Over the past 11 years I have interviewed many women that have considered breast reduction and have walked many women through the surgical process from their first phone call to their last post-operative visit.  Recently, while sending out a breast reduction patient’s before and after photos I thought about some of the same comments I hear and thought this would be a helpful blog for women that are thinking about this procedure.

Top 3 comments I hear from patients after breast reduction surgery:

1.       I should have had this procedure done years ago? 

Many patients are very nervous about reducing the size of their breasts.  This concern coupled with the thought of having a general anesthetic can create anxiety.  After a full consultation with your plastic surgeon, ask to speak with patients that have gone through the breast reduction experience.  Most patients are really very open and happy to share their thoughts and personal opinions about breast reduction.

2.       I  immediately felt relief from shoulder and neck pain.

It is common for women with large breasts to have shoulder grooves, neck and upper back pain.  By simply reducing the weight (size) of each breast, the effect is immediately noted, even on the day of surgery.

3.       I feel great and have started exercising.

Aesthetically, after breast reduction, women are very pleased with their new physique.  Having shapely, lifted breasts allows them to wear the clothes they would never consider.   With breasts that are lighter and proportioned to their frame, many feel comfortable and are encouraged by their outcome to start walking and exercising.

Q:  I am 48 years old and I am considering a breast reduction.  Can I have the surgery and return home the same day or is it necessary to stay overnight in the hospital?

A:  Since the late 80’s, I have performed all breast reductions on an out-patient basis, either in a hospital setting or an out-patient surgical facility.  You must have someone with you on the day of surgery to stay with you the first night.  After that, most can fend for themselves.  The pain after the procedure is easily controlled with oral medication.

In-hospital reductions are indicated for those with significant associated medical problems and these women usually will not opt to have an elective surgical procedure.

Q:  I am 46 years old and I have some loose skin along my jaw line.  I don’t know if I am ready for a facelift, but the idea of a mini facelift sounds nice.  What is the difference between them and how long is recovery? 

A:  A mini facelift means something different to each surgeon.  It is performed by way of an incision placed in front of the ear and in many medical practices this is where the similarity ends.  In my practice, a multi plane procedure is done with repositioning of the SMAS*, as in a standard facelift, resulting in a long lasting improvement of the jaw line and the mid face region.  There is little improvement of the neck region so this procedure is appropriate for those with early signs of facial aging without significant neck changes.  Mini facelifts as performed by some other surgeons involve elevation of the skin only with placement of traction sutures to suspend the midface and jowl followed by skin closure.  This is the “lunch hour” facelift.  The results are short lived because one is relying on stitches and the skin to achieve a lasting result.  The recovery time for the “lunch hour” face lift is about a week and for the multi plane procedure, ten days to two weeks. 

 *SMAS:   A fibrous membrane underneath the skin that is attached to the jowls and superficial neck muscles, when pulled up, it pulls the sagging areas along the jaw line.

We have tried it and here are our findings:

Zerona is a non-invasive low level laser treatment designed to reduce an average of 3.64 inches from areas such as the tummy, back, hips, thighs, buttocks, chin, neck and arms.  How does it work?  A pore is created in the fat cells by the laser allowing the fatty content to empty out of the cell which is then picked up and excreted out of the body through body fluids.

We used Zerona on 4 patients.  Each patient had an exercise program and followed the protocol with suppliments.  Patients had proper measurements and the appropriate amount of treatments and found little or no results.  The guaranteed 3.64 inches is spread throughout the body; for example, a patient might lose 1 inch around the waistline, ½ inch on each thigh and other random areas up to 3.64 inches as guaranteed by SBMI.  Our patients did not lose the guaranteed 3.64 inches.

If you are interested in sculpting your body, liposuction can accomplish this consistently and safely.  Liposuction is for people who are near or at normal weight but bothered by the presence of diet and exercise-resistant localized deposits of fat.  This procedure can be performed under local anesthesia on an outpatient basis.  Small incisions are made in inconspicuous places and a suction cannula is introduced to gently suction unwanted fat.

For a little more than what Zerona costs, you can have your abdomen or your waistline contoured with liposuction.  Many patients have liposuction on Thursday and return to work on Tuesday.

 If you are interested in Zerona as a non-invasive alternative, I recommend you speak with several patients that have had a series before making the investment.

My rule of thumb:       If it is non-invasive and sounds too good to be true, then…

Q:  I saw another doctor who recommended liposuction for my belly pouch.  He said the laser would help tighten my skin as well as remove my excess fat.  Is there a difference between laser liposuction and regular liposuction?

 A:  Is there a difference between laser liposuction, ultrasonic assisted liposuction, and standard liposuction?  This is a good question. Over the past 5 years, I have explained this to many patients.  Traditionally, standard liposuction was and is used to contour certain areas like the abdomen, hips, thighs, pelvic roll, back and neck.  Small incisions are made in natural folds or inconspicuous places at the site of the fat deposits.  A suction cannula is introduced and the fat is suctioned out.  This technique is the same no matter which method is used.  The difference is that the laser and ultrasound liquefy the fat which makes it easier to remove in areas with more fibrous tissue such as the upper abdomen and back.  I’ve performed liposuction for over 26 years using various modalities available and have found the results to be similar with all techniques.  At the recent Congress of the International Society of Aesthetic Plastic Surgeons in San Francisco, Dr. Triana from Columbia presented her groups’ finding of more than 26,000 liposuction procedures performed over the last 25 years.  All available techniques were used - standard liposuction, ultra sonic assisted liposuction, and laser assisted liposuction.  Her findings were that all modalities of treatment produced similar results.  The level of pain/discomfort was the same.  The amount of skin contracture (tightening) was the same.  The claims made by manufacturers of the different lasers are purely for marketing purposes.

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.

Read the rest of this entry »

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.