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April – National Rosacea Month

Rosacea affects more than 400 million people worldwide and over 16 million Americans!

So, what is ‘rosacea’ anyways?  Rosacea is a chronic inflammatory skin condition that affects adults and is typically seen on the central facial areas.  It is characterized by persistent flushing redness, visible blood vessels (telangiectasias), inflammatory acne like pimples.  In some cases, it may involve the conjunctiva of the eye (ocular rosacea).

Although rosacea may involve anyone, it is more common in middle aged women with fair skin and light features and most often from Scandinavian or northern European descent.  Clinical research reveals that there is a 20 – 40% familial or inherited component in rosacea in addition to certain trigger factors that can influence the frequency and severity of the symptoms. 

Psychological Profile

Although rosacea is not typically harmful and is not contagious, it can have a significant impact on a patient’s quality of life.  The psychosocial impact can involve anxiety, embarrassment, low self-esteem in addition to affecting a patient’s work and dating or personal relationships.

Causes of Rosacea

There are multiple theories regarding the complex causes of rosacea in addition to the genetic or inherited tendencies and subsequently effective treatment.  Most of the latest research on its pathophysiology identify several possibilities including blood vessel disease or inflammation, nerve or neurovascular sensitivities, autoimmune disorders or excessive reactivity of a patient’s immune system, and finally some studies have implicated a microscopic organism that is prevalent in the skin called the Demodex mite.

Proven Options to Reduce Rosacea 

Because of the genetic or inherited component of rosacea, permanent elimination is not likely, but there are several effective and proven treatment options:

 –  Trigger avoidance – rosacea has been clinically linked to smoking, sun exposure (UV light damage), cosmetics and heavy makeup, cosmetic fragrances, certain soaps, spicy foods, excessive alcohol and stress.  Becoming informed and being aware of these triggers can be helpful.  New options in medical grade makeup that reduces inflammation and calms the skin are now available and have proven efficacy.

 –  Photo protection – using a medical grade sunscreen that does not contain fragrances and other additives that can trigger inflammation is extremely important.  The UV component in sunlight is inflammatory and will thin the skin and blood vessels resulting in premature aging and more visible and inflamed vessels.  

Treatment 

It should be emphasized that any patient with severe manifestations or uncontrolled rosacea should seek the evaluation of a board-certified dermatologist.  In addition to the traditional medical management of rosacea, there are now several exciting and clinically proven new options that offer improved outcomes for the rosacea sufferer.

Comprehensive Medical Skincare for Rosacea at evolv

At evolv Medical Aesthetics, we believe in the power of restoring balanced and optimal skin health as the most effective therapy for achieving beautiful and youthful skin.  Treating and controlling chronic inflammation is one of the fundamental steps in our skin health programs and is especially beneficial for the rosacea patient as inflammation is the most influential and universal trigger in all forms of rosacea.

This comprehensive approach will involve 3 essential steps:

  1) Restore Skin Health: Get control of the inflammatory lesions with a ‘cleanse/scrub/oil control’ ZO Skin Health protocol to gently remove inflammatory oil, bacteria and debris that are triggers in inflammation.  Also essential is a topical antioxidant and Vitamin A (retinoids) that neutralize inflammatory mediators and restore a healthy barrier function.  Finally, protecting the rosacea prone skin is paramount and involves non-occlusive medical grade sunscreen with broad spectrum protection.

2) Light Therapy: visible blood vessels and redness can be dramatically improved by broad band light or BBL.  This proprietary technology is not a laser but a high intensity therapeutic light that coagulates the larger vessels and reduces excessive redness associated with rosacea.  Combined with a personalized medical skin care plan and reasonable trigger avoidance, this approach has significantly improved rosacea long term for many patients.

3) Maintenance Programs: Combined with a healthy lifestyle, an anti-inflammatory diet and reasonable stress management, new products that reduce overall redness (Rozatrol from ZO Skin Health) have been clinically tested and have been effective in over 85% of rosacea patients.  Maintenance BBL light therapy and LED red-light therapy are also helpful for long term rosacea control.  New options in medical grade makeup from Colorescience and Jane Iredale have helped improve patient confidence and have health benefits for the skin.

Rosacea is a complex and challenging skin condition that can have a significant impact on quality of life.

At evolv, we have witnessed exciting and long-term improvement for our rosacea patients by utilizing the above comprehensive approach of treating inflammation and restoring skin health.  Healthy skin with more efficient barrier function is less prone to inflammation and disease and can significantly improve quality of life for rosacea patients as well as patients of any age.

If you would like to learn more about rosacea and these new and exciting treatment options, please ask any of our skin care professionals at evolv Medical Aesthetics.

Frank Barone MD FACS

Liposculpturing: Beyond Just Suction

Liposculpturing, a technique that we like to think of as advanced liposuction, should not be taken lightly. While the process is not a panacea and will not fix all your woes, when properly performed by the right Board-Certified Plastic Surgeon the results can be life enhancing.  Through liposuction your surgeon will use his knowledge of anatomy, art, and science to SCULPT (LIPO-SCULPTURE) all of your aesthetic lines like an artist molds the medium of their choosing.  Always wanted a less bulky abdomen? Improved definition of your arms or legs? Enhance your buttock size or definition? Better define the abdominal musculature for which you spend hours in the gym working? Liposculpture may be a good procedure for you to achieve your goals. In general, satisfaction rates are extremely high, higher than non-invasive technology (coolsculpting, etc.) because your surgeon can safely remove the precise amount of excess fat to give each patient a balanced and natural-appearing outcome.

Now that we understand what Liposculpture is, let’s understand what it is NOT. While Dr. Koltz and Dr. Barone are very accomplished surgeons, they are not real magicians. Their high patient satisfaction rates come from helping patients understand realistic goals and outcomes, developing a plan, then delivering on these plans. Liposuction and liposculpture have limitations.

