Bolitho MD

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

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21Dec, 2016

Plastic surgeons recommend cessation of e-cigs prior to surgery

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Plastic surgeons recommend cessation of e-cigs prior to surgery

In a recent December publication of United Press International, Health Day News reported how two plastic surgeons stated in the Plastic and Reconstructive Surgery December issue how stopping the use of e-cigarettes prior to surgery was highly advised. The doctors highlighted in the piece included Dr. Alan Matarasso of Albert Einstein College of Medicine and Dr. Peter Taub of Mount Sinai Medical Center.

According to Health Day News, the doctors stated, “Based on our current best knowledge, it seems reasonable to advise plastic surgery candidates to cease e-cigarette use,” they said. The doctors continued, “Refraining from [e-cigarette] use four weeks before surgery is a prudent course of action, despite the fact that it has yet to be determined if the effects are similar to traditional cigarettes.”

While the health impacts of “nicotine vapor” continue to be researched, it appears the reason for this medical recommendation underscores patient care. The doctors referred to a study which revealed how stopping traditional smoking three to four weeks prior to a procedure could significantly decrease the risk of postoperative complications.

Blood flow and blood supply is essential following plastic surgery procedures, such as breast surgeries and abdominoplasties. Tissue healing following surgery requires this blood flow.

Erring on the side of caution, it’s believed that e-cigarette users should follow the same protocol as those who use traditional tobacco products. The reason behind this cautionary advice stems from the fact that the side effect of nicotine is best described as a vasoconstrictor.

According to the American College of Surgeons, traditional cigarette smoking does increase complications both during and following surgery. It’s their estimation that following the “no smoking rule” a few weeks prior and after surgery lessens the risk of wound healing by nearly half.

Many plastic surgeons also encompass the cessation of nicotine patches and gum in this medical protocol.

In addition to nicotine, carbon monoxide is also another concern.

While carbon monoxide withdraws oxygen away from the tissue area, as mentioned earlier, nicotine constricts blood vessels which deliver oxygen and nutrients to tissues. Again, this blood flow is vital to the healing process.

If the percentages in oxygen and nutrients drop during the recovery process, there is a risk factor following surgery in areas such as infection, increased chance of scarring, and additional complications.

While some plastic surgeons follow a smoking cessation of four weeks prior and after surgery, others have a more conservative approach of six weeks. A large gap of time is highly recommended and encouraged.

During a patient’s consultation with their plastic surgeon, it’s imperative to be candid regarding any smoking history. And this includes vaping. A surgeon’s top priority is the care of his/her patients and making certain, as a doctor-patient team moving forward, all can be done for an outstanding surgical outcome.

29Apr, 2016

When to begin exercising after breast augmentation surgery

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When to begin exercising after breast augmentation surgery

Plastic surgery is an exciting time to embark in one’s personal aesthetic goals. However, like with any surgery, the decision to undergo such a procedure takes much thought and consideration.

And that includes deciding to move forward with breast augmentation surgery.

Today is an era where a healthy diet and exercise are prominent in the culture. With that said, many women who have breast augmentation would like to know when they can resume their physical activity.

During a consultation with a board certified plastic surgeon, both the surgery and consultation phase will be reviewed. While this will be discussed, it’s important for patients to be empowered with knowledge including the realistic expectations of their recovery.

Spring boarding into a fitness routine needs a doctor’s approval, and one must not hurry back to resume those activities. And this is why.

The most important part of the healing process is to give one time to heal. And as a patient begins to become more active, they must avoid exercises or movements which could make them vulnerable in hindering recovery.

A routine method for breast augmentation is to place the breast implants under the pectoralis major muscle. While every plastic surgeon has their preference, those who opt for submuscular placement do so because the likelihood of a rippling effect from the implant is less likely to occur. Additionally, some surgeons also believe that implants placed under the muscle may also decrease the chances of capsular contracture.

Respectively, every plastic surgeon has their theory.

For patients who have undergone a submuscular breast implant placement, the healing portion of the surgery requires the pectoral muscle. Many doctors agree that the pectoral muscles should not be stressed for roughly a four-week period.

