July 26th, 2014 Dr. Mele
Breast Augmentation and Breast Lifts are complementary procedures. The Breast Augmentation Lift can restore perky, youthful contours to the deflated, sagging breast. With the large number of Breast Lifts and Breast Implants available, there has never been a better time to have the procedure. On the other hand, with so many choices, how do you decide what will work for you? As a Board Certified Plastic Surgeon, I help women navigate their plastic surgery options every day.
Breast Augmentation Lift Video Presentation
One way I can offer advice is via KRON 4′s Body Beautiful. This live television show covers current plastic surgery and allows viewers to call in with their questions. This Breast Augmentation Mastopexy Video segment details how the combination provides the best breast enhancing aspects of Breast Enlargement and the Breast Lift. In other words, it’s a breast lift that can add volume, especially for the empty upper breast. Augmentation Mastopexy can change sad and saggy breasts into proud and perky breasts.
Breast Augmentation Lift (Mastopexy) Video
What Breast Augmentation Mastopexy Does
Breast Augmentation and Breast Lifts are complementary procedures. Breast Augmentation adds volume to the breast. The Breast Implant can be used to enlarge the entire breast, or more selectively enhance upper pole fullness. This selective enhancement can correct the situation when you are happy with your cup size, but the breast does not fill the upper half of your bra’s cups.
Breast Lifts reshape the breasts. Not all Breast Lifts are created equal. There are many types of Breast Lifts that are used for correcting sagginess ranging from slight to massive. It is important to choose the correct lift to get the best results. A Mastopexy alone does not change the breasts’ volume. When less volume is desired, a Breast Reduction is performed. When more volume is needed, an Augmentation Mastopexy is best.
Breast Augmentation Lift Before and After Pictures
Breast Augmentation Mastopexy can lift the breast and add volume for a perky, and full, breast.
How to Choose Your Breast Aug Mastopexy
The combination of Breast Augmentation and Breast Lift is one of the most complicated plastic surgery combinations, but it can also be one of the most rewarding. It requires a thorough, in-person examination and discussion with an experienced, Board Certified Plastic Surgeon to formulate the best plan for you.
For more information about Breast Augmentation Mastopexy or any Cosmetic Plastic Surgery, give me a call at (925) 943-6353, or use the contact form in the column. A personalized consultation appointment is the best way to get the specific information you need.
July 19th, 2014 Dr. Mele
Facial Augmentation encompasses everything from Dermal Fillers like Restylane, Juvederm, Perlane and Radiesse, to chin, cheek and nasal implants. Facial Fillers and Facial Implants are used to replace lost volume, restore facial support and to create more pleasing facial proportions. Facial Fillers are a great way to try out your new Facial Enhancement; however, fillers require periodic maintenance, while Facial Implants can provide long lasting correction.
Facial Augmentation: Chin, Cheek and Nasal Implants
Facial Augmentation is used to provide harmony between the different features of the face. The size of any single facial feature is not as important as its proportion to the rest of the face. For example, a small chin will make the nose look larger, while a large chin will make the nose look smaller. Facial Plastic Surgeons use this to our advantage when we evaluate a face. It helps guide us to the safest, most predictable and thus best methods for enhancing your face.
There are many types of Facial Implants. The most common facial implants are chin implants, cheek implants and nasal implants. Like us, they come in many shapes and sizes. This allows Board Certified Plastic Surgeons to select the implant that is most harmonious with your face.
Facial Enhancement with Chin, Cheek and Nasal Implants
I had the opportunity to discuss Facial Augmentation on KRON 4′s Body Beautiful recently. The video from this television show focuses on Facial enhancement with chin implants, cheek implants and nasal implants. The procedures, recovery and outcomes are discussed, and before and after pictures are revealed.
Facial Augmentation Video Featuring Facial Implants
Facial Augmentation Frequently Asked Questions
Many of the most frequently asked questions about Facial Implants are answered in the Facial Augmentation Video above. Some of the topics discussed include:
- The most common Facial Implants
- Dorsal Nasal Implants
- Chin Implants
- Cheek Implants (Malar Implants)
- The differences between Dermal Fillers and Facial Implants
- Can you choose a shape for your new Chin Implant?
