When Breast Augmentation Needs A Lift | SF Bay Area

Posted February 05, 2017 in Breast Augmentation, Breast Lift (Mastopexy), Home, Mommy Makeover, Tubular Breasts

Mastopexy Augmentation is the combination of Breast Augmentation and Breast Lift. When is Breast Augmentation alone enough? When is a Breast Lift the best choice? When should a combination of Breast Augmentation Lift be performed? It’s a big subject, and requires an in-person consultation for your specific needs, but some general rules for the procedures are explained below. There are many options, so be certain to consult with a Board Certified Plastic Surgeon before making the decision.

Breast Augmentation Lifts Come in May Sizes

Breast Augmentation with Breast Lift was used to enlarge the breasts, elevate the nipple and tighten the breast skin, especially the skin that hangs at the bottom of the breasts. The technique used, a horizontal breast lift, does not require the vertical scar seen in the anchor or inverted-T type breast lifts.

Breast Augmentation with Breast Lift was used to enlarge the breasts, elevate the nipple and tighten the breast skin, especially the skin that hangs at the bottom of the breasts. The technique used, a horizontal breast lift, does not require the vertical scar seen in the anchor or inverted-T type breast lifts.

Breast Augmentation lifts, like the breasts themselves, come in many shapes and sizes. When the shape of the breast is good, but a larger version is desired, Breast Augmentation with a Breast Implant is often enough. When the size of the breast is good, but the breast tissue sags, a Breast Lift alone may be enough. The exception in this case is when there is no upper pole fullness, often seen as gapping of the upper bra. A small implant may be beneficial to add a bit of volume to the upper breast in these cases. When the breasts are small and saggy, the Breast Augmentation Lift is the procedure of choice.

The case above is an unusual lift in that a periareolar (defined below) and an inframammary incision (hidden in the crease beneath the breasts) were used, but there is no vertical scar. The “Horizontal Breast Lift” is great for breasts that have bottomed out or for breasts with more extreme sagging.

Breast Augmentation Lift for Tubular Breast

Smaller Breast Lifts require smaller scars. In the case above, a periareolar scar was used to reposition the nipple and reshape the breasts. Periareolar literally means “around the areola”. The areola is the pigmented skin that surrounds the nipple. While this does provide the smallest scar, it does the least. It tends to flatten the end of the breast and it is not great for reducing the size of the areolae.

The Breast Augmentation and Breast Lift combination with the smallest scar is the Periareolar Mastopexy Augmentation. An incision around the areola is used to raise the nipple and insert the Breast Implant. In the above case, the flattening effects of the periareolar lift are exploited to help reshape these tubular (tuberous) breasts.

The Breast Augmentation and Breast Lift combination with the smallest scar is the Periareolar Mastopexy Augmentation. An incision around the areola is used to raise the nipple and insert the Breast Implant. In the above case, the flattening effects of the periareolar lift are exploited to help reshape these tubular (tuberous) breasts.

For cases of Tuberous Breasts, flattening of the shape of the breast is a plus. It can be used to prevent the puffy nipple from sticking out like a cherry on top of a sundae. This patient’s breasts are narrow at the base, and the constriction gives a narrow, elongated, tubular breast. The Breast Implant helps to round the breast out, but it may not correct the areola when it is puffy.

Bigger Sagging, Bigger Problems, Bigger Breast Aug Lifts

For patients with severe postpartum breast involution (shrinkage), and for patients after massive weight loss, the breast volume has left the building, leaving only a loose, empty flap of skin. Breast Augmentation Lifts are the only solution to this problem. Breast Implants are used to restore the breasts’ volume, and it is combined with a Breast Lift to restore the breasts’ shape.

Severely deflated breasts, like those seen above after massive weight loss, need more volume and bigger lifts. An Anchor shaped scar was needed to raise the nipple, remove the overhanging lower breast skin and to tighten the breast skin in the horizontal direction, too.

Severely deflated breasts, like those seen above after massive weight loss, need more volume and bigger lifts. An Anchor shaped scar was needed to raise the nipple, remove the overhanging lower breast skin and to tighten the breast skin in the horizontal direction, too.

Often, I will see on the Internet the misconception that if a big enough implant is placed, you will not need a lift. This is not true. Imagine an implant, the size of the one used above, placed under the skin of the pre-op picture. The breast would be the same size; however, the loose skin holding the nipple would hang off the end. In the above case, only a Breast Lift can correct the problems with the breasts’ shape, nipple position and excess skin at the bottom of the breast.

More Scar = Happier Patient?

The ultimate goal of Cosmetic Plastic Surgery is a happy patient. So how can more scar lead to a happier patient? It all depends on the circumstances. If a scar is not needed, then more scar is bad. I have had patients on the borderline of needing a lift elect to not have lift because of the extra scar. Some are happy with their decision of not completely correcting the sagging, and not having extra scars. Others have come back for a Breast Lift after their Breast Augmentation, and are much happier now, after the Breast Lift. Staging does make it easier to see what each procedure has to offer the final result.

The main goal of Cosmetic Plastic Surgery is a pretty result. The Breast Augmentation Lift allows for control of both the size and the shape of the breasts. The cost is additional scar. In this case, an Inverted-T scar was needed.

The main goal of Cosmetic Plastic Surgery is a pretty result. The Breast Augmentation Lift allows for control of both the size and the shape of the breasts. The cost is additional scar. In this case, an Inverted-T scar was needed.

Above, an inverted-T Breast Lift was performed along with placement of a Breast Implant. A periareolar lift would have left the nipples low, the areolae much larger and the end of the breasts flat. A vertical lift would not have tightened the lower pole sufficiently, or coned the shape of the breast as beautifully. In my experience, the incision underneath the breasts is well hidden. By keeping its length short, the scar will hide in the shadow under the breasts.

Breast Augmentation Lift Consultations

If you are considering a Breast Augmentation, Breast Lift or the Combination Augmentation Mastopexy, be certain to consult an experienced Board Certified Plastic Surgeon. While there are advantages to combining the procedures, it is also more complicated than both procedures done separately.

If you are in the San Francisco Bay Area, give me a call at (925) 943-6353, and schedule a private comprehensive consultation. Your options will be reviewed and the best course selected to optimize you breast aesthetics.

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Bogus Plastic Surgeons – Buyer Beware

Posted November 28, 2016 in Board Certification, Breast Augmentation, Eyelid Lift (Blepharoplasty), Home, Liposuction, Patient Safety, Rhinoplasty (Nasal Surgery)

Miami Skyline

Miami, Florida, seems to be hot bed for Deceptive Plastic Surgery Practices, and is giving good Miami Plastic Surgeons a bad name. The most recent incident to make the national news is a Botched Brazilian Butt Lift at Encore Plastic Surgery. The clinic is linked to a chain that focuses on cheap plastic surgery for medical tourists visiting Florida for a procedure and a vacation.

