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Category: From Dr. Frank Barone

The Transformation of Body Contouring

There has been a steady and dramatic increase in requests and interest by patients of all ages, women as well as men, for improvement in body shaping.  Despite efforts in improving exercise and diet, many patients are unable to reach their goals due to weight gain and loss, time demands, aging and a more sedentary lifestyle.  Although liposuction, fat grafting and surgical body lifts remain the gold standard in state-of-the-art body contouring and shaping, the costs and downtime are not always possible for many patients.

In the past, non-surgical body contouring options have been few and results often disappointing due to limitations with less invasive technology.  Some excess fat reduction and skin tightening were possible but inconsistent and often not meeting patient expectations.  I would like to discuss the most recent game changing technology that has all of us at evolv so excited.  As Bob Dylan once said….’The times they are a changin’ and here’s why!

Emsculpt – patented and proprietary high frequency electromagnetic (HIFEM) energy is the leading and most exciting game changer in the non-invasive body contouring arena.  Emsculpt is a 30-minute no downtime office procedure that stimulates specific muscle contraction at higher rates (supra maximal) than voluntary movement, resulting in an increase in muscle cell size as well as number. An additional benefit of supra maximal muscle contraction is fat reduction and improved muscle definition. The result is truly transformative for patients who experience not only body sculpting but also an increase in muscle strength, tone and definition.

The Emsculpt technology is the first and only FDA cleared device for increasing muscle mass and simultaneously burning fat. The Emsculpt has a number of peer-reviewed research publications supporting the efficacy and safety of this truly revolutionary option for non-invasive body contouring. Although initially used for abdominal and buttock contouring, Emsculpt has recently been approved to treat the arms and calves for contour improvement and muscle definition.  evolv Plastic Surgery and Medical Aesthetics is proud to be the first medical practice in the Northwest Ohio area to introduce the Emsculpt.

Vanquish ME – The Vanquish ME (maximal energy) is the most effective and research validated option for non-surgical fat reduction. This is a non-contact radio frequency technology that has been proven to be more effective in permanently eliminating excess fat cells than cryolipolysis (CoolSculpting). The Vanquish technology can be used to treat the entire waistline, abdomen, hips/flanks and thighs.

Exilis Ultra/Cellutone – Tissue tightening and firming has always been a priority in non-surgical body contouring but often not significantly improved.  BTL Aesthetics has combined the benefits of ultrasound energy delivery with their proprietary and proven radio frequency technology in the Exilis Ultra to improve tissue firming and fat reduction non-invasively. Simultaneous use of the BTL Cellutone uses sound wave therapy to deeply penetrate tissue and improve lymphatic drainage and tone which benefits surgical and non-surgical outcomes. The most exciting potential involves ‘pre-treating’ patients with the Exilis Ultra/Cellutone protocols before Vanquish fat reduction and now the Emsculpt for muscle definition to provide body shaping outcomes never possible with non-surgical treatment options previously.

Biologically Active Topical Growth Factors – Obtaining the best possible result in non-surgical body contouring not only requires proven and effective energy devices, but also optimal skin health.  All of the exciting treatment options above are utilizing energy non-invasively to stimulate the soft tissue of the body and the ability of the skin and cutaneous circulation to respond maximally is a critical component in great outcomes. Recent research has identified bioactive growth factors and signaling proteins that can be applied topically to the skin to significantly improve the response to body contouring treatments.

Clinical evidence of dermal and epidermal restructuring has been proven with ZO Skin Health’s Growth Factor Serum, Defenage’s Bioserum and recently with Alastin Skincare’s TransForm Body Treatment. The pretreatment of the skin, as well as post treatment protocols, have the potential to provide significant and long-lasting results in non-invasive body contouring that truly surpass anything we have seen previously.

At evolv we have always believed that comprehensive programs provide the most beneficial and safe outcomes for our patients. This philosophy is particularly applicable to obtaining the best results in non-surgical body contouring and recently published clinical studies, as well as research-proven outcomes support it. The Emsculpt now provides a new dimension in body sculpting by adding the advantage of improved muscle definition and tone with a proven technology that can be effectively combined with non-invasive fat reduction and tissue firming options as described above. The addition of pre and post treatment topical biologically active growth factors offer additional benefits and outcomes in reducing the appearance of cellulite and improving skin tone and texture that we predict will provide long-term benefits that have not been possible previously. This is truly an exciting time in aesthetics, so we encourage you to stop in at evolv to learn more!

