This picture shows a patient who has Mondor’s disease. The patient had her breast augmentation approximately 2 weeks earlier.

After examining the patient, Dr. Moss usually comments, “What you have is Mondor’s disease.” While this sounds serious and ominous, Mondor’s disease, when associated with breast augmentation is usually self limiting and resolves on it own. “So what exactly is Mondor’s disease?” many patients ask. Dr. Moss will respond that “Mondor’s disease is a benign condition. Most patients,” he continues, “present with inflammation or thrombphlebitis of the veins in the breast area, usually just below the inframammary crease when it is associated with breast augmentation surgery. At first the vein or veins are tender and then they become asymptomatic and ultimately disappear.” It should be noted that these cord like structures are more evident when a patient lifts her breast upward or applies traction to the area. In fact, it is not uncommon for Dr. Moss to notice the visual symptoms of Mondor’s disease when he examines a breast augmentation patient and realize that the patient has felt nothing and is unaware that she has Mondor’s Disease. Dr. Moss always reassures patients that they need not worry and the situation will resolve on its own. “My wife, Carla had it when she had breast augmentation surgery and it resolved on its own with no problem,” he further elaborates.

This is a picture of Carla Moss having her broken capillaries (telangiectasias) around her nose treated. The treatment is painless and you look normal after treatment.

Dr. Samaha has a cosmetic surgical practice similar to that of Dr. Moss and like Dr. Moss performs many procedures such as breast augmentation, abdominoplasty surgery, and liposuction as well as many facial procedures. In addition to his surgical practice Dr. Samaha has opened a Skin Wellness Center within his practice and also offers many of the current treatments for skin care such as Photodynamic Therapy (PDT), the Titan Laser, Photo Laser, and the Genesis Laser Treatments. These treatments provide improvements to the skin with very little down time. Dr. Samaha also provides treatments with an Erbium laser. For more information on specific treatments please go to www.bostonplastic.com This link will take you directly to Boston Plastic Surgery website pages that are specific to the laser skin care treatments.

Because Dr. Moss has chosen not to include laser skin treatments within his practice, his wife, Carla, needed to seek treatment in another physician’s office. Well aware of the quality work provided by Kathy Antonowicz R.E., R.I., she chose to have her treatment provided by Kathy. “There is an absolute proliferation of medical skin spas but unfortunately many of them are not overseen by physicians that have a background in cosmetic surgery,” states Carla Moss. “Many of these spas are in the local malls and the main streets of many of our towns and cities. The actual facilities may be very impressive from an aesthetic standpoint, but it is often near impossible to figure out who is the physician in charge is and what specialty he/she is board certified in,” she further explains.

It is so important that potential patients understand that while many of these treatments are performed by licensed medical aestheticians, they are done so under the medical license of a physician. It is important that the medical aesthetician has easy access to this physician for questions and advice and that the physician has extensive training and education in the area of cosmetic laser procedures and safety. Plastic surgery is one of the few board certified specialties that include training in the use of lasers for cosmetic treatments in both their residency programs and in their courses for continuing education.

Medical lasers are usually classified as Class IV lasers. These are considered the lasers having the strongest effect and capability and need to be operated under the safest of conditions. “I always feel very comfortable with my safety when I am being treated at the Skin Wellness Center in the office of Boston Plastic Surgery,” Carla Moss says. “Kathy is very knowledgeable and follows all the safety precautions.”

The new spring colors in the Jane Iredale Mineral Makeup

On a lighter topic it should be noted that a new order of Jane Iredale Mineral Makeup has arrived. “I was so excited to look at the new spring colors,” said Carla Moss. “I started using this makeup at my very first laser session and found it to be my favorite brand. I love the way it evens out my skin tone in a very natural way. In addition, I have very sensitive skin and have had no allergy or irritation problems with the Jane Iredale line.”

This picture shows Kathy and me selecting my Jane Iredale Mineral Makeup purchases. Please note that my skin shows no discoloration or irritation from the laser treatment I had just received from Kathy.

It should also be noted that Dr. Samaha moved his practice and the Skin Wellness Center a few months ago to a lovely new location at 2300 Crown Colony Drive, in Quincy. This new office also houses an in office accredited Surgery Center as well as Dr. Samaha’s medical practice and the Skin Wellness Center. Anyone interested in an appointment can call 888-806-4844 or 617-786-7600 and ask for an appointment.

“Nobody likes to see the signs of aging on their face and with the high quality of injectable products available today, I can help to eliminate or soften some of those unwanted lines with a 10 to 30 minute appointment,” says an enthusiastic Dr. Moss, of his Juvederm and Botox® Boston treatments.

The facial injectable market has been steadily growing, and the statistics from the American Society of Plastic Surgeons provide proof that the American public wants to stay young looking, especially when there is little or no down time involved in the treatment.

Botox® still reins “King” in the facial injectable category. There was an estimated 4,625,192 Botox® injections performed by board certified plastic surgeons in 2007. This was a 13% increase over 2006. There are a number of reasons why Botox® is so popular.

Botox® produces results that are unique and often cannot be duplicated in any other way, including surgery. By injecting Botox® directly into a facial muscle, a physician can weaken the muscle and the contractions associated with this muscle. These facial contractions which can cause the unwanted wrinkles are therefore eliminated or softened for periods up to four months. The areas that have traditionally been treated are the frown lines between the eyes, the horizontal forehead creases, and crow’s feet around the eyes.

“Patients will often tell me that friends and co-workers will comment that they look like they are scowling or are angry when they are not,” comments Dr. Moss, Boston cosmetic surgeon. Frequently the offending muscle is the “corrugator” muscle causing the unconscious scowl.

“Patients love how a 5 minute injection with little discomfort eliminates or softens this unwanted facial expression,” Dr. Moss continues. “In addition, there usually is no bruising or swelling associated with this treatment and patients can return to work or go home with no one knowing they just had a Botox® injection.”

Patients should expect to see the effects of Botox® in about 4 days, although in some instances it can take up to 14 days for the full effect of Botox® to be seen. In addition, patients need to be aware that there can be bruising at the site of any Botox® injection.

Although bruising does not usually result from a Botox® injection, patients should be aware of its possibility, especially if they are having their treatment in preparation of a special occasion.

“My wife Carla has a tendency to bruise more than most patients, so she has purchased a concealer product from the Medical Aesthetician, Kathy Antonowicz R.E., R.I. (888-806-4844), who performs her laser skin treatments. “Carla is always happy to share any helpful hints with any of our patients, as she is aware that this can often make a patient’s treatment much easier and more pleasant,” relates Dr. Moss.

If Botox® reins “King” of the facial injectable market then Juvederm™ is the “Queen” of the facial injectables. It is important to understand that Botox® and Juvederm™ work by completely different methods. While Botox® paralyses muscles; Juvederm™ fills in valleys in the skin.

Juvederm™ is the newest of the hyaluronic acid formulations to reach the cosmetic marketplace. Restylane® and Perlane® are two other popular hyaluronic acid products that have been available for some time.

Boston cosmetic surgeon Dr. Moss has been injecting Restylane® and Perlane® since their availability and has extensive experience with the injection techniques for all of these facial fillers.