  • Liposuction and liposculpture should NOT be thought of as weight loss tools. They are aimed to remove fat from problem areas that are resistant to weight loss. Everyone has these areas. This is a tool we use to augment your improved and healthy lifestyle in order to help deliver you the body you deserve. If you gain weight, get pregnant, or lose a significant amount more weight, your results may also be less than ideal.
  • NO skin is removed in these procedures. Therefore, we depend on good skin quality in order to tighten up after removing the fat beneath the skin in order to give you your final result. This is in contrast to body contouring surgery or skin removal surgery which may give you a better contour, but this is in exchange for a larger scar that is concealed to the best of our ability.
  • Liposuction is not the best tool to get rid of cellulite when used alone. There are a variety of tools that can help with this, but liposuction alone is not enough.
  • Liposculpture does NOT need to be performed in isolation. Very frequently liposculpture is combined with other tools to get your very best result. These other tools may include a skin excision (if patients want to trade skin excision for a scar), Renuvion, Vaser, fat transfer, PRP and stem cell augmentation, as well as a variety of recovery and pain control modalities in order to hasten your recovery and make the whole experience more enjoyable.
  • Liposuction does NOT leave significant scars. Each small area where the cannula (about the size of a straw) is introduced beneath the skin leave a scar about ½ inch in size. These sites are strategically chosen to be hidden so you never see them but still allow the surgeon to get to the areas that need to be addressed. These scars are significantly smaller than skin excision procedures.
  • Liposuction is NOT necessarily permanent. While it is true, we permanently remove your fat in the areas we address, we do not remove every fat cell. This means that if you gain weight, the ones left behind just get bigger than they would have before when they had more cells to store the same amount of fat.
  • Liposuction does NOT remove the “beer belly.” Koltz and Barone can only address the subcutaneous (beneath the skin) fat. Visceral (around your organs) fat makes up the “beer belly” and cannot safely be addressed with liposuction.  Only effective weight loss can reduce this abdominal fat.

Finally, there are many new invasive and noninvasive technologies developed every day that you will read about on the internet that promise everything from more attractive feet, to a tighter vagina, to a robust head of hair. Some promises may be realistic, some just snake oil. How can you sort it out? The easiest way is to find a Board-Certified Plastic Surgeon that you trust and offers many different technologies.

  • If you see someone who is not a surgeon, they will not offer surgery as a good option. “Providers” want to take care of you. If they do not have a technology or a skill set that they can offer you, they usually will not talk to you about it in a positive light. Surgeons can offer any procedure, invasive or noninvasive, so you are starting off in the right spot. A common misconception is that if you see a Plastic Surgeon, you will only be offered surgery. With Dr. Barone and Dr. Koltz, this could not be further from the truth. Their goal is to offer you the least invasive option possible to help you achieve your goal, whether that is surgical or non-surgical.
  • If you see someone who is not a Board-Certified Plastic Surgeon, but is offering an invasive (surgical) procedure, you are choosing to “roll the dice” with your health and safety in order to perhaps save money. It may even be the same cost!  Remember doctors can be board certified in non-related medical specialties and still offer the title “Board Certified.”  The only board certification that is relevant in cosmetic surgery related to these procedures is “The American Board of Plastic Surgery.”  Simply ask, “Are you board certified by The American Board of Plastic Surgery?” If the answer is no, move on. It’s that easy. Would you want someone with no surgical (radiologist, family medicine, emergency medicine, OB/GYN) or plastic surgical (general surgery, cosmetic surgery only, ear nose and throat/ENT, etc.) training performing surgery on you? Exceptional results, delivered safely, are all that matter!

 

Best wishes for a happy and healthy April,

Dr. Koltz and Dr. Barone

Getting the Cleavage You Want with Your Breast Augmentation

One of the most common misconceptions about breast augmentation is that it’s all about size. Although this might be the main focus for some patients, many have some other factors in mind when they come in for a consultation. A good plastic surgeon can guide you to the right implant that can achieve your goals for size, shape, projection, feel, and many other factors. However, it can take a particularly skilled plastic surgeon to achieve beautiful, natural-looking cleavage. As you plan your consultation, here are some things to know about how breast augmentation can achieve your cleavage goals.

What causes cleavage?

Cleavage is the space between the breasts, and it can depend on many different factors like clothing, anatomy, and position. For some women, cleavage is a distinct, wide space through which bone structure and contours are visible. For others, cleavage is a telltale line where the two breasts meet together. Each woman’s cleavage is unique, but breast augmentation can achieve either type (and many different in between) with the right techniques. It’s mostly dependent on your breasts, their position, distance, and amount of skin.

How does breast augmentation adjust cleavage?

This can be a difficult question to answer, since plastic surgeons can utilize many different techniques and assessments to create different kinds of cleavage for each unique patient. Generally, its success can depend on things like the distance between your natural breasts, skin laxity and elasticity, and existing breast tissue. These factors can help your plastic surgeon estimate the right position for your chosen implants to create your desired cleavage. This can mean creating a breast tissue pocket that helps the implants to exist closer together or further apart.

How can I achieve my cleavage goals?

The most important factor in achieving the breasts you want is choosing a board certified plastic surgeon who has plenty of experience in performing breast augmentation. It’s important to seek out before and after photos so you can get an idea of their skills and outcomes, and whether they fit you and your goals. Remember that most photos will show breasts that are unsupported by clothing, so you should be sure to express your goals for cleavage both when wearing a bra or tight-fitting clothing and without. Communicating your goals and ensuring that your plastic surgeon can accomplish them can help you achieve the cleavage you’ve wanted with the right techniques and implants for you.

Schedule a Consultation

There are many different things to consider when it comes to your breast augmentation goals. Your first step in creating the right breast augmentation procedure for you is meeting with a board certified plastic surgeon who can discuss your options. At evolv Plastic Surgery, we seek to provide the best in expertise and patient care when it comes to breast augmentation. To schedule a consultation with our board certified providers, contact our Toledo office by calling or filling out our online form.

Considering Breast Implant Augmentation?

Breast enlargement or enhancement by implants, and more recently fat grafting, is the most popular of all cosmetic surgical procedures.  Last year over 300,000 women in the U.S. had breast implant surgery, and the procedure has nearly tripled in popularity since the year 2000.  The reasons for this dramatic increase are many but improvements in implant biomaterial, advances in operative and anesthesia techniques, and overall patient comfort and safety have resulted in more natural and balanced results with long-term patient safety and high satisfaction levels.

