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ATTORNEY GENERAL CUOMO SECURES SETTLEMENT WITH PLASTIC SURGERY FRANCHISE THAT FLOODED INTERNET WITH FALSE POSITIVE REVIEWS

Dale Reynolds M.D. — Thu, 23 Jul 2009 16:00:00 GMT

Cuomo’s deal is first case in nation against growing practice of “astroturfing” on Internet

’Lifestyle Lift’ Will Pay $300,000 in Penalties and Costs to New York State

NEW YORK, N.Y. (July 14, 2009) - Attorney General Andrew M. Cuomo today announced a settlement with cosmetic surgery outfit Lifestyle Lift over the publishing of fake consumer reviews on the Internet.

Under the settlement, Lifestyle Lift will stop publishing anonymous positive reviews about the company to Internet message boards and other Web sites, and will pay $300,000 in penalties and costs to the State of New York. The case is believed to be the first in the nation aimed at combating "astroturfing," a growing problem on the Internet.

Lifestyle Lift employees published positive reviews and comments about the company to trick Web-browsing consumers into believing that satisfied customers were posting their own stories. These tactics constitute deceptive commercial practices, false advertising, and fraudulent and illegal conduct under New York and federal consumer protection law. The settlement marks a strike against the growing practice of “astroturfing,” in which employees pose as independent consumers to post positive reviews and commentary to Web sites and Internet message boards about their own company.

“This company’s attempt to generate business by duping consumers was cynical, manipulative, and illegal,” said Attorney General Cuomo. “My office has and will continue to be on the forefront in protecting consumers against emerging fraud and deception, including ‘astroturfing,’ on the Internet.”

Lifestyle Lift has more than 40 locations across the U.S., including Manhattan, Long Island and Syracuse. The company engaged in a concerted effort to bombard Internet message boards with positive stories about themselves. Lifestyle Lift’s president believed that negative Internet postings had significantly hurt the company’s reputation and thought the success of the company hinged on controlling messages posted online. Company employees were directed to create accounts with various Internet message boards and pose as satisfied customers of Lifestyle Lift. Employees also attacked legitimate message board posters who criticized Lifestyle Lift and tried to get those posts removed from message boards.

Internal emails discovered by Attorney General Cuomo’s investigation show that Lifestyle Lift employees were given specific instructions to engage in this illegal activity. One e-mail to employees said: “Friday is going to be a slow day - I need you to devote the day to doing more postings on the web as a satisfied client.” Another internal email directed a Lifestyle Lift employee to “Put your wig and skirt on and tell them about the great experience you had.”

In addition to posting on various Internet message board services, Lifestyle Lift also registered and created stand-alone Web sites, such as MyFaceliftStory.com, designed to appear as if they were created by independent and satisfied customers of Lifestyle Lift. The sites offered positive narratives about the Lifestyle Lift experience. Some of these sites purported to offer forums for users to add their own comments about Lifestyle Lift. In reality, however, Lifestyle Lift either provided all the “user comments” themselves, or closely monitored and edited third-party comments to skew the discussion in favor of Lifestyle Lift. Examples of these narratives can be downloaded at www.oag.state.ny.us/bureaus/internet_bureau/pdfs/LifestyleLiftStories.pdf.

According to the Attorney General’s settlement, Lifestyle Lift employees will no longer pose as consumers when publishing on the Internet. The company will not promote Lifestyle Lift’s services on the Internet without clearly and conspicuously disclosing that they are responsible for the content. The company will also pay $300,000 in penalties and costs to New York State.

The investigation was handled by Chief of the Internet Bureau Justin Brookman and Investigator Vanessa Ip, under the direction of Deputy Attorney General for Economic Justice Michael Berlin.TEST

23-Jul-09 11:00 AM

Family physician jailed for assault after botched cosmetic procedures.

Wed, 11 Mar 2009 15:00:00 GMT

Editor’s note: Media reports of non-ABPS-certified physicians who have left patients injured after going beyond their core training to perform cosmetic surgery procedures, have unfortunately, become all too common. However, recent weeks have seen an encouraging uptick in courts cracking down on those who have reached beyond their skills and subsequently put the public at risk.

Two of the following cases present instances in which physicians without core training in plastic surgery performed cosmetic procedures with disastrous results. In one, a family physician whose license had already been restricted to disallow facial surgery continued to perform several facial procedures that went awry, leading to his eventual guilty plea to an assault charge. Another details the case of a radiologist accused of substandard and damaging liposuction resulting in a lawful search of his home and office by his state’s medical board.

The third case outlines a court ruling holding a publisher responsible for fraud after a deceptive Yellow Pages® ad led to a patients disfigurement after a liposuction procedure.

A Canadian family physician who ignored a College of Physicians and Surgeons of Ontario (CPSO) – imposed restriction prohibiting him from performing facial surgery was sentenced to nine months in jail late last year.

Vincent Cheng, 43, Ameliasburg, Ontario, pled guilty to two counts each of aggravated assault and assault causing bodily harm for performing facial cosmetic procedures on two women that resulted in complications.

Cheng received a restriction against performing facial surgery by the CPSO in 2004, after several patient complaints were lodged against him beginning in 2000.

The criminal charges of aggravated assault and assault causing bodily harm resulted after two patients confirmed to police that they never would have consented to surgery by Cheng in 2005 had they known his license was under restriction, according to Ontario Police Detective Sgt. Mark Allison.

