Bolitho MD

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


6Jul, 2015

How Fat Grafting Enhances Facelift Surgery

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middle age woman

Plastic surgeons have discovered the benefits of incorporating fat grafting methods as part of the protocol for operative facial rejuvenation surgery. In a recent issue of Plastic and Reconstructive Surgery, a medical journal published by the American Society of Plastic Surgeons (ASPS), they revealed some interesting data in how this technique is enhancing the world of facelift surgery.

In fact, it has swiftly become a common component to the surgery be it a limited incision facelift or a more comprehensive procedure.

The study which unveiled this information was championed by Dr. Sammy Sinno, a board certified plastic surgeon at New York University, along with the assistance of his colleagues.

Wolters Kluwer of Medical Xpress cited, “The researchers surveyed a random sample of ASPS members regarding their use of fat grafting for facelift procedures. In this technique, the surgeon performs liposuction to obtain fat cells from another part of the body—such as the abdomen or thighs—and carefully injects them to provide additional volume in selected areas of the face.”

More than 300 ASPS member surgeons took part in the survey.

Leaning on ASPS member surgeons provides an accurate base point. Those who are part of this organization are highly regarded for their education and expertise in their field of medicine.

The response from the study revealed that 85 percent of the respondents stated that they indeed utilize fat grafting during operative facial rejuvenation procedures, otherwise known as facelifts. It was suggested that the increase of this particular technique occurred within the last decade.

While operative facial rejuvenation addresses wrinkles, facial fat grafting is an excellent modality in addressing the loss of facial volume such as in the cheek area. This modality can be of great benefit to reverse this.

Leading up to fat grafting, the following occurs:

  • The collection of fat via gentle hand-harvesting (i.e., liposuction tool)
  • Process of purification
  • Delivery and transfer techniques

The study indicated that the common site where fat was harvested was the abdominal area. The amount of fat transferred into the facial area varied. The survey revealed that this small amount gathered ranged from 11 to 25 cubic centimeters, also known as cc’s.

While a degree of some fat from the transfer does have the potential to reabsorb, ASPS member surgeons agreed that the majority of the transfer was still visibly present one year postoperatively.

The common areas of fat grafting include the following:

  • Cheeks
  • Lower eyelids
  • Nasolabial Folds

In some instances, the study pointed out that fat grafting follow-up treatments were sometimes performed again four to six months after surgery to redefine specific areas. Nonetheless, both patients and their doctors were pleased with the aesthetic outcome.

Toward the end of the study, Dr. Sinno surmised, “The results of our survey demonstrate most surgeons currently believe that facial fat repositioning in combination with volume addition increases the ability to utilize these two complementary techniques to restore the volumetric highlights noted in youth, thereby enhancing facial shape.”

Frankly, volume restoration by way of fat grafting has added another level to facial rejuvenation and has invariably improved a youthful appearance for many patients. This additional phase has transformed into a more prominent role in facial rejuvenation surgery.

29Jun, 2015

Breast Reconstruction Awareness Campaign Magnifies

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In a recent edition of Plastic Surgery News, published by the American Society of Plastic Surgeons (ASPS), many of its esteemed doctor members that perform reconstruction surgeries for breast cancer patients were delighted to read how the Breast Reconstruction Awareness Campaign is indeed increasing.

The campaign was founded by Mitchell Brown, M.D., a plastic surgeon based in Canada. In 2011, his vision came to fruition. And it has done a world of good for countless women. Brown’s foresight has helped empower women to learn about their options regarding different components of breast reconstruction surgery.

When a woman is diagnosed with breast cancer and requires a mastectomy or bilateral mastectomy, through a haze of personal turmoil and confusion, navigation is essential to her well-being by understanding that she does have breast reconstruction choices.

This also holds true for women who undergo a bilateral mastectomy due to a strong family history of breast cancer or being told she tested positive for the BRCA1 and BRCA2 genes.

The ability to give women surgical possibilities to rebuild their breasts can give them a sense of control.

While some women choose not to have the reconstruction, others want to undergo the procedure; nevertheless, being afforded the option is the cornerstone of the campaign.

In a recent piece written by Rosie Marszalek, “Breast Reconstruction Awareness Campaign Expands,” she reminded readers that Breast Reconstruction Awareness Day is on October 21, 2015. She went on to cite that in 2014, ASPS members throughout 44 states took part in this campaign. Among these states, a tally of 160 plastic surgery practices joined together in hopes to help women learn about their reconstruction options after having lost either one or both breasts due to cancer.