Frank Barone MD FACS

Why You Need Skin Needling

This time of year is typically associated with vacation and less time spent at work.  But we have been very busy at evolv Plastic Surgery and Medical Aesthetics because we have been working on introducing and developing some exciting and potentially game changing technology and services in aesthetic care for our patients.  Although we have not finalized all the details, I would like to introduce some of the basic concepts and the reasons for our excitement:

New excitement with Microneedling?

Harnessing the skin and body’s stored potential to naturally repair, restore and rejuvenate new and healthy, young tissue is the very basic essential of bioregenerative medicine and is the fundamental principle in skin microneedling.  Often termed ‘collagen induction therapy’ because off its unique ability to stimulate new collagen and elastin production in the skin, we are seeing a tremendous resurgence in demand for this aesthetic service because of the natural mechanisms that it stimulates in youthful skin rejuvenation as well as the long-lasting results.

There are two essential types of skin needling:

  – Cosmetic Needling: a home program with very superficial needles, cosmetic skin needling is not painful and does not cause bleeding but can significantly improve skin care product absorption and results.  Environ Skin Care’s state-of-the-art microneedling rollers combined with their proprietary topicals designed specifically for needling can improve wrinkles, sagging and aging of the face, as well as any body area and have been extremely exciting for patients.

  – Medical Needling: a deeper treatment performed at the office by a trained medical aesthetician or nurse, medical needling usually requires a topical anesthetic and can improve fine lines, wrinkles, scars, laxity, stretch marks and general skin aging.  There is a lot of excitement with the results experienced combining medical microneedling and topical biologic products such as platelet rich plasma (PRP) and specific growth factors and peptides such as ZO Skin Health’s Growth Factor Serum, Alastin Skincare’s Regenerating skin Nectar and Defenage Skincare’s Bioserum.  

Infini Genius

Combining the benefits of medical microneedling with the addition of controlled and precise delivery of radio frequency energy to specific levels in the skin make the Infini Genius by Lutronic the most advanced and effective microneedling technology on the market.  The new technology improvements result in not only better results, but also more efficient and comfortable treatments.  Combined with Alastin Skin Nectar pretreatment and then post procedure topical Defenage or PRP, Infini Genius therapy can provide a comfortable and timely service that improves skin tone, texture, pores, fine lines and general signs of skin aging.  Infini Genius has also been used successfully to diminish excess sweating (hyperhidrosis) as swell as deeper acne and other scars.

Plasma Pen Therapy

evolv Medical Aesthetics is excited to introduce the Plasma Pen to the Toledo area.  The Plasma Pen is a handheld device that uses proprietary ionized nitrogen gas to resurface and tighten the skin.  Plasma Pen treatments are particularly effective to tightening skin laxity or creepiness around the eyelids and other facial areas.  This is a minimally invasive office treatment that has already produced some significant results in restoring more youthful and firm eyelids and facial tissues.  

At evolv Plastic Surgery and Medical Aesthetics, we are passionate about providing the most advanced and effective, research proven technology for our patient treatments.  New advances in skin needling and topical biologics, the Infini Genius and the Plasma Pen offer clinically-proven and state of the art technology that provides outcomes in aesthetic treatments that are truly revolutionary and exciting.  We invite you to learn more about these options from your evolv professional.

Now back to those lazy days of summer!

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

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!

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!

CHANGING THE BREAST CANCER EXPERIENCE

Even though it was over 30 years ago, I will never forget her face.

She was a young mother and school teacher with 2 small children and I was a first year plastic surgery resident.  She had a mastectomy for breast cancer and was left with a large and painful tight scar.  The implant that had been placed by my instructor under the scar was hard, unnatural and uncomfortable…..at that time in the mid 1980’s there just were not many options or choices. She looked at me and I did not know what to say to comfort her.  That was the day I decided to seek post graduate training in breast reconstruction and that young mother, with the eyes I cannot forget, changed my life forever.

