ZERONA^® Offers Safe Alternative for Painless Reduction of Inches and Body Fat in THE BAY AREA

Local board certified plastic surgeon, Dr. Joseph Togba announces the arrival of the ZERONA^®, the only non-invasive, body slimming, low-level laser treatment, to his practice, making him one of the first physicians to offer the ZERONA^® in the Eastbay. During clinical trials, the ZERONA® has been scientifically proven to result in an average of 3.6 inches lost from patients’ waist, hips and thighs. Unlike invasive weight loss surgery, ZERONA® is a revolutionary method that is applied externally without the dangers associated with surgery or other non-invasive devices which rely on heating the tissue. The new technology has been proven to reduce inches from target areas such as the tummy, back, hips, thighs, buttocks, chin, neck and arms; contour and reshape the body; and tighten and tone loose skin.

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Dear Dr. Togba,

Q.  I would like to increase the size of my breasts, but not with Breast Implants.  Is there a procedure that will use my own body fat to augment my breasts?

 A.  At the recent Plastic Surgery Meeting in Seattle, WA, emphasis was placed on less invasive procedures that allow patients to return to the work force earlier.  One of the more interesting topics was the use of fat harvested during liposuction to augment or improve the shape of other parts of the body.  

The use of fat for enhancement of the breast contour is not a novel idea.  It was proposed in the early eighties when liposuction was first introduced but the concept rapidly fell into disfavor because of concerns of destroying the normal architecture of the breast that could lead to misdiagnosis or delay in diagnosis of breast cancer.  Studies now show that adding fat to the breast mound does not obscure mammography, do not cause the development of suspicious masses and the majority of the transplanted fat survived with a natural feel.  Grafting was also used after breast lifts to provide fullness to the upper poles of the breast mound, an effect that is difficult to obtain with silicone implants.   Finally, fat grafts were also used in reconstructive procedures in patients that had undergone lumpectomies to fill in minor or major defects of the breast - a usually difficult reconstructive process. 

Buttock rejuvenation with fat also was a topic of presentations.  Now that the “Brazilian Butt Lift” has become more of a requested procedure, attempts to standardize the procedure and produce more predictable results have been developed.

As fat grafting for facial atrophy associated with ageing is now the standard in many practices, it is likely that the use of fat for the breasts and buttock will be part of the main stream of many practices in the near future.

Dr. T

Luscious, Long Lashes

That Are Not False

But Naturally Yours

Latisse is the new FDA approved eyelash treatment to lengthen, thicken and darken eyelashes.  If you want sultry, seductive lashes, this really works.  The company that makes this product is Allergan, the same people that bought us Botox.  One day our sales rep came into our office with lashes that seemed a mile long.  We were immediately drawn to them.  After careful examination, we found out it was not mascara or falsies, but her actual lashes.  She gave us all the information we needed about Latisse.  So, to put Latisse to the test, we did our own investigation.  Our office administrator, Karen, and nurse were the first to try Latisse.  Their lashes never fail to elicit “beautiful eyes and such long eyelashes” compliments.  Many of our patients are using Latisse and we can’t keep it on the shelf.  See the results.

Melody Askey

Patient Counselor for Dr. Joseph Togba

I look at my photos of myself in my early twenties; the difference between then and now (I am 43 years old), is that my cheeks were fuller, but my body was slimmer.  Now, it is just the opposite, my body holds more weight in the wrong places and my face is slimmer.  My friends have heard me voice my disgust with my deep malar lines and the hollowness of my under eye area.  Malar lines are the creases that sit on top of the cheek.  These along with the sunkeness underneath my eyes gave me a tired, aged look.  I wanted to regain some of the long lost volume in my face which contributed to my youthful look and do it with a long-lasting product that would build up the area without any downtime. 

Sculptra appealed to me because it appeared to be a very natural approach — helping my own body replenish collagen.  The buildup was gradual and the results were very natural.  My co-worker also wanted to fill in her chin area to create a smoother jawline, her under eye area, and her nasolabial folds.  Just this April my co-worker and I decided to have our first treatment of Sculptra.  Our nurse, Darleen, applied some topical and we sat for 1 hour and then had the injection.    I immediately loved my results.  Right after the treatment, I had swelling in the area which looked great.  I remember thinking, “This is how I want my results to look.”  After a couple of days, my swelling went down and the collagen slowly began to build. 

