Bolitho MD

9834 Genesee Ave Ste 311 La Jolla San Diego, California
Phone: (858) 458-5100


21Oct, 2016

Why a woman may seek a breast revision surgery

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Why a woman may seek a breast revision surgery

When a woman considers a breast augmentation surgery, it’s important that she is thoughtful about the decision. During her appointment with a board certified plastic surgeon, she can inquire about the procedure, the recovery and the outcome. Also at that time she can be candid in regards to why she wants this surgery and her expectations following it.

Excellent communication between plastic surgeons and their patients is imperative.

While a patient may have done their due diligence before undergoing their breast augmentation procedure, there are cases when she may very well consider a breast revision surgery based on either a desire or need. This can occur months or even years later.

These reasons may vary and include the following:

  • Challenges with breast asymmetry
  • Capsular contracture (scar tissue surrounding the implant has tightened)
  • Symmastia
  • Removing and replacing an implant(s) which has ruptured
  • Deciding on a new implant size
  • Implant rippling
  • Interchanging saline with silicone implants (or vice versa)

It’s entirely up to the patient as to whether or not they want to return to their original plastic surgeon for the revision or seek another. If the choice is the latter, it’s highly recommended to research only board certified plastic surgeons that specialize in breast surgery and ones who are adept in breast revision surgeries.  Once more, this is a personal decision. In addition to this, other surgeries they should excel in may consist of a breast lift, breast reduction, and breast reconstruction. Surgical aptitude in breast surgeries can help patients achieve a positive surgical outcome.

As mentioned earlier, there are various reasons as to why a woman may seek a revisionary breast surgery.  Some patients may discover over time that the original size implant they chose years ago no longer fits their lifestyle. For example, when a woman has completed having her family in her forties, she may come to the realization that the implant size she chose in her twenties may no longer be aesthetically appealing to her.

In the same breath, her skin tissue may have transformed over time due to weight gain, breastfeeding and weight loss.

Every patient is different as are their aesthetic needs.

For whatever reason a woman decides that she is interested in pursuing breast revision surgery, always remember that locating a board certified plastic surgeon should be at the top of the checklist.

And truly, this certification cannot be understated. A doctor certified in plastic surgery can help ensure a positive surgical outcome while keeping patient safety in the forefront.

13Oct, 2016

Facial rejuvenation after weight loss

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Facial rejuvenation after weight loss

As many can attest to, making the decision to lose weight takes patience and dedication. Reaching those weight loss goals is truly a celebratory milestone.

For those who have attained their goal by losing 20 to 25 pounds, while they have redefined their silhouette, they may also notice that their face has lost volume.

“Anytime you lose a significant amount of weight, there is a concern about volume loss and perhaps the change of laxity in your skin,” said Elizabeth Reed, an aesthetic nurse specialist who works with San Diego plastic surgeon Dr. D. Glynn Bolitho. “So what we want to do first is to restore that volume.”

Reed mentioned the optimal products she uses are Juvederm and Voluma.

While Juvederm is used to lessen the appearance of nasolabial folds and marionette lines, Voluma addresses the mid-portion of the face. According to Reed, beginning rejuvenation at the mid-face is a great starting point.

This usually begins with using one syringe of Voluma. Generally, Reed likes to deliver the Voluma first and wait a couple of weeks for the product to settle before addressing nasolabial folds. In some cases, this area may resolve itself due to the Voluma, or a patient may need a lesser amount of Juvederm.

When teaming up with patients for their skin care needs, Reed will also assess whether or not they would like to reverse any premature skin aging caused by sun damage or even brighten their skin tone with a series of chemical peels.

And for those who want to lessen the appearance of wrinkles along their forehead, around their eyes and in between their brows, Botox is the “go-to” cosmetic injection.

“The goal is to tailor a skin care regimen for every person’s specific needs,” Reed said.

Reed wants everyone to know that it’s best to be within five pounds of a weight loss goal before seeking a Juvederm or Voluma treatment. The reason behind this is that when someone is close to their goal weight, a professional such as an aesthetic nurse or plastic surgeon, can glean better insight into a person’s facial structure.

