A. Dean Jabs MD, PhD, FACS

Quicklift is here

2012-01-06T05:10:00.000-08:00

The "Quicklift" is an exciting addition to our practice that allows us to offer a safe, long lasting facial rejuvenation procedure that can be done in our office under local anesthesia in only a few hours. We are currently promoting the procedure on television and look forward to seeing many new patients.

Dean Jabs, MD, PhD, FACS

Breast Capsule after Augmentation

2011-12-05T08:10:00.000-08:00

Breast augmentation is a safe procedure with high patient satisfaction rates. But, like all surgeries, it does carry some risk of complication. Possible complications include changes in nipple sensation, a noticeable scar, infection and capsule formation. All are rare but can occur.

Capsule formation is due to inflammation leading to scar (capsule) formation around the implant. This is usually due to some form of bleeding that occurs after the surgery. The capsule that is formed can distort the breast and make it misshaped. Correction involves some form of capsule modification. This can take the form of scoring, partial excision or complete excision. I have had good luck with partial and complete excision. Sometimes this isn't enough though and the capsule can return for whatever reason.

In these cases, and they are few and far between, after removing the capsule, a tissue matrix is placed where the capsule used to be in the the lower portion of the breast and the implants replaced. This has led to a soft breast with good shape. It can be done on one or both breasts to better match the result.

If you are having this problem, I would be happy to see you. You can also send photos to my personal attention at jabs@cosmeticplastics.com

All the Best,

Dr. J

Redoing a Nose

2011-11-28T07:53:00.000-08:00

Correcting deficiencies after a rhinoplasty (secondary rhinoplasty) can be difficult. Depending on what was done in the first surgery correction can require simple rearranging of misshaped cartilage to a complete redo where cartilage is harvested from the nasal septum or the external ear and grafted in to place. Bones may even need to be reset. In some extreme cases where there is little cartilage to harvest or the nose is markedly depressed rib and even synthetic bone may be needed to achieve an acceptable result. All of this is done through an open approach where a small incision is made in the columella (little column) between the nostrils and then carried in to the inside of the nose to allow adequate exposure of the internal structures of the nose. The resulting scar is minimal and the results that can be achieved are more predictable than doing the procedure "closed" where the only incisions are on the inside of the nose.

One of the more interesting cases I've had through the years involved a young man who might be described as a 'street pugilist'. His nose had been hit several times and the last altercation had resulted in the nose being very crooked and pushed to the right side of his face. I started the operation and after opening the nose and seeing how badly the septum (the wall that separates the nostril passages internally and supplies the support for the nose) was twisted I knew something more than the standard scoring and suturing would have to be done. I elected to separate the mucosa from the wall from above and completely remove the septum. I cut is out and put it on the sterile surgical table to try to straighten it. It allowed me access to parts of the septum that I otherwise couldn't get to and allowed me to reshape it with incisions and stitches. When I was done I put it back in place but it still wasn't good enough. I noticed the bottom half was much straighter than the top so I flipped it over and put it in upside down. The nose looked great. I sewed it in to position with the other cartilage and closed the soft tissue over it holding the mucosa (and blood supply) to it with sutures. The patient healed uneventfully and the nose was markedly improved with better function (he could breath) and a straight appearance.

If you have a nose that needs redoing I would be happy to see you.

All the Best,

Dr. J

Bad 'Nose Jobs'

2011-11-21T07:41:00.000-08:00

Ever notice a bad 'nose job'? Have you stopped to think what it is that makes it look bad? Often it is overdone, meaning it looks as if too much has been changed, amplifying certain aspects while juxtaposing one ethnicity's traits next to another that you would never see in the general population. A good example was Michael Jackson's nose. It just didn't fit his face or features. You see this sometimes in celebrities. They want something that just doesn't conform to their face and they have the influence and money that can sway some surgeon to give them what they want, even if doesn't look right.

If you don't like the way your nose looks, the best thing you can do is to spend some time with a mirror to figure out exactly what it is that bother's you about it and then look at people with a similar ethnic background to find pleasing noses. They may not be an exact fit for your face but at least you will be starting in the right direction. Once you have an idea of what you would like to change then visit a board certified plastic surgeon or E.N.T. to determine if it is even possible and to have an imaging session to see how you might turn out.

