To My Patients:
It has been months since my last blog, biased opinionated newsletter—guess I haven’t had much to say about what’s new and exciting—but now there are new procedures and products that are noteworthy in this practice—it’s time to inform you again. Although the economy is in the tank, our patients still want to improve their appearance, take care of their skin and change what they don’t like about their bodies, (thank heaven) so there is still a lot going on in our offices.

The longer I’ve been in practice, now over 25 years, the more I’ve encountered patients who are well informed and briefed on cosmetic surgical operations and nonsurgical treatments, i.e. Botox, facial fillers, Thermage, nonsurgical skin tightening, lasers and general skin care. Most patients know of the many options, but need our advice as to what is best for them as individuals. So we give our patients the most proper and safest course of treatment.

If you do not wish to receive these blog letters, please let us know and we will remove you from the list.

I. Non surgical facial procedures and skin care:

A. Skin care: Aside from avoiding sunburns, suntan booths and nasty cigarettes, most of us need to be on some daily skin care regimen to avoid the leathered, wrinkled, Miami retired facial look. It can be as simple as exfoliators and moisturizers to keep your skin youthful or using medical grade lotions and potions that are appropriate for your skin. There are several new products including Nia-24 and CE Ferulic serum, all of which have their benefits. Here are a few words from Amy.

MEDICAL SKIN MESSAGE: Amy Boyd, Aesthetician.
Summer and Fall are the perfect times to schedule your Thermage skin tightening treatment. Unlike other non-surgical treatments such as IPL and Thermage does not require that you stay out of the sun for an extended period of time. In fact, there is no downtime at all! Thermage targets the deep layers of skin where there is more collagen, so the surface of the skin is usually not even pink as soon as you walk out of the office. Please contact me at 816-616-7018 or geraghtyskincare@yahoo.com for more information.
Skin Ceuticals has launched a new antioxidant product! As many of you know, my favorite anti-aging product is the C E Ferulic serum. It repairs sun damage in the skin, resulting in fewer lines, smoother and brighter texture and more even pigment while at the same time protecting the skin from further UV damage. I love it!

Well, Skin Ceuticals has now introduced Phloretin CF serum. They tag it as a new generation of antioxidant. It has the same sun damage repairing properties as CE Ferulic but it is better for pigment problems and oily skin types. Phloretin CF was featured in the June 2008 issue of Oprah they said, “Phloretin, a natural extract that’s been studied as an anticancer agent, is the newest antioxidant available topically; research has shown it can penetrate the skin and provide significant UV protection”. Contact me at 816-616-7018 or geraghtyskincare@yahoo.com if you are interested.
__________________________________________
Amy has been with me for more than ten years and can give you advice for what is most beneficial for your skin. Not only do you need to maintain some semblance of youthful skin, but you can also improve your texture and wrinkles and smooth it up. Talk to us for advice.

B. For the last three years we have used Thermage as a part of our practice. There are now improved tips, i.e. the treatment end of the machine that can tighten facial and neck skin in appropriate patients. However, this treatment is not for everyone, for example, patients with significant redundant skin, very lax jowels and with significant wrinkling. Face lifts are more appropriate for more severe sagging.

The Thermage company has developed a few of these new tips, that we have been using with improved success. I have had several of these treatments by Amy (because I own the machine and hate personal decay). It has worked well and I am pleased. Along with the new tips, this treatment is more beneficial if done several times in a year—not just a one hit treatment.

II. Surgical Facial Procedure:
A. There have been some minor changes in lifting faces, foreheads, eyelids and cheeks such as suturing techniques in modified ways and manipulating the anatomy of a patient. Although face lifts and the adjunct procedures are more aggressive, time consuming, expensive and complicated, they are time honored procedures that give long lasting improvements to sagging facial tissue.

I have not been impressed with my peers use of string lifts and mini fact lifts, because I do not think they last very long and mini lifts give mini results. So I won’t be using these techniques unless someone shows me something miraculous.