Six weeks later, I was re-evaluated and had my second treatment.  I had my second treatment with a block and I strongly recommend having it this way.  The block numbed my cheeks and I was much more comfortable.  It’s been over six weeks from that time and I like my results even more.  My under eye area looks refreshed and I was thrilled that my own collagen gave me this awesome result.  I’ve gotten comments from friends that say I look great, but they have no idea, until I tell them, that I had Sculptra.  The nurse jokingly says, “You look like you are with us now.”  “Hmmm, I could call it my “now present” look.

As soon as the schedule permits and the results of my second treatment become visible, I will have my third and final treatment and the upper eyelid lift to complete the eye area.  My co-worker just had her second injection.  She is a “delicate flower as I call her” and bruises easily, but her jawline and nasolabial folds are smoothing out nicely.  Another perk that I noticed is that the skin in my cheek area looks better.  It is something about the extra production of collagen (protein) that makes the skin look healthier.

Melody Askey

Patient Counselor for Dr. Joseph Togba

Dear Dr. Togba,

Q.   Dr. Togba, I know this is not an unusual complaint but I look older with a few more lines and less “umph” to my face as certain areas have sagged ever so slightly.  I’m only in my mid-fifties and I don’t feel I’m ready for a facelift.  My friends have mentioned several facial fillers that restore facial volume, particularly Sculptra. Could you tell me about it and why it might be better than other options?

 A.   FDA approved Sculptra is one of the newer additions to our armamentarium of products aimed at restoring facial volume associated with the aging process.  Sculptra is a crystalline form of poly-L-lactic acid, a product that has been used for more than twenty-five years as a dissolvable stitching material under the skin by most surgical specialties. 

Sculptra is mixed with sterile water and a local anesthetic before injecting it under the skin.  The initial mild swelling of the injected site caused by the water component disappears within a few days to a week.  As the residual crystalline product is metabolized by the body, it stimulates the production of collagen, which gradually causes expansion of the injected site over a period of several weeks to months.  The net result of fullness is apparent after two to three months and lasts for about two years.

Most patients with mild to moderate facial “deflation” require two to three treatments separated by a period of four to six weeks which allows for adequate clinical evaluation of the response to the previous treatment. 

Unlike other products used to restore facial volume, Sculptra brings about a gradual, predictable long-term increase in facial volume.  Results are comparable to that of fat grafting without the prolonged swelling and donor site discomfort.

The combination of Sculptra with eyelid surgery, brow lift or neck lift can result in total facial rejuvenation without a facelift for many patients in their 40’s and early 50’s.  For those requiring facelifts, the addition of Sculptra results in an even more youthful appearance.

Dear Dr. Togba,

Q.  I weigh 155 pounds, but at 5′8" I’m very well proportioned. What bothers me is the flabby skin hanging from my belly. Would I need a tummy tuck or liposuction? When is it best to do liposuction?

 A. Based upon the information provided, our recommendation would be an abdominoplasty, also known as a tummy tuck. The abdominolplasty will not only remove the excess skin of the lower abdomen giving you a flatter tummy; it can also repair the muscles of that area to prevent your tummy from sagging in the future. For patients with normal skin, liposuction is the desired procedure for sculpting such areas as the abdomen, waist, inner and outer thighs, hip rolls, back, knees, chin and enlarged breasts on males. Patients are usually near or at normal weight, but bothered by the presence of diet and exercise-resistant deposits of fat. For liposuction, small incisions are made in inconspicuous places at the site of fat deposits. Because fat cells are from specific body areas, the results are permanent if you maintain a healthy and active lifestyle. If you do gain weight, you will gain it proportionately over your entire body; you will not continue to fight this area.

Dr. T

Dear Dr. Togba,

Q.  A friend recently had liposuction to reduce her saddlebags and she looks great! I would like to have liposuction on several areas of my body. Which body areas can be reduced?

