Traditional liposuction techniques focused on de-bulking fat and attempted to show some of the contours of the muscles beneath the fat. The newest “high-definition liposuction” is focused on removing nearly all the fat and showing the muscles in great detail. This produces beautiful effects because the actual beauty of the form of the human body is the musculature rather than the fat on top.

These methods are possible because we now can define the anatomy and make deeper and thinner liposuction results in the areas where the divisions between the muscles are. In particular, the midline division between the bellybutton and the rib cage can be deepened, and this is very attractive when the rest of the fat is sculpted away. There are a lot of people who are out of shape and have a lot of musculature underneath their fat who can now be carefully defined and improved in a way that’s remarkable pleasing. The men can get six-packs if they have musculature to begin with,and women can get a defined body that was never previously possible.

In addition to the “high-definition” work, after the liposuction fat transplant is now being performed in a much more aggressive fashion on the buttocks. Our current fat transplant technique now includes the sides of the buttocks in addition to the back. This produces beautiful figure eight bodies that our patients are very proud of.

This sort of liposuction is very technique-related and results are largely dependent on the experiences of the surgeon. With over 10,000 successful liposuction cases, we have the experiences and expertise to produce high-definition cases very accurately. Please come in for a consultation to see if you're a candidate. Our consultations are free.

Cosmetic Surgery for African-Americans

Here in Los Angeles, we have a wide diversity of ethnic groups who come to see us for cosmetic surgery. At least a third of our patients have darker skin types. Why does your ethnicity and skin type matter when choosing a cosmetic surgeon? The formation of scar tissue and other characteristics of healing mean that it is extremely important for a cosmetic surgeon to have experience with surgery on many different skin tones.

We’ve also learned to recognize different body types. Every individual body is different, and Dr. Yoho always considers each individual’s body when consulting with his patients. But he is also sensitive to the fact that ethnicity does play a role. There are cultural differences that mean that patients have different standards of beauty, which a surgeon must understand. There are also body-type characteristics that tend to be predominant in different ethnic backgrounds.

African-American body types (or black body types) generally have a very narrow waist and are wider-hipped, having very full buttocks areas. We gauge our surgery to accentuate or improve these features. Other darker skin types, such as Native American skin types in the Unites States typically have thicker waists. Patients with these ethnic body types often ask that we try to improve their “figure 8” or curves with buttock fat transplants (of course this is also requested by some patients with darker skin who feel that they would like to reduce a larger body size).

The many skin types result in a big spectrum of response to incisions. The very lightest skin types do probably the best with scarring. Because they are so light the light-colored types of scars don’t show much compared to the light surrounding skin. On the other hand, the darkest skin types don’t experience the cosmetic concern of the visible darkening effect that some other healing scars have, because the surrounding skin is also dark. These skin types can often show keloid issues, which is a tendency of scar tissue to thicken and lift above the surrounding skin. We commonly inject these scars after surgery and we follow these patients for months, to be sure that they don’t have raised scars. Some of the mixed skin types, with tan-colored skin or a little darker, can develop darkened scars which can be treated with varieties of fade cream, and also sometimes they need injections if their scars are elevated.

Judy Yoho has written a special section of Dr. Yoho’s book A New Body in One Day that further discusses some of the concerns of African Americans and cosmetic surgery. So please consider us if you have an African-American background or if you have another darker skin type, because our experience is tremendous. We’ve performed over 20,000 cases on all varieties of ethnicity. Although there is no way to guarantee a certain kind of recovery, we can usually predict with great accuracy how you are going to improve.

An Unforeseen "Complication" of Breast Implant Surgery

One of our patients is having a baby!

We were delighted when patient recently sent us this picture to let us know about a “side effect” of her breast augmentation surgery. Pregnancy! As you can see, her recovery from breast implant surgery has gone remarkably well. We always do our best to avoid complications after surgery, but in this case it was a happy surprise. We are thrilled to see her enjoying her new life.

Breast augmentation surgery is still one of the most-requested cosmetic surgeries, along with liposuction. Of course everyone has their own unique reasons for requesting cosmetic surgery, but there are some nearly universal reasons as well. Patients often feel that larger breasts will give them better proportions, improving their self-confidence on a daily basis. The psychological boost that comes from changing your figure should not be underestimated. Many patients want to feel more sexy, whether they are single or in long-term relationships, and if you look in the mirror and feel dissatisfied with the way your clothes fit, or with the way you look naked, then you might decide surgery is the right option for you.

