BOTOX FOR MEN
Botox is certainly not just for women. Women may talk about their looks far more often than men, but men are concerned about their appearance as well. And with good reason. A man who goes to the gym to work out and cares about his clothes and grooming is a man who not only cares about his appearance, but what it says about him personally, as well as in business.

Men are coming in greater numbers than ever to do something about the brow lines. A man who has pronounced lines in-between his brows may be perceived as angry or stressed; not the image most men want to portray. That's why it is not surprising that men are also choosing Botox to eliminate this problem. Botox is a non-surgical procedure that can be performed over the lunch hour and then head right back to the office. Botox is the "little thing" that does so much. Patient satisfaction with Botox is over 95%.

WHAT ASPS MEMEBERSHIP MEANS TO YOU:
For a plastic surgeon to be a member of ASPS, the American Society of Plastic Surgery, means that: (1) he has at least 6 years of training and experience in surgery with at least 3 of these years specifically in plastic surgery, (2) that he is certified by the American Board of Plastic Surgery, (3) that he operates only in fully accredited medical facilities, (4) that he adheres to a strict code of ethics monitored by peer review, (5) that he must fulfill continuing education requirements every year, including special classes in patient safety, and (6) that he will be your partner, working with you to define and achieve your personal surgical goals. Prospective patients should specifically look for, and seek out surgeons who belong to ASPS and ASAPS [American Society of Aesthetic Plastic Surgery]. These are the two premier plastic surgery organizations in the world.

LIPO-ABDOMINOPLASTY vs CONVENTIONAL ABDOMINOPLASTY:
To most patients, all abdominoplasty ["tummy tuck"] procedures are just about the same. In reality, nothing could be further from the truth. Most surgeons still perform a conventional abdominoplasty whereby the skin and fat of the abdomen are lifted as one large unit up off of the abdominal muscles to the level of the ribs above and then firmly pulled downwards. The extra skin and fat of the abdomen are removed (again as a unit), and the incision line closed. This was the the classic method of abdominoplasty for 75 years, yet there was a problem. It didn't allow for much thinning of the tissues in the upper abdomen, and the extensive lifting up of tissues sometimes caused problems with healing and poor scarring.

In 2001 a new method of abdominoplasty was described by Dr. Saldanha [Brazil]. He called it "lipo-abdominoplasty" because the majority of the correction is accomplished with liposuction. There is only a limited about of undermining or "tissue lifting" which greatly improves the cosmetic results, and dramatically decreases the risk of complications. I first learned of the lipo-abominoplasty procedure in early 2006 when I saw Dr. Saldanha present his technique on lipo-abdominoplasty. I was immensely impressed and from that moment on have only performed the lipo-abdominoplasty procedure. I feel our results improved dramatically and without any additional risk to our patients. Further, since there is less internal "cutting," recovery is far easier and faster. Patient satisfaction with lipo-abdominoplasty is very, very high. Of note, a very large proportion of our lipo-abdominoplasty patients are referred by our previous lipo-abdominoplasty patients.

TUMMY TUCKS ARE IN...
Recent data has been released by the American Society of Plastic Surgery looking back over the past decade. Although abdominoplasty ["tummy tuck"] surgery currently only ranks 5th on the list of popular procedures in 2010, it had the largest increase in popularity over the past 10 years [84% increase] over any other cosmetic surgery. Further, a recent article on Abdominoplasty published 6/11/09, looked at the Quality of Life and Psychological Status of patients undergoing tummy tuck surgery. They found 74% of patients had better sexual relations, 76% of patients were satisfied with the results of surgery, 85% of patients had an improved quality of life, and 96% said they would have done the surgery again [actual reference available upon request].

BRA LINE BACK LIFT PROCEDURE
We have had numerous calls about a procedure which greatly improves the loose skin and bulges of the mid and upper back involving a surgery that removes excess skin of the back utilizing a horizontal incision that typically lies within the bra line. During this procedure the extra skin and fat of the back, everything that is lax, is removed and the remaining skin is greatly tightened and lifted. The procedure improves all the skin tissue from the waist to the lower neck area. On the morning of surgery, and with the patient in a standing position with the bra on, I mark the outline of the bra across the back, and then have the patient remove the bra. Within the bra strap outline, skin excisions are designed in such a way that a maximum amount of skin is removed and the final scar will be located inside of the bra line. The sutures used to close the incision line are placed in multiple layers to maximize the appearance of the scar. The primary downside to the procedure is the appearance of the scar which is typically quite pink for many months, and the fact that the scar often widens somewhat over time [as a result of the enormous tension of the closure]. Despite this, patient satisfaction is still very high. Downtime is 1 week.

