Nip This Tuck That

 Liposuction case today….removed almost 5,000cc’s that’s 5 liters of fat.   Let me tell you that Liposuction is hard work for the surgeon.  The premise behind Liposuction, in case anyone doesn’t already know, is the removeal of unwanted fat.  Like any fat is ever really wanted!  I use a method called Tumescent Liposuction.  Tumescent means that a small nick is made in the skin using a needle.  Through that little nick a cannula with a bunch of holes in it (like a hose used to water the garden) is placed under the skin into the fatty tissue to be removed.  Sterile saline (salt water) with dilute novacaine-like substance is then infiltrated into the tissue.  This is what Tumescent means. 

 Once the tissue is ready, the vacuum is turned on and another cannula (I use one with a blunt end and 2 or 3 small opeings along the bottom of the cannula) is attached to clear tubing that in turn is attached to a vacuum device.  Actually, it’s attached to a collection device on top of the vacuum machine.  This allows us to see how much fat is removed.  Rcently, a limit of 5,000 cc’s has been adopted by most of the surgical societies as the upper limit of fat that can be removed at any one Liposuction procedure.  What happens if you have more fat than the 5,000cc’s, you ask?  It stays until the next surgery, so the surgeon better plan appropriately or you may wind up with one leg sucked and small and the other leg with all the fat remaining.  It hasn’t happened to me but I bet it has happened!

 Now comes the hard part……I have to move the cannula…I move it…I’m the manual labor that moves the cannula back and forth, back and forth, up and down fanning through the areas of excess fat over an over until it’s removed to the proper degree.  It is physically demanding to do a large Liposcution case and remove that much fat….I am plum tuckered out afterward, I have to tell you.  The patient looks great however and she’s a sweet woman…which makes it all worth the effort.

 Hired by another consultant group today to advise clients who want to open Plastic Surgery Centers and Medical day Spas.  Easy work…over the phone mostly.  I have done the actual setup for 2 or 3 groups previously, so it’s easy enough for me to do.  Just need to find the time to speak with them…..aah, that’s the hard part.

 My daughter, Ashton was accepted to USC this weekend and we are over the moon!  We meet with another record producer in the morning about Ashton and her career…..wish us luck!

 Evan and Ashton will attend the Kids Choice Awards this Saturday because Evan’s on “Unfabulous.”  They should have a blast!  They get to go in a limo….etc.  etc.

 Removed the cast from the reviusion Rhinoplasty…..it looks amazing.  Patient is thrilled and so am I…..they’re off flying back home to another state.  Removed some stitches from one of the minilifts after I was done with the Lipo case.  She looks gorgeous and about 10 years younger…..

 A lady from another country that had consulted with me about 1 year ago came and had a surgery this afternoon under novacaine-like injections.  Quick and easy. 

FOR IMMEDIATE RELEASE:
Do Celebrities Receive “Plastic Surgery” Without Even Knowing?

  Beverly Hills, CA, March 26, 2006…What do Sarah Jessica Parker, Matthew McConaughey, Jack Nicholson, Patrick Stewart, Madeleine Albright, and Ian McKellen have in common?  They all have undergone DIGITAL SURGERY performed by Beverly Hills Plastic & Cosmetic Surgeon, Francis Rogers Palmer III, M.D., F.A.C.S.

 Dr. Palmer, the premiere Beverly Hills cosmetic and plastic surgeon, has been retained to make actors more attractive by using his very own beauty principles and expertise. The “Palmer Beauty Principles” explain what features determine overall attractiveness.  These “Palmer Beauty Principles” have been featured on Dr. Phil, The Tyra Banks Show, Star Culture, Pop Life, People Magazine, US Weekly, New Woman, and In Touch Weekly, to name a few.  Now, major motion picture companies are hiring Dr. Palmer to bring his “Palmer Beauty Principles” to the silver screen.

 Dr. Palmer has been approached to take 20 to 30 years off actors’ appearances; some because their roles require them to play their character at a much younger age and some to simply refine and enhance their beauty.   This technique of digital surgery is seen by some as Hollywood’s newest magic trick and by others as a way to prolong a successful career. 

 Gone are the days that we need to rely simply on make-up to alter an actor’s appearance.  Using a quarter of a million dollar computer, Dr. Palmer can perform facelifts, implants, rhinoplasty, botox, and liposuction without ever reaching for his needles or scalpel.
With his well-trained eye, innovative beauty principles, and groundbreaking surgical technique, Dr. Palmer is the surgeon of choice when it comes to molding the most beautiful people in Hollywood.  Has your favorite star been clicked and cropped, nipped and tucked by Tinsel Town’s best kept secret….Dr. Francis Rogers Palmer?

