Archive for the ‘General’ Category


Wednesday, March 19th, 2014


There has been a dramatic proliferation of “fractionated” lasers being marketed for improvement in skin quality. Overall, they are not cost effective.

In order to understand the issues, a little biology lesson is needed.

The skin surface cells are in a layer called epidermis. These flat, layered cells are responsible for dryness, sun damage changes ( actinic keratoses) and pigment irregularity ( “age spots’ or solar lentigines).

Procedural correction of the skin surface has traditionally been accomplised by one of three methods: chemical peels, lasers, or dermabrasion. All these methods create removal of the entire epidermis, followed by reparative healing. The advantage of these methods is effective correction. The disadvantage is potential removal of all skin pigment cells ( melanocytes), leaving white, unpigmented skin.

Enter the concept of “fractionation” of lasers…The idea being to drill a grid of injury columns into the skin while leaving the tissue between columns undisturbed. The process is similar to aerating a golf green or yard. The advantage is sparing of pigment cells. The disadvantage is that only part of the skin surface is treated.

For skin problems involving abnormal pigment or sun damage the problem is uniform. Therefore, “fractionated” treatments would only partially remove the problems. Simpler, cheaper methods such as chemical peels are more practical and more effective.


Does Experience Matter?

Sunday, May 12th, 2013


The three cornerstones of expertise in plastic surgery are: talent, quality of training, and experience.

We often overlook the value of experience. Knowledge and decision-making are very important in a surgeon, but ultimately surgery is an artistic craft. As with any artistic career, the artist gets progressively better with experience. As Malcom Gladwell observed in Outliers, it takes a minimum of 10,000 hours of concentrate practice to achieve expertise. It has been true of every great musician, painter, sculptor, or plastic surgeon.

In my own case, after over 30 years of experience and thousands of surgeries performed, I am achieving the most consistent, highest quality results of my career.