[EDITED] COPY OF A LETTER SENT TO A SALINE BREAST AUGMENTATION PATIENT WITH 16 YEAR OLD IMPLANTS
As hard as it may be to believe, it has been 16 years since your aUgmentation mammoplasty. This letter is to remind you that, as you already know, saline breast implants do not last forever, and your existing implants have entered the "autumn" of their lifetime. Studies have now shown that the average life of saline breast implants is 14-16 years. Despite this statistic, I often see patients with implants that last 18-20 years.

The purpose of this letter is to simply inform you that you may experience at some time in the future an unexplained loss of volume in your breasts. This change is usually progressive and over a few days it will become undeniable. If that should occur, you will have experienced a deflation of your implant, and you should call our office as soon as possible.

The treatment of a deflation is very simple and straightforward if it is recognized and managed early. The treatment consists of the replacement of the defective ["worn out"] implant. Often a manufacturer warranty will cover the replacement of the implant itself. This procedure can often be performed under local anesthesia on an outpatient basis with a very rapid recovery [just a few days].

There is nothing you need to do at this time, but if you should have any questions, or would like to discuss other options, please do not hesitate to contact my office.

LOVE YOUR LIPS...
Lip augmentation has been popular for a long time, but it has been especially popular in recent years. There have been many different methods described of enhancing and augmenting the lips, and we have tried nearly all of them. The most popular method currently used is to inject a filler material [such as Juvederm] into the lips to create a fuller, more attractive, and youthful lip appearance. The results of Juvederm lip augmentation are exceptional. The only drawback is that it is temporary and lasts approximately 8 months. When I was back at an International Plastic Surgery Meeting this past April in Washington, DC, I discovered a new way to do lip augmentation. Years ago we did lip augmentation by placing a thin silicone strand within the lips. The lips looked great but, in many cases, the silicone strand was palpable. A new company has now released a silicone strand that is very, very, very soft and "invisible" in tissues. Because the strand is made of silicone, the results are permanent. This new implant is FDA-approved and comes in nine diffferent sizes, so that there is a size for just about any lip. The surgery to place the silicone implants is very easy and is typically performed in the office under local anesthesia. The procedure is very safe, and complete recovery occurs in 5-7 days. Most importantly, the healed lips are extraordinarily soft and natural. We have performed this procedure on a number of patients over the past few months and the results are the best of anything we have ever seen to date. Patient satisfaction is extremely high. If you have ever considered lip augmentation, this is definitely the way to go!

THE TOP SEVEN WAYS THAT AUGMENTATION MAMMOPLASTY WILL IMPROVE YOUR LIFE
1. greatly improved self-image
2. marked increase in self-esteem
3. huge boost in self-confidence
4. more alluring and attractive to others
5. able to wear more flattering and desired clothing styles
6. feel more sexy and empowered
7. enhanced confidence in relationships with both men and women

CORRECTION OF PROMINENT EARS
"Otoplasty" is the name given to the surgical procedure to reshape and reposition the ears when they are excessively prominent or abnormally shaped. Prominent or cup-shaped ears are especially stressful for children because they are frequently teased or ridiculed by other children about their ears. Surgery involves a small incision in the fold behind the ear where the scar will be invisible. In adults the procedure is performed under local anesthesia, but in children it is best to do the surgery with the patient asleep. Surgery usually takes 1- 1 1/2 hours to perform. A bandage is worn 24 hours-a-day for the first week, and then for one month at nighttime only. The procedure and subsequent recovery period are typically very easy and straightforward. The results of the surgery are usually permanent.

Parents call our office often inquiring about the "ideal" time to have surgery on their child. As a rule of thumb, surgery should be postponed until the child reaches the age of 6; and preferably before the child starts school. By the age of 6 , the ear will have reached 75% of the adult size. By age 8, the ear will have reached 90% of the adult size. Recovery is usually uneventful.