I’m going back on my soap box because….I just can’t take it anymore!  In my 16 years of practice as a Beverly Hills Plastic & Cosmetic Surgeon, I have heard and seen many things but lately I’m increasing disturbed by what I am seeing.  People are falling prey to fake treatments and bogus beauty products.  Case in point…the woman who let her hairdresser give her a shot….a shot….of Botox it is assumed to remove some lines and wrinkles from her face.  Was she persuaded to let the hairstylist practice medicine without a license…without any training whatsoever…for a cheaper price?  Have we become a society blinded by the true value of things by what I call the “Walmart Mentality?”  Get whatever you want at the lowest possible price because it’s all the same anyway.  Really?  Do you really think this is possible when it comes to personalized services like those performed by doctors or Plastic & Cosmetic Surgeons?  Do you think that all surgeons have the exact same eye, same gift, same training, same experience….not to mention temperament and motivation?  Come on….do you really believe that or is it simply easier and more convenient to hope that it works that way?  Well I am here to tell you that it doesn’t work that way at all!  Not Once!  Not ever!  Worse, if you use those assumptions, like this woman in Monterey, you may end up with a  serious problem.

 Doctors and surgeons are not all the same.  We don’t do surgeries or procedures the same…hence the term practicing the “art of medicine”.  So you can’t and shouldn’t assume that you’ll get the same Botox treatment from every doctor or surgeon and to assume that you’ll get any type of real or safe treatment from an untrained layperson is JUST PLAIN CRAZY!  The reality is that poor woman died from her hairstylist injecting her with a bogus brand of Botox.  This is just tragic and it shouldn’t have ever happened in the first place.  Be smart, be safe, be educated about what you let people do to you….they must be trained, experienced and competent.  Pay the going rate for your treatment or surgery.  Don’t skimp….it’s better to do without until you can afford the best.  Getting second best, at a discount price, is rarely a bargain.

One of my cases today was a young woman who wanted fuller cheeks and lips.  She traveled here for a consultation, some months ago, from across the country.  Unsure of what she needed, she like many pf my patients was looking to me for specific suggestions on how she could be more attractive.  I evaluated her face using my “Palmer Beauty Principles” and showed her that she could benefit from an aesthetic improvement in 2 of the top three facial features.  Her cheeks were relatively flat and her lips were a bit thin.  She agreed and signed up for a day in the Operating Room….she wanted it right away but unfortuneately there were no OR openings for some months. 

 Today was her day and she showed up this morning just as bright, chipper and sweet as could be.  I can’t tell you how nice it is to operate on a person that is sweet, kind and appreciative.  Sometimes patients in this business can be demanding and hard to deal with….the power people with money that are used to always having things exactly their way.  More on this later.  Back to today’s patient.

 I did the Cheek Augmentation first.  I mark the outside of the face, after the patient is under anesthesia….using a purple surgical marking pen to trace the outline of each Cheek Implant as it should sit on top of her cheek bone.  There are several anatomical marks that I have used over the past 16 years that help exact Cheek Implant placement.  I then inject the area with a novacaine-like substance to control the bleeding and numb the area after the procedure.  I use a scalpel to make an incision on the inside of the upper lip close to the gums.  Using scissors, I dissect the tissue until I feel the Cheek Bone.  Dissection continues directly over the Cheek until the space inside is similar but slightly larger than what I have drawn on the outside of the cheek.  Antibiotic solution is placed inside the surgical opening and the Cheek Implant is placed inside the mouth on top of the Cheek.  Once I am satisfied that the Cheek Implant is in the proper position, I close the opening with dissolveable stitches from the inside out.  This prevents the front of the Cheek Implant from slipping downward or poking out into the mouth.  The inside lining (called mucosa) of the mouth (the incision) is closed in a water tight, double layered, running, locking, dissolveable suture.  Say that 5 times really fast!

 Then the same procedure is performed on the opposite Cheek.  I am right handed, so I tend to perform operations from the right side of the OR table and do the right side, of a procedure, followed by the left side.  The incision in the mucosa of the mouth is less than 1 inch long and the dissection goes about 4-6 inches deep…..so I wear a headlight on my head that has a high powered focused beam of light allowing me to see in deep surgical spaces.  Once the second Cheek is Augmented and the incision is closed, I use reinforced tape, on the skin, to secure the Cheek Implant.  This first set of tape (steri strips) goes over the entire Cheek and is removed after 1 week.  At that time, I place steri strips along the top, bottom and leading edge (by the nose) of the Cheek Implant to further secure the Cheek Implant for about 5-7 days.  It’s best to ice the area as much as possible for the first week but really there is not much discomfort, swelling or bruising.

