Free vivite defining lip plumper with juvederm xc treatment.

• who doesn’t want their lips plumped a little? This is a topical you put on like lip gloss to improve the appearance of lip volume, fullness, and fine lines and wrinkles.
• Who wouldn’t use the juvederm xc? (In English, that is the Juvederm with LIDOCAINE= numbing medication= less ouch.)

Botox has a deal for $50 off your treatment.

And yes, I still have a few more of the insane deal for Latisse,

Buy one get one free. $100 for TWO BOXES OF LATISSE. And you still get to send in for your free Vivite Vibrance, a $119 value.

Three things for $100.  CRAZY! Someone please come get the last ones so I can stop.

$100 for two boxes.

(this is not expired, from a foreign country, in the back of a pick up truck. etc. it is real latisse from allergan… it is just due to a great promo i was given which i am passing on…)
AND, no kidding, YOU CAN STILL USE THE MAIL IN REBATE FOR A FREE $119 VIVITE VIBRANCE. 

*WHILE SUPPLIES LAST. call asap 650 617 9907.

Buy latisse (one box special – $100) and get vivite vibrance (value $119) for free!

It is a mail in for the vibrance. I have the slips in my office….

Go summertime long lashes and pigment free skin!!!

For large volume needs (in general hollow cheeks would fall into this) I would recommend sculptra.  It is better for large volumes and lasts for 2 years.   It is more of a process, requiring 2-3 rounds of injections spaced 6 weeks apart, and it grows slowly, so the results are not immediately seen.  But for large volumes, I feel it is more cost and time effective.

Please see the other blogs on Sculptra.  I have to say I am a fan of its subtle natural results.

What is spitting a stitch?
I know. There are things which seem so normal to us surgeons, which the normal patient looks at and thinks, “What?!”
We surgeons sew. We stitch a lot.  When we put the breast together after a lift or do a tummy tuck, we sew you back together with sometimes hundresds of sutures which you don’t see.  We close your skin like layers on a cake, aligning each layer.  The deep sutures are primarily dissolving ones.  Your body slowly, over the course of months when your tissue has healed together, dissolves the internal sutures. 

Ah. But here is the rub.  Sometimes instead of dissolving the sutures, your body will push the foreign object (suture) out of your body.  When it does this, we call it spitting a stitch.  It will feel like a little bump, maybe be a little red, almost like a zit.  The the top may open with a little discharge (which looks like a small dab of “pus”- most likely just white blood cells and other things) and you will see a little fishing line sticking out.  Usually this happens along your suture line (incision/ scar).

That is your suture.

If it does spit, it is not a big deal. You likely have hundreds of internal sutures. If you can grab it with tweezers, give it a gentle pull. If it doesn’t come out you can clip the part sticking out with a nail clipper.  Clean the area with a little alcohol or hydrogen peroxide, and then apply polysporin.  If the area looks irritated, is getting worse, or there is red skin around it, then you should see your doctor. 

It is a common part of healing.  Just weird.  Certain sutures do it more often (so I try to avoid those), and some people are prone to it (guess their skin just likes to spit).  Again, the key is keep it clean, no infection, and get the irriation to stop.

How could an HERBAL do anything bad?

Quick synopsis of the article:

• Herbals are not regulated
• Herbals have contaminants.  These include: Lead, Arsenic and other heavy metals, and pesticides (yay! you get more than you paid for.)
• Herbals claim to cure cancer, fix blood pressure, and other things, most without any science proving it.
• Research has shown 1 in 4 herbal companies have quality control issues.  The biggest issues are the supplements did not have the correct amount listed of the ingredient and the supplements were contaminated by heavy metals.
• Most plants are located in China and not inspected routinely by FDA

So, this goes back to my point of herbals are medications.  Unfortunately, due to good lobbyists in this $25 billion dollar business, there is no FDA evaluation of the herbal supplements.  Quality control, including accurate dosages and removal of contaminants, is not done.  They fall somehow under food perview, not drug.

