Meetings and Coffee Go Together Like Ice Cream and Cake

There are 2 reasons to attend a medical meeting: the lectures and the coffee. The purpose of the lectures is obvious. The coffee, however, is the meat of the meeting.


I will be speaking in Croatia in a few weeks and the excitement is two-fold. First I will be able to present my work on soft tissue rejuvenation using low energy lasers and newer fillers like hyaluronic acid and poly-L-lactic acid. While our original emphasis is on facial rejuvenation and effectively reversing facial aging, our newer work involves treating floppy or sagging skin, cellulite, stretch marks, and mildly distended abdomens after pregnancy. I have been using mini-treatments of fractional laser resurfacing and injections of salt water to stimulate new collagen in all parts of the body. Many of the patients are pleased with the results though the techniques are early in development and will be much better in a few years. And that work is complemented by our results improving the aging face due to resorption and collapse of all the tissue layers of the face: bone, muscle, fat, and skin. Starting at age 20 skin begins to thin in a linear fashion with age. Also, the outer 5-10% on each side of the face withers making the face narrower and therefore appear longer. How often do I need to re-iterate that adult women have no business wearing long hair along the sides of their faces. They look older! Of course the easy thing to do would be to inject fat into the depressed areas but the reality is that women who don’t need fat have it; and women who need fat do not have it. That is where poly-L-lactic acid (Sculptra) has been such a treasure as a “biostimulant” for new collagen. Anyway, I want to present my findings and my theory that with energy and stimulation, virtually all tissue can revive. (Same with functionality and exercise. Just ask anyone in my alter cocker group.)



The coffee… the coffee is the good part. I wonder if it is beer in Croatia. Anyway. I get to meet with my European colleagues and see what they have been up to in the past year. I will have 3 American compatriots join me and we, along with the French, the Germans, the Austrians, the Italians, the Dutch, the Croatians, and whoever else will come along will do some free-associating while viewing the beautiful Adriatic and imbibing local fare. This is where the good stuff is told. Two years ago I learned techniques of the Botox face-lift, last year I learned about the physiology of facial aging, and who knows what I will learn this year.



I wish you all a youthful time and I will share secrets when I return.

John Wayne Fights Skin Cancer

Whoah!. Little Lady …(inflection as spoken by John Wayne to Janet Leigh).


Did you see them figures on the rise of skin cancer in the latest publication of The Skin Cancer Foundation? Between 1994 and 2009 the number of yearly skin cancer cases in the US has risen from 1 million cases per year to 2 million cases per year. Malignant melanoma now kills 8600 Americans per year – up from 8000. Indoor tanners have 4.44 times the risk of malignant melanoma as non-tanners (confirmed by the World Health Organization). Window glass filters UVB radiation but allows more than 60% of UVA to penetrate. So much for the ridiculous protests of the tanning industry . The federal government now taxes tanning parlors but classifies the tanning booth as a Class I medical device. Elastic bandages and tongue depressors are also Class I medical devices and I never heard anyone imply that they cause cancer and death.

Now I am not going to get smokers to stop smoking, alcoholics to stop drinking, and tanning addicts to stop tanning. But what about your kids! In Australia every child born will have at least one skin cancer in his lifetime. Right now the odds are something like 1 in 7 children born in the US will have skin cancer at least once in his lifetime and we will achieve Australian status soon. It seems to me that this epidemic will only be controlled by educating young people on the risks and rewards of sun exposure. Yes sunlight is essential for mental well being. Yes, it is an important factor in producing Vitamin D. Yes, I thank God every morning I step out of the house and the sun is shining (I am serious). But enjoying the gifts of Earth does not imply endorsing self-abuse. I see no value in cutting off skin cancer after skin cancer as if that is good medicine although it provides a great living for dermatologists and plastic surgeons.

So here are some ideas:

1. Talk to your kids and grandkids about the need to avoid too much sun and especially sunburns

2. For children under the age of 2 use protective clothing and umbrellas and do not smother them in sun screens which can penetrate their young skin and go into which organ???

3. Sun screens are screens. They let UV light through!! They must be applied every two hours to be effective and they must form a reservoir in the skin to be effective.

4. Do not use combination sunscreens and insecticides. They usually don’t work and they may be harmful.

5. If you have had skin cancer you have 100% chance of another cancer if you live long enough

6. Get on the adjuvant band-wagon. Ask your doctor to help you prevent skin cancer.

7. Take oral vitamin A 10,000-20,000 units daily and get a blood test once a year to make sure you don’t overdose.

8. Apply tretinoin (vitamin A) to your face every night for the rest of your life. Topical and oral vitamin A may provide up to 98% protection from new skin cancer.

9. If a lesion suddenly appears or changes in size, shape, color, or bleeds, see a dermatologist.

10. Don’t give double messages to your kids! If you take care of yourself they may take care of themselves. If they don’t get the message have the kids see me. Sometimes the message gets clearer when presented by someone outside the family- or by an uncle.

Cosmetic Surgery Requires Accredited Surgical Facility

I began my medical practice in 1973 knowing nothing about how to run a business let alone a medical practice. A highly respected teacher and dermatologist was kind enough to refer me to his attorney to help get me started. Bernard Kleinman was himself a respected tax attorney who took me under his wing and treated me like a son. When we first met I asked him how I might  evaluate someone as a good attorney (I am suppressing all of my cynical rejoinders). He said you start with someone you respect and have reason to believe is good at his profession. He may be a doctor, a lawyer, an accountant, or whatever and you ask him to recommend someone to you. He said that individuals who are accomplished in their profession and ethical will refer you to someone like themselves. That is because good professionals are only comfortable with accomplished professionals and poor ones need to associate with those less skilled or moral to maintain their own status. That advice has guided me through my entire career.


So why should you make sure that if you are going to have surgery, any surgery, but perhaps most importantly cosmetic surgery, the facility in which you are about to trust your future happiness or even your life is nationally accredited? (I separated cosmetic surgery because it is perhaps the least regulated of surgical subspecialties (vying with pain clinics and a few others for special mention as buyer-beware clinics or in the immortal words of the philosopher P.T. Barnum “There is a sucker born every minute.”).

There are several reasons to choose an accredited surgical facility. First, consistent with Mr. Kleinman's advice good doctors tend to congregate with good doctors and accredited surgical centers have criteria for privileging doctors that an unaccredited medical office does not. Second, accrediting bodies have a stringent list of criteria that the surgical facility must meet in order to be accredited. These criteria include sterile preparation of instruments, records of documentation of the protocols of the center, and most importantly the ability to sustain the life of a patient should a crisis arise.

The three main accreditors of ASCs are American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (Accreditation Association or AAAHC) and The Joint Commission. Ask for them and if there are any doubts call the agency to double check that the facility in question is up to date. If an ounce of prevention is worth a pound of cure this certainly should be a priority.