“For me, it’s about a patient investing in something at the right time so they achieve the overall result that they are looking for,” she said. “When you are within five pounds of your goal weight, I think that’s a great time to make an aesthetic care plan.”

6Oct, 2016

Methods to help reverse the signs of facial aging

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Methods to help reverse the signs of facial aging

As one becomes mature with age, they may notice over time that their skin appears less hydrated and fine lines are more apparent. While these signs may be normal, both women and men may very well want to take steps to facial rejuvenation.

There are various reasons as to why skin ages. For many, although they have been incredibly diligent with their sunscreen, over sun exposure may still have occurred triggering premature aging such as fine lines, wrinkles, and age spots.

While UV damage plays a role in aging skin, other factors contribute to it as well including a sluggish cellular turn over, loss of natural hydration, and repeated facial movements that cause dynamic wrinkles. For those unfamiliar with the term, “dynamic wrinkles,” this occurs from recurrent facial actions such as smiling which can develop wrinkles over time along the outer corners of the eyes and mouth.

While surgical facial rejuvenation such as a facelift or lower limited facelift can produce excellent results, some patients may decide to travel a nonsurgical pathway first. And on this road are the following aesthetic avenues.

Skin Care Regimen

One of the best investments an individual can make is to team up with a medical skin care professional. An example of this is an aesthetic nurse specialist who works alongside a board certified plastic surgeon. Partnering with such an expert will offer a springboard of skin care options such as being afforded medical grade skin care products which match a person’s needs.

While many plastic surgery offices offer specific skin care lines, one prescription product not to be overlooked is Retin-A. This topical appeared on the market nearly three decades ago and was intended for the use of patients with acne. Not long after it was on the market, users noticed another improvement in their skin: Rejuvenation.

Patients agreed that their skin appeared smoother, age spots had diminished, and fine lines and wrinkles were less noticeable.

A complete antiaging skin care regimen requires Retin-A.

In office visits with a medical specialist may also include chemical peels, dermaplaning, and micro-needling to enhance those skin care results.


As mentioned earlier, dynamic muscles occur due to the frequent use of facial muscles. One way to minimize their appearance is via Botox injections. A board certified plastic surgeon or their aesthetic nurse specialist can deliver this leading cosmetic injection. Finding a skilled injector who is adept in the facial anatomy is critical for one interested in receiving Botox. The results of Botox should be a refreshed and natural look.

It’s important to note that some individuals in their late twenties and/or early thirties utilize Botox to prevent these dynamic wrinkles from forming.


The loss of hydration in one’s skin will have side effects. Some of these may include the following:

  • Less youthful fullness
  • Dull facial canvas
  • Fine lines and wrinkles
  • Skin sensitivity

While some topical and in-office treatments can help with hydration, a group of patients turn to hyaluronic fillers to help treat nasolabial folds and marionette lines. Conversely, fillers such as Juvederm can help augment the lips, while Voluma can augment the cheek area.

From skin care products and treatments to cosmetic injections, each one should be tailored to a patient’s aesthetic needs and desires.

29Sep, 2016

A Break Time Peel Review

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A Break Time Peel Review

Since offering a “Break Time Peel” to our menu of nonsurgical antiaging services, our office has received wonderful feedback regarding this treatment protocol. In under an hour, our aesthetic nurse specialist, Elizabeth Reed, champions this visit which leaves patients looking luminous.

Recently Reed had the opportunity to perform a Break Time Peel on one of our patients, Christina M., 50.

“Elizabeth is my nurse injector for Botox, and I see her every few months for a touch-up. On my last visit with her, she mentioned how I may benefit from a Break Time Peel. I have had dermaplaning before but never a chemical peel in conjunction with it,” she said. “I decided to give it a try since Elizabeth also has me on a great SkinMedica routine. I trust Elizabeth, and she is a perfectionist.”

Before the treatment, Reed analyzed Christina’s facial canvas. She then prepared her face for the dermaplaning.

