 
So thank you everyone for Joining
the Cleveland Clinic Virtual All About Me Session,
our inaugural Virtual All About Me Session.
Today we will be hearing from Dr. Poblete
on breast and body basics,
but before we begin,
I would just like to start with a couple of reminders.
And also my name is Brianna Clare,
and I will be your facilitator for the afternoon.
So just to start,
I like to remind everyone that this session
is a voluntary opportunity
to receive educational information
from a Cleveland Clinic provider and ask general questions.
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and medical information provided
in response to other individuals questions
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please contact your Cleveland Clinic provider.
Additionally, I would like to remind
all of those that we have attending,
so you please remain on mute
throughout the entire presentation.
If you do have a question,
please type in the chat box for your question to be answered
at the end of the session, we'll have time for Q and A,
and then this session will be recorded
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with no identifying information.
All right, now I would like to introduce our speaker
for the afternoon, Dr. Poblete.
Dr. Poblete joined the Cleveland Clinic
Dermatology and Plastic Surgery Institute
from a private practice in Avon Lake, Ohio.
Dr. Poblete graduated from the university of Virginia,
School of Medicine.
He pursued his surgical training with the residency
in general surgery
at St. Vincent's Hospital and Medical Center,
New York Medical College.
After completing his training in New York,
he completed a fellowship in hand surgery
at Columbia-Presbyterian Medical Center,
Columbia university.
He also completed a facial plastic
and reconstructive surgery
at New England Deaconess Hospital,
Harvard Medical School, Boston,
and a cosmetic surgery fellowship at plastic surgery center
at the Pacific of the Pacific in Honolulu.
Dr. Poblete's special interests include,
cosmetic and facial plastic and reconstructive surgery.
He is board-certified in both general surgery
and plastic surgery,
and he is a member
of both the American Society of Aesthetic Plastic Surgery
and the American Society of Plastic
and Reconstructive Surgeons.
Now, without further ado,
I would like to welcome Dr. Poblete.
Okay, well, thanks Bri for the introduction.
I'd like to thank everyone for joining us.
I understand this is right in the middle of the day
and most are busy around this time.
So thank you for joining us.
Our goals for today will give,
will be to give everyone attending or listening an overview
and a better understanding of breast surgery,
mainly breast implant surgery, as well as body contouring.
First nonsurgical cosmetic procedures,
far outnumber surgical procedures.
As you can see from the slide,
the top five nonsurgical procedures are mainly Botox,
fillers, hair removal,
nonsurgical fat reduction,
and by that it is mainly CoolSculpting
and I believe Dr. (indistinct) discussed this last week
in the similar presentation, as well as photo rejuvenation.
The top five surgical cosmetic procedures
based on our National Societies data from 2019
for breast augmentation,
liposuction,
breast lifting,
tummy tuck and eyelid surgery.
And as you can see from the slide,
breast augmentation and liposuction,
which alternates between one and two
over the past several years,
they by far outnumber the third most common procedure,
which is breast lifting.
And just slide here
to show five-year trends in cosmetic surgeries.
It shows that most of the procedures
are increasing in frequency,
but there's a slight decrease in breast implant surgery
over the past five years.
And then by age group, you will see here in this slide
that between the ages of 18 to 34 and 35 to 50,
augmentation or breast implant surgery is the most common.
And then the younger set and slightly orders
that would be liposuction,
and above 65, it would be eye lid or blepharoplasty surgery.
Note however, that if you are interested
in having silicone implants,
the FDA requires that you be at least 22 years old.
So I know that this is a breast and body talk,
but since Botox procedure,
I mean, Botox treatments are the most common
by far nonsurgical procedures,
so just allow me to show a few slides
on neurotoxins or Botox treatment for wrinkles.
There are three,
there are three neurotoxins approved by the FDA
for treatment of facial wrinkles.
But by far Botox is the most commonly used product,
with 80 with about, about 80% of the market.