“In Ontario, you actually can ‘consent’ to an assault, which involves the use of force,” Allison says. “For instance, two guys in a fight give their implicit consent. But these two women would not have consented to the surgical activities had they known about Cheng’s restriction; therefore, they couldn’t consent to the ‘assault’ – the use of force. It becomes ‘aggravated’ because the assault resulted in maiming, a wound or disfigurement.”

Police launched their investigation after the two patients complained that Cheng- whose medical license was permanently revoked by CPSO in October 2006- performed a blepharoplasty and breast augmentation, respectively, in his office-based facility that left them with complications requiring correction by plastic surgeons.

“He knew he wasn’t suppose to be doing these (procedures) because the CPSO was clear in its intent when it handed down his license restrictions,” Allison syas.

While serving as plastic surgery division chief at the University of Toronto, PSEF President Peter Neligan, MD, Seattle ( who was recently named director of the Center for Reconstructive Surgery at the University of Washington Medical Center) was asked by the CPSO review the case. Dr.Neligan also served as a witness for the prosecution during sentencing.

To fulfill the CPSO roel, he requested 25 random charts that he pored over before a face-to-face meeting with Cheng.

“I found from the charts that his documentation was completely inadequate, and that’s dangerous,” Dr. Neligan says. “For example, in liposuction cases he didn’t document the amount of aspirate and how much fluid he had administered-and these were but the tip of the iceberg.”

“During our meeting I asked him about training, but the only plastic surgery training he had was as a medical student rotating on the plastic surgery service. I said, ’In other words, you’ve had no training in cosmetic surgery?’ He agreed that was the case. And his lack of knowledge of basic anatomy was frightening.”

During sentencing, Canadian Justice Richard Byers criticized Cheng for “becoming so greedy he became an outlaw,” according to an article by the Osprey News Network, owned by the Sun Media Network, Ontario. The article noted that Byers also criticized the CPSO for what he called its lack of oversight of Cheng: “I get the sense that the people in charge-the College- knows about this problem [of rogue physicians], but they can’t get their act together to deal with it,” Byers said.

CPSO spokesperson Kathryn Clarke says the College is working to strengthen patient safety in part by submitting proposals to the Legislative Authority of Ontario-similar in function to U.S. state legislatures-to give the College the ability to accredit office-based surgical facilities, as well as disallow physicians from advertising services for which they are not formally trained.

“We would like the ability to go into facilities to see how physicians are performing, look at their equipment and the personnel they work with and see how the facility is set up,” Clarke Says.

“We also would like the authority to prohibit physicians from using the title ‘surgeon’ or the word ‘surgery’ in their advertising if they aren’t board-certified as such,” she adds.

“Patients need to have the right information.”

In December, the Legislative Assembly of Ontario introduced the legislation as an amendment to the Regulated Health Professions Act of 1991.

Clarke says these proposals would have been introduced regardless of the Cheng case.

“He wasn’t specifically linked to this,” she says. “His behavior certainly was in the background, but it wasn’t the sole reason for moving forward with our initiatives.”

Dr. Neligan agrees with the College’s approach of submitting its own legislative proposals to better protect patients.

“It needs to do this if it’s going to prevent regulation from government-meaning having its oversight functions controlled by people other than physicians,” Dr. Neligan says. “Physicians should be making sure that they are protecting their patients.”

Radiologist ‘liposuclptor’ leaves county after home, office searched.

A Beverly Hills-based radiologist who performed liposuction procedures and used the modified aspirate to per his diesel fuel SUVs has reportedly left the country after the Medical Board of California conducted a search of his home and office on Nov. 14.

Search warrants targeting Alan Bittner, MD, were executed following several patient complaints, according to the Canyon News (Beverly Hills, Calif.). the Medial Board declined to release details of the case.

The Los Angeles Daily News reported Dec. 29 that several patients filed civil suit in 2008 against Dr. Bittner, medical director of Beverly Hills Liposculpture, for allegedly allowing his girlfriend-who does not hold a medical license-and an assistant to perform liposuction procedures that left the patients disfigured.

The Medical Board and San Francisco District Attorney filed suit against Dr.Bittner in 2003 for posting information on his website that was not based in truth, according to a Medical Board spokesperson, who declined to specify the alleged infraction. She added that Dr. Bittner corrected the information, and that no further action was taken against him at the time.

On his website (www.dralanbittner.com), Dr. Bittner’s website reports that he has left the United States for South America, in order to volunteer at a small clinic. “I am going back… to volunteer with a small clinic that is very similar to where my medical career began decades ago, where I can help those most in need,” according to the website.

Dr. Bittner gained attention last year for reportedly using liposuction-derived fat to power diesel vehicles although the practice of using human medical waste as fuel is against California law, according to Discover magazine’s online version (www.discovermagazine.com).

Misleading Yellow Pages ad leads to lipo ‘disaster,’ fraud ruling

An Oregon woman who underwent a liposuction procedure in 1997 by a dermatologist she believed was ABPS-certified-based on the physician’s deceptive Yellow Pages® advertisement-suffered a plastic surgery “disaster” that led to a $1.32 million fraud judgment against publisher Dex Media Inc. The decision was upheld by the Oregon State Supreme Court in late 2008.

