Author Archives: Dr. Pound

LASERS, LASERS, LASERS!

These days, the emphasis is less on surgery and more on non-surgical procedures in order to enhance our appearance. Fillers, Botox/Dysport, and lasers are replacing surgery to re-shape, add volume, and eliminate facial lines and wrinkles. Part of this is due to the tight economy and another part is due to the need to eliminate any lengthy recovery period.

I always admonish patients to be careful when dealing with doctors who own lasers. Lasers are very expensive to buy and doctors are therefore highly motivated to sell these treatments to patients whether they need them or not in order to pay for the laser. If a better laser or treatment option comes along, the doctor is still married to the laser he/she bought until it is paid for and will therefore promote it vigorously.

I am pleased that our office offers a variety of lasers which I rent as needed. Because I don’t own these lasers, I am not financially tied to them. I can be honest with patients when I recommend a laser since I have no financial investment in the lasers.

The fall and winter months are the best months for utilizing lasers that smooth facial wrinkles and even out blotchy skin. Following laser resurfacing of the face, the patient may be slightly crusty for a few days and may be pink for a few days to a few weeks afterwards. They may also be sun sensitive for up to six months following laser treatments of the face. For that reason, this is the perfect time of the year to get those laser treatments in so that you will be ready to get back outside when spring and summer roll around.

We also offer the SkinPen II for facial rejuvenation. While not a laser, the SkinPen II uses microneedling of the skin in order to stimulate elastin and collagen formation leading to a more youthful appearance. It is especially good for patients with acne scarring. Because it is less invasive than lasers, the SkinPen II may require three or more treatments in order to obtain results similar to the laser, however, the recovery is not as prolonged and patients may get back to their normal routine within a day or two after a treatment.

I am always fascinated by tattoos. I have been playing sand volleyball for twenty-five years. When I first started playing, I would occasionally see guys with the barbed wire tattoo around their biceps. These days, I see whole sleeves and full body tattoos on men and women when I play beach tournaments. Still, that proud eagle that you got on a spring break dare in Cancun, Mexico when you were in college might now be looking more like a tired pigeon as you have gotten older. Fortunately, we have a laser that can remove tattoos. Most tattoos require between four to eight treatments to remove in their entirety.

I am often asked about spider vein treatments. In the past, I would refer patients elsewhere, but not anymore. We now have a wonderful laser that helps get rid of unsightly skin lesions and spider veins in the legs and elsewhere. The treatments are easy and there are no compression garments to wear and no restrictions on activities afterwards.

We also have a laser that assists us in surgery. The SmartLipo Triplex laser helps liquify fat during liposuction resulting in more fat removal, smoother results, and more skin tightening, especially on patients with poor elasticity of their skin.

Finally, hair removal using lasers is popular especially during the fall and winter months. Darker pigmentation in the skin from tanning may interfere with the hair removal laser which is why January is a good time to come in for laser hair removal Most patients are out of the sun during the colder months. Laser hair removal generally takes six treatments to complete.

Lasers are an excellent, non-surgical means to improve the appearance of skin, remove hair, unwanted spider veins, and tattoos, and also improve results with liposuction. Although lasers can be used at any time of the year, fall and winter months are usually the best time for these treatments.

Kybella: A Non-surgical technique For Removing Fat

The cosmetic industry is increasingly moving from surgical to non-surgical means for achieving optimal aesthetic results without the downtime and expense of surgery. Towards this end, a new product has recently been approved by the FDA and introduced to the market for the elimination of fat under the chin.

Kybella is deoxycholic acid, a naturally-occurring material in the body, which aids in breaking down fat cells. When injected into the fat tissues under the chin, fat cells are eliminated and the skin is tightened, resulting in a more pleasing contour of the neck and chin area. Most patients will require between two to four treatments at six week intervals for maximal results.

Kybella injections are easy! The involved area is outlined and a grid of dots placed over the skin. Small doses of Kybella are injected at each dot into the fat below the skin. There may be an initial feeling of warmth or discomfort as the Kybella goes to work on the fat cells. Patients may expect some swelling, bruising, or tenderness in the area for several days following the treatments.

While currently only FDA-approved for fat deposits under the chin, Kybella may soon be used in other small areas where fat is a nuisance. Research continues in these areas.

Dr. Pound’s office is now carrying Kybella. Call today for your free consultation to see if Kybella will work for you!

Is Board Certification Really THAT Important?