On the, on the left side of your screen,
you will see a schematic diagram
showing the different areas where Botox
is injected or can be used mainly
and these are on label users.
Now Botox could be used in other parts of the face
as off-label,
but the most common sites would be the frown lines,
the forehead lines,
and the left lines or just smile lines.
And on the left side of the screen,
you can see a schematic diagram
illustrating the injection points
and an actual patient being with markings
just prior to treatment.
And you could see the way that the injection points
are located would correspond to the areas
of muscle hyperactivity.
And this is just an example of the patient before treatment
on the left side, and about one week after treatment.
And again, another example
of a patient who underwent Botox treatment
of her forehead frown lines and left lines.
Moving on to breast surgery.
The most common forms of breast surgery
would be breast implant surgery,
breast lift surgery,
breast reduction and breast reconstruction.
The most common of this would be breast implant surgery.
And I would pose it that breast reconstruction,
which is surgery after mastectomy or breast cancer surgery,
deserves another presentation of its own.
And hopefully at some point in the future,
we could have some kind of a full presentation of this
breast augmentation or breast implant surgery.
When patients come to me for a visit,
my goal with that visit as well as our goal
for the next few minutes is to help the patients navigate
the different decision-making forms
in breast implant surgery.
The first thing that you have to decide is,
will you undergo breast implant surgery or not?
Will you use saline or silicone implants?
And then would you do it over the muscle, under the muscle?
What incisions to use?
What type of implant to use?
and then the risk and complications of surgery.
It is important for the patient
contemplating breast implant surgery
that you make your decision that is fully secure,
and that you're fully convinced
that you are doing this for the right reasons.
You have to remember that you are putting something
inside your body that you want to be there forever
without problems, but in reality,
this thing may have problems and may not be there forever.
So the thing that I stress to patients is,
you have to be a 100% secure in your decision.
Therefore, when patients come in for a visit,
we make it a point to have a thorough and open discussion
on breast implant surgery.
So would you do, would you undergo breast augmentation
or breast implant surgery or not?
This is the most common cosmetic procedure in realself,
which is a very large online,
which is a very large online community
of plastic or cosmetic surgery patients.
It has, what do you call it?
An acceptance, acceptance or satisfaction rate
of about 98, 98%.
When patients come in for breast augmentation,
the more common concerns that they tell me
was that they want more volume
or they want more fullness in the upper pole fullness,
or that they're not happy with a deflated appearance
after pregnancy or fluctuations in weight.
Having said that,
a significant overwhelming majority of patients
who have undergone breast implant surgery
are relatively happy and satisfied they had the procedure.
In a study presented a couple of years ago
on a large scale study
where we had approximately 14,000 patients responded.
It was noted as part of the conclusion
that after breast augmentation surgery,
the patients found a significant
and sustained improvement in satisfaction,
as well as psychosocial wellbeing.
Several large scale studies
have supported the same conclusion
that this is quite beneficial and that the patients
are highly satisfied.
Note however, that number one,
breast augmentation is not a perfect operation.
It has its own complications and we discuss this in detail
when the patients come in for a visit,
I would also like to note at this point
that a few years ago, it has been reported
that there is what we call
breast implant associated lymphoma or ALCL.
We will discuss this in more detail
when patients come in for a visit,
but suffice to say it is a lymphoma or a soft tissue cancer
of the lining of the implant with a very rare incidents
reportedly between one in 60, one in 6,000 to one in 11,000,
I would like to stress
that this is not a form of breast cancer.
And again, we will discuss,
we do discuss this in detail when patients come in
for their visit.
Silicone versus saline,
most recent reports show that patients
overwhelmingly choose silicone implants.
Silicone implants were approved by the FDA in 2006,
after several years being off the market.
Note that saline and silicone implants
have both solid silicone shelves,
like the outer lining of the implant.
Saline has water or saline fluid inside,
silicone, as it says, has gel inside.