The good news is that when performed by an appropriately-trained and credentialed plastic surgeon in a regulated operative facility, the high patient satisfaction rates and safety have proven in clinical studies to significantly improve patient self-confidence and quality of life.   Unfortunately, when the above criteria and considerations are not followed, complications and costly long-term problems can occur which may not be entirely correctable.  At evolv Plastic Surgery, Dr. Frank Barone and Dr. Peter Koltz believe strongly in the benefits and safety of comprehensive patient education and the importance of making informed choices when it comes to any cosmetic or plastic surgical or non-surgical procedure.  The fact is that the most informed patients generally make the best choices.  https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/questions

Because there are so many choices in any elective aesthetic or cosmetic procedure, and especially in breast implant augmentation, we believe it is critical for any woman contemplating breast implant surgery to carefully review the following fundamental considerations.

Goals and Benefits

The goals of breast implant augmentation are consistent with the goals of every properly performed cosmetic or aesthetic procedure – to safely enhance or improve body contour and restore natural youthful features in order to increase self-confidence, enhance self-image and subsequently improve overall quality of life for each patient.  Each patient’s motivation may vary but improving self-image and confidence is not simple vanity but is connected to our evolution and the human desire to improve appearance for ‘survival’ benefits.  Like it or not, appearances matter, and multiple studies have consistently proven that naturally-appearing and enhanced, youthful features provide distinct advantages to quality of life.

Properly done aesthetic procedures should be balanced, safe and natural-appearing, but we have all seen poorly done cosmetic surgery in the news, that is far from ’natural appearing.’  This is especially true with breast augmentation.  Patients and providers who do not respect this fundamental concept will often have unnatural and negative outcomes with the risks of increased complications, additional costs and detrimental long-term results.

What Breast Augmentation Can and Can’t Do

Breast implant augmentation can:

  • safely improve fullness and projection to benefit overall female contour and balance
  • help restore areas, such as the upper pole of the breast, that may have lost fullness after pregnancies or aging
  • help correct imbalance or congenital and developmental asymmetries of the breasts
  • help improve self-image and self-confidence when done properly and for the right reasons in each patient

Breast Augmentation cannot correct significant sagging or laxity of the breasts that may have occurred from weight loss, multiple pregnancies or aging.  In these situations, a breast lift or mastopexy with or without implant or fat graft augmentation may be suggested by your plastic surgeon.

Costs – Price Shoppers Beware

The price of breast implant augmentation can vary widely depending upon:

  • training, qualifications and experience of the surgeon
  • location of the surgery (accredited outpatient facility vs doctor’s office operating room or clinic)
  • type of anesthesia and qualifications of anesthesia provider (certified anesthesiologist vs less experienced staff)
  • experience, training and qualifications of ancillary staff
  • manufacturer, type and quality of breast implant

Surgery is expensive and affordability is a key concern for patients contemplating breast implant surgery; however, ‘price shopping’ can be very dangerous for many reasons including all the above considerations.  The most proven and important consideration is the training and qualifications of the surgeon.  Many consumers do not realize that any physician with a medical license can legally perform breast implant surgery, as well as any cosmetic surgical procedure, in their own clinic or office even if they have not had credentialed training in that surgery or specialty.  Savvy marketing and advertising or attention grabbing ‘deals’ can be difficult to resist for many patients who have limited resources to afford the procedure.  When these ‘bargains’ are carefully analyzed, there is always a reason why the price is considerably lower, and it is no coincidence that these are the situations where more complications and re-operations occur.  It can be very costly to repair complications, and often results are compromised.  In the words of the world’s greatest investor Warren Buffet, ‘Price is what you pay….value is what you get.’

Implant Options

A variety of implant styles, shapes and types are available.  The quality, safety and performance of breast implants has dramatically improved in recent years as have patient outcomes.  All breast implants in the United States must undergo long term and rigorous testing as well as clinical studies to obtain FDA approval, and constant monitoring is done annually.  Some of the considerations in implant choices are:

Fill – Implants may either be filled with either sterile saline (salt water) or silicone gel.  Both have been thoroughly studied and fully approved by the FDA.  Gel is more popular due to its natural ’tissue like’ feel, but a discussion with your plastic surgeon will help determine which option is best for each patient’s goals and concerns.  Recently a form stable gel, often referred to as the ‘gummy bear’ implant, has been approved and has the advantage of holding its shape in anatomic or ’tear drop’ styles and avoiding the chance of leakage.

Shape – Breast implants are available in a round or anatomic (tear drop) shape. Each has a particular advantage, and these options should be reviewed with your surgeon.  Many choices in implant dimensions such as width, heath and projection are also important features in choosing the most appropriate device for each patient’s anatomy, goals and lifestyle.

Surface – Breast implant shells may be smooth or textured, and each choice has a potential advantage depending on the patient’s goals and interests.  Textured surfaces may reduce the possibility of capsular contracture or excessive firmness of the tissue around the implant.  A rare form of lymphoma called implant associated ALCL (anaplastic large cell lymphoma) has been recently reported in approximately 1:50,000 patients with textured implants.  ALCL is usually cured by removal of the implant and the surrounding capsule, but this issue should be discussed with your surgeon if a textured device is preferred.

https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/implants

Risks and Safety

When performed by an experienced, board certified plastic surgeon in a properly credentialed facility, breast implant surgery has a very high (greater than 96%) satisfaction rate and is also safe and effective.  But any procedure has risks, and these should be completely reviewed with the patient in the preoperative examination.  A thorough physical examination and complete medical history are also an essential component of reducing risks and complications. Openly defining risks and benefits along with a comprehensive medical assessment and photographic documentation/imaging are important and integral parts of properly planned aesthetic surgery.

Procedure Steps

Being well informed and prepared for surgery will reduce anxiety and improve the overall experience.  For the breast augmentation procedure, the plastic surgeon will discuss recommended anesthesia options, choice of incision location, location of implant placement (either below or above the chest wall muscle), implant type, volume and dimension, and expected post-operative course and recovery.  At evolv Plastic Surgery, Dr. Barone and Dr. Koltz often utilize the Vectra 3-D, a 3-dimensional imaging system to help predict implant choices and results specific to each patient’s own anatomy and goals.  The implant surgery typically takes less than 2 hours in the operating room.

