I was a trip to Europe for two months last year. I was intensely interested in Fat transfer , Fat Transfer with Stem Cells, Stem Cells alone and the like. There I had the opportunity to visit a few surgeons and a factory that makes an interesting device. This factory was in Lausanne ,  Switzerland. I spent the greater part of the day with a CEO after a train ride who was Italian Swiss. He convinced me that his device works and from what I have been speaking to some of my Colleagues in Asia it seems to be well accepted.

Regen Platelet Rich Plasma Kit

The kit shown above is used to Harvest the blood and separate the components. RegenKit will help  prepare Autologous Platelet Rich Plasma by centrifuge.. This device and system will  produces 4 to 5 ml of Platelet Rich Plasma from 9 ml of whole blood in less than 10 minutes.

So now that you have the Platelet Rich Plasma from the system what is it and what does it do?

Well the good thing is it comes from your own blood, so no harm there. Its non surgical and we like that. The concentrate is thought by some to contain a rich substances such as stem cells and growth factors which may regenerate at some level what you inject it in. Orthopedic surgeons use it for one thing, and cosmetic plastic surgeons use it for another.

In my practice,  I think the best potential use is on the facial skin. This appears in some patients to bring back a youthful glow and lightening effect. By no means is this standard or what we call traditional therapy,  but I believe it may prove to be useful in our quest for anti aging and plastic surgery. It is interesting !

Standard therapy or not I can see little harm coming about and its yet another component of our plastic surgeons arsenal which may be if use.

Till next Time

Doctor808

Fat Transfer and stem cell notes

Yet one of the new areas I looked into was fat transfer with or with out stem cells. There is a process manufacturer in Europe (at undisclosed location) that has quite a bit of knowledge his company share with me about the use and abuse of stem cells. We spent a good day discussing the controversial issues around this topic. I as many of my readers know went to a stem cell conference in Coranado Island last summer as well as attended the Vegas meeting. One of the top research firms is in my building having to do with stem cells as well, so I frequently visit with them or they visit me.

My point is:  somehow I being drawn into this stem cell thing rather rapidly as the field is accelerating. What will these stem cells do? Well according to some things you see on the internet–they will do everything ! Of course that’s is typical hype one sees and only a fool believes. Yet what I have noticed is with fat injection to the facial area (which has some stem cells naturally in the fat that is transferred) is a remarkable change in complexion. It seems to rejuvenate the skin to some degree -actually a big degree. As to the exact mechanism or scientific proof ? I do not have that data to share. What I am sharing is simple observation within my own clinical practice. More study is needed. so I am not formally ready to convert my practice to a “stem cell ” practice , but I am committing to learning more. It does   seem very  promising for face rejuvenation and cosmetic breast tissue regeneration. More on the stem cell issue later. Yet I wanted to introduce you to that concept  here. I might add this IS NOT embryonic stem cells which is the very controversial issue you may hear about.

I have had my web company create a web site about fat injection and as I lean more I will place what I learn there. Its not ready yet,  so do not ask.

Speaking of Regeneration

One of the  most regenerative almost magical places I know and recently visited is The Big Island of Hawaii. I took a few photos and visited with John Turner MD,  a former associate and neurosurgeon. He and I handled some of the bigger trauma cases together on the Big Island when I was working there many years ago. It was great to visit with John and talk about old times. He can be described as a bit of spiritualist/paranormal -doctor recently coming back from a sojourn in South America. Dr. Turner went his way years ago,  but stayed on the Big Island, I came to Honolulu and focused on Cosmetic Surgery.

Here are some picture of the Big Island…you can see the lush greenery and some waterfalls –Boiling Pots on the Hilo side. Please enjoy the scenery as I did.

Hilo Airport View

Boiling Pots Hilo

Hilo is always Green Green Green !

Hilo Streams everywhere

My Street Amsterdam

The above picture is the street I live on here. It has a nice view and many flowers  with two house boats right in front. House boat living is common here along the canals. My apartment is right behind the red smart car you can see behind the house boat.

The door is only the beginning of a long steep entrance way which is basically like doing a “stairmaster”. I may not have to jog if I use these steps more than once a day. There is no elevator here. These are typical dutch steps.

The stairs are extremely steep as you can  see and they go on for about 2.5 floors. Never the less its navigable. There is a special light that one has to creep along the wall to find and turn on otherwise its very dark. All of these nuances one has to learn.