By Win Pound, M.D. in Atlanta

True story: A man called my office four days after going to a spa to receive an injection of filler material into a deep line located between his eyebrows. In Georgia, anything injectable must be done by a physician, nurse, or physician’s assistant. In this instance, a physician was the injector. So the doctor overseeing the spa injects the filler and flattens out the depressed line. What could go wrong? Sounds straightforward and simple enough. Anyone could do that, right? Four days later, the patient is calling my office because part of his forehead is becoming discolored. It seems that the doctor, in this case a podiatrist or foot doctor, has injected the filler into an artery and now the skin over part of the patient’s forehead is struggling to get enough blood supply to survive. To make matters worse, the doctor used a filler that has no antidote. It can’t be easily reversed. The options for treatment at this point are limited. Sometimes even the simplest procedures can have some nasty ramifications. It pays to do your research.

The state of medicine is a mess these days. Insurance premiums are going up, medical reimbursements to doctors and hospitals are going down, and insurance companies are enjoying record profits. For doctors, the overhead costs of training, malpractice insurance, and staffing has only gone up, not down. With insurance companies decreasing the amount of money that they will pay for various procedures, doctors in all specialties are seeking out alternative sources of revenue in order to cover their costs of doing business. To this end, many are turning to cosmetic surgery as a means of bypassing insurance companies. Cosmetic surgery is generally paid for up front in cash. Doctors take weekend courses in breast augmentation, facelifts, liposuction, etc., and then call themselves “board-certified plastic surgeons.” They are board certified (in something) and they are doing plastic surgery. They just aren’t board certified by the American Board of Plastic Surgery, the only board recognized by the American Medical Association for the training and certification of plastic surgeons.

Anyone with an M.D., D.O., or even dental degree in many cases can perform cosmetic surgery. There are few regulations governing this. It is up to the patient to determine the doctor’s competency for performing the surgery they want done. While cosmetic surgeries may be more difficult to perform since doctors must have a facility and staff with which to work, injecting Botox or fillers is easy to do and requires no special equipment. Most spas offer Botox and fillers these days. They just have to have a doctor, any doctor will do, to oversee what they are doing.

True story: A few years ago, I flew to another state to observe a doctor who was demonstrating a new technique for facelifts that he did under local anesthesia in his office. This doctor had a very high profile because his relative was a marketing genius and promoted him very well. As it turned out, the doctor was board certified in emergency room medicine, not plastic surgery. He did his surgery in an office-based operating room, under the radar of government regulatory groups, and sedated his patients so heavily that they might as well have been under general anesthesia. Also, his technique for facelifts wasn’t really anything new. Of the twenty or so doctors in the group observing this “innovator”, I was the only one who was an actual plastic surgeon. The rest were general surgeons, Ob-gyn’s, family practice doctors, etc., all seeking a new source of income to offset their business costs that didn’t involve insurance companies. I felt dirty just mixing with this group and couldn’t wait to get out of there. I often wonder how many patients have been disfigured as a result of this group taking this course by this self-taught surgeon and then going out and performing facelifts for the first time in their office. In my mind, it was a disaster waiting to happen.

I am active on the website RealSelf.com., frequently answering questions posed by patients considering surgery or having questions or complications as a result of surgery. There are LOTS of questions from patients who have problems or bad results and I wonder if their doctor was an actual plastic surgeon or a pseudo-plastic surgeon. I wonder why they seek answers from strangers on the internet instead of addressing their questions to their own doctors.

Does having a doctor who is certified by the American Board of Plastic Surgery guarantee a good result? No. Every plastic surgeon, no matter how talented, has had complications or bad results. Still, these are the best trained doctors in cosmetic surgery and the best prepared to handle problems resulting from surgery. Going to an appropriately credentialed plastic surgeon offers the patient the best chance at a good outcome. The patient knows that an ABPS-certified plastic surgeon has been through years of training (not a weekend), as well as rigorous testing and oversight to become properly certified.

Finally, what should a patient look for when seeking a plastic surgeon? I propose the following:

1. First and foremost, patients should ascertain that the plastic surgeon is certified by the American Board of Plastic Surgery. There are NO other boards recognized for training and certifying plastic surgeons. If the doctor is not ABPS certified, thank them kindly and leave.

2. Do not go to a plastic surgeon simply because he charges less. Lower fees may be offered to compensate for lack or training, experience, or certification. Do not put costs ahead of your health. You want the surgery done correctly the first time.

3. Does the doctor performing the surgery you are interested in having done have a significant amount of experience performing that particular surgery? How many does he do in a year? Look at before/after pictures. Speak to former patients who have had that surgery.

4. Talk to friends who have had cosmetic surgery and see which plastic surgeon they recommend and what their experience has been.