This year an estimated 230,000 women in the U.S. will be diagnosed with breast cancer but less than 25% of those women will be aware of their reconstructive options before treatment.  The breast cancer experience touches not only those women but also their spouses, their children, their families and their lives for years.  The breast cancer experience involves much more than just removing a tumor or having a mastectomy, it is a journey that can involve medical and other post-operative treatments as well as impact a women’s personal life and self-confidence and relationships at every level.  In short it will someday effect all of us and someone we love.

The really exciting news is that the breast cancer experience is changing significantly for the better for a variety of reasons:

Education and Patient Awareness – public awareness and educational efforts by a number of professional     organizations have resulted in women being more informed and aware of their options.  The American Cancer Society, the American Society of Plastic Surgery, the Susan G. Komen Foundation, The Victory Center and many others are doing an incredible job of communicating useful information to patients and their families.  The best informed patients make the best choices!

Identifying Risks and Cancer Prevention – the most effective way to fight cancer is prevention.  New research on nutrition and life style as well as genetic testing to quantify risk factors have actually made a substantial difference in breast cancer incidence.  Advances in genetic mapping have made great progress and resulted in improved options and treatment outcomes for patients at risk.  Prophylactic mastectomy or removing the breast tissue to prevent cancer in high risk individuals, as popularized by actress Angelina Jolie, can reduce cancer risk by 90-95% in appropriate patients and result in excellent aesthetic outcomes.  We encourage everyone to learn more about these exciting advances in order to protect themselves and their families.

– Early Detection – After prevention, the next most effective way to impact breast cancer is early diagnosis.  Improved patient education and self-exam, consistent doctor’s visits, advances in imaging techniques such as mammography, ultrasound, MRI and other scans have resulted in earlier detection of breast cancer and breast ‘pre-cancers’ which will improve the overall patient experience and outcomes as well as reduce breast cancer morbidity.

– Improved Surgical and Reconstructive Techniques – Significant advances in biomaterials for breast implants and implantable materials (acellular dermal matrix) to help shape breast reconstruction procedures, have resulted in much more natural breast shapes as well as improved safety and less recovery.  Earlier detection and research on tumor biology have resulted in less invasive resection procedures (lumpectomy and mastectomy) and options such as sparing the breast skin and nipple in appropriate patients.  Placement of implants above the chest wall muscle (pre-pectoral reconstruction) and advances in tissue flap surgery reduce recovery time and have improved results for patients dramatically.  Our very own Dr. Peter Koltz, an associate with Dr. Barone at evolv Plastic Surgery, completed advanced training in tissue flap surgery for breast reconstruction last year and has been offering these options for patients in the Toledo area.

Post Treatment Quality of Life Improvementthe consequences of breast cancer treatment do not stop after the procedures have ended.  Many patients taking  estrogen blocking medication or other targeted chemotherapy or radiation deal with side effects such as bone and heart health, hair loss, premature skin aging, tissue dryness and laxity, post-menopausal vaginal dryness and urinary incontinence.  This often results in femininity and intimacy challenges, sexual difficulties and overall loss of self-confidence and intimacy.  New advances in clinically proven topicals, non-estrogen growth factors and other therapies can reduce symptoms and help restore confidence and vitality.  Regenerative treatments with platelet rich plasma (PRP) and other stem cell growth factors as well as collagen stimulating noninvasive technologies have given many patients much improvement in these issues and a better quality of life.

October is Breast Cancer Awareness month and October 17th is Breast Cancer Awareness Day (or ‘BRA Day’).  Please support these worthwhile programs and help bring more awareness, education and encouragement for the many women, men and their families that are dealing with this life changing issue.  We invite you to join myself, Dr. Peter Koltz and the evolv staff at Rosie’s on Wednesday, October 17th to support BRA DAY and spread the word on the improving awareness and quality of life for breast cancer patients and families.  

