Since 2002, over 11 million treatments are estimated to have been performed!

Botox continues to be a very popular treatment in my New Jersey plastic surgery practice. Once a month, on every third Thursday my Cherry Hill office offers a Botox Event where at an extremely competitive price (lower than even charged in the local medspas) as a thank you to my loyal patients. It is very common that we will treat 30 or 40 patients on these Thursdays alone. Botox in South Jersey continues to grow in popularity!

If you haven’t tried it, or would like to get more information, visit my website or Botox.com

I am sure this drama will play out over the next few months. It most certainly will affect my Cherry Hill plastic surgery practice where I treat women from all over south Jersey with Botox. For now, I will continue using the Botox that remains such a wonderful product however the idea of competition in the marketplace driving down prices was alluring.

I am sure this should be filed under “to be continued…..”

The more exciting news is that this approval is not only of round silicone implants but also of anatomic shaped implants. Since the 2006 Mentor and Allergan silicone gel approval, only round silicone implants have been available. Anatomic (or teardrop) shaped saline implants have continued to be available but until today only silicone round implants have been available for general use. Prior to 2006 as part of the silicone gel studies I routinely used silicone anatomic implants especially in reconstruction patients. While I have always preferred round implants in the vast majority my NJ cosmetic surgery patients.

Only time will tell about whether or not this third player in the implant business will make much of a difference. I am extremely happy with the quality of both Mentor’s and Allergan’s implants. Mentor is a quality operation (now owned by Johnson & Johnson) with implants made in the United States with strict quality control. Allergan is a huge global company (also the maker of Botox) with an incredible safety record. I do not know much about Sientra and while it is a Santa Barbara, California company with a 30 year track record of safety according to its corporate website, for now I personally do not know much about them. With the recent PIP breast implant scandal in France, safety should be everyone’s first question. Undoubtedly the FDA looked at the company’s safety data carefully.

Any new approval is exciting such as this! This is not just another choice of implants but the availability of a different shape of implants. For certain patient body types this may be a distinct advantage.

I believe that there are many advantages to using the funnel:

– Shorter Incision Lengths
– No touch technique (I’ll get back to that)
– Less force on the implant during placement and thus less damage to implants
– Decreased risk of contamination
– Decreased risk of infection
– Shorter recovery due to less surgical trauma

A recent study in the February 2012 Aesthetic Surgery Journal confirms that the funnel significantly reduces skin contact and potential contamination. This is important in theory for several reasons including less infections as well as less capsular contracture. A major theory behind capsular contracture is bacterial contamination from the skin and thus avoiding the skin contact makes sense.

I attached a Video from my operating room. You can see in the video how easy it is to place a gel implant with the funnel. After the pocket is fully created in the standard fashion the funnel is used. The funnel protects the implant from ever touching the skin. You can see that I remove the implant from its box, put it in the funnel without handling it much, and place it directly in its new home under the muscle. The shape of the breast pocket has already been created and the final step is placing the implant. Shape is then confirmed and whatever adjustments may be needed are performed as usual.

Advantages include minimal pressure on the implant shell during placement and thus in my opinion less damage to the implant, smaller incisions and thus smaller scars, and less risk of contamination. I believe that less pressure and pocket manipulation during placement yields less swelling and less pain after surgery.

My own personal opinion is that this device should be used by every plastic surgeon for every breast operation. Why don’t all surgeons use it? Perhaps they don’t know about it as it has only been on the market for a few years. Perhaps they do not feel it is worth the approximately $100 pricetag per device as the device cannot be reused. Perhaps they do not feel that it is necessary. I do not know their reasons, but use it on every silicone augmentation I perform since the day I tried it.

If you have any questions, I would love to discuss them here so feel free to comment.

The top five surgical procedures for 2011 were:

– Breast augmentation – 307,000 procedures (increased 4% from 2010)
– Rhinoplasty – 244,000 procedures (decreased 3% from 2010)
– Liposuction – 205,000 procedures (increased 1% from 2010)
– Eyelid surgery – 196,000 procedures (decreased 6% from 2010)
– Facelift – 119,000 procedures (increased 5% from 2010)

As far as minimally invasive procedures go:

– Botulinum Toxin Type A – 5.7 million procedures (increased 5% from 2010)
– Fillers – 1.9 million procedures (increased 7% from 2010)
– Chemical Peels – 1.1 million procedures (decreased 3% from 2010)
– Laser Hair Removal – 1.1. million procedures (increased 15% from 2010)
– Microdermabrasion – 900,000 procedures (increased 9$ from 2010)

The data presented by the ASPS is very interesting. In my New Jersey plastic surgery practice my number one surgical procedure is breast augmentation. I have seen increasing numbers of breast augmentation patients year after year more than the 4% number shown in the study I believe because I emphasize this procedure as what I most enjoy performing. My second most popular procedure in my practice is abdominoplasty which in the ASPS statistics went down to 115,902 procedures from 116,352 in 2010. My third most popular procedure is liposuction which also increased nationally 1% in 2011. It will be interesting to see different statistics from the Northeast versus Florida versus the West Coast which data I have not had the chance to see.