Activities to avoid include the following:

  • Avoid lifting anything that is more than 10 pounds
  • No upper body resistance training
  • Swimming moves that promote arm and chest strain
  • Avoiding sports such as tennis
  • Avoiding stretches for the chest area
  • Not attempting open chest positions in Yoga such as the Camel and Fish poses

And more….

In other words, it is advisable to avoid any workouts involving the upper body, including the arms and chest.

For exercise enthusiasts, they can most certainly resume a different level of activity such as walking, stationary bicycle, lunges, and any type of exercise equipment focusing on the lower half of the body.

And for those with small children, mothers need to confirm with their doctors as to when it is safe to lift them. For those with younger children, it may be advisable to have some assistance while one heals as well as with some help with any household chores which may impact the pectoral muscles.

Do remember that following a doctor’s guidelines on when to start incorporating exercises and certain activities is incredibly important in order to achieve optimal healing.

17Mar, 2016

Breast Revisionary Surgery Transforms and Corrects

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Breast Revisionary Surgery Transforms and Corrects

Breast surgery is a personal decision which should be made mindfully and thoughtfully. While moving forward with the best of intentions, sometimes a patient’s surgical outcome is not to her satisfaction. Be it a breast reduction, breast augmentation, or breast lift with augmentation, a situation may arise which triggers a patient to consider a revision.

There is an array of issues which may occur following the primary operation.

“There is one issue that we call symmastia in where the skin in between the breasts actually lifts off the sternum and can be challenging to correct,” said patient concierge Karen Martindale, who works alongside renowned plastic surgeon Dr. D. Glynn Bolitho. “And another issue a patient may experience is capsular contracture.”

Other matters patients experience may include symmetry challenges, downsizing or replacing breast implants, and more. Martindale explained that some patients after their childbearing years may have had implants to improve volume without a lift. Patients who want a revision in this case are generally not content with the descension.

Martindale explained that when a woman comes in for a consultation, it is most optimal if they have on hand their previous operative notes and what type of implants they currently have so the doctor can review the material.

“Following this, Dr. Bolitho will perform an examination and will be able to show patients a before-and-after gallery of those who underwent the same type of procedures with outstanding results.”

Martindale attributes Dr. Bolitho’s expertise from years of experience in performing breast reconstruction surgeries for women who had lost one or both breasts to cancer.

And each person is different in terms of how long they will wait until they seek a revision. In addition, they may undergo more than one revision.

“Some patients will travel long distances to find the right surgeon to help them with their issue. We’ve had patients in our practice who find Dr. Bolitho after undergoing several revisions,” she said.

According to Martindale, Dr. Bolitho has helped women achieve the aesthetic symmetry they desired, avoid another capsular contracture, and reverse a host of other issues.

“Many women we see in consultations are so close to taking out their implants completely due to the frustration levels,” she said. “I personally have a friend who had eight procedures before she came here to see Dr. Bolitho.”

Martindale shared how her friend was told by one surgeon that she had to have her implants removed because she was prone to capsular contracture. She would encapsulate weeks after surgery, and her implants would be hard again.

And then she went to Dr. Bolitho for a revision.

“My friend is so happy and there has been no evidence of a repeat capsular contracture,” she said.

Martindale’s friend is one of many patients who has sought Dr. Bolitho for help. Breast revisionary surgery can truly transform a woman’s desired aesthetics.

7Mar, 2016

ASPS Unveils Data

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ASPS Unveils Data

The American Society of Plastic Surgeons (ASPS) is an authority when it comes to collecting information from its elite circle of plastic surgeons so it can generate statistical data. Every year both medical professionals and laypeople are quite interested in the results for their own personal reasons.

For plastic surgeons, they can gauge trends as well as the changes in their own practice. And for non-medical individuals, they have the opportunity to see what is deemed “popular and trendy” in the world of plastic surgery.

According to the press release issued by ASPS, procedures have switched gears in relation to cosmetic procedures since the start of the millennium. And these procedures fall into the categories of operative and other treatments described as minimally-invasive.

The survey revealed a robust total of 15.9 million procedures in both categories. From the data collected in 2015, there was a 2 percent procedure spike in the United States.

In the press release, ASPS president David H. Song, MD, MBA, FACS provided his viewpoint.

