What is it Like to Have No-Scar Breast Implant Surgery-Part 3

Here you are out of surgery and in the recovery room, waking up. Will you be in pain? Odds are, you’ll wake up smiling. Most patients ask, “Are we done yet?” You shouldn’t experience any pain. Typically, you will have a slight feeling of the weight of the new implants. You will probably also feel a sensation of tightness. With the light sedation, you’ll probably need only 20-30 minutes before you are fully awake and ready for your ride home.

Your local anesthetic (remember that the local was given internally?) will last for your ride home so that you can settle in and get comfortable. On the evening after surgery, the local anesthetic will wear off. At this point, you can have some pressure and discomfort in the chest area, and perhaps some in the abdomen (from the belly button incision and tubes). You will have pain medication to take for relief from any soreness. Everyone has a different pain threshold, but the pain medication should offer plenty of relief. You might also experience some feelings of nausea for a couple of days as a side effect of anesthesia. If your surgery was performed under the light sedation, this is less likely.

As recommended by Dr. Yoho, you will be resting in the recovery area that you prepared in your home ahead of time. Your recovery area might be in your bed or in a recliner with several fluffy pillows to support and keep you elevated. You will also have bottled water, your post-op medications, your mobile phone, remote controls, books, a laptop, and some light food. All of the items that you need are within easy reach—possibly even a bell to call any friends or family members who are helping you to recover at home.

You will need to be patient for a while, because for a few days you will not be able to bend over, raise your arms, or get out of bed with ease. Dr. Yoho has also instructed you not to lift anything for the first few weeks. Many TUBA patients feel okay within a day, and others within a few days. But everyone is different and you should listen to your body. Your recovery should go smoothly if you follow Dr. Yoho’s instructions for post-operative patients. Since your consultation, you know that the best breast augmentation surgery recovery happens for patients who take good care of themselves and follow their surgeon’s instructions.

The day after surgery, you will return to Dr. Yoho’s office. Your dressings will be removed in this follow-up appointment. After that, Dr. Yoho will still be available to answer any questions or address concerns, and his office will follow up with you. During the healing phase over the next few weeks, you will experience many changes. Don’t panic. Common experiences include: an increase, decrease, or loss of sensitivity; hot or cold sensations; pins and needles; or you might even hear crackling under the skin. Less commonly, you might see bruising of the breasts, your breasts might appear pointed, asymmetrical (different sizes), flat, too big, too small, too high or too low. These conditions might be normal for your surgery. You will need to be patient with these changes, but if you feel concerned, call Dr. Yoho’s office.

If you had sub pectoral implants (under-the-muscle), your recovery might be a bit longer or more intense, but should result in a smoother appearance of your breasts. With under-the-muscle breast implants, you might have more soreness, muscle tension, or spasms in the upper back, and the pressure of the muscles might cause the breasts to look constricted. These recovery symptoms will not last long, but the muscles will need to heal from the trauma of surgery before they heal to a normal look and feel. Again, you can call Dr. Yoho or his staff at any time. After recovery, you will get used to your breasts and they will continue to improve in look and feel.

What it is Like to Have No-Scar Breast Implant Surgery, Part 2

When we left off, you were in the middle of your transumbilical breast augmentation surgery. You had been sedated, had an incision made in your navel, and an instrument had tunneled up to each breast. This allowed for the balloon-expander to create the space for your new implants. When this is removed, the space is then checked for bleeding. Remember that the pressure of the balloon expander has probably stopped any bleeding so far. Then the new pocket is irrigated with a sterile saline solution containing an antibiotic. Antibiotic solution sterilizes the implant pocket to prevent infections. Dr. Yoho is batting 1000 on this record—he can gratefully say that he has not seen a single infection from this procedure. In addition to dangerous infections, minor infections are thought to contribute to the danger of a complication called capsular contracture, or hardening of the breast around the implant. So the antibiotic solution might help to prevent this complication as well.

Next, Dr. Yoho puts a long-acting local anesthetic right inside the implant pocket. Having a local inside the breast has a painkiller effect in the area for up to 8 hours after surgery. This is important so that the patient has plenty of time to take her pain pill after waking up. This keeps the post-op pain to a bare minimum.

Now, it is time to place the actual implants. The tiny incision does not allow for a filled implant to be pushed through the belly button. So the empty implant is placed through the small tunnels under the skin while it is rolled up (like a taquito, as Dr. Yoho describes it). These are threaded up to the breasts using a “no-touch” technique. This technique doesn’t mean that Dr. Yoho operates with a “Look ma, no hands!” kind of recklessness. It means that, although he does use hands, the implant and the patient are both wetted down with the antibiotic saline solution so that all surfaces are sanitized as the surgeon is working. After the implants are in place, they are then filled with sterile saline.