Breast augmentation can help women feel more womanly. Many patients who feel that their breasts are too small have always wished for more curves. Women whose breasts have begun to sag, which can occur as an effect of age or pregnancy and breast-feeding, feel a loss of their confidence. Breast augmentation helps to make that difference in knowing that they look and feel good.

Sometimes even Dr. Yoho cannot predict the effects of his surgeries. This patient certainly seems to relish her new role! Of course, we can't take all of the credit for life's happy surprises post-surgery. But it makes us feel terrific to see our patients enjoying life with a new look. Sometimes even unexpected "complications" can be a positive side effect.

Get Discounts on Restylane Injections with a Gilt City Deal

Dr. Yoho has a full medical aesthetic spa in his Pasadena location, and invites you to get a voucher toward facial fillers with a deal from Gilt City. $49 will buy you a voucher worth $100 toward a 1 mL treatment with Restylane or a family product. Limit 3. Or for $149, you will receive a $300 voucher toward a 2mL treatment.

Restylane and related fillers use hyaluronic acid. This filler mimics a chemical in the body, and has become a popular filler because of its soft, smooth, natural results. It can be used to plump up facial wrinkles and folds. These folds can become moderate to severe with age, and filling them helps to restore a smoother, more youthful appearance. Injectable fillers are often used in the problem areas around the mouth and are occasionally used to plump the lips, cheeks, or even the brow as well. Popular treatments include the laugh lines or nasolabial folds—those “parenthesis” lines that curve around the corners of the mouth. “Marionette” lines can develop that run from the corners of the mouth down to the chin, and these also respond very well to Restylane injections.

Skillful medical aestheticians can do wonders with hyaluronic acid fillers. They can greatly smooth the facial lines without causing an unnatural frozen look, and can last about a year or even longer. It is important to find a skilled technician. Dr. Yoho’s specialists will consult with you to determine the best treatment options. Restylane has very little downtime, and low occurrences of complications such as lumps or bruising. The vouchers must be used by September 30, 2012, so call our office today, and purchase your voucher. See the limitations and terms on the Gilt City offer before purchasing.

A Few Approaches and Considerations for Breast Implantation

Each breast implant procedure has drawbacks and advantages for different patients depending on the breast size desired, the patient's breast anatomy and the patient's chest size. One of the most important variables in this question is the patient’s breast volume. If the patient has a great deal of breast tissue, going over the muscle sometimes is the easiest and most comfortable way, and has the shortest recovery time. In most cases we do this through the armpit, using an incision of about half an inch in the highest area of the armpit. But when going through the belly button or navel, breast enlargement is usually performed underneath the muscle. Women with breasts that are not too saggy or are relatively small are the best candidates for this. Another general consideration is, if you have had children, your breasts will likely stretch out better to accommodate the implant.

Absolutely no scars in the breast area result from the belly button technique. The passageway is made from the belly button to underneath the breast muscle with a special instrument. Then, the pocket that the implant is going to rest in, is prepared and shaped with other instruments. A special “sizer” implant is placed and filled with air. Once the “sizer” implant is inflated, the pocket is further checked and shaped. The permanent implant is then rolled up like a little taquito, threaded through the small passageway and inflated with salt water. The patient is then checked while sitting upright. If everything looks good (e.g., the implants are centered under the nipples, and the space where the implant is appears to be just the right size), the tubes used to fill the implants are removed and the little valves on the implant automatically close. The belly button area is stitched up, and the patient experiences some drainage for about 24 to 48 hours.

What About Getting Botox at the Shopping Mall?

The quality of your Botox results depends on three things:

1. The number of units of Botox that you receive.

2. Exactly where those units are placed.

3. The concentration of the solution used.

The Botox injection community has shifted toward using both

· more units per volume of salt water injected into the face for fewer complications

· more units total for effectiveness and probably longevity

There are many, many subtleties to the placement of Botox. The most important thing for most women is for the medicine to relax the muscles that depress or bring down the eyebrows, which are the muscles between the eyebrows and the muscles out to the side of the eyebrows. In the hands of the best Botox administrators, very little Botox is placed in the forehead because this tends to drop the eyebrows. When proper Botox placement is achieved there is a beautiful eyebrow arch, and when the proper amount of Botox is used it will last longer.

I think any good registered nurse can be trained to administer Botox, and I have no doubt that there are a few Botox administrators who are operating in malls and at parties and other informal settings who do a great job. However, your chances of getting consistently excellent results are better if you stick with an established surgeon and understand that what he is doing did take training, practice and experience and is not easily duplicated without a similar background. It is not the M.D. after the name that counts, but rather the technique when using Botox.