Remember, plastic surgeons are human and can make substantial positive changes but they don't have a magic wand and some things are just not possible, and in some cases not desirable.

Have a great Thanksgiving Holiday.

All the Best,

Dr. J

Compassionate Doctor Award

2011-11-14T07:33:00.000-08:00

I have been notified that I was selected by patients as a "most compassionate Doctor".
Evidently of the 720,000 active United States physicians, only 3% were accorded this honor. It is the most important recognition a doctor can receive: the recognition of our patients.

I am thrilled to receive the honor and rededicate myself to patient care.

All the Best,

Dr. J

Life Changing Plastic Surgery

2011-11-07T06:00:00.000-08:00

So often plastic surgery is thought of as "fluff" or "vanity" surgery that is not needed and selfish. The truth is changing one's appearance, especially a trait that causes embarrassment, can have profound effects on how you see yourself and your ability to deal with society.

I had a patient today return after treatment for gynecomastia. The man had lost over 80 lbs and the resultant excess skin and floppy breasts were a big embarrassment to him. He didn't feel confident taking his shirt off in front of anyone. The feelings had profound effects on his feelings of self worth. He didn't like undressing in front of his girlfriend, at the beach, or in the gym.

Today he told me I had changed his life. When I asked how so he told me he was now a full time student in Physical Therapy. One of the requirements is for the students to practice their art on each other. He now has the confidence to remove his shirt in front of his fellow students and not feel bad about himself.

So much for "fluff" surgery.

All the Best

Dr. Jabs

Satisfied patients

2011-10-31T06:02:00.000-07:00

I came to work today and was delighted to find a note from a recent patient. She made my day.
She writes:

Dr. Jabs, I could not have wished for a better surgeon! You are so personable and your results are exactly what I wanted. Words can not express how pleased I am with the liposuction of my inner thighs and my breast augmentation. I never would have guessed that I would feel so relaxed going into surgery but I did-thanks to you. I recommend you fully and without reservation!

Just a reminder that we should all compliment the people in our lives that please us. It doesn't take a lot of time and it can make such a difference in that person's life.

Dr. J

How are bioidentical hormones administered?

2011-10-24T06:00:00.000-07:00

How are bioidentical hormones taken?

Four hormones are typically replaced when a woman goes on HRT (hormone replacement therapy). They are Estrogen (two types), Progesterone, Testosterone and DHEA a precursor to many hormones.

Typically women begin by taking a mixture of two estrogens (Estriol and Estradiol) in a transdermal gel that is rubbed on the skin in the morning after showering. It literally takes two minutes.

Progesterone is taken at night in the form of a pill that slowly dissolves, the products of which are breast and uterus protective as well as aid in sleep induction and maintenance.

DHEA (a hormone precursor) is taken orally as well. Some of the DHEA becomes testosterone. If the testosterone level is low after a few months then low dose testosterone may be added as well.

The effects of hormone replacement are felt within a week and the benefits continue as you take them. Adjustments are made once or twice per year as your body becomes accustomed to the normalization of your hormones.

Breast Reduction

2011-10-17T12:54:00.000-07:00

In our society's focus on a woman's shape we often think only of breast augmentation when we think of breast procedures. Naturally this gets the most attention from our media because it is "sexy". But what about those women who have the opposite problem? Our ability to reduce too large a breast with less scarring has improved greatly over the last 20 years. We can now do the procedure with less than half the scarring that it used to entail.

A breast reduction can have several beneficial effects. It decreases the weight borne by shoulders as well as the stress that weight places on the lower back. It solves problems of skin irritation in the breast fold and often improves nipple sensation. By using a short scar technique we reshape the nipple/areola complex and usually maintain the ability to breast feed by not interrupting the ducts that carry milk from the breast tissue. To learn more please visit our website and be sure to check out our before and after photos.

Women's Bioidentical Hormone Safety

2011-10-10T06:00:00.000-07:00

Is Hormone Replacement Safe?

We not only want to alleviate the suffering of menopause and give a woman her energy and femininity back, but we want to do it in a safe manner. It is of no use if the side effects of the treatment are worse than the disease.