“Until the introduction of Juvederm™, I would choose a filler product that best addressed a patient’s individual needs,” states Dr. Moss. “However, with the availability of Juvederm™, I am now finding that this product has the benefits of all of the other products combined and I expect it to soon be the market leader in the facial filler category” he adds.

“What makes Juvederm™ so unique is the combination of longevity and versatility. Juvederm™ is the first hyaluronic acid that the FDA has allowed to be labeled “the effects may last up to one year.” The other available hyaluronic acids, Restylane® and Perlane® have labeling that states “the effects may last up until six months.” Radiesse® which is calcium-based microspheres suspended in a water based gel does have labeling that states “the effects may last up until one year,” however, Radiesse® cannot be injected into the lips or vermillion border.

“Having a product that lasts longer and can be injected into the lips is a big advantage for a number of reasons,” Dr. Moss continues. “Patients need to be aware that when a product is labeled “lasts on average one year” means that a patient should expect that 50% of the correction is gone at six months. This meant that any product we had for injections in the lips before the introduction of Juvederm™ would lose 50% of the correction at three months. Patients really appreciate a correction that lasts for a longer period of time.”

“Another factor concerning facial fillers that patients need to be aware of is that the more animated the area of injection, the quicker the filler is absorbed and the correction diminished. The area around the mouth has the most activity and therefore fillers are absorbed at a faster rate in this area. For example, it would not be unusual for the correction to be lost sooner in the lips than in the nasolabial folds (the lines that run from the nose to the mouth, also called the parentheses) because the lips are much more animated than the nasolabial folds. Therefore the availability of a product such as Juvederm™, which lasts longer and can be injected in the lips is big advantage,” Dr. Moss further elaborates.

Juvederm™ is available in two formulations. While both the formulations are interchangeable, the Juvederm™ Ultra Plus is more robust and used more frequently in areas such as the nasolabial folds, while the Juvederm™ Ultra, which is less viscous, is used primarily in areas such as the lips where a softer result might be more desirable.

Like Botox® injections, facial filler injections also continue to increase in popularity. The total combination of facial filler injections performed by plastic surgeons in 2007 was around 1,250,000, making facial fillers by far the second most popular procedure in the field of cosmetic surgery and procedures. Dr. Moss attributes this to both the efficacy of injections and the ease of having the treatments.

Another new trend that is appearing in the facial injectable arena is the concept of “full correction” or sometimes simply called the “Wow effect.” This is where the physician injects sufficient filler into the areas of the face needing correction in amounts that greatly diminish the wrinkles rather than softening the wrinkles.

In conjunction with fillers, Botox® is also injected in areas of concern to the patient to reduce or eliminate the dynamic wrinkles. While this is more costly to the patient the effect that can be produced will often justify the added expense. In addition, the subsequent maintenance injections are often far less than the initial injections. Achieving a “full correction” can be more difficult than simply injecting one syringe of filler or one site of Botox®. Therefore, patients considering having injections to achieve “full correction” should choose a competent physician for their treatment.

“Plastic surgeons are some of the best trained physicians for administering facial injections,” states Dr. Moss. “We fully understand the muscular and neurological anatomy of the face. It is part of the core training in a plastic surgical residency program. You cannot perform facelifts, brow lifts and eye lid surgery without fully understanding the anatomy and the perils that lie beneath the facial skin. There is no other specialty that is better trained for facial injections than the specialties of plastic surgery and facial plastic surgery. I sometimes wonder why any patient would want to choose a provider from a website that does not clearly state who the physician in charge is at the facility, his/her training, and what specific board this physician is certified by.”

In order to stay current on all of the popular facial injectable techniques, Dr. Moss frequently attends courses.

In February of 2008 Dr. Moss attended the “Baker Gordon” Cosmetic Symposium in Miami, Florida. In May Dr. Moss attended an advanced course on Botox®, Juvederm™, Restylane®, and Perlane®. He is also scheduled to attend another full day course in June devoted to the more advanced techniques on the injection of Botox® and many of the facial fillers including Juvederm Ultra™ and Juvederm™ Ultra Plus.

“Patients who come to me do so because they are looking for the expertise of a Board Certified Plastic Surgeon. Whether it’s breast augmentation, tummy tucks, or Botox®, I pride myself on staying abreast of all of the latest techniques as well as continually evaluating the results my patients receive. I always offer my patients the opportunity to return and have 2 week to 1 month post injection pictures taken and to compare them to their pre-injection pictures. We can discuss if any further treatments are necessary or if the patient is happy with his/her result. I find that most are happy but occasionally someone wants more of a correction or even another area treated. My goal is always to have a satisfied patient.”

April is here and as the days become warmer the telephone rings more frequently in the office of Dr. Richard Moss, Boston abdominoplasty specialist. Many of these calls are from women who are dissatisfied with sagging skin of their abdomen and breasts. Frequently these women are looking to reverse the results of pregnancy and the devastating effect it can have on a woman’s body.

The after effects of pregnancy is one of the most common reasons that women seek cosmetic surgery of the abdomen (abdominoplasty surgery) and breasts (breast lifts, breast augmentation, and breast reductions).

Our Boston plastic surgeon, Dr. Moss, is also receiving an ever increasing amount of phone calls from women who have lost large amounts of weight and have considerable amount of skin sag over their entire body. Often times these women have had a gastric bypass procedure but there are also some who have lost 100 pounds or more by adjusting their caloric intake. “Massive weight loss” patients usually find that their sagging abdominal and breast skin can be quite bothersome not to mention unpleasant to look at.

Patients who have lost large amounts of weight either through gastric bypass or appropriate diet management often seek cosmetic surgery afterwards to reduce the excess skin of their abdomen and breasts.

Many of these callers accurately ask for consultations that are appropriate for their situation while others have goals that are entirely unachievable. This article will focus on helping women determine what surgery will help them achieve their goal as well as what scars she can expect to have after her procedure. One fact that all patients with sagging breast or abdominal skin need to accept is that it is impossible to remove excess skin without leaving a scar. While some of these scars are hidden others are quite visible, especially when a patient is without clothing. Plastic surgeons always try to place scars in areas of the body that are hidden by clothing. Some women, however find that a scar even though it is hidden beneath clothing can be bothersome to the point that they will choose to forgo the surgery and live with their skin sag. “While there is no perfect answer to reducing skin sag,” states Dr. Moss, Boston tummy tuck specialist, “one of the most important factors in a successful cosmetic surgery outcome, is that the patient fully understands the length of the scar and where it will be placed on her breasts or abdomen.”

This article will address the skin sag of the breast and abdomen separately since the surgical options are different and a patient’s feeling about the scars on the breast can be different than her feelings about a scar on her abdomen. Dr. Moss finds that many women are far less accepting of scars on their breasts than on their abdomen. What is also factored into the decision of whether a scar is acceptable or not is the extent of sag. The more their abdomen or breast sags the more a woman is accepting of the scar from an abdominoplasty or breast lift. In addition, a woman with excessively large breasts that also sag will get two benefits from a breast reduction (smaller, more appropriate sized breasts that sag less); and therefore, is usually more accepting of the resulting scars. In addition, if she has had back and neck pain or rashes under her breasts, she often sees improvement here as well. These patients rarely complain about breast scars.