All About Hand Rejuvenation

Did you know that if your hands look old, appear to have too many veins, or are discolored, we can make them look a lot better? There are, in fact, a number of ways we can improve the look of your hands. First, we can add volume to the hand. We prefer to do this by using your own fat, which requires taking fat from another part of your body where you would rather not have any fat. We then inject the hands with small amounts of this fat and massage it around the backs of the hands. Typically, the hand is also treated with a fractionated CO2 laser, to remove brown spots and age signs. This treatment results in a plumper, healthier-looking back of the hand with less aging signs.

Other filler products such as Juvederm and Perlane can also be used for hand improvement. These products are natural body substances that are retained in the hands for many months, and plump the backs of the hands in a way that makes them look much younger. Your natural fat, however, can be retained almost indefinitely.


_______________________

Robert Yoho, M.D.

Have You Heard About Dr. Yoho's New Skin Care Line?

Dr. Yoho has a special skin care line formulated just for his patients.

Our glycolic peel pads, which exfoliate dead skin cells while removing excess oil and impurities from the skin, are pretty strong, and so should be used with care. If you scrub your skin with these, you can get some redness which can last even up to a few days. So we recommend using these, at most, once a week, and only if you have oily skin.

We also have a night cream which has some ingredients that are among the most popular in the cosmeceutical industry. It's not greasy and shouldn't cause acne.

Our day cream contains Idebenone, which is in some of Perricone's products that cost $300 or more per bottle. All of our skin care is packaged in a attractive glassine container that handsomely showcases the modern creams.

Sunscreens--Again

Yosemite

I want to review again for our patients the importance of sunscreens and the types of sunscreens. It’s well-known that there’s an “SPF” number that supposedly tells the effectiveness of the sunscreen. This number is quite deceptive, and only covers one type of the light reaching the skin, the “UVB”. These sun rays do burn the skin, however there is a probably worse spectrum of sun rays called the “UVA” which causes deep penetration into the skin and ultimately probably cause more aging. These rays can be blocked at this time only by a particulate sunscreen or what’s called a micronized metallic sunscreen such as zinc, titanium, or iron. Fortunately, these tiny bits of metal are small enough to rub in clear and we heavily recommend that you use a sunscreen that incorporates both UVA and UVB protection. For UVB, of course, there are chemicals that have been used for years that are pretty effective, and we recommend sunscreens that have both the chemicals for the UVB and the particulate or “micronized” sunscreen for the UVA protection. One good sunscreen is the Fallene Total Block, which can be purchased at many pharmacies or online. This contains again both the chemical component for the UVB and the particulate component for the UVA. If rubbed in aggressively, many times this is almost a clear sunscreen. Dr. Yoho’s sunscreen has the particulate block which does block both the UVA and UVB, but not as well as the kind with the chemicals plus the tiny metallic particles. It’s excellent for those with sensitive skin and people who don’t tolerate chemicals on their skin. And you’re welcome to try a sample at our front desk. Otherwise, twice daily application of Fallene Total Block will cover all of your needs.

There have been many reports of vitamin D deficiency in the last decade and taking vitamin D is a good idea for most Americans or people who don’t get a lot of sun exposure. The recommended daily allowance is only 1000 IU per day, but we recommend 5000-10,000 IU a day. This certainly will do no harm and probably is the real requirement for someone who has vitamin D deficiency. Some reports have shown that as many as a quarter to a third of Americans has a vitamin D deficiency or near vitamin D deficiency so it certainly doesn’t do any harm to take vitamin D supplements.

The Brazilian Butt-Lift and Buttocks Fat Transplantation

A little Christmas in July-Christmas Tree in Mall of America

Did you know that as of May 2012 Dr. Yoho has been performing buttocks fat transplantation and facial fat transplantation for over 15 years? All the new hype about these procedures is kind of puzzling to Dr. Yoho. He has an enormous experience with this, including experience with the last time the public became aware of this, which was probably 12 years ago. He injects fat nearly every day of the week somewhere.