I do think herbals can be beneficial.  So how do you know what is truly in your herbal? Contaminants? Dosage?  Which brand? I don’t know how to find the “good” brands with high quality control… I’ll have to research it for another blog.  Until then, here is the article from the NYT.

http://www.nytimes.com/2010/05/26/health/policy/26herbal.html?emc=eta1

California summer sun is rapidly approaching. This means sun protection for you and your kiddos. I will repeat some of the most common mistakes and advice with sunscreen.

• Apply 20 minutes BEFORE going into sun.  If you are already at the beach, it is too late.
• Reapply every two hours
• Reapply every 45 minutes if in the water
• Throw out sunscreen over a year old (You know what I mean. That sunscreen which looks like some kind of vintage throwback to the 80s…)

What kind of sunscreen?

• SPF 30.  Anything over SPF 30 (and likely over 15) is just them concentrating the product more because people tend to be stingy with how much they put on.
• I like the clear zinc products.  Think white nose on little kids in the past, but they now make it so it is clear.  Zinc is a mechanical blocker which blocks the UVA and UVB rays. Very effective, and safer for kids and pregnant mommies to be.  (I carry these by skinceuticals and obagi)

Other thoughts:

• Wear it daily.  Even if you are ”going to work and I’m going to be inside all day…” you get a lot of exposure walking to your car, outside at lunch,etc.  You live in Palo Alto.  California.  This is the land of sunshine.
• Clothes don’t always protect you.  The finer the weave, particularly when wet, lowers the protection.
• For kids, come on- let’s have a little confessional here- you are NOT getting it all over them, in every nook and cranny, and reapplying after they get out of the water.  So, RASH GUARD SPF swim SHIRT, and a hat if you can swing it.  We see lots of skin cancers in the scalp.
• And if you are protecting your kids, how can you wear a teeny bikini? What kind of example are you setting? So I strongly believe in swim shirts and hats for mommies and daddies too.
• Put a bottle everywhere.   At the front door.  In the car.  In your purse.  In your diaper bag. 

Now go out and smell the barbeque…. Feel the watermelon dripping off your fingers…

SUMMER!

PRE INJECTION: (starting two weeks out)

• Avoid things which make you bleed.  Aspirin, NSAIDs (like advil, motrin, naprosyn), vitamin E (the amount in a multivitamin is ok. A vit E pill is not), and herbals (anything heart healthy = makes you bleed.  Ex: ginseng, gingko, fish oil, ginger.  See link.)  The effects of these medications stay in your system for two weeks.  So stop two weeks ahead of time.
• Herbals which reduce swelling and bruise.  Arnica and Bromelain are the two biggies.  You should start these two days prior to the procedure and take for a week afterwards.
• Don’t be hot and sweaty when you come in.  If you just worked out and come in, your skin blood vessels are dilated to get rid of all that extra heat.  Dilated blood vessels = higher chance of bruising.
• What area are you doing?  The nasolabial fold (parethesis around your mouth) don’t tend to bruise much.  The lips and area under the eye are more prone.

DURING

• Ice, elevation, small needles to inject, and a dose of dumb luck.  I shine a bright light on you to try to illuminate where the vessels are. 

AFTER

• Ice
• Elevate (this includes sleeping with an extra pillow that night)
• Herbal medications arnica and bromelain
• Avoid being hot (I see higher rates of bruise with injections in the summer.  When your body is hot, your skin blood vessels dilate to get rid of heat. )
• No vigorous exercise for 24 hours.  (If you are really bruised, then longer. Wait until your bruise is turning yellow green before restarting.)
• Avoid heavy lifting, straining, bending over. These all raise the blood pressure in your face, which leads to bruise.

Some people also just tend to bruise more easily.  Thin skinned and fair skinned women see bruise more easily.  If you have never done an injection before, do it at the end of a day on Thursday or Friday, so if you bruise you can recoup over the weekend.  For those who have done injections before, you tend to react the same way most of the time.

A board certified plastic surgeon.

Yes, I am a real plastic surgeon certified by the American Board of Plastic Surgery.  I am also a cosmetic surgeon.  I do not call myself a family practice doctor, dermatologist, or ENT- though many of those specialties call themselves  plastic surgeons.  If you want to see how someone trained, find out what their residency and board certification is.  It cuts through all the trickery and deception.

What are the boards?