5. Finally, when you meet with your plastic surgeon, do you feel comfortable with him? After all, you are entrusting your health and well-being to this person. It would be nice to know that he has taken the time to answer all of your questions and will be there in case you have a problem after the surgery. If you are not totally comfortable then seek out another consultation or two. It never hurts to get differing perspectives.

Surgical and Non-surgical Options for Rejuvenation – Win Pound, M.D. in Atlanta

We spend billions of dollars in this country every year trying to re-capture our youth. Some of the changes we make are permanent and others are only temporary.

I had an older patient in my office the other day looking to improve her appearance. She was concerned about the lines, depressions, and sagging skin in her face. As I reviewed her options, I realized that I was essentially categorizing the possibilities into two areas – non-surgical and surgical options, temporary versus more permanent solutions.

In the past, this patient would have been an excellent candidate for a facelift, browlift, and upper and lower blepharoplasty (eyelid surgery). She would have had a short recovery period with a dramatic improvement that would last for many years.

With improvements in skin care products, Botox, and fillers, she can now get a very nice result immediately with essentially no down time. The results may not last as long as surgery and the costs may eventually add up to more than the surgery, but there is very little interference to her daily life. She won’t have to take time out from her routine. Additionally, there are now newer fillers on the market such as Voluma and Bellafil that will last several years.

The trend these days is away from surgical options and more towards the non-surgical. While a dermatologist may have experience with the non-surgical side of things, a plastic surgeon has experience in both surgical and non-surgical procedures and can give a more comprehensive assessment.

In our office, we have extensive training in surgical and non-surgical techniques to improve and enhance a patient’s appearance. We invite you to visit us so that we can give you a free consultation and assessment.

Tummy Tuck or Liposuction in Atlanta

 

Tummy Tuck or Liposuction for the Abdomen
-Win Pound, M.D.
Which will work best for my stomach area, a tummy tuck or liposuction? This is a question I see frequently on plastic surgery discussion boards.
The old adage is that if you can “pinch an inch” then it is fat. If the stomach area has fat but little or no loose skin then liposuction may be the best option. Liposuction can remove the unwanted fat and the incisions used are very small and usually well-concealed. If the patient has good elasticity of the skin then it should tighten down very nicely giving you a good result.
If the patient has a small amount of loose skin or stretch marks (thus, poor elasticity of the skin), then the patient may still be a good candidate for liposuction, especially if laser-assisted liposuction (SmartLipo or SlimLipo) is used. The advantage of using the laser in this instance is that the laser will heat up the undersurface of the skin resulting in better skin tightening. While more expensive than traditional liposuction, the results may be worth the extra cost in borderline candidates who want to avoid a long scar across the lower stomach.
For patients with excessive skin of the lower stomach, even if there is a large amount of fat present, a tummy tuck is probably the best option, especially if the skin tends to hang. Suctioning the fat in this instance will only lead to more loose, hanging skin.
When deciding on whether to perform liposuction or a tummy tuck, another consideration is the tightness of the abdominal wall under the fat and skin. In patients who have had a pregnancy or a large weight loss, the two paired stomach muscles that run up and down the stomach may tighten back up, however, the connection between these muscles may not. This weakness in the stomach wall may cause the stomach to protrude. If patients tighten up their stomach as tight as they can, what protrudes is fat and skin. When they relax their stomach, the weakness in the abdominal wall may become apparent. This weakness can only be repaired with a tummy tuck.

The Pros and Cons of Outpatient Surgery by Win Pound M.D. in Atlanta

The Pros and Cons of Outpatient Surgery
-Win Pound, M.D.
When my father started our practice in 1961, surgery was exclusively done on an in-patient basis. As time went on and techniques improved, my father suggested to the leaders at the hospital where he worked that we could do a lot of our surgery on an out-patient basis. No one believed that that was really a viable option so, together with a couple of other surgeons, they started their own outpatient surgery center. Now, outpatient surgery is a common way to do almost all cosmetic surgery. In fact, many plastic surgeons have even progressed to having surgery suites within their own offices. There are benefits and risks to this.
The advantage of out-patient surgery is that patients can recover in the comfort of their own home. This also removes them from proximity to other patients who may have more serious and possibly contagious illnesses. As long as there is a responsible adult serving as their “nurse” this works very well. In my practice, I tell patients that I am just a phone call away if they have any questions or problems so, in essence, there are two people taking care of the patient – the immediate caregiver and, more remotely, me.
The risk of home recovery is that the family member providing care for the patient is not trained in patient care. They may not know what to look for as far as possible problems. They are not taking vital signs periodically as might be done in a hospital. This is why it is important for the doctor to communicate to the caregiver specific instructions about what to look for post-operatively. He/she should also be available by telephone if questions or problems arise. Fortunately, cosmetic surgery is elective. Patients undergoing cosmetic surgery are generally younger, healthier patients for whom post-operative risks are lower. Even those who are older or have medical issues can be managed so that they are in the best possible condition prior to surgery.
Another risk of out-patient surgery is that some doctors have abused this concept. Doctors who may not have privileges to do certain procedures in a hospital may bypass this problem by performing surgery in an out-patient center or office surgical suite where oversight by regulatory bodies may be more lax. Credentials are important. Patients should always check to ensure that the surgical facility is accredited. They should also check to make sure that the surgeon is certified by the appropriate board and has privileges to perform his surgery in a hospital.