A. Liposuction is popular because it’s the proven solution for removal of fat from nearly any body area. The basic "tumescent" procedure is used for all body sculpting. The ultrasonic technique is commonly used in conjunction with the tumescent procedure in areas where tissue is more fibrotic. Women generally want liposuction on their hips, thighs, abdomen, and "saddlebag "area. Men generally want their "spare tire" removed-an area that is ideally suited for ultrasonic liposuction. Men should also know that the ultrasonic liposuction technique has revolutionized the treatment of gynecomastia(enlarged male breasts). Ultrasonic techniques were invented for, and are very effective at removing fat from the upper- and mid-back. Other less common areas that can also be reduced include knees and ankles. Because of its visibility, the neck is a common small area for liposuction. Very little postoperative pain combined with a quick recovery time have made this a popular area for young people.

Dr. T

Dear Dr. Togba,

Q.  Does ultrasonic liposuction really "melt" fat? I know you can do liposuction on different areas, but can you do arms? What is the long term effect?

A. Ultrasonic liposuction doesn’t exactly melt fat; rather it liquefies fat before it is removed with suction. Electrical energy is translated into high-frequency sound, which is then transduced through a hand piece into mechanical vibrations emitted at the tip of a hollow titanium rod. The fat cells implode and liquefy, then the fatty emulsion is aspirated. The advantages of ultrasonic liposuction are easier removal of fat in hard to treat areas (fibrotic areas with dense tissue) and more precise sculpting in difficult areas. Ultrasonic liposuction is not "better" than tumescent liposuction, but, rather, it is better suited to achieving optimum results in fibrotic areas including the male chest, upper abdomen, "love handles,"and dense tissue areas. In fact, ultrasonic liposuction is an adjunct to regular tumescent liposuction; I always employ the tumescent technique during liposuction and, in certain cases, I use the ultrasonic wand as an additional surgical tool. Tumescent liposuction alone can actually be preferable for areas with thin skin, such as chins and arms. The arms respond well to liposuction; I use a thin cannula best suited to the thin skin of that area. The long term effect is that those fat cells are gone forever.

Dr. T

Dear Dr. Togba,

Q.  I am a woman in my mid-40s who used to be very obese. I underwent a laparoscopic gastric bypass procedure one year ago and have lost over 100 pounds. My health is much improved, but nobody told me that I would have loose, hanging rolls of skin everywhere. When I’m unclothed looking in the mirror, I really dislike the rolls of skin. Many of my friends in my bariatric support group complain of a similar problem. What can be done to help?

 A. Developing loose, hanging skin throughout the body is very common after losing a large amount of weight, for example, after bariatric surgery such as gastric bypass or Lap Band. Body contouring procedures such as the body lift (also known as the belt lipectomy), breast lift, thigh thift, arm lift, facelift, and necklift can help remove the extra skin.

Dr. T

Dear Dr. Togba,

Q.  A lot of my girlfriends have had their breasts enlarged. I like how some of them look and not others. One friend has breasts that sit up "too high" on her chest. Another friend’s breasts look fake; you can see the implants. Yet several of my friends have beautiful, natural-looking breasts that simply look several sizes larger than they had before. That’s what I want. Please tell me how you would ensure surgically that I get the look I want.

A. These less than satisfactory results can be avoided, in my most cases, by selecting the surgical approach appropriate for your situation. Let me first address the problem of implants sitting "too high"on the chest. Many women seeking breast enlargement surgery do not have distance between the areolar complex (nipple) and the bottom of their breast to increase their size as much as they might like. The patient has much more latitude with sizing if the surgeon she selects has experience with lowering the infra-mammary crease (crease created as the breast hangs against the chest wall). This increases the breast envelope size, which allows the space for the larger implant. The final result is a naturally-hanging breast where the breast implant does not sit high on the chest. By using this technique and also placing most implants under the muscle, it helps to produce a natural appearance as well as disguise the implant, thus avoiding the "fake" look which you mentioned. I have performed more than 1,000 breast surgeries and learned how these techniques can improve the result. A Board Certified Plastic Surgeon with a greatest deal of breast surgery experience can offer you these options. At my office you can view before-and-after books showing all types of breast surgery.

Dr. T