Botulism toxin, the protein used as the active ingredient in BOTOX is the most acutely toxic substance known to humankind. Just a microgram of botulinum toxin could be enough to kill a person, and four kilograms of the toxin, if evenly distributed, would be more than enough to kill everyone on planet Earth. Yet, we don’t think twice before paying good money to have it injected into our faces to reduce wrinkles.  Some even go as far as celebrating this poison at “Botox parties”.

Botulinum toxin, is an interesting substance.   The protein comes from the bacterium Clostridium botulinum. It causes the disease botulism, a potentially life threatening illness, that is marked by progressive paralysis of muscles including the ones we need to breath.  Yes, it is the same paralyzing properties of this toxin that are responsible for the thousands of frozen faces in Hollywood.

But Botulism toxin is not just used for wrinkle reduction. In fact, the poison has been used for decades treating many other conditions such as:
“Crossed eyes” or strabismus, a condition in which the eyes are not properly aligned with each other.
“Uncontrollable blinking” (blepharospasm).
Spasm of the lower esophageal sphincter[(achalasia)
Excessive sweating, “Hyperhidrosis” of the arm pits and palms.
And even migraines, although the evidence is conflicting in this indication.

Other “off label” uses of botulinum toxin type A that are widely known include treatment of:

Pediatric incontinence
To reduce the spasm of the vaginal muscles
Movement disorders associated with injury or disease of the central nervous system including trauma, stroke, multiple sclerosis, Parkinson’s disease, or cerebral palsy
TMJ pain disorders
Excessive salivation
Vocal cord dysfunction
And reduction of the Masseter muscle for decreasing the apparent size of the lower jaw (often done in women to feminize the face).

In 2002, the FDA announced regulatory approval of botulinum toxin type A (Botox Cosmetic) to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines). Botox generally lasts about four months, and the side effects are rather minimal.  Generally, a treatment of Botox will use just a fraction of one vial.  The good news is, to kill an adult human, one would probably need at least entire 30 vials injected at one setting.

This recent question that was presented to me came from came from Houston, Texas. Are you surprised? Houston is where silicone breast implants were concocted. There is an apparent predilection for Texans to be silicone savvy. The breast implant story is rather interesting. The developing team was led by Dr Thomas Cronin, and a resident, Thomas Biggs (a fitting name wouldn’t you say?). The bodacious idea popped up when a fellow colleague, Frank Gerow, walked to the hospital blood bank. During this era, the hospital had just stopped putting blood in bottles and started putting the blood products into plastic bags. While walking with a bag of blood, Gerow began massaging the item in his hand.  Wouldn’t you?   And then it dawned on him. “This feels like a breast”. Then, the rest is history. The silicone breast implant was developed. However, butt implants are slightly different.  Unfortunately, they don’t have the same massaging capacity as a silicone breast implant. While there was a time when silicone gel implants (like breast implants) were used, they had a notorious deflation and rupture rate.   And  although butt implants are still made of silicone, they are typically a solid composite. So bursting really isn’t an issue with your typical silicone butt implant. You’re more likely to injure your gluteus maximus muscle than a firm silicone butt implant with a good fall. And then there are the “wrong” ways to improve your buttock shape with silicone. There have been horror stories as recently as last year about unqualified people injecting silicone into the butt, and in some cases, leading to fatalities. This link tells such a tale of a woman putting junk in her trunk (link).
A more common way (and still burst free) of improving the shape and volume of a tush is through autologous fat grafting. This is where fat is removed through liposuction from the hips, and then injected directly into the buttock to restore projection. The results can be fantastic fanny and long lasting, and it obviates the need for a prosthetic implant (silicone).  Check out my blog  here on the science of the beautiful butt.

Recently on my radio show with Dr. Gordon, I received a very interesting question from a listener in Nome, Alaska.  It came from a woman who had a breast augmentation a few months ago.  She wanted to know if her breast implants could freeze in extremely cold weather.
The answer, is “yes”, with two conditions.  One, the implants must be saline. The second criteria, is that the person must freeze to death first.