Fake San Francisco Plastic Surgery

San Francisco Skyline

Miami is not unique, however. This year, Carlos Guzmangarza was sentenced to 20 years in prison for performing illegal plastic surgery out of his fake San Francisco, California “plastic surgery” clinic. His Mission District clinic preyed on many Central American immigrants. Allegations include: smoking a cigar during surgery, flushing Liposuction fat down the toilet, sexual assault, the injection of unknown skin fillers and leaving a four inch needle in a patient’s buttocks. Eventually, he was convicted of thirty-three felonies and eight misdemeanors.

Caveat Emptor – Let the Buyer Beware

Caveat Emptor

In most cases, there are clues that everything is not up to the usual standard of care. In the case of Mr. Guzmangarza, not only was he not a Board Certified Plastic Surgeon, he was not a doctor. He did not have a medical license, and that’s something that anyone could check.

Check the Medical License

California Medical License

Notice the medical license is for a “Physician and Surgeon.” California, like all states, does not differentiate.

Medical Licenses are issued by the state in which the doctor practices. Simply google your state’s medical board to use their free online look-up service. If you are in California, click here to check your doctors medical license and any disciplinary actions.

Check For Plastic Surgery Board Certification

American Board of Plastic Surgery MOC

I am Certified by the American Board of Plastic Surgery. The only ABMS recognized board for Plastic Surgery.

The American Board of Plastic Surgery offers a free, online certification lookup. Click here to see if your doctor is certified by the American Board of Plastic Surgery. Most doctors claiming the title “Plastic Surgeon” are not certified by the American Board of Plastic Surgery. In fact, it is estimated that only one in twelve practitioners practicing plastic surgery are Certified by the American Board of Plastic Surgery. Does your doctor have the best training?

Check For Other Board for Certifications

American Board of Surgery MOC

I am also certified by the American Board of Surgery, because I completed a residency in General Surgery, too.

If your doctor is not certified by the American Board of Plastic Surgery, who are they certified by? Click here to see if your doctor has any board certifications.

If your doctor is certified by the American Board of Ophthalmology, they are trained in surgery of the eyes. So if you are having Eyelid Surgery, they should have had the appropriate training. On the other hand, if you are having Liposuction, buyer beware.

If your doctor is certified by the American Board of Otolaryngology, the are trained in ear, nose and throat surgery, so Facial Plastic Surgery is within the scope of their training. If you are having Rhinoplasty, this is an appropriate board for certification. If you are having Breast Augmentation, buyer beware.

Non-Surgical Board Certification

The non-plastic surgery boards listed above are at least surgical boards. Some “cosmetic surgeons” have non-surgical board certifications. Certification by Family Practice and Internal Medicine Boards is not reassuring if you are having a surgical procedure. Proof of additional surgical training should be made available, and it should be years or training, not a weekend course.

Do Your Homework

A well trained, experienced practitioner will be up-front and honest about their training and abilities, but those who are not honest may be even more convincing. You need to do your homework. Use the links above to confirm what you are being told. If it does not fit, do not commit.

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Breast Cancer Awareness Month – SF Bay Area

Posted October 22, 2016 in Breast Cancer Awareness, Breast Reconstruction, Home

October is Breast Cancer Awareness Month.

October is Breast Cancer Awareness Month.

You may have noticed that the silver and black are wearing pink this month. For the last few Octobers, the National Football League has teamed up with the American Cancer Society to highlight breast cancer awareness and raise funds for breast cancer research.

Who Gets Breast Cancer?

One in nine women will develop breast cancer. That’s 12% of the female population, and women make up 99% of the cases of breast cancer. Less than 1% of people with breast cancer are men, and a man’s chance of a breast cancer diagnosis is about one in a thousand.

How Does Breast Cancer Spread?

By definition, breast cancer starts in the breast. Theses abnormal breast cancer cells begin to grow uncontrollably and invade the normal breast tissue. It takes months, sometimes years, for enough cells to amass to be felt. A one centimeter lump contains about a billion cancer cells. As the cells grow they continue to directly invade their neighbors, but cancer cells can also float through the circulatory system.

The most common place that breast cancer cells are found outside the breast are in the axillary lymph nodes. Let me translate that from medicine to English. Lymph is the liquid part of the blood, also called plasma. It slowly leaks out of the blood vessels from the capillaries and needs to be collected and returned to circulation. If lymph is not returned to circulation, we swell. If you ever looked at pictures of Elephantiasis as a kid (maybe it was just me) this disease is what happens when lymph does not return to circulation. In Elephantiasis, the lymph vessels become clogged and the lymph fluid become trapped in the legs. The legs begin to resemble elephant’s legs as the lymph fluid continues to build up and inflate the skin.

What Are Lymphatics (Lymphatic Blood Vessels)?

The lymphatic vessels are a third type of blood vessel, the first two being arteries and veins. Lymphatics are found throughout the body, including the breasts. Breast cancer cells can float through the lymphatic system and migrate to other organs. For cancer cells, this migration is called metastasizing. After a breast cancer lump reaches a critical size, the chances of a metastasis increases rapidly. This is why breast cancer awareness and early detection are so important.

What Are Lymph Nodes?

The breast's main drainage system is through the axillary lymph nodes.

The breast’s main drainage system is through the axillary lymph nodes.

Lymph is only fluid, so unlike other blood vessels, it is not normal to have a lot cells traveling through the lymphatic blood vessels. In fact, the body has filters along the lymph vessels, called lymph nodes, which trap unwanted cells, preventing them from moving freely throughout the body. The two types of undesirable cells that lymph nodes filter most frequently are bacteria and cancer cells. In both cases, the lymph nodes present the invaders to the body’s immune system, it’s police force if you will. When the immune system recognizes the invaders as bad, it kills them, and prevents any further invasion. This probably happens all the time without us being aware of it. Unfortunately, sometimes the immune system cannot handle the invasion, and the problem spreads.

The majority of the lymph from the breast drains to the armpit (the axilla), so the most common place we find breast cancer outside the breast is in the lymph nodes of the armpit or the axillary lymph nodes. This is why checking the axillary lymph nodes is so important in staging breast cancer. No nodes involved (negative lymph nodes) is good, and means there is a higher chance that the cancer has not escaped the breast and thus a higher chance of curing the breast cancer. Breast cancer found in the lymph nodes (positive lymph nodes) are a worse sign, and often means additional treatment will be recommended to try and kill any cells that have escaped the breast.