Recovery and Down Time

After surgery is completed, patients are dressed in a custom post-operative bra and taken to the recovery room.  Because the anesthetic is light, recovery room time is usually less than one hour for most patients.  Patient comfort is a priority at evolv Plastic Surgery and precise and less traumatic dissection techniques, headlight illumination, prevention of bleeding and long acting nerve blocks (Exparel) and post-operative lymphatic massage all play an integral part in minimizing discomfort and downtime and improving the overall experience for our patients.  Each patient will be given specific instructions and advice on resuming activities and return to work.

The Most Important Decision – Choosing a Plastic Surgeon

Breast Augmentation surgery involves many choices.  Studies confirm that the first and most important choice is selecting a qualified plastic surgeon that you can trust and who is a member of the American Society of Plastic Surgery as well as board certified in Plastic Surgery by the American College of Surgeons.  As members, these surgeons must meet the following rigorous standards:

  • Board certification by the American Board of Plastic Surgery (ABPS) or in Canada by the Royal College of Physicians and Surgeons of Canada
  • Complete at least six years of surgical training following medical school, with a minimum of three years of plastic surgery residency training
  • Pass comprehensive oral and written exams
  • Graduate from an accredited medical school
  • Complete continuing medical education, including patient safety, each year
  • Perform surgery in accredited, state-licensed or Medicare-certified surgical facilities

Be wary and cautious of other ‘official’ sounding boards and certifications or by the term ‘board certified’ if it is in another specialty.

https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/surgeon

Conclusion

The decision to have breast augmentation surgery is a highly personal one, as is any aesthetic surgery or procedure.  Any woman considering breast implant surgery should carefully evaluate their options, take appropriate time to learn as much as possible from reliable sources, and take their time in making a well-informed decision.  The most important decision is choosing an experienced and board-certified plastic surgeon.  Despite the excellent safety and high satisfaction rates in breast implant procedures, it is still a significant surgical procedure and one that can have higher risks and complications if done by a less experienced or non-specialty trained physician in an unregulated clinic or office procedure room.  Aggressive internet marketing and advertising that attracts patient candidates with considerably lower price offers and unrealistic outcomes are not only unethical but dangerous.

Trust is the most important criteria in the doctor-patient relationship and must be earned with honest communication, transparency and dedication to specialty training and ongoing education.  If you are interested in more information or would like to learn more about the many facets and options in breast implant augmentation, please contact Dr Barone or Dr Koltz at evolv Plastic Surgery and Medical Aesthetics.

Thank you for your attention and interest!

The Importance of Knowing Your Breast Surgeon’s Credentials

When it comes to plastic surgery, the most important decision you will make is choosing the surgeon who will perform your procedure. While general surgeons and non-surgeons alike will sometimes offer plastic surgery, you should always choose a plastic surgeon that has the credentials and specialized training necessary to provide you with the safest, most natural results possible. So before choosing your surgeon for your procedure, make sure you understand the credentials to look for!

Basic Requirements for Plastic Surgeons

The first steps to becoming a certified plastic surgeon is to complete medical school, typically four years, and then going on to complete an additional residency in general surgery. This can vary from 3-7 years. This broad medical and surgical training is then followed by several more years of specific training in a Plastic Surgery residency.  These are the basic schooling requirements that you should always ensure your Plastic Surgeon has completed.

Additional Specialized Training

When it comes choosing the right surgeon for your Plastic Surgery, you’ll want to look for someone who has gone above and beyond the required general and plastic surgery training. Dr. Koltz and Barone both completed an additional fellowship (specialty) program after they completed their residency. This involves one to two years of specialized training with well-recognized and published surgeons in their specific focus area. Although fellowship training is not required for plastic surgery board certification, it is an option to become much more exposed to advanced, cutting-edge techniques in a specific area of interest.

Dr. Barone and Dr. Koltz have both completed fellowships which focused their talents in Breast Augmentation. Their additional training also provided them best practices for breasts in all types of cases. This includes cases of making breasts larger or smaller, correcting deformities, and helping breast cancer survivors. Dr. Koltz completed his fellowship training in Reconstructive Microsurgery at the University of Pennsylvania. Dr. Barone completed a craniofacial surgery fellowship at Eastern Virginia Medical Center in Norfolk, followed by a fellowship at Vanderbilt University in breast reconstructive and aesthetic surgery.

Board Certification Process

After the required schooling, plastic surgeons who have completed the adequate training are invited to become certified by the American Board of Plastic Surgery, a rigorous certification process that attests to the skill and ethics of their practice. This is not required to practice plastic surgery but provides an advanced level of certification that you should absolutely look for when choosing your surgeon! The certification process involves training with top surgeons, written and oral evaluations, as well as required maintenance exams to ensure the ongoing safety and ethics of the surgeon’s practice.

Both Dr. Barone and Dr. Koltz have gone on to become certified by the American Board of Plastic Surgery in addition to their required training and fellowships. To learn more about their credentials and breast surgery expertise, contact our office and schedule your consultation.

The Newest Board-Certified Member- Dr. Koltz

Recently our trusted, reliable, and caring practitioner, Dr. Koltz has been certified by The American Board of Plastic Surgery. This is a huge accomplishment for Dr. Koltz. Over his career, Dr. Koltz has worked very hard for this certification. Starting from obtaining his training in plastic surgery in New York, then going to the University of Pennsylvania for a fellowship in Reconstructive Microsurgery. Dr. Koltz is well-renowned, and often reviews several publications and textbooks, while also traveling all over to present his own research at different meetings around the world.

Getting Board Certified

Getting certified by The American Board of Plastic Surgery is well-renowned and not an easy thing to accomplish. The American Board of Plastic Surgery was founded in 1931 and represents around 93% of all board-certified plastic surgeons. They wish to advance the quality of care by setting high standards for their doctors as well as furthering their education. In order to become board certified, doctors have to go through extensive training into the field of plastic surgery as well as complete exams for the board certification. Members of The American Board of Plastic Surgery must meet standards set by the foundation of their facility, patient care, and education.

Training

Dr. Koltz has worked very hard for this moment. Training in plastic surgery is a long process, taking years and years of practice. First, going to medical school, then completing a residency in general surgery at an accredited practice. After those basic steps, you can apply for a certified plastic surgery residency. Overall, the complete training takes eight to ten years. Dr. Koltz has gone above and beyond that, by taking extra years for research in breast implant-related scar formation, body contouring, congenital craniofacial malformations, breast rejuvenation, hernias, and pain control options. He not only wants to better his education, but he wants to better the education of all future generations of plastic surgeons. He also completed a year of fellowship training at the University of Pennsylvania in reconstructive microsurgery. All of his hard work over the years has led him to become officially board certified.