Once the implants are placed and filled, Dr. Yoho sits the patient up. This is to check the evenness of the breasts and the appearance (because we don’t look the same sitting or standing as we do lying down). Although, just like natural breasts, implants are rarely if ever perfectly even, Dr. Yoho checks and adjusts the saline levels to make sure they are as symmetrical as possible. Once the desired levels are reached, Dr. Yoho tugs out the fill tubes. The implants have a valve that self-seals once these tubes come out.

After the tubes come out, your surgery is basically finished. Your breasts will immediately be wrapped with a light elastic bandage to help prevent swelling. A sports bra is placed over this, and an elastic band is placed above the breasts. You will also have a small dressing covering the little belly button incision.

By the time this is completed, you will be awake. Your family or friends can then come in and see you in recovery.

Part 3 will cover the surgical recovery.

What Is it Like to Have No-Scar Breast Implant Surgery: Part 1

Do you know what TUBA is? No, not the musical instrument. It’s actually a kind of cosmetic surgery. TUBA stands for Trans-Umbilical Breast Augmentation. This surgery actually puts in the breast implants through an incision in the belly button (also called the umbilicus). This way, there is no scar in and around the breast after the breast augmentation surgery. This surgery is favored by Dr. Yoho for its safety, speed, accuracy, and for the no-scar results. Well, to be specific, there is a scar, but it’s inside the belly button-not an area that most patients worry about. Dr. Yoho has successfully performed TUBA method surgery thousands of times.

Transumbilical breast augmentation has many advantages over standard approaches for the right patient. Patients experience less downtime and need less post-operative care. So who is the right patient? Good candidates desire larger breast or need breast reconstruction. Good candidates for TUBA also do not want or need a breast lift in addition to breast augmentation, and have good skin elasticity (relatively tight skin). Finally, as with other surgeries, candidates should be in good physical and mental condition (no active diseases, disorders, or mental instabilities).

So, how can breast implants be placed through the navel?

If you were to have TUBA surgery, you would probably be on the operating table for less than an hour. In fact, typical transumbilical breast augmentation takes as little as 20 to 30 minutes. You could have either general anesthetic (which knocks you out), or local anesthesia with IV sedation. Dr. Yoho has long used this special light sedation method to reduce patient side effects from anesthesia. Although the patient is awake during surgery, they are given relaxation medicine and usually don’t remember anything.

But we’re getting ahead of ourselves. The first step would be a consultation to evaluate you as a candidate. Then you would decide on the size of your implants. You will try on some different outfits with bra implants to see how you feel with different sizes. Dr. Yoho will also help you to evaluate sizes in terms of your body frame and current breast shape and size. When you go in on the day of surgery, you will once again talk to Dr. Yoho about the implant sizing, and he will mark your body in preparation for the surgery. The lines that cosmetic surgeons draw on patients’ bodies are like a diagram for the operation, partly because bodies look different lying down than standing up. In the case of TUBA, the lines show where the tunnels will go from your belly button to your breasts. You will then be taken to the operating room.

You will be sedated and prepped for surgery. You will receive local anesthetic around the breasts and around your belly button area that will help reduce soreness in post-op and reduce bleeding during surgery. Then, the actual incision is made in your navel. Dr. Yoho carefully separates the tissues around the navel, which helps to prevent the formation of scar tissue. Dr. Yoho thinks that this is one of the advantages of his extensive experience: doctors with less experience might not do this.

Next, a device is threaded inside the incision that creates a tunnel between the navel and each breast. These tunnels are done with a blunt device and not with a knife. In other words, there is no cutting or slicing of tissue in the tunneling procedure. Pockets are also created in the breast area to hold the implant. Dr. Yoho will consult with you before the procedure about his placement (under or over the muscle) of your breast implants.

Next, a tube is run up to the breast with a balloon-expander device. This is inflated until the tissue is taught so that the pressure slows or stops the bleeding, and also finishes the space inside so that the implant will rest easily and naturally after surgery.

Next week: part 2.

Discount on Injectable Fillers

Now, with a Gilt City deal, you can get a voucher worth $100 toward a 1 mL treatment with Restylane or a related product for $49. Limit 3. Or for $149, you can purchase a $300-off voucher toward a 2mL treatment. Los Angeles cosmetic surgeon Dr. Robert Yoho is participating in this Gilt City deal. His full service surgical center in Pasadena also houses a medical spa with highly trained and experienced technicians. The offer must be used by the end of September (see terms and restrictions on the Gilt City page), so make your appointment now.

Restylane is a kind of filler that is made of hyaluronic acid. If that sounds scary, don’t worry—hyaluronic acid mimics a natural bodily chemical. It is also mixed with a small amount of a local anesthetic called lidocaine. The injections are usually easily tolerable—some people report a virtually painless experience. After the injection, there is very little in the way of downtime or recovery. You might see a little redness, but you should be able to resume normal activities very quickly. This treatment is very well-tolerated.

Another advantage is the soft, natural appearance of the fillers. Restylane stays soft under the skin, so that the injectable doesn’t result in lumps or stiffness. It is also longer-lasting than older fillers. Restylane can last a year or longer. Dr. Yoho and his staff have found that, by using a little extra filler, the effect can last for up to two years.