Ok now the living quarters are taken care of next will be transportation. Remember I am in Amsterdam which is the Bicycle Capital of the  world so I bought a bicycle of course

After a Bicycle the most important thing to me is a good gym. I found one less than two blocks away and I signed up today ! The cost was about 100 euros for month but this is a high end gym with some great equipment and staff. Its name is a little funky.

Well other than that I laid out my study material to start on. First topic for review is basic sciences as it relates to plastic surgery. Let me see how many strands are there in Collagen molecule is it two or three?  Oh yes and what about Glycine is that the major component I think so. Well I will be sure by the time the exam takes place. Seems in every day cosmetic surgery practice I do not think much about how many strands there are in Collagen.

Well that’s what I will be doing and this the start.

Until next time

doctor808

Since my last writing I took up farming (in my back yard) , went to various travels for my web company AiMiYo LTD , Business in Thailand and medical meetings.

Peppers grew in my Garden

I look through my last 24 months and I have been on a lot of trips.

Korea with Dr. Lee , Dr Cuvo

My garden has grown nice peppers, eggplant and squash.

MY Operating room

Asian Surgery Colleques

Done a lot of surgery and taught a lot of surgery and learned a lot of technique as well.

I love Asia because its different and I always learn something new and exciting as well.

Europe on the other hand is relaxing and serene to me. I never learn as much there as far as Plastic Surgery goes as I get the latest through American Plastic Surgery Literature. So Europe is more of a vacation and some work. Yet I confess I take it easy there.

The Praque

Shinjuku Crossing

Clinic In China and gang

From Tokyo to Dailin China my travels have been intersting to say the least.

So this has kept me busy.

Street Bangkok Thailand

Did I mention Hong Kong, Vegas and Kauai ?

Some of these more than once. My plan was to write about each trip and make a journal to some degree but as mentioned I was busy with:

-writing content for web sites

-running a cosmetic practice

-improving my design skills with illustrating web sites -photoshop, fireworks and various web design programs

-teaching my fellow surgeons and learning from them

Also I spend some time setting up web servers and then there is the financial aspect , bookeeping billing and many more things too busy to mention. When you are the chief of these things, all the stuff people who work for you who do not do, then falls on you to do. I cannot even keep myself organized so that’s the last thing I need is to be mommy to others. Yet that is what I do.

So I have made some decisions about prioritizing some things. All of this came about on this trip to Las Vegas for 5 days in which I attended various lectures and had the AiMiYo booth to show our web talents and try to get a few new clients. More on that later.

Cosmetic Surgery Meeting Vegas !

The medical meeting side of things is what I really enjoyed as talking to doctors about Internet marketing is really a struggle. There are two types , those who think they know everything and those who do not even know how to spell : HTTP. Well I am not sure which one is harder to deal with. Some from last years meeting I talked to about web marketing were worse off so I got to say “I told you so” and then others were so hard to educate that it will take a year.

SO back to the medical meetings. I was not a lecturer this time which I was rather happy about that. I need to improve my skills not only teach others. I must say the lectures here and the quality of the speeches were excellent. What this was a multi specialty conference meaning there were not only Plastic Surgeons but Dermatologist, Ear Nose and throat doctors in summary everyone who performs cosmetic surgery.

One of the huge topics here was fillers of the face, fat , sculptura, restylene  and the host of products on the market. I was amazed at some of the results these doctors were getting with non surgical methods. As a surgeon of course I have some extra tools ( no pun intended) to use  so I can not only make corrections with non surgical means but can offer surgery. Yet that aside, I was surprised at some of the fantastic results some doctors were showing. It energized me towards looking to do more in the non surgical realm.

So this next year for me will definitely be one of pursing some of the nonsurgical methods and improving my own.

The scoop on these medical meetings is one has to learn to sort out what is valuable and what is hype. If you followed this blog before you will know I am not one for hype and like to use things in my practice which really work rather than to spread the gospel according to “marketing bible”. What that means is No I do not use something simply because its NEW BETTER IMPROVED AND THE IN THING.  I take the reality of if something works very seriously.

That is the main scoop of these medical meetings. Choose what you learn wisely.

I promise my readers I will back track and keep up in the future about what I have been up to..news and and information. I also my next post will not be CHAOTIC. Yet That’s my mind after travels.

until then…

doctor808

Resting at base of alps

My friend Dr. Cuvo and I went to Switzerland and rented motorcycles after visiting Amsterdam for a few days. There we caught a plane and landed in Switzerland to take the trip to the Swiss Alps. It was a true vacation in that we did not Plastic Surgery business what so ever. Amsterdam as many of my readers no is one of my favorite haunts to Bicycle ride but motorcycle in the Alps is a different story.