For buttocks, the amount of fat injected is not unlimited. Patients assume that just because it’s their fat that they can put all the fat that’s taken out of other parts of their body into their butt. This just isn’t true, because there is a risk of infection and other serious problems. We have had several thousand cases’ experience sculpting buttocks and injecting fat and have seen complications related to injecting too much fat. The shape of the buttocks is very important, and improving the area on top, on the sides, and underneath the buttocks is at least as important as the amount of fat injected for the final result. Patients often think more is better, and in this case there is definitely a limit for each procedure. However, the procedure can be repeated at 4-month intervals if you have more fat on your body.

Note that foreign substances such as silicone are being injected at house parties across the country by persons unknown, possibly individuals who don’t have medical licenses or who only have licenses from other countries. This injection of large quantities of these substances is an exceedingly dangerous practice and produces many bizarre and dangerous results. Just don’t do it. You may have a long-term problem where you may need a lot of surgical treatment to get rid of it and it may be actually seriously hazardous for your health. We are happy to discuss these issues when you come in for your consultation about your buttocks improvement surgery.

It's Never Too Late to Start Wearing Daily Sunscreen

Big Sur redwoods 2

The new sunscreens are fantastic compared to what existed in the past. There are two spectra of damaging light that sunscreens need to block: ultraviolet A (UVA) and ultraviolet B (UVB). The UVB are the burning rays, and the chemicals that are typically used in sunscreens do a pretty effective job of blocking these rays. The new chemicals don’t usually cause sensitivity or allergic reactions, either.

The big problem is UVA. These rays penetrate deeply into the skin, destroy facial fat deposits, and cause long-term damage that isn’t marked by immediate sunburn. There had been no chemical way to block these, so the clever scientists were able to make physical particles smaller and smaller until they could be rubbed into the skin and actually block out a great deal of the radiation. Formerly, zinc oxide (or Desinex) cream was used by skiers, lifeguards and other people who needed heavy-duty ultraviolet protection. Zinc oxide preparations were available in colors, so you may remember skiers putting colored cream on their noses and cheeks like war paint. However, the new preparations contain micronized (very, very small) particles that can be rubbed in, and are virtually colorless on the skin. These also generally don’t cause any allergies, but they might be a little bit less elegant than the more creamy chemicals that are used to block UVB.

Our particular proprietary sunscreen contains the particulate zinc and iron that can be rubbed into the skin and is a good alternative, particularly for those with dark skin. For those needing the total block, such as those being treated for dark spots on their skin, or people who’ve had cancers or who really understand how important it is to keep the sun off of their skin, we recommend Fallene Coat Total Block. This contains both the particulate block for the UVA and the chemical block for UVB. You can buy this online or in many pharmacies.

One last consideration is vitamin D deficiency, which is somewhat controversial but thought to be a relatively common thing due to the sunscreens. It doesn’t do any harm to take a vitamin D supplement, 5000 IU per day, which is more than is generally recommended by the FDA.

Scared of Needles But Want the Benefits of a Cosmetic Specialist?

Seattle Harbor at Night

We are specialists in “scaredy-cat” patients. Are you afraid of needles? Dr. Yoho has special techniques to make your experience in surgery or even a minimally invasive procedure as painless as possible. For example, he has a method where he starts an I.V. using a very tiny needle and a tiny amount of local anesthetic and almost no pain is perceived by the patient. Before the local anesthetic is put into the skin, he scratches the area in order to fool the nerves and most people feel nothing at all.

Also, many “non-invasive” procedures are performed with just numbing cream placed on the face. Dr. Yoho believes that all of his patients should have a chance to go to sleep briefly if they wish, and accordingly, offers his “non-invasive” patients no-charge sedation for their procedure. Of course, they need to be accompanied by a person who can drive them home, but they generally feel fine within 15 minutes of waking up, because the sedation medicine is so short acting.

Additionally, we use a special Botox needle that most people can’t feel. It’s a 32-gauge needle, which is smaller than was ever available a few years ago. By pressing the fingernail into the area to be injected, the nerves again are fooled and often the patients feel no injection for the Botox.

About Breast Implant Warranties

For all patients that have had Mentor implants within the last ten years: you can switch to saline whether you have a deflation or not, and all you have to do is pay $300 for each implant to go from saline to silicone, which are over the muscle and much better. They’ve come out with a new silicone implant that’s made of gel and FDA-approved and people have had a great success with it.

Allergan implants are a little different, and you can call our office and give us your information. If you are ten years out, you still get $1,200 or $2,400 if you upgraded. And they will replace one side, possibly two.

But you’re more than welcome to call our office at 626-585-0800 and ask us about the warranties on the implants, because many people are coming up on the ten-year cutoff.