These fillers are used to plump up moderate to severe folds and wrinkles. They are commonly used around the mouth, but are also sometimes used to plump up the cheeks or even to fill in brow wrinkles. Dr. Yoho and his staff have obtained excellent results with these fillers. If you are worrying about facial lines making you look older, call our Pasadena office for your appointment and get your discount voucher.

How to Approach Your Breast Sizing For Your New Implants

Do not focus on the exact implant size! Instead, put the sizer implant in a bra and see how it looks on you…

Everything depends on how you look with the given style and shape and size of your implants. The “high profile” implants should be tried and compared with the other styles. Do not look at the “before and after” pictures, as they are irrelevant. Examine how you feel with the different looks and the different implants. Take home the sizer implants if possible and try them on with different bras (Dr. Yoho’s office offers this). Your surgeon will help you with what’s reasonable for your body style, chest size and breast characteristics. Listen carefully to all the information available at the office; there are important aesthetic and health issues involved.

Dr. Yoho likes under-the-muscle implants for many cases in which the patient has substantial breast tissue. These often look absolutely fabulous right after the procedure, and can’t get “hung up” under the muscle and “ride high.” When the breasts aren’t too saggy, inserting the implants through the armpit is a very nice approach which can give very satisfying results. With the “under the muscle” approach, however, you do risk eventual implant displacement and movement, and the procedure requires eliminating the lower part of the chest or “pectoralis” muscle during the surgery. But if there’s very little breast tissue, the implant should generally go under the muscle, using the “through the belly button technique” which works nicely for many patients. These are all big decisions to make, and the patient should read as much as she can and learn as much as possible from the surgeon in order to obtain the best result.

About Face Lifts For Men

The potential for a man to get a really tight facelift is not quite as good as a woman's. The complication rate is somewhat higher, because there are more blood vessels. For this reason, male facelifts have to be carefully picked and chosen to be sure that the result will be worth the expense, the hassle and the risk of complication. There are many Hollywood stars who have attempted to get very tight skin underneath their chin through the use of facelifts, but success in this area is difficult. There is always a little bit of loose skin down there even after the tightest of facelifts, because this area tends to loosen up over a relatively short time. Additionally, bleeding is much more common, as men seem to have a difficult time sitting still and letting the healing process occur for the first day or two, so we see blood underneath the skin that has to be taken out on the next day or the day after. Relatively thin-skinned Caucasian women whose face can be lifted without the examining physician making incisions are probably the best candidates for a facelift.

All this aside, if performed with the right accompanying procedures, such as cheek or chin implants or peels, male facelifts can be satisfying. Men just have to know the limits and the likelihood of problems and be counseled appropriately. We have seen exceedingly dramatic results with facial implants alone, which can be a good option to consider – having an implant procedure without actually lifting the face. Of course, this isn’t practical in an older man who has a lot of loose skin or a lot of sun damage. In these cases, the skin should be improved with the usual technique of pulling it back and trimming the skin around the ears.

One advantage that men have in facelifts is that their beards allow the lifting of the skin without concern about changing the sideburn area. In women, sometimes the scar must go in front of the sideburn or else the little tuft of hair in front of the ear gets lifted too high. In men, this scar can almost universally be hidden within the scalp behind the sideburn and above the sideburn, so this is one advantage of male facelifts. Occasionally men will complain of hair growing over the little bit of cartilage that sticks out from the middle of the front of the ear, the Tragus. This can be treated with laser hair removal, and sometimes the hair seems to fall out on its own and not be as active around a year or 18 months after the facelift.

All in all, as in every cosmetic procedure, the physician and the patient must work together to individualize treatment, in order to obtain the best result.

Big Buttocks Are In Fashion

Cosmetic surgeons keep hearing about weekend house parties where unknown substances are injected into buttocks. We also hear stories from hospitals and other physicians that, due to this practice, terrible problems with chronic infection have occurred.

There is much speculation about what is being injected. Some think people may be buying breast implants, and injecting the silicone from them into the buttocks with no sterilization. Unfortunately, the silicone in breast implants is a thicker silicone and has a high risk of infection when injected into human tissue in large quantities. To be used safely, this type of silicone needs to be encased in the capsule that surrounds a silicone implant. We have seen several cases of people who had large, firm, tender, red buttocks that looked very unnatural, and were apparently injected with some sort of foreign substance. I was concerned that if I biopsied the area, the whole buttock area would become infected.

There are other injected filler substances that, while legal in other countries, have caused a lot of infection and inflammation in many patients. When the patient shows up in the U.S., we have to deal with it. In some cases, these foreign doctors don’t even document what they are actually using, perhaps because they suspect that the sort of permanent filler they’re administering is really a magnet for infection. We have seen some of these cases in our clinic. They are not easy to treat.