Yes the breast cancer experience is changing for the better and helping improve the quality of life for many.  Advances in clinical research, cancer biology, genetic testing, surgical and reconstructive option have transformed the breast cancer experience in such positive way.  The quality and safety of new reconstruction choices and postoperative treatment options can restore a patient’s self-confidence and lifestyle. As plastic surgeons we now may often hear a post reconstructive patient say, “Doctor, I sometimes forget I had a mastectomy!”

And I am forever grateful to that young mother and cancer survivor that inspired me with her courage so many years ago.

Real Skin Health Takes Work.

The mission of creating and maintaining skin that is optimally healthy, youthful, vibrant and cancer-free is a passion that all of us at evolv Plastic Surgery & Medical Aesthetics share and believe in. As summer comes to a close, it’s an excellent time to evaluate your skin health and make a personalized plan to achieve these goals for yourself. Summer is a time when many patients have had excessive sun exposure, lending itself to hyperpigmentation, fine lines, premature aging and pre-cancerous lesions (actinic keratosis). These skin issues are especially prevalent this time of year, not only in older adults but also in many younger patients.

Unfortunately, we are all inundated by companies promoting the next ‘miracle’ cream that promises to quickly and easily erase skin damage and restore youthful skin. Promotions by celebrities and very clever marketing are all around us in the media and online, convincing even well-educated consumers to buy their product with unproven promises and unrealistic expectations. The sales tactic of ‘snake oil’ in a bottle and promising more youthful and beautiful skin has always been and remains an extremely effective marketing technique. But the truth behind their marketing is that there is rarely any science or credible research to back up these claims, and the majority of consumers end up spending significant amounts of their resources for ineffective products that are cleverly packaged and promoted. There is definitely a lack of trust and credibility in the skin care and cosmetics industry.

After nearly 30 years of involvement and dedication in medical skin care and skin health, I can assure you that the advice of Dr. Obagi, “real skin health takes work,” is spot on! In order to repair, restore and rejuvenate aging or damaged skin, one must understand the physiology of healthy skin and how it is designed to function naturally and optimally. Years of research and the benefits of science and biotechnology have opened the door to many exciting possibilities in achieving and maintaining youthful and healthy skin, as well as reducing cancer risk by utilizing and respecting the natural functions of the skin. Research supports the basic principles of skin health which are the fundamental of the ZO Skin Programs:

  • Effective, but not traumatic, daily cleansing and exfoliation
  • Restoration of a normal maturation cycle through conditioning and stimulation
  • Repair of cell damage, excessive pigmentation, injury and disease
  • Protection and reduction of inflammation
  • Hydration and calming
  • Protection from ultraviolet radiation and reducing skin cancer risk

Because of the interactive nature of the skin, as well as ethnic and environmental factors, every patient’s program must be personalized to each individual’s ethnicity, lifestyle and unique skin characteristics. Obviously no single product or treatment can repair and restore skin health. A medical history, complete evaluation and understanding of the comprehensive nature of skin function and health by an experienced and knowledgeable professional are absolutely necessary for achieving youthful, healthy skin and reducing the signs of aging and risk of skin cancer.

Yes, restoring and maintaining beautiful, youthful skin takes work and commitment, but the results can be not only gratifying, but life changing for those who ‘show up’ every day for their skin workout! If you would like to find out more, please contact an evolv medical aesthetician to learn about what a difference healthy and ageless skin can make in your life.

ensoCLUB Update

We are all more than thrilled to report that after introducing evolv’s ensoCLUB subscription for personalized, aesthetic treatment plans last month, we have had more than 115 new patients subscribe as new members! At evolv, we believe that a comprehensive plan as an ensoCLUB member is the most cost effective and successful way to achieve optimal results for each patient. Be sure to inquire and find out more about the game-changing benefits available to ensoCLUB members, and come see what all the excitement is about!

The Growth of Non Surgical Aesthetics

The latest statistics are quite remarkable: last year in 2017, there were over 20 million non-surgical cosmetic procedures performed in the U.S. and nearly 16 million of that number were injectables of Botox type neuromodulators and soft tissue volume replacement (fillers).  So what could possibly explain this explosive growth?

At evolv Plastic Surgery and Medical Aesthetics, we have a long term commitment and interest in ongoing education for our staff as well as our patients.  So let’s take a look at some of the reasons driving the increased demand and popularity of injectable soft tissue fillers and Botox type neuromodulators.

