tag:blogger.com,1999:blog-32890153639947055712012-02-16T18:19:05.281-08:00The Brian Dickinson M.D. Plastic &amp; Reconstructive Surgery Blog is an online professional journal with reflections, comments, experiences, opinions, articles, inspirational quotations, and patient testimonials. Brian P. Dickinson M.D. Inc.Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comBlogger641100tag:blogger.com,1999:blog-3289015363994705571.post-9518835620601469062010-06-08T22:00:00.000-07:002010-06-08T22:05:01.838-07:00<a href="http://2.bp.blogspot.com/_254hvtdnRaE/TA8gLkauVQI/AAAAAAAAAkM/W8IaILvmMUc/s1600/Facelift+Before+%26+After.png"><img id="BLOGGER_PHOTO_ID_5480634654659597570" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 314px; CURSOR: hand; HEIGHT: 218px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/TA8gLkauVQI/AAAAAAAAAkM/W8IaILvmMUc/s400/Facelift+Before+%26+After.png" border="0" /></a>The deep plane facelift is a technique that can be used in conjunction with an upper and lower blepharoplasty as well as a coronal brow lift.<br /><br />While the deep plane facelift affords excellent correction of the nasolabial folds, jowls, and neck, I have found that the aperture of the upper eyelids can yield a significant positive impact on the aesthetic result on the overall youthful appearance of the face.<br /><br />It is very common for women as they age to have an accumulation of skin on their upper eyelids. This accumulation of skin has been given the medical term, dermatochalasis. Often this accumulation can be asymmetric-meaning greater on one side versus the other and can create differences in the aperture of the eye. It is important when correcting this asymmetry to note the location of the tarsal fold or eyelid crease.<br /><br />As you can see in the above photograph the patient's right eye has significantly more skin pre-operatively than the left eye. Careful notation of these asymmetries is important so that post-operatively the eyes can have equal apertures and yield an optimal aesthetic result.<br /><br /><div align="center"><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-951883562060146906?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-77106955689589859642010-04-23T15:54:00.001-07:002010-04-23T17:22:44.210-07:00<a href="http://4.bp.blogspot.com/_254hvtdnRaE/S9I5ZbMiP1I/AAAAAAAAAgU/InD-3cOzF-0/s1600/Vascularblog.png"><img id="BLOGGER_PHOTO_ID_5463492406913679186" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 140px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S9I5ZbMiP1I/AAAAAAAAAgU/InD-3cOzF-0/s400/Vascularblog.png" border="0" /></a>One very important aspect of Plastic &amp; Reconstructive Surgery is the management of complex wounds of the lower extremity. It is of paramount importance for the Plastic &amp; Reconstructive Surgeon to work in close collaboration with Vascular Surgeons in the management of these complex wounds. <div><div><br /><div>I have found that in addition to Vascular Surgeons, close collaboration with other medical specialist such as Orthopedic Surgeons, Infectious Disease Doctors, Internal Medicine, and Renal Physicians is important to optimizing patient outcome.</div><div> </div><div>Brian P. Dickinson, M.D.</div><div><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a></div><div> </div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-7710695568958985964?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-83527326078027881212010-03-23T15:21:00.000-07:002010-03-24T16:00:37.802-07:00<img id="BLOGGER_PHOTO_ID_5451958064010560914" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 314px; CURSOR: hand; HEIGHT: 218px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S6k--TetBZI/AAAAAAAAAe0/G5vg2ZUIgDE/s400/Facelift+Before+%26+After.png" border="0" />Aesthetic and reconstructive facial surgery is particularly enjoyable to me. The deep plane facelift is a technique that I commonly use in my aesthetic practice and which I frequently use in conjunction with an upper and lower blepharoplasty as well as a coronal brow lift.<br /><br />Analyzing my own results is an important part of my practice so that I can continually improve. While the correction in the nasolabial folds, jowls, and neck are more obvious from the deep plane facelift, I continue to learn more about the impact of the aperture of the upper eyelids as their appropriate placement can yield a significant result on the overall youthful appearance of the face.<br /><br />It is very common for women as they age to have an accumulation of skin on their upper eyelids. This accumulation of skin has been given the medical term, dermatochalasis. Often this accumulation can be asymmetric-meaning greater on one side versus the other and can create differences in the aperture of the eye. It is important when correcting this asymmetry to note the location of the tarsal fold or eyelid crease. As you can see in the above photograph the patient's right eye has significantly more skin pre-operatively than the left eye. Careful notation of these asymmetries is important so that post-operatively the eyes can have equal apertures and yield an optimal aesthetic result.<br /><br />I continue to see great improvements in the overall skin texture and quality with the deep plane facelift.<br /><br />Brian P. Dickinson, M.D.<br /><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-8352732607802788121?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-2298636231720785602010-03-17T00:01:00.001-07:002010-03-18T06:01:09.659-07:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/S6B_D2yxZyI/AAAAAAAAAes/BcrD_9kpq0I/s1600-h/Flexor+Pollicis+Brevis+Blog.bmp"><img id="BLOGGER_PHOTO_ID_5449495253343102754" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 278px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S6B_D2yxZyI/AAAAAAAAAes/BcrD_9kpq0I/s400/Flexor+Pollicis+Brevis+Blog.bmp" border="0" /></a>The flexor pollicis brevis is an intrinsic muscle of the hand that originates from the flexor retinaculum of the wrist and tubercle of the trapezium. The muscle inserts on the radial side at the base of the proximal phalanx of the thumb. The recurrent branch of the median nerve and the deep branch of the ulnar nerve provide motor innervation that allows the flexor pollicis brevis to flex the thumb at the first metacarpophalangeal joint.<br /><br />Laceration of the flexor pollicis brevis due to trauma significantly impairs hand function as the patient is unable to fully oppose the thumb to the small finger.<br /><br /><div><a href="http://1.bp.blogspot.com/_254hvtdnRaE/S6B-3mnEO0I/AAAAAAAAAek/mI6WUq8zE3o/s1600-h/Flexor+Pollicis+Brevis+Blog.JPG"><img id="BLOGGER_PHOTO_ID_5449495042840607554" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 332px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S6B-3mnEO0I/AAAAAAAAAek/mI6WUq8zE3o/s400/Flexor+Pollicis+Brevis+Blog.JPG" border="0" /></a> I prefer repairing the tendon of the flexor pollicis brevis tendon with 3.0 and 4.0 nylon suture with a modified Kessler stitch and horizontal mattress sutures. A 5.0 epitendinous suture allows an adequate contour to the repair and facilitates opposition of the thumb to the small finger.<br /><br /><div><a href="http://4.bp.blogspot.com/_254hvtdnRaE/S6B-tqRH3UI/AAAAAAAAAec/PdK8IRKqBS0/s1600-h/Flexor+Pollicis+Brevis+Blog+3.JPG"><img id="BLOGGER_PHOTO_ID_5449494872023620930" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 229px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S6B-tqRH3UI/AAAAAAAAAec/PdK8IRKqBS0/s400/Flexor+Pollicis+Brevis+Blog+3.JPG" border="0" /></a><br />Brian P. Dickinson, M.D.</div><div><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div><br /></div><div></div><div></div><div></div><div><br /><div></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-229863623172078560?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-33527671371120127982010-03-11T09:26:00.000-08:002010-03-11T11:27:59.318-08:00<a href="http://4.bp.blogspot.com/_254hvtdnRaE/S5kpIU2neRI/AAAAAAAAAeM/sCWe_1jIC2Q/s1600-h/Capsular+Contracture+Blog.JPG"><img id="BLOGGER_PHOTO_ID_5447430447294806290" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 268px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S5kpIU2neRI/AAAAAAAAAeM/sCWe_1jIC2Q/s400/Capsular+Contracture+Blog.JPG" border="0" /></a><br /><br />Revision breast augmentation in Fitness Models possess unique challenges to the surgeon. Aesthetic results are usually quite optimal after complete capsulectomy, but the thinning tissue often allows implant visibility or rippling. I often choose to perform complete capsulectomy to allow the breast to re-drape over the implant. It is important for the surgeon to have a thorough knowledge of the previous operations, as implants may have been in prior planes, or neosubpectoral pockets may have been created from prior capsules and have subsequently contracted. I have used the neosubpectoral pocket on many occasions for revision aesthetic breast surgery and have found it useful. However, in women who present with recurrent capsular contracture, it is important to remove the capsules to allow the breast to re-expand and produce an optimal aesthetic shape.<br /><div><br /><br /><div><a href="http://2.bp.blogspot.com/_254hvtdnRaE/S5kongVYd0I/AAAAAAAAAd8/2m87l9ZypfE/s1600-h/Capsular+Contracture+Blog+4.JPG"><img id="BLOGGER_PHOTO_ID_5447429883440953154" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 268px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S5kongVYd0I/AAAAAAAAAd8/2m87l9ZypfE/s400/Capsular+Contracture+Blog+4.JPG" border="0" /></a>Often in patients who have undergone previous revision aesthetic breast surgery and who are competitive athletes, fitness models, or clothing models, the breast and surrounding subcutaneous tissue is thin. To prevent implant visibility or palpable rippling in this population, I have found Strattice to be quite useful.<br /></div><br /><div><br /><div><a href="http://3.bp.blogspot.com/_254hvtdnRaE/S5koS1CkSAI/AAAAAAAAAd0/QC_4sQgMCaE/s1600-h/Capsular+Contracture+Blog+3.JPG"><img id="BLOGGER_PHOTO_ID_5447429528221927426" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 268px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S5koS1CkSAI/AAAAAAAAAd0/QC_4sQgMCaE/s400/Capsular+Contracture+Blog+3.JPG" border="0" /></a><br />The Roxbury Clinic &amp; Surgery Center continues to grow as a center for capsular contracture as well as revision aesthetic breast surgery. An increasing number of women choose to undergo their mastopexy/augmentation, capsular contracture surgery, breast augmentation, removal and replacement, as well as second stage breast reconstruction surgery at the Roxbury Clinic &amp; Surgery Center. </div><div> </div><div></div><div>Brian P. Dickinson, M.D.</div><div><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div></div><div><br /><br /><br /><div></div></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-3352767137112012798?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-78476534004002533932010-03-05T21:32:00.000-08:002010-03-05T22:02:33.221-08:00<a href="http://2.bp.blogspot.com/_254hvtdnRaE/S5HrkpTEEsI/AAAAAAAAAds/xH3250s18Cs/s1600-h/New+Picture.png"><img id="BLOGGER_PHOTO_ID_5445392439261270722" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 100px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S5HrkpTEEsI/AAAAAAAAAds/xH3250s18Cs/s400/New+Picture.png" border="0" /></a><br /><div><div><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img id="BLOGGER_PHOTO_ID_5445392010795246418" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 237px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S5HrLtIzY1I/AAAAAAAAAdc/L7bWLwccYtk/s400/1.JPG" border="0" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img id="BLOGGER_PHOTO_ID_5445391755104768562" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 296px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S5Hq80ncUjI/AAAAAAAAAdU/jT_P-LNL0RA/s400/2.JPG" border="0" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img id="BLOGGER_PHOTO_ID_5445391299200564434" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 320px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S5HqiSPaPNI/AAAAAAAAAdM/yPHPnTYKjdE/s400/3.JPG" border="0" /></a><br />We are starting to see many patients come from out of state to have their revision augmentation procedures or capsulectomy surgeries performed at the Roxbury Clinic &amp; Surgery Center. I have been using the Strattice in the manner as taught to me by Neal Handel, M.D. When working through small incisions, I have found the use of appropriately and carefully placed marionette sutures to align the Strattice in correct position while the remaining sutures are performed through the limited incision.<br /><br />I have found Strattice to be very helpful in the revision breast augmentation patient who has rippling, implant palpability, synmastia, bottoming out, and fold asymmetry. I have also found Strattice to be helpful as a barrier between the nipple areola complex incision and the capsule of the breast implant.<br /><br />I remember repeatedly, the lessons on tendon healing by one of my great mentors, Malcolm Lesavoy, M.D. He would always describe the "one wound/one scar" theory for tendon healing. I find that the same theory can apply to breast implant capsules.<br /><br />Frequently, I see patients who present for capsular contracture surgery who have a thickened scar beneath their periareolar incision with a "scar rind" that is aggressively fixed to their underlying capsule. It is my belief that the interposed Strattice may prevent the "scar rind" that I frequently see beneath the periareolar incision that is firmly fixed to the capsule. I hope this has great implications for reducing capsular contracture.<br /><br />Brian P. Dickinson, M.D.<br /><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a><br /></div></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-7847653400400253393?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-45819611067808033172010-03-01T21:23:00.000-08:002010-03-01T21:25:45.524-08:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/S4yhIO_QG-I/AAAAAAAAAc8/672dWGU4_FE/s1600-h/FatTransferBlog.png"><img id="BLOGGER_PHOTO_ID_5443903212418505698" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 147px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S4yhIO_QG-I/AAAAAAAAAc8/672dWGU4_FE/s400/FatTransferBlog.png" border="0" /></a><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-4581961106780803317?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-14276951123367823152010-02-26T08:21:00.001-08:002010-02-26T18:31:10.239-08:00<a href="http://2.bp.blogspot.com/_254hvtdnRaE/S4f_QqkOnqI/AAAAAAAAAc0/Z5Xt9ZbI5hg/s1600-h/Fat+Transfer+Blog.png"><img id="BLOGGER_PHOTO_ID_5442599336469765794" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 109px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S4f_QqkOnqI/AAAAAAAAAc0/Z5Xt9ZbI5hg/s400/Fat+Transfer+Blog.png" border="0" /></a><br /><div align="center"><span style="font-size:85%;"><strong>Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells<br /></strong>Kotaro Yoshimura,1 Katsujiro Sato,2 Noriyuki Aoi,1 Masakazu Kurita,3 Toshitsugu Hirohi,4 and Kiyonori Harii3</span><br />Aesthetic Plast Surg. 2008 January; 32(1): 48–55.<br /></div>I have had the great opportunity to reacquaint with a mentor who has sparked my interest in the use of autologous fat transfer for breast augmentation. As I read through the selected reading articles, I have found excellent results published by Japan and Korea on the use of adipose derived stem cells of autologous fat transfer for cosmetic breast augmentation.<br /><br />My interest in this grows, as I continue to having a growing group of patients who are interested in a small to modest increase in breast size and who do not want an implant of either silicone or saline. In these patients, available fat can be harvested from the lower abdomen, buttocks, and thighs and transferred to the breast for augmentation.<br /><br />I am very satisfied with the results we are achieving with silicone gel implants and find that there will always be a continued role for them in women who desire a larger augmentation or require replacement of significant breast volume following mastectomy. I believe that fat transfer will not replace silicone breast augmentation, but serves as an alternative for those women who do not want a large volume augmentation and who do not want an implant based augmentation.<br /><br />Brian P. Dickinson, M.D.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-1427695112336782315?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-57158608831159841022010-02-25T21:19:00.000-08:002010-02-25T21:31:16.232-08:00<a href="http://1.bp.blogspot.com/_254hvtdnRaE/S4daEfn6CDI/AAAAAAAAAcs/j5FkTRyx1-U/s1600-h/Testimonial.png"><img id="BLOGGER_PHOTO_ID_5442417707955390514" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 183px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S4daEfn6CDI/AAAAAAAAAcs/j5FkTRyx1-U/s400/Testimonial.png" border="0" /></a> Testimonials from patients and family are one of the highest compliments that I could ever receive. This patient family member writes:<br /><br /><br />Dr. Dickinson,<br /><br />I would like to thank you from the bottom of my heart for helping my son through this. You are an extraordinarily skilled surgeon and a very special person. You took the time to help him, not many people do that anymore. I cannot thank you enough or express what your kindness has meant to me enough. My family and I will be forever indebted to you. Please tell your staff that they are the most caring people in the world and thank them for me.<br /><br />Thank you again,<br /><br />-------------------<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-5715860883115984102?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-14984922398738113252010-02-23T00:27:00.001-08:002010-02-24T20:09:58.527-08:00<a href="http://1.bp.blogspot.com/_254hvtdnRaE/S4ORxruhcZI/AAAAAAAAAcU/4nM3_Hw1ZUM/s1600-h/Blog+Photo+2.png"><img id="BLOGGER_PHOTO_ID_5441353057531163026" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 286px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S4ORxruhcZI/AAAAAAAAAcU/4nM3_Hw1ZUM/s400/Blog+Photo+2.png" border="0" /></a><br /><div><a href="http://2.bp.blogspot.com/_254hvtdnRaE/S4ORmCukeBI/AAAAAAAAAcM/Fd15CNVsxLA/s1600-h/Blog+Photo.png"><img id="BLOGGER_PHOTO_ID_5441352857546946578" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 212px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S4ORmCukeBI/AAAAAAAAAcM/Fd15CNVsxLA/s400/Blog+Photo.png" border="0" /></a></div><div align="center"><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a> </div><div> </div><div>Patient testimonials are one of the highest compliments I could ever receive. This happy patient writes in her testimonial:<br /><br />"This experience couldn't possibly have been any better, and bless Dr. L for referring me to you! You're the best -- Dr L told me you were going to be the next big bev hills plastic surgeon, and I think he's right.... from the first visit I felt comfortable and am soooooo pleased with my results, you have NO idea!<br /><br />Every visit has been a true delight, and actually fun and entertaining (not usually the case half naked in a dr office!).... I love that I found a Doc that I didn't feel all weird with, and that I NEVER felt judged, and was always treated with the utmost respect. Thanks!;"</div><div> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-1498492239873811325?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-91694741797385209222010-02-22T19:47:00.001-08:002010-02-22T20:07:45.962-08:00<a href="http://2.bp.blogspot.com/_254hvtdnRaE/S4NSwj_-MAI/AAAAAAAAAcE/MquxF1WYgk8/s1600-h/Keller.png"><img id="BLOGGER_PHOTO_ID_5441283769044447234" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 85px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S4NSwj_-MAI/AAAAAAAAAcE/MquxF1WYgk8/s400/Keller.png" border="0" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img id="BLOGGER_PHOTO_ID_5441281790887382306" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 177px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S4NQ9aykzSI/AAAAAAAAAb8/eI4K1gsOFag/s400/Copy+of+DSC_0235.JPG" border="0" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img id="BLOGGER_PHOTO_ID_5441280937314685650" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 230px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S4NQLu-_EtI/AAAAAAAAAb0/AlOEU1R4ngg/s400/Copy+of+DSC_0234.JPG" border="0" /></a><br />I have been using the Keller Funnel routinely for my periareolar and transaxillary breast augmentation cases. The Keller Funnel allows me to deliver larger implants through a smaller incision without traumatizing the breast implant, the skin, or having the breast implant come into contact with the skin.<br /><br />I believe strongly that this "no touch technique delivery system" can help reduce the incidence of capsular contracture. It is of paramount importance to me that my patients receive great results and that I try to do everything possible to minimize complications.