Why The Push For early Detection?

If you understand how breast cancer usually spreads, then the emphasis on early detection becomes clear. The sooner breast cancer is detected, the smaller it is and the less likely it is to have spread. Small tumors found in the breast early can often be cured by simply excising them. Larger tumors will be more likely to require a mastectomy, but once the tumor has left the breast, surgery alone is not enough. Additional treatment is needed to kill the cells that have escaped. Unfortunately, the more cells that have escaped, the harder it is to cure breast cancer. The goal of breast cancer awareness and early detection is to find tumors when they are small are treatable and to prevent the larger tumor that cannot be cured.

Different Breast Cancers Require Different Treatment

Since there is more than one cell type in the breasts, there is more than one type of breast cancer. The most common types of breast cancer behave as described above, the majority of the time. However, there are exceptions to every rule. For example, some less common tumors that arise in the breast spread directly through the blood stream, bypassing the lymphatics. Moreover, tumors that develop at the edge of the breast can directly invade the skin, muscle or bone of the chest wall. In every case though, the earlier it is detected, the better your chances of survival. If you don’t do monthly breast exams, I hope this makes you reconsider how such a small chore can prevent an enormous amount of suffering.

What Can I Do About Breast Cancer?

Awareness is the first step. Next comes action. Do your monthly breast self-exams, get your mammograms as recommended, and if you find something, don’t be scared, be proactive. Most breast lumps are not dangerous, cysts and benign fibroadenomas are the most common, but if you find one that is not benign, the sooner it’s identified the better your chances. Do it for yourself. For men, the most common breast lump is Gynecomastia.

Early detection means you increase your chances of living a longer, cancer-free, life.

Early detection means you increase your chances of living a longer, cancer-free, life.

If you want to help others there are many avenues available. The American Cancer Society accepts donations, which are used to accelerate breast cancer research, and many volunteer opportunities are available if you can spare a little time. If you want more information on how to get involved check out the Get Involved page on the American Cancer Society’s website.

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Plastic Surgery Board Certification and MOC

Posted October 10, 2016 in About Dr. Mele, Board Certification, Home, Patient Safety

Dr. Joseph Mele maintains his Board Certifications with two ABMS recognized boards: The American Board of Plastic Surgery and the American Board of Surgery to demonstrate his commitment to excellence in up-to-date Plastic Surgery

Dr. Joseph Mele maintains his Board Certifications with two ABMS recognized boards: The American Board of Plastic Surgery and the American Board of Surgery to demonstrate his commitment to excellence in up-to-date Plastic Surgery

Plastic Surgery Board Certification and MOC

Another year, another round of American Board of Plastic Surgery MOC (Maintenance of Board Certification) chores. I have two American Board of Medical Specialties (ABMS) recognized board certifications. One is from the American Board of Plastic Surgery and the second is from the American Board of Surgery. Both represent years of training and hard work and now with the additional MOC requirements, the completion of yearly chores.

Achieving Board Certification

Achieving Board Certification is an important milestone in a doctor’s training. It certifies that they graduated from a recognized residency training program and that they have passed a series of written and oral examinations, and if I had graduated two years sooner, that would have been the end of the story. I graduated and certified in the era of time-limited certification, so every year there are some requirements to fulfill.

Maintenance of Board Certification

The MOC examinations are given at computer based testing centers throughout the nation. All sorts of examinations are given at these centers and most have nothing to do with medicine. The staff at these institutions have strict regulations to enforce. The rules are designed to stop cheating and protect the proprietary information that is contained on the examination. I recently visited one such institution to take my ten-year recertification examination for the American Board of Surgery, and am required to take the American Board of Plastic Surgery MOC examination by 2019.

Why Maintain Board Certification?

This question is becoming more and more controversial as the fees, exams and other hurdles are raised higher and higher each year. It took several days to complete the application and collect the required information, and it’s not cheap. Those in favor of MOC claim that board certification is a way to make sure that your doctor is still good. Those opposed cite the ever escalating cost and time away from the practice required as prohibitive. They are also correct in pointing out the lack of evidence that MOC actually makes us better doctors. Personally, I don’t mind. It is a hassle, and it does not change the way I practice. On the other hand, it shows my patients a clear commitment to being the best Plastic Surgeon I can be. I don’t mind being tested. Plus, when I pass, I will have another lovely certificate to show everyone.

My Board Certifications

American Board of Surgery MOC

I completed a General Surgery residency in 1994. I passed my General Surgery Boards in 1995 and have recertified twice. I am good until 12/31/2025, as long as I complete my yearly chores and pay my yearly fees.

American Board of Plastic Surgery MOC

I completed a Plastic Surgery residency in 1997. When I finished my training, it took two years to take the certification exams. I passed my Plastic Surgery Boards in 1999, and have recertified once, so I am good until 12/31/2019. Looking forward to the next exam.

American Board of Medical Specialties

There are many boards out there, but the “real” boards are those under the umbrella of the American Board of Medical Specialties (ABMS). This is the longest standing body for Medical Certification in the US. The American Board of Plastic Surgery was born from members of the American Board of Surgery and the American Board of Otolaryngology who did what is now recognized as Plastic Surgery, and remains the only ABMS Board certifying Plastic Surgeons.

Board Certified Plastic Surgeon

If you are considering Plastic Surgery, be certain to check your doctor’s training. Good training, and the maintenance of that training, are essential for providing the safest and most predictable results.

If you are in the San Francisco Bay Area and would like to schedule an appointment, call (925) 943-6353. And if you want to check out my, or any doctor’s, qualifications, here are some links to help you:

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.

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Bogus Breast Implants – PIP President Goes To Jail

Posted August 28, 2016 in Breast Augmentation, Breast Implant Revision Surgery, Home

Two and one half years ago, I posted about Jean-Claude Mas and his substandard PIP Breast Implants. Poly Implant Protheses, PIP for short, had their Breast Implants banned in 2010, after it was revealed that industrial grade silicone was being used, rather than the medical grade silicone that has passed safety tests for use in the human body.

PIP’s Jean-Claude Mas Goes To Jail

PIP founder, Jean Claude Mas, loses appeal in French court, and goes to jail. Photo credit: Guillaume Horcajuelo

PIP founder, Jean Claude Mas, loses appeal in French court, and goes to jail.
Photo credit: Guillaume Horcajuelo

In 2013, Jean-Claude Mas was convicted of fraud. His sentence included: four years in prison, a75,000 euros ($86,000) fine and that he be banned for life from working in medical services or running a company. This year, a French appeals court upheld the decision.