- Who is a candidate for Facial Augmentation?
- The importance of Facial Proportions – Math helps!
- How are Facial Implants placed?
- How do Cheek Implants help the eyelids?
- How do Chin Implants effect the nose?
- What is the recovery period associated with Facial Augmentation?
Facial Implants Before and After Pictures
Before and After Pictures of the most frequently used implants for Facial Enhancement are also included:
- Before and After Nasal Implants Pictures
- (Nose Implants for enhancing a nose that is flat between the eyes)
- Before and After Malar Implant Pictures
- (Cheek Implants to enhance the cheeks and support the lower eyelids)
- Before and After Chin Implant Pictures
- (Chin Implants enhance the chin and shrink the appearance of the nose)
Chin, Cheek and Nasal Implants
If you are seeking more information about Chin, Cheek and Nasal Enhancement, call (925) 943-6353, or contact me through the form in the side column. While the Internet can provide good general information, only an in-person consultation with a well trained and experienced Cosmetic Plastic Surgeon can get you the details required to make an informed decision. I frequently use Computer Imaging to help me understand what you are looking for, and to explain what can be expected. This makes Plastic Surgery, personal surgery.
July 12th, 2014 Dr. Mele
This weekend the San Francisco Bay Area is focused on protecting your breasts. The Avon Walk for Breast Cancer: San Francisco and Breastfest are both happening today at Fort Mason.
Avon Walk for Breast Cancer: San Francisco
2014 Avon Walk for Breast Cancer: San Francisco Map
The Avon Walk for Breast Cancer: San Francisco kicks off this morning. It is one of the most scenic breast cancer walks available, incorporating North Beach, my home during my Plastic Surgery residency, as well as Pacific Heights, Fisherman’s Wharf, the Ferry Building, the Presidio, the Golden Gate Bridge, Sausalito and the Marin countryside. Saturday’s route is 23.8 miles and the walk continues on Sunday with another 15.5 miles. An optional 2.5 mile additional loop is available for those who want to walk a full marathon before recuperating at the Wellness Village, located at the base of Mount Tamalpais.
More than 192,000 Avon Walk participants have raised donations of over $500 million to breast cancer programs since 2003. The dollars are used both nationally and locally to help in the research, diagnosis and treatment of breast cancer. Today’s event promotes healthy activities and supports patients, centers and treatments alike. The event funds safety net hospitals and provides access for those who may not otherwise be able to afford, or understand, the complexities of breast cancer treatment.
Last year’s Avon Walk for Breast Cancer made a large impact on local efforts to fight breast cancer. Some of the San Francisco Bay Area organizations which benefitted include:
- $700,000 to San Francisco General Hospital for patient care and research
- $300,000 to the University of California, Berkeley to research environmental exposure risks for breast cancer
- $150,000 to Stanford University to research tobacco smoke and Bisphenol-A interactions with breast cancer
- $125,000 to Zero Breast Cancer to research genetic and environmental factors leading to breast cancer
- $110,000 to the Alameda Health System to support the breast cancer patient navigation program
- $110,000 to the Women’s Cancer Resource Center to support breast cancer patient care
- $150,000 to the Charlotte Maxwell Complementary Clinic to support complementary (not alternative) breast cancer patient care
- $200,000 to Project Open Hand to provide nutritional support for patients with breast cancer
Non Walking Breast Cancer Support Also Available
BreastFest 2014 Kicks off in Fort Mason Center at 2 PM – 6 PM today.
If you prefer a cold brew to a long walk, an alternative is available. In fact, this complementary event supports complementary approaches to Breast Cancer Treatment. BreastFest has been supporting the Charlotte Maxwell Complementary Clinic since 2000. The first Brewfest was held in Marin County, CA, hosting 16 local breweries. The 2014 event is expected to have more than 80 breweries supporting the cause. The 2013 event raised over $40,000.