</div><div></div><div>Brian P. Dickinson, M.D.</div><div><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-9169474179738520922?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-67662947146841289352010-02-21T22:55:00.000-08:002010-02-21T23:16:09.446-08:00<a href="http://www.drbriandickinson.com/"><img id="BLOGGER_PHOTO_ID_5440958544541578354" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 208px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S4Iq-AUG9HI/AAAAAAAAAbs/PPhwfmtbZNw/s400/Microsurgery+Blog.JPG" border="0" /></a> <div>Microsurgical nerve repair and use of the operating microscope is a particular area of interest for me and has become a significant part of my practice. I enjoy the optics of the Carl Zeiss Pentero microscope. The Pentero provides adequate resolution for nerve repair on the magnitude of 2mm and even less.<br /><br />Peripheral nerve injuries in the upper and lower extremity are common with the frequent physical activity in southern California. Activities such as biking, surfing, motorcycles, climbing, as well as occupational hazards can cause peripheral nerve injury.<br /><br />In the photograph above, the blue background contains a grid with 1 mm squares, allowing the surgeon to assess the dimensions of the injured nerve.</div><div> </div><div></div><div>Brian P. Dickinson, M.D.</div><div><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div></div><div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-6766294714684128935?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-59834056267946647302010-02-16T20:15:00.000-08:002010-02-20T12:54:05.006-08:00<div><a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp"><img id="BLOGGER_PHOTO_ID_5439063871224550066" style="margin: 0px auto 10px; display: block; width: 400px; height: 331px; text-align: center;" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S3tvxgMAErI/AAAAAAAAAbc/fgPhj_xNfYA/s400/Ptosis+Blog2.png" border="0" /></a> <br /><div><a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp"><img id="BLOGGER_PHOTO_ID_5439063715540240306" style="margin: 0px auto 10px; display: block; width: 400px; height: 301px; text-align: center;" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S3tvocN-B7I/AAAAAAAAAbU/IUQqEFhsmAs/s400/Ptosis+Blog.JPG" border="0" /></a> <br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CStaff%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="text-align: center;" align="center">www.drbriandickinson.com<o:p></o:p></p> <p class="MsoNormal"> <br />I have found an increasing number of women who present to my office in consultation who had saline breast implants placed ten years ago and who are now requesting removal and replacement of their mammary implants for highly cohesive silicone gel mammary prosthesis. <br /> <br />Often these women underwent reduction mammoplasty with an implant to maintain upper pole fullness, but now want to change to an implant with a slightly higher profile to deliver more breast projection. <br /> <br />We are seeing more women present from out of state who come to <st1:city st="on">Newport Beach</st1:city> and <st1:city st="on"><st1:place st="on">Beverly Hills</st1:place></st1:city> who have capsular contracture and who now want to have their breast implant capsules removed, saline implants replaced for silicone gel implants, and a simultaneous breast lift. <br /> <br />These operations are challenging to preserve the blood supply to the nipple areola complex as previous operations contribute to scarring and necessitate experience with these cases to deliver consistent results. <br /> <br />Bilateral capsulectomies, implant exchange, and mastopexy are commonly performed operations in <st1:city st="on">Newport Beach</st1:city> and <st1:city st="on"><st1:place st="on">Beverly Hills</st1:place></st1:city>. <br /> <br />Brian P. Dickinson, M.D. <br />www.drbriandickinson.com</p> <br /> <br /><div></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-5983405626794664730?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-14818244772242661292010-02-16T18:05:00.000-08:002010-02-16T18:19:10.747-08:00<a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp"><img id="BLOGGER_PHOTO_ID_5439028171950695714" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 264px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S3tPTiB2pSI/AAAAAAAAAbE/or37gTgMTkQ/s400/Abdominoplasty.png" border="0" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp"><img id="BLOGGER_PHOTO_ID_5439028017669966402" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 201px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S3tPKjSdikI/AAAAAAAAAa8/YqrcyoP8yZM/s400/Abdominoplasty-Panniculectomy.png" border="0" /></a><br /><div>The post-bariatric body contouring surgery program at the Roxbury Clinic &amp; Surgery center continues to grow with more patients enrolling in post-bariatric body contouring procedures.<br /><br />Patients present to our office and are very excited about having their body contouring procedures done at either the Newport Beach or Beverly Hills, CA surgery centers.<br /><br />We encourage all patients who desire to have post-bariatric body contouring procedures to bring their insurance cards with them during their consultations. It is a great time to utilize health insurance plans to undergo lap band procedures. Typically after patients undergo their lap band operation they return for their post-bariatric body contouring surgery within 9 months to one year. Patients are very happy after having their panniculectomy and abdominoplasty surgeries and greatly look forward to having their mastopexy, breast reduction, brachioplasty, or medial thigh lift.<br /><br />Performing <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">post-bariatric plastic surgery</a> is very gratifying for the patient and physician.</div><div> </div><div>Brian P. Dickinson, M.D.</div><div><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a></div><div> </div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-1481824477224266129?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-83469528807470311902010-02-12T22:48:00.001-08:002010-02-15T23:14:44.033-08:00<a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp"><img id="BLOGGER_PHOTO_ID_5437616952360708402" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 268px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S3ZLzvYaKTI/AAAAAAAAAa0/Za31E2w6g18/s400/Orbital+Fracture+Blog.JPG" border="0" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp"><img id="BLOGGER_PHOTO_ID_5437616678960800370" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 186px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S3ZLj04yonI/AAAAAAAAAas/snzF4chYJJg/s400/Ear+Cartilage.JPG" border="0" /></a><br /><div>Orbital fractures are very common. There is an increasing frequency of orbital fractures being repaired at the Roxbury Clinic &amp; Surgery Center in Beverly Hills, CA. Orbital fractures are becoming frequently more common in older individuals who may fall and suffer a trauma to the region of their eye.<br /><br />By nature of the design of the globe and bony orbital frame, the bone tends to fracture first to prevent damage to the eye itself. Repair of the bony defect is often required for greater than 1 square cm defects and/or defects comprising greater than 50% of the floor of the orbit.<br /><br />Patients who come to the Roxbury Clinic &amp; Surgery Center in Beverly Hills to have their surgery are fortunate to have the expertise of <a href="http://www.oculoplastic.info/profile.html">Dr. Kami Parsa</a>. Dr. Kami Parsa is a world renowned ophthalmologist with exceptional talent in oculoplastic and reconstructive surgery of the eye. Smaller orbital floor defects are often repaired with ear cartilage harvested from the ear, while larger defects or defects of the orbital rim often require repair with titanium mesh or porous polyethylene.</div><div> </div><div> </div><div></div><div>Brian P. Dickinson, M.D.</div><div><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-8346952880747031190?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-59819889216660896122010-02-11T14:32:00.000-08:002010-02-11T14:49:15.409-08:00<div align="center"><a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp"><img id="BLOGGER_PHOTO_ID_5437120858915251058" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 223px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S3SInTSCo3I/AAAAAAAAAaE/Glvhn8l5kwc/s400/Breast+Augmentation+Blog.png" border="0" /></a> <a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a><br /></div>Breast implants are medical devices and over time, like all medical devices, are subject to fatigue. Over time, the development of a capsular contracture around a breast implant can cause folds in the shell of a saline implant. Repeated creasing in the fold of a saline implant can cause the shell to fatigue and allow the saline to leak.<br /><br />The leak of saline into the body is not harmful to the patient, but is nonetheless, psycholocially distressing. These patients have been coming to our office with an increasing frequency and request the removal of their saline implants for silicone implants. Often patients who have a deflation of their saline implants have had their devices for over 8-10 years.<br /><br />These patients who have undergone <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">removal and replacement </a>of their saline implants for silicone gel implants are starting to tell their friends how happy they are with the improvement in the shape and feel of their breasts. As a result, I am seeing an increase in the number of patients who present to the office requesting their saline implants to be exchanged for silicone implants.<br /><br /><br /><br />Brian P. Dickinson, M.D.<br /><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-5981988921666089612?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-28355986782850523192010-02-09T21:45:00.000-08:002010-02-09T21:49:05.104-08:00I had the great pleasure of attending the LifeCell educational forum this past weekend in Las Vegas, Nevada. The meeting was very helpful to solidify my experience with regenerative tissue matrices.<br /><br />This conference came at a timely fashion for me as it reinforced my educational experience on the use of Strattice for revision aesthetic breast surgery in women with thinning tissues.<br /><br />I have seen many women in consultation recently with fitness model physiques and a history of recurrent <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture </a>and severe thinning tissues.<br /><br />As was taught to me by my mentor, the reinforcement of the thin lower pole skin with Strattice can help visible and palpable ripping in this population. The Strattice held in by marionette sutures and then sutured with long-acting absorbable will decrease the incidence of palpable rippling and may reduce the rate of capsular contracture.<br /><br />Brian P. Dickinson, M.D.<br /><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-2835598678285052319?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-7820880125131407992010-02-04T11:27:00.000-08:002010-02-04T22:23:57.541-08:00<div align="center"><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img id="BLOGGER_PHOTO_ID_5434472759055513794" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 268px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S2sgLmkKeMI/AAAAAAAAAZs/zWNDWjGP3Xo/s400/Saline+Implant+Blog.JPG" border="0" /></a><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a></div><br />I am seeing more and more women in consultation in my office with deflation of their saline <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implants</a>. In fact, twice this month we had women who presented with the development of pain around their <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implant </a>with an associated distortion of the breast shape secondary to <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implant </a>valve failure.<br /><br />It has been my experience that the development of a <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture </a>around the breast implant changes not only the shape of the <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implant </a>capsule complex, but may incorporate around the valve of the <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">saline implant </a>(as shown in the image above).<br /><br />Either continued contraction of the breast capsule resulting in a change in the surface area to volume ratio and/or ingrowth of the capsule to the valve disrupts the valve and allows the saline to extravasate. These women often present with continued pain and the apparent deflation of the <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">implant</a> can be distressing to the patient.<br /><br />In these cases I recommend that women undergo removal and replacement of their <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implants </a>and <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsulectomy</a>. Many women are opting now to exchange their saline implants for silicone gel breast implants.After these surgeries, patients are very happy with the new contour of their <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">implants</a> and their pain is often markedly improved.<br /><br />Brian P. Dickinson, M.D.<br /><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-782088012513140799?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-79671761156143146622010-02-03T21:08:00.000-08:002010-02-03T21:17:18.977-08:00<a href="http://www.sustainableweight.com/pouya-shafipour-md"><img id="BLOGGER_PHOTO_ID_5434251765670613602" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 142px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S2pXMGDWEmI/AAAAAAAAAZk/Lz-FGXWzG24/s400/Sustainable+Weight+Loss.bmp" border="0" /></a><br /><div><a href="http://www.roxburysurgery.com/"><img id="BLOGGER_PHOTO_ID_5434251654581013666" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 322px; CURSOR: hand; HEIGHT: 173px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S2pXFoNhTKI/AAAAAAAAAZc/6NiN_RnjEt0/s400/Rox+Bariatric.bmp" border="0" /></a><br />The Rox Bariatric program continues to grow. I was very fortunate today to hear some excellent feedback from one of our patients who is recently post-op from her panniculectomy and medial thigh lift.<br /><br />She was very thankful for her results as well as to have had an excellent team of surgeons tend to her care. This group of surgeons not only pays close attention during her surgery, but also to the post-operative care that is so important to ensure proper healing.<br /><br />I was truly thankful to hear how highly our patient spoke of our team of doctors. Specifically, the patient expressed her gratitude to <a href="http://www.jaycalvertmd.com/">Dr. Jay Calvert</a>, <a href="http://www.anitapatelmd.com/">Dr. Anita Patel</a>, as well as the USC plastic surgery resident Dr. Joe Carey was so helpful during our case.<br /><br /><a href="http://www.roxburysurgery.com/">Dr. Patel </a>has been taking a great interest in post-bariatric body contouring surgery and post-bariatric patients. Together with <a href="http://www.anitapatelmd.com/">Dr. Patel</a>, <a href="http://www.sustainableweight.com/pouya-shafipour-md">Dr. Shafipour</a>, and the help of the USC residents we are able to provide complete and excellent care to these great patients who have lost massive amounts of weight. I am very proud of how hard our patients work to achieve their goals.<br /><br />Brian P. Dickinson, M.D.<br /><div><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-7967176115614314662?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-30796935930363292172010-02-02T21:01:00.000-08:002010-02-03T09:13:21.370-08:00<a href="http://1.bp.blogspot.com/_254hvtdnRaE/S2kFwcHo40I/AAAAAAAAAZU/6t1oulxHjgM/s1600-h/Rox+Bariatric.bmp"><img id="BLOGGER_PHOTO_ID_5433880755139306306" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 378px; CURSOR: hand; HEIGHT: 229px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S2kFwcHo40I/AAAAAAAAAZU/6t1oulxHjgM/s400/Rox+Bariatric.bmp" border="0" /></a>The Rox Bariatric program continues to gain significant traction. We are seeing many patients return for the second stages of their operations. I continue to be impressed by the power of panniculectomy to facilitate weight loss.<br /><br />Not only does the removal of the abdominal pannus seem to allow patients the ability to workout and exercise, but also significantly motivates them to loose weight through appropriate dietary measures.<br /><br />Today in the operating room I was truly impressed with a patient who returned for her bilateral mastopexy and bilateral brachioplasty after she continued to loose weight after her panniculectomy a few months ago. I continue to be very proud of how hard our patients work to improve themselves and their health.<br /><div></div><br /><div>Brian P. Dickinson, M.D.</div><br /><div><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-3079693593036329217?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-36126338573477455592010-02-02T19:47:00.000-08:002010-02-03T09:12:17.665-08:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/S2jz5e37mLI/AAAAAAAAAZE/VjLqIT1RASg/s1600-h/Keller.JPG"><img id="BLOGGER_PHOTO_ID_5433861119288252594" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 263px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S2jz5e37mLI/AAAAAAAAAZE/VjLqIT1RASg/s400/Keller.JPG" border="0" /></a><br /><div><a href="http://3.bp.blogspot.com/_254hvtdnRaE/S2jzt0EVbdI/AAAAAAAAAY8/DQtm0Q9Bn3s/s1600-h/Keller.bmp"><img id="BLOGGER_PHOTO_ID_5433860918818991570" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 85px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S2jzt0EVbdI/AAAAAAAAAY8/DQtm0Q9Bn3s/s400/Keller.bmp" border="0" /></a><br /><div><a href="http://4.bp.blogspot.com/_254hvtdnRaE/S2jzH2w6aJI/AAAAAAAAAY0/UmvNPmZNnks/s1600-h/Keller+Funnel.JPG"></a>Today was truly a great day of cases. As the <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast augmentation</a>, <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">revision breast augmentation</a>, and <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture </a>surgery practice grows, I continually look for ways to improve patient outcomes, reduce patient recovery time, reduce incision length, and prevent <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture</a>.<br /><br />I have found that the Keller Funnel facilitates delivery of silicone gel implants through smaller incisions and allows me to employ a no-touch delivery technique whereby the gel implant does not come into contact with the nipple areola complex or the axillary skin when placing implants. I found that the Keller Funnel greatly facilitated today's cases and I will use it for the breast augmentation cases later in the week.<br /><br />I anticipate that the no-touch delivery technique is one method to further reduce the prevalence and incidence of <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture</a>. I look forward to continued success with is device.</div><div></div><div> </div><div>Brian P. Dickinson, M.D.<br /></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-3612633857347745559?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-34898215922172717532010-01-31T12:26:00.000-08:002010-01-31T18:26:34.927-08:00<a href="http://1.bp.blogspot.com/_254hvtdnRaE/S2XsiyWOQqI/AAAAAAAAAYk/GHP_3Ta22OA/s1600-h/Microsurgery+Blog.png"><img id="BLOGGER_PHOTO_ID_5433008607867060898" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 261px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S2XsiyWOQqI/AAAAAAAAAYk/GHP_3Ta22OA/s400/Microsurgery+Blog.png" border="0" /></a><br /><div align="center">Reconstruction of Total Laryngopharyngectomy Defects with Deep Inferior Epigastric Perforator Flaps:<br /></div><div align="center">Otway Louie, Brian Dickinson, Jay Granzow, J. Brian Boyd<br /></div><div align="center">Journal of Reconstructive Microsurgery. 25(9):555-558, November 2009</div><div><br />It is truly a great honor and distinct pleasure to publish in the Journal of Reconstructive Microsurgery with Dr. Otway Louie, Dr. Jay Granzow, and Dr. J. Brian Boyd. I received outstanding microsurgical training from them during my time training at Harbor-UCLA. </div><div><br /> </div><div>Brian P. Dickinson, M.D.</div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-3489821592217271753?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-67113202032265663272010-01-31T01:08:00.000-08:002010-01-31T01:12:27.892-08:00<a href="http://4.bp.blogspot.com/_254hvtdnRaE/S2VJWfnXPeI/AAAAAAAAAYU/c7Yz1frkqxM/s1600-h/Prosthetic+Reconstruction+in+the+Radiated+Breast.JPG"><img id="BLOGGER_PHOTO_ID_5432829176284921314" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 290px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S2VJWfnXPeI/AAAAAAAAAYU/c7Yz1frkqxM/s400/Prosthetic+Reconstruction+in+the+Radiated+Breast.JPG" border="0" /></a><br /><div>Surgery of The Breast Principles and Art Ed. Scott Spear<br />Chapter 33. Prosthetic Reconstruction in the Radiated Breast.