San Diego Facial Plastic Surgery

Yelp is an online review site where people can express their opinions on everything from hamburger joints to dog washers. It is an amusing site for a person to go and vent some frustrations or rave about the best doughnut they ever ate. It can even be useful to a certain extent. The problem is that somewhere along the way, these folks at Yelp began to take themselves too seriously….


Yelp apparently began contacting business owners-who didn’t even know their businesses were on Yelp-and asked them for money to “promote their businesses on Yelp.” So what’s the harm in that? Well, apparently some business owners recently filed a class action lawsuit against Yelp. According to the lawsuit, despite Yelp’s claim of bias-free, fair reviews, those businesses who paid Yelp were rewarded with positive reviews while their bad reviews “disappeared." If you didn’t pay Yelp, it seems the opposite happened: good reviews faded away and bad ones appeared. Yelp claims to avoid this practice, which many business owners felt amounted to extortion.



With that little tidbit to kick things off, here is a list of why Medical Services do Not belong on Yelp:



1. Yelp may be hazardous for your health (part 1): The “Yelp Filter” may be based on profit, not fairness. Let’s say you search for a burger joint and end up choosing a not so good place because its reviews were skewed positive on Yelp, possibly because that business paid Yelp for advertising. Worst case scenario- you ate a crummy burger and never went back there again. Now, substitute “spine surgeon” for “burger joint.” Kind of scary, huh?



2. Yelp may be hazardous for your health (part 2): Anyone is qualified to review a burger joint. It either tastes good or it doesn’t! Not everyone, however, is qualified or willing to put in the complex reasoning to review a doctor. That is just a bit more involved. Let’s say you went to see a spine surgeon Dr. X. You waited over an hour in his waiting room, only to end up having him tell you something you didn’t want to hear. You’re mad, and go on Yelp and give Dr. X one star, calling him the worst doctor ever. Only thing is, Dr. X was late for your appointment because he was in the middle of a complex surgery in the hospital and couldn’t just walk out. Additionally, he happens to be the best trained, most skilled spine surgeon in town. Now, another prospective patient looking for a spine surgeon - for a serious medical condition - sees your review on Dr. X, and as a result chooses a less skilled surgeon. Reviewing a doctor and placing “One Star” next to their name because you waited in their waiting room longer than usual potentially puts the next “yelper” at risk!



3. Yelp reviews for Physicians are simply Not Necessary: Physicians in our state are currently reviewed by the following respected entities: state medical board, county medical society (produces “best doctor” lists), hospital review boards, medical specialty board, better business bureau, word of mouth, primary (family) physicians. If your doctor truly did something awful- complain to the medical board! Unlike Yelp, they will investigate him/her. You can also access the medical board website to check on any doctor or medical director for an office you are considering.



4. Doctors typically don’t get enough reviews to make them an accurate reflection of the doctor’s ability or skill. Unlike restaurants, movie theatres, retail stores, doctors don’t see 100s of “customers” per day. Most see 10-20 at the most. Because medical care is private and personal, very few patients bother to write reviews of their experience online- unless they have an axe to grind. Hence one bad review can tarnish the reputation of an otherwise great doctor- or vice versa.



5. Unlike Restaurants or Oil change shops- Doctors cannot fairly defend themselves against many false claims. HIPPA is the patient privacy act that prevents doctors from disclosing facts pertaining to a patient’s condition or treatment, or posting before and after photos without permission. While you can go online and post any opinion that comes to your mind about Dr. X, Dr. X cannot defend himself by sharing any identifying facts related to your case. This can lead to baseless reviews hurting or destroying a doctor’s reputation or practice that may have taken him decades to build.






So what does this mean for you? Are we saying don’t read Yelp reviews or post yelp reviews on doctors? No, that is your decision. But we recommend you think very carefully before making medical care related decisions or choosing a doctor based on the reviews written by other people on Yelp. That medical spa with a 5 star rating on Yelp just may have a medical director whose license has been sanctioned by the CA state medical board. Twice.

Labels: doctor reviews on yelp, unfair reviews, yelp, yelp and doctors, yelp dangers, yelp lawsuit, yelp reviews

Is the Eyelid Lift being replaced?

Injectable fillers such as restylane and juvederm are becoming more and more popular for rejuvenating the areas around the upper and lower eyelids. Common complaints pertaining to these areas include: excess skin, wrinkling or “crepiness” of the skin, and hollow areas both above and below the eyes.

In the past, a patient’s only choice for “freshening” the eyes involved surgery. A classic upper eye lift or lower eye lift involves removing excess skin and/or muscle, as well as fat, to create a smoother, tighter lid area. However, we now know that a natural, youthful eye region must have appropriate volume; in a youthful face, one does not see boney margins and concavities around the eyes. Removal of tissue around the eyes must be done judiciously, with careful attention to preservation or even augmentation of volume in these areas. Indeed, fat transfer or grafting around the eyes is done very commonly along with eyelid lifting in our practice.

So can one skip the surgical “lifting” altogether and just treat the eyes with adding some extra volume? In some cases, the answer is yes.