THE IMPORTANCE OF ANTIOXIDANTS
Everyone knows that sun exposure is bad for the skin, but when it comes to protecting the skin against the sun, it often takes more than just a good sunblock. The additional essential factor is topical antioxidants. Topical antioxidants are far better absorbed and effective than antioxidants obtained from the diet or dietary supplements. Further, once the topical antioxidants are absorbed into the skin, they cannot be washed away, rubbed off, or minimized by sweating. The two most important topical antioxidants are Vitamin C and Vitamin E. The problem for consumers is that not all topical antioxidants are the same. The critical issue is how effectively they are absorbed into the skin. Most commercial preparations are poorly absorbed, thus minimally effective. It is absolutely essential to select a topical antioxidant that is chemically stable and easily absorbed through the skin. There are a number of good products out there, but it often requires the assistance of a professional who understands advanced skin care to advise you on the product that will be best for you.

Vitamin C is the body's major antioxidant. An antioxidant is a specialized chemical that neutralizes or deactivates a dangerous chemical called "free radicals" that are created by ultraviolet [UV] light. These free radicals are implicated in premature skin aging, brown spots, destruction of elastic fibers in the skin, but also many forms of skin cancer. Thus the use of a topical antioxidant is extremely important. Moreover, it is known that topical vitamin C also stimulates collagen synthesis in the deeper layers of the skin. This tends to make the skin thicker and stronger and thus resist the formation of fine lines and wrinkles. Vitamin C is a water-soluble vitamin and is concentrated inside of the skin cells.

Vitamin E is also an important antioxidant. Vitamin E performs many of the same functions as vitamin C but it is largely concentrated on the outer layer of the skin cells.

For the best protection, it is advisable to use the two vitamins in combination. Ferulic acid is also an antioxidant, but it is most noteworthy for stabilizing both vitamin C and vitamin E to improve absorption. In fact, the absorption of vitamin C and E are increased four-fold with the addition of Ferulic acid. This triple antioxidant combination is called CE-FERULIC. Allure Magazine said of CE-Ferulic, "just a few drops under sunscreen acts like armor against sun and pollution." Another superb antioxidant by SkinCeuticals is PHLORETIN-CF, which is particulary effective against environmental damage. Summer is here and you really do need to incorporate an antioxidant into your sun protection program. If you would like to learn more about antioxidants, please call our office and our aesthetician, Jamie Hummel, will call you back.

BREAST AUGMENTATION VIA BELLY BUTTON APPROACH

We received a number of phone calls last week about this procedure. I felt some clarifiction was in order. This operation, called the TUBA [transumbilical breast augmentation] procedure is an alternative method to perform breast augmentation surgery. Instead of a small incision placed on the breast [edge of the nipple or in the fold under the breast], the incision is made at the belly button and a tunnel is created from the belly button below to the breast tissue above. An empty balloon-like device is inserted and then greatly expanded. This develops the space for the new implant by a blunt stretching and tearing of the breast tissues. The balloon-like device is then removed and a saline implant is placed and filled via a special long filling tube. The naval incision is then closed with sutures.

The TUBA procedure remains a controversial procedure. It is true that the scar is generally well healed and hidden and that some surgeons are able to obtain consistent good results with this procedure. However, significant disadvantages and drawbacks are associated with this procedure and must be taken into account when considering this method.

These negative issues are: (1) due to the limited access tunnel, it is only possible to use saline-style implants, which greatly limits implant selection. (2) because the surgical pocket is created from such a great distance away from the breast, it can be very difficult to make the breast pockets in the proper location and perfectly symmetric. According to published reports, implants inserted with this procedure tend to be positioned too high and have too much space between the breasts [i.e., poor cleavage]. (3) a key to a natural appearing breast is presrvation of very delicate muscle attachments at the base of the breasts, and this can be difficult to do when operating via a small tube so far away from the intended surgical site. (4) if bleeding should occur at surgery there is no way to control it other than by the placement of direct pressure over the breasts which leads to a greater risk for hematoma [blood clot] formation post-operatively. (5) on occassion, as a result of the dissection between the belly button and the breasts, there can be visible grooves in the upper abdomen which are difficult to treat. (6) the surgery is advocated to eliminate the scars on the breasts, however the usual incisions placed on the breast in conventional breast augmentation surgery are quite excellent and very well accepted by patients, (7) if any kind of breast revision surgery is ever required, it is not possible to perform such revision surgery via the TUBA approach, so a second incision [on the breast] will be necessary anyway, and (8) finally, due to the large number of implants that have been damaged during insertion with the TUBA method, many implant companies will now void and nullify the usual implant warranty if the surgery is performed in this fashion [a huge price to pay].