Breast implants are composed of either saline or silicone. Saline refers to them
being salt water. Salt water has a freezing temperature lower than
pure water. The ocean can freeze at approximately –2 C or 28 or 29 degrees
Fahrenheit. Saline breast implants would act similarly, and because
the body is composed mainly of salt water, saline implants should heat
and cool similarly to the way your body heats and cools. Silicone breast implants act slightly different. I’m not aware of a freezing point for silicone.  Silicone implants tend to always

be at a temperature somewhere between body temperature and the
temperature of the surroundings, and their temperature will change
slower than the surface of your skin when your surroundings change.

While being in cold weather won’t freeze your saline or silicone breast implants, being in hot whether is a bit different.  For one, hot weather will not harm your breast implant weather it is saline or silicone. The heat of a sauna should not damage breast implants. Silicone melts at over 200°C (392°F), which should be nowhere near the temperature of even a Russian sauna (VODA Spa on Santa Monica, anyone?). However, most sauna manufacturers recommend that you check with your surgeon and the manufacturer of the implants before using a sauna.

But it IS possible that the breast implant can harm your skin in excessive heat. This is very, very rare. Hot tubs go up to about 106 degrees and are safe for your breast implants. Saunas can approach 200 degrees, perhaps even more, which again, is perfectly safe for your implant. However, the silicone implant can heat as well, particularly if you have little breast tissue, and this heat CAN be transmitted to the breast tissue which would then be heated
from inside AND outside. This COULD theoretically burn tissue, although I am personally unaware of any cases.

What is still rare but more likely is a burn from a heating pad placed on a chest with breast implants.  If you put a localized source of high heat directly on the breast, like a hot water bottle or heating pad, the implant will gradually warm up, and your
breast skin will then be getting heat from both outside and inside -
and you can burn the breast skin. Do not put heating pads on the
breast if you have breast implants.  And do not fall asleep nude in Nome, Alaska.

In Beverly Hills, where beauty and vanity are the rule, plastic surgery for many is not just a luxury, but a necessity. Even as the Dow dipped to multi-year lows in 2011, men and women in the City of Angels have continued to rise above and beyond the standard of beauty. The quest for perfect beauty is not dead in Hollywood, but for some, the idea has been forced to be put on hold. Virtually every economic sector has taken a blow in the last few years, and plastic surgery, even in a city where pretty is a priority,  has not been immune to the economic anemia. From Wall Street to Main Street, we witnessed cash combusted in a raging savings disco inferno in 2008, 2009, and 2010.  Is Ugly Street next?  No. Not even close. In fact, 1.6 cosmetic procedures were performed in 2011, a 2% increase over the previous year. Below are some details on the top five in 2011 compared to 2010:

• Breast augmentation- 307,000. A rise of 4%
• Rhinoplasty (nose job) – 244,000. A drop of 3%
• Liposuction (liposculpture) – 205,000. A rise of 1%
• Blepharoplasty (eyelid surgery) – 196,000. A reduction of 6%
• Rhytidectomy (facelift) – 119,00. A rise of 5%

Facelifts replaced tummy tuck (abdominoplasty) for fifth place in 2011.

Surprisingly, chin augmentations, also known as “chin implants”, rose 71% to approximately 21,000 procedures in 2011. And lip enhancement, also known as “lip augmentation” increased by 49% to 25,000 procedures carried out last year.

While it is true that many plastic surgeons are operating less frequently than from 2006, being beautiful is still within the budget for many men and women. And because beauty can be high maintenance, many men and women are turning to less expensive rejuvenation methods such as Botox®, and ‘fillers’ such as Juvederm and Restylane, as they weather the financial storm. Through the thunder and lightning, injectables, at least in the short term, can offer a more affordable appearance boost than most facial surgeries, such as facelift or facial fat grafting. But one must understand that injectables, although quick, safe, and effective, are often insufficient for optimal correction of many facial aging signs. In other words, some people are just ‘beyond injectables’.