Plastic Surgeons Blew The Whistle First

Plastic Surgeons were aware there was a problem years before the government took action, because PIP Breast Implants leaked about ten times as often as FDA approved breast implants. In fact, the US FDA refused PIP’s application for Silicone Breast Implant sales in the US.

Unfortunately, the Pre-filled Saline version of PIP Breast Implants was sold here for a short time. They also leaked at much higher rates than those seen with the other FDA approved Saline Breast Implant manufacturers at the time: Allergan and Mentor.

PIP – Cheaper Is Not Better

You have likely heard the expressions, “You get what you pay for,” and that, If something is too good to be true, it is false.” Well both these expressions apply to Plastic Surgery. It is not an area that you want to get the cheapest price.

PIP’s appeal was that they were cheap. While they claimed to be equivalent to other manufacturers, they were not. They cost less, because they were made cheaply. Industrial silicone is not the same grade or cost as medical silicone, and the company substituted industrial grade silicone for medical grade silicone for years without regulators catching on.

Jean-Claude Mas posing at his manufacturing facility. Only a few knew what was really going on  with PIP's breast implant quality control.

Jean-Claude Mas posing at his manufacturing facility. Only a few knew what was really going on with PIP’s breast implant quality control.

Plastic Surgeons complained for years that something was wrong with PIP Breast Implants, but the final straw was when the company supplying the large quantities of industrial grade silicone raised their suspicions also. Even the people selling the industrial grade silicone knew there was nothing good about these Cheap Breast Implants.

PIP Knew The End Was Coming

PIP Breast Implants manufacturing was headquartered in La Seyne-sur-Mer, France. Since they were not FDA approved, they were not subject to FDA rules, like surprise inspections. Incredulously, European inspectors had to give 10-days notice prior to an inspection. During this grace period, PIP would remove drums of industrial silicone from their manufacturing facility and quickly order the medical grade silicone they should have been using all along. After the inspection, the industrial silicone was brought out again and cheap manufacturing resumed.

When it was clear that the end was near, PIP slashed its prices further. Knowing that their inventory was going to be confiscated, they sold in bulk, and they sold quickly. PIP flooded the market with cheap “European Approved” breast implants throughout Europe and South America. In the end, between 300,000 and 400,000 women in 65 countries are believed to have received PIP implants. Europe was a major market, but more than half went to South America. Fortunately, they were not sold in the United States.

Medical Tourism – Buyer Beware

Poly Implant Protheses was founded in 1991 and shut down in 2010. It is thought that the manufacture of the Bogus Breast Implants, those made with industrial grade silicone, began in 2001.

It Is Recommended That All PIP Silicone Breast Implants Be Removed

PIP Silicone Breast Implants were never sold in the US; however, if you took advantage of cheap overseas breast augmentation early this millennium, you need to check if you have PIP Silicone Breast Implants.

Breast Implant Removal Before And After Photos: One option is to have the breast implants removed and not replaced. Another is to replace your PIP breast implants with FDA approved breast implants, the later options will also preserve the size of your breast. Be certain to ask your Board Certified Plastic Surgeon about your options for treatment.

Breast Implant Removal Before And After Photos: One option is to have the breast implants removed and not replaced. Another is to replace your PIP breast implants with FDA approved breast implants, the later options will also preserve the size of your breast. Be certain to ask your Board Certified Plastic Surgeon about your options for treatment.

PIP Silicone Breast Implants have a higher risk of leaking than approved models, as well as being implicated in several deaths due to systemic toxicity and several cases of induced breast cancer. If you have these breast implants, the current world-wide recommendation is to have them removed, and if you desire, replaced with approved Medical Grade Silicone Breast Implants.

Breast Implant Revision Surgery Consultations

The UK’s National Health Service (NHS) recommendations include seeking immediate care if you have any of the following signs:

  • Lumpiness or swelling in and around the breast
  • A change in the shape of the breast
  • Redness
  • Pain and tenderness
  • A burning sensation
  • Enlarged lymph nodes in the armpit

If you have PIP Silicone Breast Implant’s, find an Experienced Board Certified Plastic Surgeon in your area and get the information about the benefits, and risks, of having them removed. I have removed several. The Ruptured Saline Breast Implants are easy to remove. The saline is absorbed by the body, and all that remains is the solid shell. Ruptured Silicone Breast Implants, especially those filled with the less cohesive gel, are a much bigger problem.

When Breast Implants are ruptured, the gel that fills them can migrate. Most the PIP silicone Breast Implants I have removed were ruptured. The longer the Leaking Breast Implants remain in your body, the less likely it is that all the industrial silicone gel can be removed. Like most problems, the sooner it is addressed the better the outcome. Breast Augmentation Revision is a better option. If you are in the San Francisco Bay Area, call (925) 943-6353 today.

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Melatonin and Migraine Headaches

Posted May 29, 2016 in Home, Patient Safety, Uncategorized

Many suffer from Migraines. Thanks to Allergan, we know that Botox can help, but there may be something safer and cheaper the can help, too.

Many suffer from Migraines. Thanks to Allergan, we know that Botox can help, but there may be something safer and cheaper the can help, too.

A lot of my San Francisco Bay Area Plastic Surgery patients suffer from Migraine Headaches, so I looked into the incidence of Migraines and found that according to the Migraine Research Foundation, it is the third most prevalent and the eight most disabling illness in the world. In the U.S., 18% of women, 6% of men and 10% of children suffer from migraines, and I have found this to be true within my own patient population.

Migraines Run In Families

About 80% of Migraine sufferers have a positive family history. It runs in my family. I had a few myself, but I seem to have outgrown them. Thankfully, mine were few and far between, and they seemed to be associated with sleep deprivation. So diet, exercise and regular sleep were enough to keep them to a minimum, but others are not so lucky. Every 10 seconds, someone in the U.S. goes to the emergency room complaining of head pain. While most sufferers experience attacks once or twice a month, more than 4 million people have chronic daily migraine, with at least 15 migraine days per month.

Sleep and Migraines

My observation of an association between Migraines and sleep is not unique. One of the most commonly cited triggering agents happens to be changes in sleep habits. Insufficient sleep, greater than normal sleep, disturbed sleep or alterations to daily bedtime or waking all have been strongly correlated with initiating migraine attacks. Recent research suggests that some migraineurs might be deficient in melatonin production.

A nap can cure a Migraine, but sleep may also be preventative.

A nap can cure a Migraine, but sleep may also be preventative.