His Memberships

Dr. Koltz has long-standing memberships with many different accredited groups such as the American Society of Reconstructive Microsurgery, American Burn Association, and the Northeast Society of Plastic Surgeons, as well as many more. He has received many different awards and recognition for his hard work such as The Joseph M. Serletti, MD Resident Award for Excellence in Academic Plastic Surgery, University of Rochester Plastic Surgery- Top Gun Award for Highest Plastic Surgery In-Service Examination Score and University of Rochester Medical Center – Strong Star for Excellence in Patient Care, Patient Nominated. His patients and our team here at evolv Medical Aesthetics know that he is reliable and delivers amazing results.

Meet Dr. Koltz Today

By going above and beyond in his career, Dr. Koltz has received this great honor to be board certified. The team at evolv Medical Aesthetics is thrilled for him, and his patients are as well. If you wish to be treated by Dr. Koltz then contact our office today.

What is a ‘Real Plastic Surgeon’?

Cosmetic (also called ‘aesthetic’) plastic surgery is more popular than ever these days.

Nearly 18 million cosmetic procedures, both surgical and non-surgical, were performed in the United States last year which is a 200% increase since the year 2000!  There are a variety of reasons for this increase including improved and more natural appearing results, better products and technology, and an increase in lifespan and work years.  Despite the dramatic increase in demand, there remains a significant deficiency of adequately trained and appropriately credentialed physicians and licensed professional providers.  Considering these trends, it is not surprising that the number of complications and unfavorable or unnatural results, most of them preventable or unnecessary, have also significantly increased.  Most of these complications or unnatural appearing results are often associated with inadequately trained or inexperienced providers, as well as treatments performed in non-certified or non-credentialed medical spas, private clinics or physician offices….and sometimes unfortunately hotel rooms!

While it has become easier and more commonplace to obtain cosmetic plastic surgery and aesthetic procedures, it also has become exceedingly more challenging and confusing for the consumer to find a qualified plastic surgeon and especially a trained professional provider that they can trust.  With the internet and rapid dissemination of marketing disguised as ‘education,’ finding fair, accurate and unbiased information in order to make such an important decision has become an increasing challenge even for the most educated of consumers.

To illustrate this growing concern, let’s see how your general plastic surgery IQ relates to some of the more common questions or assumptions that face the average consumer considering a plastic surgical or aesthetic procedure.  Answers can be found below the test.

All answers are either true or false.

1) Only a credentialed and board-certified plastic surgeon can legally perform cosmetic surgical procedures in the U.S. such as breast implants, tummy tucks, facelifts, liposuction, etc.

2) Any medical doctor (M.D.) can advertise, promote and legally perform any cosmetic surgical or non-surgical treatment even if they have never completed a credentialed surgical training program or validated training in the specialty involving the cosmetic procedure they are promoting.

3) A doctor who is ‘Board Certified in Cosmetic Surgery’ is also considered a plastic surgeon.

4) A ‘Board Certified Facial Plastic Surgeon’ is also considered a plastic surgeon.

5) The training and experience of a plastic surgeon in cosmetic surgery and non-surgical aesthetic procedures can vary significantly even for board certified plastic surgeons.

6) Traveling outside the United States to have plastic surgery in order to reduce costs can be safe and effective if the medical clinic and treating physician have proper credentials and certification.

7) Potential complications and risks in cosmetic surgery and non-surgical cosmetic procedures are unavoidable, infrequent and usually not life threatening.

8) State Medical Boards will not allow a physician (M.D.) who has not had credentialed surgical training to advertise, market and perform plastic surgical procedures on patients in the United States.

9) Non-surgical cosmetic treatments such as Botox or filler (Restylane, Juvéderm, fat grafting) injections, fat reduction, cosmetic laser treatments, etc., can be legally performed in the United States by dentists, registered nurses, healthcare professionals or any medical doctor. 

10) The cost for cosmetic surgery procedures such as breast implants or liposuction, as well as non-surgical aesthetic treatments such as Botox and filler injections, can vary significantly between different physicians, but the surgery or treatment and the results are essentially the same.

 Answers 

1)False

Any physician with a M.D. degree can perform plastic surgical procedures legally in the U.S.  These will usually be done in the doctor’s office or a ‘medical clinic’ associated with the physician because hospitals or accredited surgical facilities will require appropriate surgical training or verified board certification in plastic surgery in their credentialing process.

2) True

A medical license (M.D.) in the U.S. allows the physician the option or legal right to perform any medical or surgical procedure in their office or clinic even if they have not completed a validated training program in surgery or accredited residency in that treatment or specialty.  Most states allow any physician to advertise or promote cosmetic surgical and non-surgical treatments even if they trained in a residency or specialty that is unrelated to the services and procedures they are promoting.  Recently, however, the Medical Board of California did place some restrictions on these misleading advertising practices (see answer #3  and link below).

3) False

The only official accrediting body for medical specialties is the American Board of Medical Specialties (ABMS), and ‘plastic surgery’ is one of the 24 recognized specialties.  There is no board certification or specialty of ‘Cosmetic Surgery’ recognized by the ABMS.  There is an American Board of Cosmetic Surgery which is an organization created more recently by non-plastic surgeon physicians, but it is not recognized by the ABMS.  These physicians are not trained in a plastic surgical residency but can take one year of cosmetic surgical training to qualify for the American Board of Cosmetic Surgery and call themselves ‘board certified in cosmetic surgery.’  Recently, the Medical Board of California denied the request of the American Board of Cosmetic Surgery (ABCS) that its members be allowed to advertise themselves as ‘board certified cosmetic surgeons’ because it is so misleading to consumers and that the ABCS is not a recognized board. https://www.plasticsurgery.org/for-medical-professionals/resources-and-education/publications/psn-extra/news/medical-board-of-california-abcs-is-not-equivalent-to-abms-board  Board certification in plastic surgery requires a minimum of 6 or 7 years of surgical and plastic surgical specialty training from an accredited residency program, as well as passing a rigorous written and then oral examination.