Injectables, while fantastic, do have their limitations. In fact, one can easily end up spending an equal amount or more on frequent large volume injections, than on more permanent anti-aging maneuvers from surgery or facial fat grafting.
Prior to signing up for any injectable, one should discuss with your plastic surgeon your expectations, potential risks, potential side effects, expected product duration, and reasonable alternatives to the injectable, ranging from surgery to doing nothing at all. With a skilled plastic surgeon and the right plan, injectables can be a wonderful beauty adjunct.
Below is a list of some of the more commonly used injectables in alphabetical order with their active component.

• Artefill® ,Artecoll® (polymethylmethacrylate (PMMA) microspheres)
• Botox® (protein derived from Botulism toxin)
• CosmoDermTM and CosmoPlastTM (purified form of human collagen)
• ElevessTM (hyaluronic acid (HA))
• Evolence (porcine derived collagen)
• Fat (autologous, or ‘your own’ fat)
• Hyalaform® (hyaluronic acid (HA))
• JuvidermTM (hyaluronic acid. (HA))
• Perlane® (hyaluronic acid)
• Radiesse® (calcium hydraxylapetite)
• Restylane® (hyaluronic acid (HA))
• SculptraTM (poly-L-lactic acid)

For more information about injectables, the following website is filled, pun intended, with very helpful information: injectablesafety.org.

Beverly Hills breast augmentation specialist Dr. Tim Neavin is a Beverly Hills plastic surgeon Certified by the American Board of Plastic Surgery. Dr. Neavin has offices in Beverly Hills, Dubai, and Glendora.

Back in the caveman days, before supermarkets, silicone breast implants, condoms,  and the Wonder Bra, sociobiologists like Marvin Harris believed that men probably viewed big breasts as a marker for fertility. What does this mean? Well, consider that our ancestors struggled to meet their daily needs of food and shelter much more than we do now.  Clubbing deer over the  head is a bit more exerting than sitting in a Hybrid in a In-N-Out  drive-in (pardon the LA analogy).    Gestating a child without folate and prenatal vitamins, and then raising a child without modern luxuries such as running water, pasteurized milk, diapers, and formula  meant that physical fitness equaled potential success for offspring to live. Women who were well nourished had a clear reproductive advantage over women who  were not well nourished. Our cavemen weren’t equipped with body mass index measuring devices, but they WERE programmed to recognized markers for suitable women to carry out 9 months of pregnancy and nourish their child. One marker for ample caloric storage, and hence, a capacity to nourish their sperm to fetus, and fetus to child, and child to another cave man (or cave woman) was big breasts. Big breasts for hundreds of thousands of years were found almost exclusively in well nourished women.  Women starving, who would be unfit to fulfill 9 months of pregnancy and care for a newborn, were not only thin and frail, they were flat-chested.   Thus, from a Darwinian point of view, these women who possessed a baby-maker bulls eye on their chest were selected for sex. And voila, humans now are the only mammalian species to possess perennially large breasts!  With no other mammalian species do females have large breasts solely unless they pregnant.   Now I know what you’re saying.  If big breasts are a marker for fitness and fat storage for , shouldn’t obesity be a similar marker and possess a similar power of attraction.  Obese people have a lot of calories to share, too.   The difference is that  obesity is not healthy.  It  is maladaptive for our race.  Now, thin women can have big breasts with breast augmentation, but you must realize that our primordial brain has not caught up with this new way of thinking.  Not even in Beverly Hills, where bigger is always better.   The big, beautiful breast obsession still exists in heterosexual men, and it is live and well in Los Angeles, California.

