Bloomfield Hills Doctors

Is it Encouraged to Bring Photos of Noses I Like to a Consultation for Rhinoplasty?

Hi, I am going for a primary consultation for rhinoplasty. Is it frowned upon to bring photos of noses I like to a consult? Obviously, it is not going to look exactly like another persons nose, but does it help a surgeon as a guideline?

Part of a successful consultation process in rhinoplasty is establishing a good rapport and building effective communication tools. This is why "morphing" or digitally enhancing existing photographs has become so popular. Patients do no have the same vocabulary as surgeons do when it comes to describing the nose. We  (plastic surgeons) talk in terms of angles and proportions, however our patients just intuitively know what aesthetic they prefer. In fact the most popular answer to my question of what changes my patients want is, "I know I just do not want my nose to look like Michael Jackson's".  One way of bypassing this potential for confusion is to bring pictures from the popular media to understand exactly what our patients likes and dislikes are. From there a surgical plan can be developed to tailor specific changes to fit each individuals' nose.  Open communication and honesty are the backbones of a successful outcome. Good Luck!

Giancarlo Zuliani, MD

Detroit Facial Plastic Surgeon

Gastric Banding Less Invasive?

Is gastric banding less invasive than gastric bypass? What kinds of drawbacks are there to gastric banding? I've heard you can stretch the bands back out if you eat too much.

Yes, in theory gastric banding is the least invasive weight loss operation; but complications can occur.  This includes leaks, bleeding, and death.  These complications are less common than with other weight loss operations, but they are still reported.  On the other hand, long term complications are more common after gastric banding than with the other procedures.  In fact, reoperation is needed more after gastric banding than after any other weight loss operation.  Reasons include port problems, slippage, and erosion.  Most bothersome is that weight loss is poorer with gastric banding than it is with bypass or sleeve gastrectomy.

Another thing to consider is that even though gastric banding is "reversible," the scar tissue caused by the band is permanent.  This means conversion to another procedure will be more difficult and success rate may even be lower.  These are some of the many reasons why gastric banding is falling out of favor worldwide.

Mark Pleatman, MD

Bloomfield Hills Bariatric Surgeon

Confused About Units of Botox Received Previously Vs. New Recommendation, Am I Missing Something?

4/11 in Texas I got "10 units Botox in 1 syringe, 7 for forehead/glabella, 3 for frown lines at $25 a unit=$250, dilution ratio 4:1. Saw results I was pleased with (didn't know what to expect for 1st time but definitely improved) for 5 months. 10/2011 MD -recommends 20-25 units for forehead/glabella and 20 (total) for both frown lines so 40-45 total 'units'. Cost around $575. See everywhere that current recommendation is the norm. Confused by what what given in TX. What am I missing?

The proof is in the pudding: if u got results & are happy with them, u have received the corect amount. Usually the total dose for the "11 ' frown lines is 12-25 units, depending on the particular patient. However , I do have a couple of patients that receive only 6 units total. Any higher doses, for them, lead to abnormal looks! In ur case, maybe u misunderstood the number of units used. Bottom line: you are happy with the results,[ & the total price is very reasonable]. 

Khaled El-Hoshy, MD

Detroit Dermatologic Surgeon