Doctor808 Plastic Surgeon Honolulu Hawaii

Well I have not been able to write much these days in this blog,  as I was preparing to teach in China next week. I was invited to a gathering of cosmetic and plastic surgeons in Dialin China to give a lecture on and hold a work shop on face lifting. My assigned task is to teach facial anatomy and facial nerve. This is a very difficult task in that some how I have to figure out how to do this as it relates to face lifting and teach it in less than two days. Well I finally decided and completely my presentation.

Of course these are all physicians from China and Japan –maybe some other assorted cosmetic surgeons from Korea and who knows where else. I doubt there will be many westerners.  Yet the face has extremely complex anatomy so I cant waste time even with Doctors. So I decided I will call my lecture “Essential Face Lift Anatomy”. What I will do is skip all the esoteric anatomical details and just get to pure essence. Maybe I should entitle this lecture “FACE LIFTING FOR DUMMIES” as I will give only the details that one needs to know when doing a face lift.

As far as complexity goes I am showing you a picture below which only shows a few of the details.

A few details

This picture from Netter’s textbook only shows the sensory nerve anatomy of the face. So you get an idea of how complex the face is. Then there are the muscles, the blood vessels , motor nerves,  bone and other soft tissues.

We will have cadavers there to dissect to further the study for these plastic surgeons. I had done a facial nerve (and peripheral nerve) fellowship for one year under Dr. Julia Terzis at the microsurgical research center, so I guess that is why they asked me to teach.  In face lifting the most important structure is the nerve as injury to the facial nerve is the worse complications. I am very happy that I spent a entire year focused on that and it has certainly helped me in face lifting. I do get referrals from other surgeons who have injured the facial nerve during cosmetic surgery but fortunately this is very rare and they for the most part of been temporary.

At any rate I will enjoy a quick look at China and  see how cosmetic surgery is done there. I will let you know about this as it unfolds.

Doctor808

LASER liposuction and other fancy things as you know are not my forte. I have written before about such new fangled techniques such as belly button approach to breast augmentation. These “newer” , “better”, “cooler” and “gods gift” to plastic surgery techniques I have always look at with a jaundice eye. It seems every two years in the world of Plastic Surgery a new technique or device comes out which is all the rage. I have seen this happen non stop for twenty years.  So please forgive me,  if I am not that excited about 99% of  new devices or so called new techniques.

NEWER !! COOLER !! WOW !!!

In my honest and sincere opinion most of these things are driven by marketing and not by solid medical science. It seems to me that even though cosmetic plastic surgery is more consumer driven and not medically required for health it should be based in a solid foundation. Money drives this market as with a Holywood movie and this produces what we may call “Hype”. So surrounding all of these new techniques is a onslaught of Madison Avenue Public Relations and marketing hype.  Medical and surgical breakthroughs should be studied and the results analyzed first not get a quick aproval from the FDA and then loudly marketed.  Unfortunatedly this is not always the case.

Hype Central

In the case of LASER assisted liposuction the marketing hype is very rich. “go back to work the next day” or “less pain” or ‘faster healing”. All of these crys of better newer faster are more appropriate for Tide clothes washing detergent than for a medical procedure. Marketers know that using these key words like “NEWER” Or “IMPROVED” will grab consumer attention so they of course utilize these keywords as much as possible.

Yet what is really behind LASER assisted lipo, smart lipo or any of the other brand names? I have spoken with many of the LASER liposuction advocates and detractors , looked at the results and feel I have a good understanding of the procedures.  Basically a very small cannula , which is a tube has a LASER at the end which produces heat. This “melts” some of the fat which turns it to an oily liquid. This is then sucked out with  the cannula. Rather simple concept really. The same thing was done (sorta)  with ultrasonic liposuction which was the latest greatest thing a few years ago. The problem with this LASER lipo is that the cannula’s so far are very very small. So each practioner tells me in any sizeble area  of fat , they still have to use traditional liposuction. —–HUH@#$%^&* !!!????.

I am not a “hater” but my gosh these pencil thin cannulas cannot take out any appreciable amount of fat. So that is exactly why the LASER lipo doctors have to go over the area with traditional liposuction technique.  Now the advanatage is lost completely as you are still doing traditional liposuction in the area. So what is the purpose of using the LASER lipo? I have heard skin tightening, which may be true in a small area like under the chin but for abddominal or thigh or any  larger area there does not to be any benifit what so ever to my eyes and the cases I have seen. So I conclude that the only advantage of LASER lipo suction in most cases is simply marketing.