Today in my Beverly Hills Office I saw a 30 year old woman who wanted a fresher look. Many men and women will tell you that they just are starting to look older, but it is difficult to pinpoint the area(s). Well, good news. Skilled plastic surgeons can tell you, and turn a general request into very specific treatments. For one, I always evaluate the skin. With age, pigment changes begin. That is, the skin gets irregularities in color. Sometimes a mild bleaching agent will improve this. These agents are generally much less expensive than lasers. Next, is the skin texture. With age, large pores and fine wrinkles develop. This is where something like Retin-A and Botox help. Lasers may work also, but often these two products alone do wonders and can save patients hundreds of dollars and multiple trips to the office. The next thing I look at is shadows generated by descent of tissue and volume loss from the bottom of the face up. Areas that make someone look old in the lower third of the face are the shadows below the corner of the mouth, the area just in front of the early jowl, and the upper and lower lips which lose its curl and volume. These areas are easily filled in the office with Juvederm or Restylane. The upper lip also elongates with age to hide the upper teeth with parting of the mouth at rest. This looks old. An easy fix to this is a lip lift which can be done in the office. Lip augmentation is often necessary to restore young lips.  Poutiness can be restored to the lips by injected simply the middle third of the lip – extending injections toward the corner of the mouth impart a trout-pout fake look. We’ve all seen it. Middle third of the face aging is marked by deepening of the laugh lines, also called nasolabial folds. An easy quick way to soften the middle third of the face is Juvederm or Restylane injections into this region. Moving upward, the areas below the eyes tend to follow out with age giving a tired appearance to the face. Juvederm or Restylane into this region freshens the face, and tends to look very, very natural. Lastly, with age, is the generation of an upside down heart-shaped face- bottom heavy, if you will. Thus, I like to inject high on the cheek bone just a pinch to build out the arch of the cheek bone. It is subtle, but significant, and imparts a mild shadow below the cheek bone that looks very attractive.  Ultimately, at some point, the amount of Juvederm needed to optimize correction of shadows and add volume become unrealistically expensive and impractical.  This is where fat grafting has a role.  Fat can be taken from an unwanted area such as the hips and flanks, and injected into the deepest shadows of the face such as the temples, the orbital hollows, under the eyes, lips, jaw line, and cheek bone.  I often inject up to 50 cc in a face, which is the equivalent of over 60 Juvederm syringes.  The results of fat grafting are dramatic and very natural looking.  It is one of my favorite operations.  For a recent fat grafting before and after, click on this fat grafting link.

In my Beverly Hills, Glendora, and even now in the Dubai offices, I do quite a bit lip augmentation with Juvederm. I would state that half of the patients I am seeing now never had lip augmentations. As such, this blog is devoted to the lip augmentation newbies.

Some of the most common questions are how long will it last and will it hurt?  I’ll address those questions in a bit.  Let me entice you first.   I like to use Juvederm Ultra or Juvederm Ultra Plus. These are both hyaluronic acid fillers similar to Restylane. The Ultra Plus has lidocaine in the syringe. Thus there may be added comfort to using this product, but it costs a bit more. Generally, Juvederm in the lips last approximately six months. However,  some people note that the fullness is retained longer. I am not sure if this is related to prolonged Juvederm life or just a remodeling of the tissues from the injection.

“Is this going to hurt?”.   Well, a little. There are ways to alleviate the discomfort of these injections. Some of them include nerve blocks similar to the one that you get from a dentist. These are done prior to injecting the lips which are much more sensitive than the cheek and the mandible where the nerve blocks are performed. Two is topical cream. This could be applied to the lips. This probably has a minimal relief with topical application of lidocaine cream. Some people use ice to numb the lips. I often use a combination of all of these. Very rarely I have a patient who wants nothing at all and just wants the injection. This is rather courageous and is very atypical.

Then next common question is,  “How much Juvederm do I need?”. Well, that depends on what kind of augmentation you desire. As a rule, the smaller the lips, the less volume is needed to make them noticeably larger. Very large lips need larger amounts of products to make a noticeable difference. A common request is patients asking to simply fill their upper lips in order to either save money or because they do not see the benefit of adding volume to the lower lip. This is a big no-no. I have never injected just an upper lip. The consequence of simply injecting the upper lip and ignoring the lower lip is creating a very fake looking lip augmentation. It is important to know that the bottom lip should be 1.5 times the size of the upper lip. But it is not just the volume; it is the shape and curvature of the vermillion border. This is the area between the skin and the lip. When you inject a lip along the border like we do with Juvederm, we curl it. To curl an upper lip and not a lower lip makes the lips look obviously augmented. In addition, there are certain aesthetic units of the lip which should be injected and certain areas of the lip that should not be injected. Violation of these aesthetic lip units (like the mid-line of the lower lip) can create an unnatural appearance. In addition, the injection should not extend beyond the middle third of the upper lip. As the injection moves towards the corners of the mouth, a trout pout develop. This is another big no-no. I generally explain all of this to the patient before we conduct a lip augmentation.