“I was used to this portion of the treatment. Elizabeth gently glides this stainless steel tool over my face,” Christina said. “There is no discomfort whatsoever and is quite relaxing.”

The dermaplaning removes vellus hair, also known as peach fuzz, as well as the top layer of dead skin cells.

Next came the light chemical peel.

“Elizabeth gently applied a topical ingredient. A small fan was placed over my face to lessen any tingly or burning sensation,” Christina said. “And even that was minimal.”

Elizabeth made a couple more passes with the topical chemical peel. She ensured Christina was comfortable by having the small fan rotating overhead.

“Elizabeth is so conscientious making certain I was comfortable,” Christina said. “The Break Time Peel lasted under an hour and before I left, Elizabeth applied sunscreen on my face and reminded me to always wear it when outdoors.”

A few days later, Christina has noticed a youthful skin boost. While her skin is visibly smoother, her facial canvas is brighter. And skin peeling is minimal.

“I absolutely love the results of the Break Time Peel,” Christina said. “This is something I am definitely going to do regularly!”

24Sep, 2016

Nonsurgical facial contouring choices

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Nonsurgical facial contouring choices
As one reaches their forties and fifties, they may undoubtedly notice their facial contours have altered over time. For example, the fullness in the midportion of their face, particularly in their cheeks, may have lost their youthful volume. As someone looks closely at the lower portion of their face, they may also witness submental fullness, which is more often referred to as a double chin. At different angles, the submental fullness may appear more prominent.

Although these changes don’t occur overnight, many can attest to the fact that it almost appears as if it has. The truth of the matter is that these facial transformations creep up year after year. In addition to maturity, other reasons for these changes may be heredity, weight gain, or weight loss.

Cosmetic injections have made incredible strides in the world of aesthetics. Botox, for example, is one of the leading injections used to diminish lines and wrinkles along the forehead, between the brows, and crow’s feet. While Botox is in the lead, other cosmetic injections have been pioneers in their own aesthetic right. And these injections are top choices for nonsurgical facial contouring.

To address the loss of fullness in the cheek area, a product by the name of Voluma has been considered one which has offered patients with an outstanding outcome. While patient dependent, the effects of Voluma may last up to two years.

During a consultation with a plastic surgeon or their aesthetic nurse specialist, they will determine if a person is a good candidate for Voluma. If it is determined so, photos may be taken prior to the injection so before-and-after pictures will be available.

Prior to the injection, a topical lidocaine cream will be applied to help ensure more comfort for the patient. Methodically, the medical professional will deliver the Voluma slowly. Towards the end of the injection series, a mirror will be on hand so the patient can see the aesthetic transformation. And the results are immediate. There is no downtime with Voluma; however, there may be a bit of bruising which can be easily camouflaged by makeup.

A quickly rising star for addressing submental fullness is another cosmetic injection called Kybella. While the former injection only requires one visit, Kybella is considered more of a treatment plan which may range from two to five series. Kybella’s main ingredient of deoxycholic acid breaks down and destroys fat deposits to help eradicate the appearance of a double chin. Once a person is determined to be a candidate for Kybella, the medical professional will map out the injection area on the underside portion of the chin and numb the region prior to delivering the treatment.

Treatment sessions are generally recommended to be spaced about six weeks apart. Icing is important after treatment to help alleviate any bruising or swelling following the injections.

While these treatments are considered nonsurgical, it’s incredibly important to have them executed by a medical professional who is adept in the facial anatomy.

18Sep, 2016

The Cosmetic Injection Progression

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The Cosmetic Injection Progression

One of the leading manufacturers of cosmetic injections is Allergan which has undoubtedly been described as the pioneer in a special niche of nonsurgical facial rejuvenation. Its best known product is Botox, a purified substance of botulinum toxin A. For years, Botox has become the “go to” minimally invasive treatment to smooth out “dynamic wrinkles” along the forehead, between the brows and around the eyes to treat crow’s feet.

Dynamic wrinkles emerge from repeated muscle movement and Botox helps by intercepting these movements to smooth out those fine lines.