At issue was Dex Media’s failure to properly consider “reasonable foresee ability” for consequences related to its printed material. The patient, M.M. Knepper, settled out of court in 2005 with the dermatologist Timothy Brown, MD for $175,000, according to the State Supreme Court decision obtained from the Oregon Judicial Department Appellate Court Decisions website (www.publicatoins.ojd.state.or.us).

Dr. Brown used a Yellow Pages advertisement to announce that he was “board certified” – but it did not refer to his certification in dermatology-which prompted Knepper to choose him for a tumescent liposuction procedure that resulted in chronic pain and misshapen skin. ASPS Life Member Lloyd Hale, MD, who testified as an expert witness on Knepper’s behalf in 2002, described her outcome as an “uncorrectable disaster”.

The State Supreme Court ruling affirmed the $1.32 million jury verdict against Dex for allegedly publishing the advertisement that misrepresented Brown’s qualifications with knowledge that the information contained within was inaccurate. In fact, the DEX sales representative convinced Dr. Brown to drop the reference to his dermatology certification in the ad, as well as place it under the heading, “Surgery, Plastic and Reconstructive,” the court document states.

However, Dr. Brown began performing liposuction only after receiving some limited informal training in how to perform that procedure,” according to the document.

Knepper testified that she never would have consented to the procedure by Dr. Brown had she known that he was ABPS-certified. Her pain and misshapen skin could not be corrected even after two follow-up procedures by Dr. Brown.

Dex attorneys argued that fraud was not present in this case, because there was no evidence the injury to Knepper was “a reasonably foreseeable consequence of the defendant’s conduct” – that there was no way to establish that by printing the ad, the publisher should have known that the adverse result was possible.

The state Supreme Court rejected that argument. “Dex had reason to expect that… and adverse result was more likely if Brown, rather than a board-certified plastic surgeon performed the liposuction,” it stated.

Dex also based its claim of innocence on the plaintiff’s failure to prove that it “acted maliciously, with the intention to harm another, or in reckless regard of consequence.” This, too, was rejected by the court: “This is not a case of the unwitting publications of an advertisement that turns out to be false. It is, instead, a case in which the publisher took a knowing and active part in the perpetration of the fraud.

“An advertisement that misrepresents a medical provider’s qualifications self-evidently creates a risk that a consumer who seeks treatment from the provider in reliance on that misrepresentation will suffer an adverse result that would not have occurred if the provider’s qualifications had been as represented,” the court stated.

11-Mar-09 10:00 AM

US Cosmetic Trends for Men

Thu, 26 Feb 2009 21:00:00 GMT

At Reynolds Plastic Surgery we like to keep current with industry trends. Here is an article we found interesting and have been passing around the office. Now, we would like to pass it on to you.

"Cosmetic Surgery Losing Stigma for U.S. Men, Rises 17% in 2007

By Michelle Fay Cortez

Feb. 26 (Bloomberg) -- American men, favoring Botox injections and liposuction, underwent 17 percent more cosmetic procedures in 2007 to more than 1 million treatments, according to the American Society for Aesthetic Plastic Surgery. Operations and less-invasive procedures among women still outnumbered those in men by 10 to one, and men mostly eschewed a buttocks operation that's gaining popularity, the society said yesterday. Botox, the biggest product from Irvine, California- based Allergan Inc., generated $1.21 billion in sales last year, a 23 percent gain, counting cosmetic and medical..."

To read the full article, please visit www.bloomberg.com

26-Feb-09 3:00 PM

El Paso Magazine - Best Doctors of 2009

Dale Reynolds, M.D. — Tue, 03 Feb 2009 15:00:00 GMT

Dr. R. Dale Reynolds, M.D.

Dr. Reynolds is a native third generation El Pasoan. He was trained in Houston in the largest medical center in the world under internationally renowned plastic surgeons.

While he is best known for his excellent cosmetic work, he still volunteers his time as the director of both cleft lip and palate clinics in the El Paso region. Dr. Reynolds is the only private practice plastic surgeon to provide this service for our community. This allows underprivileged kids to stay close to home instead of traveling hundreds of miles for treatment.

His ability as a pen and ink artist and excellent training translates into a combination of science and beauty like no one else can. His staff treats each patient with warmth and personal attention. Dr. Reynolds has an office on the Westside and the Eastside of town to better serve you.

Dr. Reynolds is the El Paso Times choice for plastic surgery articles and was selected as Best of the Best 2008 by What’s Up magazine. He is board certified by the American Board of Plastic Surgery and will be honored with induction into the American Society of Aesthetic Surgery in April 2009.

3-Feb-09 9:00 AM

Is a Mini Tummy Tuck Surgery for Me?

Richard Reynolds — Wed, 05 Nov 2008 18:00:00 GMT

R. Dale Reynolds, M.D.

Some patients have heard the term mini tummy tuck surgery but are unsure of what that is or if it is right for them. This abdominoplasty procedure is best for patients who have a limited amount of skin or fat excess in their lower abdomen (below their belly button). If the area above the belly button is relatively tight and without much fullness, then a full tummy tuck surgery may not be necessary.