We landed in Geneva and went to the local motorcycle shop trying to find Harley’s,  but none were available. So we rented two large Honda’s. Not my first choice but not bad, similar in size to a Harley.

The first day we rode around Geneva to practice and make sure we packed our gear properly. The next morning we left for the alps. The road was a highway at first around Lake Geneva then onward to the hills then the mountains on the way to the Matterhorn.

Dr Cuvo , My Bike was Black One

We needed a MAP for drmap

A view of the Lake

The trip went very well and the high peaks of the Alps were great. The best way was on the way down. Well not much to say really–pictures tell the story of  three day trip.

This was great for a plastic surgeon from Honolulu and one from Tokyo , a nice break.

Nice view of alps in distance

side of hill

Good Curves of Alps

Holding The Matterhorn

Swiss Village

A tired Doctor808 jet lag

There was also the trip to Amsterdam and the Swiss Alps on motorcycle a few months ago as well but sorry no time to write about that just yet. Maybe next post I will do that. Korea was a direct flight to Seol. My good buddy was suppose to meet us at the airport–no. So I waited for 30 minutes and caught the bus to Seol. My student Dr. Yeum had arranged a very nice Hotel for us. The bus ride took us right there. It was around a nice area with a restaurant district so there were things to do around the hotel for Rose while I went to the conference. Dr Yeum thinks ahead. My lecture presented to the cosmetic surgeons from Korea, China , Hong Kong and Japan was recieved well and as usual the Chinese cosmetic surgeons all have to get their picture taken with the White Guy. Seems as I have stated before its a bit of status symbol for them. These are eager beavers when it comes to wanting to learn cosmetic surgery which is fairly recent event when it comes to China. The three I met are shown below but there were maybe 100 or so from China.

Well aside from the lecturs I gave in Korea and attended we had a lot of evenings out with my colleagues of fine food and drink. Korea has some great food and you can bet I imbibed as usual.

Great Korean Food

My Korean, Chines and Japanese Cosmetic Surgery Peers

Aside from the meals and great exchange of information there was the typical discussions of new techiques which when ever I go to these meetings I learn more. I think we learned more at this meeting than I did at the Vegas Cosmetic Surgery meeting I went to last August. As a lot of these lectures are geared to my Asian patients. The Joint conference in Vegas last summer was good but only 30% of my patient population here in Hawaii is caucasian After the conference we took off to Bangkok where I tended to my real estate business and web company. We are developing 6 new web sites , one in Hair Transplant and the others are related to Thailand but more on that later. So this visit to Bangkok was more of work visit rather than vacation. Well I hope to write more later in the next post , in the mean time here are some more photos.

A unusual Korean Dish

Fried Insects In Bangkok

I have to get ready again for the Korean Cosmetic Surgery Meeting in Seoul Again, after that I will go to China again. These will be for cosmetic surgery lectures and teaching  that I will give. It seems that last conference in Korea was not to long ago or was that Tokyo I am confused.  China will be on the Agenda as well this year just like the conference in Fuzhou.

Dr. Lee and Dr. Pasquale China Fuzhou Conference

Korea is always a lot of fun , there will be the usual gang from Tokyo, Korea and China all running around and being very doctor like !  I have to prepare my lecture which is going to be on Breast Augmentation again. This is my reputation there as the” Hawaii Breast Augmentation Guy”.  Yet I do facial plastic surgery as well, but for some reason all the Korean’s come to my clinic to study breast augmentation.

Now for the Europe trip, My plan is to go to Amsterdam and stay at the usual place called the Amsterdam American Hotel. There I will meet my friend from Tokyo , Dr. Kuvo and we plan to rent two large motorcycles.  From there we cruise through Germany on the way to Lausanne to take part in some training of a new rejuvenation technique having to do with stem cells etc. Do not know much about it yet but sounds promising.

Outdoor market in Amsterdam

So this will be a busy couple of weeks preparing for the trips and making sure patients are being well cared for by me and m staff. The fun starts at the end of the month first off to Europe.

Thats it for now

Doctor808

What do you think?