“Recognizing that women are fighting breast cancer every day, however, this year the Society is encouraging all ASPS members who perform breast reconstruction procedures to host a Breast Reconstruction Awareness event on any day throughout the entire year as part of the new ‘BRAve Face” campaign,” Marszalek writes. She continues, “In addition to local events, the BRAve Face campaign also features Patti LaBelle as its national spokesperson.”

Many have described the acclaimed singer as an ardent supporter of women who have undergone breast cancer.

In a statement, LaBelle told ASPS, “Women battling this disease need to have access to information about their rights and options to make informed choices about what’s best for them and their life following breast cancer treatment.”

As mentioned before, it is a time not only on October 21, but throughout the year, to provide resources and access to women so they can become educated. It’s the hope of ASPS that members will join together by championing events in an effort to raise this awareness.

In the past, an array of events has taken place such as:

  • Educational Receptions and Seminars
  • Art Exhibits and Contests
  • Luncheons and Galas
  • Sporting Activities and Contests
  • Flash Mobs
  • Dance Contests
  • And more….

ASPS members are encouraged to think “outside the box” and champion an event large or small. It is an opportunity for a community of like-minded and dedicated people to join together for a special cause.

Helping women who are “fighting the fight” and arming them with knowledge on breast reconstruction is a powerful movement for all involved.

19Jun, 2015

Sizzling Summer Special

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MD Solar SciencesAs we get ready for summer, receive 10% off Dr. Bolitho’s inventory of MD SolarSciences™ for the entire month of June! MD SolarSciences™, a lightweight product, is the leading sun protection manufacturer with active ingredients of titanium dioxide and zinc oxide. While it shields, it promotes healthy skin.

We have an array of sunscreen products to protect the whole family.

Call the office at (858) 458-5100 or email us at to place your order.

This summer special ends on June 30, 2015. And if you’re in the area, please stop by for a visit!

16Jun, 2015

Changing the Face of Facial Rejuvenation

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woman middle ageThe world of cosmetic surgery is growing more popular, and with it, new technology to help promote a more youthful appearance continues to emerge. Many companies are pioneering technology to help reduce fine lines and wrinkles.

While new technology continues to appear on the horizon, it’s critical that consumers do their due diligence while leaning on a plastic surgeon for their honest point of view regarding a novel noninvasive treatment.

The advent of these new treatments is highly popular to patients because in essence they require no downtime. The idea of reversing facial aging with the aid of ultrasound or radiofrequency is incredibly attractive. The thought of lifting and tightening the brow, chin and neck area can naturally spark a great deal of interest. Yet, one must not forget to do their homework.

Following research, one is encouraged to team up with their plastic surgeon in looking at the new technologies that have come along while judging them against what the industry already has. Quite frankly, the field of facial rejuvenation already has a significant arsenal of techniques and modalities to treat different patients in various areas.

As new technology comes forth, in tandem with being FDA approved, it’s important to note that it may not necessarily be better than what is currently being used. And this is where research comes in.

It’s the responsibility of a board certified plastic surgeon to be cautious with new technology and use it appropriately, only when there is sufficient data.

For example, statistical data for newer technology needs to be balanced with the reality of sound research versus what is being driven by the industry. At the end of the day, it’s the responsibility of a doctor to make a truly objective assessment.

The one thing a plastic surgeon does not want on their menu of services is to offer a patient a modality or technique that they do not have the greatest confidence in – even if it is being touted as the next “big” thing.

Conversely, many of these treatments are costly and may require more than one session to receive the full benefit. While these noninvasive treatments may offer a youthful change, one needs to address if they provide more than just a subtle transformation.

Also, some treatments may not be as benign as one thought. Once again, lean on a plastic surgeon for guidance as well as seeking a second opinion. Inquire about any side effects in terms of the underlying tissue.

Some plastic surgeons who perform facial surgery are noticing a variance in the tissue where some of this new technology has been utilized. While it won’t affect the outcome of a facial rejuvenation surgery, there may be changes to the tissue.

For those patients wanting more than an understated aesthetic enhancement, they may very well consider that investing in a limited operative facial rejuvenation procedure to be ideal. When calculating costs and final results, this would provide an immediate and a longstanding outcome.

Cosmetic treatments are a personal decision. When one is ready to embark on a particular modality, please peruse the research data, independent patient reviews and team up with a board certified plastic surgeon for guidance.