TOP FIVE SURGICAL AND NONSURGICAL COSMETIC PROCEDURES AMONG MEN AND WOMEN IN 2009

According to the American Society for Aesthetic Plastic Surgery almost 10 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2009. The Aesthetic Society reports procedures have increased 147 percent since the tracking of statistics first began in 1997.

The top 5 Surgical procedures were (in order of popularity): Augmentation Mammoplasty [breast enlargement surgery], Liposuction, Eyelid rejuvenation [eyelid "tuck"], Rhinoplasty [nasal surgery], and Abdominoplasty ["tummy tuck"].

The top 5 Non-Surgical procedures were (in order of popularity): Botox, Tissue Fillers [i.e., Juvederm], Laser Hair Removal, Microdermabrasion, and Chemical Peels.

DR. BURLIN LECTURES ON BREAST AUGMENTATION

Dr. Burlin was recently a lecturer at the American Society of Aesthetic Plastic Surgery Annual International Meeting held in Washington, DC, in April 2010. Dr. Burlin spoke on his experience with the new investigational Ideal Breast Implant. Dr. Burlin has performed more breast augmentation procedures with this new implant than any other surgeon in the US. The implant is currently being evaluated in a very controlled FDA sanctioned Clinical Study. The Ideal Implant Company hopes that the implant will be available for widespread use by 2013.

ISSUES OF BREAST IMPLANT SCAR TISSUE FORMATION [CAPSULE CONTRACTURE].
Probably the most common complication of breast augmentation surgery is scar tissue that forms around the breast implants making them feel harder than desired. It is important to remember that the body is programmed to form a layer of scar tissue around any internal "foreign body" to isolate it from the rest of the body. This is not a rejection reaction but simply the body's normal and healthy response to any foreign material. A "capsular contracture" is then, an envelope of heavy scar tissue that forms around the implant [either saline or silicone] making it feel firm or hard. A capsule is important only if it occurs to such a degree that patients have symptoms [discomfort], asymmetry [one breast is soft and the other breast is hard], or distortion [breast has a rounded, spherical shape, or is pulled by the scar tissue out of alignment with the other breast]. In these instances, patients usually submit to additional surgery to remedy the problem.

It is very difficult to determine exactly what percentage of women will experience "capsular contracture," since perceptions of firmness of implanted women vary widely from patient to patient. Thus one patient may be delighted with the degree of firmness to her breasts whereas another woman may think it was "too firm."

It is important to know that most "capsular contracture" occur within the first year of surgery, but patients are never ever completely free from the risk of capsule formation and can unfortunately form problematic "capsular contracture" at any time following surgery.

Capsular contracture is never a health risk, but can be very bothersome [pain or discomfort], and can often trigger the need for additional unanticipated surgery to the augmented breast.

After 26 years of performing breast augmentation I am still intrigued and occasionally frustrated by capsular contracture. No one understands exactly why a breast will form a "capsule" or envelope of scar tissue around the implant. In my experience it is actually most common for the scar capsule to only form around one breast with the result that one breast is very soft and natural and the other breast is firm and quite "different." Oftentimes the patient will be led to think that the breast implant itself has hardened and they will come to the office thinking that the implant is defective. However, in reality the implant is almost always completely normal and it is the dense scar tissue that surrounds the implant that actually makes the implant feel firm or hard.

The widely quoted national statistics for breast implant scar encapsulation is around 15-20%. We are very proud of our statistics, which show an encapsulation rate of less than 4%.

There are certain circumstances that tend to increase the risk for capsular contracture. The list below is certainly not complete, but in my experience has proven to be true:

* subglandular placement of the implants "above the muscle"
* silicone implants are slightly more prone to capsule issues than saline implants.
* patients with very tight skin envelopes [not much room for the implant]
* patients who request and/or receive implants that seem to exceed the capacity of the overlying skin envelope [implants seem very tight at implantation]
* any infection following surgery [especially staphylococcus epidermidis in the ductal system]
* any collection of fluid within the breast pocket [blood or clear seroma fluid]
* a previous personal history of capsular contracture
* non-compliant patients who do not faithfully follow the post-operative instructions and exercises
* patients with a history of silent infections [frequent urinary tract infections, sinus infections, advanced gingivitis or teeth abscesses]
* patients who have had radiation therapy to the breasts [in association with treatment for breast cancer]

Our very successful approach t