The Brazilian Butt Lift by Dr Edwin Pound in Atlanta Georgia


The Brazilian Butt Lift
-Win Pound, M.D.
Enhancement of the buttocks in the past has been done via fat transfer or silicone rubber implant placement. Due to the low survivability of fat, most initial treatments consisted of inserting large implants through an incision in the cleft of the buttocks. This technique was also fraught with problems ranging from infection, migration or malposition of the implants, seromas, nerve issues, scarring, etc. These days the tables have turned. The majority of buttock augmentation procedures are now done using fat rather than implants.
Fat is very fragile material with poor blood supply. In the past, transferring fat from one part of the body to another was difficult. Survival of the fat was hard to predict. Even under the best of circumstances, only about 30 – 50% of the transferred fat could be expected to survive. With better techniques for harvesting and transferring fat, we can now depend upon more fat to survive, thus making it a more predictable filler material as well as a more permanent one.
The Brazilian Butt Lift consists of two parts: harvesting fat and injecting fat. In order to create a noticeable change to the buttocks, a significant amount of fat must be transferred. This requires that a large amount of fat be harvested for use. The more fat that can be obtained, the better. The most obvious places for removing fat are in the thighs, hips, and abdominal areas. These are areas traditionally approached for liposuction, areas where the most fat tends to accumulate. Simply by removing fat from these areas alone, we can help shape the buttocks. This is shaping the butt by subtraction of the fat around the buttocks before the fat is even transferred. Patients with little fat to harvest will have little fat to add and their results will not be as good.
The second part of the Brazilian Butt Lift consists of the injection of the harvested fat. The fat is washed to remove blood and fluid. The fat cells are then carefully injected in layers into the buttock area on each side in order to produce a uniform, symmetrical result. It is important to limit the amount of fat resorption. This is accomplished by placing the patient in a compressive garment which helps shape and stabilize the fat. We also want to avoid pressure on the fat which might crush the fat cells. We want the fat to grow a new blood supply in its new home. Any movement or pressure on the fat will prevent this. With this in mind, patients should avoid sitting directly on the buttocks as much as possible for several weeks following their procedure. Placing a cushion under the thighs so that the thighs absorb the weight when sitting works well.
The Brazilian Butt Lift has become an increasingly popular procedure. With newer techniques in fat management, results for this procedure have improved dramatically over the past several years.