Buttock implantation is also being performed using firm implants that are designed for this purpose. However, the ones I’ve seen look unnatural. The top part of the buttocks often sticks out, and the implant does not adequately support the bottom buttock. It may be painful to sit on and may come through the skin by itself. Additionally, it needs a large opening for placement which ends up leaving a significant scar.

My experience and opinion is that the only reasonable way to improve buttock shape, contour and size is fat transplantation. We do this nearly every week at New Body Cosmetic Surgery and we have many, many happy and satisfied patients. Complications are rare. The procedure can be repeated more than once at intervals of 3 to 4 months. Just the right amount of fat should be transplanted, for if too much fat is placed, infection and other problems are more likely to occur. The buttock size and shape can progressively be improved. And liposuction in the areas around the buttock—the outer thighs and hips—also helps the appearance of the buttocks. If the patient gains back a little bit of the fat that was suctioned away after the procedure, the fat may go to “desired” places like breasts and buttocks, and the overall shape may be enhanced.

Cosmetic Surgery 2.0

On the Internet, there is a saying that the new Internet is version 2.0. We like to think that our cosmetic surgery is version 2.0. Shorter recovery times, simpler procedures, more natural results, and overall safety improvements are what we strive for and what the latest technology promises. We are doing our best every year to bring you a superior experience and better results with the latest techniques in surgery and recovery. See DrYoho.com or look at the affiliated websites to which Dr. Yoho contributes numerous blog posts, which can be found by googling “Dr. Yoho.”

_______________________

Robert Yoho, M.D.

Did You Know That All of Our Surgeries Can Be Done Awake?

If you have special fears of anesthetic, we can perform your surgery under local anesthesia, even a tummy tuck. We do give some oral medicines and perhaps a shot prior to the main event, to be sure that you’re nice and relaxed and not afraid. However, the local anesthetic does the trick for the pain relief, and you can watch the whole thing.

We have successfully performed breast augmentations, liposuctions, tummy tucks, facelifts, and eyelid procedures all under pure local anesthetic technique. If fear of general anesthetic is your issue, please be sure to ask us about this possibility.

While we’re able to do the above, we generally feel that a little intravenous sedation is appropriate for most patients and they usually do respond very well without any nausea or other discomfort. We can keep you comfortable and unaware of your surroundings without using all the drugs and so on that make general anesthetic such an uncomfortable and possibly hazardous experience. Ask us about our anesthetic techniques when you come in for your consultation.

Some Notes in Regard to Tummy Tuck Surgery

Tummy tuck, or abdominoplasty, is a surgery that has some pluses and some minuses. When compared to liposuction, on the plus side there is a tightness of the front of the tummy skin, and the surgeon is able to sometimes tighten the muscles underneath. After pregnancy, these muscles pull apart in a fashion that is sort of like felt. Felt would not shrink back or “rubber band” back into its original state, but instead stays loose. When the tummy tuck is performed, the muscles in the middle of the “six pack” can be laced together with permanent sutures, and therefore the pulled-apart middle can sometimes be repaired. On the other hand, if there is a great deal of fat underneath the muscle surrounding the stomach and other internal organs, it doesn’t work very well because it’s sort of like suturing a drum head.

The downsides of tummy tuck are as follows:

1. It’s quite a dangerous operation compared to anything else in cosmetic surgery. The fatality rate (death rate) is approximately 1 in 3000.

2. You end up with a huge (about two-and-a-half-feet long) scar.

3. The belly buttons postsurgery are often a bit unnatural or very unnatural looking.

4. Liposuction at the same time is not usually regarded as safe. The reason for this is that the blood vessels that supply the area of the abdominal skin that’s to be pulled town to meet the pubic bone can be easily compromised by liposuction, and so liposuction is usually done on another occasion many months separated from the tummy tuck.

5. Liposuction if done instead of the tummy tuck can often produce a great deal of skin shrinkage and a very satisfactory result, and a recovery which is very, very minimal compared to a tummy tuck, which generally has a painful and prolonged recovery.

Remember when thinking about your alternatives between tummy tuck and liposuction it’s not a clear “yes” and “no” answer in most cases. Tummy tucks are not for everyone, because of the risks, deformity of the scarring, and other factors. Think carefully about these issues, and although the risks associated with liposuction are modest, they are still a factor too. Use your best judgment and your doctor’s advice in regard to these issues.

Liposuction Revolution!

Sushi dinner in Hawaii

Did you know that finally there is a new machine that helps liposuction surgery? We have tried almost every single new device (laser, Vaser, “Smart” Lipo, etc. etc) over the years, and they have provided minimal improvements at best. They just weren’t worth buying because they didn’t work. Since our experience extends over almost 20 years and 10,000 cases we knew they didn’t work.

Now, we have the new Power X® liposuction machine. It is a refinement of a patented design that has been around for almost a decade. The old machine broke down, and worked just a little, but the new one has been completely re-engineered by a new company and we bought one the first day we tried it. I do not spend money on devices that don’t work. Every fool and his mother is trying to sell me something because they believe we are a gold mine and foolish enough to buy any type of medical device.