Each specialty has its board.  Dermatology, Internal Medicine, Family Practice, Orthopedic Surgery, etc.  Trickery abounds- there is no “cosmetic surgery” board, yet I found a website saying there is.  The Mission Statement of The American Board of Plastic Surgery, Inc. is to promote safe, ethical, efficacious plastic surgery to the public by maintaining high standards for the education, examination, certification and maintenance of certification of plastic surgeons as specialists and subspecialists.

I sat for my first round of board exams after residency.  First for the written test, and then two years later for the oral test.  The oral boards are tough.  You have to be in practice for a while, collect cases, and submit those cases.  Then you submit some in incredible detail (with op notes, clinic notes, photos, even how you billed).  If you pass these hurdles, you sit for the oral boards.  At the oral exam, you meet with leaders in the field and are quizzed on your cases and a group of unknown cases, which you had the pleasure of seeing for the first time only minutes before.  During this exam in the imaginary cases, every skin graft and flap you do will fail.  You are guaranteed complication after complication until the examiners see how you handle adversity.  They want to see what you have done in practice.  They want to see how you think.  Will you be a good surgeon? A safe surgeon?  The true test of a good surgeon is not how you do on the cases which go well.  It is how you do on the ones which don’t.  My year, 20% of the doctors failed the oral boards.  20%.  These doctors went to medical school, accredited plastic surgery fellowship programs, and passed the written test. It is tough.

I can’t believe how times flies.  It has already been a decade.  My original certification was to expire, so I recertified.  I submitted all of my cases over a 6 month period.   They check your hospital status, references, and other paramenters. When you pass this, you take a written test.  We all take a general test- basic fundamentals of plastic surgery we should all know.  And then we take a specialized test, where they tailor this part to what you actually do in practice.  Over a decade in practice, your practice evolves.  So hand doctors aren’t tested in depth on breast augmentations, and pediatric plastic surgeons aren’t tested on breast cancer reconstruction.  My focus is cosmetic- breast, body, face.  That is what I was tested on.

I am now board certified by the American Board of Plastic Surgery until 2021.

The next time you’re at the doctor’s office, take a peek at those certificates hanging on the wall. Like gallons of milk, some of them are expiring.

For the first time since leaving medical school, many doctors are having to take tests to renew board certification in their fields — 147 specialties from dermatology to obstetrics.

Any doctor can deliver a baby, treat cancer, or declare himself a cardiologist. Certification means the doctor had special training in that field and passed an exam to prove knowledge of it.

They used to do this once and be certified for life. That changed in the 1990s — doctors certified since then must retest every six to 10 years to prove their skills haven’t gone stale.

For some specialists, like the doctors who push tubes into heart arteries to unclog blockages, this is the first year many are going through retesting.

Older doctors also are feeling the heat. More than a quarter of a million of them were “grandfathered” with lifetime certificates, but are being urged to retest voluntarily to show they still know their stuff.

http://news.yahoo.com/s/ap/20100405/ap_on_he_me/us_med_retraining_doctors;_ylt=AjmNNJyskv31bKyNLpFGxOPVJRIF;_ylu=X3oDMTJxNGJpb2thBGFzc2V0A2FwLzIwMTAwNDA1L3VzX21lZF9yZXRyYWluaW5nX2RvY3RvcnMEY3BvcwMxBHBvcwMyBHNlYwN5bl90b3Bfc3RvcnkEc2xrA2RvY3RvcnNmYWNlYg–

I hate all of these things which wear off if not maintained.  It seems a lot of my plastic surgery bag of tricks: botox, latisse eyelash enhancer, and soft tissue fillers like juvederm and restylane all go away. 

Latisse will thicken and lengthen lashes.  It really really works.  But the catch (ah, there is always a catch) is you can’t stop using it.  I’ve been told the eyelash cycle is around 4 months.  If you were to stop cold turkey, the latisse benefits would linger for a while, gradually reversing and be totally gone at 4 months. 

So what to do? How can you avoid bankrupcy to have better eyelashes?

I would stretch out your use of latisse.  Do it every other day, or even every third day.  You likely won’t get the thickness and length you would if you use it daily, but it may be more sustainable …  and affordable.  Which is better than having amazing lashes for a few months and then going back to …gasp… normal.