FAQ’s About Breast Implants by Dr Edwin Pound in Atlanta

 FAQ’s About Breast Implants

-Win Pound, M.D.
  1. How long do breast implants last?
I am always asked if implants need to be replaced every ten years. I believe people tend to get that number based on the “warranty” on the implants. In my mind, as we say in the south, “if it ain’t broke, don’t fix it.” I have seen saline implants last as long as 29 years before breaking and some of my dad’s silicone gel patients have had their implants for 35-40 years.
  1. How can you tell if one breaks?
If a saline implant breaks, you will have a “flat tire” within a matter of days. The saline will leak out quickly and be absorbed. You will notice the resulting volume discrepancy between your breasts. A rupture in the newer cohesive silicone gel implants may be a little more difficult to detect. When the FDA returned the silicone gel implants to the market in 2006, they recommended that patients get an MRI three years after implantation and every other year after that. The problem is that MRI’s are very expensive and they are not 100% accurate. Cohesive gel tends to hold its shape even in the presence of a large rupture so, again, unless there is a clinical problem associated with the implant, an undetected rupture in a silicone gel implant should not be a problem.
  1. What if I decide to take them out later?
Removing volume (the implant) from a breast is kind of like removing fat from the thigh. The skin does not spring right back immediately but takes some time for the elastic fibers in the skin to tighten down. Just as I do with my liposuction patients, I advise my implant removal patients to wear something compressive for two to three weeks following their surgery.
  1. Will removing my implants make my breasts sag?
Not necessarily. Removing the volume from the breast will make the nipple/areola move towards the chest wall rather than downward. I tell my patients that their breasts will look essentially like they do prior to removal, just smaller in volume.
  1. Which is better, saline or silicone gel?
There are pros and cons to each. To me, silicone gel more closely approximates the feel of real breast tissue. Saline implants are essentially a bag full of water and have the potential to look/feel like a bag full of water. On the flip side of the coin, saline implants are less expensive and the volume can be adjusted during surgery before the fill tube is removed. Silicone gel implants come pre-filled and therefore cannot be adjusted.
  1. Which looks more natural, over the muscle or under the muscle?
If the surgery is performed properly, it should look natural in either position. Initially, the tissue over the implants will be tight and the implants may sit high. This will loosen up over time. I tell my patients that, when implants are above the chest muscle, they may see their final results in two or three weeks. When the implants are placed below the chest muscle, it may take as long as two or three months for everything to settle and soften up.
  1. My breasts are sagging. Will implants lift them up?
Implants provide volume. That is all that they do. There is nothing about an implant that can lift a breast. That requires a breast lift procedure.
  1. What will happen to my implants as I age?
Your breast tissue is affected by a number of factors over time – weight gain/loss, periods, pregnancy, etc. These are changes to your breast tissue which are difficult to predict. The implants themselves will not change. They are just along for the ride. The addition of implants should not cause your breasts to sag over time unless you go with really large implants that overwhelm the suspensory ligaments in your breasts.

Medical Mission Trips with Dr Pound


Medical Mission Trips
-Win Pound, M.D.
“What you are is God’s gift to you.
What you become is your gift to God.”
Participating in medical mission trips abroad is one way to re-pay God for the blessings He has bestowed upon me as a plastic surgeon. To date, I have been on over a dozen trips, primarily to South and Central America but also to India. They are a win-win situation for everyone. I get to see parts of the world that I would never visit otherwise and patients have access to surgery that they might never have otherwise,
Surgical mission trips require a lot of money, time, and gathering of materials. Most of the money used to purchase the materials used is raised through fundraisers and donations. This material must then be shipped to the destination and placed in the hands of trusted local groups who also serve as our hosts, organizing everything from lodging and food to transportation. This is not a small task as most of the trips that I have been on include 20-25 people – pre-op nurses, anesthesiologists, surgical assistants, doctors, recovery room nurses, and administrative personnel.
On the day of our arrival, we hold a screening clinic. Part of the team sets up the operating room or rooms that we will use, part sets up our materials in central supply, and the rest screen anywhere from 200-400 patients, many of whom have traveled as far as 100 miles in order to be seen. From this group, we select the patients on whom we will operate and map out our surgery schedule for the coming week. Only when all of this is completed are we able to go to our hotel for the first time, rest, and unpack.
We usually operate for one week, sometimes taking a day in the middle to shop in the local market or visit a local attraction. We arrive at the hospital at sun-up, visit patients on the ward for dressing changes, and then operate non-stop until sundown. Lunch is brought to the hospital so that we have minimal disruption of our surgery. Most of the surgeries involve cleft lips, cleft palates, and burn reconstructions, but we see an assortment of other surgical challenges as well.
I usually do the burn reconstructions. Most of the doctors don’t like doing burns but I find them very challenging. In poor households, dwellings are heated and lit using candles and fire since they do not have electricity. If the candles burn down and fall over, the entire house will go up in flames. Too poor for medical access, children must learn to adapt to the distortions caused by their burn scars as they grow. I would love to make these children beautiful again, but my primary priority is simply to restore them to normal functioning. Arms, legs, and hands distorted by burn scars must be straightened using skin grafts or skin flaps and then splinted.
At the end of the week, we hold our final clinic to see our post-op patients. Then it is off to the airport to wind our way back to the cities from whence we came. Leaving is always an emotional time as the team has been through a lot together. It is a bonding experience for all of us, extremely grueling but also extremely rewarding.
I keep a few photo albums in my office of some of my trips. Sometimes patients look at them and tell me they feel guilty about being vain and having cosmetic surgery when there are so many needy people in the world. I am always happy to remind them that it is because they came to see me for their cosmetic surgery that I am able to go and help those needy people elsewhere. Their patronage is what allows me to go on these medical mission trips.
Dr. Pound and patientWin ecuador