Well marketing is potent stuff. If you do not have any patients you cannot do any liposuction,  be it LASER, Ultrasonic or traditional.  So I see the reason why many surgeons like this idea , it is great marketing. Yet for me I have seen these trends come and go and until someone shows me an advantage that I consider worthy,  I will stick to the techniques which I have used for many years with so much success. Maybe I am old fashion, but somehow I cannot stomach doing something just for marketing or 90% marketing. I know Plastic Surgery is suppose to slick and whiz bang,  but again I like the traditional well proven techniques  over marketing . Thats me.

doctor808

Well ……I am sorry my dear and loyal readers I did not keep my blog up during my travels,  as time was so limited. So, I will briefly go over things here to catch my millions of readers up  (I think I have only  two readers ). I will probably have less readers after this post.

First as previously stated, I was going to Amsterdam which is one of my favorite haunts. The reasons are many. First are the people , I love the dutch as they are always friendly like the Thai people. They are straight forward and get along well. The other Europeans are so…. shall I say snobby (over nothing)  that I dont care for them as a whole. Of course many are quite nice and good descent people , but the Dutch it seems as whole are the way I like people.  Lets take the Swiss in Geneva which are a French speaking people. Some are very friendly,  but overall I would rate that town as a small town with small minded people pretending to be important. If it were not for the bankers hiding the worlds money the place would be just another dying European city in my view. No new life. As the first President Bush would say “old Europe”. They tell me that you have to live there to appreciate Geneva and perhaps,  as I only visited but…..not my cup of tea.  That is my simple minded dumb American view. In this blog I dont review the great history ( like Nazi Germans influence ?) but that’s my basic feeling.  What I do like about Geneva is the kick boxing which is why I went and I will tell you more about that later.

Part one Amsterdam

Well we arrive in Amsterdam and  get there at our usual time of 7 am in the morning from a flight from Seattle. We have to wait for the hotel as check in is at 11 am. This is no problem becuase we can get a great breakfast at the usual spot.  This time we also wanted to look at property for a possible retreat so we scout around. This place is easy to scout as there is one way to see Amsterdam –Bycycle. We rent a couple at 15 euros a day and start to scout around. If you go please rent a bike.

As you can see there is no shortage of bicycles in Amsterdam. In fact they number over 5 times the population but no one knows for sure. There are  so many and they are everywhere. Anyone and everyone old, young , crippled , athletic and entire families use them as their main source of transportation’s. The bike roads are great and easy to use. Don’t wast your time with any other means of transportation.

This is one thing I love about this place everything is so easy to do. No traffic jams, no crazy people or homeless that you can see in the central part of the city. Its clean, organized and easy to navigate around on foot or bike.

I like it because of the people I meet and the kick boxing. Rose likes it because of the Art and Museums and Food. There are great restaurants and since Rose is Malaysian Chinese she has a chance to get real Malaysian food and eats there almost every day. Below is a picture of that restaurant located next to the Red light District. That’s the famous place with hooker on display in the windows. Sort of a another type of take out menu.

The food at the Malaysian restaurant is authentic and quite good. Here you can study Malaysian Chinese, in their natural habitat eating good Malay food. This I believe  is their normal “in the wild ” behavior to eat eat eat.  Such are the Chinese…did you know that when you go into a Chinese persons home they don’t ask how are you,  but the first thing they ask is “Did you eat yet?”. If you find a Chinese person in the wild some day just ask them.  They will tell you its true. The couple at the Top are the owners by the way- her name is “Candy and his is Buddha” , I am not kidding.

Amsterdam is famous for legal drugs ( not hard ones) and everywhere you go are the “coffee houses” where you can buy either hash or marijuana cigarettes and smoke it right there while you drink coffee. Not that I would know,  but I was able to observe this. It appeared fun and seemed harmless enough. Yet I think it must appeal to a different crowd as I am a doctor. Everyone knows doctors don’t smoke pot. In case you want to know what these places look like I have several pictures below. They tell me that its cheap to buy and is high quality.