Abdominal Skin Sag: There are really no other options for abdominal skin sag other than an abdominoplasty or mini-abdominopasty, (only if a patient meets the requirements). While these scars can be extensive, Dr. Moss tries to place them as low as possible so that they can be hidden even underneath a two piece bathing suit. Patients do need to keep in mind that this two piece bathing suit needs to have some amount of fabric around the front portion to hide the scar and therefore a string bikini would not suffice. Most patients who need an abdominoplasty find that without this surgery they can’t wear a two piece bathing suit anyway.

Dr. Moss likes to point out that he performs abdominoplasty surgery using the “progressive tension suturing” technique that can often result in a better quality of scar. Because the additional suturing throughout the abdominal flap, removes some of the tension from the incision area, the quality of the scar may be better. While “progressive tension suturing” will not reduce the length of the scar it may reduce the thickness of the scar.

These pictures demonstrate what the scar might look like within the first year after abdominoplasty surgery.

Breast Skin Sag: Skin sag of the breast is more complex and there are more choices depending on the situation. The following paragraphs outlines the options available to women with breast sag, medically referred to as breast ptosis. It is important to understand that a patient needs to be a clinically acceptable candidate for each individual option and cannot simply chose the option she finds most desirable. In some situations she may be a candidate for more than one option and she will need to weigh the advantages and disadvantages of each.

Women who have breast fed may find that their breasts have more sag after they stop breast feeding than women who did not breast feed. Sometimes if the baby favored one breast more than the other, the favored breast will sag more than the non favored breast.

Breast Augmentation: A woman who has always had small breasts (A-cup) may find that after pregnancy and breast feeding that while her breasts sag, the skin envelope of the breast remains relatively small and they are best served by having breast augmentation surgery. These women really don’t have skin sag as much as they have deflation of the breast or loss of breast tissue after pregnancy and especially breast feeding. Breast implants will very nicely replace this lost breast tissue. The good news is that the scars are minimal with breast augmentation surgery. Dr. Moss, Boston breast augmentation expert, offers patients two choices for scar surgery. He can make his incisions through either an inframammary incision or a periareola incision. Either one of these incisions is well hidden after surgery and healing takes place.

It is important that patients understand that breast implants do not lift the breasts but rather fill them out. While this often sufficient enough to aesthetically make the breasts more attractive, some women may decide to have a breast lift at a subsequent surgery.

The following pictures demonstrate a patient who had breast sag prior to breast augmentation. The breast implants filled out the breasts sufficiently that a breast lift would not be necessary.

Breast Lifts: A breast lift, medically referred to as mastopexy, reduces the amount of skin sag but does not increase the size of the breast. For women who are bothered by the amount of sag to their breasts, but are satisfied with the size of their breasts, Dr. Moss will offer a breast lift. Because the scarring is much more extensive (anchor scar), than that of a breast augmentation, breast lift surgery is not as popular as breast augmentation surgery. Patient’s also need to factor in that breast lift surgery does not provide the patient with a permanent result as her breasts may sag again with time.

Besides the rather extensive scarring that breast lifts result in, breast lifts do not provide a patient with the “perky” breasts of a teenager. So often patients are pushing their entire breasts up to their upper chest region and stating “this is what I want!” Unfortunately, this is not achievable, and in many instances an under wire push-up bra might give her more of this result. Women with sagging breasts have usually lost the support of internal ligaments called “Cooper’s ligaments.” It is Cooper’s ligaments that normally support some of the breast tissue and fat in what is medically referred to as the “superpole” (upper) region of the breasts. While breasts that have been surgically lifted almost always have a much nicer overall shape than before the lift, they will not have the “perky” shape of a young breast. It is also important to note that when performing a breast lift, the surgeon will also reposition the nipple in a higher more aesthetically pleasing position.

These pictures demonstrate a patient who was an excellent candidate for a breast lift and abdominoplasty. Her breasts were not too large (a B cup), she had breast ptosis (sag) and her abdominal skin sagged as well. In addition she was at her ideal body weight.

Dr. Moss always addresses the issue of how long a breast lift will last during his consultation with a patient. He states “While it is impossible to accurately predict the length of time a patient’s breast lift will last, it could be months, it could be years, there are some factors that can influence the duration of the result. One is the size of the breast that is lifted. A smaller breast such as a B-cup will most likely retain its result longer than that of a full C-cup or a D-cup. I always recommend that a woman with a large C-cup or D-cup who is contemplating a breast lift also consider a small reduction as well,” he further elaborates. “Unfortunately, some of these women, especially the C-cup women do not want this and so in the end do nothing. Many of them find that the trade off of scars and smaller breasts outweigh the benefit of reducing the sag and in the end decide that doing nothing, at least for the present, is the better option.”

Another factor that influences the longevity of a breast lift is the elasticity of the skin. A woman’s breasts that have not been stretched to a much larger size at one time are more likely to retain the result than breasts that have been stretched due to pregnancy, breast feeding or large amounts of weight gain and loss. Also age can be a factor. A younger woman’s skin that has more elasticity than an older woman’s skin is more likely to retain the result of a breast lift.

Breast Reduction: Breast reduction surgery is very similar to that of breast lift surgery, except that breast tissue is removed as well as breast skin. These patients obtain the same type of correction in skin sag as that of a breast lift. In addition, the nipples are repositioned, as in the breast lift. The scars are often identical to that of a breast lift (anchor scar).

Although the scars from a breast reduction are as extensive as those from a breast lift many of the breast reduction patients are more tolerant of them. This is because they are so bothered by the large size of their breasts that they are more than accepting of the scars in order to have their breasts made smaller.

This patient was an excellent candidate for a breast reduction. Her breasts were large (32DD) and she was at her ideal body weight.

There are also situational factors that can influence a woman’s acceptance of scars on her breast or abdomen. Generally, younger women are more sensitive to their appearance and therefore less accepting of scars. At the same time these young women, often young mothers who have had a child at a very young age, are very troubled by their bodies after a pregnancy. Dr. Moss finds that most of these young women who seek him out for abdominoplasty surgery do proceed with a tummy tuck because they are so unhappy with their bulging bellies and abdominal skin sag they are willing to accept the scar.

Another situation that is often a factor in a woman’s acceptance of a scar is whether or not she is already married or in a committed relationship. These women generally feel more secure about their bodies and are less concerned about a scar. Frequently, they have already discussed it with their significant other and he has relayed to her that a scar does not bother him. Women who are not married or in a committed relationship are sometimes more anxious about a scar because they feel a man might be less attracted to them in the future. Dr. Moss states that “There is no right or wrong decision about a woman’s acceptance or unwillingness to accept a scar. The most important thing is that she is aware what the resulting scar will be and then she makes her own decision.”

Another factor that sometimes influences whether a patient elects to go forward with surgery is the predictability of the quality of the scar once the skin has healed. “Women with darker complexions are more likely to have more noticeable scars. Also women who have some natural redness to their hair color and skin tend to scar more poorly,” Dr. Moss says. “Women with blue eyes and fair skin (not redheads), generally have better quality scars. However, I always point out to patients that scarring is not in the hands of the surgeon, and it is what it is, and patients need to accept this before proceeding with surgery. The good news is,” he further elaborates, “is that scars tend to fade with time. Although they do not disappear, I am often impressed with how much they have faded when a patient returns years later for some other surgery. I usually don’t have the opportunity to evaluate my scars beyond one year and most of my post operative pictures are at one year or at six months. I am often impressed with the improvement in the scar when I see these patients years later.”