<br /><br />Prosthetic breast reconstruction in the radiated breast is a complex issue.<br /><br />-Radiated reconstructions tend to be of poorer quality than non-radiated reconstructions.<br />-Radiation increases the complication rates associated with reconstructive options<br />-Not all radiation is the same.<br /><br /><br />The dose, location, type, and purpose of radiation substantially affects the local tissue response and thus indirectly the hospitality of those tissues to reconstructive surgery.<br /><br />Radiation may be delivered to the breast under a variety of circumstances:<br /><br />-As part of breast conservation treatment, along with lumpectomy and axillary sampling.<br />-Postmastectomy, according to the American Society of Clinical Oncology Guidelines<br />-Postmastectomy for a local recurrence.<br />-After immediate reconstruction for unfavorable tumor<br />-After immediate or delayed reconstruction for recurrence<br /><br />If radiation prior to reconstruction:<br /><br />Indications<br />Dose of radiation<br />Quality of tissues after radiation<br /><br />Lumpectomy and radiation often 5,000 cGY<br />Patients radiated after mastectomy more likely high-dose radiation because radiation recommended on basis of extensive or aggressive disease.<br /><br />Lower dose radiation: tissues look and feel reasonably normal<br />Higher dose radiation: tissues look tight, inelastic, thickened.<br /><br />All radiation increases risk of complications.<br />Obvious radiation damage advised to undergo autologous or autologous assisted types of reconstruction.<br /><br />Indications for radiation by American Society of Clinical Oncology:<br /><br />Tumor greater than 4 cm.<br />4 or more positive lymph nodes<br />Tumor near resection margins (skin or chest wall)<br /><br />Radiation dose for these indications is usually substantial 9,500 to 10,000 cGy.</div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-6711320203226566327?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-40105070088118140042010-01-30T18:54:00.000-08:002010-01-31T01:05:43.614-08:00<a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img id="BLOGGER_PHOTO_ID_5432732112972139346" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 249px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S2TxEqmPy1I/AAAAAAAAAYM/CNBkzRibXFI/s400/Capsular+Contracture.png" border="0" /></a><br /><p align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></p><p>As I continue to learn about both aesthetic and reconstructive <a href="http://www.drbriandickinson.com/sub/breast-enhancement-newport-beach.jsp">breast surgery</a>, I find that the same tools, skill sets, and planning that I use for <a href="http://www.drbriandickinson.com/sub/breast-enhancement-newport-beach.jsp">aesthetic breast surgery</a> apply to reconstructive <a href="http://www.drbriandickinson.com/sub/breast-enhancement-newport-beach.jsp">breast surgery </a>and vice versa.</p><p><br />Frequently, I see many women in consultation who have undergone first a breast augmentation, second a <a href="http://www.drbriandickinson.com/sub/breast-enhancement-newport-beach.jsp">breast reduction</a>, and often present desiring further reduction of their breasts or require surgery for <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture</a>.<br />I enjoy these challenging cases as it is important to be knowledgeable of the blood supply of the nipple areola complex, the prior surgeries, and how to most effectively manage the <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture</a>. </p><p>Women who present after numerous operations often have thinning skin or breast tissue, asymmetry, <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture</a>, or unwanted motion of the implant, and desire correction.</p><p><br />I have found that the <a href="http://www.drbriandickinson.com/sub/breast-enhancement-newport-beach.jsp">breast surgery </a>techniques taught to me by Handel have been very effective for identifying, addressing, and managing these difficult cases. <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">Capsular contracture </a>can be very painful for the patient and interfere with daily activities and be psychologically distressing.<br /></p><p>The patient in the above photograph is happy with her removal of her <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">saline implants</a> in exchange for <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">silicone implants</a>, change of implant plane, nipple areola reduction, and mastopexy. The scars are still hyperemic in this early one month post-operative result. I routinely educate patients that scars tend to be the most indurated and red approximately one month after surgery and then soften as the collagen in the scar remodels.</p><p>I have found that as larger saline implants are removed and exchanged for smaller lighter silicone implants, it is easier for patients to excercise, return to the gym, and loose weight.</p><p>Brian P. Dickinson, M.D.</p><p><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></p><p></p><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-4010507008811814004?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-50578397682938475392010-01-28T21:21:00.001-08:002010-01-28T21:58:53.201-08:00<div align="center"><a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp"><img id="BLOGGER_PHOTO_ID_5432027786841042674" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 219px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S2JwffS2LvI/AAAAAAAAAYE/w7-aEhy_J-8/s400/Mastopexy+Augmentation.png" border="0" /></a><a href="http://www.drbriandickinsonmd.com/">www.drbriandickinsonmd.com</a> </div><br />Frequently, I encounter more women in consultation who present to my office desiring a revision of their <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast augmentation </a>from 8 to 10 years prior. Frequently these women have had saline <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implants </a>in for almost ten years and now want to exchange their saline <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implants </a>for silicone <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implants.<br /></a><br />Often women who have had larger <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">implants</a> and now want to downsize desire to have the breasts placed more centrally on their chest wall away from their armpits, with a reduction in the size of their areola, and a <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">lift of the breast</a>.<br /><br />Depending upon the age of the patient and whether or not she has had children and/or breast fed, the incision pattern used to make the breast appear more youthful depends upon the degree of <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast ptosis</a>. <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">Breast ptosis </a>or the "breast fall" can be corrected by different methods or incisions patterns depending upon the degree of <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast ptosis</a>. The youthful appearance of the breast is best corrected by the relationship of the nipple areola complex to the breast crease or inframmary fold.<br /><br />I use in consultation, the <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast ptosis </a>method as classified by Regnault with modification: Grade 1 ptosis - The nipple areola complex has descend to the level of the inframammary fold. Grade 2 ptosis - The nipple areola complex has descended below the inframammary fold. Grade 3 ptosis - The nipple areola complex has descended below the inframammary fold with no lower pole tissue below nipple.<br /><br />In general I have found that <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">Grade I ptosis </a>can be corrected with the placement of an implant and/or a superiorly placed crescent mastopexy incision. Often a Benelli type mastopexy can be incorporated to reduced the diameter of the nipple areola complex. <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">Grade II ptosis </a>often necessitates a vertical incision with/without a lateral limb extending from the nipple areola complex. <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">Grade III ptosis</a> often requires a vertical component and horizontal component(s) to make the breast appear youthful.<br /><br />As one can understand from the photograph above in the after picture on the left, the breast appears more youthful based on the relative size of the nipple areola complex and its position relative to the breast crease. Furthermore the breast has been centralized with its take-off no further lateral than the anterior axillary line. This position of the breast on the chest wall facilitates physical exercise. At three weeks post-operatively, I anticipate that the scars will soften and the swelling will subside giving an even more natural and youthful appearance to the breast as time progresses. Full post-operative change and swelling takes approximately 6 months to one year.<br /><br />Brian P. Dickinson, M.D.<br /><a href="http://www.drbriandickinsonmd.com/">www.drbriandickinsonmd.com</a><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-5057839768293847539?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-12654798347146759482010-01-25T22:23:00.000-08:002010-01-25T22:59:45.327-08:00The RoxBariatric program continues to grow as more patients enroll for the lap band procedure. Upon enrollment patients meet with Bariatric Medicine Specialists who calculate their BMI.<br /><br /><span style="color:#33ccff;">BMI stands for body mass index which is in units of (kg/m ^2)<br /><br />BMI (kg/m2) = Weight in kilograms/Height in meters ^2.<br /><br />People with a BMI below 18.5 are Underweight.<br />People with a BMI between 18.5-24.9 are Normal.<br />People with a BMI between 25-29.9 are Overweight.<br />People with a BMI above 30 are Obese.</span><br /><br />Many insurance companies will authorize lap band surgery if patients meet the following indications:<br />1. An individual has clinical severe obesity, BMI >40, or BMI> 35 with co-morbidities such as heart disease, diabetes, hypertension, sleep apnea, or degenerative arthritis.2. An individual has suffered from morbid obesity for at least five years. 3. An individual has failed non-surgical attempts at weight loss over the years.4. An individual is at a high-risk for obesity-associated morbidity or mortality. 5. An individual is motivated and has an acceptable operative risk.<br /><br />Once individuals have had their lap band surgery, they are usually candidates for <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">post-bariatric body contouring surgery </a>9 to 12 months after. I stress to the patients in our program the importance of adequate protein intake prior to their body contouring operations. For the <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">post-bariatric body contouring </a>patients, it is important to eat 1-2 mg of protein for every kilogram of ideal body weight (IBW) provided they have normal kidney function.<br /><br />When pre-operative labs are drawn before surgery, it is optimal to have serum albumin levels between 3.5-5 g/dl. It is optimal to have serum pre-albumin levels on the high end of normal levels 17-40 mg/dl. Pre-albumin has a half-life of 1.9 days compared to the half-life of albumin which has a half life of 21 days. Therefore pre-albumin levels tend to be more reflective of the more recent nutritional protein intake.<br /><br />Brian P. Dickinson, M.D.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-1265479834714675948?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-82060411605802279462010-01-23T20:43:00.000-08:002010-05-11T08:56:15.936-07:00<a href="http://1.bp.blogspot.com/_254hvtdnRaE/S1v2UsrtRdI/AAAAAAAAAX0/quctj5KrDX0/s1600-h/FightBiteExtensor.png"><img id="BLOGGER_PHOTO_ID_5430204611177563602" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 256px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S1v2UsrtRdI/AAAAAAAAAX0/quctj5KrDX0/s400/FightBiteExtensor.png" border="0" /></a><br /><div><a href="http://www.drbriandickinson.com/"></a><br /><div><a href="http://www.drbriandickinson.com/"><img id="BLOGGER_PHOTO_ID_5430164314924420194" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 276px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S1vRrJcSjGI/AAAAAAAAAXc/lvGc55xwj_0/s400/DSC_0324.JPG" border="0" /></a> </div><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div align="center"><br /></div><div align="left">The "fight bite" injury typically occurs during altercations where the clenched fist of one individual comes into contact with the incisor teeth of another individual.<br /><br />These injuries can be serious for two reasons: 1. There is often a laceration of the extensor tendon that crosses the metacarpal joint that strikes the teeth, 2. There is often an injury to the underlying joint capsule that not only causes injury to the joint capsule, but also introduces bacteria into the joint.<br /><br />I prefer to treat these injuries in stages, with the first stage being washout, irrigation, debridement of the joint followed by antibiotics. Once there has been no declaration of infection I find it safe to proceed with repair of the extensor tendon. The goal is to minimize extensor lag and permit full flexion of the digit.</div><div align="left"></div><div align="left">Brian P. Dickinson, M.D.<br /><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div align="left"></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-8206041160580227946?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-90401541316904907492010-01-23T20:05:00.000-08:002010-01-23T20:36:22.720-08:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/S1vH88k2m7I/AAAAAAAAAXM/NKGYdkuQxxE/s1600-h/NetterHandblog.png"><img id="BLOGGER_PHOTO_ID_5430153625592044466" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 156px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S1vH88k2m7I/AAAAAAAAAXM/NKGYdkuQxxE/s400/NetterHandblog.png" border="0" /></a><br /><div align="left"><a href="http://www.drbriandickinson.com/"><img id="BLOGGER_PHOTO_ID_5430153536219081266" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 268px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S1vH3vorajI/AAAAAAAAAXE/k96D3Mw7sE0/s400/Hand+Blog+2.JPG" border="0" /></a></div><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div align="left"><br />While I enjoy all aspects of <a href="http://www.drbriandickinson.com/">plastic and reconstructive surgery</a>, hand and microsurgery are particularly enjoyable as the anatomical dissections closely resemble the diagrams in the text books. In fact, surgery of the hand is what stimulated my interest in <a href="http://www.drbriandickinson.com/">plastic &amp; reconstructive surgery</a>. I find that I use mostly the techniques taught to me by Dr. Miachael Hausman, Dr. Prosper Benhaim, and Dr. Neil F. Jones.<br /><br />I find that studying and performing surgery of the hand, improves techniques for <a href="http://www.drbriandickinson.com/sub/breast-reconstruction.jsp">microsurgical breast reconstruction </a>and vice versa.<br /><br />It is important when repairing flexor tendons in zone II of the hand, to preserve the A2 and A4 pulleys. After fenestrations have been made in the synovium between the pulley system of the hand the injured flexor tendon can be easily identified. Occasionally I have found that the cruciate pulleys often need to be partially excised so that adequate purchase can be made on the flexor tendons to ensure a strong and durable repair.</div><div align="left"><br />Immediate post-operative mobilization with the Duran protocol is important to ensure adequate flexor tendon gliding.<br /><br />Brian P. Dickinson, M.D.<br /><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div><div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-9040154131690490749?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-55697500490332844912010-01-21T18:23:00.000-08:002010-01-24T10:01:23.010-08:00<a href="http://4.bp.blogspot.com/_254hvtdnRaE/S1yJX9SmmgI/AAAAAAAAAX8/HxrhKpkwXHc/s1600-h/BreastAugmentationBlog.png"><img id="BLOGGER_PHOTO_ID_5430366295384562178" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 395px; CURSOR: hand; HEIGHT: 184px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S1yJX9SmmgI/AAAAAAAAAX8/HxrhKpkwXHc/s400/BreastAugmentationBlog.png" border="0" /></a><br /><div><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><br /><div align="left">I find that the most important aspect of <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast augmentation</a>, is that the operative plan needs to be individualized for each patient. I have found that different <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implant </a>profiles work very well and can produce a similar aesthetic look depending upon the anatomic dimensions of the patient and tissue characteristics.<br /><br />It is important when operating on a patient with a short nipple to inframammary fold distance to select a <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implant </a>that not only is proportionate to the base diameter, but also to the breast height. While it is important to maintain superior fullness of the breast it is important that the "take off" of the breast contour is not placed to superiorly or that the chest to breast angle is not too acute.<br /><br />This patient is very happy with her breast augmentation as her breast/waist/hip ratio is in better proportion. Selection of appropriate breast implant size and dimension is paramount to an optimal outcome.<br /><br />There are three different dimensions and profiles of <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implants</a>. Mentor corporation makes a moderate, moderate plus, and high profile silicone gel <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implant</a>. Allergan produces a style 10, style 15, and style 20 for their <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implants</a>. These labels respectively correspond to <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-newport-beach.jsp">breast implants </a>with increasing projection to base diameter ratios.</div><div align="left"> </div><div align="left">Brian P. Dickinson, M.D.</div><div align="left"><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-5569750049033284491?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-56281327949847621892010-01-18T21:36:00.000-08:002010-01-20T14:54:34.450-08:00<img id="BLOGGER_PHOTO_ID_5428322453015149154" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 235px; CURSOR: hand; HEIGHT: 246px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S1VGgrI-umI/AAAAAAAAAW0/ISU95-0T_Js/s400/Breast+Reconstruction+Blog.bmp" border="0" />Proper nutrition should be an important part of everyone's daily life. Both aesthetic and reconstructive surgery place an increased metabolic demand on the body. It is important both pre-operatively and post-operatively to ensure adequate protein intake before and after surgery. Frequently nutrition comes up in consultations, so I have included below a standard post-operative diet protocol as well as an easy method for patients to understand the amount of protein they will need post operatively.<br /><br />The post-operative diet below is for tissue expander/implant reconstruction. It is modified for TRAM, DIEP, and SIEA reconstructions.<br /><div><br /><span style="color:#33ccff;">Post-Operative Breast Reconstruction Diet Protocol Pathway<br /></span><br /><span style="color:#33ccff;">Post-Op Day 0</span><br /><br />Clear Liquid Diet as Tolerated.<br /><br /><span style="color:#33ccff;">Post-Op Day 1</span><br /><br />Regular Diet. Ensure 1 can three times per day between meals.<br /><br /><span style="color:#33ccff;">Post-Op Day 2</span><br /><br />Regular Diet. Ensure 1 can three times per day between meals.<br /><br /><span style="color:#33ccff;">Discharge Diet:<br /></span><br /><span style="color:#33ccff;">Breast reconstruction surgery is very energy consuming to the body. There is also protein loss from drain output.</span> It is important to maintain a high protein diet for two to three weeks post-operatively to maximize healing.<br /><br />Regular Diet high in protein + Ensure three times/day between meals.<br /><br /><span style="color:#33ccff;">Goal is to eat 1 gram of protein per kg of bodyweight:</span> </div><br /><div>For example, if your body weight is 140 lbs, then your weight in kg is 140/2.2 or 63 kg. Therefore, patient with normal renal and liver function should eat at least 63 grams of protein per day.