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.