This thing safely speeds the procedure up. We think we are spending 1/3 less time on liposuction; in other words, you need half the medication you would have used with the manual systems. Anesthesia medications are the most dangerous thing in the operating room, as they have the potential to cause you not only discomfort post operatively, but problems during surgery, sometimes serious ones. We have to watch carefully during the procedure to be sure you don’t get too much medication.

An additional benefit: we think it helps prevent some of the irregularities in skin quality that inevitably occur after some liposuction procedures. AND we have seen no more complications or problems post operatively than we had before.

Don’t be fooled: our experience still means a lot. Surgeons can’t start out and get great results because they have this machine. We still need all our expertise. But we think this device will improve our results, your postoperative experience, and our overall safety.

Call our office today to see how you can benefit from the LIPOSUCTION REVOLUTION!

Everything You Wanted to Know About Breast Implants but Were Afraid or Ashamed to Ask

Seattle Port at Night

Did you know that the most important factor in predicting your result with breast implants is the type of breasts you have before the surgery? I always check the breasts and make sure that we don’t have an unusual problem. Some breasts are very, very saggy and need a lift before doing implants. It used to be that the surgeons generally performed the lift and the implant at the same time, but opinion is shifting on this issue because the complications are so high if these two procedures are performed together. All kinds of problems, including nipple areolar area skin death, occur. And the general opinion now is that it’s better to do a lift in one procedure and wait four to five months before inserting an implant, if necessary.

Other breasts are different than the “standard model.” Some breasts are long and skinny, and these breasts deserve special treatment before performing the implant. Sometimes they need a reduction. Sometimes they need a procedure that makes them look more like normal breasts before doing the implant.

Another problem is the question of a person with slightly saggy breasts who might not want scars on her breasts. In this case, we offer a lift first, but many of these individuals like a fairly large implant, and this will lift the nipple to some degree. They accept a somewhat more “natural” look, which is a little bit saggy, rather than having scars on their breasts. We frequently insert these through the armpit, through an incision which for saline implants is only about an inch long or less.

There are many breast augmentations that are performed above the muscle and many that are performed below the muscle. The theory about the above-the-muscle implant is that it produces a smoother upper curve of the breast. However, if you have rather reasonably full breasts that aren’t too saggy, an over-the-muscle implant is much easier recovery process and produces a very predictable result in our hands. Additionally, below-the-muscle implants over the long term may produce several undesirable effects. These include the breast falling off of an implant that is riding high under the muscle, and while this is acceptable in some cases, in others it’s not. A second complication which is very common is over the two to three years after getting your implants below the muscle, the activity of the muscle pushes the implant down and out. So the implants become saggy sooner rather than later.

We always recommend good bras for our breast implant patients, and in particular, we like Bali brand “Minimizer” bras, which have broad straps and full support and full coverage. Stretchy, “sports-type” bras are generally not as good because they just don’t supply the support, even though perhaps some manufacturers and individuals think that they’re very supportive.

Each breast project is an individual effort based on your particular idea of the size that you want, and we size you very carefully in the preoperative period. Your breasts also determine what kind of result you’re going to get, and the surgical technique also is very important. We perform breast augmentations through the belly button, under the muscle, through the armpit, above the muscle, and also use areolar incisions at times where this is the best option or the patient wants this. The crease at the bottom of the breast can also be used as an entry point to insert the implant. However, this is probably less desirable in many cases because the scar is visible in a lot of situations.

So your consultation will take you through the process and we will check the size you want, tell you the limitations that exist because of your breast type, and make a recommendation based on your individual needs and desires.

Breasts Are All Different, So You May Need a Special Procedure To Make Yours Look Better

Mt Rainier February 2012-by Dr. Yoho

By: Robert Yoho, M.D.

Putting an implant in your breast is not always the answer to give you a better breast look. Implants work beautifully for breasts that are generally formed well, but in some cases shouldn’t be used at all, and in other cases should be used after a primary surgery to get the breasts in a shape that can accept an implant and stretch out over the implant properly and produce a normal-looking, round, pleasing breast. 

Note that many of our patients like different looks in their breasts. Some patients like rather large breasts and they don’t mind having a bit of a demarcation in the upper pole of the breasts. Others don’t like this look at all and want a much more sloping look. Different effects can occur based on whether you have a lot of breast tissue or very little breast tissue and whether the implant is placed above or below the muscle. 

Other people have breasts which are different than the average, such as long, narrow breasts, which are called “tubular” breasts, and these need special treatment. The general pattern is to do a special reconstruction surgery or lift and then four to six months later use an implant if needed to create a larger volume breast. A little bit of volume can be added with fat transplant, but this is nowhere near the volume which is possible with implants.

The practice of putting an implant in along with a breast reconstruction at the same time adds so many variables that very few surgeons can do this with any degree of predictability. Indeed, one of the most famous breast surgeons in the country wrote an article saying that this should never be done and that all breast reconstruction should be done prior to implant placement, which should be delayed at least four to five months. He showed pictures of his own cases where the whole nipple areolar complex had died during the process of attempting to put the implant in and reconstructing the breast at the same operation on the same day.