<br /><br /><span style="color:#33ccff;">Ensure 1 can: 9 grams of protein<br />Glucerna 1 can : 10 grams of protein<br /></span></div><br /><div><span style="color:#33ccff;">Therefore, three cans give you 30 grams of protein.</span><br /><br /><span style="color:#33ccff;">1 can of tunafish contains approximately 25 grams of protein.</span><br /><br />or<br /><br /><span style="color:#33ccff;">1 chicken breast contains approximately 30 grams of protein.</span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-5628132794984762189?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-67394583595649315422010-01-18T19:01:00.000-08:002010-01-18T19:27:07.054-08:00<img id="BLOGGER_PHOTO_ID_5428286312616025410" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 235px; CURSOR: hand; HEIGHT: 246px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S1UlpBqX3UI/AAAAAAAAAWs/B0mqWTch33E/s400/Breast+Reconstruction+Blog.bmp" border="0" /><br /><div align="left">Post-operative patient comfort is of paramount importance in breast reconstruction following mastectomy. Controlling pain can be challenging for both the patient and surgeon. The patient's goal is to have a pain score of close to zero. While this is also the surgeon's goal, many of medications used to treat pain may contain their own inherent undesirable sequelae such as nausea, vomiting, insomnia, hives, disorientation, etc.<br /><br />I have found that using several different medications that work on slightly different pain receptors or that have slightly different pain targets to be the most effective. I have posted the following pain protocol pathway that I am currently using so that patients can know what to expect during their hospital stay. If significant side effects occur from the pathway or the pathway is not effective, adjustments can be made accordingly based on age, allergies, weight, and renal function.<br /><br /><span style="color:#33ccff;">Pre-operatively:</span><br /><br />Emend 40 mg by mouth with a sip of water the morning of surgery to prevent nausea.<br /><br /><span style="color:#33ccff;">In Hospital Pain Regimen:</span><br /><br /><span style="color:#33ccff;">Post-Op Day 0:</span><br /><br />Toradol: Loading Dose 30 mg IV x 1 then:<br />Toradol: 15 mg IV 4 times per day x 48 hours.<br />Dilaudid PCA pump. PCA. Patient controlled analgesia. 0.2 mg IV every 6 minute lockout for max of 2 mg/hr.<br />Diazepam 5 mg by mouth every 6 hours as needed for muscle spasms (tissue expander reconstruction)<br /><br /><span style="color:#33ccff;">Post-Op Day 1:</span><br /><br />Continue Toradol 15 mg IV 4 times per day<br />Dilaudid PCA pump. PCA Patient controlled analgesia for ½ day with transition to:<br />Percocet 5mg/325mg i-ii tabs by mouth every 4 to 6 hours as needed.<br />Diazepam 5 mg by mouth every 6 hours as needed. (tissue expander reconstruction)<br />Colace 100 mg by mouth twice a day.<br /><br /><span style="color:#33ccff;">Post-Op Day 2:</span><br /><br />Discontinue Toradol IV and transitio to Toradol Oral 10 mg po qid<br />Percocet 5mg/235 mg i-ii tabs by mouth every 4 to 6 hours as needed.<br />Diazepam 5 mg by mouth every 6 hours as needed. (tissue expander reconstruction)<br />Colace 100 mg by mouth twice a day.<br /><br /><span style="color:#33ccff;">Discharge Medications Home:</span><br /><br />Percocet 5/325 mg i-ii tabs by mouth every 4 to 6 hours as needed.<br />Diazepam 5 mg by mouth every 8 hours as needed. (tissue expander reconstruction)<br />Ambien 10 mg by mouth at night as needed for sleep.<br />Colace 100 mg by mouth twice a day.</div><div align="left"> </div><div align="left">Brian P. Dickinson, M.D.</div><div align="left"><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-6739458359564931542?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-28357741022386727982010-01-16T13:29:00.000-08:002010-01-16T13:53:24.797-08:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/S1IwK-XXo4I/AAAAAAAAAWk/O6kVnPAjnR0/s1600-h/Capsular+Contracture+Breast+Implant.JPG"><img id="BLOGGER_PHOTO_ID_5427453466032710530" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 348px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/S1IwK-XXo4I/AAAAAAAAAWk/O6kVnPAjnR0/s400/Capsular+Contracture+Breast+Implant.JPG" border="0" /></a><br /><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">Capsular contracture symptoms </a>usually begin with the patient noticing a distortion of their breast implant shape or the beginning of an occasional pain around the implant or the breast.<br /><br />To explain the changes in the shape of the implanted breast with the development of <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture </a>it is important to understand the following:<br /><br />Most breast implants while they may vary slightly depending upon profile are the shape of a disc. When the lining around the implant starts to aggressively contract symmetrically, the shape that forms is a sphere. Now the breast implant which was once a fixed volume in a defined surface area is now changed to the same volume being compressed into a smaller surface area by the <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture.</a> This change not only distorts the augmented breast, but the augmented breast also becomes firm. This firmness can cause <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture symptoms</a> such as sharp pain, dull pain, pain with movement of the breast, or with exercise. When the capsule implant complex becomes painful, the patient has developed a Baker IV <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture</a>.<br /><br />Typically in these patients, my preferred method of <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture treatment </a>is total "en bloc" <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsulectomy</a> so that the entire capsule and implant contents can be removed in their entirety. Removal "en bloc" allows for an optimal plane with which to attempt implantation.<br /><br />In the picture shown above, the one appreciates the spherical shape of the hard capsule lining which has compressed the discoid silicone implant. In this case the silicone implant shell was ruptured with the silicone remaining within the capsule.<br /><br />I will continue to research <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture treatment </a>and <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">prevention</a>.<br /><br />Brian Dickinson, M.D.<br /><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-2835774102238672798?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-66089767265894191752010-01-15T15:54:00.000-08:002010-01-15T16:48:04.773-08:00<a href="http://4.bp.blogspot.com/_254hvtdnRaE/S1EG9enbKeI/AAAAAAAAAWc/lpiCaaeVJ94/s1600-h/Capsular+Contracture+Blog.JPG"><img id="BLOGGER_PHOTO_ID_5427126679218366946" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 268px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S1EG9enbKeI/AAAAAAAAAWc/lpiCaaeVJ94/s400/Capsular+Contracture+Blog.JPG" border="0" /></a><br /><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div align="center"></div><div></div><div>There are an increasing number of patients who come into my office for consultation regarding <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture pain</a>. Recently, I am seeing more patients come to both the Beverly Hills and Newport Beach offices from the South, Midwest, and East Coast with <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture symptoms.</a><br /><br />Frequently these patients present with signs and symptoms related to their <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture </a>such as change in shape of their breast, asymmetry, pain, and more frequently I see women who present with malfunction of their saline breast implants. Occasionally if saline implants have been in place for a long period of time, the shell may undergo “fold flaws" and rupture at the weakest location of the shell.<br /><br />Most recently, I have seen several cases where a <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture </a>has started to cause <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">breast pain </a>and soon after the patient experiences a deflation of their saline implant. While the leakage of saline does not cause any physical harm to the patient, it is nonetheless very distressing and post rupture may cause more pain to the patient.<br /><br />In a recent case, as depicted above, I noticed that a small portion of the capsule had grown into the saline valve. While I cannot prove this, I believe that the continued pain experienced by the patient is the adherence of the <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsule </a>to the chest wall, muscle, or skin and the mobility of the ruptured implant within the <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsule lining</a>.<br /><br />This motion with exertion, movement, etc. can be extremely painful to the patient and warrant surgical removal and replacement of the mammary prosthesis. More frequently, I am seeing more patients from outside of California who present with either Baker Grade IV <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture</a> or Baker Grade III capsular contracture who also have a malfunctioning of their breast prosthesis. Capsular contracture surgery is frequently performed at both the Beverly Hills and Newport Beach, CA surgery centers.</div><div> </div><div> </div><div></div><div></div><div>Brian P. Dickinson, M.D.</div><div><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div><div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-6608976726589419175?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-36969479573178481962010-01-15T14:24:00.000-08:002010-01-15T22:08:42.746-08:00<a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp"></a><br /><div><div><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /><br /></div><div>The RoxBariatric <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">post-bariatric plastic surgery </a>program continues to grow and expand. <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">Post-bariatic body contouring surgery </a>is becoming very popular as we are seeing patients not only from Southern California, but now patients from the Midwest who travel to Beverly Hills and Newport Beach to have their <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">post-bariatric surgery performed</a>. More patients are coming to the RoxBariatric Center to meet our team of plastic &amp; reconstructive surgeons and then be introduced to a <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">bariatric surgeon </a>who will perform either a <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">lapband procedure </a>or <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">gastric bypass procedure</a>.<br /><br />Occasionally, in patients who undergo <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">bariatric surgery </a>or simply loose weight through a bariatric diet, they develop excess of overlying abdominal skin termed a “pannus”.</div><div><br />Patients are coming to the <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">RoxBariatric Plastic Surgery Program </a>from out of state to have their panniculectomy or body contouring surgery performed by our team of <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">plastic &amp; reconstructive surgeons</a>.<br /><br /><span style="color:#33ccff;">Insurance companies will pay for patients to have a </span><a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp"><span style="color:#33ccff;">panniculectomy</span></a><span style="color:#33ccff;"> performed or removal of this overhanging skin as long as certain criteria are met that deem the procedure medically necessary. These criteria include:</span> </div><div><br /><span style="color:#33ccff;">1. Panniculus hangs below the level of the pubis; and</span><br /><span style="color:#33ccff;">2. Patients have chronic intertrigo</span> (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs for a period of over 3 months while receiving appropriate medical therapy, or remains refractory to appropriate medical therapy over a period of 3 months.<br />Frequently patients with subcostal scars present for these operations. Subcostal scars are normally right sided scars used to remove the gallbladder. We have seen many patients who have been turned away for abdominoplasty or panniculectomy operations due to the presence of these scars.<br /><br />These operations can be performed, but need to be performed carefully by plastic &amp; reconstructive surgeons who have demonstrated experience in these operations to ensure proper wound healing. When addressing panniculectomy or abdominoplasty in these patients it is important to respect the remaining blood supply to ensure rapid healing and prevent infection. Adequate nutrition is paramount for proper wound healing.<br /><br />Brian P. Dickinson, M.D.</div><div><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-3696947957317848196?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-31571941328802968952010-01-11T22:40:00.000-08:002010-01-11T22:54:20.168-08:00<img id="BLOGGER_PHOTO_ID_5425741365798995794" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 185px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S0wbBn-Xh1I/AAAAAAAAAV8/8qpQQcN4G6w/s400/Bariatric+Blog.png" border="0" /><br /><div>The RoxBariatric program continues to grow with as the most recent five patients who underwent lap band procedures continue to loose weight. We are starting to see not only significant reduction in weight of these patients, but ancillary physical signs improve as well. Notably one patient has lost a significant amount of weight in his neck and no longer snores at night. Not only has this improved his sleep patterns, but also those of his spouse.<br /><br /><a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">Bariatric patients</a> often loose greater than 100 lbs of weight over the course of six months to one year post surgery. Not only do these patients desire <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">body contouring surgery</a>, but also <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">rejuvenation</a> of their <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">face</a> and <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">neck</a>. I have found that <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">facelift</a> and <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">necklift</a> techniques provide a significant change in the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">facial aesthetics</a> and be quite rewarding to these patients.<br /><br />Traditionally when <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">body contouring </a>and <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">facelift procedures</a>, our patients stay over one night at an aftercare facility where they are examined by a physician that evening and the next morning at the aftercare facility or at the office. </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-3157194132880296895?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-60142748736906965382010-01-10T20:23:00.000-08:002010-01-10T20:34:47.249-08:00<a href="http://4.bp.blogspot.com/_254hvtdnRaE/S0qprhHhSeI/AAAAAAAAAV0/TJL4Fskotqc/s1600-h/Bariatric+Blog+1.png"><img id="BLOGGER_PHOTO_ID_5425335266210564578" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 200px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/S0qprhHhSeI/AAAAAAAAAV0/TJL4Fskotqc/s400/Bariatric+Blog+1.png" border="0" /></a><br /><div><a href="http://1.bp.blogspot.com/_254hvtdnRaE/S0qphZwnN8I/AAAAAAAAAVs/eFFNLAoXjYs/s1600-h/Bariatric+Blog+2.png"><img id="BLOGGER_PHOTO_ID_5425335092436744130" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 372px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S0qphZwnN8I/AAAAAAAAAVs/eFFNLAoXjYs/s400/Bariatric+Blog+2.png" border="0" /></a><br /><br /><div><a href="http://2.bp.blogspot.com/_254hvtdnRaE/S0qpaWBg2PI/AAAAAAAAAVk/6nY_pvhpPEI/s1600-h/Bariatric+Blog+Photo+3.bmp"><img id="BLOGGER_PHOTO_ID_5425334971174803698" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 243px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/S0qpaWBg2PI/AAAAAAAAAVk/6nY_pvhpPEI/s400/Bariatric+Blog+Photo+3.bmp" border="0" /></a><br /><a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">Post-Bariatric Body Contouring Surgery </a>is very rewarding to both the patient and Plastic &amp; Reconstructive Surgeon. It is truly a great to be a part of the RoxBariatric program in Beverly Hills, CA. The RoxBariatric program is a Comprehensive Health &amp; Lifestyle program initiated by Plastic &amp; Reconstructive Surgeons and Bariatric Medicine Specialists. <div><div><div><br /><div><strong><span style="color:#33ccff;">Many patients ask me, Dr. D. what is bariatric surgery?</span></strong> </div><div><br />Bariatric surgery, or weight loss surgery, are procedures performed on people who are dangerously obese, for the purpose of losing weight and improving their overall health. Weight loss is achieved by reducing the size of the stomach, through removal of a portion of the stomach, or by resecting and re-routing the small intestines to a small stomach pouch. These procedures are called gastric banding, sleeve gastrectomy, or gastric bypass surgery, respectively. Not only can these surgeries produce significant long-term loss of weight, but also improve diabetes, lower blood pressure, improve cardiovascular risk factors, and reduce mortality. </div><div><br /><strong><span style="color:#33ccff;">Many patients then ask me, Dr. D. can bariatric surgery be covered or partially covered by my insurance?</span></strong> </div><div><br />Generally insurance will assist in covering these procedures for obese people with a BMI over 40 or people with a BMI of over 35 with coexisting medical conditions.<br /><br /><strong><span style="color:#33ccff;">Finally, patients will ask me, Dr. D. can the post-bariatric body contouring procedures be covered or partially covered by my insurance?</span></strong> </div><div><br /> </div><div>Patients who have <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">bariatric procedures </a>loose over 100 lbs of weight and are left with excess skin that they find impossible to loose. Occasionally, the abdominal skin that overhangs the pubis can cause rashes in the area between the skin. Typically, if patients have these rashes and they are not relieved by prescription medications or other conservative measures to treat them for over six months, then insurance will cover or partially cover a panniculectomy. A <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">panniculectomy</a> is the removal of the overhanging skin or pannus. Other <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">post-bariatric procedures </a>may be covered or partially covered by health insurance or patients may pay for these procedures out-of-pocket. The RoxBariatric program is unique in that patients develop a relationship primarily with the Plastic &amp; Reconstructive surgeons who will be performing their post-bariatric body contouring procedures. The initial consultation into the program includes a consult with a plastic &amp; reconstructive surgeon as well as <a href="http://www.sustainableweight.com/pouya-shafipour-md">Dr. Pouya Shafipour </a>and his colleagues who are Bariatric Medicine specialists. Once patients are deemed physically fit for surgery, they undergo their lap band or gastric bypass procedure. The patients are closely followed by the physicians and physician assistants at RoxBariatric to guide them through their weight loss to their <a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">post-bariatric body contouring </a>procedures. </div><br /><div><strong><span style="color:#33ccff;">I am frequently asked, Dr. Dickinson-What can I do nutritionally to prepare for surgery?</span></strong></div><br /><div><a href="http://www.drbriandickinson.com/sub/post-bariatric-surgery.jsp">Post-bariatric body contouring procedures </a>are significant surgeries that require a lot of energy expenditure for the body to heal. I typically tell patients to eat one to two grams of protein per kilogram of body weight 4 weeks prior to and 4 weeks after surgery to optimize their healing. This diet improves outcomes and prevents wound complications.</div></div></div></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-6014274873690696538?