July 5th, 2014 Dr. Mele
Dr. Mele’s profile is featured in this month’s Diablo Magazine’s Best of the East Bay edition
Diablo Magazine’s Best of the East Bay
Diablo Magazine‘s Best of the East Bay is out this month. The edition features the best people, places and things to do in the East San Francisco Bay Area. This year’s people include Golden State Warriors point guard, Steph Curry, and Sharknado director Anthony C. Ferrante. New places include dining at the Cooperage American Grille in Lafayette, CA, and Cosplay at East Bay Comic-Con in Concord, CA. One of my favorite Walnut Creek, CA, restaurants, Vanessa’s Bistro 2, also made list for Diablo Readers Pick for their Vietnamese cuisine. While perusing the glossy Diablo Magazine pages, be certain to look for the Joseph A. Mele, MD, FACS, profile. Thanks again this year, Jessamyn and Robert of Jessamyn Photography for making me look good.
Board Certified Plastic Surgery since 1997
I decided to go into Medicine as a Sophomore at Campolindo, and I was fortunate to be able to remain in the greater San Francisco Bay Area for both my training and private practice. It was a long path, which included eight years of training after medical school, with chief residencies in both General Surgery and Plastic Surgery. This allowed me to become Double Board Certified by the American Board of Surgery and the American Board of Plastic Surgery.
World Renowned Professional Societies
The training also allows me to be an active member of some the world’s premier professional societies. Some of these organization are listed below, and more information on each is available by clicking on their names:
Even the best training is meaningless without the ability to apply the knowledge to improving my patients’ lives. Providing High Patient Satisfaction is what keeps me working hard, refining the traditional and learning the latest techniques in Cosmetic Plastic Surgery. Balancing safe and effective with cutting-edge techniques is how I continue to improve my Walnut Creek Plastic Surgery practice.
If you are considering Cosmetic Plastic Surgery, give me a call at (925) 943-6353, or contact me through the contact form on this page. I specialize in cosmetic plastic surgery, both Facial Plastic Surgery and Body Shaping procedures.
June 28th, 2014 Dr. Mele
An ounce of prevention is worth a pound of cure, so every few months I dedicate a post to preventative medicine. Simple actions can have profound effects. Using sunscreen, not smoking and Breast Health Screening are all areas that we hear about so often that the message can get lost. In an effort to catch our attention, the message can also get distorted.
The Crystal Ball of Medicine
Can your doctor predict the future?
It’s hard to predict the future, but doctors are asked to do so every day. Usually we are right, because we can recognize patterns in symptoms or behaviors that are likely to result from a specific disease. Our knowledge of the natural history of the diseases we treat gives us a meaningful basis on which to plan the best treatment. Practicing medicine is made difficult because diseases, and people, do not always behave as predicted. Sometimes, even with the best intensions, in a effort to do good, bad things happen.
If Medicine Were As Simple As Using Google
The Internet is a wealth of information. Not a day goes by without a patient asking me about something they read on-line. When I started my practice in 1997, much of the information about Plastic Surgery was not very helpful. Providing accurate Cosmetic Surgery Information, that is accessible, remains the reason I continuously update my websites and the San Francisco Plastic Surgery Blog. It is still a challenge I enjoy and requires constant investigation into what is new with an open mind and a healthy dose of skepticism.
If it Sounds too Good to be True, It’s Likely False
Rarely does a new technology come along that provides treatments that are safer, more predictable, more effective, cheaper, faster, less painful and with less downtime. Patients, doctors and even insurance plans are constantly searching for these panaceas, and rarely they emerge. When they do, this is called progress. Unfortunately, our desire for progress can sometimes blind us from the truth.
Breast Health Screening
Amy Robach and the Mammography Machine that Saved her Life.
Lately, the information distortion in the area of Breast Health Screening seems to be getting worse. And to be fair, the “facts” can be counter intuitive and are sometimes, frankly contradictory. A study recently publicized out of Canada, the Canadian National Breast Screening Study (CNBSS), showed no difference in breast cancer related mortality in screened women versus a “control group”. For those opposed to mammography, this has added more fuel to their side of the fire. The national news has picked this up story as the headline. It makes good news, but it makes poor medicine, because the rest of the story remains buried.