According to a well referenced online article by Dr. Mathew Long, Melatonin (a derivative of serotonin) is manufactured in the pineal gland at night, and it functions to regulate the sleep-wake cycle. Furthermore, it has been implicated in migraine pathophysiology due to its anti-inflammatory effects, ability to scavenge free-radicals, inhibition of dopamine and stimulation of nitric oxide synthase. Melatonin also has a role in membrane stabilization. With sleep-related factors featuring so prominently in migraineur’s lives, it makes sense that we examine the relationship between poor sleep hygiene, melatonin synthesis and the tendency to migraine. Research has linked low levels of melatonin in plasma and urine and altered peak time in melatonin levels to a variety of headache types, including migraines.

Sleep and Melatonin

Melatonin has been available as a supplement in the United States since the 1990s and is often used to aid sleep and attenuate jet lag. A study in published in Neurology in 2004 showed promising results in migraine prevention when 3 mg of melatonin was taken 1 hour prior to bedtime. This was confirmed 10 years later when Melatonin was compared head-to-head-to-head with amitriptyline and placebo.

As reported on Medscape, results from a multi-center, randomized, double-blind, placebo-controlled trial showed that 3 mg of melatonin was more effective than placebo and had efficacy similar to that of 25 mg of amitriptyline. Furthermore, it was better tolerated than amitriptyline, with lower rates of daytime sleepiness and no weight gain.

More Migraine Research Results

The principal investigator, Mario Peres, MD, PhD, published the Randomized clinical trial comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention in the Journal of Neurology, Neurosurgery & Psychiatry. He also presented his results at the 65th Annual Meeting of the American Academy of Neurology.

To test the efficacy and tolerability of melatonin and amitriptyline vs placebo for migraine prevention, the investigators recruited 178 men and women who met International Headache Society diagnostic criteria for migraine with and without aura and who had 2 to 8 migraine attacks per month. All patients underwent a 4-week baseline phase during which each participant kept a diary of migraine frequency.Participants were then randomly assigned to receive 3 mg melatonin (n = 60), 25 mg amitriptyline (n = 59), or placebo (n = 59) for 3 months. Medication was taken between 10 and 11 pm daily.

The study’s primary outcome was a reduction in the number of headache days per month. Secondary endpoints included migraine intensity and duration and analgesic use. Tolerability was also measured in all 3 study groups. The mean reduction in headache frequency was 2.7 in the melatonin group, 2.18 in the amitriptyline group, and 1.18 in the placebo group.

Proportion of responders (patients with a higher than 50% improvement in headache frequency, number of migraine headache days) comparing baseline vs last month of treatment.

Proportion of responders (patients with a higher than 50% improvement in headache frequency, number of migraine headache days) comparing baseline vs last month of treatment.

Although migraine frequency did not differ between the 2 active treatment groups, the proportion of responders was greatest in the melatonin group: 54% vs 39.1% for amitriptyline and 20.4% for placebo. Melatonin was also “very tolerable” and had significantly fewer adverse effects compared with amitriptyline. Daytime sleepiness was the most frequent symptom in all 3 groups but was most pronounced in the amitriptyline group (n = 24). Although patients gained weight in both the amitriptyline (n = 3) and placebo (n = 1) groups, melatonin was associated with weight loss.

Timing of administration and formulation is also important. Ideally, melatonin should be taken between 10 pm and 11 pm to mimic the physiologic peak. In addition, a fast-acting rather than a slow-release formula should be used.

Overall, said Dr. Peres, the study’s findings are promising and warrant further research.

Migraine Treatment

If you suffer from Migraines, Melatonin, a relatively inexpensive and safe over-the-counter supplement may help. I am not recommending you base your treatment on the blog post of a San Francisco Bay Area Plastic Surgeon. You should see a real headache doctor and have the appropriate testing and examinations performed prior to initiating treatment. However, when you see your doctor, if they do not bring up Melatonin, be certain to ask.

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Accredited Surgery Centers SF Bay Area

Posted February 06, 2016 in Accreditation, Home, Patient Safety

Surgery Center Accreditation - Another Way to Protect Plastic Surgery Patients

Surgery Center Accreditation – Another Way to Protect Plastic Surgery Patients

The majority of Plastic Surgery is performed in the outpatient setting, and in the San Francisco Bay Area, the majority of the these procedures are performed in Outpatient Surgery Centers. These facilities offer many advantages to patients and plastic surgeons, but are they safe? How can you be certain the ambulatory facility your cosmetic surgeon is using is up to the high standards required for surgery?

Accredited Ambulatory Surgery Centers

As a Board Certified Plastic Surgeon and an active member of both the American Society for Aesthetic Plastic Surgery and the American Society (ASAPS) of Plastic Surgeons (ASPS), I only operate in Fully Accredited Operating Rooms.

Professional societies are not all created equally. The ASAPS and ASPS are two of the most stringent when it comes to member requirements. Not only is proper training, ethical standards and board certification required, but every member is required to operate exclusively in Accredited Ambulatory Surgery Centers when anything other than local anesthesia is required. The reason — Patient Safety.

Plastic Surgery Patient Safety

Accreditation is performed by a limited number of regulatory bodies to assure the public that a Surgery Center is up to standards for both physical and administrative operations.

Physical Characteristics: include building codes like width of halls and doorways, construction materials, fire exits, power backup, oxygen safety and delivery and environmental heating, cooling and ventilation. Also included are the types of equipment kept on site for anesthesia, life support, sterilization and fire suppression.

Administrative Operations: include how patients and their private medical information are handled, as well as staff selection and peer review, drug tracking and data tracking of procedures and complications.

The Cost of Patient Safety

Don’t be fooled by doctors promoting the safety of surgery done under local anesthesia. They may be masking an unaccredited facility and the inability to offer general anesthesia. Often, they will offer lower prices, because accreditation may not be the only corner they are cutting.

Unfortunately, it is not cheap to maintain accreditation. Regulations change frequently. Often, consultants are hired before inspections to be certain the latest rules are being followed. The cost of the inspection is borne by the facility, and this is in addition to meeting additional building requirements and having the proper well maintained equipment. Often, multiple types of accreditation is required, and inspections may be required every three years or more, depending on the agency and the findings during inspection.

How To Check Accreditation

Below is a list of the current nationally recognized accrediting bodies. Ask your surgeon, or better the surgery center directly, which they are accredited by. You can also use the links below to learn more about the accrediting organizations.