9Jun, 2015

Sun Safety Tips For Healthy Skin

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woman outdoor by pixomar

Summertime is almost here and the countdown for summer break is on the way. While the outdoors will certainly beckon many, always remember the first step in summertime fun is keeping skin sun safe.

As many have sunscreen on their shopping list, what’s even more important is knowing how and when to apply it for optimal protection. According to the Skin Cancer Foundation, it’s estimated that more than 3 million Americans are diagnosed with skin cancer so a quick sunscreen tutorial is vital.

While solar protection can help ward off cancer, it can also prevent premature skin damage such as:

  • Wrinkles and fine lines
  • Age spots
  • Broken blood vessels
  • Freckles
  • Solar elastosis (saggy skin, rough patches and grainy facade)

Here are some tips for healthier skin during the summer months:

Sunscreen: Purchase a water resistant sunscreen which has a broad spectrum of SPF 30 or more. Even if one doesn’t partake in water sports, sweating is still an issue so please toss a water resistant product in your shopping cart.

More Than Once A Day: Applying sunscreen is not just a once-a-day affair. It must be applied roughly 20 minutes before going outdoors. And once “fun in the sun” begins, it must be applied every couple of hours. Following a dip in the pool or ocean, it must be reapplied immediately.

Apply More Than Normal: Studies are suggesting that people are not applying enough sunscreen and being quite frugal. On average, one ounce of sunscreen provides good solar protection.

The Neglected Areas: While applying and reapplying don’t overlook areas such as the back of legs, tops of feet and hands, and receding hairlines.

Summertime Drives: It’s a myth thinking one is protected from the sun’s rays while in the car. While one is protected from UVB light, they will succumb to UVA light.

Remaining “sun safe” will encourage healthier and younger looking skin. Here’s to a fun, healthy and memorable summer season!

2Jun, 2015

Study Reveals The Benefits of Botox May Exceed Expectations

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Happy Attractive Woman and Man Couple In Sunglasses At Beach

Botox remains a staple in facial rejuvenation. As it hinders muscles to contract, any wrinkles which are treated around the eyes or forehead area are lessened considerably. Indeed, Botox has been one of the leading cosmetic injections over the years which enhance a youthful canvas which many seek.

At the University of Ottowa, Canada, plastic and reconstructive surgeon, Dr. James Bonaparte, conducted a study which revealed interesting data regarding Botox. In a recent edition of JAMA Facial Plastic Surgery, it was irrefutably suggested that this cosmetic injection may deliver another aesthetically pleasing pathway for many patients.

According to the study, skin endures stretching and receding with a Botox treatment. Moreover, it was indicated that on a whole, this anti-aging treatment encouraged collagen and elastin.

The road to younger looking skin is elastin and collagen. A depletion of these proteins cause slack and lackluster skin in tandem with wrinkles.

In his report Bonaparte cited, “We found if we treat people with Botox using standard techniques, we see an increase in elasticity, which is what you’d see in people with more youthful skin.” He continued, “We’re actually seeing evidence that we, for some reason, are getting more elastin and collagen in the skin.”

A total of 48 women, around the median age of 55 took part in the study. All of the participants never underwent a Botox treatment before. Areas treated were around the eye contours and in the middle of the brows.

Afterward, the women were monitored for a total of four months.

An enhanced appearance of elasticity and younger looking skin was discovered. Researchers compared the changes to a skin tightening procedure via radiofrequency.

Also disregarded during the course of the study was the concept of inflammation from the injections. According to Bonaparte, this did not cause the new tautness to the skin. Moreover, these youthful skin changes were bracketed around the same timeframe as the Botox effectiveness results: which was a few months.

It’s important to note that other plastic surgeons may have their own theories as to why elastin and collagen are promoted. Nevertheless, there is no clear cut theory as to what prompts Botox recipients to have their skin undergo a surge of youth

Bonaparte did indicate a hypothesis that elastin and collagen cells may have a receptor which reacts to Botox in this manner.

This notion has some wondering if anti-aging skin manufacturers may be inclined to produce a product(s) which hones in on these receptors.

And Bonaparte believes this is so.

“We may be able to develop some medications that don’t require injection, that you can apply topically and get the same skin rejuvenation effect as Botox,” he said.

While this study has come to a close, Bonaparte and his team will be branching off in a different direction but now with a focus on the long-term use of Botox.

27May, 2015

Plastic Surgery Popularity Worldwide

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women worldwide

Photo Credit: Women’s Health Magazine

While the USA leads in plastic surgery around the globe, when compared to other countries and matched up against their own population numbers, it rates at number four. It’s an interesting twist.