I posted about Mammograms last year, when Amy Robach was diagnosed at 40 with breast cancer after being coerced into getting one for a feature story on Good Morning America. Her story exemplifies the benefits of breast health screening, and demonstrates how silent tumors can be revealed with the proper test. Another (former) GMA Host, Joan Lunden, has also recently been diagnoses with breast cancer after breast cancer screening that included a normal Mammogram and a positive screening ultrasound. On the other hand, most of the lumps found and biopsied with screening are not cancer, and some will argue that the anxiety and expense of screening and treatment outweighs any benefits.
Fact: Breast Screening Works
Breast Health Screening has been shown to reduce both the morbidity (disfigurement and illness) and the mortality (death) associated with breast cancer. This is clearly and significantly demonstrated in seven large randomized controlled studies. The CNBSS study is the only one that failed to find a reduction in breast cancer mortality with screening mammography. The headline should not be Mammography Fails to Prevent Death from Breast Cancer. The real question should be, Why did the CNBSS fail to demonstrate the benefits of breast cancer screening that other large studies have?
What’s Wrong With CNBSS?
Amy’s story showed what can go right with breast cancer screening. The CNBSS story showed how a poorly designed study can hide the facts, so what’s wrong with the study? Space limits me from expanding the details, but a superficial look at the study reveals several problem areas:
- A Poorly Selected Control Group – The screened group was selected to include more large palpable cancers. In effect, the screened group was a higher risk group when compared to the control group. A better way to think of the study’s results is that with screening, the higher risk group lived just as long as the lower risk group did without screening.
- Poor Mammogram Image Quality – The CNBSS study is a twenty-five year old study with twenty-five year old technology. Older mammogram techniques have since been replaced with digital mammograms and Tomosynthesis, which allows for more accurate readings, especially in younger women or women with more dense breasts.
More Recent Studies
Tomosynthesis promises better pictures with lower radiation and more accurate results for breast cancer screening. Unfortunately, it still requires compressing the breasts.
Between 2001 and 2014, studies using more modern mammography have demonstrated a 25-50% reduction in breast cancer mortality for women between the ages of 40 to 74 years. This leap has been made possible largely by moving from film based mammography to digital mammography. In this month’s Journal of the American Medical Association (JAMA) the next leap forward may be emerging. In the article Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography, adding tomosynthesis to screening digital mammography decreases the “recall” rate by 15% while increasing the cancer detection rate by 29%. Sounds too good to be true. Is it? Critics point to the fact that the study was funded by the company providing one version of the tomosynthesis machine. Moreover, more objective readers will note the study is retrospective, i.e., digs through old data to find trends. Only well designed, large, prospective, randomized, multi-center clinical trials, which can evaluate all four currently available tomosynthesis systems can answer if there really is a benefit. These take time and money, and need to be planned better than the CNBSS study.
So many Studies Show Progress. Why Doesn’t This Make the News?
In medical speak, the tomosynthesis data is biased and retrospective, but encouraging. It suggests real progress, but further research is needed. Not exactly a sexy headline, but the truth. Doctors are conservative by nature, because we know lives are at stake. The lives of people we know and care for are at stake. We are taught tried an true methods that we know are not perfect, but are the best available. This takes years of formal training, a lifetime of ongoing education and years of experience treating patients. Moving away from tools that work requires more than a sexy headline. It requires objective evidence. Unlike a Google search, objective evidence takes years to research and tends to be slow, methodical and boring. What makes it harder to explain is that the results are never black and white. The results are always grey, they vary by patient and so we play the odds. Always striving for the path most likely to give the results we and our patients desire. Always striving to influence the future, even if we can’t predict it.
June 21st, 2014 Dr. Mele
I have noticed my San Francisco Bay Area Breast Augmentation patients are some of my happiest patients, and a recent study out of Philadelphia, PA, shows this is a national trend. Over 600,000 women had Cosmetic Breast Surgery last year, with more than half choosing Breast Augmentation. Recent improvements in Breast Implants‘ quality and choices are providing women with safer and more predictable options for Breast Enlargement in the Bay Area.
New research confirms what plastic surgeons have known for years.
Breast Augmentation does more for a woman than just enlarging her breasts.
Breast Implants and Patient Satisfaction
According to an article recently published in Plastic and Reconstructive Surgery, Breast Augmentation is associated with high patient satisfaction and significant improvements in quality of life.
Who Gets Breast Augmentation?