Many people (including physicians) erroneously associate hormone replacement therapy with the medications used in the Women's Health Initiative (WHI) study from 2002 that led to the wholesale cessation of hormone replacement by many doctors due to the findings that the drugs that were being used were leading to blood clots, strokes and breast cancer increases in the test subjects. The medications that were used were estrogen and progestin (not progesterone). The synthetic progestin led to the problems associated with the hormone replacement. When estrogen alone was evaluated there was a decrease in breast cancer, heart disease, stroke and dementia. There was no change in mortality compared to controls.

A French study of 54, 548 women for 3 years put on different forms of hormone replacement found little to or no increase in risk in breast cancer when estrogens were used alone or with extended release progesterone.

The answer to the problem of safety is to use an estrogen and progesterone that is exactly like the ones found in your body. Bio identical.

Bio identical hormones have been studied extensively and found to be safe.

Lombardi Cancer Center Gala Donations

2011-10-03T06:00:00.000-07:00

Each year the Lombardi Gala, an unparalleled celebration to benefit the Georgetown Lombardi Comprehensive Cancer Center raises thousands of dollars for cancer research at Georgetown University. You can help by donating some of that high quality plonk you have in your cellar that you won't possibly be able to get to before it goes bad without you getting a liver transplant.

Your donation will be auctioned and gross more than the money you paid for the wine and you can take it as a tax deduction. In addition your name will be known far and wide as a compassionate human being and wine lover.

Just shoot an email to Gina DeLuca (gmd34@georgetown.edu) with your donation and she will take care of the rest.

Don't put this off. Do it today. It will only take a few minutes and it really won't hurt that much. You won't have a headache in the morning either.

Thank you for your donation and for helping the Lombardi Center help those in need.

All the Best,

Dean Jabs, MD

Lombardi Gala Benefit Committee

Menopause symptoms and Bioidentical HRT

2011-09-26T12:41:00.000-07:00

Symptoms of Menopause/Perimenopause

Menopause (the cessation of menstrual periods for 12 months) and Perimenopause, the stage of gradually falling hormone levels prior to menopause affect about 70% of women, some more severely than others. Symptoms begin to occur when a woman's ovaries decrease and eventually stop producing the hormones necessary to maintain the normal monthly cycle. The fluctuating and eventual marked decrease of estrogen and progesterone lead to symptoms which include hot flashes, mood swings, night sweats, irregular periods, loss of libido and vaginal dryness just to name the most common ones. Other symptoms include fatigue, hair loss, sleep disorders, memory lapses, weight gain, bloating, depression, anxiety, irritability, headaches, osteoporosis, joint pain and itchy skin.

Besides alleviating some or all of these symptoms, hormone replacement can have long lasting benefits for a woman's health.

How is Testosterone Administered

2011-09-19T11:13:00.000-07:00

What is the best way to administer T? That all depends on what your priorities are. There are three basic routes, listed below with their positives and negatives.The choice really is up to you

Daily cream
-easy to apply
-raises T quickly, easy to control and adjust dose
-may lead to more DHT DiHydroTestosterone) production and it's effects on hair and benign prostatic hypertrophy
-can get on significant others in the first hour

Weekly injections
-easily done with small needle injection into fat
-less daily hassle
-can adjust dose as needed
-does require taking tuberculin syringes and medicine if on an extended trip

Sub-Cutaneous Pellets
-good steady state delivery for 3-4 mos
-no need to remember to use
-does require a small in office procedure to place
-dosage cannot be adjusted once placed
-can (rarely) become infected

Liposuction in the wrong hands ; Cosmetic surgery can be deadly!

2011-09-15T14:06:00.000-07:00

USA today posted a front page article on Sept 14, 2011 about deaths occurring after liposuction by doctors who are not plastic surgeons. The article emphasizes the necessity for proper training and how many doctors who have not had that training are trying to do cosmetic procedures to inflate their incomes during these tough economic times. Most states permit any physician do procedures in their offices that do not require general anesthesia regardless of their specialty training. Problems often arise after the procedure when the patient is at home recovering. Be vigilant and check your doctor's credentials before booking that procedure. A good place to start is at the American Board of Plastic Surgery which maintains a list of the doctors that are Board Certified to practice the specialty. It is also prudent to remember that there are "boards" that certify doctors that aren't recognized by the American Board of Medical Specialties. Don't fall for a fake board certification. Many doctors would like to do plastic surgery but they don't want to spend the 7 plus years of training after medical school that is necessary. Don't be fooled, play it safe.