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-14340578472090863842010-01-04T22:51:00.000-08:002010-01-04T23:17:17.294-08:00<a href="http://1.bp.blogspot.com/_254hvtdnRaE/S0LmxxoBstI/AAAAAAAAAUA/jEJeVyGJs3o/s1600-h/Revision+Breast+Augmentation.png"><img id="BLOGGER_PHOTO_ID_5423150644116697810" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 171px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S0LmxxoBstI/AAAAAAAAAUA/jEJeVyGJs3o/s400/Revision+Breast+Augmentation.png" border="0" /></a><br /><div><div><div><div>It is truly a great honor to contribute to breast augmentation research and publish in the Journal of Plastic &amp; Reconstructive Surgery with Dr. Malcolm Lesavoy and Dr. Andrew Trussler. Dr. Lesavoy is a great mentor to me and is a pioneer and leader in the field of plastic and reconstructive surgery. Dr. Trussler is the best chief resident I have ever learned from and is well on his way to becoming a leader in academic cosmetic surgery. I am very fortunate to know such great individuals.</div></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-1434057847209086384?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-64881111275682243632010-01-03T19:20:00.000-08:002010-01-03T19:45:04.088-08:00<a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp"><img id="BLOGGER_PHOTO_ID_5422719682927336050" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 282px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/S0Fe0iFnGnI/AAAAAAAAASY/mYbXxb2jCV8/s400/Facelift.png" border="0" /></a><br /><br />I am a strong proponent of significant attention to the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">neck</a> and <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">jowls</a> in <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">facelift</a> surgery. While I find it equally important to elevate the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">cheek</a> and <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">midface</a>, I believe that many patients are immediately satisfied with the appearance of the neck.<br /><br />I have found that <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">SMAS flaps </a>used to define the angle of the mandible are very effective. I have found that direct excision of fat to give the greatest control to defat the neck. Anterior platysmaplasty is most effective to reduce platysmal banding.<br /><br /><a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">Upper blepharoplasty </a>with excision of periorbital fat is beneficial to rejuvenate the eyes. I am a proponent of transconjunctival removal of fat for <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">lower blepharoplasty </a>and when indicated "skin pinch" lower blepharoplasty to rejuvenate the lower eyelid.<br /><br />While I have found many positive aspects to all of the different facelift techniques, my preferred technique involves sub-SMAS dissection and wide subcutaneous undermining.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-6488111127568224363?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-54228504891424659842009-12-29T09:29:00.000-08:002009-12-29T09:31:08.850-08:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/Szo8muQEtgI/AAAAAAAAASQ/JCoGKUhlVLQ/s1600-h/Micro+blog.JPG"><img id="BLOGGER_PHOTO_ID_5420711737441957378" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 392px; CURSOR: hand; HEIGHT: 270px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/Szo8muQEtgI/AAAAAAAAASQ/JCoGKUhlVLQ/s400/Micro+blog.JPG" border="0" /></a><br />Recipient Vessels Veins:<br /><br />1. Internal Mammary-3rd rib.<br />2. Internal Mammary – 2nd rib<br />3. External Jugular<br />4. Brachiocephalic<br />5. Thoracodorsal*<br /><br />Diameters of Deep Inferior Epigastric Vessels- 2.5 mm<br />Pedicle Length- 5 cm<br /><br />Coupler: Mobile to non-mobile (or)<br />Coupler: Diameter to be shortened 1st to match size discrepancy.<br /><br />Perforator Flap (Venous Flow). Perforator Decision Tree<br /><br />Palpable Pulse, No Venous Signal: +++<br />Arterial Signal, Venous Signal: +<br />No Arterial Signal, Venous Signal: ---<br /><br />Harvest of DIEP Flap:<br /><br />Vein<br />Artery<br />Vein<br /><br />Anastamosis Clamps Off:<br /><br />Venous Anastamosis<br />Arterial Anastamosis<br /><br />Fill Test, Reflow Test<br /><br />Doppler-Venous Augmentation Test<br /><div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-5422850489142465984?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-16432400163885019592009-12-27T22:29:00.000-08:002009-12-27T22:34:27.107-08:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/SzhRHet_KzI/AAAAAAAAASI/O62nKdRxlM0/s1600-h/Blog+SIEA.png"><img id="BLOGGER_PHOTO_ID_5420171340487273266" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 282px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/SzhRHet_KzI/AAAAAAAAASI/O62nKdRxlM0/s400/Blog+SIEA.png" border="0" /></a><br /><div><a href="http://1.bp.blogspot.com/_254hvtdnRaE/SzhQaDn-SCI/AAAAAAAAASA/3nxB10yHHPQ/s1600-h/DSC_0659.JPG"></a><br />Superficial Inferior Epigastric Artery Flap<br /><br />Features:<br /><br /><span style="color:#3333ff;">LOCATION:</span> Vertical or Horizontal Flap<br />Vertical flaps may extend up to the costal margin.<br />Horizontal flaps extend from ipsilateral anterior superior iliac spine across midline to the lateral border of contralateral rectus.<br /><br /><span style="color:#3333ff;">SIZE:</span> 15 x 30 cm<br /><span style="color:#3333ff;">FLAP TYPE:</span> Fasciocutaneous<br /><span style="color:#3333ff;">PATTERN OF CIRCULATION:</span> Type A<br /><br /><span style="color:#3333ff;">VASCULAR ANATOMY:</span><br />Dominant Pedicle: Superficial inferior epigastic artery and venae comitantes.<br />Regional Source: Superfical femoral artery and vein<br />Length: 4 to 6 cm<br />Diameter: 1 to 1.5 mm<br />Location The SIEA orginates from anterior surface of femoral artery 4 to 5 cm below inguinal ligament.<br /><br /><span style="color:#3333ff;">48% Common Origin with SCIA<br />10-15% Large SCIA without SIEA<br />42-47% Separate Orgins</span><br /><br />Arc of Rotation:Cover defects in lower abdomen, groin, perineum, gentalia, upper thigh, and trochanter. As a tubed flap, may be used for upper extremity reconstruction.<br /><div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-1643240016388501959?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-19946935084172501422009-12-27T21:52:00.000-08:002009-12-27T21:58:30.848-08:00<a href="http://1.bp.blogspot.com/_254hvtdnRaE/SzhH9X0lfoI/AAAAAAAAAR4/5lex-PW1i3I/s1600-h/DSC_0657.JPG"><img id="BLOGGER_PHOTO_ID_5420161271232560770" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 302px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/SzhH9X0lfoI/AAAAAAAAAR4/5lex-PW1i3I/s400/DSC_0657.JPG" border="0" /></a><br /><div><strong><span style="color:#ff99ff;">Chapter 4: Pathology of Breast Disorders</span></strong><br /><br />Functional unit of the breast is the terminal ductal lobular unit.<br /><br />The entire lobular and ductal structure of the breast is lined by two layers of cells:the inner epithelial layer and the outer myopepithelial layer.<br /><br />“Breast cancer” typically refers to breast carcinoma that arises by preferential growth of the inner epithelial layer.<br /><br /><strong><span style="color:#ff99ff;">Benign Disorders:</span><br /></strong><br />Fibrocystic change-pathologic condition that correlates with ‘lumpy’ breasts.<br /><br />This term is applied to a plethora of benign changes in the breast, which are best categorized based on the subsequent risk of development of breast carcinoma.<br /><br /><strong><span style="color:#ff99ff;">Three categories:</span></strong><br /><br />Non-proliferative lesions:<br />Proliferative lesions without atypia<br />Atypical hyperplasia<br /><br /><strong><span style="color:#ff99ff;">Nonproliferative Lesions</span></strong><br /><br /> This is the most common category of breast disorders and includes cysts, papillary apocrine change, mild hyperplasia of the usual type, and epithelial-related calcifications.<br /><br /> Women with these lesions do not incur a higher risk of development of breast carcinoma than that of women who had no breast biopsy (relative risk, 0.89)<br /><br /><span style="color:#ff99ff;"><strong>Proliferative Lesions without Atypia</strong><br /></span><br /> Women with these lesions have a slight risk of developing breast carcinoma, 1.5 to 2 times greater than the general population. This category includes moderate or florid hyperplasia of the usual type, sclerosing adenosis, small duct papillomas, and fibroadenomas.<br /><br />Sclerosis adenosis is the most common lesion and refers to expanded lobular units with a proliferation of both acini and intervening stroma. Microcalcifications are frequently seen and correspond to “benign calcifications” seen on mammography.<br /> </div><div><strong><span style="color:#ff99ff;">Atpical Hyperplasia</span></strong><br /><br /> Atypical hyperplasia confers a risk of development of breast cancer that is 3.5-5 times that of the reference population. This category includes both atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH).<br /><br /><strong><span style="color:#ff99ff;">Radial Scars and Complex Sclerosing Lesions</span></strong><br /><br />Radial scars are typically small areas of scarring (less than 1 cm) surrounded by glandular elements. <br /><br /><strong><span style="color:#ff99ff;">Benign Neoplasms</span></strong><br /><br /><strong><span style="color:#ff99ff;">Fibroadenoma</span></strong><br /><br />Fibroadenomas typically present as painless, mobile, rubbery masses. They are usually solitary but occasionally multiple. Most often present in the upper-outer quadrant and slightly more common in the left breast.<br /><br /><strong><span style="color:#ff99ff;">Solitary (Large Duct) Intraductal Papilloma<br /></span></strong><br />These tumors typically arise in a large duct in the subareolar region and present with unilateral hemorrhagic discharge.<br /><br /><strong><span style="color:#ff99ff;">Phyllodes Tumor</span></strong><br /><br />Character may be benign to malignant. Phyllodes tumors tend to have local recurrences and should be widely excised.<br /><br /><strong><span style="color:#ff99ff;">Lobular Carcinoma in Situ (LCIS)</span><br /></strong><br />LCIS is a rare multicentric entity that can not be identified clinically or on gross examination.<br /><br />The invasive carcinoma that may develop may be either ductal or lobular.<br /><br />LCIS is more common in younger, premenopausal women, and the mean age of diagnosis is 44 to 46 years.<br /><br />LCIS is commonly bilateral and multicentric (present in more than one quadrant).<br /><br />LCIS is typically an incidental finding in a breast biopsy done for a mammographically detectable lesion, which may be calcifications in adjacent sclerosing adenosis or other proliferative lesions.<br /><br />Estrogen receptor (ER) is typically over expressed in cells of LCIS, whereas Her-2/neu is not. E-cadherin is a useful marker to distinguish lobular and ductal proliferations because it is preferentially expressed in ductal proliferations.<br /><br />Most women with LCIS do not develop invasive carcinoma on follow-up, but it does confer a relative risk from 6.9 to 12. The carcinomas that develop are mostly invasive ductal carcinoma.<br /><br />LCIS is best considered to be a risk factor rather than a precursor of invasive carcinoma. Thus, the surgical management of LCIS does not aim for negative margins, and radiation therapy has no role in management of LCIS.<br /><br /><strong><span style="color:#ff99ff;">Ductal Carcinoma in Situ</span></strong><br /><br />Ductal carcinoma in situ (DCIS) comprises lesions in which the neoplastic growth of ductal cells is restricted within the ductal system.<br /><br />DCIS is considered to be a direct precursor of invasive carcinoma.<br /><br />The incidence of carcinoma in patients with DCIS varies from 11% to 53% and occurs in the ipsilateral breast.<br /><br />Mammographic abnormalities, which commonly show microcalcifications, are the most common presentation of DCIS.<br /><br />Comedo DCIS refers to central necrosis in the ducts that are lined by poorly differentiated cells. Comedo DCIS is invariably associated with calcifications.<br /><br />Comedo necrosis was the only factor found to correlate with ipsilateral recurrence in a multivariate analysis of nine histologic features of DCIS.<br /><br />The distinction between LCIS and DCIS can usually be made with E-cadherin staining. E-cadherin shows no staining in lobular proliferations.<br /><br />Low Grade DCIS tends to be ER and PR positive and Her2/neu negative.<br />High Grade DCIS tends to be ER/PR positive and Her2/neu positive.<br /><br />Tamoxifen decreases recurrence rates in patients with DCIS.<br /><br />DCIS specimens should be inked for margins. In NSABPB-17, only the presence of a tumor-filled duct in contact with the inked margin was categorized as a positive margin.<br /><br />Silverstein et al. showed that quantification of the distance of DCIS from the margin is useful, and greater than 1 cm is deemed to be a negative margin.<br /><br /><strong><span style="color:#ff99ff;">Paget’s Disease of the Nipple</span></strong><br /><br />Association of eczematous changes in the nipple with underlying mammary carcinoma. Paget’s disease of the nipple refers to the extension of underlying breast cancer to the skin of the nipple.<br /><br />Paget’s disease presents as scaling and erythema of the nipple-areola complex.<br /><br />95% of cases of Paget’s have underlying carcinoma, invariably ductal, and often associated with comedo-type DCIS.<br /><br />Immunohistochemical stains are useful to distinguish Paget’s from melanoma and clear cells of the epidermis.<br /><br />Her2/neu, epithelial membrane antigen, and polyclonal CEA are expressed in Paget’s CK 7 is positive in both Toker cells and Paget’s disease.<br /> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-1994693508417250142?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-82717395826585395432009-12-25T21:50:00.000-08:002009-12-25T21:58:09.877-08:00<a href="http://4.bp.blogspot.com/_254hvtdnRaE/SzWk4BK4FKI/AAAAAAAAARw/h3c-EHAQl1M/s1600-h/DSC_0655.JPG"><img id="BLOGGER_PHOTO_ID_5419419008903943330" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 294px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/SzWk4BK4FKI/AAAAAAAAARw/h3c-EHAQl1M/s400/DSC_0655.JPG" border="0" /></a><br /><div><strong><span style="color:#ff99ff;">Chapter 3: Mammography of the Surgically Altered Breast</span></strong><br /><br /><strong><span style="color:#ff99ff;">The Mammogram:Basic Principles:</span></strong><br /><br />Compression of the breast is important to separate structures, improve contrast and resolution, and minimize x-ray dose.</div><div><br />Standard mammogram two views of each breast:</div><div><br />The craniocaudal (CC) view is the projection from top to bottom.<br />The mediolateral oblique (MLO) view is the projection from side to side with the compression plates and x-ray tube angled obliquely parallel to the pectoralis major muscle to optimize imaging of the axillary tail.<br /><br />By convention, the projection markers are placed toward the axilla in each view.<br />Signs of malignancy include:<br /><br />A speculated lesion and calcifications that may be described at casting, granular, pleomorphic, or linear. </div><div><br />Other findings may include architectural distortion (speculations without central density), mass (which is usually ill defined but may be well defined), or an area of tissue asymmetry, not forming a three dimensional mass.<br /><br /><strong><span style="color:#ff99ff;">Studies:</span></strong><br /><br />A screening study is that which is performed on an individual in whom no disease is suspected.<br /><br />A diagnostic study is that performed on an individual with physical signs or symptoms of breast cancer or whose screening mammogram results were abnormal.<br /><br />Ultrasound is usually suggested when a cyst is a diagnostic possibility or to guide interventional procedures such as aspiration, biopsy, or abscess drainage.<br /><br /><strong><span style="color:#ff99ff;">Benign Biopsy Changes:</span></strong><br /><br />Dystrophic Calcifications<br />Spherical Calcifications<br /><br /><span style="color:#ff99ff;"><strong>Imaging the Conservatively Treated Breast:</strong><br /></span><br />Breast conservation therapy following lumpectomy or segmentectomy with radiation therapy and axillary node dissection presents unique challenges to the radiologist who must discriminate treatment changes from recurrence and monitor for metachronous lesions.<br />Mammography and physical examination are complementary and should in all cases be used as first-line follow-up methods.<br /><br />To establish a post treatment mammographic baseline, a unilateral examination is obtained of the post treatment breast at approximately six months after the initial diagnosis when surgery and radiation are completed.<br /><br /><strong><span style="color:#ff99ff;">Imaging the Postmastectomy Breast without Reconstruction:<br /></span></strong><br />In practice, there is typically insufficient tissue for mammographic evaluation, and standard compression mammography requires some amount of mobile tissue.<br /><br />Any recurrence in the skin or chest wall are appreciated by physical examination. CT-scan or ultrasound may be helpful in evaluating any possibility of recurrence.<br /><br /><strong><span style="color:#ff99ff;">Imaging the Postmastectomy Breast with Implant Reconstruction:<br /></span></strong><br />There is usually little to no residual breast tissue after mastectomy. Placement of an implant obscures native tissue, only a small rim of native tissue remains. Other imaging modalities may therefore be used in conjunction with mammogram.<br /><br /><strong><span style="color:#ff99ff;">Imaging the Postmastectomy Breast with Autogenous Reconstruction:</span></strong><br /><br />The autogenously reconstructed breast involves transfer of tissue as a myocutaneous flap on a pedicle, as a free flap attached by microvascular techniques, or a combination.<br /><br />There is no clearly established protocol for imaging the autogenously reconstructed breast. The reconstructed breast mound appears primarily lucent due to the fatty tissue.<br /><br />The imaging is more useful in evaluating the more common occurrence of fat necrosis, which may present as a palpable abnormality and is a benign process. Benign dystrophic calcifications or lipid cysts may appear mammographically.<br /><br /><strong><span style="color:#ff99ff;">Imaging the Implant-Augmented Breast:</span></strong><br /><br />The breast, augmented with saline, silicone, or saline-covered silicone (double-lumen) implant, is an important imaging topic because the patient population who were in their 20s and 30s during the 1970s have now entered the mammographic screening population.<br /><br />The normal implant appears as a radiodense oblong structure that may be subglandular or subpectoral. The margins are smooth. If the implant is double lumen, in many cases the density differences between the outer saline and inner silicone components makes these compartments radiographically visible.<br /><br />Mammography may detect some proportion of implant ruptures, but only when loss of integrity results in some change in shape or volume that can be projected in tangent to the dense implant itself.<br /><br />Intracapsular ruptures of silicone are mammographically occult.<br /><br />Saline implant ruptures are typically clinically apparent as abrupt decompression and usually do not warrant further imaging.<br /><br />Capsular calcification (unrelated to implant integrity) or a round configuration of the implant suggesting capsular contracture may also be observed mammographically.<br /><br />Supplemental views of the breast have been developed to optimize imaging of native glandular tissues to screen for breast cancer. Displacement views developed by Eklund involves pushing back the implant while pulling forward the native tissues with sufficient diagnostic compression.<br /><br />Native tissue may be obscured from the mammogram depending upon implant plane and the presence of capsular contracture.<br /><br /><strong><span style="color:#ff99ff;">Imaging the Postexplantation Breast:</span></strong><br /><br />Mammographic findings after implant removal are varied.<br /><br />Serous fluid may fill the cavity and give the appearance of the implant itself. As this pocket matures and fibroses, masslike density with or without coarse calcification may develop. When the implant is removed without complication by rupture, the are may heal completely without identifiable scarring.<br /><br /><strong><span style="color:#ff99ff;">Postreduction Mammoplasty Breast:</span></strong><br /><br />Reduction mammoplasty is a commonly performed procedure:<br /><br />Either:<br /><br />To achieve breast symmetry (typically after surgical management of a contralateral breast cancer has resulted in breast asymmetry)<br />To relieve macromastia.<br /><br />Mammogram should be obtained pre-operatively in the age-appropriate patient so an occult cancer can be excluded.<br /><br />Once the procedure is done, a follow-up mammogram should be obtained in 1 year to reestablish the new mammographic baseline appearance.</div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-8271739582658539543?