More natural long lasting results
 

Gone are the days of simply injecting Botox to the scowl lines of the forehead (glabella) or adding filler to the nasolabial folds to rejuvenate the aging face.  The commitment to comprehensive aesthetics at evolv is a holistic appreciation of all of the parameters of the aging face and body.  Along with the fundamentals of a personalized skin health program, a number of different FDA approved injectable neuromodulators (Botox/Xeomin/Dysport) may be used for different applications and results balancing facial expressions and movement to obtain a more youthful outcome as well as to reduce migraine headache triggers.  Patients may be surprised to learn that there are over 100 medically approved therapeutic indications for current Botox type treatments!  A new Botox type injectable (DaxibotulinumtoxinA or RT002) is scheduled for release soon and has the advantage of lasting 50% longer or up to 6 months.  Combining neuromodulators and soft tissue fillers properly can result in a natural and balanced youthful appearance that can be quite cost effective and lasting.  New ‘flexible’ fillers (Galderma’s Refyne and Defyne) which create volume replacement while maintaining harmonious movement in the face resulting in a more natural result along with less swelling.

Less chance for bruising, swelling and discomfort with treatments

For many patients, the risk of bruising and prolonged swelling with traditional injection is a major concern.  This risk can be minimized by the use of cannulas for soft tissue filler placement in some areas instead of needles.  In addition, advances in bioengineering and technology have resulted in new fillers that last longer and induce significantly less swelling (Allergan’s Voluma, Vollure and Volbella and Bellotero form Merz).  evolv recently introduced the ProNox system for patients which allows them to self-administer nitrous oxide gas to reduce the perception of any discomfort during treatment.  Finally, new formulations in topical numbing or anesthetic creams are more effective in reducing any discomfort during injection and other procedures in the office.  All of the above have significantly improved the patient experience during injectable treatments at evolv.

Expanding patient base and options

Because of the improvement in products and the potential for more natural and affordable outcomes, more patients, male and female, and of all ages, are seeking treatments.  Indications as well as ‘off label’ uses of FDA fillers and neuromodulators are providing more comprehensive and natural appearing results.  A few examples are the use of Botox for migraine prevention, and the use of injectable soft tissue fillers for rejuvenation of the aging hands as well as for correcting depressions and cellulite improvement on the body and buttocks.  A new category of fillers that induce soft tissue growth from the patient’s own cells are called ‘biostimulators’ and they include Sculptra and the new exciting product Renuva which is called an ‘adipose matrix’ and triggers natural fat and tissue growth in areas of scars or depression.

The importance of safety and training

As in all areas of aesthetics, the key to achieving high patient satisfaction and safety is comprehensive and ongoing training for all providers and staff. At evolv, education and patient safety are our passion and we believe it is everyone’s responsibility to keep patients safe and happy with their overall experience.  We take this commitment seriously because, as everyone is aware, complications and unfavorable results are all too common in cosmetic treatments.  The high demand for aesthetic treatments has outpaced the number of properly trained and credentialed service providers so it is especially important for anyone interested in these treatments to carefully research and understand the experience and training credentials of any provider offering services in aesthetic care.  Complications can be very difficult and expensive to treat and correct so we encourage any interested patient to be well informed before making a decision to undergo cosmetic treatment.

The advances in biomaterials, technology and research proven new products and techniques have resulted in significant improvement and new options in non-surgical facial and body rejuvenation with injectable soft tissue filler augmentation and Botox type neuromodulators.  Safety and longevity of results, when performed by a board certified/eligible plastic surgeon or properly trained registered nurse injector, have also resulted in a tremendous increase in the popularity of these procedures.  At evolv Plastic Surgery and Medical Aesthetics, we believe in and emphasize comprehensive aesthetic programs combining these options along with a personalized skin care plan as the most effective way to achieve long lasting and natural appearing outcomes for each patient.  And finally, evolv has recently introduced the ensoClub which is a private membership program with the benefits of reduced cost, preferred bookings and more affordable customized treatment plans.  If you are interested in more information on the ensoClub program be sure to ask any of the evolv professional staff.