The following pictures demonstrate that a scar from an abdominoplasty does fade with time.

Tummy Tuck before	Tummy Tuck 1 month after	Tummy Tuck 6 months after	Tummy Tuck 2 years after

“Another issue that is most important,” Dr. Moss further elaborates, “is that a patient doesn’t choose a surgery that doesn’t correct her problem, solely for the reason of avoiding a scar. We have many women calling in who inquire about liposuction of the abdomen because they think it will eliminate their abdominal sag without a scar. Not only will the skin sag not be reduced or eliminated, it will be made worse.” Dr. Moss emphasizes. “My staff always tries to redirect potential patients to surgeries that are appropriate for their problem and instill realistic expectations before they are given an appointment. It is a waste of time to spend thirty minutes with a patient reviewing all the details of abdominoplasty surgery with her, if the only thing she can think about during the consultation is the scar. I would rather wait and see a patient like this only after she is willing to accept that to reduce her abdominal skin sag, she will have a scar on her abdomen. Although the scar is permanent it will fade with time.”

“My staff members also relay to me that often women ask to see me in consultation for breast augmentation surgery,” Dr. Moss relays. “In asking the patient about her situation they discover her breasts are often at least a C-cup with considerable sag. When they bring up the subject of a breast lift they are told by the caller that they find a breast lift unacceptable because of the scars. However, they really are happy with the size of their breasts but not the amount of sag. Somewhere in this caller’s mind she has come to think that a breast augmentation will lift her breasts. This is basically a misinformed caller that my staff members try to better educate. Sometimes I think what happens is that these patients spend hours on the internet scrolling through hundreds of before and after pictures and they prefer the after pictures of the breast augmentation patients compared to the breast lift patients, so they just assume they can have a breast augmentation and obtain the same result of a patient who had no sag before surgery. This is not the case. Appropriate patient selection for any surgery is as important as a surgeon’s technical skills. And a patient needs to have realistic expectations. This is why a consultation with a board certified plastic surgeon like myself is so important. Realistic expectations for the correction of a given body deformity, need to be in place for a patient to have a satisfactory result.”

Patients sometimes inquire as to whether there is anything that they can do to help improve the quality of a scar. “First and foremost I would recommend that patients not expose the area of incisions and surgery to the sun or a tanning booth at least two weeks before or six months afterwards. I am not a fan of tanning in the first place as it is well known to increase a patient’s chances of having skin cancer, but it can also worsen the quality of scar tissue,” states Dr. Moss.

There is also a product that patients can purchase in Dr. Moss’ office called Scarguard ScarCare. This product combines hydrocortisone, Vitamin E, and silicone in a clear liquid that brushes on, dries quickly and forms a nearly invisible protective film over the wound. This product is one of the most popular products with plastic surgeons for the treatment of scars. No treatment will “erase” a scar, but Scarguard ScarCare will minimize the risk of a poor scar. Dr. Moss will usually allow patients to start using this product at about one month post-operatively.

Boston Botox patient brow at rest before	Boston Botox patient brow raised before
Boston Botox patient brow at rest after	Boston Botox patient brow raised after

Most patients have the full benefit of BOTOX® about four days from their BOTOX® injections. Allergan Inc. the corporation that markets BOTOX® states that all patients should wait up until 2 weeks before determining whether or not their result is satisfactory or whether they want additional BOTOX® injected to improve their result. Most patients find that their initial injections with Dr. Moss are satisfactory and do not require additional material to be injected.

The results from BOTOX® injections last on average for four months, at which point patients should expect to be re-injected in order to maintain their result.

So if you don’t like the New England weather, wait a few days. It will change. If you don’t like the wrinkles on your face, don’t wait. Call Dr. Moss at 508-747-1322 and schedule an appointment for BOTOX® injections.

“What patients may not be aware of is that all competent plastic surgeons are always emphasizing patient safety throughout a patient’s entire surgical experience. From the first phone call a patient makes requesting information about a consultation to the last appointment before patient discharge (sometimes a year after surgery) I, like many of my colleagues, always have a patient’s safety foremost on my mind. Patients are not necessarily aware of the many decisions that are made concerning patient safety unless it becomes an issue. For example I will not bring up the maximum amount of surgery a patient can have at one time unless it becomes an issue. This type of safety issue will be discussed only with a patient who is attempting to have too many procedures at once,” Dr. Moss elaborates.

Dr. Moss’ staff inquires about a patient’s medical history during the initial contact, prior to setting up an appointment.

There are many topics that are related to patient safety. Some are specific to a surgeon’s training and competence and others are related to a patient’s individual situation and choices that she/he might make. The following is an overview that should put patients at ease with Dr. Moss and his attention to detail when it involves patient safety.

Medical Licensure: Any physician in practice must have a license to practice medicine. What many people do not realize is that licenses to practice medicine are issued at the state not the federal level. Therefore any information on a physician such as malpractice claims would be provided by the state that the physician practices in and not by any federal agency. Dr. Moss holds an active medical license in the state of Massachusetts. In Massachusetts the licensing board for medical doctors is the Commonwealth of Massachusetts Board of Registration in Medicine. Their website is: http://www.massmedboard.org/.

You may view information concerning Dr. Moss at this website. Dr. Moss has never had a malpractice judgment against him during his 26 years in practice. He also has no outstanding malpractice claims against him. “I attribute my excellent track record to many things, including close attention to patient safety,” states Dr. Moss. “In addition I always inform my patients fully before they make any decision to proceed with surgery. And obviously I always try to obtain the surgical result that was anticipated.” For a direct link to the information on Dr. Moss provided by the Commonwealth of Massachusetts Board of Registration in Medicine please go to: http://profiles.massmedboard.org/MA-Physician-Profile-View-Doctor.asp?ID=26890

Board Certification in Plastic Surgery: This is not only one of the most talked about issues in cosmetic surgery but also one of the most misunderstood issues in cosmetic surgery. Most patients have no idea what “board certification” really means. First and foremost patients need to understand that there is no such thing as “board certification in cosmetic surgery.” Secondly, any physician can legally call himself/herself a “plastic surgeon” and not actually be “board certified in plastic surgery.”

The American Board of Medical Specialties is the official organization in the United States under which the individual specialties are organized. The following is a paragraph from their website explaining who they are:

Established in 1933, the American Board of Medical Specialties (ABMS), a not-for-profit organization comprising 24 medical specialty Member Boards, is the pre-eminent entity overseeing the certification of physician specialists in the United States. The primary function of ABMS is to assist its Member Boards in developing and implementing educational and professional standards to evaluate and certify physician specialists. By participating in these initiatives, ABMS also serves as a unique and highly influential voice in the healthcare industry, bringing focus and rigor to issues involving specialization and certification in medicine. ABMS is a designated primary equivalent source of credential information.

For more important information about this organization please go to: http://www.abms.org/

There are only three specialties that receive the required training to perform “cosmetic surgery.” Plastic surgery is one of the three and is the only board specialty to provide the required training for cosmetic surgery of the breasts and body as well as for facial cosmetic surgery. Board certification in plastic surgery is provided by The American Board of Plastic Surgery. For more information on the certification process and the rigorous training required please visit their website at: https://www.abplsurg.org/.