So we need to evaluate you individually. Your breasts are a certain kind of project; it may be a complex project or it may be an easy project, but please come in for your own complimentary consultation and we’ll tell you exactly what to expect. Note that every breast operation has the risk of imperfection in its results, but things can almost always be improved by a secondary procedure or even a third procedure. We have performed breast reconstructions where we haven’t “gotten it right” until the third procedure, and the patients have been very good about letting us continue to operate at intervals of four months. In many of these cases, the patients end up with a very satisfactory result and breasts that look fantastic compared to their breasts preoperatively.


Breast wishes,

Robert Yoho, M.D.

Dr. Yoho’s Approach to Facial Rejuvenation

A family vacation moment, nothing to do with facial fillers!

One of the fantastic things that has happened with facial cosmetic surgery is the introduction of “hyaluronic acid” fillers, including Juvederm® and Restylane®. These fillers can help make a 45- or 50-year-old face look 10 or 20 years younger in some cases. The wife of a friend of mine recently was looking so fantastic that I had to ask her why, and she said she’d had 14 syringes of Restylane® placed in her face over the last 9 months. She looked like she was 27 and she is in her late 40s! The Restylane® had replaced the facial fat loss that she had undergone as a natural aging process, and because she had been using excellent skin products as well, she didn’t need a facelift or anything more aggressive than filler. Her lips were naturally full without being overdone and her cheeks, brow area, and the sides of her face all looked very youthful.

We also like facial implants, particularly cheek and chin implants. These are essentially permanent fillers. The facial lifting that these two implants produce is exceedingly natural in most cases and is more and more being used by Hollywood for virtually all of the actors and actresses.

We believe that the facial fillers, which are reputed to last only a year, last much longer if larger volumes are used. Our pricing is reasonable and we encourage our patients to have a consultation for facial fillers. If you use less (at least 5cc’s) many times a more temporary result is produced although it can still be very attractive.

We (as is standard practice) do face lifting along with eyelid surgery, facial fillers, and facial skin resurfacing. When multiple procedures are desired, all of these procedures are typically done at once in one procedure to produce the best possible result. We use local anesthetic plus our unique sedation process to give you the most comfortable experience during the procedure.

While the facial fillers have very minimal recovery, the other procedures of course do require more “downtime” and we will counsel you individually about your needs during your visit to Dr. Yoho’s office.

Wonderful New Device Has Been Invented to Improve Liposuction Results

Have you heard of the abrasive cannula that is used by all the advanced liposuction surgeons these days? This cannula helps us spread the fat around and make the surface much more even after liposuction. What we do is at the beginning of the case, we use this special instrument in order to abrade and loosen the fat after insertion of the local anesthetic. Then the fat is suctioned and the patient is checked while standing. Any areas that are improper or irregular are marked with a sterile Sharpie marker and the patient is then put back on the operating table and sedated again so they don't remember or feel anything during the case.

The special cannula is again used and sometimes a bit more suctioning is performed. After this, foam and the specially designed compression garment is applied and the patient is allowed to wake up and given fluid to recover. 

We hope this detail isn't too technical for you. Some patients would rather not hear about it, but we think that this helps some people learn more and understand more and have a better feel for what is happening during surgery.

X Marks the Spot:  A New Gynecomastia or "Man Boob" Removal Technique

Dr. Yoho recently attended a medical conference for advanced cosmetic surgery in Buenos Aires, Argentina. There he learned an excellent technique for improving the results in gynecomastia surgery. Dr. Blugerman, just like Dr. Yoho, aggressively liposuctions the area around the problem using a special local anesthetic. After this is performed, instead of making an incision in the lower part of the nipple of the areola right at the junction of the skin, an X is incised right through the middle of the nipple areolar area. Oddly enough, these come together and look fantastic after the surgery, rarely causing problems of any kind, and in most cases making much smaller incisions and leaving no scars.

That said, remember that fluid buildup and sometimes a little bleeding into the area is not that uncommon with gynecomastia surgery. Be prepared to follow up closely with Dr. Yoho when you have your "man boob" improvement procedure, because occasionally this fluid needs to be removed postoperatively in order to get the best result possible and avoid complications such as infection.

The "Gummy Bear" Implant is a Failed Implant

Unrelated to Gummy Bears or implants

The claim with the gummy bear implant is that if ruptured, the silicone on the inside will not bleed into the surrounding tissues. This is a patently false proposition, because those of us who have taken out gummy bear implants which have been ruptured have seen the silicone spread in just exactly the same way that a gel implant or an ordinary silicone implant's contents will leak out of the implant shell. So therefore this is not an advantage. 

The other advantage claimed for the gummy bear implant is the lower capsular contracture rate. This is a falsehood, because the gummy bear implant is naturally as firm as if the patient already had a Class II capsule or a quite firm breast. Therefore, the Class II capsules aren't counted in the statistics, and this distorts the perception in the studies that the gummy bear implant is superior. 