4) False

A ‘board certified facial plastic surgeon’ is typically a physician trained in otolaryngology or ENT who then goes on to take additional training in cosmetic facial surgery to qualify.  A ‘board certified plastic surgeon’ has typically completed 4 or 5 years of general surgery training from an approved residency, an additional 2-3 years in an ABMS approved plastic surgery program, and then passed both the written and oral examinations administered by the American Board of Plastic Surgery.

5) True

Even among board certified plastic surgeons, training and experience in the many different cosmetic surgical procedures and non-surgical aesthetic treatments may vary significantly from program to program.  Some plastic surgeons will elect to take an optional additional year or more of specialty training in cosmetic surgery and or reconstructive surgery with an accredited program and a recognized expert plastic surgeon. This additional training is called a post graduate fellowship.  Dr. Barone completed post graduate fellowships in aesthetic and reconstructive breast surgery, cosmetic surgery, and facial reconstruction.  Dr. Koltz completed a post graduate fellowship in microvascular breast surgery and reconstruction.  The American Society of Aesthetic Plastic Surgeons is a prestigious organization that admits only board-certified plastic surgeons that have documented and proven experience and expertise in cosmetic surgery and aesthetic procedures.

6) False

Many patients are lured to travel outside the U.S. by significantly lowered pricing and other incentives to have cosmetic procedures.  Although there are many well trained and board-certified plastic surgeons in other countries, it is very difficult for a ‘medical tourist’ to verify the training and credentials of physicians offering these ‘deals’ in other countries.  The facilities or ‘specialty clinics’ where they are performed also have little to no ongoing regulation and validation for training, sterile technique and anesthesia safety, and the results can be disastrous.  In addition, air travel after surgical procedures can be especially risky because of the potential for the development of blood clots and pulmonary embolism after surgery.  Repairing complications or unfavorable results can be far more expensive and less effective than doing the procedure properly in the right facility and with a qualified plastic surgeon.

7) False

While any procedure, surgical or non-surgical, may have the risk of a complication, seeking out an experienced board-certified plastic surgeon who performs elective surgery in an accredited, outpatient operating room facility will reduce the chance of complications.   In addition, utilizing an experienced anesthesiologist, as well as appropriately trained nurses and professional staff, will minimize any risks and increase the likelihood of a safe and natural-appearing outcome.  It’s important to remember that the decision to have a cosmetic procedure is highly personal and impactful and can have lifelong consequences.  https://www.nbclosangeles.com/news/local/Warning-Plastic-Surgeries-in-Tijuana-504213161.html

8) False

Most states do not prevent physicians from advertising or marketing plastic surgery or cosmetic procedures even if they have not had accredited training in that specialty.  Because this is so misleading to even the most educated consumers, the Medical Board of California recently changed their state law and ruled that in order to advertise for a plastic surgery procedure, the physician must be trained and credentialed by the American Board of Medical Specialties which is the only recognized body for medical/surgical specialties.  https://www.plasticsurgery.org/for-medical-professionals/resources-and-education/publications/psn-extra/news/medical-board-of-california-abcs-is-not-equivalent-to-abms-board  There is no recognized ‘board of cosmetic surgery’ and no valid ‘board certified cosmetic surgeon’ specialty.

9)True

The legal right to perform non-surgical procedures such as Botox and filler injections, cosmetic laser treatment, and fat reduction are often regulated by state medical boards and can vary significantly in each state.    Appropriately trained and certified physician assistants, nurse practitioners, registered nurses and other licensed professionals can be accredited for performing these aesthetic treatments and some have excellent training and experience, but this can vary significantly.  It is critical that prospective patients do their homework on the provider and the facility before considering any aesthetic procedure.

10) False

Costs for cosmetic surgery or non-surgical aesthetic treatments may vary significantly but so can the results, safety and risks!   While more cost or expense does not guarantee a better outcome, many factors involved in the total treatment can have a considerable impact on quality, risk and results.  Even though the name of procedures such as breast augmentation, liposuction, facelift, and Botox injection may sound the same, quality and results can be impacted by many significant factors.  Physician training and experience, technique of the surgery, quality of implants, concentration of Botox, qualifications of the treatment facility, anesthesia methods and anesthesiologist experience, pain control, nursing staff experience, training, and other factors can all have an impact on total procedure cost.  The old adage ‘You get what you pay for’ may not always be true, but it is a famous and time-tested quote for a reason!

How to Find a Real Plastic Surgeon

When performed by a qualified plastic surgeon or credentialed and supervised aesthetic provider, cosmetic surgery and aesthetic procedures are not only life changing for patients, but also consistently safe and natural appearing.  Natural and balanced cosmetic treatments can significantly improve self-confidence and quality of life for the appropriate patient.

But how does an interested consumer go about finding the right physician or practice from the often-dizzying array and Google lists of surgeon candidates?  One helpful consideration is to organize a solid set of minimal criteria to help you with your search.  The following suggestions and checklist are based on real data and outcomes and can be a helpful starting point in vetting potential surgeon and aesthetic provider candidates:

– Appropriate Board Certification

Look for an experienced surgeon who is trained in the specialty that you are considering and is certified by the American Board of Plastic Surgery, https://www.abplasticsurgery.org/public/verify-certification/ModDefault.aspx?section=SurgeonSearch which is the only plastic surgery board recognized by the American Board of Medical Specialties.

– Proven experience and natural appearing results with before and after photos only of their own patients.

– Verified and credible reviews by real patients

– Strict adherence to safety standards for the practice and all staff

– Access to a fully accredited and/or state licensed surgical facility

– Proven dedication to ongoing continuing education and training by doctor and staff

– Thorough and comprehensive patient consultations

– A personal rapport, communication and trust with the physician and staff

The decision to have a cosmetic procedure is a critically important and personal one and can have lifelong consequences.  The challenge of finding the right plastic surgeon can be made easier with the assistance of the criteria listed above, professional standards and personal preferences.  Patients can feel much more confident about achieving the optimal result with safety and natural and balanced outcomes when they can find a plastic surgeon that has the experience, qualifications and compassion that they can trust.