How do I find a board certified plastic surgeon? Board certified plastic surgeons belong to The American Society of Plastic Surgeons. This society provides each member with information on the continuing education that is required and also offers website locations where prospective patients can search for qualified plastic surgeons. Many of the courses provided for plastic surgeons by The American Society of Plastic Surgeons, involve topics specific to patient safety. In addition, to remain an active member of The American Society of Plastic Surgeons, members must earn a certain number of their continuing medical education (CME’s) credits in patient safety. The website of The American Society of Plastic Surgeons is http://www.plasticsurgery.org/. This website provides a listing of all board certified plastic surgeons who are members of this society. To view Dr. Moss website page on this website please go to http://www1.plasticsurgery.org/ebusiness4/md/DRMOSSCOSMETIC.aspx.

This is Dr. Moss’ page on the American Society of Plastic Surgeon’s (ASPS) website.

It should be noted that The American Society of Plastic Surgeons stresses patient safety at all times. Unfortunately there are surgeons who are not properly trained in cosmetic surgery, yet desire to perform cosmetic surgery. This has caused problems that the public attributes to the cosmetic procedure rather than the real problem which is the surgeon is not properly trained. It is important to note than some of the “famous television personalities” who are leading viewers to believe that they are “board certified in plastic surgery” have not receive certification in this specialty. The other two specialties that receive the required training for some or all of the facial cosmetic surgery procedures are “facial plastic surgery, (a subspecialty of otolaryngology)” and “ocular plastic surgery (a subspecialty of ophthalmology).”

Now that we have provided our readers with sufficient information on licensure, training and credentialing, it is important to discuss with potential patients how we protect their safety once they have arrived at Dr. Moss’ office.

Medical History: This is of utmost importance for the patient who has any medical problems. Your medical history is reviewed many times before your surgery.

1. Prior to scheduling an appointment; Dr. Moss’ staff will ask you if you have any medical problems and what medications you are currently taking.

2. At your initial consultation; you will be asked to complete a medical history form. Dr. Moss will review this with you. If your medical condition requires a medical clearance from your primary care physician or some other medical specialist Dr. Moss will explain to you what is necessary and Dr. Moss’ staff will assist you in obtaining the necessary clearance(s).

3. When Dr. Moss fills out your history and physical form for the hospital; Dr. Moss again reviews your medical history to determine if all the necessary clearances, tests and information are in order.

4. At your pre-operative visit; Again Dr. Moss and staff review your medical history to confirm all the necessary paperwork and instructions are complete and patient is “set for surgery.”

5. At your anesthesia pre-operative visit (or anesthesia telephone pre-test), the anesthesia staff and nurses will ask all the necessary questions and review all of the paperwork faxed from Dr. Moss’ office to ensure that the patient is “set for anesthesia.”

6. The morning of surgery Dr. Moss, the anesthesiologist, and nursing staff will review patient’s medical history to ensure that patient’s surgery and care will be provided in the safest possible manner.

7. During surgery; Anesthesia and the surgery itself is performed keeping in mind at all times any pre-existing medical conditions.

8. Post-operative care; From the recovery room to and including all of your post-operative appointments, care will be provided in a manner that takes into account your previous medical history. This might include restarting medications patients are already taking or adjusting diabetic medication to account for reduced eating patterns after surgery.

Medical Clearances: Dr. Moss may ask that you get a medical clearance (or any other relevant clearance) before your surgery. You may also need testing such as an EKG, lab work or other relevant tests performed in order to obtain these clearances. All of these clearances and tests are provided to all physicians (including anesthesia) and hospital operating room staff in advance of your surgery to assure you receive the highest level of care and safety.

Carla always assists Dr. Moss and patients in obtaining the appropriate medical clearances.

Some other examples of medical clearances that might be required are the following:

1. Endocrinology clearance for a patient who has diabetes

2. Neurological clearance for a patient who has multiple sclerosis

3. Cardiology clearance for patient who has a cardiac condition

4. Hematology clearance for a patient who has blood disorders

5. General surgical clearance for an abdominoplasty patient who has a pre-existing hernia

6. General surgical breast clearance for a breast augmentation patient who has potential issues for breast cancer

Dr. Moss will always speak with a patient’s primary care physician or other specialist whenever it is necessary, in order to ensure a patient’s safety during surgery.

Pre-operative Tests: Some patients will need specific tests before having their cosmetic surgical procedure. These tests are sometimes ordered to eliminate “surprises” during the cosmetic surgical procedure or to rule out problems that could result in a patient having her cosmetic surgery result compromised at a later date due to existing medical problems. Some of these tests may be performed to ensure that the patient can safely undergo anesthesia. Examples of tests that might be needed:

1. Mammogram is required for all women ages 40 and older who would like to have any cosmetic breast procedure such as breast augmentation or maxtopexy (breast lift). This is done to preclude any possible issues such as breast cancer before cosmetic surgery is performed.

2. CAT scan of the abdomen to rule out hernia. If Dr. Moss discovers a possible abdominal hernia during his initial examination of the patient, he will require the patient to have a CAT scan to rule out an existing hernia. If the patient does have a hernia this may need to be repaired prior to abdominoplasty surgery.

3. EKG: All patients 50 years of age and older are required to have an EKG to ensure that their heart can safely undergo anesthesia. If the patient is younger than 50 but has cardiac issues then she will also be required to have an EKG.

Psychological issues related to Cosmetic Surgery: Most of the information above has dealt with medical issues. However, for positive outcomes to be obtained, cosmetic surgery more than any other surgery requires that the patient be appropriate from a psychological standpoint and that the surgery selected be appropriate. Dr. Moss states, “It is so important with any cosmetic surgery procedure that the patient is well informed and is making the decision to go forward for the right reasons. Cosmetic surgery is totally elective, we are not saving lives, and therefore as healthcare providers we need to do what we can to ensure that these surgeries are in the patient’s best interest.” So what is done in Dr. Moss’ office helps ensure that from a psychological standpoint the patient is making an informed decision?

Dr. Moss’ medical history intake form specifically asks if the patient has been under psychiatric care over the last 5 years and if the patient is taking any medication such as anti-depressants or anti anxiety medication. If the answer is yes then Dr. Moss will ask the treating physician or therapist for a clearance. Dr. Moss will always dictate a letter to the treating provider explaining what the planned surgery is and what he is requiring to proceed with surgery. In the vast majority of situations Dr. Moss receives clearances of this nature and can proceed with the desired surgery.

Dr. Moss and his staff members are always assessing patients for any signs that cosmetic surgery is not in the patient’s best interest. If a patient seems unable to focus on the information presented or seems unaccepting of potential complications, Dr. Moss would suggest deferring any elective procedures until a later date. Patient compliance is another important issue that needs to be in place. While a non compliant patient may simply be aggravating to staff and physician before surgery, she/he could present issues of safety once surgery has been performed. Therefore it is always important that patients who are planning to undergo cosmetic surgery follow instructions that are presented to them before surgery.

Another aspect to the psychological well being of cosmetic surgery patients is that the patient has realistic goals, having the surgery for the right reasons, and is not undergoing an unreasonable amount of stress over other issues. An example of a poor reason to have cosmetic surgery such as breast augmentation would be to solve marital problems or “hold on to my man”. The last thing a woman needs who is undergoing this type of stress is more decisions to make and the stress of surgery and subsequent recovery. Dr. Moss would recommend that this patient resolve her other issues and then decide “she want to have breast augmentation to please herself.”