These establishments are everywhere scattered among the sex shops. I have a picture of one sex shop and of some of the evil weed that people smoke. Why people make such a big deal about a silly plant I can still cannot figure out. Its like anything else in my view–abuse it and it may cause problems. So I remind my readers that as I am a libertarian I am against government regulation of such. Amsterdam has no crime attributable to rampant drug use like we do in The States. The criminalization of this plant and other such drugs is why in my view we waste so much money. Libertarians believe if you want to kill yourself who are we to stop you, as a freedom loving bunch. We believe in a freedom to self destruct.

Well the above is only a very small part of Amsterdam,  there is something for everyone there. Art , Museums , food , drugs, sex, business deals, Muslim and Buddhist temples, churches and and a wide variety of everything. That sums up Amsterdam ,  which is a city of extreme diversity and more important— tolerance for diversity. I watched one night at 5 am the practicality of the place as the party goers were in one square when some drunken hell raisers started a fight. The police cleared them out in less than ten minutes with Horse Riding police they were there in seconds appearing from nowhere. They were professional,  efficient and cleared the crowd with out any evidence of brutality nor disrespect. They did their job quickly and the party on the street continued. I was impressed.

Bicycling around I looked over many properties and potential places to live. Signs were posted as shown :

Ideally one would not need a large place,  but some place to call home in Europe so you could have a home base. A base camp if you will.

Yet there are catches in the Amsterdam’s real estate market. Interestingly, one must be careful about what are some unusual laws.

If you buy a place and leave it empty , squatters may take over and inhabit there and you may have a ridiculous time trying to get them out. They in some case have more rights then the owners who they are not paying rent too. Crazy?  Well yes, but that is Amsterdam. I never saw such a bad deal for property owners. The original idea was that the city did not want empty buildings around by absentee land holders or something like that. Well it seems to work and the properties are all well kept. Yet maybe its been taken to far. I have more research to do in these laws.

Geneva

Well I went to a kick boxing place in Geneva where my old instructor from Thailand recommended as he was recruited in his younger years as a Swiss Muay Thai fighter. There he went on to be a Swiss national champion before returning to his home in Thailand where I first met him.

This gym was quite busy with over twenty fighter level members and huge intermediate level trainees in Muay Thai. They take their fighters to Thailand once a year for training. This gym is run by a Swiss fellow and his Thai wife. Very nice place I recommend to anyone. Unfortunately back in Amsterdam I could not find the Merijo Gym which is the famous gym there I trained at before a few times. This gym apparently moved location and due to time limitations I could spend too much time looking. So I trained on my own while in Amsterdam jumping rope , weights and shadow boxing and of course cycling hours a day.

That’s about it for Geneva to me that’s all the two itself offers. I did meet a few people and had brief conversations shall I say. The Swiss don’t speak much english There main languages are German and french. They also have that attitude of your stupid if you only speak french. As example I asked a cab driver to take me to the Hotel Savoy. He looked at me like I was nuts. I pronounce Savoy as most Americans would like rhymes with “JOY”. So he finally figured out what I was saying as he pronounced as Sav-0-aaa a definite french accent. But what I found most ridiculous was the scolding he gave me. “I have been driving a cab for 15 years and never once have I heard that way to say Savoy” he said in a most condescending manner. I could not help but tell him back—” I believe that you have not in your limited life experience of driving a cab in Geneva heard any other variation”  as I chuckled to myself. Score one for the American verses the Geneva Red neck cab driver with a “limited ” small mind. So it goes. I left Geneva vowing never to come back…well maybe I will for the Muay Thai.

Other than these issues of looking for property , relaxing and Muay Thai the most memorable issues was the Bicycling. I truly loved that around Amsterdam and I will do it again and again its a bike paradise. I also thought I will take a motorcycle trip around the country and maybe to others next time I go.  That will be fun. As far as business goes , well I did see some plastic surgeons in Geneva and was impressed but the Swiss are known for a long History of cosmetic plastic surgery. I also spoke with some Web Designers and found out about the local community in terms of Web design and marketing as well as in Amsterdam. There will be some of the best Internet and media conferences coming up these next few years like next fall which I will plan for.

Well my dear readers I don’t want to bore you with too much, so I will go over some other details in later blogs as I am still suffering from jet lag. As always enjoy.

Doctor 808