Dr. J

Possible Testosterone side effects

2011-09-12T11:10:00.000-07:00

The side effects of increased testosterone are easily managed. The major effect is an increase in red blood cells. This leads to an increased oxygen carrying capacity, although if too high it is not healthy. This is more often seen when T injections are used. The treatment is to donate blood twice a year. There have been no testosterone associated thromboembolic (clotting) events reported to date.

Gynecomastia (swelling of the breast tissue) can be seen if testosterone is converted to Estrogen (female hormone). Estrogen levels are checked while on T and can be controlled by blocking the enzyme (aromatase) that converts T to Estrogen. This decreases the swelling. As your body fat decreases while on T, and aromatase is made in fat, estrogen will naturally decrease. Interestingly men need some estrogen to maintain libido and a sense of well being.

Fluid retention is rare and self limiting.

Decrease in testicular size and sperm count. Other drugs must be taken with T if you and your partner are trying to become pregnant.

Does T increase male pattern baldness? It is unknown at this time. Men that are susceptible to hair loss from Testosterone typically have exhibited this trait earlier in their lives. The culprit is DHT (dihydro T) that is made from T. This can be blocked using Avodart.

Patient notes

2011-09-10T08:12:00.000-07:00

I just received this from a patient. It is so nice to hear from happy patients.

Thank you so much for the wonderful New Look!

The apparent care and enthusiasm you displayed while answering my questions and my husband's questions put me at ease.

I had been contemplating the surgery for years but after the first visit to your office my decision was easy.

I absolutely love my new figure and have already referred you to a number of people who are looking to have various work done including my physician!

Thank you so much from a truly satisfied customer!

Lots of well wishes,

R.B.

Testosterone and "Roid Rage"

2011-09-05T08:01:00.000-07:00

Some of my patients and frankly their spouses, worry that replacing T will lead to easy excitability and "roid rage". Remember our goal is to replace your T to its healthiest levels, not something that is abnormal. We are using Testosterone and not a synthetic that was designed to skirt sports bans and has serious side effects. Just the opposite is seen in men who had low T. They are more calm and less "grumpy" when their T is normalized. They lose the "grumpy old man" syndrome that may have developed. They have more energy and are calmer. In general, they are happier.

Is Testosterone Replacement Safe?

2011-08-29T10:40:00.000-07:00

The biggest fear among men and their doctors is that elevating Testosterone will lead to an increase in prostate cancer. Paradoxically men who develop prostate cancer do so when their levels are low, not high. The other question is whether adding T to an existing prostate cancer that is slow growing will speed it up or make a small cancer that is dormant flourish. Dr. Abraham Morgentaler, is a urologist at Harvard and a nationally recognized expert on Testosterone replacement. He has studied this extensively and has stated in writing "There is not now-nor has there ever been a scientific basis for the belief that T causes prostate cancer to grow." There is no adverse effect of T on the prostate.

With all of the benefits to health in general it seems that normalizing Testosterone can only have a beneficial effect on a man.

Women's HRT

2011-08-25T19:23:00.000-07:00

Just saw a female patient who was having trouble with hot flashes, her mood and loss of energy. We started her on bioidentical hormones six weeks ago and she is ecstatic about the change in how she feels and how she is acting. She told me when people would say good morning to her she said it back but thought "what's so good about it?" Now, she says she means it when she says it. Her hot flashes are also markedly improved. What she really likes is her ability to get a full nights sleep now. That alone she said is worth using bioidenticals.

This story is not new. I've heard it over and over from women. The safety of this type of treatment continues to be documented while the improvement in overall health is enjoyed by women patients.

Benefits of Replacing Testosterone

2011-08-17T14:05:00.000-07:00

Studies have shown that replacing lost Testosterone to levels that were present when a man was younger has a host of benefits. The goal here is not to use testosterone in excess but to rebalance the body's level to its natural state when younger and in better health. Energy is increased, muscle mass goes up (substantially if combined with a low carb diet and moderate exercise), belly fat goes down and libido and sexual performance go up. A sense of well being is reestablished and cognitive function is improved. Testosterone lowers cardiac morbidity and decreases inflammatory proteins. In addition normal T levels help prevent Alzheimer's disease. High endogenous T = low mortality from cardiovascular disease and cancer. There is a 41% decrease in the chance of dying in men with T>564 compared to 350 at 70 years of age.