The study entitled Understanding the Effect of Breast Augmentation on Quality of Life: Prospective Analysis Using the BREAST-Q followed 611 women with an average age of 33.5 years and an average BMI of 21.7 for 6 months. The average Breast Implant Size was 360 cc’s and 73% chose silicone gel filled breast implants over saline. These demographics are very similar to my San Francisco Bay Area Breast Implant patient population.
Mommies get Breast Augmentation. The Mommy Makeover above includes a Tummy Tuck and Breast Augmentation.
How Happy are Breast Augmentation Patients?
Significant improvement in patient satisfaction was demonstrated at 6 weeks and 6 months after Breast Augmentation in multiple areas including:
- Satisfaction with Breasts (p<0.001 Kazis effect size of 3.66)
- Psychosocial well-being (p<0.001 Kazis effect size of 2.39)
- Sexual well-being (p<0.001 Kazis effect size of 2.56)
Younger women tended to be more satisfied with their “new” breasts than older women. Not surprising, since younger women tend to have firmer breasts and more elastic breast skin, and both factors contribute to better results. Younger and perkier breasts are also less likely to require a Breast Lift. The study also confirmed that it can take months to adjust physically to Breast Enhancement. Whether this is due to the demands of the Breast Augmentation Surgery or getting used to larger breasts was not studied.
Breast Augmentation Before and Afters
Breasts that have always been small have an advantage when it comes to Breast Augmentation.
Breast Augmentation in the San Francisco Bay Area
Breast Augmentation Surgery in the San Francisco Bay Area, like in the United States in general, remains the most popular cosmetic plastic surgery. It is performed for women who develop small breasts, as well as women who lose breast volume after pregnancy or weight loss. If you are considering Breast Augmentation, more information is available on the San Francisco Plastic Surgery Blog and through the links in this article.
My goal is to provide you with a good foundation of the options for Breast Enhancement, but web sites cannot substitute for an in-person consultation with a Board Certified Plastic Surgeon.
To schedule your personal Breast Augmentation Consultation, call (925) 943-6353 or use the contact form in the margin.
June 14th, 2014 Dr. Mele
Since I opened my San Francisco Bay Area Plastic Surgery office in 1997, the demand for Plastic Surgery Procedures has increased almost 300%. Both surgical and nonsurgical procedures have improved and advanced over the last 17 years. Women account for 90% of all plastic surgery patients, but men have kept up their demand, too. Plastic surgery procedures have adapted to allow women to achieve more feminine, and men more masculine, results. The Mommy Makeover has been well described, but for Father’s Day, I thought some Manly Makeover information might be appropriate. We will explore a new topic today, the Daddy Makeover.
Before and After Gynecomastia Reduction – A well defined masculine chest is hard work, but sometimes being in incredible shape is still not enough. This patient works very hard for his physique. He had small amounts of natural breast tissue (gynecomastia) behind the areolae, his left greater than right.
Gynecomastia Reduction provided smaller areolae, improved symmetry, elevation of the left nipple and removal of the stigma of possible steroid use. The difference in projection of the tissue beneath the nipple, before and after gynecomastia surgery, is best seen on the lateral view.
Gynecomastia Reduction is a uniquely male plastic surgery, and one of my specialties. The before and after pictures above show how plastic surgery can complement a good workout ethic. This gentleman works hard to look this good, but was still bothered by Gynecomastia. What looks like a small change is not simple to achieve, but it makes a big difference in how tight muscle shirts fit. With the workouts he puts in, he deserves to look great.
Nonsurgical Plastic Surgery
Many of the common non-surgical enhancements available today were either not approved or nonexistent in 1997. Now, you can’t walk down Main Street, USA, without seeing advertisements for Botox and Fillers. Botox was part of my training, but the use of Botox for wrinkles was an off-label use then. The first approved botulinum toxin was Botox Cosmetic (Onabotulinumtoxin A). Botox Cosmetic was approved by the FDA in April 2002, for the treatment of moderate to severe glabellar lines (frown lines) in men and women, ages 18 to 65. Any other treatments, while often safe and effective, are still considered off label.