B. Liposuction of the neck with Thermage. I have seen some promising results completing liposuction on the neck of patients with thick, fatty necks and only a moderate amount of skin laxity followed up by Thermage to tighten the remaining skin. These procedures are more appropriate for the fatty neck that does not have a good deal of skin redundancy or “waddle”. There is some down time but not as long as you get from face lifts.
The touted and advertised “lunch time liposuction” where you allegedly can return to the office that day refreshed and with no down time is pure BS. Don’t believe it. Don’t do it.

C. Botox and Hyaluronic acid fillers. In 2007 there were 3 million Botox injections in the United States and 1 ½ million injections of Hyaluronic acid (Juvederm and Restylane). That is comparable to several swimming pools filled with Botox and tractor trailers packed with facial fillers. I personally have used these products for years and do all of the injections myself. Granted, many medical practices have their nurse or aesthetician complete these but I’m just more comfortable in doing these procedures. The only real complications from Botox and Hyaluronic acid fillers are bruising and swelling which should quickly subside.
Botox blocks muscle motor function of fine facial muscles and creates less wrinkling in those areas. Hyaluronic acid i.e. Restylane and Juvederm fill deeper wrinkles around the lips and nasolabial folds (the lip/cheek junction) and even disguise jowling. Both of these products are excellent to use as lip fillers. I have been reluctant to use the more permanent fillers which may have delayed foreign body reactions and may cause pustules or granulomas (inflammatory tissue) months or years later. Juvederm which is a hyaluronic acid is our only new product and it allegedly lasts longer than Restylane allegedly. They do resorb after a year or so.

II. Thermage for the abdomen, thighs and buttocks.

A. Having used Thermage for several years on the face and some on the abdomen, we have been less impressed with skin tightening of the abdomen—until recently. In the past we have had good results but not on a regular, predictable basis. Now that the Thermage company has developed improved products, i.e. the deeper tip (one that penetrates and tightens deeper tissue) we are seeing good to excellent results in tightening loose skin of the abdomen. This is only good for mild to moderate skin looseness with a minimal amount of fat and not appropriate for an abdomen that needs liposuction or abdominoplasty treating thicker redundant skin and fat. There is minimal down time for this procedure, but does hurt and you need to take some drugs to take the edge off. We are also using thermage for post liposuction and abdominoplasty patients for that extra potential tightening. Using this combination of liposuction/abdominoplasty with thermage several months later is not appropriate for all patients.

In the future we may be treating cellulite and loose leg plus buttock areas but the results are not conclusive as yet – so we’re waiting. Review Body by Thermage results and treatment modalities at www.Thermage.com and look up the cellulite and body treatment plans and photos.

Conclusion: In the next several months I’d like to give you more advice on new liposuction and abdominoplasty procedures, breast implants and cosmetic breast procedures. I would also like to give you some thoughts on advertising in medicine (of course this is like an ad), charlatans in this town (no names) and my continued thoughts of communist bastard medical insurance companies and Medicare.
There is a bar in southern California that not only serves martinis, wine and whiskey but also Botox is injected by a physician while you are sipping new wines. Simply crazy.
So be cautious and conservative and I’ll inform you more next time.
Again if you do not wish to receive these blogs, let us know.
Thanks.
Sincerely,

Thomas E. Geraghty, M.D.

JANUARY 2007 NEWSLETTER

As threatened in last month’s newsletter, plans are to present a new topic each month to keep you informed of the changing practice of plastic surgery as it affects you, my patients. Last month’s biased opinion on lipodissolve versus liposuction were well received with many positive responses. This can be reviewed per our website at www.geraghtymd.com.
January 2007 Subject: Silicon Gel Breast Implants
This month I would like to briefly inform you of the recent approval of silicone gel breast implants for general use in cosmetic breast enhancement. Since we do several hundred breast implant procedures a year, I would like to give you my take on this after several decades of experience.

Please if you do not wish these newsletter rantings, let us know and you’ll be eliminated—so to speak.