The main reason patients
overwhelmingly choose silicone implant
is that it has a much better feel and consistency.
The biggest difference is if ruptured,
a saline implant will immediately deflate,
or it can deflect gradually too,
but you will notice a volume change in your breast,
whereas in a silicone implant,
if the rupture is contained, there may no,
there may be no noticeable volume change.
Therefore, the FDA recommends
that for surveillance purposes,
that patients with silicone implant undergo MRI studies
several years after implantation
and every few years thereafter.
These are the different access incisions.
You could do axillary, areolar incision
or under the inframammary or under the breast incision.
And then the discussion on,
do you place it over or under the muscle?
This is a schematic diagram showing on the left side
an under the muscle placement,
the middle is over the muscle placement.
And the one on the right
is a complete under the muscle placement.
For all intents and purposes,
when we talk about under the muscle placement,
it referred to the left most image,
which is a Dual-Plane insertion,
or a partially under the muscle insertion.
Note that it is Dual-Plane or partially under the muscle,
because when you look at your pectoralis major muscle,
which goes this way, the implant will be partially covered,
hence the third important phrase, Dual-Plane insertion.
When the lower part and the outer part of the breast,
you will feel the implant more
than the upper inner two thirds.
And that is the Dual-Plane placement.
So a very common question when patients come in
is what size will I be after surgery?
Which is a very common concern,
which is a very reasonable concern.
That's the reason you're having this procedure done.
I tell the patients, number one, we, I cannot guarantee
what raise your cup size will be for one basic reason.
Different Brazil makers have different sizes.
Most patients will want or desire in natural look
although some will want an augmented or fake look.
The main determinants of what size implant to use,
as you can see in this schematics here
is the base width of the breast,
as well as the amount of tissue laxity
and the thickness of that issue that we are starting with.
Typically, what I will do
is I will measure the patient
and then I will bring several pairs of implants,
the size I think we will be using,
a few sizes below it and a few sizes above it.
So when we are in the operating room,
we have several sizes and we use temporary sizers
and then put it while the patient's asleep
and then make the final choice in the operating room.
Now, as you can see in the slide here,
it shows that there are different kinds of projections.
And majority of the patients will desire
a mild to moderate fullness up top,
or a mild to moderate roundness on the upper pole.
And you could see that there are different implant shapes
that could give us those different projections.
You will see in this illustration here
that these three implants above,
believe it or not have the same base width,
meaning they have the same width,
but when you look at them from top,
you will see that the one on the left has more projection
than the one in the middle and then the one on the right,
and this is also discussed with a patient
during their consultation to get their opinion
and their input on what kind of appearance or image
or projection they want.
So let's touch on implant cohesivity.
Okay, the latest generation of implants
or what they call the highly cohesive implants.
The chart on the left shows
the different implant manufacturers,
and it shows that the mammogram on the right side
of that bar graph, manufacturers the most cohesive implants,
and you can see the schematic on the right,
shows that the more cohesive the implant,
the less rippling or the less folks.
I think the best way to illustrate that
if you bring it to the next slide,
it will show you,
it will show two different types of implants.
Showing that on one side,
there is more cohesivity than the others,
meaning more cohesive,
meaning the ability of the tail to stay within shape
and maintain shape.
So that in an upright position, there's less collapse
compared to a less cohesive implant.
So a more cohesive implant will maintain shape
better than a less cohesive implant.
Next, we maybe could display this short video clip.
And basically what is happening here is,
I sliced two implants,
a more cohesive implant on the right,
And a less cohesive implant on the left
and you will, it will show here once we slice it open,
you will see that the more cohesive implant
has a better ability to maintain shape because it's gel,
doesn't spread or doesn't leak out as much as the other one.
So here we are doing the more cohesive implant
on the right side,
and you will see how much tighter wound
the contents of that implant is.
And when I'm talking about right,
I mean, right off your screen, my left in the picture.