Patient Safety First

Using only Accredited Surgery Centers is just one more way that your Plastic Surgeon can demonstrate that they care about your safety. If your surgeon is using accredited surgery centers, they will not be offended if you ask them. The hospitals and surgery centers I use are accredited by the state, federal (medicare) and at least one other of the above agencies.

The Accreditation Association for Ambulatory Health Care (AAAHC) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are two of the national recognized accreditation bodies in the United States.

The Accreditation Association for Ambulatory Health Care (AAAHC) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are two of the national recognized accreditation bodies in the United States.

John Muir Hospital Walnut Creek, John Muir Hospital Concord and San Ramon Regional Medical Center are all JCAHO Accredited, while Premier Surgery Center, Diablo Valley Surgery Center, Aspen Surgery Center and Sequoia Surgical Center are all AAAHC Accredited. This accreditation gives me peace of mind that every facility is regularly checked by an independent organization dedicated to the safety of my patients. It also means I can spend more of my time taking care of you.

Outpatient Surgery Centers Provide Convenience Too

Most surgical procedures are outpatient, meaning you can go home the same day. This is true for all surgery performed in the United States, not just Plastic Surgery. The vast majority of these procedures are performed in an ambulatory surgery center. In fact, there are not enough hospital operating rooms to accommodate the volume of surgery performed in ambulatory surgery centers. Without them, we could not provide appropriate patient care in a timely manner.

The main difference between a surgery center and a hospital is the amount of time you can spend there. Legally, an ambulatory center can keep you for 24-hours. After this time, either you should be safely on your way back home or transferred to a hospital if additional care is necessary.

There are other differences which may not be as obvious. Hospitals are for sick people, so that is where you find them, along with the diseases they are suffering from. Some of these diseases are contagious, and if you do not require the higher level of care that a hospital provides, staying away from the inpatient setting also means staying away from sick people. On the other hand, if you have multiple medical problems, or require a complicated surgical procedure, the higher risk of the hospital setting is more than balanced by the additional care that they provide.

Convenience is another factor that the ambulatory surgery center can provide. While Safety is number one, Predictability is a close second. Since Surgery Centers deal with healthier patients and less complicated procedures, they are more likely to run on time. Unlike a hospital with emergency rooms and trauma centers, there are few emergencies to “bump” the operating schedule and cause understandable, medically necessary but inconvenient delays.

This is the operating room for cardiovascular surgery at Gemelli Hospital in Rome, Italy. This hospital operating room is specialized, provides a higher level of care and is very expensive and excessive for Breast Augmentation.

This is the operating room for cardiovascular surgery at Gemelli Hospital in Rome, Italy. This hospital operating room is specialized, provides a higher level of care making it very expensive, and excessive, for Face Lifts or Breast Augmentation.

Cost is another factor. Ambulatory Surgery Centers do not need to be staffed 24-hours a day, and do not need all the additional equipment needed for the most complicated surgical procedures. Because of this, the hourly rate for an operating room located in an outpatient center averages significantly less then the hourly rate for an operating room located in a hospital.

Cosmetic Plastic Surgery

If you are considering Cosmetic Plastic Surgery in the San Francisco Bay Area, give me a call at (925) 943-6353. By using only accredited facilities, my goal is to provide you with the safest and most predictable results possible.

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Zika Virus News You Can Use

Posted January 30, 2016 in Breast Augmentation, Home, Mommy Makeover, Patient Safety, Tummy Tuck (Abdominoplasty)

Updated: 15 March, 2016 – new evidence of link between Zika virus and microcephaly and the sexual transmission of virus.
Updated: 28 March, 2016 – new recommendations for couples trying to conceive who have potentially be exposed to the Zika virus.
Updated: 09 April, 2016 – transmission rate estimates from mother to infant.
Updated: 07 May, 2016 – 80% of those infected with the Zika virus have no symptoms.

It’s no secret that most Plastic Surgery Patients are women. While most Plastic Surgery Procedures are for age management, a significant number of Cosmetic Surgeries are performed to repair the ravages of pregnancy. In fact, surgery to repair the changes after pregnancy is common enough to have it own name: Mommy Makeover. The Mommy Makeover is a combination of procedures that provides Breast Enhancement and Abdominal Sculpting, the most common combination being Breast Augmentation with a Tummy Tuck.

Pregnancy and the Zika Virus

Since many of my patients are of child bearing age, and since the Zika virus has been in the news, this week’s post is a PSA with the latest information and links to more information about the Zika Virus.

If you’ve seen the evening news lately, then you know the Zika virus is associated with severe birth defects when it infects a pregnant woman. To date, there have been no cases of direct transmission between people (except sexually), so how is it transmitted and what exactly does it do?

How the Zika Virus Spreads

In almost every documented case, the Zika virus needs a vector to spread. In the case of the Zika virus, the vector is the Aedes mosquito, the same mosquito that spreads dengue and chikungunya. If a mosquito bites a person infected with the Zika virus, it can then spread the virus to the people it bites subsequently.

An Aedes albopictus female mosquito feeds on a human blood meal. Photo by James Gathany, Centers for Disease Control and Prevention

An Aedes albopictus female mosquito feeds on a human blood meal.
Photo by James Gathany, Centers for Disease Control and Prevention

The virus can also be transmitted through a blood transfusion of infected blood, and cases of suspected sexual transmission have now been confirmed. In terms of the numbers of people infected, these are extremely rare means of transmission. If you are pregnant, or trying to get pregnant; however, prevention is the best medicine. For most people infected by the virus the symptoms are mild, but for pregnant women there is substantial new clinical and epidemiological research, which strengthens the association between Zika infection and the occurrence of fetal malformations and neurological disorders. One particularly devastating disorder is microcephaly. Microcephaly is a severe birth defect resulting from decreased brain size, and it seems to be more likely to occur with Zika virus infection.

Zika research is still in its early stages. Despite what you may have heard on the evening news, information on transmission from mothers to babies during pregnancy or childbirth is currently very limited. Current estimates are that one infant in one-hundred is affected. Perinatal transmission has been reported with other mosquito-borne viruses such as dengue and chikungunya, so transmission of the Zika virus seems likely. Research is currently under way on possible mother-to-child transmission of the virus and its effects on babies. Pregnant women in general, and particularly those who develop symptoms of Zika virus infection, should be closely monitored by health providers.