We think the gummy bear implant is too firm to be very natural and not a good choice in general for anyone. We like gel implants. We don't believe they have a higher capsule rate than saline implants, and their only problem is their expense. A new device that allows us to put them in more easily and damage them less is a great help to their placement. This is the "Keller Funnel", and we have had a great deal of satisfactory experience with it in easing the insertion of our implants, using a smaller incision for the implant's placement, and lowering the chance that we will distort the implant shell in some way, thus leading to a higher chance of rupture later in the patient's history. 

Please feel free to come in for your consultation in Los Angeles or Visalia in regard to these issues and chat about the various options in regard to silicone and saline implants.

What Are My Chances of a Complication After Breast Surgery?

Vacation photo by Dr. Yoho

Breast surgery recovery is relatively predictable, but the most important predictor of an individual’s surgical result is their psychological and physical preparation before the surgery. Their breast shape and size often dictates how good a result can be obtained, and although we can make great improvements in many cases, certain breasts are just very difficult to make perfect. In particular, patients with long, skinny breasts or very droopy breasts require fairly extensive surgery which is significantly less predictable than just inserting an implant. Additionally, we absolutely refuse to put an implant in at the same time as a breast lift is performed. The implant pushes out on the repaired area while the little stitches and the tissue try to heal and hold the breast implant in. This is a recipe for repeat surgeries, and there are a significant number of articles in the medical journals that recommend that breast lifts not be performed at the same time that an implant is inserted. 

The complications that occur with breast surgery include about a five percent rate of hardening or capsular contracture over the life of the implant. If this happens, you need to report back to us as soon as possible, because there are medical ways to treat it. 

Other potential complications include: infection, but this has a very low rate at less than one percent; blood buildup around the implant which might need to be taken out within a few days, and variations in shape and position that may be related to the surgery or it may be related to the shape and size and contours of the pre-existing breast. 

Touchups are just a few percent of what we do, but if we consider the result imperfect and a touchup appropriate, we do breast touchups at no charge. Come in and see us for a free consultation.


Breast wishes,


_________________________
Robert Yoho, M.D.

What to Watch For After Your Breast Surgery

One of Dr. Yoho's children during a beach vacation

First, the surgeon may have taped areas of your breast or given you a special bra or binding to wear after your breast implant. We generally use an elastic dressing which should be removed at 24 hours, and a bra should be applied or the bra which is underneath the elastic should be left on. Checking on the breasts at 24 hours is always desirable, because one of the rare complications of breast implant surgery is blood buildup around the implant, and sometimes this has to be removed within a few days to prevent a breast capsule or hardening.

We always emphasize the following in follow-up visits: First, good support bras are exceedingly important and we really like the Bali Minimizer bra for this. There are some exceptions, so some women need to wear no bra or a bra that doesn’t offer much support for the initial period after the breast surgery.

Secondly, we recommend 800 IU of Vitamin E each day taken orally, which can be purchased at any health food store. This should be taken indefinitely and may significantly decrease the chance of hardening or capsular contracture of the breast. We also believe fish oil is a great boon to decrease inflammation and also decrease the chance of capsular contracture. We recommend a teaspoon of liquid fish oil a day, which is the equivalent of four to five of those large fish oil 1,000 mg pills taken with food, and sometimes we recommend more if the patient is starting to have trouble with a capsule for short periods of time. Note that you can buy this on vitacost.com and we recommend several brands, including Carlson’s or Nordic Naturals or Eskimo brand fish oil, all of which have very little fishy taste.

Breast wishes,

_______________________________

Robert Yoho, M.D.

Does Dr. Yoho Touch Up Other Surgeons’ Cosmetic Surgery?

Dr. Yoho loves to visit Yosemite with his family

We are happy to have a look at problem surgeries. Sometimes patients lose faith in their surgeon due to a surgical complication or sometimes due to inexpert work or personality problems. We are happy to evaluate these people on a case-by-case basis and as long as your attitude is good and you don’t have an unreasonable expectation about your result, we’re happy to help. Note that in some cases it may be tougher to get quite as good a result in the secondary case as if we operated to begin with, because of scarring issues or healing issues and sometimes because of psychological issues. We work hard on surgeries such as “tummy tuck tune-ups,” which involve liposuction of the appropriate areas surrounding a surgery which was originally a tummy tuck. Some people have weight gain after liposuction or tummy tuck, and these cases can be improved a great deal also. We also have the ability to touch up the “pixie ear” of a facelift which has been inexpertly performed. Sometimes this involves a small touch-up facelift, and the general rule of thumb is that waiting at least four to six months after the prior surgery is the best policy. The cases that are even farther from the original surgery than this, that is, several years afterward, sometimes react even better to the touch-up surgery, because the tissues have had time to completely mature. 

