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.