Massage Therapy of Breast Implants and Breasts After Breast Implantation

On the beach in Trinidad

Most surgeons believe massage to be of critical importance after breast implantation, as it is thought by most to decrease the chances of firming of the breast or capsular contracture. We generally recommend massage, but it must be done in specific ways, so please discuss this with Dr. Yoho during your follow-up visits.

During the first few days after breast implantation, you do not have to massage your breasts because generally they are too tender. But if you can handle a little light massage, this will help you get the best results. The first object of massage is to keep the area above the implant open. In order to do this, you squeeze the bottom of the breast implant and breast with your thumb on one side and your fingers on the other, several times a day. Again, these techniques must be individualized, so if your breasts are taped up or you are in a special garment, don't massage it until after your first follow-up visit.

The other wonderful thing about massage is that you can reshape your breasts, particularly in the first few months after your implantation, with the proper massage. For example, in order to lower or increase the pocket in an area that seems to need a larger pocket, in other words, if there is a little flat area, pull up on the skin right next to the fold, push the implant down, and massage right along the fold with your other hand. We will demonstrate this technique in follow-up. If your fold seems too high on one side, you can lower the fold a bit by doing this type of massage. Examine the lower part of your breasts where the chest skin meets the upward swell of your breast, so you can understand the curve and how each breast is different, because they are always a little bit different. You can dramatically improve your breast implant results by the proper massage.

We also use a variety of support bras to improve the result. We strongly recommend that most patients wear bras continuously for the first nine to twelve months after the breast implant procedure. Many patients are a candidate for a properly fitting under-wire bra relatively soon after the surgery, but if you have an under-wire bra that sticks into your breast, that's not proper so please don't wear anything like this. If you're having discomfort, we want to know about it and see you as soon as possible. Please stay in close contact over the telephone and by coming in for your follow-up as directed in order to achieve the best results. Remember that your surgery is not done the moment you leave the office, because if you don't follow up and you don't follow our instructions properly, you may have breasts that hang too low, or have one breast higher than the other, or run into a variety of other complications. Rarely do we need to perform a second surgery to improve a result, and this is generally not necessary in a patient who is able to follow directions about bra wear and massage properly.

We Frequently Have Our Thank-Yous Delivered by Florists

The accompanying photo is of a beautiful flower arrangement that was given to us by a patient who had just had a large-volume liposuction. She gave us a little card (I cut her name out of the card so that it would protect her privacy online). She was very enthusiastic about her results. She could tell that she obtained a beautiful result even four days postoperatively, which is when we received the flowers.

Dr. Yoho and Judy Go to Swim Camp in the U.S. Virgin Islands

Recently, Dr. Yoho and Judy decided to improve their swimming technique and went to the U.S. Virgin Islands for a camp which consisted of four hours of swimming a day. It wasn’t as hard as you might suspect, because a lot of it was instruction. Judy was at about the dog-paddle stage. Dr. Yoho had a confident stroke, but it wasn’t very refined and he’d never swum on competitive teams in the past. The mission was to attempt to learn “total immersion” technique from Terry Laughlin, who can be found at http://www.totalimmersion.net/ with lots of videos to explain this particular kind of swimming. The object is to swim long distances without expending a lot of energy. It’s harder than it looks, and despite swimming four miles once during camp, Dr. Yoho has still a long way to go in his technique. Judy made great improvements and had great instruction and had a lot of fun, but is still not a super-confident swimmer. They thought that few of these photographs might be fun for our patients and friends to see.

We recommend active and healthy lifestyles, and here is a link to our website where Dr. Yoho recommends nutrition advice as well as exercise advice.

Have You Heard About the Liposuction Revolution?

Dr. Yoho (while NOT performing liposuction) and friends

There is a new device that we have had for several months that has revolutionized our ability to extract fat in a safe, even fashion. This instrument is a mechanical device which rotates 360 degrees in each direction every second. And this motion is safe and makes the liposuctionist's ability to extract fat in an even, rapid fashion much better. 

Our experience with this has been all positive. We've never had any significant complications. We seem to be cutting our times down by about 25 or 30 percent, which helps the patient because they receive less anesthetic and therefore are not as groggy after the case. Having them get in the compression garment sooner is a big advantage because the tissues don't have time to get swollen. 

There is nothing else different about how we do the procedure; we use the same local anesthetic and the same sedation techniques we describe in our other blogs, and the operation by the surgeon mimics identically the stroking that is necessary in the older technique. 