“While more traditional facial procedures and breast augmentations are still among the most popular, we’re seeing much more diversity in the areas of the body patients are choosing to address,” he said. Dr. Song added, “Patients have more options than ever, and working closely with their surgeon, they’re able to focus on specific target areas of the body to achieve the look they desire.”

While the press release was indeed filled with statistics, on the other hand, it provided an educational outlet. Interestingly the organization pointed out how in the past “plastic surgery” used to be tantamount facelift procedures. Yes, while facial rejuvenation is still a sought after procedure among certain demographics, other aesthetic procedures have made their own significant mark included the following:

  • Brachioplasty (arm lift)
  • Mastopexy (breast lift)
  • Gluteal Augmentation (buttock lift)
  • Lower Body Lift

According to ASPS, they compared patient stats from 2000. The numbers of arm lifts increased 4,959 percent with 17,099 procedures performed in 2015. Breast lifts increased 89 percent with 99,614 procedures performed in 2015, buttock lifts increased 252 percent with 4,767 procedures performed in 2015, and lower body lifts increased 3,973 percent with 8,431 procedures performed in 2015.

In 2015, the top surgical procedures in the lead were breast augmentation, liposuction, rhinoplasty, eyelid surgery and tummy tucks.

In the minimally-invasive category, it’s not surprising to discover that Botox was at the top of the list with 6.7 million treatments performed in 2015. The other procedures that followed were fillers, chemical peels, laser hair removal, and microdermabrasion.

Dr. Song made another critical statement regarding minimally-invasive procedures.

“The number of available providers, lower costs and the less-invasive nature of these procedures obviously appeal to a much broader range of patients,” said Dr. Song. “However, we urge anyone who is considering a minimally-invasive procedure to consult with a board-certified, ASPS-member surgeon.”

While these procedures are not deemed surgical, they are still considered medical procedures and should be carried out in a medical setting.

Like all ASPS members, Dr. Song encouraged patients to seek only the most “qualified and highly trained” medical professionals for these procedures. And of course, this holds true for all plastic surgeries.

As many begin to digest the newest data from ASPS, it will be interesting to see what 2016 brings.

18Apr, 2015

A Quick Guide Into Breast Implants

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Doctor With Rx Prescription

While breast augmentation surgeries continue to be a sought after procedure for women of varying ages, it is important to glean a better understanding regarding breast implants. The size of the implants will invariably influence how a woman appears as well as what their daily lifestyle is, including sports and activities.

First and foremost, it is highly important that a woman does her due diligence in terms of researching the right plastic surgeon. They must be board certified in plastic surgery and specialize in surgeries of the breast.

As mentioned earlier, women seek this surgery at different ages and timeframes of their lives. For example, a woman in her twenties may want to increase the volume in her breasts, while others who have had children and breastfed, decide to have a breast lift and augmentation with implants.

It’s important to note here that a breast lift may not always need an implant. This decision is made between the doctor and their patient.

Despite the original aesthetic goals, this surgery will increase breast volume and projection. The goal for a plastic surgeon is to make certain that the augmentation improves a woman’s silhouette; in other words, balance her proportionately.

Breast implants are measured by cubic centimeters. The larger the implants, the greater the cubic centimeter numbers. Implants are filled with either silicone or saline, and its shell is almost always made of silicone.

So how many cubic centimeters does it take to go up a bra size? This popular question is answered with 150 to 200 cubic centimeters. When looking at breast implants, it’s difficult for a patient to determine by mere sight alone what size would be best. However, when she explains during a consultation she would like to increase her cup size by one or two, this can help a surgeon hone in on her aesthetic wishes.

Nevertheless, before deciding on what cubic centimeters is best, a doctor and patient must be mindful of the following:

  • The implants match breast width
  • Implant size matches a woman’s lifestyle in terms of exercising and sports
  • The implants are proportionate with a woman’s frame and do not make her heavier in size

For some women, their reaction into getting an augmentation is to have larger, fuller breasts. But the best plastic surgeon will explain any risks which may be involved in going “too large.” A handful of these risks may include:

  • Atrophy caused by the weight of the implants
  • Muscles and tissues start to thin out
  • Stretch marks caused by the implant weight
  • Large implants may cause rippling appearance
  • Bottoming out from the implant weight

And more…

There are instances where a woman decided to undergo a drastic augmentation with very large implants, and within a year, decided to replace them with a lower cubic centimeter number. If a patient waits too long to replace them and the skin is stretched, a breast lift may need to be implemented with the new augmentation procedure.