The incision for the mini tummy tuck is about the length of a c-section incision and is low so it is well hidden. Other differences are that the belly button has no incision and the muscle layer is not tightened with a mini tummy tuck. However, most patients that need a tummy tuck surgery need a full tummy tuck. After childbirth or weight loss, the entire abdominal region is usually affected and anything less than a full abdominoplasty procedure will give suboptimal results. The full tummy tuck will remove significantly more tissue and it will tighten the abdominal muscle fascia. There is an incision around the belly button because the skin around it is redistributed. The incision is low and well hidden.

Liposuction can be combined with either kind of abdominoplasty procedure. Some liposuction is usually done as part of the procedure, but if an extensive amount is required in other areas, then you can discuss with your surgeon if this would be the best time to do this.

If you’re interested in a tummy tuck in El Paso, Dr. Reynolds and his knowledgeable, skilled staff at Reynolds Plastic Surgery will be happy to consult with you to see if you are a likely candidate. Out-of-state visitors and residents of El Paso with abdominoplasty needs can call or contact the office for more information at 915-532-6662.

5-Nov-08 12:00 PM

IS COSMETIC EYELID SURGERY OR A BROW LIFT FOR ME?

Richard Reynolds — Wed, 02 Jul 2008 15:00:00 GMT

Dale Reynolds, MD

Blepharoplasty, or cosmetic eyelid surgery, can be useful way to improve your overall appearance and diminish a haggard or tired look. Many people begin to consider surgery on their eyelids, or alternatively a brow lift, because they have a tired look about them even when they don’t feel tired. They are often asked by others if they are tired although they feel great.

In some patients, this begins early in their 20’s or even teens and is usually from darker skin in the area or from a prominence under the eyes which produces shadows giving the appearance of bags. This prominence is from excess fat around the eye itself. Redistributing or removing this via cosmetic eyelid surgery will remove the bags under the eyes. As the aging process continues, excess skin develops in the upper and lower eyelids. This usually becomes noticeable in the mid-forties and bothersome in the fifties.

Often, the excess skin in the upper eyelids can become such a problem that peripheral vision can be affected. Removing this excess skin from your upper eyelids during cosmetic eyelid surgery will significantly improve your appearance and will make you look more alert and more vibrant. If the skin was so excessive as to affect your peripheral vision, this will be corrected as well. Removing this excess skin from your lower eyelids will further improve the bags under your eyes, and in this age group, cosmetic eyelid surgery is usually done in conjunction with removal or redistribution of fat in the lower eyelid.

Approximately half of the patients that have excess skin in their upper eyelids could also benefit from a concurrent forehead lift (brow lift). Aging causes the forehead and eyebrows to descend causing bunching of the upper eyelid skin, and the excess skin in that area is accentuated by the descent of the brow. In these cases, if the brow lift is ignored, then there will only be partial improvement (usually around 75%). If a brow lift is performed, it can be done as an open procedure or as an endoscopic procedure. The open approach requires a longer incision but can often be hidden in the hair and is sometimes a better approach if the hairline is high. Numbness is more common with the open approach but usually resolves within a year. The endoscopic approach requires small incisions hidden in the hair, and the chance for numbness is greatly reduced. If the hairline is high, then caution must be used with an endoscopic approach because the hairline will be raised after the procedure.

If an extreme brow lift is required, the endoscopic approach may not be best. As with any procedure, there are risks that should be considered. There will be some asymmetry, swelling, and bruising for several weeks. Some patients are not candidates or are poor candidates for cosmetic eyelid surgery or a brow lift if they have excess laxity of their lower eyelid. These patients are at higher risk for ectropion (abnormal position of lower eyelid) post-operatively. If dry eyes are a problem before the brow lift surgery, then one should seriously re-consider surgery because dry eyes can become much worse post-operatively. If excess fluid has built up (edema) under the skin of the lower eyelid from an allergic response to the brow lift surgery, there may not be significant improvement with a lower blepharoplasty procedure. After an examination by your plastic surgeon, a recommendation will be made and risks complication will be discussed in detail taking into account your unique anatomy. Most patients are happy with the results after cosmetic eyelid surgery and look years younger. It can significantly improve a tired look and replace lost vibrancy to your face.

2-Jul-08 10:00 AM

Cosmetic Surgery in Men

Richard Reynolds — Fri, 23 May 2008 16:00:00 GMT

R. Dale Reynolds, MD

According to statistics from the American Society of Aesthetic Plastic Surgery, cosmetic surgery in men is increasing every year. Most plastic surgery on men is for those who want to improve their confidence. Some want to feel more competitive in the marketplace. All want to feel better. Cosmetic surgery and related procedures in the United States increased 32% last year. Some of the most common procedures for cosmetic surgery in men include (most common are underlined): liposuction, abdominal etching, rhinoplasty, blepharoplasty (eyelids), facelift, chin implants, gynecomastia reduction, breast reduction after weight loss, laser hair removal, Botox injections, Radiesse injections, Juvederm injections and chemical peels.

Gynecomastia is the presence of excessive breast tissue in men or “women-like breasts.” Some men have this to a minor degree while other men have a more severe problem. Often, men feel like they need to wear three or four shirts so that the breast tissue can be hidden. It often causes a limitation in activities and avoidance of some situations such as swimming. Plastic surgery in men can usually improve this condition with ultrasonic liposuction using small incisions. Sometimes, a larger incision is required under the areola to remove breast tissue under the areola. In severe cases or in those losing over 50 pounds, additional incisions may be required.