On November 28, 2015, Brazil’s Ministry of Health established a relationship between an increase in cases of microcephaly in newborns and Zika virus infections in the country’s northeast. According to a preliminary analysis of research carried out by Brazilian authorities, the greatest risk of microcephaly and malformations appears to be associated with infection during the first trimester of pregnancy. How often Zika virus infection leads to microcephaly has yet to be determined. Precise numbers will be hard to determine, especially since the virus can infect without symptoms. Only a small fraction of infections seem to lead to birth defects; however, the World Health Organization (WHO) has recently strengthened there warning to pregnant women. The WHO ‘s original recommendation urged pregnant women to avoid bites from the mosquitos that carry the virus. Now the WHO is advising them to avoid travel to areas where the transmission of the virus is widespread. Next may be advice to avoid having sexual relations with anyone recently traveling to areas where Zika virus exposure is on going.

How Long To Wait Before Conception If Exposed to the Zika Virus

On March 25, 2016, the CDC updated the guidelines for reproductive-age women and their partners who have been exposed, or potentially exposed, to the Zika virus. Women who have been diagnosed with acute Zika virus disease should wait at least 8 weeks from symptom onset to attempted conception. Zika-diagnosed men should wait at least 6 months. Both men and women who may have been exposed to Zika virus should wait at least 8 weeks from possible exposure to time of attempted conception. Possible exposure events include travel to or residence in a Zika-endemic area or unprotected sexual intercourse with a man who has traveled to or resided in a Zika-endemic area up 6 months after his latest potential exposure.

The History of the Zika Virus

The Zika Virus was discovered in 1947 in the Zika forest of Uganda. For much of its history, it remained in Africa, with small sporadic outbreaks in Asia. In 2007, the first major Zika virus epidemic occurred on the Micronesian island of Yap. Nearly 75% of the population was infected.

In 2014, a case of Zika virus transmission on Easter Island was reported by Chile. The virus was detectable from March until June, 2014.

Human Cases of Zika virus for 2015-2016 from the Pan American Health Organization.

Human Cases of Zika virus for 2015-2016 from the Pan American Health Organization.

In May of 2015, Brazil confirmed an outbreak of Zika virus in its northeast quadrant. According to the Pan American Health Organization (PAHO), in 2015 and 2016, the virus has spread to most of northern South America, Central America, the Caribbean and Mexico.

Since the Zika virus is not currently being spread by mosquitos in the US, it has become the hot spot for research on alternate means of spread, especially sexual transmission. While cases have been identified, it is still not clear how easily the virus spreads with this methods of transmission.

Symptoms of the Zika Virus

Zika virus infections can be without symptoms; however, symptoms usually begin 2-7 days after the bite of an infected mosquito. It commonly presents as mild fever with a skin rash (exanthema), often with eye irritation (conjunctivitis), muscle and joint pain, and general malaise. There is no association between the Zika virus and death. An increase in Guillain-Barré syndrome (GBS) has been observed in areas where a Zika virus epidemic has been documented (e.g., in French Polynesia and Brazil).

Zika Virus Treatment

Blood tests can help to confirm the diagnosis. Some (virological PCR tests) are useful in the first 3-5 days after the onset of symptoms, while others (serological tests) detect the presence of antibodies but are useful only after five days.

Like most viral infections, there is no vaccine or specific treatment for Zika virus infection. Therefore, treatment for everyone, including pregnant women, is directed at alleviating symptoms such as fever and body aches. To prevent dehydration, it is recommended to control the fever, rest, and drink plenty of water.

Prevention is the best treatment available. Avoiding travel to regions with ongoing transmission is the best prevention, especially if you are pregnant. When this is not an option, precautions should be taken to avoid mosquito bites.

Since mosquitos spread the virus, prevention is directed toward control of the vector and prevention of mosquito bites. The Aedes mosquito bites mostly during the day. Long sleeves, mosquito nets and repellents can help, but repellents should not be used on children younger than two years of age. A more complete list of preventive measures is available on the CDC website.

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Maintenance of Board Certification in Plastic Surgery – SF Bay Area

Posted October 31, 2015 in About Dr. Mele, Board Certification, Home, Patient Safety

For your safety, Dr. Mele maintains his Board Certifications with two ABMS recognized boards: The American Board of Plastic Surgery and the American Board of Surgery.

For your safety, Dr. Mele maintains his Board Certifications with two ABMS recognized boards: The American Board of Plastic Surgery and the American Board of Surgery.

Maintenance of Board Certification or MOC

As another year nears its end, it is time for the yearly Maintenance of Board Certification (MOC) chores. I have two American Board of Medical Specialties (ABMS) recognized board certifications. One is from the American Board of Plastic Surgery and the second is from the American Board of Surgery. Both represent years of training and hard work and the relatively new requirement for the completion of yearly chores.

Achieving Board Certification

Achieving Board Certification is an important milestone in a doctor’s training. It certifies that they graduated from a recognized residency training program and that they have passed a series of written and oral examinations. If you are a plastic surgeon and have gone through the process, the expression, “Plastic surgeons eat their young,” may come to mind. The process is both rigorous and anxiety promoting.

The Qualifying Examination is a written exam that must be passed to qualify for the oral exams. Back in the olden days, we all had to fly to a designated city for the examination, so it was an even more expensive and time consuming commitment. For my plastic surgery board examination, the testing was done in Houston, TX, in the summer. There is some bonding that occurs when a group survives a stressful situation together. Now, with the advent of computer testing centers, rather than one central location for the examination, many cities offer the examination each year. When sitting for the exam, you may be the only one taking the American Board of Plastic Surgery‘s written exam, making it even more impersonal.

The Oral Exams

In order to qualify for the oral exam, not only do you have to pass the written exam, you have to submit six months of your own cases. Every single one of them, with notarized confirmation from the medical staff office of every hospital and surgery center where you hold privileges that every case has been submitted. From these, specific cases are selected for you to bring to the exam. Each case must have all the charting, billing and before and after pictures for the examiners to review. You submit your books upon arrival, and wait to see if they qualify you for the exam. If they are insufficient, you will have to try again next year. If your books pass scrutiny, then the oral examinations proceed.

The oral exams are very personal. There are three groups of oral examiners to negotiate. Two groups test you with standard patient cases. You are given a brief history, physical examination and pictures, and off you go. The questions start with, “What are you going to do doctor?” and progress through your rationale. If you are doing well, one of the other examiners will often interrupt your best plans with, “Well, that didn’t work. Now what are you going to do?” All the while, remaining poker faced, but you know inside they are smirking, at least a little bit. The third oral examination session is similar to the other two, except they are your cases. Everything is fair game, not just your patient care, but your charting, picture taking, billing and outcomes.

Maintenance of Board Certification

Shortly before I graduated, once you passed your oral examination you were done. You were done. You were Board Certified forever. No more fees, no more travel, no more exams. But that is no longer true. Now, there is a price to pay and chores to perform every year, including a written examination every ten years.