Informed Consent: Another issue involving patient safety is that of giving the patient sufficient information to make an informed consent. A patient needs to understand what risks a surgery involves before she/he makes the decision to have elective surgery. “There is no such thing as “risk free” surgery and a patient has to be accepting of that before I will perform surgery on them,” states Dr. Moss. I spend at least thirty minutes with every patient during consultation and for some surgeries that are more intricate the consultation takes at least an hour. Consultations on multiple procedures take at least one hour as there is more information to provide patients. The subject of complications is also discussed in great detail with each patient prior to their making any decision to have surgery. “While I feel that my complication rate is very low, I spend a large amount of time reviewing potential complications which each patient,” states Dr. Moss. “That way every patient can be making a well informed decision as to whether or not to proceed with surgery,” he further elaborates.

During your pre-operative visit Carla will review many of the pre and post operative instructions. All patients then meet with Dr. Moss to review the goals of the surgery, have pre-operative pictures taken. Dr. Moss will also examine the patient as well as answer any remaining questions that a patient might have. Prescriptions are also provided at the pre-operative visit.

Patient Instructions: Additionally all patients need to be given sufficient instructions to be followed both pre-operatively and post-operatively. Dr. Moss’ patients should plan on spending at least one hour in his office for all pre-operative visits. The following is a summary of what is covered in a pre-operative visit at Dr. Moss’ office to ensure a patient is “Safe for surgery.”

1. All consent forms are reviewed and signed

2. All prescriptions are given to the patient. Both oral and written instructions for these medications are provided

3. Two full pages of pre-operative instructions and post-operative instructions are provided to the patient. All of these instructions are reviewed with the patient by Dr. Moss’ staff and a written copy is provided to the patient

4. Dr. Moss sees all patients to “review the goals of the surgery,” take pre-operative photos, examine the patient and answer any questions the patient might have. If the patient is on prescription medication for other reasons a review of those medications will be done by Dr. Moss.

Dr. Moss examines all patients at their pre-operative visit. In some instances he also performs pre-operative testing. This picture demonstrates the Shirmer’s test, which is a test performed to determine that a patient produces enough tearing.

Dr. Moss always takes a patient’s pre-operative pictures at the pre-operative visit. These pictures allow a patient to compare their post operative result to what they looked like before. Dr. Moss will provide all patients with a copy of their pre and post operative pictures when they have achieved their final result, usually somewhere between six to twelve months.

Patient Safety during the surgical procedure: Dr. Moss performs all of his surgery himself. While he will have available all the necessary help such as surgical scrub technologists, nurses and surgical assistants, the actual surgery itself is always performed by Dr. Moss. In addition all of the anesthesiologists are “Board Certified” in anesthesia. Patients should also be aware that The American Society of Anesthesiologists undertook a massive effort in 1985 to greatly improve the safety of anesthesia. The number of problems with anesthesia has dropped precipitously since then. Dr. Moss will provide a patient with access to an anesthesiologist who wishes to discuss their surgery prior to making the decision to have surgery. In addition, they can visit the website of the American Society of Anesthesiologists at www.asahq.org.

Dr. Moss performs all of his surgeries at accredited facilities. Dr. Moss always performs all of his surgeries.

Post-Operative Care: Dr. Moss provides the “Gold Standard of Care” when it comes to post-operative care. Like all surgeons he provides 24/7 care postoperatively to all of his patients. Surgeries are scheduled so that all patients should be getting all of their postoperative care by him. When he his out of town another “Board Certified” Plastic Surgeon covers for him.

Dr. Moss is readily available to his postoperative patients for any questions and be seen even for non-scheduled appointments. All patients are seen the day after their discharge from the hospital even if that day is a Sunday or holiday. This allows Dr. Moss to closely examine all surgical sites and for patients to ask any questions.

Occasionally patients will telephone Dr. Moss’ office with a question of some sort and then ask “Is this normal?” In situations like this Dr. Moss will always want to examine the patient rather than diagnose or treat over the phone. “While almost all of these situations are quite normal, I can only be sure after an actual examination,” states Dr. Moss. “Diagnosing and treating over the phone can lead to problems that otherwise could be avoided by performing a medical examination on the patient. I would rather err on the side of safety rather than risk missing something important. I would much rather come in even if it is a Sunday, than worry about a patient’s condition. We never charge the patient for any of these extra visits.” Dr. Moss and staff find that most patients appreciate Dr. Moss’ availability and desire to put them at ease.

Hospital or Surgical Facility: Another important aspect of patient safety is the facility(s) where the surgery takes place. Dr. Moss operates at three local hospitals all of which are accredited by The Joint Commission on Accreditation of Health Care Organizations also known as JCAHO. To visit the website of JCAHO please go to http://www.jointcommission.org/. There is a section devoted to “patient safety” on this website which can be readily accessed from their homepage. Any plastic surgeon who is “board certified” in plastic surgery can operate only in facilities that are accredited when anesthesia is administered. This is true whether it is a facility within a doctor’s office or a hospital. Dr. Moss has chosen to operate at local hospitals rather than in his office because he found that it was more economical to the patient to have these surgeries in a local hospital than building an operative suite within his office. In addition, the hospitals all have overnight capabilities for those surgical patients who require an overnight stay before being discharged.

Day Surgery or Overnight Stay: Another issue that involves patient safety is whether or not to admit the patient for an overnight stay. Dr. Moss admits almost all abdominoplasty patients for an overnight stay. With lesser surgeries such as breast augmentation, rhinoplasty or liposuction he will usually discharge the patient the same day of surgery. Dr. Moss takes into account the length of time of the surgical procedure(s), the invasiveness of the actual procedure(s) and the overall health of the patient when he makes his decision whether or not to admit the patient or not for an overnight stay. Dr. Moss is usually able to tell the patient in advance as to whether or not an overnight will be required. In addition, he always has the option of admitting the patient overnight after the surgery has been performed if this seems to be in the best interest of the patient. While very few patients are unexpectedly admitted overnight, the decision as to when a patient is discharged from the hospital is always made when the patient is ready for discharge and patient safety is always a priority.

How Much Surgery is Too Much? First let us tell our readers that when a patient calls and wants everything done and can’t prioritize “what bothers them the most” Dr. Moss’ staff informs them that “they are not yet ready for a consultation.” Massive weight loss, pregnancy, and the aging process all can result in the patient needing multiple procedures. However, the first step that needs to be achieved before even a consultation can be planned is that the patient needs to be able to communicate to staff and doctor “what bothers her the most.” Dr. Moss always lets patients know, “I operate on patients to make them happy. Therefore, I need to know what bothers them, not me. Certainly, I will let them know what surgical procedure will address their concerns or if I feel their goals are unrealistic. But the need should always come from the patient. Occasionally, I or my staff will point something out to a patient if we feel at there is some cosmetic surgery that they should consider that they have not brought up. An example of this is that some patients who consult with me for a rhinoplasty also have a recessed chin and need a chin implant as well to achieve a more proportioned appearance.”

There are many factors that are considered when multiple surgeries are planned at one time.

