.m. and 4 p.m., when UV rays are strongest.
Avoid tanning beds and sunlamps. Both can cause serious long-term skin damage and contribute to skin cancer.

 

Castle Connolly “Top Doctors” Recognition

I am honored to be selected, once again, as a Castle Connolly “Top Doctors” in Plastic Surgery for 2013. Castle Connolly Medical Ltd. is a health care research and information company recognized for their established survey and research process.  Their team of researchers follow a rigorous screening process of doctors’ educational and professional experience to make selections.  Doctors do not and cannot pay to be selected and profiled as “Top Doctors”. This is my fourth consecutive year for this selection and I am humbled to be recognized.

Avoiding the “Three F’s” – Fake, Filled and Frozen

Those of you who know my Plastic Surgery philosophy and expertise are aware I tend to be  “conservative”… less is generally best.  I avoid making my patients look “Fake, (over)Filled, or Frozen(too much BOTOX®).  This article about how to avoid “the 3 F’s” written by Project Beauty, a good resource about cosmetic procedures for the non-professional sponsored by the American Society for Aesthetic Plastic Surgery, one of my specialty societies, eloquently discusses the problems with “over treatment”.  BOTOX® and injectable fillers were originally used by Plastic Surgeons as  non-invasive procedures to create “the Liquid Facelift”.  But too much of a good thing has resulted in unnatural appearances, ranging from “the zombie”, to “balloon cheeks”, “monkey” or “duck” lips, and other strange looks. 

To read the article, click on this link http://www.projectbeauty.com/blog/blog-post/avoiding-the-3-fs-fake-filled-and-frozen/

Consider “liking” Project Beauty on Facebook to get their updates www.facebook.com/ProjectBeauty  or go to their website http://www.projectbeauty.com and review their frequent blogs.