Low T Symptoms

2011-08-03T11:49:00.001-07:00

What are the Symptoms of Low T?

Low Testosterone leads to a host of problems that manifest themselves gradually over time. The process is often so slow that it isn't noticed. The symptoms are chalked up to "aging" and are considered inevitable. These include weight gain (especially around the waist), loss of energy and drive, decreased ability to add muscle at the gym, decreased memory, and decreased libido and performance ability, both athletically and in bed.

Low T leads to increased ageing of the heart and circulation along with increased heart attacks and strokes. The brain also ages prematurely leading to decreased memory and an increase in the incidence of dementia and Alzheimer's Disease. Muscle pain and stiffness in the joints is seen along with a decrease in lean body mass (less muscle) and anemia. Mentally men get " Grumpy Old Man Syndrome": fatigue, tiredness, depression, mood changes and even dysphoria (an uncomfortable mood in response to ordinary life events).

Low T is a lethal disease. It leads to excess fat, diabetes and metabolic syndrome.

Hormone Replacement for Men

2011-07-28T10:56:00.000-07:00

Male Menopause (Andropause)

We age because our hormones decline; our hormones don't decline because we age.

Andropause is the term used to describe the male condition of low testosterone that gradually occurs as a man ages. Men typically begin to have a lower T level beginning in their 40's that progressively worsens as they age. This isn't true for all men, but it is the norm. Half of seemingly healthy men between the ages of 50 and 70 will have a T level below the lowest level seen in healthy men between the ages of 20-40. Testosterone gets lower every year. The long term consequences of low T are severe and lead to a loss of the ability to enjoy life.

Over the next few blogs I'll cover the symptoms, the benefits, the side effects and the methods of optimizing a man's hormones so he can feel as good as he looks and lead a more healthy life.

Dr. J

Ratings recognition

2011-04-01T13:14:00.000-07:00

If you are like many people, you use the web to check on people before you use them for medical care, legal services or home repair. I often do the same. I am delighted to learn that my ratings on Vitals have earned me a Patient's Choice award as well as Recognition as a Compassionate Doctor.
I urge you to check out this site and view the comments of previous patients.

Dr. Jabs

Non surgical facial rejuvenation

2011-02-21T13:12:00.000-08:00

Many women want to improve the appearance of their faces without the discomfort and down time that a surgical procedure entails. Besides taking care of her skin (hydration, moisturizers, sun block and occasional treatments with Retin A) the best thing a woman can do as she ages is replace the volume she loses with the aging process.
Volume replacement is most helpful for women that notice a loss in their temples, upper cheeks, around their eyes and the folds that run from their noses to their outer lips.
Volume can be replaced with a crystal clear, naturally occurring skin component, Hyaluronic Acid, HA, or by transplanting some of their own fat. Both work well and give long term results (up to 2 years in some areas).
The advantage of HA is that you don't have to harvest it. The advantage of your own fat is that it has the potential to be permanent. Typically a percentage of either of these agents is permanent depending upon where it is placed.
I recently added 15 ml. of fat to a very thin, athletic woman's face in the cheek region, along with 4 ml of Juvaderm to the temples and a small amount to her lips. She looked much younger when we finished and experienced very little down time.

Adding volume may be the way to postpone surgery. Especially if you are thin and have lost facial volume, and have little excess, droopy skin.

Dr. Jabs

Open vs. Closed Rhinoplasty

2011-01-06T17:56:00.001-08:00

Over the years I've often been asked why I choose an open or closed approach to rhinoplasty. An "open" rhinoplasty involves making a small incision across the columella (little column) that separates the nostrils which is carried inward to allow the entire tip and dorsum or top of the nose to be exposed. A "closed" approach, on the other hand, is limited to incisions within the nostrils which naturally limits the visualization and opportunity to alter the structures of the nose.

I choose an open approach if the tip needs to be altered much or if the dorsum needs more than rudimentary reshaping. The closed approach is excellent when dealing with a dorsal hump when the tip needs only a small amount of refinement. The only advantage to the closed approach is the slightly quicker healing time and a decrease in the amount of swelling that is typically experienced.

I welcome any and all question you might have regarding rhinoplasty.

All the best,

Dr. Jabs