Another common reason for plastic surgery in men is fat around the abdomen. Many men also complain of their love handles as being an area that they just can’t get rid of no matter how much they diet and exercise. Liposuction is often used to reduce the fullness in the “love handle” area or remove excess tissue in the abdomen. Abdominal etching is the removal of excess fat in the abdominal area especially in the area of the “six-pack” to create more definition. This type of cosmetic surgery for men works best in those close to their ideal weight looking for more definition.

Other popular options for cosmetic surgery in men are hair removal and facial injections or fillers. Hair removal can be done so that the beard and neck doesn’t require shaving as frequently or at all. Botox temporarily decreases activity in facial muscles which allows the creases to relax. Radiesse, Restylane, Juvederm and Collagen are fillers used to build-up depressions and fill in deeper creases. Often, a combination of Botox and fillers complement each other to give a more youthful look.

On men, all of these procedures are always done in a way to complement masculine features while looking more youthful – a big motivation for obtaining plastic surgery. As men become aware of what is available to them and are open to looking into these procedures, they can improve their confidence and competitive edge in the marketplace.

This article, printed in the El Paso Times, was written by Dr. Reynolds, who is the local Plastic Surgery expert for the newspaper.

Contact Reynolds Plastic Surgery to learn more about our cosmetic surgery for men.

23-May-08 11:00 AM

Body Contouring

Richard Reynolds — Fri, 23 May 2008 16:00:00 GMT

R. Dale Reynolds, M.D.

What is “body contouring” and is it right for me?

Liposuction surgery, abdominoplasty (or tummy tuck), buttock lift, thigh lift, body lift, belt lipectomy and buttocks (gluteal) augmentation all fall under the category of body contouring procedures.

Which procedure is right for you depends upon several factors. In general, patients with good skin tone and small pockets of fat deposits (or lipodystrophy) are best suited for liposuction surgery.

Patients with excess skin or loss of skin tone are often better candidates for a body contouring procedure where excess skin will be excised and tightened (resectional procedure). The abdominoplasty or tummy tuck deals with the front (abdominal) part of the lower trunk. An abdominoplasty or tummy tuck is often the best procedure for a woman trying to regain her youthful figure after the trauma of childbirth. It is best to wait to have an abdominoplasty until after childbirth is completed so the benefits of the surgery will not be lost. A buttock lift resects excess tissue (skin and fat) from the buttocks and lifts it into the correct position. This can be combined with an augmentation of the buttocks to increase fullness or rearranging the patient's own tissue to increase fullness (auto-augmentation). A thigh lift resects excess tissue from the thighs and repositions them correctly thus tightening the upper thigh.

A body lift combines the abdominoplasty, thigh lift and a buttock lift to re-contour the entire lower trunk. The body lift is a common body contouring procedure that is performed on our bariatric patients after they reach a stable weight. These patients often lose 100 to 250 pounds, and the excess skin they are left with can be quite limiting. The body lift is often the best option for patients who have always been a normal weight. Sometimes after pregnancy the tissue in this area is best dealt with using a body lift, especially if there is excess skin in the thighs and buttocks. A belt lipectomy is similar to the body lift in that it is a circumferential procedure (incision goes all of the way around the trunk) but the incision is higher and the thighs and buttocks aren’t lifted as much.

Buttocks (gluteal) augmentation or enhancement can be performed with fat translocation, tissue rearrangement, soft silicone implants or hard silicone implants. There are advantages and disadvantages to each and they should be discussed at length before deciding.

Most of these body contouring procedures, including liposuction surgery, thigh lifts, and buttock lifts are performed as an outpatient, but the circumferential procedures often require a brief stay.

All activities can resume at six weeks, after gradual increase in activities up to that point. It often takes six to 16 weeks to see the final result with these procedures. As with all procedures, some risks exist. Make sure these are discussed with your surgeon before proceeding.

This article, printed in the El Paso Times, was written by Dr. Reynolds, who is the local Plastic Surgery expert for the newspaper.

Contact Reynolds Plastic Surgery for a consultation to determine the right body contouring procedure for you.

23-May-08 11:00 AM

Botox Injection or Dermal Fillers?

Richard Reynolds — Fri, 23 May 2008 16:00:00 GMT

Every day, millions of patients receive a Botox injection or dermal fillers. Patients hear these discussed in the media daily, but there are so many options, and with new ones coming to the market each year, the choice can become confusing. Patients often ask for a Botox injection or dermal fillers when they usually need a combination of both.

Botox is a neurotoxin which temporarily paralyzes the muscle that it is injected into. A Botox injection acts by inhibiting muscular activity in the area of concern. By relaxing the muscle in the area, the folds or creases are no longer prominent and often disappear. Botox injection charges are calculated by unit or by area. One area is usually around $300, and 1 unit is usually $9-16 dollars. If the surgeon is charging less than $9/ unit, ask him or her to mix it in your presence and make sure that at least two mL are used because they may be using a diluted product. If charges are by unit, then the number of units required will vary by gender (men usually require more), area, and degree of muscular activity in each area. There are 100 units of Botox in one bottle. The forehead usually requires 30-50 units, the area between the eyebrows (glabellar region) usually requires 20-30 units, and the areas outside of the eyes (crow’s feet area or lateral orbital region) usually require 25-35 units of Botox injection. There are other areas which can also be treated like the neck bands, around the mouth or the nasal area.

