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.


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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.