Botox then and Now
Men often request Botox or Dysport treatments to reduce frown lines. These are the lines that form between our brows when we frown, concentrate or squint. No matter the reason, these lines make men look angry and less approachable. The treatment of these rhytids (wrinkles) involves an injection into the paired corrugator supercilii muscles and the procures muscle, to relax the central brow, and mute the ability to frown. Not frowning might make you feel better too, see: Darwin, Depression and Botox on the San Francisco Plastic Surgery Blog.
Fillers, like Restylane, Juvederm, Perlane and Radiesse were not around in 1997. Collagen ruled the world, and was the only available wrinkle filler. For the fine wrinkles in and around the lips, Collagen worked better, but it didn’t last long. Collagen would begin to absorb the minute it was injected. This was the main reason for overdone “Collagen Lips.” A ten percent “over correction” was normal to help prolong the results.
Current fillers last longer, are softer and give more natural results than Collagen. While not permanent, these fillers do not absorb immediately. Each provides a prolonged period of stable augmentation, after which it slowly absorbs. This eliminates the need for over correction. There is some swelling the first few days, however, so the “Trout Pout” has not been eliminated.
Dermal fillers, like Perlane, Restylane and Juvederm, are used to soften the naso-labial folds that extend from the sides of the nose around the corners of the mouth.
Dermal Fillers are most used to soften the lines that run from the nose to the lips, the naso-labial folds. Men and women have them, and they tend to be a more masculine trait. It is no surprise that most naso-labial fold treatments are done for women, but even for men, sometimes less is more. Deeper lines tend to age the face, so often the lines are reduced with a little filler. In Male Facial Plastic Surgery, deeper naso-labial folds may be more masculine, but softening them can often give a more relaxed and rested appearance. Fillers are also used to augment the face. Stronger cheeks, chins and noses, all more masculine features, can be created with the use of dermal fillers.
Surgical Plastic Surgery
All plastic surgery procedures share similarities; however, Male Plastic Surgery procedures are often modified to avoid feminizing the face and body. Common procedures that may require variations are Face Lifts, Eyelid Lifts, Brow Lifts, Nasal Surgery, Breast Reduction, Liposuction and even Tummy Tucks.
The Male Eyelid Lift (Male Blepharoplasty) above was performed to improve sight. Upper and lateral (outer) gaze was blocked by overhanging skin. Just look were his pupils are. The Upper Blepharoplasty lifts the eyelids without distorting the eyebrows. Bags beneath the eyes were also reduced with a Lower Blepharoplasty. Comparing the upper and lower (before and after) pictures, he looks less angry and tired and more friendly and rested, yet remains recognizably male.
For the face, men tend to have lower brows (Ladies, please no snickering), heavier upper eyelids, stronger chins and larger noses. These normal differences in male anatomy, and the difference in male hair patterns, need to be considered in all Facial Plastic Surgery Procedures.
Above – Liposuction is used to remove the Male Muffin Top to create a more fit and masculine, inverted pyramid shape.
The male body is less curvy. The Liposuction before and after pictures above come from the recent San Francisco Plastic Surgery Blog article about treating the Male Muffin Top. In general, the masculine chest is a reversed pyramid, and below this it’s fairly straight down to the thighs. The male chest is wider, the breasts are smaller and even the nipples and areolae are in different positions with different shapes. The details are sometimes subtle, but always worth noting. For Male Body Shaping, the procedures are modified to better suit the ideal male shape.
It’s another beautiful day in the San Francisco Bay Area, and my children are up to enjoy their first day of summer vacation. I hope you have the time and opportunity to enjoy your Father’s Day. If you have questions about plastic surgery, give me a call at (925) 943-6353 or use the contact form in the margin and I will be in touch.
June 7th, 2014 Dr. Mele
In the United States, there are hundreds of thousands of people practicing “Plastic Surgery“; however, there are fewer then 10,000 Board Certified Plastic Surgeons.
Dr. Mele is Board Certified by the American Board of Plastic Surgery
How Many Plastic Surgeons Are There in the United States?
According to the less than aesthetic, American Board of Plastic Surgery home page, “The total number of ABPS Board Certified Plastic Surgeons since 1937 is now 8,521.” At John Muir Hospital in Walnut Creek, CA, we have a couple dozen. Incredible for a city with a population of 64,000, and that’s not including the Plastic Surgeons practicing at the Kaiser Walnut Creek Hospital.