Botox has other uses as well such as treating excessive underarm sweating or a spasm around the eye. Side effects and complications are very rare although it does take 5-7 days to paralyze the muscle.

Dermal fillers include an ever growing list of products. A few of the more popular choices are fat, Collagen (Zyderm, Cosmoderm), Radiesse, Restylane, and Juvederm. All dermal fillers have pros and cons and vary in composition and duration of effect, but all act to fill grooves or creases with volume rather than by acting on the underlying muscle. If you paralyze the muscle and fill the crease, you get more than a two-fold effect. There are at least twenty different kinds of fillers, so you should ask your plastic surgeon which one is best for you. Make sure you know which ones have been approved by the FDA and for what uses. Complications are uncommon with dermal fillers although bruising that can last for days or even weeks occurs 15-40% of the time. Stopping any aspirin or Motrin for two weeks before receiving dermal fillers will help minimize this possibility. The injection can be done quickly in the office with a nerve block or no anesthetic. If topical anesthetic is used (to numb the skin) then it is necessary to wait for 20-30 minutes to allow this to work. The size of the needle and the pain threshold of the patient determine the best type of anesthetic.

The Botox injection and dermal fillers are so popular because they are quick, effective, predictable, affordable and safe. Most patients are very happy with the results and this is the reason this area of Plastic Surgery continues to grow.

This article, printed in the El Paso Times, was written by Dr. Reynolds, who is the local Plastic Surgery expert for the newspaper.

Contact Reynolds Plastic Surgery to find out if a Botox injection is right for you.

23-May-08 11:00 AM

Having a Breast Augmentation Procedure

Richard Reynolds — Fri, 23 May 2008 16:00:00 GMT

Dale Reynolds, MD

Breast augmentation is a procedure used to enhance the size of a woman’s breast or to obtain more symmetry. For many women, the confidence boost this procedure gives them makes the potential side effects of breast implants well worth it. Childbirth often causes significant deflation and sometimes droopiness of the breasts which can often be reversed by filling this deflated breast with more volume. Often during development, a significant amount of breast tissue doesn’t form leaving ladies feeling less feminine.

In November of 2007, the FDA re- approved use of silicone implants for all women over 22 years old having a breast augmentation procedure, which ended a 14 year restriction due to the side effect of breast implants made from silicone experienced by many women. Advances in silicone implants mean that it is now safe to use silicone or saline implants for a breast augmentation procedure depending upon patient preference and anatomy.

The implants can be placed above or below the chest muscle if silicone implants are used. If saline implants are used, most plastic surgeons will place them under the muscle. Placing them above the muscle decreases post-operative pain and may decrease distortion during heavy chest muscle activity (important for body builders). Placing the implants below the muscle hides the upper portion of the implants (especially saline) and offers slightly more tissue coverage if tissue in this area was very deficient. Placing them below the muscle also decreases visibility or rippling of the implants.

Short-term side effects of breast implants include soreness, swelling, change in nipple sensation (increased or decreased sensation), and bruising. Most of these resolve completely within a few weeks to months. Some potential long-term problems include deflation, leak, rupture, capsular contracture (abnormal scar tissue around the implant), and rippling. All implants develop a capsule around them, but some can become hard or painful and may require removing this scar tissue. An MRI can confirm leakage of a silicone implant if suspected. Saline implants usually deflate entirely when there is a leak or rupture, so no additional studies are required. The implants will most likely have to be replaced at some point, but it is not necessary to change them at a fixed interval if there are no problems.

The breast augmentation procedure is performed as an outpatient, usually under a general anesthetic and takes about one hour. Breast augmentation recovery is typically short. Most patients experience mild to moderate soreness that improves significantly 2-3 days after surgery, and most patients are back to work 3-4 days after surgery. Most activities can resume immediately, but there are some restrictions on strenuous activity for 3-6 weeks. After 6 weeks, there are no restrictions. After undergoing a breast augmentation procedure, mammography continues at the same intervals, but a slightly different technique will be used.

This article, printed in the El Paso Times, was written by Dr. Reynolds, who is the local Plastic Surgery expert for the newspaper.

Contact Reynolds Plastic Surgery to schedule a consultation for a breast augmentation procedure.

23-May-08 11:00 AM

Options for Facelift Surgery

Richard Reynolds — Fri, 23 May 2008 16:00:00 GMT

Dale Reynolds, MD

Is a lunchtime facelift a contradiction in terms? It really depends on what your plastic surgeon means when they say facelift surgery – a surgical or non-surgical facelift. Any “facelift” should improve the jawline, tighten the neck and remove the jowls in the lower face. There also may be some improvement in the nasolabial folds and marionette lines. A facelift shouldn’t be expected to help much with most other lines or creases in the face.

A classical facelift surgery involves removing excess skin of the face and neck to obtain a more youthful look. The most popular and effective facelift surgery technique involves tightening or removing some of the muscle layer (SMAS) under the skin so that the tension of the lift is not on the skin. This avoids the over-pulled, windblown look that everyone wants to avoid. In addition to an incision around the ear, an incision is often needed under the chin to tighten the muscle layer of the neck and to remove any excess fat in this area (if it cannot be removed by liposuction alone). For this type of facelift procedure, local anesthesia is required. Most plastic surgeons will also give sedation or a general anesthetic. It can usually be performed as an outpatient procedure and is often combined with eyelid surgery (blepharoplasty) or a forehead lift. Pain is usually minimal, but strenuous activity must be avoided for 4 weeks after surgery. Some swelling or bruising may occur, especially around the eyes.

