The Next Generation Breast Implants

In my practice, I am always looking at ways to make procedures and techniques better, give patients more options, and enhance patient satisfaction.  One area where I have seen ongoing advancements is with Breast Augmentation options.  Breast implants have been around for decades and they definitely have evolved over that period of time. A recent entry to the mix is the Allergan 410 implant. It has been around for many years in development and is really not a new implant. The implant is an anatomical or tear drop shape silicone gel implant. You might be wondering, why did we need another implant style or shape? Well, every woman is unique, and it is important to have options for every woman’s unique anatomy.  Women have different shaped breasts and different desires for their breasts with implants. With the shaped 410 implant, the volume or projection is concentrated to the lower part of the breast to give a more natural shape. The round implants are not able to do this and tend to give a round shape to the breast which is less like a natural breast contour. I have used the 410 implant extensively in breast reconstruction since it became available. The results are hands down an improvement in results since patients will see a more natural shape to the reconstructed breast. In my opinion, it is a great option to explore if you are wanting a more natural shape and have lost volume to your breast after having children.  The 410 implant may be perfect fit for you.


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Permanent Cellulite Reduction: Introducing Cellulaze

Cellulite has been a prevalent issue for many women I have seen in my practice. In the past there have not been many ways to treat this unwanted “cottage cheese” appearance to the skin, and of the treatments available, results were often times very inconsistent. Cellulite is a difficult problem to solve because it relates to a person’s skin texture rather than their fat tissue, and can be caused by many different factors.

That is why I am very excited about the latest technology designed to treat the cause of cellulite: Cellulaze. Cellulite is comprised of connective tissue bands between pockets of fat cells. Overtime, these tissue bands can become rigid and inflexible. When that process occurs, the pockets of fat cells push out and become herniated creating dimpling and depressions. The final component of cellulite is thinning skin, which accentuates what is happening below the surface. Due to all these factors creating cellulite, most products or treatments you use on your skin will be ineffective. Cellulaze is different. It is a laser that works beneath the superficial level to treat the underlying problems that create cellulite. The laser goes beneath the skin and breaks up the fibrous tissue and then emulsifies the fat, thereby smoothing out the depressions and creating a flat surface.

The treatment is minimally invasive and lasts anywhere from 1-2 hours. A patient will have a couple tiny incisions the size of a pen tip, and will be awake for the duration of the procedure. Oral and topical anesthesia is administered to prevent any discomfort for the patient. The Cellulaze cannula is inserted into the incision sites where we begin the process of breaking apart the fibrous bands that pull down the skin and cause dimpling. During this process, the laser is also stimulating collagen, increasing the thickness of the skin and restoring elasticity to the area. Once we’ve completed this process, the incisions are bandaged and the patient begins the recovery process. Some swelling and bruising will occur due to the procedure being more superficial. These symptoms are temporary and will dissipate within a few weeks.

Cellulaze has been FDA approved to treat and correct cellulite, and the results are long lasting. We are very excited to bring this groundbreaking technology to our office to provide an effective solution to a problem that has challenged women for far too long. Call our office for more information or to schedule your complimentary consultation with me on Cellulaze.

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Ultherapy-Skin Tightening That Works

I am back from my blogging hiatus. I am excited to announce the addition of a new modality to our practice called Ultherapy® . It is something that caught my attention in the fall last year. We have always been interested in something that will tighten the face without surgery. However, the issue is does it work effectively and is it safe?  Up until now the technologies have been very inconsistent and sometimes very painful. Also,  much of the marketing by the companies selling them is hype vs. reality. From my standpoint I want to see the science behind the technology and judge the results based on input from my respected unbiased colleagues who are experts in the field. Ultherapy® has delivered, and my colleagues have given it their endorsement. We brought the ultrasound technology in a few weeks ago and have treated a number of patients. Their results have been amazing across the board. It is tightening their neck and face along with elevating their brows – all without surgery! There is no downtime or recovery with the procedure. The results peak at three to six months and should last over two years. Physicians in Europe are seeing results last three to five years. The ultrasound based technology targets the energy in the dermis and the muscle layers with a focused thermal injury that stimulates new collagen production/tightening. Other technologies have not been able to do this and as a result have had less effect or success. I was so impressed with it that I personally had a treatment at our Ultherapy® event. There is some discomfort with it that can vary with each person. We typically perform nerve blocks and offer oral sedatives to our patients. They have tolerated the treatments very well. This technology is another piece of the puzzle and allows more choice to tailor the right treatment for our patients both surgical and non-surgical.