Walnut Creek Gets a Facelift
I am not talking about the availability of Botox on every corner, though downtown it is. While walking around downtown Walnut Creek last night, I noticed it is starting to look like Beverly Hills. Nordstrom, Cole Haan, Eileen Fisher, Gucci, Kate Spade, Neiman Marcus, Tiffany & Co., Apple and Tesla Motors are all there, and the 62-year-old Broadway Plaza is “Having some work done” too. Soon, it will look more like Rodeo Drive rather than the Crossroads.
The Crossroads – South Main Street Walnut Creek, CA, looking north in 1849.
The Modern Crossroads – South Main Street Walnut Creek, CA, looking south in 2014.
Craftsmanship and Quality
The Broadway Plaza Renovation will take years. The quality of the renovation will be a combination of the materials and methods used. The primary determinant of the finish work depends on the experience and expertise of the craftsmen creating the new and improved space.
The same can be said for Plastic Surgery. The final product is the result of careful planning and meticulous execution. We, plastic surgeons, cannot get all new materials, so our training and expertise are the most important components of achieving a safe and predictable result. The tools we use are important, but not as important as the hands holding them. For Plastic Surgeons, this is where Board Certification comes in.
How to Choose a Real Plastic Surgeon
There are many people performing Cosmetic Plastic Surgery, but only a few are Board Certified Plastic Surgeons. Board Certification means your Plastic Surgeon has received the best Plastic Surgery training, continues to pass multiple examinations testing their skills and maintains a dedication to life-long continuing medical education. What I do to maintain my Board Certification can be found here: Board Certified by the American Board of Plastic Surgery.
You owe it to yourself to do the research and check your plastic surgeon before having any procedure. The Internet makes it easy. The following links, will make it even easier. Just click on what you want to do:
Check if your doctor is Board Certified by the American Board of Plastic Surgery.
Check if your doctor is Board Certified by another American Board of Medical Specialties board. You will need to register to use this site, but it is safe, free and fast.
Check if your doctor has an unrestricted California Medical License. Read the disclaimer and click “Continue to Search” at the bottom. If you are not in California, Google your local medical board for a link.
May 31st, 2014 Dr. Mele
Darwin on Botox – Botox was not a beauty aid in Darwin’s era, but he did have a theory linking facial expression to emotions that still applies today. On the other hand, I don’t see any frown lines on his face.
Darwin was Right
Charles Darwin was one of the first scientists to suggest that the changes in the body caused by emotions, reinforce and have a direct impact on the emotions. A simple illustration of this is the Facial Feedback Hypothesis.
Darwin is one of the most influential figures in human history. He was a nineteenth century naturalist and geologist and is best known for his scientific observations and his theory of evolution. While Darwin may not be as well known for his research on emotions, in 1872, he wrote the book, “The Expression of the Emotions in Man and Animals.” In the book he states:
The free expression by outward signs of an emotion intensifies it. On the other hand, the repression, as far as this is possible, of all outward signs softens our emotions. Even the simulation of an emotion tends to arouse it in our minds. - Charles Darwin
Emotions lead to Facial Expressions which lead to Emotions
The Facial Feedback Hypothesis was furthered by William James, the “Father of American Psychology”. A philosopher, psychologist and physician, he proposed, “that skeletal muscle feedback from facial expressions plays a causal role in regulating emotional experience and behaviour.”
Refuse to express a passion, and it dies - William James
Darwin Didn’t Do Botox
While many experiments have been devised to provide evidence for the Facial Feedback Hypothesis, the multiple pathways of interaction between facial activity and emotions has made proving the hypothesis complicated, until recently.
Botox and Emotions
Have you heard the story about the actress who lost a role because she was unable to express emotions due to Botox? In 2010, an article was published in Psychological Science entitled,”Cosmetic use of botulinum toxin-a affects processing of emotional language,” raised questions about Botox and the ability to process emotions. The study was not focussed on the ability of others to read the emotions of someone treated with Botox, but rather on the Botox users ability to process the emotions of other people.