So these are the main manufacturers allowed by the FDA
here in the United States
and presently here in the Cleveland Clinic
we use in the (indistinct) implants.
So the next, next slide, please.
So the next would be just a run through
of some representative before and after patients.
And this one,
this one had a saline augmentation under the muscle
and the slide show one year out.
This one is again,
an implantation breast augmentation patient
this time using an areolar incision
or very areolar incision under the muscle placement
using saline implants.
Okay, so this one is a silicone augmentation.
This time placed over the muscle.
You will note the patient requested
an over the muscle placement,
and you will note that she has,
I mean, I guess it's hard to see from the side,
but the tissue thickness,
or she has some preexisting breast tissue,
therefore it is easier to hide the outline of the implant.
And this one is a silicone implant surgery,
inframammary fold or under the breast
under the muscle placement, one year out.
Breast reduction,
breast reduction is a very common operation as well.
We do this regular several times a month.
The main indication or the main reason why patients come in
is mainly because of back pain, neck, back pain, neck pain,
and shoulder pain.
In some cases, insurance companies do cover this.
We do send letters of predetermination.
If we think the patient is an appropriate candidate,
we evaluate the patient,
send a letter and it takes one to two months before,
you know, we get a reply, it will be covered or not.
Again, this is a representative patient
who underwent breast reduction
with a post of picture about a year out.
Breast lift.
Again, patients complain of sagging breasts.
And the procedure here is similar to a reduction,
but in a breast lift,
you're removing mainly skin
without removal of breast tissue.
And this is a patient about a year out
showing the scars in a breast lift
when the scar could be around the areola,
down inside the side underneath.
Note however, that in patients
who undergo breast lift surgery alone,
there still lack of upper pole fullness
and over time, it may get to be an accentuated
or more obvious because the tissues tend to migrate downward
because of gravity.
So we have seen an increasing number.
Next slide now, please,
one way to address this relative lack of upper pole fullness
is to combine breast implants with breast lifting.
And this is a representative patient of someone
who underwent both a lift
and placement of a silicone implant same to same time.
And again, her profile view
showing the improved projection
positioning an upper pole fullness,
and again, another lift and implant,
a patient here showing in frontal,
oblique and lateral profile views.
So to wrap up implant surgery,
a couple of years ago, as I noted,
that there was a large scale study published
when it presented 50,000 plus subjects,
an overwhelming majority had silicone implants.
The inframammary fold incision was the most common,
90% had it placed in a Dual-Plane
or sub muscular positioning.
And majority, 93%, use smooth implants.
And the most common implant size range
was from 300 to 399 cc.
And again, one slide in breast reconstruction.
Breast reconstruction, as I noted earlier,
deserved another presentation of its own
because there are a lot of things to process here.
But this pieces of represent representative patient
of someone who underwent a nipple sparing,
a mastectomy with immediate reconstruction.
So in breast reconstruction,
that decision making points would be a number one.
Well, the mastectomy you will need, okay?
This is what I tell the patients that mastectomy is needed.
My part is more or less an elective part.
So the decision making process will be,
do I undergo reconstruction or not, number one,
do I do this immediate
meaning that general surgery removes the breast tissue.
I'm on standby, we do the procedure
or delayed, where in the (indistinct),
there's the mastectomy with spoons allowed here.
And then the reconstructive done,
months or years down the road.
And then the third decision
would be what type of reconstruction will I use?
And the majority of reconstruction being used today
would be the, either the expander implant reconstruction
or a direct implant reconstruction.
So that's the breast surgery part of this presentation,
moving on to body contouring.
There aren't nonsurgical body contouring,
but there are surgical body contouring.
And of those liposuction is the most common.
And that's what we will focus on today.
When patients, next slide, patients come in
in a whole range of sizes and shapes,
and you can see as we go from left to right.
On the left side,
the main problem is,
but with the skin still relatively tight,
want to back up, one slide please.