 Once that’s done, I move on to the Lip Augmentation.  I use Alloderm for my Lip Augmentations and I believe that it’s the gold standard for soft, natural fuller lips.  I have had the residents at USC write several pappers about how my experience with Alloderm stating how great Alloderm is over the past 10 years, or so, that I have been using it for Lip Augmentation.  The Alloderm is rolled and then passed under the mucosa (red portion) of the lips through a small incision in the corner of the mouth.  The incision is closed with dissolveable stitches.  I tell patients that Alloderm Lip Augmenattaion lasts about 7 years and that I think it’s #1 in soft, natural looking lips.

She looked great when I was done…..I was happy and I’m sure she’ll be thrilled!  Just a glimpse at what goes on to make people look good…..and you thought that the beautiful people were just natural gorgeous, didn’t you?  Guess again!

Exciting day here today.  VIP surgery (celebrity, public figure, roaylty, captain of industry?) and then did a case with a TV film crew.  From the VIP case where secrecy is paramount…to the oepnness of doing surgery with a film crew filming everything.

 As the VIP is leaving…the film crew is setting up in another portion of our facility and my staff is directing traffic.  That’s one thing about my staff…they are superb at their jobs…and they sure can kep a secret.  They directed everyone around and the film crew hadn’t a clue who had just had surgery or that they were even there. The operation they were there to film started less than 1 hour after the film crew first arrived.

 When a film crew comes there’s a brief meeting with the director and the crew to set some basic line for the shoot and to brief them as to what they can do and where they can go.  I never assume that they have been filming inside an operatuing room before and give them a brief set of do’s and don’t.  For example….don’t touch the patient once they have been prepared for surgery…and don’t touch the back table with all the instruments…heck, pretty much don’t touch anything unless we tell you it’s OK to do so.  Then there’s the introductory interviews with the patient and then with me.  They film a brief consultation and then I scrub for surgery.

 In the OR, it’s easy to become distracted except that I have done this many…many times before and I’m used to it.  It doesn’t really phase me.  I am happy to provide the film crew a running dialogue of what I am doing and why…in that regard it’s not much different then teaching resident surgeons Plastic & Cosmetic Surgery procedures.  I quickly settle into a routine and go about my business.  I have learned that if I’m at a point in the operation where I can’t speak….I just hold up my hand and say “not now…I’ll be able to speak with you in just a minute.” 

Beverly Hills Rhinoplasty, Face Lift, Neck Lift, Cheek Implants, Chin Implants, Brow Lift, Blepharoplasty, Breast Augmentation, Tummy Tucks, Lip Augmentation, Radiesse Injections, Botox Injections..these are all plastic and cosmetic surgery procedures that seem to interest TV shows whether they are based here in LA, NY, London or elsewhere.

Following the completion of the surgery comes the exit or concluding interview with the patient another one with me and then a wrap up by the field reporter or the producer.  All of this on top of me doing my usual things before, during and after the operation.  It’s fun but it does take effort.  From about 6 hours of filmiing today, 5-10 minutes will be aired as the edited version. That’s why TV seems to flow seamlessly.  It’s edited to look that way.  Take it from me…it takes way more time and effort than it appears when you see the final program.  Mr Demille…I’m ready for my close up!

Dr. Francis R Palmer, III

Breast Augmentation in Celebrities has been in the news lately. 

 Did several Breast Augmentations today.  It’s amazing how nice the patients look after the surgery.  I prefer placing the Breast Implants below the muscle if at all possible….it looks more natural and allows for more options in the future.

 Breasts are making a huge comeback…no pun intended.  We see lots of women asking for larger or more shapely breasts.  In my practice there are two distinct sets or groups of patients interested in Breast Augmentation.  There are the younger women typically in their twenties that are looking for larger breasts.  Then there is the second group of women that have had children and want to have more shapely breasts once again. 

 For women looking to augment or enlarge their breasts….it’s a matter of how large are they looking to go?  I use a simple formula that takes into account the size of the hips.  This way, the breasts always look proportioned to the body.  If more cleavage is desired, Breast Implants with a higher profile (thicker implant) would be considered.  So what you should be asking yourself right now is “how am I supposed to know what size I want my breasts?”  Great question…..let’s see.  Fist question.  Are you looking for prominent cleavage or not?  Next question.  How far outward towards your armpit are you willing to have your breasts extend?  These two decisions will help decide the size of the breasts.  Cup size is determined by the diameter of the breast.  By measuring the breast and/or the existing skin over the breast (if the breasts are no longer filled out as is frequently the case after having children) you can get a good idea of the maximum sized breasts that you could have.  Questions is: do you want that much breast augmentation?  I advice buying a bra in the desired larger size and then fill a zip lock baggie with tap water so that the bra is completely filled up.  Walk around with the filled up bra and see how you like it.

Saw several consults for Rhinoplasty, Blepharoplasty, Cheek Implants, Tummy Tucks (Abdominoplasty), Chin Implant, our Celebrity Face Lift, Forehead Lifts, Lip Augmentation and Botox/Radiesse/Juvederm Injections.

Francis R Palmer, III MD