Subject: Silicone gel breast implants
In November, 2006 the FDA approved the return of silicone gel breast implants for general use in cosmetic breast surgery after a 15 year hiatus when the FDA restricted access due to safety concerns. Although I have been using silicone gel breast implants for only specific cases since then, i.e. congenital breast problems, patients with failure of saline implants, breast reconstruction patients and those patients needing an augmentation and a mastopexy or lift with very thin tissue. Now these implants can be used in most all cosmetic breast patients with certain conditions. Because I have completed nearly 3,000 operations with breast implants, a third using silicone implants, this is a timely topic.
Silicone gel breast implants have been studied and scrutinized more than any medical device in history. Now plastic surgeons will have a choice in offering silicone gel filled or saline filled implants and the patients will have an informed choice. Literally when shit hit the fan in 1991, the FDA pulled gel implants off the market for general use. At the time the trial lawyers were circling like buzzards allegedly seeking restitution for patients. At that time I was the local president of the Kansas City Plastic Surgical Society and we had to calm my patients and others to ease their feelings that they were sitting on some sort of a time bomb. Granted, the gel implants were not made as well as our new cohesive implants of today and had a very high leakage rate and a high incidence of capsular contraction or firmness. None of this was admitted by the implant manufacturers, most of whom went out of business. These companies went bankrupt and most of the trial lawyers dispersed because of the lack of deep pockets to pick. Subsequently the new implant companies, the FDA and our plastic surgical societies proceeded in a 15 year process of scientific reviews, clinical trials and extensive data collection to determine the benefits and risks of gel implants. Since most plastic surgeons are committed to our patients’ safety and education, these numerous studies have shown that silicone gel implants have a significant psychological and physical benefit for women choosing these procedures and science has won out. All patients need to know of the inherent risks before making a choice. Please refer to www.memorygel.com for more information from the implant company.
My experience still dictates to proceed with caution with my patients’ health and well-being of the utmost importance. So, yes, I’ll be using silicone gel breast implants in my patients, but still the vast majority of my patients will continue to undergo cosmetic breast surgery with saline implants. In my surgical practice in the last 15 years, augmentation with saline implants has reached a reasonable gold standard and are appropriate for most patients. The exceptions, those patients wishing silicone gel implants, will be patients who strongly desire these type of implants after extensive informed consent, patients with failure of saline implants, i.e. frequent ruptures, wrinkling and dislike for the feel, and patients with minimal breast tissue and muscle (very thin chest wall and tissue) and those patients with thin skin and tissue requiring lifts with augmentations.
With the plethora of reported complications from silicone, my personal studies have shown a high satisfaction in those above mentioned patient categories with some accepted drawbacks. Silicone gel breast implants require a longer incision, a higher incidence of capsular contraction or firmness, are more costly and need more follow-up including MRI studies at three and five years to detect rupture. The old silicone implants when ruptured would ooze a liquid gel but now the implants are cohesive and a cut in the implant will not leak throughout the tissue. Even with accepted complications, there is a greater than 95% satisfaction rate with silicone gel implants.
Recommendations to my personal patients who have saline implants would be don’t replace your saline implants if they function well, have no problems and they still look and feel good. If you’re having no problems, leave them alone.
However, if you have silicone gel or saline implants from the past that are too high, too firm, have wrinkling or you do not like their size and feel, then a change may be in order. Patients with silicone gel implants that are older than 15 years (implants, that is) have a high incidence of internal rupture rate and should be evaluated by exam, mammograms and even MRIs. Please look up the following web sites: www.memorygel.com and www.breastimplantsafety.org and even the New Beauty magazine (the Winter/Spring edition of ’07) as there are informative articles throughout regarding breast implants.
Since this office takes care of over 200 patients a year for breast implants, be assured that we will help our patients make informed and healthy decisions. Having the option of gel implants, we’re still proceeding conservatively informing our patients of the pluses and minuses and avoiding all of the media hype.
Sincerely,
Thomas E. Geraghty, M. D.
PS: In the next few months biased thoughts on new face lifts, abdominoplasty and liposuction techniques and overhyped television plastic surgery programs will be faithfully explained to you.
PSS: Remember all women should do monthly breast exams and after the age of 40, yearly mammograms are a must.