Kybella, another injectable by Allergan that was FDA approved last year, is being considered as another pioneer treatment. It has made strides in eliminating the appearance of submental fullness, otherwise known to many as the dreaded double chin.

The main ingredient of this newest product is a synthetic form of deoxycholic acid. It works like a “bile acid” that can dissolve fat. When injected, Kybella has the ability to target and disintegrate this unwanted fat.

While each patient is different regarding their aesthetic needs, Kybella is performed in a treatment series. Before the injection, the area is mapped out.

Generally, patients require two to four treatments, and it is recommended to space the treatments apart every couple of months. Number of visits is dependent on the scope and thickness of the area being treated. The reason for this duration is to give Kybella the appropriate time needed to resolve the issues of submental fullness. At the next session, updated aesthetic decisions can be made.

The treatment takes under 30 minutes and patients may experience some swelling, redness, or tenderness for a short period of time. Icing is recommended to minimize any side effects.

According to media coverage, such as in the Quartz publication, “…the company [Allergan] is testing the drug for FDA-approved use on other paranoia-inducing rolls, including what some refer to as ‘bra overhang.’”

And yes, there appears to be other discussion treatment items on the horizon.

In the Quartz publication, it was noted that Amy Lewis, a clinical assistant professor of dermatology at Yale School of Medicine was interviewed by Allure Magazine.

“There have been attempts to dissolve fat before, but this is the first time it’s worked—and that’s pretty exciting. In the future, Kybella could be used to improve the appearance of stubborn fat pads elsewhere on the body, like bags under the eyes or so-called ‘bra bulges.'”

Research continues on whether or not Kybella can be used in other areas such as the following:

  • Inner knee fat
  • Thick ankles
  • Armpit overhang

And more…

The goal of cosmetic injections is to afford patients with minimally invasive options with little to no downtime.  Although these treatments are considered nonsurgical, it’s imperative that patients seek the delivery of these injections by medical professionals such as a board certified dermatologist, board certified plastic surgeon, or aesthetic nurse specialist. These adept professionals will have in-depth knowledge about the product(s) as well as the facial anatomy which will offer patients optimal results.


14Sep, 2016

Skin Care Product Awareness

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Skin Care Product Awareness

During the early part of summer 2016, the Food and Drug Administration (FDA) warned consumers to research their skin care products for a harmful ingredient: Mercury. And this warning was not the first of its kind.

In 2012, the FDA made this announcement regarding the toxic ingredient which they claim was in possibly 35 products which were manufactured overseas. These skin care products claimed to have anti-aging properties as well as the ability to treat acne. The New York Daily News reported the FDA findings underscoring the harmful effects of mercury. These toxic products were found in various states such as New York, California, and Texas.

According to FDA reports, these mercury-containing skin care products are seeping into the states once more. Yet again, these legally imported products are claiming to perform the following:

  • Skin lighteners and enhancers
  • Lessening the appearance of fine lines and wrinkles
  • Lessening the appearance of age spots
  • Treating acne prone skin

These skin care items also come in the form of topical facial creams, lotions, and soap bars.

In an article written by Michael Roizen, MD and Mehmet Oz, MD, in the King Features Syndicate, the doctors conveyed that these products are also sold and promoted on the internet. And oftentimes, they may have no ingredients listed which should raise a red flag for the consumer – the FDA’s protocol is that all ingredients must be labeled on the product.

The ingredients to be on the lookout for include following:

  • Mercury
  • Mercurous chloride
  • Mercuric
  • Mercurio
  • Calomel

If the ingredients are missing and/or not in a language that a consumer understands, the best course of action is not to use the product. On the other hand, if one of the above ingredients is detected, immediately dispose the product by placing it in a sealed bag or container and contact the FDA for further instructions.

“The danger is that you’ll absorb mercury through your skin, and what accumulates can take decades to get rid of. That can trigger heart and neurological problems,” the doctors wrote. They continued, “If you’re nursing and use these products, you can pass mercury through your breastmilk. The mercury can quickly damage a baby’s developing brain and nervous system. Those skin products also produce mercury vapors, or you may leave residue on a towel and can make family members ill, too.”