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-64760918673174184022009-12-20T20:41:00.000-08:002009-12-20T20:54:49.194-08:00<img id="BLOGGER_PHOTO_ID_5417547987811418146" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 295px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/Sy7_MQchwCI/AAAAAAAAARg/6jO5dchzZx8/s400/Spear+Blog.png" border="0" /><br /><span style="color:#ff99ff;">Surgery of the Breast: Principles &amp; Art. Editor Scott L. Spear. Associate Editors: Shawna C. Willey, Geoffrey L. Robb, Dennis C. Hammond, Maurice Y. Hahabedian.</span><br /><br />Chapter 1. Incidence, Trends, and the Epidemiology of Breast Cancer.<br /><br /><span style="color:#ff99ff;">Reading Notes: Part I. </span><br /><br />Breast Cancer is the most common cancer among women in North America, representing 32% of all new female cancers.<br />Physicians from all specialties will commonly see women with breast cancer in their practices and should understand the etiology of the disease.<br /><br />Trends in Breast Cancer Incidence, Stage at Diagnosis, and Mortality<br /><br /><span style="color:#ff99ff;">Invasive Breast Cancer</span><br /><br />In the United States, breast caner incidence has steadily increased, with a concomitant decrease in mortality.<br /><div><div><br />Stage Distribution of Breast Cancer Cases:<br /><br />1995 and 2000 -- 63% of women diagnosed with breast cancer had localized disease, 29% had regional involvement, and 6% were diagnosed de novo with metastatic disease.<br />Improved since: 1974 and 1985 -- when the incidences were 48%, 41%, 7%.<br /><br />This supports the value of screening in providing early detection. Mortality has<br />decreased, evidenced by the increased use of mammography.<br /><br /><span style="color:#ff99ff;">Ductal Carcinoma in Situ (DCIS)<br /></span><span style="color:#ffccff;"><br /></span>Ductal carcinoma in situ (DCIS) is a noninvasive form of breast cancer that may progress to invasive disease if not detected and treated.<br />Prior to 1970 DCIS represented 3-4% of breast cancer diagnoses and most commonly presented as a palpable mass greater than 1 cm. in diameter.<br /><span style="color:#ff99ff;">DCIS now represents 25% of new breast cancer diagnoses, and most commonly presents as clustered microcalcifications detected mammographically.</span> DCIS is 98% curable and early detection has contributed to the observed decrease in breast cancer mortality.<br /><span style="color:#ff99ff;">Because mastectomy is associated with both physical and emotional morbidity, breast conserving surgery has been studied in DCIS patients.</span><br /><br /><span style="color:#ff99ff;">Lobular Carcinoma in Situ (LCIS)</span><br /><br /><span style="color:#ff99ff;">Lobular carcinoma in situ increases the risk of cancer, but it is not a premalignant lesion. Instead, it is a marker of increased risk</span>. The conclusion is drawn from the observations that most subsequent invasive cancers are infiltrating ductal, not lobular, carcinomas and that LCIS and invasive lobular carcinoma rarely coexist in the same specimen.<br /><span style="color:#ff99ff;">The risk of breast cancer when LCIS is present is bilateral, so management should address both breasts as a single organ.</span> Because LCIS is premalignant, there is no role for lumpectomy, radiation therapy, unilateral mastectomy, or systemic chemotherapy.<br /><br />Options for LCIS:<br /><br />1. One option is <span style="color:#ff99ff;">frequent observation</span> because some patients may not develop cancer. This management consists of breast examination every 3-6 months with yearly mammograms and prompt workup and/or biopsy of suspicious findings. This option is designed to detect cancer, should it occur, at the earliest possible stage and is not designed to prevent cancer.<br /><br />2. A second option includes <span style="color:#ff99ff;">bilateral prophylactic mastectomy</span> that removes tissue at risk. </div><div><br />3. A third option is a <span style="color:#ffccff;">5 year course of tamoxifen</span>. In the NSABP P-1 study, the Breast Cancer Prevention Study, tamoxifen reduced the risk of breast cancer by 56% </div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-6476091867317418402?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-1794651174453160192009-12-20T11:37:00.001-08:002009-12-20T11:51:03.402-08:00<a href="http://4.bp.blogspot.com/_254hvtdnRaE/Sy59DocVgPI/AAAAAAAAARQ/NfbWNfMGs14/s1600-h/DCIS+Blog.png"><img id="BLOGGER_PHOTO_ID_5417404903122632946" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 348px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/Sy59DocVgPI/AAAAAAAAARQ/NfbWNfMGs14/s400/DCIS+Blog.png" border="0" /></a><br /><div>Article Review of <span style="color:#ff99ff;">"Re: Trends in the Treatment of Ductal Carcinoma In Situ of the Breast." Journal of the National Cancer Institute. 96(16):1258-1259, August 18, 2004.[CORRESPONDENCE] by Gordon F. Schwartz, Michael D. Lagios, Melvin J. Silverstein.</span></div><div> </div><div></div><div>Synopsis: At the time the article was written, the management of DCIS was in evolution to include: Breast conservation therapy, the use of adequate excision alone without radiation therapy, and the avoidance of axillary lymph node dissection for the disease. The management of DCIS needs a dedicated team for mammographic pathologic correlation, specimen radiography, inking of margins, and thorough histologic examination. </div><div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-179465117445316019?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-27897268047948737632009-12-19T13:21:00.001-08:002009-12-20T11:39:40.989-08:00<a href="http://journals.lww.com/plasreconsurg/pages/default.aspx"><img id="BLOGGER_PHOTO_ID_5417065248054879986" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 235px; CURSOR: hand; HEIGHT: 289px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/Sy1IJGtspvI/AAAAAAAAARA/Yxctd9YkqiE/s400/Breast+Cancer+in+Augmented+Women+Blog.png" border="0" /></a><br /><div>Review of <span style="color:#ff99ff;">"</span><span style="color:#ff99ff;">Breast Cancer Diagnosis and Prognosis in Augmented Women" Plastic &amp; Reconstructive Surgery 118: 587-593, 2006 by Neal Handel &amp; Melvin J. Silverstein."</span></div><br /><div>Frequently in my practice I am asked by many women who desire breast augmentation or who have already had a breast augmentation and now want a lift, removal and replacement, or surgery for capsular contracture the following question:<br /><br /><strong><span style="color:#ff99ff;">Do breast implants impair my ability to detect breast cancer or increase my risk of getting breast cancer?</span></strong><br /><br />To answer this question and as part of my own self study, I read and reviewed an article in Plastic &amp; Reconstructive Surgery 118: 587-593, 2006 by Neal Handel &amp; Melvin J. Silverstein. I present here notes which are helpful for my own self study as well as for patient education during consultation:<br /><br /><strong>Background:</strong><br />--Breast enlargement surgery is popular. More than 334,000 women underwent elective breast augmentation in 2004.<br />--A woman in the United States has a 1 in 7 (13.4 percent) lifetime risk of developing breast cancer.<br />--There is no etiologic link between implants and breast tumors. Numerous studies show that the rate of breast cancer is not increased among augmented women, and some studies demonstrate lower than expected rates.<br />--However, because of the large number of women undergoing augmentation, there have been persistent concerns about possible adverse effects of implants on cancer detection and treatment.<br /><br /><strong>Methods:</strong><br />The authors reviewed their database of women with breast cancer and determined if there was a difference in breast cancer between augmented and non-augmented women.<br /><br /><strong>Results:</strong><br />--<span style="color:#ff99ff;">There was no statistically significant difference in stage of disease between augmented and non-augmented patients. The mean tumor size, recurrence rates, and breast cancer- specific survival were virtually identical in both groups.<br /></span>--Augmented patients were more likely to present with palpable lesions.<br /><br /><strong>Conclusion:</strong><br /><span style="color:#ff99ff;">Augmented and nonaugmented patients are diagnosed at a similar stage of breast cancer and have a comparable diagnosis. While implants may impair mammography, they appear to facilitate detection of palpable breast cancers on physical examination.</span> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-2789726804794873763?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-17895761233432398992009-12-19T07:19:00.001-08:002009-12-19T13:20:52.878-08:00<img id="BLOGGER_PHOTO_ID_5417042185826659026" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 196px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/Sy0zKtOA6tI/AAAAAAAAAQw/-jObFJSLPJw/s400/Airway+Reconstruction.png" border="0" /><br /><div>In <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">nasal airway surgery</a>, it is a great compliment when involuntarily the patient closes her mouth and breathes through her nose in the post operative photograph.<br /></div><br /><div><a href="http://3.bp.blogspot.com/_254hvtdnRaE/Syzyv4XxdWI/AAAAAAAAAQY/s_HjWVn42dc/s1600-h/Airway+Reconstruction+1.jpg"><img id="BLOGGER_PHOTO_ID_5416971356219733346" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 294px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/Syzyv4XxdWI/AAAAAAAAAQY/s_HjWVn42dc/s400/Airway+Reconstruction+1.jpg" border="0" /></a><br /><div><div><div>As an associate to world <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">rhinoplasty</a> expert Dr. Jay Calvert, I am constantly learning about <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">complex airway surgery</a>, <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">secondary rhinoplasty with rib graft</a>, and <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">total nasal reconstructions</a>.<br /><br />Since Dr. Calvert often speaks both nationally and internationally about rhinoplasty, it is important as his associate that I understand about the pre-operative, operative, and post-operative care of the rhinoplasty patient. Being Dr. Calvert's associate is demanding, but the rewards are great. The reading list to begin understanding Dr. Calvert's practice, started with Dr. Daniel’s book, Rhinoplasty: An Atlas of Surgical Techniques.<br /><br />As an associate to Dr. Calvert, my own <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">airway reconstruction </a>and <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">rhinoplasty </a>practice has started to grow. One of the more interesting observations in my patients is the ancillary findings on physical examination. Usually, I appreciate an unintentional open mouth smile in my post-operative photographs. However, for <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">airway reconstructions</a>, I am most pleased when the mouth is involuntarily closed. In these cases, I am convinced that the nasal airway is patent and the <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">airway surgery </a>was successful.<br /><br />At this point in my career, I have found that an optimal view of a <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">deviated</a> <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">septum</a> is best obtained via an <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">open rhinoplasty </a>incision. This approach allows separation of the <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">lower lateral cartilages</a>, visualization of the entire septum, and an optimal view through which to perform septoplasty. The harvested <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">septum</a> is then used for spreader grafts to support the <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">internal nasal valve</a>. I have been very happy with the use of <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">septal cartilage </a>for <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">lateral crural strut grafts </a>to stabilize the <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">external nasal valve</a>. </div></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-1789576123343239899?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-65242757201502433962009-12-10T21:53:00.000-08:002009-12-18T19:06:35.023-08:00<a href="http://www.drbriandickinson.com/sub/breast-reconstruction.jsp"><img id="BLOGGER_PHOTO_ID_5413854802599265394" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 214px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/SyHgQlZ4xHI/AAAAAAAAAOw/upsUnTJj2Qk/s400/Blog+Photo.png" border="0" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/breast-reconstruction.jsp"><img id="BLOGGER_PHOTO_ID_5413854633929965682" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 258px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/SyHgGxD_gHI/AAAAAAAAAOo/gZJJQ-1H90E/s400/Blog+Photo+2.png" border="0" /></a><br /><span style="color:#99ffff;">It is truly a great honor and privilege to have an opportunity to apply my aesthetic surgery training to breast reconstruction. Measurements I have found helpful for modifications of <a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp">TRAM flap reconstructions </a>are: 1) Base width, 2) Breast Height, 3) and transverse diameter of breast cup size as described by Pechter. In the photographs shown above, the patient is seven days post-operatively from her reconstruction. She will return for second stage <a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp">breast reconstruction </a>adjustments as well as reconstruction of her nipple areola complex. As a physician and surgeon I have made an agreement and commitment to myself to continuously learn and improve. While setting aside one hour a day to read in one’s field is extremely powerful, it is most advantages to perform those learning activities that increase one’s ability to “attend” or focus on a topic. The more proactive the learning activity the more effective the learning tool.<br /><br />Reading Material: </span></div><div><span style="color:#99ffff;"></span></div><span style="color:#99ffff;">1. </span><a href="http://www.chipsbooks.com/reoplast.htm"><span style="color:#99ffff;">Reoperative Plastic Surgery of the Breast, Kenneth C. Shestak</span></a><span style="color:#99ffff;"><br />2. Surgery of the Breast: Principles and Art, by Scott Spear<br />3. Silverstein, MJ: Published Articles<br /><br />I have found these textbooks to provide excellent background on aesthetic and reconstructive principles of the breast. </span><div></div><div><br /><span style="color:#99ffff;">The Hoag Breast Cancer Weekly Conference: </span></div><div><br /><span style="color:#99ffff;">I have been truly fortunate to interact with an outstanding group of clinical and academic surgical oncologists, oncoplastic surgeons, oncologists, radiologists, radiation oncologists, and geneticists.<br /><br />One world renowned oncoplastic surgeon Dr. Melvin Silverstein is truly a leader in his field. Not only is he a truly committed surgeon, but he has over thirty publications in the surgical literature and continually educates through lectures at conference. I look forward to reading his publications. The cosmetic results of Dr. Silverstein's oncologic resections are truly outstanding. </span></div><div><br /><span style="color:#99ffff;">My education continues through the examination of mammograms and MRIs with the radiologists, radiation treatments with the radiation oncologists, genetic trees with the geneticists, and finally I am becoming reacquainted with chemotherapy regimens and their mechanisms with the oncologists.<br /><br /></span></div><span style="color:#99ffff;"><strong>Research Idea:<br /></strong><br />The trend in <a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp">microsurgical breast reconstruction </a>appears to have moved towards improving the donor defect of the abdominal wall. I have always been fascinated by the “delay phenomenon” for the <a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp">TRAM flap </a>that when the <a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp">DIEA</a> is ligated the SEA increases in diameter and the zones of perfusion of the abdomen improve. The physiology occurs secondary to the pressure gradients within the vessels that provide circulation to the lower abdominal wall.<br /><br />I hope to one day research and translate findings to the clinical setting of a delay procedure for the <a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp">SIEA flap</a>. The <a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp">SIEA flap </a>obviates the need for the surgeon to open up the fascia of the anterior rectus sheath, potentially decreasing operative time and abdominal donor site morbidity for the patient. </span><div></div><div><span style="color:#99ffff;">In therory, if the deep inferior epigastric system were ligated distally via the perforators through the fascia, then could a “delay phenomenon” increase the diameter of the <a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp">SIEA</a> and <a href="http://www.drbriandickinson.com/sub/facial-trauma.jsp">SIEV</a> reliably to obviate the need for the surgeon to enter the fascia. If these procedures are easily reproducible, then could free microvascular tissue transfer for breast reconstruction then be done on a completely outpatient basis?</span></div><div> </div><div><span style="color:#99ffff;"></span></div><div><span style="color:#99ffff;"></span></div><div><span style="color:#99ffff;">Brian P. Dickinson, M.D.</span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-6524275720150243396?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-89496451076431740212009-12-03T15:08:00.000-08:002009-12-03T17:07:01.503-08:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/SxhghBkQe2I/AAAAAAAAANk/i0JiTTWue9o/s1600-h/Breast+Augmentation.png"><img id="BLOGGER_PHOTO_ID_5411181072758111074" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 295px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/SxhghBkQe2I/AAAAAAAAANk/i0JiTTWue9o/s400/Breast+Augmentation.png" border="0" /></a><br /><div><div>The most personally rewarding part of my day is the expression of gratitude I receive from my patients. The highest compliment that I could ever receive is a patient testimonial.<br /><br />One recent patient testimonial came in the form of before and after photographs from her recent photoshoot.<br /><br />Breast augmentation in the runway model physique is particularly challenging as it is important to hide the appearance that a surgery was performed. Furthermore, it is a requirement for these models to “fit” their respective clothing line and often remain in the same cup size bra or within a cup. While the increase in cup size is usually modest in comparison to other breast augmentation populations, the difference is significant to the camera, the advertisement, the patient, and her family. </div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-8949645107643174021?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-5962821492868881452009-12-01T18:36:00.000-08:002009-12-01T19:15:59.143-08:00<a href="http://2.bp.blogspot.com/_254hvtdnRaE/SxXbyzbXxwI/AAAAAAAAANM/HH2Yse0tr-Y/s1600-h/Capsular+Contracture.png"><img id="BLOGGER_PHOTO_ID_5410472193200473858" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 209px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/SxXbyzbXxwI/AAAAAAAAANM/HH2Yse0tr-Y/s400/Capsular+Contracture.png" border="0" /></a><br /><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">Capsular contracture</a> is common sequelae of breast augmentation surgery. When a <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">breast implant </a>or other medical device is placed in the body a <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">lining</a> may form around the device. The <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">lining</a> that is created is the body's natural response. In some individuals or in some scenarios the <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">lining</a> that forms can contract or thicken aggressively which is an unnatural or undesirable response of the body to the <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">breast implant</a>. When the lining contracts around something that is soft, such as a <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">breast implant</a>, the surface area: volume ratio of the lining: implant changes.