And so on the left side, the main problem is fat.
And then as we go from left to right.
You could see that loose skin
is becoming more and more of a problem.
And on the extreme right,
is a deflated appearance on patient
who has had significant weight loss.
And the main problem though,
is a deflated appearance with mainly loose skin.
So when patients come in,
the things that we take into consideration
when examining the patient is number one,
the amount of skin laxity
and is a laxity above or below the belly button or both.
The amount of coexisting muscle laxity deeper, dep inside,
and then the presence or absence of fat
and is the fat localized in one area or is circumferential?
It is also an important consideration
if the patient has undergone
massive or significant weight loss.
And again, the representative,
several representative patients,
this is a patient who underwent laser assisted liposuction
or Smartlipo of the abdomen and flanks
and abdomen and flanks here.
This next slide,
this shows how we mark our patients.
We do a topographical mapping
of the area to be treated before surgery.
We must, as you can see the central part
would be the main treatment area,
and then laterally or in the periphery,
I mark it so that we, this would be the transition stone,
where we will do some suctioning there
so that we could further the area being treated
so there will be minimal abrupt changes
in contour or minimal irregularity.
And the picture on the right is a representative aspirate
showing a relatively high proportion of that being removed.
This is a patient who underwent,
Smartlipo-abdomen implants one year out preoperative.
You could see here, the aspiration,
the one advantage of using laser assisted liposuction
is we're able to break down the fat
before to removal or aspiration phase.
And you could see a really good homogenous slurry type
amount of fat being extracted or removed.
This is a typical Smartlipo patient preoperative
and one year out,
and one lesson smart lobby, you could see here,
patient pre-op, the middle picture was taken three days
after he showed minimal bruising
with some swelling ass noted.
And then six weeks out.
And the main problem is skin,
the treatment would be an abdominoplasty
and there are different forms of tummy tuck, tummy tuck.
And this is a typical patient where the incision
was just above the pubic hairline,
extending to side to side,
and she underwent an abdominoplasty
and a circumferential treatment or a combined treatment
where the patient was treated in front
with a tummy tuck or abdominoplasty
and she had liposuction of the flanks.
A combined liposuction and tummy tuck patient
wherein we treated her flanks with liposuction,
and then we burned her supine.
And on the same sitting, did a combined tummy tuck
and liposuction of the upper abdominal area.
So in summary, just to note,
breast and body procedures are very common.
They have a relatively high patient satisfaction.
A very important consideration really
is in the preoperative phase,
where in patient selection and planning is quite important.
Safety considerations are very important
during and after surgery.
It is strongly recommended that procedures be done
in an accredited facility.
And when patients are interested
in these kinds of procedures,
that it is best to consult
with a Board-Certified plastic surgeon.
Thank you for everyone's attention.
Thank you for participating in this.
Thank you Brianna for hosting this.
I guess we have several minutes now
for question and answer form.
Thank you so much, Dr. Poblete
for giving us insight into options
for surgical breast and body contouring.
So if there are any questions,
please remember to enter them into the chat box,
I will then read them out loud
for Dr. Poblete to respond to.
So we do have one question and the first question is,
how much does liposuction cost?
Okay, in the Cleveland Clinic, we have a,
what do you call it?
You know, a chart of what are the various costs
associated with various procedures?
I do not have to have exact details presently,
we do have financial counselors who would answer that,
or you could email us on our website,
but basically at least the way we do it,
is we charge by area.
So hypothetically they take treatment of the abdomen
is one area.
So that would be one charge.
If we do abdomen and flanks, that would be two areas.
So obviously the more areas being treated,
correspondingly, the higher the charge,
but associated with that is the more areas being treated,
there are price breaks for the second,
third area and so forth.
Our next question is,
what are the risks associated with liposuction?
Okay, I think that's a very good question.
As I know that early, earlier,
all the surgical procedures have associated risks.