We would like you to come in and we can show you this device and tell you more about how it has improved our liposuction results in practice.

The Best Thing Since Sliced Bread

We believe our Fractionated CO2 laser, the SmartXide DOT is absolutely fantastic and many of the experts in the field have said that it’s a huge advancement in laser technology. 

The technique is that the laser sprays tiny treatment areas—literally, many tens of thousands of them onto the face with each treatment.  It leaves bridges of normal skin in between the treated areas which are very tiny and which allow the face to regenerate in a very natural fashion.  The treatment takes about fifteen minutes. 

We have had great results with people of all different skin types; and particularly with moderate, intermediate skin types such as Hispanic and Middle Eastern skin types.  The color improvement can be marvelous.

Please come in for your free consultation as soon as you can so you can get your laser treatment lined up.  We offer free sedation if you have a driver--and your experience will be a very pleasant and relaxing one; furthermore, you won’t even remember the procedure!!!



Fractional Laser Improves Skin Color Irregularities in Previously Laser-Damaged Skin

Gorgeous getaway--Dr. Yoho vacation photo

We have a patient who had a prior laser procedure on her neck and had irregular pigmentation where there were some white areas and some darker areas. This individual had this problem for over ten years and had tried all kinds of things, including the Fraxel laser treatment, which is another wavelength than the fractional CO2 laser, even though the names sound very similar. 

With a couple of fractional CO2 laser treatments with our SmartXide DOT laser, all of the skin on her neck evened out to a healthy tan color and the “splotchiness” went away. We think that these fractional CO2 treatments stimulated the pigment in the areas that were lighter and also took away pigment in the areas that were darker. It just has a very nice quality of evening the skin texture and color and making a much more pleasing and youthful finish on the skin. It has been quoted to be one of the biggest advances in laser technology we've had in the last 15 years by at least one famous dermatologist, and we believe this is true. We have more or less abandoned use of the other treatment modalities for light and intermediate depth peels because the fractionated laser works so well. 

We only charge $750 for a full-face laser treatment and a bit more for face and neck and chest. Many of the dermatology offices charge twice this. We use this as an accompanying treatment in many of our surgeries and the patients really appreciate their results.

Did You Know That the Upper Pelvic Area of Female Anatomy Has Different Standards of Beauty in Different Cultures?

In certain South American cultures, the area below the belly and above the vagina is deemed very beautiful if it’s plump and even a little over weight by most American standards. Certain people and certain cultures like this area bigger, and fat transplant can accomplish this if you think that your area is too thin.

For the most part, however, American women like this area liposuctioned when we liposuction the rest of their trunk area or torso. We do this as a matter of course unless there are other requests.

We occasionally come across someone who has a different standard of beauty and for these people fat transplant is not appropriate.

So it’s entirely up to you. We can change your body the way that you think is best by either fat transplant or liposuction. Please come in for your consultation to see just what we can do for you.


All the best,


Robert Yoho, M.D.

If My Breasts Are Uneven After My Implant Surgery, Can I Have a Touchup?



Dr. Yoho and Judy Yoho enjoying some time away from the office

These cases are very individual. Many times the breast implant surgery is a compromise between creating scars on the breast by doing more incisions, and having the best shape. Each case is its own animal, so to speak, and we need to carefully evaluate and do a lot of thought before touching up breast surgery.

That said, if your breasts are significantly uneven after our initial surgery, sometimes a simple procedure is all that is needed to make them closer to perfect.

Touching up breast implant always involves further risk of capsule formation or hardening of the breasts. This problem probably increases with every additional surgery on the breast, and additionally, careful attention must be given to the original approach to the breast implant to be sure that we’re not cutting off additional circulation to the breast tissue. The rule of thumb is that if it’s possible, we need to use the same incisions as were used originally. We view these cases as a challenge, and we need our patients to have proper expectations about this sort of surgery. Particularly, patients need to understand the idea that a second touchup might be necessary in cases like these.

Generally, the implants are changed out with new implants if the implant space is entered.

Most of this depends on you: Your psychological setup about your expectations, your level of perfectionism, but most importantly, just what your breasts look like and how much breast tissue you have to work with over top of the implant.

Breast wishes,


________________________
Robert Yoho, M.D.

Did You Know That You Can Have Your Breast Implants Insured?