The abstract states, “Subcutaneous injections of botulinum toxin-A (BTX) were used to temporarily paralyze the facial muscles used in frowning. We found that BTX selectively slowed the reading of sentences that described situations that normally require the paralyzed muscle for expressing the emotions evoked by the sentences.” More specifically, two weeks after receiving Botox injections into the muscles necessary for frowning, participants were timed while reading emotionally charged stories. Reading times for angry and sad sections were longer after receiving Botox than before the injections, while reading times for happy sections were unchanged. The researchers were able to demonstrate a selective effect on processing the emotional content directly related to the facial expression suppressed with Botox. Much as Darwin’s quote above says, repression of the outward signs of emotion, in this case with Botox, can dampen one’s ability to understand another’s emotions.
Botox and Depression
At first glance, dampening emotions doesn’t sound great, but a recent article in the Journal of Psychiatric Research shows how this can be the desired effect. In the largest randomized, double-blind, placebo controlled study to date on the effect of Onabotulinumtoxin-A (Botox) on depression, researchers found that more than half of subjects suffering from moderate to severe depression showed a substantial improvement (greater than or equal to 50% of baseline) in their depressive symptoms as measured by the MADRS scale.
Of the 74 patients included in the study, depressive symptoms in the Botox treated group decreased 47 percent after six weeks, compared to 21 percent in the placebo group. The remission rate for the Botox treated group was 27% compared to 7% in the placebo control group.
More Evidence for the Facial Feedback Hypothesis
The study is ground breaking in that it opens a new pathway for treating the severely depressed. Not only might it serve as a stand-alone method of treatment in selective cases, but since it doesn’t interfere with current treatments, it could be used to augment current therapy without removing the support it provides. Similar research has not been published for Dysport or Xeomin at this time.
I will stick to the cosmetic uses of Botox, and leave the anti-depression indications to the experts. On the other hand, Botox treatments for depression might give a whole new meaning to the expression, “Put on a happy face.”
May 24th, 2014 Dr. Mele
Men can get Muffin Tops too. Here, the disproportionate bulge above the belt-line was quickly removed with liposuction.
Men get muffin tops too. Last week, I wrote about Female Muffin Top Removal, but this week it’s all about male muffin tops. Also called the “spare tire,” disproportionate fat often collects around the male midsection. If the collection is large enough, it forms an unflattering bulge above the belt-line.
Muffin Top Removal with Liposuction
The Liposuction Before and After Pictures above show how effectively Male Muffin Tops can be removed. A quick, outpatient procedure, Liposuction effectively removed the disproportionate back fat localized to the lower back, just above the jeans. The results were obvious in a few days, and continued to improve as the area healed over several months.
Liposuction Requires Teamwork
Great liposuction results are no accident. Good technique must be combined with good habits to get the best results. The man whose Liposuction Before and After Pictures are shown above was in great shape, was not overweight and had good skin tone. These are the keys to Great Liposuction Results. Liposuction is not a license to overeat. Good skin tone and maintenance of weight are important to obtaining and keeping you new shape.
Liposuction Before and Afters
Liposuction sculpts the body by removing disproportionate pockets of fat. The result: an improved physique that is much easier to maintain.
Other Popular Area for Liposuction
Fat is the bodies way of storing extra energy, and every body has its own storage map. Some people store fat evenly around their body, while others will put it all in one place. While weight loss will help, the localized areas of disproportionate fat storage can be stubborn, and unlike Liposuction, weight loss cannot spot-remove a specific bulge. Your fat comes off according to how your body is programmed to store it. Sometimes, in order to get a specific area to go away, other parts of the body look too thin.
The most common areas of Liposuction for Men are the abdomen, flanks, lower back and chest. This goes along with the “apple shape” seen more commonly in men, but the thighs and arms can also collect disproportionate fat. Women tend to be more “pear shaped,” so Liposuction of the thighs is more common with women than with men.
Liposuction Consultation Appointments
If you are considering Liposuction, more information is available on the San Francisco Plastic Surgery Blog, and on my main website (DrMele.com), but the best way to find out what Liposuction can offer you is during an in-person Liposuction Consultation. Call (925) 943-6353 to schedule your appointment today.