Both consumers and healthcare professionals are incredibly thankful that the FDA has released this news once again and that doctors Michael Roizen and Mehmet Oz raised awareness level. It serves as a concrete reminder regarding the importance of teaming up with medical professionals who implement sterling patient care.

Dermatologists, plastic surgeons, and aesthetic nurse specialists will navigate patients toward exceptional and safe skin care products while incorporating a variety of treatments for anti-aging goals.  Teaming up with a healthcare professional helps ensure that they have a patient’s best interest at heart.

9Sep, 2016

A great skin care routine makes a difference

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A great skin care routine makes a difference

While individuals are incorporating a healthy lifestyle through diet and exercise, their desire to keep their skin looking youthful is also important to them. Many are beginning to realize that incorporating a great skin care routine compliments those health and wellness efforts.

As one ages, skin changes naturally occur such as the following:

  • Fine lines and wrinkles
  • Age spots
  • Lack of skin hydration
  • Loss of volume
  • Loss of elasticity

While the aging process impacts the above facial characteristics, it is also important to point out how the environment takes a toll on one’s skin.  For example, free radicals, pollution, and unprotected sun exposure can also accelerate premature skin aging.

Despite these daily challenges, one should not curtail their skin care energies but instead implement a regular regime for both morning and night.

Partner with a skin care professional

With a mountain of skin care products to choose from, the task of choosing the right skin care routine can be downright daunting. Teaming up with a skin care professional, particularly an aesthetic nurse specialist, is an exceptional choice.

A person of this magnitude and skill can perform a skin care evaluation and help map out the right morning and evening routines. They can also afford patients medical grade skin care products which truly offer users driven results.

Skin care plans are tailored specifically for one’s skin type and examples may include the following:

  • Cleanse – To prepare skin for topical treatments
  • Treat – To target specific challenges such as fine lines and wrinkles or hydration
  • Repair – To reverse skin damage such as the use of a retinol product
  • Moisturize – To add hydration to the facial canvas including the eye area
  • Protect – To implement a solar defense to help ward off future skin damage

Skin care treatments to reverse skin damage

The advantage of partnering with an aesthetic nurse also means that they are adept in particular skin care treatments that can help diminish the signs of aging. Even in cases where one has undergone surgical facial rejuvenation, such as a lower limited facelift, skin care texture still needs to be addressed.

Most skin care treatments can be performed on a monthly basis, but again, it’s all patient dependent. And some treatments can be done with less frequency. These procedures require minimal to no downtime and produce radiant results:

  • Dermaplaning: To remove the top layer of dead skin cells and vellus hair (peach fuzz)
  • Chemical Peels: To help rejuvenate the skin by diminishing the signs of fine lines, even out skin tone, and lessen the appearance of age spots
  • Micro-Needling: To help stimulate collagen and to deliver medical grade products into the skin for more luminosity.

In addition to these treatments, patients may also decide that they want to pursue cosmetic injections which may consist of Botox, Kybella, Juvederm, or Voluma to maintain their youthful skin care goals.

Solar protection bears repeating

While one is implementing a healthy lifestyle and skin care routine, a SPF sunscreen defense is of the utmost importance. When an individual turns a broad spectrum sunscreen application into a daily habit, they will invariably reap the rewards because of it.



1Sep, 2016


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For the entire month of September, let Elizabeth Reed, Dr. Bolitho’s aesthetic nurse specialist, reveal a more youthful and luminous you. In addition to a complimentary skin care evaluation, Scripps Campus staff members have the opportunity to also receive 20% off the following:






This 20% discount also applies to skin care treatments and skin care products which include:


*Chemical Peels





And for all that you do, please accept our appreciation by dropping by to receive your VIP Card which grants you 10% off of the above mentioned services and products all year long!

*Please note that Scripps Campus Appreciation Month ends on September 31, 2016. Discounted services apply to nonsurgical treatments with Elizabeth Reed, RN and skin care products. Year-round VIP 10% discounts cannot be applied to other specials.