 No, this doesn’t mean that you’ll get a million dollars if one of your breast implants ruptures and you’re not as pretty as you were before. It does, however, mean that for ten years your surgeon will be paid to replace your breast implants if there’s a deflation or loss of volume in your implant. The insurance covers both implants, and you can get the other one replaced at the same time as the problem implant at no extra charge. The fee is just $100 and you have to turn in your insurance forms and pay your $100 within 30 days of your surgery in order to get this special coverage. We recommend it to all of our breast implant patients and we think it’s really worth the nominal fee.

Breast wishes,
______________________

 Robert Yoho, M.D.

Dr. Yoho’s New Skin Care Product

We have developed a new skin care product that is better than anything we’ve tried before, and we’ve been using it for our patients with sun damage and irregular skin and have found that it has impressive results for our patients. This new skin care has a special fresh ingredient without preservatives, so it has to be refrigerated. The product creates new collagen in the skin and turns over the surface skin in a way that makes your skin refreshed-looking and usually lighter in color (producing a more even appearance). 

Note that if you’re not using sun screen, any skin care or special products just won’t work very well. The sun is your enemy in this department. And if you don’t wear your sunscreen, no skin care which is supposed to improve your skin will stand much of a chance. 

We recommend Fallene brand sunscreen, which has both a chemical and a physical sunscreen product included. The physical sunscreen are tiny particles of metallic substance which will go on clear if you rub it into your skin, and this provides instant protection in addition to the chemicals which absorb the sun’s harmful rays.

Botox and the New Botox Medications

One of Dr. Yoho's daughters at the Louvre

Botox is one of the most popular cosmetic procedure options ever, and certainly there are more Botox treatments than any other kind of cosmetic surgery performed in America. Unfortunately, the material only has an affect for three to four months or a bit longer and has to be repeated, but the good side is that if you repeat it regularly for a year at three-month intervals to four-month intervals, less Botox is probably needed.

The other good news is that a cheaper Botox is available now and this is called Dysport. Despite claims of the manufacturers that one is superior to the other, we find these products in practice to be virtually identical, with the advantage of Dysport being a bit less expensive. Whether or not the surgeon passes this savings on to the patient is up to the individual surgeon.

Also, surgeons are ordering these products from outside of the country. This is actually against the law, but in practice, the material seems to be identical, although the bottles can be identified by someone who knows what they’re looking for. Dr. Yoho does not use out-of-the-country Botox or Dysport. 

The second piece of good news is that a new neuromuscular blocker or muscle relaxer is on the horizon and slated to be marketed this year, hopefully for a lower price even than Dysport. We would love to have a product that lasted longer, but we’ve heard no reports to the effect that this new Botox lasts any longer. Hopefully, though, we will be able to pass the price savings on if the new product turns out to be virtually the same as Botox or Dysport.

So don’t believe any claims that one of these things is better than the other. The skill of the injector, the amount used, and just where the material is placed are the critical variables in how long it lasts and what kind of a result you have. Remember to check with your administering surgeon or medical aesthetician two weeks later if you have any question or problem with your Botox or Dysport result. Often there will be a little irregularity in the response or a problem that can be fixed with a few units of additional material, and we do this for free.

What We Feel is Most Important for Breast Implants After the Operation

Today, Dr. Yoho brings you a two-for-one blog post

We emphasize the big three. Number one, support. Number two, fish oil. And number three, Vitamin E. 
 The support will help maintain the shape of the breast. The breast is sort of like Silly Putty, and it will gradually sag if not supported aggressively with the weight of the implant. Sometimes young people can get away with breasts that don’t sag so much for a while, but in the long run gravity catches up.

The other two things we emphasize after breast surgery involve prevention of capsular contracture. Capsular contracture or firming of the breast implant is the most common problem after breast surgery. We really think that Vitamin E is very helpful and have seen patients who weren’t taking their Vitamin E soften their breasts after starting just the Vitamin E. We recommend 800 IU a day in tablet form. This along with the fish oil can be purchased at vitacost.com.

Fish oil is now regarded as an excellent anti-inflammatory. Dr. Yoho takes it in large quantities himself for foot arthritis. We recommend a teaspoon of the fish oil a day and recommend the purified fish oil such as Nordic Naturals, Carlson’s brand or Eskimo brand fish oils. If you must take the capsules, you can take at least four a day, and if you actually have the start of firming of the breasts, Dr. Yoho may recommend a larger dose for a few months. 

Breast wishes,

 _______________________________



Robert Yoho, M.D.