1. The length of time of each individual procedure: It is easier to combine 2 smaller procedures than 2 large procedures.

2. The location of each procedure being considered: Often times it is best to stage procedures at or near the same place on the face or body at two separate times. Examples of 2 surgeries that Dr. Moss likes to do at separate times would be breast lift and breast augmentation or brow lift and upper lid blepharoplasty (eye lid lift). This provides a more predictable result.

3. The health and age of the patient: The healthier the patient, the more likely that Dr. Moss will consider combining procedures. The patient’s medical history is more important than her/his age although age is a factor considered.

4. Weight: The closer a patient is to her/his ideal weight the more likely it is that Dr. Moss will combine procedures. Likewise, the more overweight or obese a patient is the less likely it is that he will combine procedures.

5. A willingness to stay overnight: Sometimes Dr. Moss will consider combining cosmetic procedures that he would individually perform on an outpatient basis, however if performed together he would require the patient spend the night in the hospital.

Another issue that always needs to be considered when a patient requests a consultation with Dr. Moss on multiple procedures is, “are these procedures being considered for the right reason?” Dr. Moss’ staff would be concerned if a patient calls and instead of focusing on one or two procedures is “all over the place” and in a period of five minutes has usually brought up half a dozen surgeries. These patients often present in an almost manic or depressed like state. In addition, these patients often bring up a multitude of personal problems and crisis currently taking place in their life. Cosmetic surgery in situations like this is not appropriate because it is for the wrong reasons and the end result is always a dissatisfied patient.

Cosmetic Surgery / Pregnancy, Childbirth, and Breast Feeding: Dr. Moss will not consider performing any cosmetic surgery procedure on a woman who is pregnant or breast feeding. The risks outweigh any possible benefits including unnecessarily exposing the fetus or infant to potentially harmful medications. Likewise he will not consider scheduling a patient for a cosmetic surgery procedure if she is actively trying to get pregnant.

It is not unusual for patients to call Dr. Moss’ office a few months after the birth of a child, looking to schedule a consultation for cosmetic surgery of the breasts and/or abdomen. The staff can usually hear the infant crying in the background. The mother often seems overwhelmed with both the care of her baby and the condition of her body. She often times is still carrying much of the weight gained during her pregnancy. While it is understandable that a mother of an infant would be looking for a “quick fix,” safety takes precedence in situations like this. The restoration of a mother’s body to pre-pregnancy appearance is not as easy as the Hollywood glossy tabloids like to make it appear.

As anxious as many mothers are to restore their bodies with cosmetic surgery, Dr. Moss requires mothers be at least six months from the birth of their baby for abdominoplasty surgery. For breast surgery Dr. Moss requires that mothers be at least six months from childbirth or breast feeding, whichever is the latest. These requirements provide for the safety of the patient.

Dr. Moss requires all women who would like to have cosmetic breast surgery such as breast augmentation to have stopped breast feeding for at least six months. If the patient did not breast feed the baby then she would have to wait six months from the time of childbirth. This is to ensure that the milk glands of the breast are not actively producing large amounts of breast milk. Dr. Moss’ office will schedule an appointment at around five months post partum or five months after she has stopped breast feeding, whichever comes last. “Quite frankly an examination and consultation is of little value until we can get an accurate picture of what her breasts are going to look like once they have stopped producing breast milk,” states Dr. Moss. “It is impossible for me to even make any size recommendations until we know what size her breasts eventually be, once the milk production has stopped. We will accommodate these women on my surgical schedule so that they can have their surgery as soon as it can safely be performed; however even preliminary evaluations cannot be made until at least five months after the breasts have stopped producing milk,” he further adds. For further information on this subject please go to another blog article of Dr. Moss’ at http://www.drmossthebeautyboss.com/blog/2007/10/breast-implant/cosmetic-surgery-in-boston-breast-implants-and-pregnancy/.

Abdominoplasty surgery, (also commonly referred to as tummy tuck) is another procedure that mothers flock to in an attempt to restore their bodies. Again all patients need to wait six months after having their baby(s) before having this surgery so that their body can return to its final post pregnancy condition before planning any cosmetic surgical procedure. It is also important for patient’s considering any type of cosmetic breast or body surgery to have lost as much pregnancy gained weight as possible before coming in for a consultation. “All patients will obtain their best result when they are at their ideal body weight; abdominoplasty and breast augmentation are no exceptions to this rule,” says Dr. Moss. It is also important that any patient considering an abdominoplasty who still wants to have additional children must realize that future pregnancies could undo all the results of an abdominoplasty. Therefore she might want to wait until she has had all of the children that she plans on having, before having an abdominoplasty. “A woman can safely get pregnant a year after having abdominoplasty surgery; however she may loose all of the benefits from her surgery,” states Dr. Moss. For more information on this subject please go to another blog article of Dr. Moss’ at http://www.drmossthebeautyboss.com/blog/2007/10/abdomioplasty-procedure/tummy-tuck-in-boston-abdominoplasty-and-pregnancy/.

Pulmonary Embolus: Although rare this is one potential complication that all surgeons are watchful for because it can be life threatening. A pulmonary embolus is a blood clot from another part of the body (usually an extremity such as the leg) that has travelled to the lung. It is treatable but it is life threatening. All of Dr. Moss’ patients are made aware of such a situation, the symptoms, and what she/he should do (phone 911). In over 26 years of practice as a plastic surgeon, Dr. Moss has had less than five patients develop a pulmonary embolus and all were successfully treated.

To help reduce the incidence of pulmonary embolus all hospitals now utilize “compression boots” during and after surgery. Patients are encouraged to ambulate after surgery as soon as is safely possible. There are situations where there can be a higher incidence of pulmonary embolus. The following are situations where a higher incidence of pulmonary embolus can occur and precautions may be taken:

1. The longer the surgery the greater the risk of pulmonary embolus. Therefore Dr. Moss will always consider an overnight stay for surgeries over five hours in length.

2. Patients who have a previous history of pulmonary embolus are more likely to have another.

3. Patients who have certain pre-existing blood disorders may be more prone to a pulmonary embolus.

4. Patients who smoke have a higher incidence of pulmonary embolus.

5. Patients who are obese have a greater incidence of pulmonary embolus.

6. Hormonal medication including birth control pills can increase the incidence of pulmonary embolus.

7. Patients with a previous diagnosis of cancer have a higher incidence of pulmonary embolus.

8. Older patients have a higher incidence of pulmonary embolus.

Smoking: It is a well known fact that smoking can interfere with the healing process. The nicotine interferes with the oxygen in the blood stream which is necessary for healing. Therefore, applying a nicotine patch within 2 weeks of surgery, in hopes of lessening or stopping smoking before surgery will not improve the postoperative healing process. What will help the healing process is to stop smoking entirely for two weeks or more before surgery.

Smoking can also affect the safety of anesthesia. This is due to the fact that smoking has a negative effect on the lungs. However, most healthy patients who smoke 1 pack or less per day less will be able to safely have cosmetic surgery with Dr. Moss. Dr. Moss is very reluctant to perform cosmetic surgery on a patient who smokes over 1 pack of cigarettes per day.

Smoking can interfere with the healing process. The healing process may be improved if the patient stops smoking for at least two weeks prior to surgery.