In some patients, the eyes are showing their age mainly due to loss of fat around the eyes. In these cases, by injecting restylane around the eyes, we can restore volume and thereby lift and even tighten the overlying skin. The extra volume from the filler “pads” the bone around the eye, creating the softer appearance of youth.


The patient below had Restylane injected to the lower eyelid “groove”:








Interestingly, we are finding that injected hyaluronic acid-based products such as restylane and juvederm persist in the skin for up to several years. While patients may return in 9-12 months for additional plumping in constantly-moving areas such as the lips or smile lines, the eyelid region tends to retain the product much longer. Patients may go for 1-2 years or longer without needing a touchup in these areas. Should the patient or doctor decide that the filler is undesirable for some reason, it can be dissolved by injecting a material called hyaluronidase into the skin.

And what are the risks of injecting fillers around the eyes? Complications such as bruising or lumpiness may occur, both of which either resolve on their own or with limited intervention. Overfilling is a possibility, but completely reversible with hyaluronidase. There is a remote possibility that filler may occlude a small blood vessel causing damage to surrounding tissue, but this can be reduced by using small needles and injecting slowly and carefully.

Overall, injectable fillers are proving to be a powerful tool for rejuvenation the eyelid regions without need for surgery or downtime. We expect this office procedure to grow more and more popular in 2011.

But is the Eyelid Lift being replaced? Not completely. Some patients will always benefit from skin removal or other surgical intervention- with or without addition of volume. However, for many of us, injectable fillers may indefinitely postpone or improve the results of a surgical lift. As with any other procedure it is important to choose an experienced and skilled injector to achieve the best results around the eyes.

Labels: fillers for eyes, liquid eye lift, non surgical eye lift, restylane for lower eyes

Q & A with Roy A. David, MD:

One of the most common questions patients ask at their rhinoplasty consultation is "Will I be bruised afterward?"
The answer is usually "probably." The chief cause of bruising is the osteotomy, or fine cuts that are made in the bones to reposition them. Not every patient requires osteotomies, however, and those patients generally have little to no bruising at one week. For the majority of rhinoplasty patients, there will be some osteotomy-related bruising but usually it is already resolving at the one week point- which is when the external splint is removed and most patients resume most of their normal activities. For women , the minimal bruising at this point around the lower eyes can be managed with some makeup and our fine esthetician staff is always ready to help!

Labels: bruising, ethnic rhinoplasty

The practice will be undergoing an expansion in the next months. We are adding approximately 800sf to accomodate the growing medical spa, as well as add additonal exam rooms and a private recovery room. Our surgical patients will have a private entrance and exit for the days following their procedure. We hope to keep the disturbance minimal and do not anticipate any sheduling changes. Thank you for your patience!

For many patients considering facelift surgery or mini facelift at our San Diego office, one of their chief concerns is the recovery period or downtime. By using twilight sedation and performing the procedure in a precise and custom-tailored fashion, we generally limit recovery to one to two weeks. This may vary of course if additional procedures such as eyelid lift or laser resurfacing and fat grafting are added- but even so, most patients fall within that range for facelift recovery.

On the first night after having a facelift at our La Jolla Center, patients often choose to have a professional nursing assistant stay with them. This can be at their own home if they live close by, or at the adjacent Sheraton Hotel. Other patients who have a comfortable or experienced family member or friend and had a relatively short procedure may choose to have this person stay with them instead.

Facelift sutures are removed between 5-7 days after surgery, and at this point swelling and bruising are becoming minimal. Makeup can usually be applied, and patients will start to resume some of their activities.

The important thing to keep in mind with any surgical procedure is that recovery times are estimates- everyone is different, and it is important to feel relaxed during this period, and to be able to take one or two extra days if needed.

Labels: branded facelifts, facelift recovery, facelift san diego, mini facelift

In our San Diego plastic surgery practice we see a lot of patients who are interested in eyelid rejuvenation or blepharoplasty. Often, they are not sure what exactly they don't like about their eyes- only that they look "tired" or "aged."

It is the job of the facial plastic surgeon to make an accurate diagnosis and to also explain to the patient what they see as as the problem and what can be done to correct it.

In the past- plastic surgeons would address most lower eyelids the same way: removal of fat-as well as skin and occasionally muscle, to try to "smooth out" the lower lid area.
Unfortunately, not all eyelids respond well to "removal" of tissue, and in some cases this will create an artificial appearing "hollow" look around the eye.

In many cases, it is helpful to address the groove beneath the lower eyelids: this is called the nasojugal crease. It is formed due to thinning of the skin over the boney orbital rim, and leads to an aged appearance with a resulting shadow over the area.

The nasojugal crease can be addressed with fat grafting, fat repositioning, a midface lift, or with implants.

Fat repositioning can often be the most straightforward approach-as we are able to use tissue that is already there, avoiding liposuction or additional surgery. The fat that is herniated or bulging below the lower eyelashes is manipulated into a new position over the boney orbital rim, and often secured with sutures. The loose skin and muscle layers are then redraped over this, and excess skin and muscle may be removed.

Labels: eyelid lift, fat repositioning, san diego eyelid lift