The Advantage of Coming to See Dr. Yoho for Non-Invasive Procedures If You Are Prone to Anxiety

Did you know that because Dr. Yoho’s office is an accredited surgical center with AAAHC accreditation, Dr. Yoho has the ability to use intravenous medications for your more minor procedures as well as the major ones? We have patients that are scared of needles, which is a common phobia. We administer a little bit of relaxation medicine to these patients so they don’t feel anything at all during their Botox injections. Even for those who don’t have needle anxiety, we have reduced discomfort by using 32-gauge needles, which are the smallest needles commonly used in clinical practice. These can hardly be felt during administration of Botox. 

Additionally, we offer no extra charge sedation for our procedure with the fractionated CO2 laser, a procedure which has been popular and successful. You do need to bring a driver if you have sedation administered to you, but this is the only other requirement. We feel the risks are virtually nonexistent for the small amount of medication you’re given in order to accomplish these procedures in a way that’s pain-free and that erases memory of it. Additionally, you can use these procedures for fillers or any other minor surgical procedure if you are one of those people who is a bit anxious about discomfort. Lastly, we can get that intravenous line in your vein with no pain whatsoever in 90+ percent of the cases and in a fashion that most people won’t notice.

 

I like my breast size but they’re just saggy

Is there any way to do a breast lift and preserve my breast tissue?

When he's not in surgery, Dr. Yoho is with his family. Dr. Yoho's daughter in a light moment.

The answer, of course, is if your breasts are appropriate, we can preserve every bit of breast tissue you have and make them much perkier. The “LeJour mastopexy” that we do has a variation that allows for no removal of breast tissue whatsoever. In fact, this is the most common lift procedure we perform. Ordinary breast lifts typically remove 10 percent to 50 percent of the breast tissue, resulting in much smaller breasts.  

 Be sure to ask Dr. Yoho about the breast-preserving breast lift on your next consultation.

How Much Does It Cost For My Facial Procedures?

Moment from a great family vacation (not related to facial surgery).

Many people desire correction of one or two facial problems, such as a very weak chin or saggy eyelids. However, traditionally and very reasonably, when we work on a face, we often will correct all the defects in one appointment. This can include facelift, eyelids, skin resurfacing with peeling, and Botox and filler. Additionally, in most patients facial implants are very helpful, especially in older patients who have lost their fat volume.

Although we price our facelifts at $4,999, we’re willing to do whatever is appropriate for your face for $10,000. This includes all the above treatments, with the exception of nose surgery, which is a whole other specialty and a separate operation, in our view. We will evaluate you and do whatever is appropriate and whatever procedures you agree to have for this price. We think this is reasonable because the typical facelifts are at least $7,500. Facial implants range from $2,500 to $7,000 for one area and the peels can be $800 to $4,000. Eyelids range from $2,500 to $5,000 for uppers and the same for lowers.

We always use our sedation technique with a single agent and our patients don’t have to undergo general anesthesia. They have a reasonably comfortable experience with any nausea or problems afterwards being extremely rare. This is all included in the above pricing scheme.

The Use of Sticky Foam After Liposuction

Dr. Yoho climing El Capitan. No sticky foam here!

Reston foam was commonly used by liposuction surgeons worldwide ten to fifteen years ago. Its utility involved pasting the loose skin just exactly where the surgeon wanted it to the muscle tissues after the liposuction procedure. The advantage to this is that the girdle and the patient’s movement were unable to distort the skin placement and produce strange wrinkles that would take many months to go away. The disadvantage of this was the possibility that the patient would become irritated from the adhesive, have an allergic reaction to the adhesive which would produce a red skin or a rash, or even tear the skin when they were taking the adhesive-backed foam off.

Our solution to these problems is as follows: We instruct our patients very carefully to watch their skin irritation level and come right back into the office if they’re having any problems or any pain. We tell them to soak in a bath at day four, and this dissolves the adhesive to some degree, and then at day five after the surgery, they can more easily remove the adhesive-backed foam. While this is not a comfortable process, we’ve found that the foam, particularly in the front of the abdomen (not so much the sides) generally produces a far smoother result with much less irritation, despite the aggravation of having to take the foam off.

That said, pigment problems, areas of skin irritation or even superficial loss, and some other problems occur with the foam. Despite this, use of the sticky foam is exceedingly helpful, particularly in large-volume liposuction cases.

Another alternative to the foam is if the responsible patient is able to massage the area from day one or day two after the surgery, they can keep the wrinkles from occurring. This usually has to be done, however, in a lying-down position because the patients have a tendency to feel faint when they take the garment off this early.