Ultherapy Before

Ultherapy After


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The battle has begun over how best to reduce fat without invasive surgery. I have been patiently and curiously waiting to see where technology would send us in this endeavor. For years we have had surgical options to contour the body, usually with liposuction to reduce the fat layer-fullness. However, not everyone is excited about surgery: the cost, the risk and the down time. So offering a procedure that is non-invasive, low risk and has minimal downtime, is somethign I have eagerly anticipated adding to my practice. There have been procedures that have claimed to work, but the results up until now have been disappointing. Recently, there has been a great deal of press about external laser fat reduction using ZERONA™. It essentially reduces volume by shrinking the size of the fat cell. It is relatively painless and requires a series of treatments. There is no down time, but it can be expensive since the results are only temporary. As a result, I have not jumped on the bandwagon for this procedure. Also, physicans using this procedure typically rent out a machine on an as-needed basis, limiting their ability to control quality. I have tried to stay abreast of emerging technologies and recently read an article about ZELTIQ™ in which I recognized one of the quoted physicians who had used the machine with encouraging results. Next, I did my own research and found out that the technology made sense and the results were predictable. Simply put, the machine causes a cold thermal injury to the fat cell called cryolipolysis that destroys the fat cell permanently without damaging the surrounding tissue. Areas that have been successfully treated include the abdomen, flanks, back and thighs. The treatment is painless without downtime or recovery with the area treated losing 25-40 percent of volume. The volume loss occurs over a two to four month period as the body absorbs the destroyed fat cells.  It is ideal for people that are unable to lose volume in these difficult areas that we previously could only offer liposuction. ZELTIQ™, from my standpoint, has won the battle. Approximately two months ago I had a treatment done on my abdomen and have been impressed with the results. You can see the video of my procedure here:

If you are interested in seeing if ZELTIQ™ is right for you, please come in for a free consultation. Visit our website for more information.

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Patient Beware

Recently, I have seen and heard about cosmetic surgery being done by physicians that are performing the procedures in their offices in the local area that I do not know. Definitely there are going to be new surgeons moving to Austin to practice and older ones retiring. However, after investigating these new practices they are not what they seem. They are offering deals that seem great to the consumer but do we know their credentials. Some of the practices are using physicians that do not live here and are flying them in to do the services-itinerant type surgery. Who is responsible if the patient has a complication if they have flown away in an airplane? Where does the patient go if there is a problem? What are their qualifications to perform the surgery and what is the safety of their facility? Does the facility have certification to the appropriate level? I respect the fact that there is some overlap of surgical specialities to perform certain procedures. However, when physicians have no formal surgical training it is placing the patient at risk. Why do you think there are formal residency training programs and board certification that take many years to complete? One might be able to learn a technique going to a weekend course but clinical judgment is not learned overnight. Unfortunately, profit can take a backseat to safety. Cosmetic medicine is becoming more and more competitive and lucrative to the provider. Insurance reimbursement continues to decline and physicians are looking to cosmetic medicine since it is done on a cash basis prior to surgery. Also, technology companies are complicit in the problem as well. They are providing equipment and surgical material to these physicians with little oversight on their training. Their bottom line is to make a profit and sell their product. I have seen the consequences from patients having had surgery or treatments done by some of these businesses. Some patients have paid significant amounts of money without results or they have had complications that are not easily corrected. The bottom line is that no one is monitoring surgery that is done in the office and there are no penalties to the physicians. There is some oversight by the American Society of Plastic Surgeons in that if you are a member you sign an affidavit each year concerning what level of anesthesia is done in your office and that you have the appropriate level credentialing for surgery.

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Facelifts-Are they all the same?

Facelifts are definitely not all the same. Over the years the techniques have evolved for facelifts and there are many forms that are currently being marketed. What is confusing is do you need one and which one is best for you. There are some basic principles that we have learned in rejuvenating the face including how we analyze the anatomy. In the beginning we tended to focus on the skin and did procedures that only addressed this problem of sagging skin and wrinkles. However, our results tended to look unnatural and to not last very long. The pendulum swung the other direction and more invasive deeper procedures were developed. The results were better but the cost and recovery was more intense. Now, more and more physicians are trying to get into the game-the cosmetic business. They tend to market their procedures as minimally invasive and little down time. That may be the case and may work well in some-usually the person that needs the least. Otherwise, the results tend to look unnatural and not last very long. From my standpoint the facelift should be only part of the picture in rejuvenating the face. One needs to address the whole area-brow, eyes, midface, and neck-and make a individual plan for each person. We cannot assume that the face changes the same in all areas at the same rate. So, fit the procedure to the needed changes and not to a gimmick or how inexpensive it is.

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Read the Label-Food, Inc.

Recently, a movie came out that is called Food, Inc. My wife and I were looking for a movie to watch on Apple TV and she said that she had heard of it. She was interested in watching it since it was about the food industry and your health. We made a New Year’s resolution to be better with our health and diet. So, we rented the movie and it was very eye opening. We both knew that the food that we eat has additives quite often and that we should be better in eating organic foods. The problem is going 100% organic means paying more for the food and finding it is more difficult. The movie shows how the food gets from its origin to the table. Basically, the food industry is now controlled by a limited number of people and profit is the bottom line not your health. Watch the movie and you will understand the process how our food is manipulated, processed, and altered. Now, my wife and I realize that the added cost and the difficulty of getting organic to be worth it to ensure the best for our families health. The movie confirmed that what we did in the past by giving our children only foods that organic and have no additives since birth was the right choice.

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