The examinations are given at computer based testing centers throughout the nation. All sorts of examinations are given at these centers and most have nothing to do with medicine. The staff at these institutions have strict rules to enforce – rules designed to stop cheating and protect the proprietary information that is contained on the examination. I recently visited one such institution to take my ten-year recertification examination for the American Board of Surgery.

The testing center is located about an hour from my office, so much more convenient than flying to Houston. After showing my ID, my examination slip and signing into the building, I was escorted to the testing center like I was in custody. I dutifully called the plastic surgeon covering for me to let them know I would not me in possession of my phone for the duration of the exam. Before I let them know that I would call as soon as I was finished, I was getting the evil eye. It seems using a cell phone, even in the reception area outside of the examination, is not allowed. Did I mention the exam is anxiety promoting?

Why Maintain Board Certification?

This question is becoming more and more controversial as the fees, exams and other hurdles are raised higher and higher each year. Those in favor claim that board certification is good, and recertification makes sure that your doctor is still good. Those opposed site the ever escalating cost and time required and the lack of evidence that it makes us better doctors. Personally, I don’t mind. It is a hassle, and it does not change the way I practice. On the other hand, it shows my patients that I am committed to being the best, and I don’t mind being tested on it. Plus, when I pass, I have the lovely certificate shown above to show everyone.

My Board Certifications

American Board of Surgery MOC

I completed a General Surgery residency in 1994. I passed my General Surgery Boards in 1995 and have recertified twice. I am good until 12/31/2025, as long as I complete my yearly chores and pay my yearly fees.

American Board of Plastic Surgery MOC

I completed a Plastic Surgery residency in 1997. When I finished my training, it took two years to take the certification exams. I passed my Plastic Surgery Boards in 1999, and have recertified once, so I am good until 12/31/2019. Looking forward to the next exam.

American Board of Medical Specialties

There are many boards out there, but the “real” boards are those under the umbrella of the American Board of Medical Specialties (ABMS). This is the longest standing body for Medical Certification in the US. The American Board of Plastic Surgery was born from members of the American Board of Surgery and the American Board of Otolaryngology who did what is now recognized as Plastic Surgery, and remains the only ABMS Board certifying Plastic Surgeons.

Board Certified Plastic Surgeon

So now you know more about how I spend my time away from patient care. Plastic Surgery is not all glamour; there is always more paperwork to do. If you are considering Plastic Surgery, be certain to check your doctor’s training. Good training, and maintenance of that training, are essential for providing the safest and most predictable results.

If you are in the San Francisco Bay Area and would like to schedule an appointment with me, call (925) 943-6353. And if you want to check out my qualifications, here are some links to help you:

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.

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Counterfeit Botox is Back Bay Area

Posted April 25, 2015 in Botulinum Toxin (Botox Dysport Xeomin), Chemical Peels, Facelift (Rhytidectomy), Fillers (Restylane Juvederm Perlane Radiesse), Home, Patient Safety, Wrinkle Reduction (Non-surgical)

The real Botox bottle and box have many security features to prevent counterfeiting.

The real Botox bottle and box have many security features to prevent counterfeiting.

Botulinum Toxin remains the number one non-surgical cosmetic treatment year after year. In 2014, 3,588,218 neuromodulating wrinkle treatments were reported by the American Society for Aesthetic Plastic Surgery alone. Botulinum Toxin Treatments were more popular than the next four nonsurgical beauty treatments combined:

The Top Five Nonsurgical Cosmetic Procedures

  1. Botulinum Toxin (Botox, Dysport, Xeomin, Myobloc) – 3,588,218
  2. Hyaluronic Acid (Restylane, Juvederm, Perlane, etc…) – 1,696,621
  3. Hair Removal (Laser or Pulsed Light) – 828,480
  4. Chemical Peel (TCA, Phenol) – 484,053
  5. Microdermabrasion – 417,034

Counterfeit Botox

The latest counterfeit Botox bottles look a lot like the old Botox bottles. They are taller, thinner, lack holograms, lack unique lot numbers, lot numbers on bottle and box may not match and they have "Botulinum Toxin Type A" instead of "Botox Cosmetic OnabotulinumtoxinA."

The latest counterfeit Botox bottles look a lot like the old Botox bottles. They are taller, thinner, lack holograms, lack unique lot numbers, lot numbers on bottle and box may not match and they have “Botulinum Toxin Type A” instead of “Botox Cosmetic OnabotulinumtoxinA.”

When I say, “Counterfeit Botox,” I am not talking about competitive brands of FDA approved Botulinum Toxin. Botox was the first to market in the US, while Dysport was the first to market in Europe. Both are FDA approved, as are two others:

  • Botox® (onabotulinumtoxinA)
  • Dysport® (abobotulinumtoxinA
  • Xeomin® (incobotulinumtoxinA)
  • Myobloc® (rimabotulinumtoxinB)

FDA Approved Botulinum Toxin – What’s The Difference?

Dysport was the first to market in Europe, second in the US and is also FDA approved.

Dysport was the first to market in Europe, second in the US and is also FDA approved.

There is a big difference between FDA approved Botulinum Toxin and everything else fraudulently making the claim. The approved drugs are deemed safe and effective when administered in the prescribed fashion by a qualified and experienced injector. These drugs have been tested, and are manufactured under the supervision of the FDA. Their factories are open to surprise inspection at any time, and the distribution can be stopped when problems are found.

Counterfeit Botulinum Toxin on the other hand, is not manufactured with the same quality controls. It may not contain any Botulinum Toxin, and when it does, the dosing can range from ineffective to lethal.

How to Avoid Counterfeit Botox

You get what you pay for, and beauty is not cheap. If an offer seems too good to be true, it’s most likely false. It takes experience to become a good injector, so look for an established practice with experienced injectors. Ask questions:

  • How many Botox injections do you do a month?
  • How long have you been performing Botox injections?
  • What is your training?
  • Can I see the bottle? (for Botox look for the Allergan hologram)
  • How long between mixing the Botox and Administration?

Reputable doctors will be happy to explain. Grumpy or evasive responses are a red flag.

Wrinkle Ridding Consultations

As a Board Certified Plastic Surgeon, I perform everything from Botox to Facelifts. Botox is usually performed in the office on the third Wednesday of each month. It’s a busy day, but it allows me to use Botox or Dysport within a few hours of mixing, so nothing gets stale. If you are interested in Botox, Fillers or Surgical Correction of Facial Wrinkles, give me call at (925) 943-6353. More Plastic Surgery Information is available on our newly revamped and mobile friendly web site: DrMele.com.

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