Recently, some surgeons and non-surgeons have been promoting a less-invasive non-surgical “facelift.” Non-surgeons promote this for obvious reasons. Options include fillers (fat, Radiesse, Restylane, etc) or barbed sutures. A non-surgical facelift can be done with barbed sutures that are placed under the skin under a local anesthetic with the patient awake. It doesn’t last as long, look as natural, or do as much as a true facelift surgery. There may a place for the non-surgical facelift in young (30’s) patients that need minimal refinement or don’t have the time required or the desire to undergo a surgical recovery. The degree of change from this type of facelift procedure is less dramatic and only lasts several months to 2 years depending upon the procedure. While they are less invasive, they still carry risks and these should be understood. Patients have more options than ever before and must know what they want and how to obtain the best results possible by weighing the advantages and disadvantages of each procedure.

Some questions to consider asking your plastic surgeon before facelift surgery are:
-How much longevity should I expect from this procedure?
-What are the possible complications and likelihood of each?
-How long will the procedure take?
-What should I expect during recovery?
-How common are revisions and how are they handled?

It may also help to speak with other patients who have had a similar facelift procedure by the same plastic surgeon. Photographs may help but each patient has unique anatomy and everyone has a different potential for healing. An endorsement by happy patients after a facelift surgery by the same plastic surgeon is the best screening tool. To ensure a good experience make sure you are comfortable with your surgeon, your options, and the procedure you choose together.

This article, printed in the El Paso Times, was written by Dr. Reynolds, who is the local Plastic Surgery expert for the newspaper.

To schedule a consultation for a facelift surgery with Reynolds Plastic Surgery, contact us today.

23-May-08 11:00 AM

Considering Breast Enhancement? What You Need to Know

Richard Reynolds — Wed, 17 Oct 2007 14:00:00 GMT

Breast augmentation surgery is a procedure that plastic surgeons use for breast enhancement or to obtain more symmetry. Every day, women all over the world decide to undergo breast augmentation surgery for a variety of reasons. It is important to research and understand the surgery and examine your reasons for considering it when deciding whether breast augmentation is the right procedure for you.

Is Breast Augmentation Surgery Right for Me?

Women are impacted by the pressure from society to look perfect from a young age. Compound that with a spouse or partner that prefers larger breasts and it is reason enough for many women to decide to undergo breast augmentation surgery. There are plenty of women that decide to proceed with breast enhancement for the right reasons, based solely on their own wants and needs. To ensure a successful outcome, it is important to take a close look at what is behind your desire for enhanced breasts.

Have realistic expectations - Women must go into breast enhancement with realistic expectations of what the operation will do for them. It is important to keep in mind that even though breast augmentation surgery can do wonders for self-esteem, it is meant to enhance your appearance, not make your life perfect.
Who are you doing it for? Yourself or someone else's happiness? - It is essential that you decide to explore breast enhancement for yourself and not for anyone else. Many women make the mistake of going through with breast augmentation surgery to please their spouse or partner, or to comply with social pressures, instead of listening to their own needs. This is a mistake that will not fix problems, but has the potential to multiply them.
Be physically healthy - The best age for breast enhancement is anywhere between 18 and 50. After 50, you can still get implants, but there is a higher risk of medical complications, and the operation has a lower success rate. If you are pregnant or nursing, now is not the time for breast augmentation surgery. Make sure that you don't have any serious chronic diseases or ongoing treatments that may pose a risk. The best way to be sure that you are a good candidate for breast enhancement is to talk to your doctor.
Does your surgeon have the necessary experience to deliver the breast enhancement result you are looking for? Ask potential surgeons to disclose important information about their background, including; education, professional experience, board certification, and the number of years they have performed breast augmentation surgery.
Be mentally prepared for altering the appearance of the body – Often, there is a period of adjustment after surgery. Take the time to ensure that breast enhancement is right for you from both a physical and mental perspective.
Know what results you want to see - Be upfront and open with your doctor about what you want your breasts to look like after the breast augmentation surgery. Clear up any questions or lingering concerns about expectations before moving forward with breast enhancement.
Know what type of breast implants you want - The two options for breast implants are silicone or saline. Both are safe for breast enhancement, but each has pros and cons that need to be considered.
Understand the maintenance that may be required over the long-term - You can undergo breast enhancement, but you cannot stop the process of aging and your shape may change with time and a breast lift may be required later. Many women have to go in for follow-up treatment, either to remove or replace the implants, or have them adjusted due to the effects of age.

The Breast Augmentation Surgery: Before and After

Although breast augmentation surgery is a quick and efficient procedure, it is still serious and it is important to know what to expect during and after, in terms of pain and recovery. A breast enhancement is performed as an outpatient procedure, usually under a general anesthetic and takes about one hour. There is mild to moderate soreness that improves significantly two to three days after breast augmentation surgery and most patients are back to work three to four days after surgery. Low impact activities can resume immediately but there are some restrictions on strenuous activity for three to six weeks. Six weeks after the surgery there are no restrictions.