Frank Barone MD FACS

The Embrace of Aging

‘Anti-Aging’……….we have all heard the term and experienced its use associated with creams, potions, diets, supplements, lifestyles, workouts, and on and on and on.   This is especially pervasive in our aesthetic or cosmetic profession.  But don’t worry, wanting to hold on to or regain your natural youthful characteristics and look younger is not just mere vanity but a basic and hardwired human characteristic ingrained by many thousands of years of evolution.  Looking younger and more attractive is essential to preservation of the species and thus a powerful biological drive and an essential part of our humanness.

But the use of the term ‘anti-aging’ would imply that any of these heavily promoted products or options would somehow potentially stop or at least slow down the aging process…..at least that’s what the marketers would like you to believe.

What they don’t want you to know, and what science clearly has proven, is that biological aging is an inevitable process that cannot be stopped……at least not yet.   None of the ‘anti-aging’ products, treatments or services currently available have ever been proven to affect or slow the biological process of human aging.  On the other hand, the  good news is that the signs or manifestations of aging can certainly be reduced or improved as has been credibly proven in many peer reviewed and respected studies.  Credible and proven aesthetic products and cosmetic procedures performed by appropriately trained professionals can restore natural and balanced youthful features, resulting in tremendous personal satisfaction and confidence for patients of any age.   Just ask any of our evolv patients who have been consistent with their ZO Skin Health programs, and that includes myself!

Since it has been proven consistently that we cannot stop the aging process, what if we changed our attitude toward aging and just embraced it?  What if we ignored the ‘hype’ of the ‘anti-aging’ marketing and focused our energies on living well, taking great care of ourselves, looking our best and just accepting the natural aging process?

I was asked to write an article for Emmy Award winning director Keith Famie’s documentary ‘The Embrace of Aging,’ which was a series aired on PBS several years ago.  In the programs, Keith examined both the female as well as the male perspective on aging gracefully and well.  He also interviewed a number of experts and professionals involved with aging research and in treating the aging population.  So what were the ‘secrets’ to happiness and longevity?  What might allow us to truly embrace our inevitable aging that is proven by the most knowledgeable and experienced scientists who have studied longevity and aging populations around the world?  Actually the answers are not surprising, but here is a summary of their findings and conclusions:

Pay attention to what you eat…..mostly plant based foods, less meat (especially processed), more seafood, less salt and less sugar and processed carbohydrates.  Also try to reduce your portion sizes.  In general, the less you eat, the longer you are likely to live.

– Increase your physical and mental activity, especially as you age.  The more you sit, the less long you will live.  We have an epidemic of ‘sitting disease’ in our culture!  Do something active with your body and your mind every day….walk, jog, dance, lift weights, stretch…..just move…it’s all good!  Regular mental activity can also reduce your risk of dementia.

– Please don’t smoke.  Smoking has been proven to reduce your average lifespan by more than 10 years as well as cause widespread health problems that reduce quality not life.  Smoking will also prematurely age the skin and dramatically reduce skin health.

– Be social and try to cultivate a positive attitude.  Happy and optimistic people have been shown to not only live longer but also better!  We are social creatures and we need each other…. loneliness is bad for your health.  Cultures with a spiritual connection or religion that were studies tended to live longer and happier lives.

-Make an effort to control and reduce your chronic stress.  Take the time to learn to meditate…..it works!   A number of studies have clearly documented the many physical and mental health benefits of regular mediation.  Yoga and regular mindful activities and exercise along with adequate sleep are all beneficial.  Ongoing stress will reduce the quantity and quality of your life.

These are the ‘secrets’ of the longest living cultures and populations in the world that are supported by science.

So now that we clearly know what to do……..how do we actually do it?

There is always a predictable spike in new gym memberships and use of exercise apps after New Year’s Day, as resolutions are made with good intent.  Unfortunately, reality soon sets in, and very few of us are successful long-term.  Real life seems to get in the way of our best intentions and resolutions.  The reality is that real change takes work, commitment and organization.  Based on a recent study, here are some suggestions that can really improve your chances of sticking with those New Year’s Resolutions to improve your health, quality of life and well-being to embrace your aging!

– Integrate – incorporating the above health fundamentals or your resolutions are not just one more thing to cram into your busy schedule.  ‘Integrate’ your new goals into your day, and find a sense of balance. What can you eliminate or reduce to find the time?  Try to fit it in to your routine and schedule in a way that is practical and convenient.

– Be Realistic – try to set goals that are simple and realistic.  Set lower goals.  It is better to succeed at one resolution than to fail at many.

– Embrace the Fail – statistics confirm that you are likely to fail or not attain some of your goals.   That is just human nature.  Instead of being self-critical or quitting, simply embrace it.  Don’t get discouraged, or if you do, embrace that too!  The fundamental of mindfulness is to just notice it, acknowledge it, and then let it go! The funny thing is that as soon as you notice the failure, you are no longer failing.  Let the failure go, and just move on…..it’s a new day, and it’s all good.

Forgive – since we are all likely to experience some ‘failure’ in achieving our resolutions at some point, why don’t we just incorporate some forgiveness into our New Year’s Resolutions?  Instead of making absolute or rigid goals such as ‘I will lose 10 pounds by February,’ try something more flexible.  If you do fail, resolve to forgive yourself too, and move on with your goals.  Allowing yourself forgiveness can result in setting yourself up for success and keep you in the game.

Our mission at evolv Plastic Surgery and Medical Aesthetics is not only to safely provide proven and state of the art aesthetic procedures, treatments and products but also to improve the quality of life and overall well-being for our patients, our families and ourselves.  That is our promise and our commitment.  We believe that aging can be embraced and enjoyed by incorporating the above health fundamentals for anyone at any age.  We believe that through education, research and commitment, combined with personalized programs that achieve natural and balanced results for each patient, we all can ’embrace our aging’ and enjoy an improved and optimal quality of life.

As we begin 2019, Dr. Peter Koltz and I, as well as our entire evolv staff, would like to thank all of you, our patients and friends, for your ongoing support.  We are especially thankful and appreciate your trust in us and in our patient care.  We would like to wish all of you and your families happiness, joy and peace in your lives.

Attitude, Gratitude, Happiness and our Well Being

Welcome to the Holiday Season from all of us at evolv!