The data for noninvasive procedures also shows what we all knew already. Botox is the most popular procedure performed annually in the United States. I perform Botox almost every day in my Cherry Hill Botox office and every third Thursday have a “Discounted Botox Event” which is extremely popular. Please call the office for more information about this. Fillers, Laser Hair Removal, Laser Tattoo Removal also continue to be popular procedures.

I hope that you find this information interesting!

Botox was initially approved by the FDA for treatment of strabismus or an abnormality in the eye muscles in 1989. In 2002 the FDA approved Botox Cosmetic for the temporary improvement in wrinkles between the eyebrows or for treatment of the glabella muscles.

Botox Cosmetic is the most common cosmetic procedure performed in the United States year after year and the same thing stands true in my NJ plastic surgery practice. Every week I inject patients in their glabella, which treats the “11″ lines in between the eyebrows but also off-label in areas like the forehead or crow’s feet. After injection, 2 or 3 days later, these muscles do not move and thus the wrinkles or “angry” lines between the eyebrows are no longer there.

I get many ladies coming in asking for Botox around the nasolabial folds and lip lines. In these areas fillers tend to work better and I discuss things like Juvederm or Radiesse to fill out these lines. Laser resurfacing is an exciting option for lip lines.

I hope this brief discussion helps explain these products better!

The reason for not eating or drinking on the morning of surgery (or being kept NPO) is that any food or liquid in the stomach can be vomited during the start of anesthesia and if aspirated into the lungs can cause severe breathing problems.

The true amount of time needed to wait after eating or drinking is believed to be between 6-8 hours by most anesthesiologists. The patients in my practice are getting elective surgery and it makes sense to take every safety precaution possible.

I have had patients come in who directly disregard the instructions not to eat. They believe that this is an optional instruction and that coffee/milk and a small breakfast won’t matter. The truth is, it does make a difference, and the result of ignoring this instruction is usually postponement of surgery.

The goal of any surgery should be to optimize safety for plastic surgery patients and observing the restriction of not eating before elective surgery should be understood and respected.

I value the reviews that patients write about me and about my practice. One site that we are associated with has a large number of frequent reviews of my NJ plastic surgery practice which I wanted to share.

Other sites such as yelp reviews, yahoo reviews, google places, insiderpages are always growing.

I value the information posted and read it carefully. If you have concerns I wish you would contact me directly at esorokin@delawarevalleyplasticsurgery.com so we can address any issue. If you have the time to post a review, I certainly appreciate it!

The articles describes many patients as wanting to “go underground” during the recovery process and using the holiday season to be able to avoid work, school and friends.

Every year I see patients schedule surgery often in February or March for December of the upcoming year. They know when they will have time off and schedule early for these weeks. I see this in my New Jersey Plastic Surgery practice every year.

I don’t know that this is absolutely necessary especially with rapid recovery procedures such as breast augmentation where I tell patients in my NJ cosmetic breast implant practice to take 3 or 4 days off from work and that this is all that they will need. Even for facial resurfacing procedures such as my fractional Smartskin CO2 laser the recovery is only 5 or 6 days.

Still, I see this phenomenon every year and it is interesting to see it in the Wall Street Journal. In contrast the slow time of year is usually the last week in August or first week in September when kids are home from camp and school is about to start.

The repeal of the tax will be implemented over a 3 year period starting in July 2012. In July the tax will be reduced from 6% to 4%. It will go to 2% from July 2013 to July 2014. It will then goto 0% after July 1, 2014.

NJ implemented this tax in 2004. It quickly failed to raise the revenue that had been hoped. A repeal measure previously failed to pass when Governor Corzine would not sign it into law. It has been said that it cost more to implement and run the tax than was collected.

The law has been very difficult to New Jersey patients. Some patients have chosen to go to neighboring states like New York or Pennsylvania to avoid paying the 6% tax. Other patients who save for years for these procedures have had to save even longer and wait to have surgery or have not been able to afford it altogether due to this extra burden. Many people have called the tax discriminatory against women and the middle class who constitute the majority of plastic surgery patients.

In the end, it will be nice to see this tax go away. The administrative burden alone is a nuisance. While going away in stages of 4% then 2% then ultimately 0 is annoying, it is better than it never going away!

I’d love to hear your comments and posts on this topic!