A few weeks ago  friend of mine was expressing to me the concern they seemed to note at a cosmetic surgery meeting. They said to me “these cosmetic surgeons all they care about is money” in a holier than thou attitude.  The attitude reflected the attitude of others I have heard before, who either do not think cosmetic surgery is needed or see the money some of these surgeons make. Well since this was a friend I asked candidly ” do you think that is all I care about ?” My friend said “no”. Well this bothered me to some degree for two reasons. First what is wrong with making money for ones labors ? I mean rewarding people in a competitive fashion with money,  for doing good work —-it actually does work. We have seen this propel society to grow more food for its people. We have seen such a formula of    reward the individual = better production and achievement tried many times and we can observe the failures and the successes of this. Like wise we have seen the formula   reward everyone equally =  less production and achievement proven as well.

In agriculture,  farms that made good production of food  made the most money, the farms that did not produce much food efficiently  lost money and failed. The Soviet economic system completely crumbled due to the lack of incentives other than a banner or badge from the state which said “good job”. Seemed it was not enough to keep things going. More food is a good thing, less food is a bad thing. I think I have made my point here.

So if we apply these principles to cosmetic surgery, what we have is people competing for more money. This means those that do better at cosmetic surgery, produce better results will earn more money than those who produce less results. Although,  in general I think this may be true but  not 100% of the time. People who want cosmetic surgery will want the best I believe. So it follows they will try to find the best for their budget.

So when someone tells my like my friend, Cosmetic Surgeons are only interested in money. In one way –I think that is good thing because of what I said in the above paragraph.  It will produce the best results. A poorly performing cosmetic surgeon will not earn much money and if they are really bad will hopefully go out of business. So in this way, greed is a good thing I think. This is because people have FREE WILL. That is to say,  they can choose this cosmetic surgeon or that one,  depending on what they think is the best. Cosmetic Surgery is unregulated to some degree.

The same applies to many aspects of society. When people are given a choice to work hard and earn more money and if they want more money they work harder, then there are those who try to slide by , talking  a lot or pretending to do a lot,  but do not. The latter typically get rewarded the least with money. That seems fair to me. So I disagree with the notion that cosmetic surgeons greed is 100% a bad thing. It produces the best cosmetic surgeons,  as societies based on a reward system for work performed,  should win. Again we have seen this over and over again,  so I cannot say why people fail to see this.

Now all  rewards are not money. Yet there is a system of rewards which works for some people. Maybe its prestige as seen in academic life such as a promotion to tenure as a professor or a missionary who gives health care free to the poor in some out of the way place like Cambodia. Well they have there rewards as well. They good from their works. I do not think one is worse than the other money verses a good feeling. Both are rewards.

So back to greedy cosmetic surgeons.  Well greed can be good if greed is simply the desire to get some reward such as  money , good feeling or whatever system of values are in place. This is greed? If that is what my friend meant then I think this is a a wrong opinion. What I think is greed in a bad way is when someone wants something through trickery or doing nothing. This means for example a cosmetic surgeon gives Botox charges the patient  for a certain amount then does not give that amount. Like the doctor who went to jail for telling patients he was giving them a cancer drug but sold then water instead which an actual case, That is what I call bad greed. Like wise are people who expect the society to give them something for nothing. We all must contribute.

Contribute is what most cosmetic surgeons have done especially the traditionalist such as myself who were plastic surgeons. Plastic Surgeons are called all the time to emergency rooms to take care of people. Most who have no money and thus the doctor does not get paid. Would you do work for free ? Well I am sure some of you will , but would you do work for free and then risk getting sued? Well most plastic surgeons will and do.

So I have no problem with a cosmetic surgeon who cares about money if that is type of greed. In most ways I think that is good. This is why I am a libertarian and subscribe to some of the philosophies of Ayn Rand.  Please try and understand the difference.

doctor808

Lifguard Va Beach

I have been in practice for many years as Plastic Surgeon in Hawaii, I think,  I lost count. As I become older I realize it has been a very interesting career for me. I am not like many Plastic Surgeons . I have been told I do not have a “Plastic Surgeons Personality” by a peer many years ago. I was taken back , at the time because I was not sure what he meant. I still till this day am unsure what it meant unless he meant high brow or snobby or maybe he meant eloquent with grace and class.

I am more down to earth easy to talk to I think than what the public perceives a plastic surgeon should be. Is this a weakness or a strength?  I think it has to do with ones upbringing and life experience. From high school surfer and life guard to soldier, to good college student to physician to surgeon then plastic surgeon was my path. I forgot to mention I was a bar tender, a short term as policeman and even a paramedic. That a lot of different experiences for one guy over the years and has led to some personality factors. Many plastic surgeons were genetically bred to be plastic surgeons since being an egg in their mothers wound. I on the other hand was not, I made my way through lower middle class with no educational history in my family, in fact I was the only who made it to college not to mention medical school etc.