The Thanksgiving through Christmas Holiday season has always been my favorite time of year for many reasons.  Growing up in a large Italian family in the 60’s meant lots of family traditions, celebration, anticipation and best of all…..Rosie’s (my Mom) food!

This is a time of year that just about everyone can appreciate.  Who among us wouldn’t benefit from a little more gratitude in their lives?  A little less taken for granted; a little more time to stop and smell the roses.  Even though this season can be the ‘best of times’ for many, it can also be one of the most stressful and challenging as well.

Evolutionary scientists believe there may be a negativity bias built in to the human brain……it’s easier to survive threats and danger if you are constantly on guard, suspicious or worried.  Unfortunately, it just may be a human nature survival instinct to dwell too much on what’s wrong rather than appreciate what’s right.  Have you ever noticed that after you’ve had a backache, you are grateful when it goes away?  But how many of us woke up this morning and were thankful for not having a backache?

Science has also taught us that chronic stress, anxiety and worry can also make us physically ill and shorten our lives.  Conversely, studies also prove that the practice of developing a more positive attitude, and being grateful and appreciative, can also improve our health, well-being and longevity.

What if this year we could truly take stock of the good and get some balance to correct the bias of negativity that is hardwired into our ‘survival human brains?’  What if we could find an ‘attitude of gratitude?’  Here are three suggestions on how to do it:

1) ‘Accounting of the Soul’ 

In his ‘Nightly Gratitude Meditation,’ Jeff Warren recommends that every evening we just think of a single thing or event from the day that was good or positive in our life.  It’s not complicated or difficult…..just a single thing that matters and is positive.  You could appreciate someone in your family, a friend, your work, your health, anything…..there’s a lot of good out there if only you could just stop for a moment and listen.

2) Share your Feelings

This season provides a great opportunity to open up and share your feelings.  Feelings and emotions are a very powerful force in our lives, and sharing them with family or friends can reduce stress and be a very healthy mental exercise.  Just letting those you work or live with know how much you appreciate them can bring happiness and peace of mind not only to others, but also to ourselves.

3) Consider the Present Moment and Then Let Go

The realization and acceptance that nearly all worry and anxiety and tension are rooted in thoughts of the past or future is the basis of meditation practice. Perhaps that is why meditation philosophy focuses on releasing all of the constant ‘chatter’ in our heads, to let go of worries of the future or thoughts of the past, and just sit back and observe the moment,  just hang out.

The spiritual teacher Eckhart Tolle said ‘turn your entire attention to the now, and tell me what your problem is.’  This may sound naive, impractical or unrealistic because the ‘present moment’ is not the whole story and we do indeed have problems in this world.  But although it may take a little effort and consistency, it is possible to stop for a moment, to practice mindfulness, and learn how to let go of thoughts of the past or future, just for a moment, to rest.

I can personally support the benefits of this practice.  I lost my mother of 98 years after a wonderful, lifelong relationship, earlier this year. Rosie was a selfless and special woman who touched so many lives.  As I sat at her bedside overwhelmed with thoughts of sadness and worry and struggle, I found a moment when I just let it all go.  And then I noticed the snow softly falling on the trees, there was a beauty in her face, there was love all around, there was continuity….and that is when I found peace, with all of it.

Thanksgiving and the Holiday Season are a once a year opportunity for ‘gratitude practice.’  And it is that ‘attitude of gratitude’ that can provide a wonderful possibility to be ‘calm in your heart’ and to find peace….right there in the midst of all the anxiety, noise and trouble of a crazy and beautiful life!

All of us at evolv are thankful and appreciate you and the belief and trust that you have placed in us for you care.

Happy Holidays and Blessings to all of you and your families!

Fall in Love with Healthy Skin

All of us at evolv Plastic Surgery and Medical Aesthetics would like to welcome you to the Holiday Season!

November is National Healthy Skin Month, and achieving and maintaining optimal skin health is something we strongly believe in and practice every day at evolv.  Our skin health is often neglected or taken for granted with our hectic schedules particularly during the holidays.  In honor of National Healthy Skin Month, here are a few interesting facts to consider:

– The skin is the largest organ in the body, and the average adult has approximately 16-22 square feet of skin weighing around 9-11 pounds.

– The skin surface completely renews itself about every 28 days by constantly shedding dead skin cells (a large part of the dust in your home actually came from your skin surface)!

– Your skin surface is home to millions of bacteria (over 1,000 species) and fungi!

– Healthy skin functions as a very selective barrier to keep out harmful toxins and pathogens while protecting, retaining moisture and regulating temperature.

– The skin is the source of more cancers in humans than all other organs combined…..one in five Americans will be diagnosed with skin cancer in their lifetime, and one person dies of melanoma in the U.S. every hour.

– There are over 60 million Americans living with actinic keratosis, the most common type of pre-cancer of the skin. 

– Multiple studies confirm that skin health and youthfulness has a significant impact on self-confidence, overall well-being and quality of life.

At evolv, we have witnessed how improving skin health can positively and powerfully impact the lives of our patients at any age and in many ways.  We have also experienced how healthy skin can improve results and patient satisfaction in any cosmetic surgical procedure, as well as any non-surgical aesthetic treatment.  Optimal skin health plays an essential role in the comprehensive aesthetic care that we provide for all of our evolv patients.

Personalized medical skin care programs with ZO Skin Health can reduce or prevent many of the signs of aging and restore youthful and ageless skin quality, as well as prevent or reduce the risk of cancer, acne and other inflammatory conditions, treat hyperpigmentation and rosacea.

During the cooler months, dry and dehydrated skin is very common and frustrating but can be effectively controlled or prevented and treated with an individualized skin care plan provided by Dr. Barone, Dr. Koltz or one of our evolv aestheticians.

This Holiday Season we would like to encourage everyone to consider the importance of their skin health and the effect it can have on reducing the risk of cancer, as well as improving quality of life.  The reality is that healthy skin takes work, especially as we get older.  We encourage you to come in and learn about the many exciting new and affordable options in aesthetic skin services, products and treatments that can achieve results in skin health and youthfulness far beyond most patients’ expectations.  We believe in comprehensive, natural appearing outcomes and long term programs and would like to share these concepts with our patients and their families!  So CHEERS from all of us at evolv to your new skin health and younger look!