Dr. Rachel recognized as national expert in rhinoplasty

Dr. John Rachel, my esteemed colleague and friend, has recently received national attention for his expertise in nose surgery. Rhinoplasty is so important to aesthetic appeal. Ethnic differences must be respected and it must not create a point of undue attention. With that in mind and concise artistic ability, Dr. Rachel has created a portfolio of knowledge and skill that has been pleasing patients in the Chicagoland area for the past 7 years. Two weeks ago he was asked to lecture at the 24th annual meeting of the American Academy of Cosmetic Surgery on the fine points of rhinoplasty and next year he will be teaching an intensive course on the subject. I have asked Dr. Rachel to comment on his experience at the meeting.
Be sure to check out the addendum at the end of the blog.
Dr. Rachel:
The 24th Annual Meeting of the American Academy of Cosmetic Surgery was recently held in Orlando, Florida. This well attended meeting consisted of 5 full days of lectures, panels and seminars covering all the topics related to cosmetic surgery. These meetings are attended by physicians of diverse backgrounds with a common interest in sharing information about the Art of Cosmetic Surgery. There were scientific sessions with presentations of basic and clinical research as well as breakout sessions consisting of experienced surgeons discussing the technical pearls of a procedure. Featured lecturers who are considered the experts in their field included talks on the management of the dark skinned patient, advanced techniques for mid and lower face rejuvenation and the future of stem cell research. I was honored to be asked to lecture on the Art of Rhinoplasty and take part in a panel discussion with 2 experienced and respected Nasal Surgeons in our academy. The preparation for a lecture on my personal experience with open rhinoplasty required much insight and review of the technique and of the long term results associated with my cases. This preparation actually provided an excellent opportunity to study the results and visualize the changes that occur with modification of the nasal tissues over an extended post-operative period. Even the questions following the lectures provoked a well-rounded discussion on specific problemsassociated with rhinoplasty. In the spirit of learning at the Academy Meeting , the preparation and delivery of a lecture improved my experience in Orlando while hopefully making another attendees meeting worthwhile. This concept emphasizes the importance and need for physicians in all fields to participate in continuing medical education and highlights the trends toward policy for maintenance of certification from many certifying boards.

• Addendum: Dr. Rachel and I will be conducting a free skin cancer screening at St. Peter Community Church in Northbrook on Feb. 14 in conjunction with Life Line Screening for vascular diease like carotid artery, aortic aneurysm, peripheral arterial disease, and osteoporosis. Call 1-800-324-1851 for an appointment.

Smartlipo: The New Liposculpture Technology

Liposculpture has become so proficient in accomplishing aesthetic body shapes that I am usually amazed at our results no matter how long I do this. And it all happened over the past 20 years!
First, Jeffrey Klein invented the tumescent technique of local anesthesia and microinstrumentation so that body sculpting could be accomplished with patients awake in an essentially bloodless manner. Then a group of cosmetic surgeons of whom I am so proud to have been one, developed artistic sculpting techniques so that we could do circumferential contouring of the upper body, or the lower body, or the silhouette, or the neck and lower face.
Then we introduced ultrasonic assisted liposculpture which gave us the advantage of adding energy to the process to help tighten overlying skin and reduce the trauma of the procedure. Finally in 2000 we introduced low level laser therapy during the procedure which reduced drainage time to 10 hours and visible results within 2 weeks. Our patients exercise the next day and do not need pain medication!
For the past 7 years there were no significant innovations until now.
Enter: Smartlipo. This extends the concept of laser assisted liposculpture to laser lipolysis, or liquefaction of fat. A laser fiber is introduced through the skin in a hole about 1 mm and by controlling the laser energy 2 goals can be accomplished. First the fat is liquefied so that it is more easily removed (less trauma). Then a certain amount of energy goes into the skin to tighten and shrink the overlying surface. And this with much less risk of injury than ultrasound of the 90's. As a result patients have smaller incision sites, easier disappearance of scars, less chance of pigment deposits, faster healing because of less trauma and the healing effect of energy deposition, and the potential for tighter skin. Go away post operative girdles; go away pain medication; go away staying at home or in bed. Patient results have been positive and enthusiastic and I am excited that this innovation has initiated the new era of body sculpting.

Botox Non-Surgical Facelift

Botox is the most successful medication/treatment in the history of cosmetic surgery in terms of number of people using the treatment. For almost 20 years now people have been having botox injected into dynamic facial lines to smooth out their face, take away a worried look, and eliminate frowning. More recently botox has been used to elevate eyebrows that have fallen and to lift the corners of the mouth. From all of this work we have learned much about how facial muscles interact and how we make the expressions that are familiar to us.
Basically facial expressions are a sum of the actions which pull the facial soft tissue (and skin) upward and those that pull it downward. So the person who looks like they are constantly frowning is often the victim of depressor muscles of the inner brows pulling down harder than the forehead muscles pull up. And the patient who looks sad because their mouth droops at the corners has stronger muscles pulling down the corners of the mouth than the cheek muscles which pull it up. The same goes for early jowl formation of the cheeks which is often the result of the platysma muscle of the neck pulling the cheek down more forcefully than the cheek muscles pull it up.
Enter the Botox Non Surgical Facelift. Cosmetic surgeons have learned to elevate the eyebrow, the jowls of the cheeks, and the corners of the mouth with tiny doses of botox placed into the depressor muscles so that the elevator muscles are relatively stronger and can pull tissue upward. The procedure needs to be done over several weeks until the correct dosage is achieved. We have created a fee system where a fee is charged for a cosmetic area and that includes 2-4 return visits until the correct titration is reached. In addition, VIP program members enjoy a 25% discount off of that fee. Patients enjoy the results of their "facelift" for 3-6 months without invasive surgery and they can combine it with a filler like restylane which usually lasts twice as long when it is combined with botox.
Visit out website www.metropolitanmds.com and click on face and botox non-surgical facelift to see before and after pictures of some of our patients.

MetropolitanMD and LifeLine Screening Present a Preventive Medicine Screening for Valentine's Day

Several months ago I blogged about a small study that indicated in one dermatology practice 2/3 of malignant melanoma cases were detected on routine preventive screening and the patients did not come in complaining about the lesion. 1/3 of patients with malignant melanoma succumb to the disease. We do not seem to be a nation that cares about preventive medicine. As a cancer survivor this saddens me. There is no national will to reduce the severity of disease. Insurance programs are meager at best as companies scale back their offerings. Politicians give lip service to medical care while rationalizing by all sorts of means to maintain the status quo, even if they have to disguise it under a different name.
Life Line Screening is a company that provides preventive ultrasound screening for carotid artery disease, abdominal aortic aneurysm, peripheral arterial disease, and osteoporosis with a simple procedure. Many physicians support this work as it is preventive and low cost. Their package price is $129.00.
On Thursday, Feb 14 (is this a great Valentine's gift or what?) Dr. Rachel and I will join Life Line Screening at St. Peter Community Church, 2700 Willow Road, in Northbrook for a day of screening. Dr. Rachel and I will be doing skin exams to look for malignant or pre-malignant lesions at no cost and Life Line Screening will provide a valuable internal screen for their package price. You can check them out at www.lifelinescreening.com . You can spare yourself and your loved ones some grief if you will attend. I hope to see you there.