So does that mean my blue collar roots made me what I am, a dash of various experiences , oh I forgot to mention carpenter when in high school for a few years we had our own after school and summer framing crew. I don’t know although I have tried to analyze that. Maybe that is why I do not have a plastic surgeons personality.

Plastic Surgeon Thinking

What I do have is the energy to pursue what I want till the very end. No silver spoon here only a strong persistence. That is how I completed medical school. We called it “a grind’ because you “grind” and persist your way through mountains of memorization. I have “grind” tendency meaning I usually never give up. This was required when I went through a tough microsurgery fellowship and would be in the operating room for 18 to 34 hours at times (with bathroom breaks and some food). We had a team so we would allow each other short if lucky an hour or two break while the rest of the team operated. Rewarding it was to perform microsurgery yet after a few years I found it tedious and somewhat boring. Cosmetic surgery was more of a challenge for me as it allowed expression artistically and the end result is not easy to define. So in Hawaii I have been a cosmetic plastic surgeon.

Laser Plastic Surgery

Many many years ago I started on the Big Island primarily doing hand surgery because of my microsurgery training. That ended for  reasons and I moved to Honolulu where I developed a large cosmetic surgery practice. Its been that way since. Its been good.  I have met a lot of people and very interesting people. Some I have described in my blog others I do not mention. Some I want to forget.

Where my life will end up I am not sure. Lately I have thought about many things.  I will be in cosmetic surgery practice for a while. Maybe I will be lucky and can retire early and walk the earth like a monk from place to place. It will all depend on what I want in the end, as mentioned  I am a grind. The only issue for me is if I decide that I want something or not. If its obtainable and that is the key to success if I want it of not its formula for failure. I could come to Hawaii from the east coast and it was obtainable and I did it. Yet other things are not so I gave up. I could not on the Big Island have a big cosmetic practice as the market was not there. I could only have a small cosmetic practice and perform some hand surgery so I gave up there.No matter how much I wanted a Big Island large cosmetic practice it was not possible so I moved.

Reality is however what you make it as well. When I first moved to Hawaii,  a neurosurgeon friend told me “you can have anything you want here this is paradise” I did not believe him. Yet I realize that you can have what you want if 1. if its obtainable 2. If you put our the effort and become a grind about it.

Well I wrote too much about me tonight. I promise i will write about others next post but this is my blog.

Doctor808

The meeting was held in one of Tokyo’s famous sushi places where exotic Japanese dishes are served. Not to my taste but very edible and different. I was with Taka and not really involved in the discussion but allow me to say I would love to help out a upstart cosmetic surgery clinic in China.

Meeting with Chinese Taka Cuvo

The meeting may or may not bear fruit but good ideas were kicked around so stay tuned about this. I love working with the Chinese and every visit has been a pleasure.

The interesting thing for Americans to note is that its almost like celebrity status to be a white guy in China.  The media seems to love to show a Caucasian face. its as if they are saying “Look at us we have western people here so we are coming on strong–look out world here we come!

This is not my idea but has been written about in the press the idea of having a white face in their corporate media–Chinese Multiculturalism ?

In fact I had my Chinese administrative assistant search the Chinese internet for anything about our visits there. I though maybe I would be lucky if one picture or statement was found. Yet I was very surprised.

My photo was all over the internet , web sites looking important and shown on not only news media but hospital web sites. I must say I was entertained by this. I was touted as an western expert which I suppose I am. Yet if you know me you will also know I do not particularly have a high brow demeanor and more or less casual in approach to my practice. I prefer to really get know my patients as opposed to come on too “doctorly”.

I have enclosed some of these photos below which I thought the poses and the lightening etc was actually pretty good. I almost believe looking at these photos that its not me but some very important guy !!

Well what else can I say about this international cosmetic surgery business? All in all I say its fun I learn a lot from my peers abroad and I hope they learn from me as well. The point is to me its all how can we be the very best we can to our patients? That is what I try to do I hope.

Its easy to get caught up in the glamor of cosmetic surgery field but we always must keep in mind that our patients place their trust in us which is a humble experience.

Well my dear readers until next time and please enjoy the photos.

doctor808

Dr Pasquale examines a burn patient in China

Group Photo In China--mandatory white guy in middle

Plastic Surgeon From 9th Miltary Hospital China discusses case