The rule of thumb in soft tissue work is that four months is a minimum before a repeat surgery is done in general. However, we believe that healing processes, especially in darker skins, can go out a year or more. In orthopedic surgery, or bone surgery, just as a matter of interest, the healing curve is two years or even longer. Dr. Yoho has experienced this himself with his own adjustment to a foot fracture which is much better at three years than it was at two years.

But in any case, please feel confident to have a free consultation at Dr. Yoho’s office for other surgeons’ work and we’ll see if we can improve things. And we’re happy to give opinions about what we think would be beneficial or how improvement might be best effected.


__________________________



Robert Yoho, M.D.

The Biggest Misunderstanding Regarding Weight Loss

Dr. Yoho has been an observer of the weight loss/large volume liposuction scene for many years, and he’s also an aggressive amateur athlete who is well past his days where he was very accomplished in anything. In any case, he has some observations regarding diet and exercise that he’d like to share. 

The biggest misconception about diet and exercise is that the exercise is the critical component. Diet is much more important, and especially with women, any attempt to lose weight with just exercise without regarding the diet carefully is doomed to failure. There are some men that can tolerate heavy exercise and be successful at weight loss and ignore their diet; however, these individuals often get injured at “boot camps” and other excessively aggressive exercise regimens. One of the fittest and best muscled individuals known to Dr. Yoho, a semi-professional body-builder, exercises at his body-building only about four days a week for a half an hour. That said, his diet is what Dr. Yoho calls the “Nazi Diet.” He never has a cupcake to save his life, never eats any chocolate, and never eats any refined sugar of any kind. He restricts himself to what would be regarded as very strict health food.

The other misconception is that diet pills and injections are a smart idea. While these can help in the short term, the long-term issue with them is well known, that is, recurrence of the weight problem.

Of course, the long-term results of gastric bypass surgery of any kind are unknown and probably much worse than the proponents (who have an enormous financial conflict of interest) would tell you.

What Dr. Yoho does recommend heavily is “programmed diets” such as Jenny Craig and others, which give you the food and portion-control your consumption by showing you exactly what it is to eat just the right amount and the right composition of different foods. These, while not easy, do have the potential for long-term success and long-term training of the individual. Dr. Yoho himself uses a form of a programmed diet and buys his meals that he eats during the week from SterlingCuisine.com, a local food service that gives him excellent nutrition at a reasonable price.

I’m Under Thirty Years Old or I Look Under Thirty Years Old:

What can Botox, facial fillers, and facial cosmetic surgery do for me?

Unrelated to medical spa services!! Dr. Yoho's daughter after a gritty race.



We frequently work with people who look absolutely great before we start with them. For these people, looking fantastic is the goal. Many options are available. Facial fillers, especially in the lips, are quite popular. Cheek implants can give exotic looks to people whose faces look good to begin with but not extraordinary. Botox elevates the brows even in an individual with no wrinkles because it relaxes the muscles that ordinarily pull down the middle of the forehead and the side of the forehead, thus allowing the brow muscles to elevate the brows. This is a very pleasing look in young women. 

 So if you’re interested in looking your best, we have something for you. Even if you look great already.

All About Our Botox Expertise

Dr. Yoho relaxes in Argentina. The crowd behind him does not represent our Botox work!!

Did you know that Jeremy Romaine, P.A., who has worked with Dr. Yoho for over a decade, trains physicians in proper Botox usage? Our techniques are derived from the Carruthers, who pioneered Botox for cosmetic facial work. We’re doing what we believe to be the same dosing and application techniques that they use currently in their office. (And I might add, at prices that are probably three times ours.) The key to Botox is the proper quantity, and each of our patients gets about a half a bottle, which is a significant dose, and proper placement with no skimping in the proper areas and not overdoing the areas that should be left alone.

The thing patients enjoy the most about Botox is the brow arch, which is a natural occurrence of the numbing or decreased function of the muscles pulling down in the face, which have Botox injected into them. The frontalis, or muscles right above the eyebrows, are activated for some reason and these pull the eyebrows up and produce a very pleasing effect. The object is not to completely eliminate all the motion in the brow, but to get rid of the key wrinkles in the middle of the brow and at the sides of the eyes while allowing this arch effect to happen naturally.

Please come in for a free consultation with Jeremy and see what you can expect from your expert Botox application.

Dr. Yoho Performs Pure Local Anesthetic Liposuction Too

Dr. Yoho on the edge

Although most of our patients like some sort of light sedation, we can do breast augmentation, liposuction, and eyelid procedures with pure local anesthetic. We often will give a relaxation pill prior to this, but local anesthetic does the job, and if you’re a calm and relaxed individual who doesn’t want any intravenous medicine, we’re certainly happy to help you using the pure local anesthetic liposuction technique. A few of our patients choose this method, and we can make you perfectly comfortable with it. It does take a little bit of talking during the procedure and hand-holding, but pain isn’t a significant problem at all; in fact, most of our patients have no pain and are able to go home almost immediately after the procedure is complete. Please let us know if this is what you want and we’ll be happy to oblige you.