Short term side effects of breast augmentation surgery include soreness, swelling, change in nipple sensation (increased or decreased sensation), and bruising. Most of these resolve completely within a few weeks to a few months. Some potential long term problems include deflation, leaking, rupture, capsular contracture, and rippling. Capsular contracture is abnormal scar tissue around the implant. All implants develop a capsule around them but some can become hard or painful and may require a procedure to remove the scar tissue. An MRI can confirm leakage of a silicone implant if suspected and saline implants usually deflate entirely when there is a leak or rupture.

When considering breast augmentation surgery, do your homework on the options available for types of implants. In November of last year, the FDA approved use of silicone implants for all women over twenty-two years old, which ended a thirteen year restriction on silicone implants. Plastic surgeons can now use silicone or saline implants for breast enhancement, depending upon patient preference and anatomy.

If silicone implants are used during breast augmentation surgery, the implants can be placed above or below the chest muscle. If saline implants are used for breast enhancement, most plastic surgeons will place them under the muscle. There are pros and cons to placing them above and under the muscle. Placing the implants above the muscle decreases post-operative pain and may decrease distortion during heavy chest muscle activity—important for body builders or weight lifting enthusiasts. Placing the implants below the muscle hides the upper portion of the implants and offers slightly more tissue coverage if tissue in this area was very deficient.

Conclusion

Breast enhancement is a valuable option for women who want to enhance their appearance, with realistic expectations in mind. In order to ensure a successful outcome from breast augmentation surgery, it is important to understand your own motives and to do your homework to learn about all the risks and potential side effects that could result from the procedure in the short and long-term.

About the Author

Dr. Richard Reynolds attended medical school and completed a fellowship on Plastic & Reconstructive Surgery at the University of Texas at Houston. He completed his five year General Surgery Residency at Texas Tech. He is board-certified by the American Board of Plastic Surgery and has been performing plastic surgery at his own private practice in El Paso, Texas for over three years. Dr. Reynolds takes pride in providing the best care possible while keeping quality and customer service high, and costs low. If you have any questions about this topic or other plastic surgery topics please visit the Reynolds Plastic Surgery Center in El Paso at www.reynoldsplasticsurgery.com.

17-Oct-07 9:00 AM

TX Health Magazine Discusses Breast Augmentation with Richard Reynolds, M.D.

Richard Dale Reynolds M.D. — Fri, 26 Jan 2007 21:00:00 GMT

Breast augmentation is one of the most popular procedures for plastic surgeons across the country. Besides those just seeking the cosmetic benefits, there are many women wanted to regain their femininity after a mastectomy. TX Health talked with Dr. Richard Reynolds, of Reynolds Plastic Surgery Center, about this medical practice.

What is the first step for someone seeking augmentation?

The first step is to speak with a plastic surgeon about options. The reason the person is seeking augmentation will help determine her options. Options to consider include placing the implant above or below the muscle and what kind of implant to use, whether it's silicone or saline, textured or smooth, anatomic or round. There are benefits and drawbacks to each of those that they should discuss with their surgeon.

How would you work with someone who just wants to increase their size?

I would talk to the individual to find out more about their motivation for an augmentation. Why is she interested in having an augmentation and I would make sure her expectations are realistic and that she's a good candidate for the procedure. We'll make some measurements regarding her symmetry, size and breast measurements. From those measurements and after discussing the desires of the patient, we'll devise a plan together.

How does someone decide whether they want the implant beneath the muscle or above?

All implants form a fibrous capsule around them because it's a foreign body. Sometimes this becomes more evident with time, but the majority of time it's not noticed by the patient. Putting the implant below the muscle decreases the possibility of this problem. Sometimes putting it above the muscle will get a better result, but this is only done with silicone implants. Putting the implant above the muscle increased the chance of waviness or rippling from the implant and this is the main reason I usually place the implant under the muscle.

What type of procedure is easiest in terms of placing the implant?

The majority of patients are best served with the incision in the crease underneath the breast. It usually heals well and is hidden after the surgery. It also minimizes the possibiulity of change in sensation of the nipple or areola. It allows the surgeon the most precision in placing the implant and usually produces a maximal result. However, if some skin needs to be removed to correct droopiness or ptosis of the breast, then a periareolar approach with a possible vertical extension may be best.

What are the best options as far as breast reconstruction?

There are several options for breast reconstruction. The best choice, if it's possible, is to do an immediate reconstruction at the time of the mastectomy. The general surgeon makes an incision to remove the breast, but most of the breast envelope is left in place. A plastic surgeon can put something in that envelope to keep it expanded temporarily or to put a permanent implant or the patients own tissue in that skin envelope. If this isn't possible, or if the patient is going to receive radiation, it is usually better to wait.

Some general surgeons are very good about discussing the option of immediate breast construction with patients. If we work with the general surgeon at the time of the mastectomy, we usually design the incision together. The general surgeon removes the breast and then the plastic surgeon will fill that breast envelope with either tissue from the abdomen, the back, an expander, an implant or a combination.

What is your greatest joy in the work that you do?

My greatest satisfaction comes from my patient's satisfaction as a result of the surgery, whether it's cosmetic or reconstructive. It usually makes a significant difference in their life and in their self-esteem. Plastic surgery procedures are usually procedures that patients request and after the procedure are happy that they made the decision to have it done.

26-Jan-07 3:00 PM