<br /><br />When the surface area lining decreases around the fixed implant volume, the construct becomes hard. This <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">hardening of the implant </a>can cause significant pain to the patient and may temporarily disfigure the breast until the <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsule</a> is released or removed. There is a four grade classification scale, the Baker Grading Scale to describe <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture</a>:<br /><br />Grade I - The breast is soft, and appears natural.<br />Grade II- The breast is firm, but still appears natural. <div><div><div>Grade III - The breast is firm, and is beginning to appear distorted in shape. Grade IV- The breast is hard, distorted in shape, and is painful.<br /><br />Typically patients present to our office when a Grade III or Grade IV <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsule</a> has developed. Often patients choose to undergo surgery for their <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture</a> for these grades secondary to pain or because the distortion has changed the appearance or begins to interfere with mammography.<br /><br />The above patient presented with bilateral painful <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">Baker Grade IV capsular contracture</a> that was surgically corrected with bilateral "en bloc" <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsulectomy</a>, change of implant plane, and replacement of the breast implant.<br /><br /><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">Capsular contracture surgery </a>is commonly performed in both the Beverly Hills and Newport Beach, CA locations.</div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-596282149286888145?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-7881825362069622172009-11-24T10:07:00.000-08:002009-11-24T10:51:03.202-08:00<div align="left"><a href="http://2.bp.blogspot.com/_254hvtdnRaE/SwwhBOx3IkI/AAAAAAAAAMc/cwriEZmuBNY/s1600/Journal+Blog.png"><img id="BLOGGER_PHOTO_ID_5407733557595939394" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 337px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_254hvtdnRaE/SwwhBOx3IkI/AAAAAAAAAMc/cwriEZmuBNY/s400/Journal+Blog.png" border="0" /></a><br />I am honored to be published in the Journal of Craniofacial Surgery with surgeons who are pioneers and leaders in the field. It is a great and unique opportunity to be able to contribute to Plastic &amp; Reconstructive Surgery research with one of my greatest mentors in the field, Dr. Malcolm A. Lesavoy.<br /><br /></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-788182536206962217?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-3389088639876629622009-11-18T19:28:00.000-08:002009-11-18T20:03:13.842-08:00<a href="http://1.bp.blogspot.com/_254hvtdnRaE/SwTBFeNN-pI/AAAAAAAAAMM/zJ2GtMtE77Y/s1600/Blog+Card.png"><img id="BLOGGER_PHOTO_ID_5405657752503450258" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 174px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/SwTBFeNN-pI/AAAAAAAAAMM/zJ2GtMtE77Y/s400/Blog+Card.png" border="0" /></a><br /><div><div><a href="http://www.drbriandickinson.com/"><img id="BLOGGER_PHOTO_ID_5405651692865389106" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 197px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/SwS7kwS7AjI/AAAAAAAAAL0/O3Qj1HfnPdQ/s400/Facial+Fracture+Blog.png" border="0" /></a><br /></div><div>Facial trauma and facial fractures are surgical procedures I enjoy, as I find the anatomy fascinating and I enjoy continually trying to improve ways in which to conceal scars. The one aspect that I appreciate the most about my profession, are cards or testimonials that I receive from patients or their family members.<br /><br />This nice family member writes:<br /><br />"I want to thank you for your kindness, generosity and most of all for taking care of my brother this past week.<br /><br />Having unexpected surgery is always a little unsettling, but your demeanor, dedication, and expertise made my family and I feel very comfortable and confident in you. Right from the start we knew we were in great hands.<br /><br />We will be forever thankful to you and there will always be a piece in our hearts that will remind us of you very fondly.<br /><br />Thank You. Thank You. Thank You"<br /><br />Cards such as these are one of the highest compliments that I could ever receive and I am truly touched.<br /><br />As my career advances, I find more similarity between reconstructive and aesthetic surgery. Both disciplines require a well thought out operative plan, a thorough knowledge of the anatomy, and conscientious and careful patient follow-up. I am very thankful to have had excellent training.<br /><br />Brian P. Dickinson, M.D.</div></div><div><br /></div><br /><div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-338908863987662962?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-42436075738621516422009-11-02T16:00:00.000-08:002009-11-02T22:28:59.036-08:00<a href="http://www.drbriandickinson.com/"><img id="BLOGGER_PHOTO_ID_5399662458388357650" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 217px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/Su90ZbNAIhI/AAAAAAAAAKk/SAumv1Z-pc8/s400/Mastopexy+Aug+Frontal.png" border="0" /></a><br /><div><a href="http://www.drbriandickinson.com/"><img id="BLOGGER_PHOTO_ID_5399661534358647218" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 277px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_254hvtdnRaE/Su9zjo7JsbI/AAAAAAAAAKc/f2aTrn-QzEI/s400/DSC_0403.JPG" border="0" /></a><br /><br /></div><div><div><div><a href="http://www.drbriandickinson.com/"><img id="BLOGGER_PHOTO_ID_5399661011054512594" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 235px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_254hvtdnRaE/Su9zFLduSdI/AAAAAAAAAKM/G32tnXxBCeg/s400/Mastopexy+Aug+75L.png" border="0" /></a><br /><br /><div><a href="http://www.drbriandickinson.com/"><img id="BLOGGER_PHOTO_ID_5399660819074613602" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 234px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_254hvtdnRaE/Su9y6ASJgWI/AAAAAAAAAKE/u6ehavf1XPQ/s400/Mastopexy+Aug+75R.png" border="0" /></a> </div><div>More frequently, I am seeing patients in my office who have had large <a href="http://www.drbriandickinson.com/">implants </a>for quite some time and now want their <a href="http://www.drbriandickinson.com/">implants exchanged </a>for smaller implants and would also like their breasts lifted. These operations are typically challenging. As one reduces the size of the <a href="http://www.drbriandickinson.com/">breast</a> or changes the shape of the <a href="http://www.drbriandickinson.com/">breast</a>, it is important to respect the blood supply of the nipple areola complex.<br /><br />For example, this patient had a prior <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">mastopexy augmentation </a>via a superior crescent <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">mastopexy augmentation </a>incision in the submuscular position. Therefore, one needs to be cognizant of the remaining blood supply when attempting to raise the <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">nipple areola complex</a>.<br /><br />This patient underwent <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">bilateral capsulectomy</a>, bilateral removal and replacement of saline <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">implants</a> for Mentor smooth round high profile silicone <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">gel implants</a>, and <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">mastopexy </a>via an oblique pattern.<br /><br />I have found that the vertical, oblique, and helium balloon pattern mastopexy (described by Dr. Ed Pechter of Valencia, California) to provide excellent projection while removing excess skin. I have found that many women appreciate the breast projection that these patterns in combination with the high profile implant provide. </div></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-4243607573862151642?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-75126100972344385022009-10-25T10:29:00.000-07:002009-10-25T13:34:47.095-07:00<a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5396591550140909714" src="http://1.bp.blogspot.com/_254hvtdnRaE/SuSLbCgGCJI/AAAAAAAAAIk/mt4YqHFFcGE/s400/Oblique+Facelift+1.png" style="cursor: hand; display: block; height: 252px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5396591317395505794" src="http://1.bp.blogspot.com/_254hvtdnRaE/SuSLNfdRAoI/AAAAAAAAAIc/5vz6_ut5WRw/s400/Frontal+Facelift+Photo.png" style="cursor: hand; display: block; height: 247px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /></div><div><br />While I enjoy all aspects of Plastic &amp; Reconstructive surgery, <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">facelift surgery </a>is particularly enjoyable to me. I am very fortunate to have a successful <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">facelift</a> practice at such an early point in my career. I am very grateful to have learned from such excellent mentors in Beverly Hills and I give the highest thanks to Dr. Giacobazzi, Dr. Moelleken, Dr. Markowitz, Dr. Perlman, Dr. Lesavoy, &amp; Dr. Leaf for giving me the opportunity to watch and learn from them. They provided me with invaluable knowlege, experience, lessons, and insight.<br /><br />As I review my results, I understand the importance of <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">rejuvenation</a> of the eyes to create a more youthful appearance to the face. As the face ages, the brow descends and skin accumulates around the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">upper lid </a>and fat begins to herniate through the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">lower lids </a>creating a tired appearance to the eye. While I do not encourage procedures during <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">consultations,</a> I often point out to patients who present for <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">facelifts</a> that small, subtle changes to the eye can yield a large difference. In this photograph one notices how effectively an <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">upper blepharoplasty</a>, or <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">upper eyelid</a>, procedure in conjunction with removal of fat from the lower eye can restore a youthful appearance to the face when utilized in conjunction with a <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">facelift</a>.<br /></div><div></div><div></div><div>Brian P. Dickinson, M.D.<br /></div><div></div><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-7512610097234438502?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-50525149717533267552009-10-21T23:47:00.000-07:002009-10-25T13:11:12.349-07:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/SuAARgqq3XI/AAAAAAAAAG0/SE7kEQ8dmFY/s1600-h/PFGBPD.JPG"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395312654416534898" src="http://3.bp.blogspot.com/_254hvtdnRaE/SuAARgqq3XI/AAAAAAAAAG0/SE7kEQ8dmFY/s400/PFGBPD.JPG" style="cursor: hand; display: block; height: 274px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div><a href="http://1.bp.blogspot.com/_254hvtdnRaE/SuAALECm-YI/AAAAAAAAAGs/ppyI-XxmURc/s1600-h/Copy+of+Men_at_work.JPG"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395312543653099906" src="http://1.bp.blogspot.com/_254hvtdnRaE/SuAALECm-YI/AAAAAAAAAGs/ppyI-XxmURc/s400/Copy+of+Men_at_work.JPG" style="cursor: hand; display: block; height: 246px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> <br /></div><br />I am truly grateful to have Plastic &amp; Reconstructive surgery practices in both Orange County and Beverly Hills, California. As another birthday passes, my career advances, I accrue more wisdom, and I give thanks for what I have and what I have attained.<br /><br />Among the many things I am thankful for, one is the great relationships that I have developed with the outstanding surgeons who trained me and who are truly masters in the field. I look forward to maintaining these relationships in the future. Relationships take time, effort, and energy. I look forward to the benefits that will be gained from the hard work and I look forward to making my mentors proud.<br /><br />Brian P. Dickinson, M.D.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-5052514971753326755?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-24960187911383516852009-10-21T18:00:00.000-07:002009-10-25T13:32:55.663-07:00<a href="http://www.getsizedup.com/"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395305431332950562" src="http://4.bp.blogspot.com/_254hvtdnRaE/St_5tElWEiI/AAAAAAAAAGc/yuMudz_NkZE/s400/Pechter.bmp" style="cursor: hand; display: block; height: 143px; margin: 0px auto 10px; text-align: center; width: 383px;" /></a><br /><div><a href="http://1.bp.blogspot.com/_254hvtdnRaE/St_4oK1z2AI/AAAAAAAAAGU/upBpifuncSs/s1600-h/Pechter.bmp"></a>Breast augmentation consultations and procedures may be challenging when trying to determine post-operative bra size. I have found the bra-sizing system designed by Dr. Edward A. Pechter from Valencia, CA to be the most effective method for successful breast procedures.<br /></div><br /><div><a href="http://2.bp.blogspot.com/_254hvtdnRaE/St-vAJt8baI/AAAAAAAAAGM/mcvpVSeNjLg/s1600-h/Breast+Augmentation+Sizing.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395223295756627362" src="http://2.bp.blogspot.com/_254hvtdnRaE/St-vAJt8baI/AAAAAAAAAGM/mcvpVSeNjLg/s400/Breast+Augmentation+Sizing.png" style="cursor: hand; display: block; height: 228px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div><a href="http://1.bp.blogspot.com/_254hvtdnRaE/St-u341cenI/AAAAAAAAAGE/wX-W4ANgnp8/s1600-h/Breast+Augmentation+Sizing+2.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395223153785731698" src="http://1.bp.blogspot.com/_254hvtdnRaE/St-u341cenI/AAAAAAAAAGE/wX-W4ANgnp8/s400/Breast+Augmentation+Sizing+2.png" style="cursor: hand; display: block; height: 263px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br />The <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast augmentation </a>consultation can often bring anxiety to the patient as there are many questions to be addressed or discussed. These variables can range from topics pertaining to the patient (medical conditions, height &amp; weight, bra size, pre-operative breast shape); surgeon (preference for above vs. below the muscle, incision choice); or implant (saline vs. silicone, smooth vs. textured, profile).<br /><br />Determining bra size in <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast procedure </a>consultations creates a common frame of reference for the physician and patient to discuss post operative bra size. The first step in the physical examination is observation. In the observation step, both the patient and I stand in front of the mirror and with the same perspective identify any asymmetries between the breasts. <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">Breasts</a> are more often than not asymmetric with either a discrepancy in breast volume, breast fold position, nipple position, shoulder height, and chest wall asymmetry. After this step of the physical examination we proceed to pre-operative <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">bra sizing</a>.<br /><br /><strong>Bra Sizing: The Basics</strong><br /><br />The size of a bra is determined by two factors: 1) The Band Size &amp; 2) The Cup Size.<br /><br /><strong>1) The Band Size</strong><br /><br />Step 1. The band size of the bra is relatively a fixed number determined by the circumference of a woman’s chest. This number can be measured with a measuring tape in inches, just beneath the <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breasts</a>, in the crease where the band of the bra would be placed.<br />Step 2. Add five to the number of inches determined from this measurement. For example, if the measured number is 27” then if you add the number 5, the result is 32. Therefore the band size of the bra necessary is 32. If the measured number were 28” adding 5 would result in a 33 band. One quickly realizes when bra shopping that there are no odd number band sizes, so one would try on a 32 or 34 band bra to see which fit best. In this scenario, the 32 bra would be worn on the last of three clasps and a 34 bra would be worn on the first of three clasps.<br /><br />The band size is relatively consistent in women of adult age as the bony ribcage has completed growing. This number will change to a small degree if a woman gains or looses weight around the chest where the band of the bra would normally be placed. The so called “bra fat”.<br /><br /><strong>2) The Cup Size </strong><br /></div><div><br />I have found the “Size Me Up” system designed by Edward Pechter in Valencia, CA to be the best system for determining cup size. In the “Size Me Up” system, the dome of the breast is measured by starting the measurement from where the <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast</a> begins on the side of the chest, passing over the nipple and finishing towards the sternum where the breast ends. The resulting measurement is then compared on the “Size Me Up” chart to determine the cup and bra size.<br /><br />One point I have learned is that the “cup volume” or “measured breast dome” increases depending upon the band width. That is, a “C” cup represents a smaller volume <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast</a> for a woman with a small ribcage (i.e.32 band size bra, C-cup) than a woman with a larger ribcage (i.e. 36 band size bra, C-cup).<br /><br />In my experience, the best manner in which to predict the post-operative cup size is to determine the pre-operative bra size measurements and base diameter of the patient. The post-operative cup size can be predicted by using these measurements with the volume per base diameter of the <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast implant</a>.<br /><br />While the prediction of post-operative cup size is not exact, I find this step to be helpful, as it facilitates a common frame of reference between the patient and surgeon.<br /><br />Photograph: <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">Revision breast augmentation</a>. <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">Bilateral Capsulectomy</a>, Conversion of total submuscular saline <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast augmentation </a>to dual plane silicone <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast augmentation</a>.<br /></div><br /><br /><div></div><br /><br /><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div><br /><br /><div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-2496018791138351685?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-24091964534083955152009-10-20T18:20:00.001-07:002009-10-25T13:32:36.890-07:00<a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5394858595347362658" src="http://4.bp.blogspot.com/_254hvtdnRaE/St5jTy0kc2I/AAAAAAAAAF8/6WsnjBerR2c/s400/Anterior+Medial,+Lateral+Thigh+Lipo.png" style="cursor: hand; display: block; height: 237px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5394858495630392418" src="http://4.bp.blogspot.com/_254hvtdnRaE/St5jN_WMPGI/AAAAAAAAAF0/el7vknyst3Q/s400/Close-Up,+Medial,+Lateral+Thigh+Lipo.png" style="cursor: hand; display: block; height: 145px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><br /><div align="left"><a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5394858352026223986" src="http://1.bp.blogspot.com/_254hvtdnRaE/St5jFoYShXI/AAAAAAAAAFs/svnjHWzOypk/s400/Posterior+Medial,Lateral+Thigh+Lipo.png" style="cursor: hand; display: block; height: 267px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><br />While I enjoy all aspects of my Plastic and Reconstructive Surgery practices in Newport Beach &amp; Beverly Hills, California, I have found that <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> is often a very powerful tool whether it is used alone or in conjunction with other <a href="http://www.drbriandickinson.com/sub/cosmetic-procedures-newport-beach.jsp">aesthetic procedures</a>.<br /><br />I have already commented on the efficacy of <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> for the "upper arm and bra fat" areas in my previous blog publication. <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">Liposuction</a> is an excellent adjunct to <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp">breast augmentation</a>, <a href="http://www.drbriandickinson.com/sub/implant-removal-replacement-breast-lift.jsp">breast lifts</a>, <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">rhinoplasty</a>, and <a href="http://www.drbriandickinson.com/sub/abdominoplasty.jsp">abdominoplasty</a>.