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.

26May, 2016

Considerations for revisionary breast surgery

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Considerations for revisionary breast surgery

Through many years of practice, revisionary breast surgery has evolved into a specialty.  Those who have undergone a breast enhancement procedure will sometimes want–or sometimes need–a revision surgery. Implants may be used in procedures such as a breast augmentation, breast lift, or breast reduction.

It’s important to note that not all patients who undergo a lift or reduction may require an implant – it’s a personal choice that can be discussed at a consultation with a board certified plastic surgeon.

While some patients may be displeased with the aesthetic outcome of their initial procedure, there may be other factors which lead them to seek a revision. These reasons, both personal and medical, may include the following:

  • Symmastia
  • Capsular contracture
  • Implant rupture
  • Bottoming out
  • Symmetry issues
  • Implant disappointment
  • Downsizing implants
  • Replacing implants

 

In some instances, women who are finished having their families may have chosen to have implants placed without undergoing a breast lift. While some patients are content with the results, others may be dissatisfied with the position and want to improve their appearance with a revision.

For mothers who had an enhancement prior to bearing children, undergoing a second augmentation after building their families is also another aesthetic scenario. The effects of bearing children, such as weight gain and breastfeeding, may alter the appearance of woman’s bust line. In some instances, a lift may be recommended to address skin redundancy

Another motive may be when a woman decides that the upper silhouette she wanted to achieve many years ago through implants is not a current aesthetic goal at this point in her life. In these instances, she may decide to downsize.

As one can imagine, revisionary breast surgeries are performed for a variety of reasons.

When electing to undergo a revision for aesthetic purposes, it’s generally advised to wait four to six months following the initial surgery to ensure all healing is complete–this includes any residual swelling. If a patient decides that she does not want to return to her original surgeon for a revision, it’s highly advised that she seeks a board certified plastic surgeon that specializes in breast revision surgery. Surgeons at this level have mastered their craft.

During a consultation with a new cosmetic surgeon, be candid with the doctor when it comes to the reason, or reasons, behind the revision. At this first appointment, clear communication is necessary. It’s important that the surgeon doing the revision surgery and the patient have an excellent rapport.

Following an exam, the doctor will convey their thoughts regarding a revision. The details of the surgery, the recovery process, and realistic expectations will also be discussed.

Before or during the consultation, make it a priority to review their patient gallery photos of women who have undergone a breast revision surgery. If possible, ask the doctor if they have any “before or after” images of patients who were in a similar circumstance(s). This will provide an excellent gauge as to whether or not the surgeon’s talents are aligned with a patient’s goals.

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.

13Feb, 2015

Recovery Time for a Mommy Makeover Varies

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Mother and two kids silhouettes on beach at sunset

When a woman completes her family and has given birth to her last child, she may begin to think of a rejuvenation surgery for her body. For many females, undergoing pregnancy can take a bodily toll on her abdomen and breasts.

While the numbers may drop on the scale, the excess skin generally remains and cannot return to its natural position. It’s all part of pregnancy.

The great news is that a rejuvenation procedure called a mommy makeover can help restore a woman’s body back to her pre-pregnancy days. While the procedure undoubtedly provides wonderful results including a flatter abdomen, a slimmer waistline, and more youthful looking breasts, the recovery time is indeed something to be mindful about.

Some women try comparing the recovery time of a mommy makeover to a C-section, but this isn’t quite accurate in terms of a tummy tuck, also known as an abdominoplasty.

While each woman recovers at a different rate, at the end of the day, what dictates the recovery time is what type of tummy tuck a surgeon has chosen for their patient.

A breast lift, with or without an implant, will cause some discomfort, but the abdominoplasty along with muscle plication is really the determining factor.

Liposuction is generally utilized during a tummy tuck as it truly sculpts the abdomen, hips and waist. The three types of procedures to choose from are the following:

  • Liposuction only: For patients with limited excess skin and small amounts of fat deposits
  • Mini-abdominoplasty: For patients who require below the belly button abdominal improvements
  • Full abdominoplasty: For patients who require both below and above the belly button abdominal improvements

As mentioned before, the more muscle plication involved, the longer the recovery.

The good news, however, is over the last few years the advent of longer acting anesthetics lasting up to four to five days has modernized healing.

San Diego board certified surgeons are discovering that by utilizing this along with spinal anesthesia during the time of general anesthesia, is providing patients different modalities to enhance their recovery.

In turn, patients are in less discomfort after surgery.

The revolutionary idea that pain management starts in the operating room has broken the proverbial glass ceiling and is making huge strides in the world of not only cosmetic surgery, but all operations.

Some surgeons are calling this movement preempted pain relief so that prior to even starting the surgery, local anesthetic is injected into the surgical field. This very well has proved to minimize a patient’s anesthetic requirements so they awaken more clearly while blocking the pain for a longer period of time.

Patients following this surgical protocol, including mommy makeovers, do much better.

In terms of recovery, while patients may be walking the day of surgery or on the very next day, total recovery takes about four weeks. And if a woman’s profession is not physically laborious, she can return to work sooner.

For the first few days following surgery, assistance will be needed especially if a patient has younger children. In advance, she will need to designate a caregiver, be it a family member or friend. It’s also recommended to have a nurse stay with her the first night or two following surgery to monitor her progress.

Plastic surgery takes patience because it is a journey with amazing results. And mommy makeovers afford ladies a lovely transformation.