Before sharing who the top five countries are, it’s fascinating to note how plastic surgery is becoming so well accepted in the world. What was once a surgery for only the “rich and famous” has indeed transcended to others not in this category.

People who consider plastic surgery come from all backgrounds. For example, those who are working later in life are considering it so they can look more youthful in the corporate world.

While these top five countries are the most popular in plastic surgery, if one is considering surgery outside of their country, it’s important to do all the necessary research as one would embark on here in the states. Double checking that a surgeon is board certified, qualified, and has hospital privileges truly transcend to other countries.

Some patients are tying in a surgery with a vacation beforehand. However, always remember that safety is a priority and should always trump any other decisions.

Starting from the fifth ranking country and working upward, here are the countries which made the cut:


  1. Colombia

 It’s estimated that more than 90,000 plastic surgery procedures were performed in Colombia. The leading surgery performed is liposuction.


  1. USA

In 2014, the USA performed 10,663,607 cosmetic surgeries. Like Colombia, liposuction was the most popular. Other treatments in the country included nose surgery, eyelid surgery, and the cosmetic injection, Botox. From 2013-2014, it was estimated that Americans spent nearly $12 billion in this area of medicine.


  1. Italy

Botox has been incredibly widespread in Italy for non-operative procedures. For surgical procedures, liposuction once again was the most popular with an estimated 69,000 surgeries performed in 2010.


  1. Greece

For many, learning that Greece is rated second is quite a surprise. The most popular procedure in this country is breast augmentations.


  1. South Korea

Where beauty is held in high regard in South Korea, it’s estimated that 1 out of 5 individuals have undergone cosmetic surgery. While all procedures are in demand, the one that leads the way is upper and lower eyelid surgeries.

So many countries around the world have adopted cosmetic surgery into their culture. The trends have clearly branched from the Western culture into a variety of others. Plastic surgery is no longer the exception but becoming more common in everyday life.

25May, 2015

Tips To Find The Best Plastic Surgeon

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In San Diego County, it’s no surprise how there are an enormous amount of talented board certified plastic surgeons. With such an overwhelming number, how does one go about finding the best plastic surgeon?

The answer is that it truly takes some meticulous research in terms of locating one whose specialty is in the area of person’s surgical aesthetic goals.

A great area for people to begin their search is on regarded sites such as the American Society of Plastic Surgeons. On this website, researchers can double check that the doctor they are interested in is indeed board certified. They can also learn more about their educational background, their areas of specialty, and be given an opportunity to read any answers a doctor may have provided to people asking questions about an array of plastic surgery questions.

When a doctor is involved in answering a series of online medical questions, it provides potential patients a better perspective on how the doctor interacts with others. And if the doctor has answered questions based on someone’s surgery of interest, this is another great avenue to explore.

The American Society of Plastic Surgeons also has a review for its board certified plastic surgeons. This is another area worth perusing and learning more about a surgeon of interest and what past patients have said about him or her.

On this site which highlights a particular doctor, there is a direct link back to the board certified plastic surgeon’s personal website.

A doctor’s website is an extension of their office. It affords a person with more knowledge about the procedure, more detailed information about the surgeon, patient testimonials, and more importantly, before and after photo galleries.

These patient photo galleries are incredibly helpful since they offer patients a view of a doctor’s surgical skill and the ability to see if there is a patient’s “before photo” that mirrors their own aesthetic situation.

Pushing on, do visit other doctor referral sites such as Health Grades and other notable ones for more knowledge. Also, referrals from family members, friends and family doctors are other great avenues.

Once a year San Diego Magazine lists Top Doctors in all fields of medicine, including plastic surgery. The list is compiled by votes by a doctor’s peers and conducted by the San Diego County Medical Society.

If locating a doctor with this type of honor is important, then do search this annual special edition online.

Other “Top Doctor” votes outside of San Diego can include the Castle Connolly Top Doctor List.

It is the consultation appointment, however, which really is the time to discover whether or not one is comfortable with the San Diego plastic surgeon. This is a special occasion where one can freely discuss their aesthetic goals and wishes and get to know the surgeon better. This is an opportunity to truly “interview” the surgeon and to make certain all questions are answered.

Plastic surgery should never be done in haste. After a consultation, there’s no need to book a surgery appointment. Take the time needed for thoughtful consideration.