Therefore, the decision to undergo cosmetic surgery
should be a balance
between this is how much I want this done,
or this is how much this thing bothers me
versus your fear of what could go wrong
or what are the potential potential problems, right?
So having said that,
anytime you're dealing with cosmetic surgery,
I always discuss with a patient that there is a chance
that you will not be happy with the results
of your cosmetic procedure.
Seeing that one thing you need with this procedures
are these are not like medically needed procedures.
We have to keep that in mind
and the results in cosmetic surgery range
from I'm very happy with the results,
to I'm not happy with the results.
So it is very important that we approach this
with that perspective.
Having said that again now, with liposuction in particular
surgical risk could build infection,
there's risk of bleeding,
there's risk of scarring.
With liposuction, there's risks of contour irregularities.
Anytime you do a contouring procedure,
there's always a chance
you could have gone through irregularities.
Now, contour irregularities are very common
in the immediate post treatment area
when there was a significant amount of swelling.
But as time goes by, they should subside.
But in some cases there are irregularities or dumplings
that may be permanent.
So that's one of the potential problems of liposuction.
The other is whether you call it fat embolism
or pulmonary embolism or fat or air confabulatory or lungs,
and that can be a problem.
So I've heard some people like say,
it is just like liposuction,
in my mind, at least liposuction is surgery.
And it brings us to one of the points
I stressed during the summary slide,
which says it is highly recommended
that you have these procedures done
in an accredited facility,
because if something wrong happened and believe me,
things can go wrong.
Fortunately, they don't happen frequently,
but if something wrong happens,
you wanna be in a facility that can handle
whatever potential problem may happen.
Thank you, Dr. Poblete for explaining the risks.
We also have a question about the recovery time
associated with liposuction.
Okay, great.
Okay so, there is straightforward liposuction
and there's liposuction
combined with tummy tucks or other procedures.
So let's start with liposuction per se.
And it's just for example,
we're doing liposuction of the abdomen, like one area.
Number one week,
I do my liposuction under local anesthesia for most part,
obviously if I combine liposuction with a tummy tuck,
or we combine liposuction with breast surgery,
then the patient goes to sleep.
But liposuction per se, we do it under local anesthesia
to minimize the risk of general anesthesia.
So the patient comes in.
It's the same day procedure.
It's an outpatient, we do the procedure,
the patient goes home.
We encourage the patients to walk the same day.
We would see the patient the next day
to make sure everything is fine.
We see the patient in a week,
to remove a couple of the suture,
assuming that the patient does not engage
in heavy, strenuous activity at work,
we have the patients that you could get back to work
in a couple of days.
Now, going back to work obviously
is a function of what kind of work you do.
So everyone has a different situation,
but like we said, generally,
we come in, we do the procedure.
We see the next day and you could go back to work
in a couple of days.
Now we tell the patients, no working out,
no heavy or strenuous activities
in three to four weeks.
And you have to wear a form fitting compression garment
anywhere from three to four weeks.
Great, thank you.
We also have a question stating,
how common is it for people to have repeated liposuction
of the same area?
Unfortunately, fortunately,
we don't have that problem.
we don't have that problem.
I think the more common thing that we would see
is see a lot of this has something
to do with patient expectation.
And this is a very important thing to stress.
Patient selection is very important.
If the main problem is fat
and the skin is still relatively tight.
Liposuction is a good option,
whether it's regular liposuction
or laser assisted liposuction or ultrasound assisted.
If the main problem is fat
and the skin's still relatively tight,
liposuction's a good option.
The problem, so wherever this patients come in
thinking they will get liposuction
but then when they come in, they've got a lot of loose skin.
So obviously the best treatment,
there will be some kind of tuck,
whether, irregular tummy tuck or a mini tuck
or a tuck combined with liposuction.
So the point I'm bringing up is patients will come in,
they will have liposuction,
but they're more candidates
or some kind of then months or years out,
they are not happy.