<br /><br />For example, frequently I have patients who undergo <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp">breast augmentation </a>who would also like to have <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> performed on the localized fat deposits beneath their chin or neck. Or, a woman who wants to have a rhinoplasty or "nosejob" performed and have the fat removed from beneath her chin or neck. These types of combination procedures are very powerful when performed in the same aesthetic region, for example <a href="http://www.drbriandickinson.com/sub/rhinoplasty-procedure.jsp">rhinoplasty</a> and neck/chin <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> as well as breast lift with <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> of the bra fat.<br /><br />Above you see before and after results of <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> of the inner and outer thighs and lower abdomen of a happy patient. I find it to be of paramount importance that <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> should not be overdone as the natural contour of the body part may become distorted and appear obvious. When in consultation with your plastic surgeon, always inquire about <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> as an adjunct procedure for the procedure you are about to undergo.<br /></div><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-2409196453408395515?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-51207998790698738332009-10-16T16:39:00.001-07:002009-10-25T13:32:10.183-07:00<a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5393348100429804962" src="http://2.bp.blogspot.com/_254hvtdnRaE/StkFhawldaI/AAAAAAAAAFE/xdtx09JEkyM/s400/LASER+Blepharoplasty.png" style="cursor: hand; display: block; height: 84px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div><div><br />I have been very impressed with the results of the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">Fractional CO2 Laser </a>for full facial resurfacing as well as for concentrated efforts on the upper and lower eyelids.<br /><br />Patients who are excellent candidates for <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">Fractional CO2 Laser </a>include younger patients with fair skin who are not quite yet surgical candidates for either <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">upper or lower blepharoplasty</a>, <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">facelift</a>, or <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">necklift</a>.<br /><br />Traditionally I have found that female patients in their late thirties and early thirties who do not want aesthetic surgery and who are starting to develop skin laxity do great with these treatments in the areas of the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">eyelids</a>, <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">jowls</a>, <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">neck</a>, and <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">nasolabial folds</a>.<br /><br />Often these happy patients will return for their post-procedure appointments and say that their friends all ask, “Did you just get back from vacation?” or “You look so well rested”.<br /><br />I am very happy with the results I am obtaining with the CO2 Laser and look forward to using it in conjunction with <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">rhytidectomy</a> in the months ahead.<br /><br />Brian P. Dickinson, M.D.<br /><br /></div><div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-5120799879069873833?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-85049450231194953192009-10-14T22:55:00.001-07:002009-10-25T13:31:49.319-07:00<a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5393315289360760322" src="http://4.bp.blogspot.com/_254hvtdnRaE/StjnrkAH_gI/AAAAAAAAAE0/W3uSaRvxDNM/s400/Left+Oblique+Photograph.png" style="cursor: hand; display: block; height: 237px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> <br /><div><a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5393315078602610466" src="http://1.bp.blogspot.com/_254hvtdnRaE/StjnfS3d1yI/AAAAAAAAAEs/zWRm5aiEuUE/s400/Frontal+Photograph.png" style="cursor: hand; display: block; height: 231px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> <br /><div><a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5393314921788641618" src="http://1.bp.blogspot.com/_254hvtdnRaE/StjnWKsGkVI/AAAAAAAAAEk/S2duE-dfHVA/s400/Right+Oblique+Photograph.png" style="cursor: hand; display: block; height: 228px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /></div><div></div><div>Revision <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp">breast augmentation procedures </a>may be challenging for the <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp">Plastic &amp; Reconstructive Surgeon</a> as there are many variables to consider. I find these <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp">revision breast augmentation </a>operations to be particularly enjoyable as there are often significant anatomic and aesthetic variables to address so that the outcome is successful.<br /><br />Common variables in “Fitness Models” &amp; “Runway” models include:<br /><br />1) Prior <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp">breast augmentation</a> surgery<br />2) Implant Malposition (Most Commonly Lateral/Axillary Displacement of Implant)<br />3) Muscle Contraction Induced Deformity<br />4) Initial scar placement<br />5) Capsular contracture<br />6) Avoiding or minimizing loss of strength<br />7) Low body fat<br />8) Desire for early return to exercise<br /><br />It is important for the <a href="http://www.drbriandickinson.com/sub/breast-augmentation-surgery-beverly-hills.jsp">Plastic &amp; Reconstructive Surgeon </a>to be aware of dimensions and profiles of implants available to the patient to best camouflage the implant. In the “Fitness Model” and “Runway model” population the variables mentioned above make the margin for error small and the visibility of the implant may be very unforgiving. Appropriate selection of implant based on the base diameter of the patient, soft tissue characteristics of the patient, and implant profile may optimize the outcome. It may require several discussions between the surgeon and patient to make sure that everyone is on the same page with respect to implant size, shape, desired cup size, and realistic expectations.<br /><br /><br /><div></div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-8504945023119495319?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-11879938119799303542009-10-08T21:43:00.000-07:002009-10-25T13:31:15.308-07:00<a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5390456785235476914" src="http://1.bp.blogspot.com/_254hvtdnRaE/Ss6_4uUOAbI/AAAAAAAAAEc/V0hWnW6jOes/s400/Capsular+Contracture.png" style="cursor: hand; display: block; height: 202px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5390456648785841634" src="http://1.bp.blogspot.com/_254hvtdnRaE/Ss6_wyAFzeI/AAAAAAAAAEU/3evEoOorkSI/s400/Capsular+Contracture+ROBLIQUE.png" style="cursor: hand; display: block; height: 226px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div><a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5390456482521920226" src="http://4.bp.blogspot.com/_254hvtdnRaE/Ss6_nGnrsuI/AAAAAAAAAEM/dqQijDiuvlk/s400/Capsular+Contracture+LOBLIQUE.png" style="cursor: hand; display: block; height: 246px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br />While I enjoy all aspects of Aesthetic Surgery, correction of <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture </a>and <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">revision breast surgery</a> is particularly enjoyable to me. Not only do I enjoy anatomic and aesthetic challenges of these operations, but also the degree of patient satisfaction is high. <br /></div><div><br />This patient had painful <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsular contracture </a>and left <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">breast double-bubble deformity</a>. Correction of this asymmetry was done with bilateral "en bloc" <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">capsulectomy</a>, re-set of the inframammary fold, and change of implant profile. I am very thankful to have had such excellent <a href="http://www.drbriandickinson.com/sub/capsular-contracture.jsp">aesthetic surgery </a>training from outstanding mentors in Beverly Hills, Sherman Oaks, Encino, and Valencia. I am truly fortunate.<br /><br /></div><div></div><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-1187993811979930354?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-30537698129061114772009-09-30T20:57:00.000-07:002009-10-25T13:30:39.934-07:00<a href="http://www.drbriandickinson.com/"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387476497846201186" src="http://2.bp.blogspot.com/_254hvtdnRaE/SsQpVKnja2I/AAAAAAAAADc/61qPwTKWR44/s400/Frontal+Blepharoplasty+1.png" style="cursor: hand; display: block; height: 92px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div><div align="left"><br />As I complete my one year follow-up on <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">rhytidectomy</a> or <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">facelift</a>, I am impressed by the impact of the combination of upper and lower blepharoplasty on these results.<br /><br />To evaluate an <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">upper blepharoplasty</a>: look at the amount of skin that "hangs" over or toward the lash line. Only a minimal amount of skin needs to be resected with the incsion best placed in the eyelid crease to hide the incision. Removal of this skin eliminates the "hooding" and allows the eyes to appear more open and well rested.<br /><br />To evaluate a <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">lower blepharoplasty</a>: examine the lower lid fat pads or "bags" that can easily be treated by removing a small amount of fat from these lower lids. Removal of this fat reduces the "puffiness" of the lower lids and prevents a cast of a shadow on the cheek allowing the eyes to appear more well rested.<br /><br /><br /></div><a href="http://www.drbriandickinson.com/"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387476406487315986" src="http://3.bp.blogspot.com/_254hvtdnRaE/SsQpP2R5dhI/AAAAAAAAADU/elH8x06f_lg/s400/Profile+Blepaharoplasty+1.png" style="cursor: hand; display: block; height: 109px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br />These improvements are also readiy apparent when the upper and lower <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">eyelids</a> are viewed in profile.<br /><br /><div><a href="http://www.drbriandickinson.com/"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387476261485855346" src="http://2.bp.blogspot.com/_254hvtdnRaE/SsQpHaG2wnI/AAAAAAAAADM/HYhRslLBtc8/s400/Facelift+Profile+1.png" style="cursor: hand; display: block; height: 355px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> <br /></div><br /><div>While the improvement in the appearance in the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">eyelids</a> are significant in themselves alone, the effect is mangified to a greater extent when used in conjunction with a facelift to elevate the cheek, define the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">jowls</a>, and improve the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">neckline</a>.<br /><br /><br /></div><div><a href="http://www.drbriandickinson.com/"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5387476109392670114" src="http://1.bp.blogspot.com/_254hvtdnRaE/SsQo-jhA7aI/AAAAAAAAADE/OgnYtHA7Of0/s400/Facelift+Frontal+1.png" style="cursor: hand; display: block; height: 276px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> <br /></div><br /><div></div><div>When viewed from the frontal view the eyes appear awake, alert, and rested from the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">blepharoplasty</a>. The cheek, jowls, and neck are youthfully restored from the <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">facelift</a> or <a href="http://www.drbriandickinson.com/sub/face-lift-surgery-newport-beach.jsp">rhytidectomy</a>.<br /></div><div></div><div></div><div>It is truly a pleasure to perform this powerful combination of procedures together so that small subtle changes can sum to acheive one large dramtic change in the youthful appearance of the face. <br /></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-3053769812906111477?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-34443688815099044522009-09-10T13:05:00.000-07:002009-10-25T13:29:30.157-07:00<a href="http://4.bp.blogspot.com/_254hvtdnRaE/SqlcbulibiI/AAAAAAAAACg/WkJIL5_mGYE/s1600-h/Lipo_Arms_&amp;_Bra_Fat[1].png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5379932861302468130" src="http://4.bp.blogspot.com/_254hvtdnRaE/SqlcbulibiI/AAAAAAAAACg/WkJIL5_mGYE/s400/Lipo_Arms_%26_Bra_Fat%5B1%5D.png" style="cursor: hand; display: block; height: 217px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div><a href="http://2.bp.blogspot.com/_254hvtdnRaE/SqlcPh2YA_I/AAAAAAAAACY/OIXb5IbAnzY/s1600-h/Lipo_Arms_&amp;_Bra_Fat_Right[1].png"></a><br />Liposuction of the Upper Arm &amp; Bra Line<br /><br />Frequently women come to the office for consultation and say, “Dr. Dickinson, no matter how hard I exercise, the fat on the back of my upper arm and bra line persists. I become self conscious of this when I wear a bikini or strapless dress. Can liposuction help?”<br /><br /><a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">Liposuction</a> of the upper arm and bra fat can be very rewarding to the patient who is the right candidate. Great candidates for <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> have localized deposits of fat that are more resistant to diet and exercise compared to the rest of their body.<br /><br />Significant changes after <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> can be readily seen within 4 weeks post-operatively and continue to improve over many months and stabilize at one year. It is not uncommon for me to see women who are very self assurred, successful, and accomplished although they may feel limited by the clothing they can wear beause of fat they can not get rid of.<br /><br />This patient is very happy with her results 4 weeks after <a href="http://www.drbriandickinson.com/sub/liposuction-newport-beach.jsp">liposuction</a> of her upper arms and bra fat.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-3444368881509904452?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-5525756920471617622009-09-07T16:24:00.000-07:002009-10-25T13:29:18.604-07:00<a href="http://3.bp.blogspot.com/_254hvtdnRaE/SqWWo67IQlI/AAAAAAAAACQ/4MfKs1T96OE/s1600-h/Necklift+75.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5378870959720120914" src="http://3.bp.blogspot.com/_254hvtdnRaE/SqWWo67IQlI/AAAAAAAAACQ/4MfKs1T96OE/s400/Necklift+75.png" style="cursor: hand; display: block; height: 261px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><a href="http://1.bp.blogspot.com/_254hvtdnRaE/SqWWeHkJykI/AAAAAAAAACI/p_N7k2MGfOs/s1600-h/Necklift+Front.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5378870774134852162" src="http://1.bp.blogspot.com/_254hvtdnRaE/SqWWeHkJykI/AAAAAAAAACI/p_N7k2MGfOs/s400/Necklift+Front.png" style="cursor: hand; display: block; height: 260px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div><a href="http://4.bp.blogspot.com/_254hvtdnRaE/SqWWUJuwzgI/AAAAAAAAACA/9X5i3Mua_04/s1600-h/Necklift+Profile.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5378870602917531138" src="http://4.bp.blogspot.com/_254hvtdnRaE/SqWWUJuwzgI/AAAAAAAAACA/9X5i3Mua_04/s400/Necklift+Profile.png" style="cursor: hand; display: block; height: 337px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> <br /></div><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div><div><br />I review my <a href="http://www.drbriandickinson.com/">facelift</a> and <a href="http:////www.drbriandickinson.com/">necklift</a> results in order to learn and improve. Frequently, I notice a youthful change in the appearance of the eyes without a single procedure being done to either the upper or lower eyelid.<br /><br />I attribute this change to the repositioning of the cheek fat pad or malar fat pad back to the normal anatomical or pre-aged position. This restoration of volume not only recreates harmony to the lower eyelid and tear trough, but also improves the position and contour of the upper eyelid and seems to affect the overall aperture.<br /><br />It is a pleasure to see a very attractive person pre-operatively become a very well rested appearing individual post-operatively. It is rewarding when patients have a difficult time holding back their smile in their post-operative photos. This makes me very happy.<br /><br /></div><div>Brian P. Dickinson, M.D.<br /></div><div><br /></div><div style="text-align: center;"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-552575692047161762?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-87799669429532680392009-09-01T19:16:00.000-07:002009-10-25T13:28:37.201-07:00<a href="http://1.bp.blogspot.com/_254hvtdnRaE/Sp3SNF8VXLI/AAAAAAAAABE/08OiySR7Yo0/s1600-h/Facelift+75R1.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5376684652525608114" src="http://1.bp.blogspot.com/_254hvtdnRaE/Sp3SNF8VXLI/AAAAAAAAABE/08OiySR7Yo0/s400/Facelift+75R1.png" style="cursor: hand; display: block; height: 258px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><div><a href="http://2.bp.blogspot.com/_254hvtdnRaE/Sp3SAR6l-3I/AAAAAAAAAA8/I_VCVELZUo4/s1600-h/Facelift+Frontal1.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5376684432401234802" src="http://2.bp.blogspot.com/_254hvtdnRaE/Sp3SAR6l-3I/AAAAAAAAAA8/I_VCVELZUo4/s400/Facelift+Frontal1.png" style="cursor: hand; display: block; height: 247px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /><br /><div><a href="http://1.bp.blogspot.com/_254hvtdnRaE/Sp3R2dNkPMI/AAAAAAAAAA0/2E9T3V3hG40/s1600-h/Facelift+Profile1.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5376684263634910402" src="http://1.bp.blogspot.com/_254hvtdnRaE/Sp3R2dNkPMI/AAAAAAAAAA0/2E9T3V3hG40/s400/Facelift+Profile1.png" style="cursor: hand; display: block; height: 341px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br /></div><div align="center"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a> <br /></div><br /><strong>CO2 LASER for Fine Lines and Skin Resurfacing in Conjunction with Facelift and Blepharoplasty</strong>.<br /><br />Now that the summer months have ended, more women in Orange County and Los Angeles are talking about <a href="http://drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">facelifts</a>. These women are planning their facelifts in the fall and winter months to come.<br /><br /><a href="http://drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">Facial rejuvenation </a>surgery is enjoyable for me from both a technical standpoint as well as the individuality of each case as it pertains to the patient. Some women require the lower third of the face to be addressed, others the midface, and some the brow and eyelids. Recently, I have appreciated the power of CO2 LASERS in many aspects facial rejuvenation.<br /><br />I have had great success with the Mixto CO2 laser as it can improve the fine lines of the lower eyelid, the crow’s feet, and the fine vertical lines around the mouth. The CO2 laser effectively tightens and improves the quality of the lower eyelid skin, and in some cases obviates the need for a lower blepharoplasty. The CO2 laser has proven to be very powerful for improving pigment changes secondary to sun exposure and sun spots known as seborrheic keratosis. This patient is very happy with her results 4 months post-operatively from <a href="http://drbriandickinson.com/sub/face-lift-surgery-beverly-hills.jsp">facelift</a>, upper blepharoplasty, and CO2 laser to the lower eyelids and peri-oral rhytids.<br /><br />Brian P. Dickinson, M.D.<br /><br /><div style="text-align: center;"><a href="http://www.drbriandickinson.com/">http://www.drbriandickinson.com/</a><br /></div><div></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-8779966942953268039?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.comtag:blogger.com,1999:blog-3289015363994705571.post-37112955369836327092009-08-25T08:34:00.000-07:002009-09-30T21:30:34.600-07:00<div align="center"><a href="http://www.drbriandickinson.com/">www.drbriandickinson.com</a></div><br />Webster's Definition of a Blog: a Web site that contains an online personal journal with reflections, comments, and often hyperlinks provided by the writer; also : the contents of such a site.<br /><br />The <a href="http://www.drbriandickinson.com/">Brian Dickinson M.D.</a> Plastic Surgery Blog will be an online <em>professional</em> journal with reflections, comments, experiences, opinions, articles, inspirational quotations, and patient testimonials.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3289015363994705571-3711295536983632709?l=briandickinson.blogspot.com' alt='' /></div>Brian Dickinson, M.D.http://www.blogger.com/profile/01339658969172639026noreply@blogger.com