Plastic surgery is a personal decision, especially that of a breast augmentation. Much thought and consideration needs to be made and working with a skilled plastic surgeon is essential during the process.

 

21Mar, 2015

The History of Breast Augmentation

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Sunset 

Think that the first breast augmentation surgery was in the 1980s? Try earlier, and flip a couple numbers to read the 1890s. While breast augmentation is one of the most highly performed cosmetic surgeries both nationally and internationally, doctors have been testing ways to enhance volume for decades.

And, yes, it has come a long way.

Back in the 1890s, paraffin was injected into the bust for enhancement, but this treatment stopped rather quickly after it was discovered that the ingredient was seeping into other areas of the body.

Years later, more specifically in the 1920s and 1930s, doctors tried an “early version” of a fat transfer. They actually extracted fat from parts of the patient’s body and injected it into the breasts. This treatment didn’t have a very long shelf life.

In the 1950s, the introduction of the insertion of sponges, cartilage, polyurethane and even glass balls were utilized to examine what method was best. Out of all of these, the sponges worked well, but the results were not long lasting. The sponges would shrink and become stiff after a period of time.

In 1962, a shift in breast augmentation occurred. Timmie Jean Lindsey, hailing from Houston, Texas, agreed to undergo the surgery using silicone implants. What she originally went into surgery for was to remove tattoos on her breasts and what she got in return was an enhancement from a B to C cup and a gratis otoplasty which she wanted for aesthetic improvement.

In the operating room were Drs. Frank Gerow and Thomas Cronin performing this historical surgery.

Little did anyone know that this two hour procedure would change the way breast augmentation would be done in the future.

For Cronin, the concept really became a reality when he gave his presentation at the 1963 International Society of Plastic Surgeons convention in Washington DC. Those in attendance thought it was remarkable.

And as many say, the rest is history.

Known as medical devices, breast implants have solid silicone shell. Inside them, doctors and patients have a choice whether they prefer a silicone or saline filled implant. Each kind is approved by the FDA.

And since the 1960s, these implants have improved and changed dramatically including these following nuances and features:

  • The shell texture of an implant
  • The projection and profile of an implant
  • The anatomic shape of an implant
  • Diameter of an implant

 

It’s also important to note that while the U.S. Food and Drug Administration conclude that the silicone-gel implants to be “generally safe,” it is advisable that patients who undergo an enhancement using these medical devices communicate with their surgeons on a frequent basis. Routine postoperative appointments are part of this protocol, and sometimes an MRI may be recommended every few years.

When a woman decides to undergo a surgery such as this, it should never be done in haste. It’s always recommended to have a thorough consultation with a board certified plastic surgeon, discuss the benefits of the procedure, choose the right size of an implant which is proportionate to the body, and touch upon any risks factors.

 

3Jun, 2013

The Dr. Bolitho Team Garners Positive Feedback

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Dr. Bolitho
Dr. Bolitho frequently hears kind patient feedback when it comes to his front and back office staff.

When he chose his team, Dr. Bolitho shared, a great deal of it had to do with instinct coupled with their training.

“I always like to think that someone can be trained up to a level of clinical proficiency provided that they have the empathic nature to do a job,” Bolitho said. He added, “I would rather have that type of team member, than someone let’s say, who is highly trained but lacks that type of character who cannot relate well to patients.”

For Dr. Bolitho, it has always been more important to him to bring a team member onboard who conveyed special human characteristics when interacting with patients.

While Dr. Bolitho is well known for an array of different cosmetic surgical procedures, he also performs many breast reconstruction surgeries for women who have lost a breast either from a mastectomy or other condition. So having a compassionate medical team at his practice was imperative.

For Dr. Bolitho’s office, every day is a new day to treat their patients with the genuine medical care they deserve.

To reach Dr. Bolitho’s office, please call (866) 738-9360 or e-mail them at info@bolithomd.com.