2012 is here. This blog is devoted to prediction regarding upcoming trends for the New Year in Beverly Hills plastic surgery. Indeed, even the economic crunch has made its impact in Los Angeles.  Virtually every honest Beverly Hills plastic surgeon (yes, there are plenty) will tell you that their volume is down from 2007.    In 2012, for one, I think we will start seeing an improving economy.  Perhaps banks will be less stringent upon loaning money, and people will have more money to spend on plastic surgery procedures such as breast augmentation, tummy tuck, face lift, rhinoplasty, and fat grafting, etc.

Beverly Hills plastic surgeon Dr. Tim Neavin looks forward to a great year, predicting that the growing trend of injectables will continue, and banks will get looser in lending money, etc. There was a time when clients would take a home equity loan out to finance their new body. Now, getting second loans have been very, very tough. Carecredit is a rather helpful company that provides financing to plastic surgery patients at a reasonable rate.

The lousy economy from 2008-2011 has been an important lesson for Beverly Hills plastic surgery.   Patients have moved towards using a lot of the injectables such as Botox, Restylane, Radiesse,  and Juvederm. We have learned that these products not only work well, but when you use them regularly on patients, it is rather easy to maintain beauty.  And products like these alone can make men and women happy.    After all, beauty IS maintenance.   Injectables like Botox every four months and Juvederm every 6 months is something that many men and women just accept, now.   And so it is likely that this of more injectables and less surgery for the face will continue because patients have found out how magnificent these products actually work in rejuvenating the face. And when used properly, the results of Juvederm and fat grafting are incredibly natural looking.

As far as our office is concerned, we will be structuring new financing programs for patients for breast augmentation, tummy tucks, face lift, rhinoplasy, and various plastic surgery procedures. Please inquire with the office for details; however, they have been formulated so that the pricing is very fair and competitive.

Another Beverly Hills plastic surgery trend I think you will see in 2012 is the gaining interest in plastic surgery and Botox and Juvederm for male patients. Most common procedures for male patients in my practice include Botox, Juvederm, rhinoplasty, liposuction, and facial fat grafting.  These trends will continue, I’m certain. Anyway, those are the Beverly Hills plastic surgery predictions in 2012. We look forward to seeing you in the office!  Happy New Year!

You may be aware of the Beverly Hills breast augmentation that saved a woman in a dentist’s office from a bullet.   She was shot in the chest, and the silicone breast implant took the blow.   If you forgot this story, you can find it here.  But here’s another tale of the breast implant bizarre:

Breast implants come in many shapes and sizes. Breast implants can be big, small, high profile, and moderate profile just to name a few examples. Breast implants may also be made of silicone or saline. The risks and benefits of breast augmentation and breast implants are well known. The upside to breast augmentation is that a plastic surgeon can turn your droopy or flat breasts into a perky C cup (or A or B, to each their own). The downside of breast augmentation is mainly the cost of surgery, and the infrequent risk of complications. Thankfully, life threatening complications from breast augmentation are exceptionally, exceptionally rare. However, there is an apparent advantage to large silicone breast implants that you may have not known about.  And I’m betting you never tried to rationalize dropping several thousand dollars for this one.  Ready?   Did you know that they can save your life?  Well, I wouldn’t sell this benefit by any stretch of the imagination, but it makes for good news.  On  7, 2012, a Russian newspaper Pravda reported that a  woman from Moscow was stabbed with a knife by her  husband, but her life was spared when the knife struck her silicone breast implant, absorbing most of the impact!  Ironically, the woman’s husband asked his wife to enlarge her breasts five years ago.   Just as interesting, the implant didn’t even leak, and the implant (and breast) retained its normal shape.  While I’m not sure that the moral of the story is that big silicone breast implants save lives, or if a Beverly Hills breast augmentation (or a Moscow, St. Petersburg, or any city breast augmentation)  can save your life, or perhaps there is no moral of this most bizarre breast tale.