18May, 2015

May is Melanoma/Skin Cancer Detection and Prevention Month

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sunscreen 1

As we head into summer, May marks Melanoma/Skin Cancer Detection and Prevention Month. Skin cancer is considered the most common forms of cancer in our nation. The ultraviolet rays from the sun are the main cause. Healthcare professionals say that ultraviolet rays can also be found in tanning booths and sunlamps.

Skin cancer is the most common type of cancer in the United States. Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. UV radiation can also come from tanning booths or sunlamps.

The most serious form is called melanoma. But when detected and treated early, the outcome can be promising for patients.

The number of skin cancer cases is climbing each year. So, it’s extremely important to regularly check our skin from “head to toe.” By doing so, if any skin areas change, we’ll be alerted to get it checked with a healthcare provider.

Many people often wonder what malignant melanoma looks like.

Generally, it’s when an existing mole or new growth on your skin changes in size, color or even shape.

One of the best guidelines is following the “ABCD” skin cancer warning signs.

These easy-to-follow rules include:

A = Asymmetry: when the growth on the skin has unmatched halves

B= Border: blurred and not clearly defined edges

C= Color: a blotchy appearance with colors ranging from brown, black, tan, red, white or even blue

D= Diameter: a skin growth larger than 6 millimeters or concerning size increase

If any of the above rules are present, seeking the advice of a healthcare professional is highly advised. And remember, a regular self-skin check is never a substitute for it being done by a dermatologist or plastic surgeon.

Let’s raise awareness this month and keep one step ahead in our skin care health.


16May, 2015

Study Reveals Safest Procedures In Non-Operative Cosmetic Procedures

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woman-in-hat-300x191Not long ago, Northwestern University published their national study on what they discovered to be the safest cosmetic procedures. Based on over 20,000 procedures and treatments in the nation, researchers found that minimally invasive procedures were deemed the safest.

Doctors who participated in the study were all dermatologists, so it’s important to point out that this study did not involve operative procedures performed by board certified plastic surgeons. The research conducted was only regarding non-operative treatments.

Nonetheless, as with any study, it offered information and statistics.

The study was championed by Murad Alam, M.D., who practices medicine at Northwestern Memorial Hospital and is a professor of dermatology at Northwestern University Feinberg School of Medicine. The complete study was also published in JAMA Dermatology.

Science Daily was one of the first media outlets to report the news.

Its reporter, Marla Paul of Science Daily wrote, “Minimally invasive cosmetic procedures, including fillers, neurotoxins and laser and energy device procedures are exceedingly safe and have essentially no risk of serious adverse events….” She continued, “This is believed to be the first large, multi-center study that prospectively analyzed the rate of adverse events among tens of thousands of cosmetic procedures done at many centers around the United States by experienced dermatologists. These procedures are used to decrease the visible facial signs of aging.”

In the world of plastic surgery, a sample of this roster includes a neurotoxin such as Botox and fillers like Juvederm. Botox reduces the appearance of wrinkles by temporarily disengaging muscle contractions whereas Juvederm adds volume to plump up wrinkles and fine lines. Generally neurotoxins are used for the upper portion of the face where fillers are used on the lower portion.

The study did concur that a few patients, below one percent, experienced minimal bruising, swelling or reddening of the site treated.

Paul went on to report, “For many years, there was a perception that minimally invasive cosmetic procedures are safer than larger, more invasive cosmetic procedures. However, there was little evidence to back up this belief.”

In the study, Alam indicated, “The message for patients is that if you are thinking of getting one of these procedures, you are not indulging in something drastic or high risk.”

During a timeframe of 9 months, a total of 23 board certified dermatologists took part in the study with research data that included a total of 20,399 procedures. To keep track of treatments, the doctors were required to enter their patient data every single day.

The data included the following:

  • Type of treatment
  • Treatments performed per day
  • Indicating side-effects or complications
  • Describing the side-effects, if any

Following this, the data was collected by researchers by tallying the above information for calculations.

Paul reported, “While all the adverse rates were low, the rates for fillers at .52 percent were slightly higher than those for energy devices and neurotoxins. However, this is to be expected, the authors said because in the world of non-invasive and minimally invasive procedures, fillers are slightly more invasive than lasers and neurotoxins.”

During an era where individuals seek non-invasive treatments such as Botox and Juvederm, this study gave many patients, future patients, and healthcare professionals interesting insight.

Cosmetic injections, also referred to as a liquid facelift, remain a vital part to board certified plastic surgeons and their patients.