So the, the revision will now be converting
a former liposuction patient
into a tummy tuck or mini tuck patient,
but it is not really often that we do revision liposuction
on someone who has a prior liposuction before.
The more common thing is a patient will come in and said,
I had liposuction a year or two ago.
I'm not happy with it.
And, and when I asked them why you're not happy with it,
I've got this loose skin and you'll find out from the get go
that the patient should have benefited
from some kind of tuck before and not just liposuction.
Great, thank you.
Our next question is,
is the charge for Botox similar to liposuction?
Meaning is it determined by how many locations are injected?
There are two ways that a Botox is charged.
One is like by area or by unit,
we charge by unit.
I think from conversations with, you know,
the Botox Queens or business managers for (indistinct)
or the Derma, right?
Majority of the practices will charge by unit.
At least for me, I believe everyone is different.
So when patients come to me,
everyone has their own specific,
what we call treatment patterns.
Some will look at the frown lines, for example,
some will require 20, some will require 12.
So we charge Botox or Dysport by the unit.
I appreciate that explanation.
Our next question is when doing liposuction,
do you do any skin tightening at the same time?
They're a couple, let's be more specific
when we talk about skin tightening.
Liposuction per se
would have some degree of skin tightening,
but the ultimate skin tightening procedure
is when you actually excise or remove skin,
which is what you see in a tummy tuck or a mini tuck.
So experts on the patients will be good candidates
for liposuction alone,
and the skin tightening associated with that
will be mainly from the volume reduction
and by nature the skin will tighten.
One of my biases in why I use laser liposuction
is I'm able to use a laser and keep the skin underneath,
give you better skin tightening
compared to regular liposuction.
However, it doesn't matter what kind of liposuction you do.
You cannot compare the skin tightening you will get
from that tummy tuck or a mini tummy tuck.
So when patients come in,
we assess them,
are they liposuction only?
Are they tummy tuck only?
Or are they better served
with a combined liposuction and tummy tuck,
and this is discussed with a patient.
All right,
now we have a couple of Botox questions coming in.
How long does Botox last
and does Dysport last longer than Botox?
Generally this neurotoxins,
which is the catch all phrase for Botox, Dysport and Xeomin,
they are reported to last anywhere from four to six months,
I perceived and I think Dysport lasts longer than Botox.
It has been reported that Dysport may have a faster onset
than Botox.
I haven't quite seen that definitively,
but to be honest, I really have not seen a patient.
and we've been injecting since 2002.
I have not seen a patient complained that Botox
did not work fast enough.
The biggest complaint is how come this doesn't work longer
than what it usually does.
There are two kinds of Botox or Dysport patients.
One who will come in regularly
'cause they wanna maintain the look
and most would come in two or three times a year.
And then there are those we call the special events,
Botox patients.
There's a wedding, there's a reunion or some special event,
and they will come in to get the treatment.
But majority of those who want to maintain the look
will come in for a treatment two or three times a year.
Thank you, our next question,
and this will be one of our final questions is,
do silicone implants hide mammogram results?
That's a good question.
I think it has been studied exhaustively,
I don't think what we tell the patients,
well, categorically, implants have not been shown
to delay detection of breast cancer.
So that is the direct answer to the question,
do implant delayed detecting breast cancer, no,
However, we tell the patients when you have an implant,
right, when you have an implant, number one,
when you place it in the under the muscle positioning,
then you are, you have the muscle to separate implant
from the overlying breast tissue.
Next we tell our patients that,
when you are going to be undergoing your mammogram,
you want to tell the technician that you have an implant.
So there will be additional views taken
to get a better analysis of your breast tissue.
All right, well, thank you Dr. Poblete.
We truly appreciate you taking the time
to engage with your patients in this way.
Thank you everyone as well for joining us
in this innovative manner virtually.
Have a good afternoon all, thank you.
Thank you.