Alcohol and/or Substance Abuse: Dr. Moss would not consider performing any cosmetic procedure on a patient with an active addiction to either alcohol, narcotics or recreational drugs. These patients have enough to deal with without adding the stress of elective surgery to their life. In addition pain control would be extremely difficult.

Dr. Moss has experienced success in providing cosmetic surgery for patients who have recovered from either alcohol or narcotic addiction. The first requirement is that the patient be psychologically fit and appropriate for cosmetic surgery. Once that is established, the main issue is one of pain control. Past exposure to alcohol or narcotics makes pain control more difficult and requires a greater amount of narcotics. Dr. Moss always requires a consultation with an anesthesiologist at the hospital where the surgery is being performed for the purposes of planning post operative pain control. Anesthesiologists are the specialists in pain control and can safely monitor the larger amounts of narcotics that are required.

Dr. Moss also requires that the patient stay overnight in the hospital so that she/he has access to intravenous (IV) narcotics which are more effective than oral narcotics. In addition, the patient is required to be able to tolerate the pain and discomfort with only oral narcotics (no IV narcotics) for eight hours before she/he will be discharged from the hospital. This is to prevent the patient needing to return to the hospital for the purposes of reestablishing IV narcotics. Dr. Moss has found that with these procedures in place, he has been able to provide cosmetic surgery for many grateful patients. In addition these patients when screened properly have been some of the nicest patients in his practice.

What can you do to insure that you receive the highest level of care and safety? There are a few things that patients can do to increase the safety of their cosmetic procedures with either Dr. Moss or any other plastic surgeon.

1. Disclose all appropriate information accurately to any surgeon you are consulting with for cosmetic surgery.

2. Make sure that you have all of your questions answered in a way that you understand.

3. Listen to what your surgeon and staff tell you.

4. Confirm you surgeon’s credentials.

5. Follow preoperative and postoperative directions that are provided to you.

6. Keep all of you scheduled appointments to ensure proper follow-up.

7. Arrive on time for your appointments.

8. Be honest and forthright with your surgeon. Express any concerns that you have both before and after surgery.

Not enough kisses under the mistletoe this year?

Boston facial filler expert, Richard A. Moss M.D. has the perfect solution. Restylane® injections to fill out and plump up your lips! “Restylane® is one of the most popular ‘fillers’ currently being used to plump up thin lips,” states Dr. Moss. “It is an ideal filler in that it fills out the lips while still leaving them with a natural feel. It can also be used to improve the appearance of nasolabial folds (those pesky vertical lines that run from the nose to the side of the mouth).

Richard A. Moss M.D. finds that around the holidays the number of patients interested in facial injectables sharply increases. “The number of patients scheduling appointments for BOTOX®, Restylane®, Perlane®, and Radiesse®, dramatically rises around Thanksgiving and remains at a very high level until after New Years Day. We stock a number of facial injectable products so that I can personally tailor a patient’s treatment to her individual needs and desired results”.

A Restylane expert, Dr. Moss explains that most women want to look their best around the holidays for all the family, friends and business celebrations. “Many of my patients just want a freshening up. Some are concerned that while they want to look younger they don’t want a radical change. Something that says you look ‘rested’ but not an obvious ‘overhaul’ is often what the goal is”.

Dr. Moss further explains that lips are starting to play an increasingly greater part in the rejuvenation process for many women. “No longer are they satisfied with reducing the wrinkles, they also want the lip fullness that is recognized as an important part of a youthful appearance. This is all part of the trend in the anti-aging industry of not just removing excess skin but replacing ‘lost volume.’ Even facial cosmetic surgery is trending towards the replacement or realignment of lost facial fat pad volume, not just redraping the facial skin and excising the excess.”

“Even those patients who are avid cosmetic surgery patients are supplementing their surgical results with facial fillers (Restylane®, Radiesse®, and Perlane®) for a more natural look,” explains Dr. Moss.

Another popular reason that many patients turn to Restylane® injections in their lips is that, if it is injected along the edges of the lip, (referred to as the vermilion border), there can be a reduction in the depth of lip lines around the mouth. “Women especially hate these lip lines. Lipstick bleeds into them, accentuating an already unpleasant feature of their face. And unlike men, then can’t grow a beard,” Dr. Moss further explains.

Dr. Moss has two different injection techniques for the lips. He can inject along the vermilion border of the lip to help reduce lip lines and improve definition or he can inject into the body of the lips to plump them up. He can also perform a combination of the two techniques. “One of the challenges of injecting along the vermillion border is to avoid overdoing it so that the patient still retains a natural appearance. Often times I will utilize both techniques for an optimum result. If a patient has no lip lines then I might inject just into the body of the lip as it is unnecessary to inject the vermilion border,” explains Dr. Moss. “It is so important to individually tailor the injection treatment to the patient’s specific issues and goals.”

Before	After

This Boston facial filler patient had 1 syringe of Restylane®. Dr. Moss injected part of the syringe along the vermillion border of her lips and the remainder of the syringe into the body of her lips. No other area of her face was injected.

When looking for facial injectables, patients should direct as much attention to the qualifications of the injector as they are to the material they are selecting for injection (BOTOX®, Restylane®, Perlane®, and Radiesse®). Dr. Moss is board certified in Plastic Surgery and has twenty six years of experience. All of the training that he continually receives to stay current is in the area of cosmetic surgery and facial injectables. So before the holidays are over, call 508-747-1322 or 781-337-2421 to schedule an appointment. Dr. Moss’ staff will be happy to answer any questions you might have.

Facial Injectables are a great way to refresh your appearance for the Holidays!

Dr. Moss recently performed a number of facial injectables on his wife; Lisa a new staff member photographed the entire process. Lisa also photographed the before and after pictures. Carla routinely has Radiesse® injections to lessen her nasolabial folds (lines from nose to mouth) and Restylane® injections in her lips to make them fuller. She also has BOTOX® injections to eliminate the lines on her forehead and brow as well as around her eyes to reduce the crow’s feet.

Carla Moss before her facial injectables	Carla Moss after her facial injectables

For more close up before and after pictures please scroll to the bottom of this article!

Dr. Moss first applies an internal topical numbing gel

Dr. Moss then injects a “dental block” of a Novocain like substance. This injection is identical to what a patient has in a dentist’s office.

Dr. Moss then applies an external topical numbing cream to the sites that he will inject with Radiesse® and Restylane®

Dr. Moss then marks the sites of injection for BOTOX® with a red iodine ointment. The red color is easy to identify and iodine has an antibacterial effect on the skin. He has the patient move their facial muscles to mark the sites of injection. Please note that because Dr. Moss uses a very small 32 gauge needle, Carla can barely feel the injections.

Dr. Moss then injects the BOTOX® into all of the spots that he has marked with Betadine ointment. Here he is injecting the forehead.

This picture shows Dr. Moss injecting around the eyes to eliminate some of the lines that are commonly referred to as crows feet.

Before starting the injections of facial fillers Dr. Moss has patients wipe off all of the Betadine ointment from the BOTOX® injections and also all of the numbing cream around the mouth.

Please note that during Carla’s injections in the pictures shown below she can barely feel any of the needles as she has been numbed by the “dental block” and topical numbing creams.

Dr. Moss then proceeds to inject the upper lip with Restylane®. Restylane® is the product used most frequently for injections in the lips.

Dr. Moss then proceeds to inject the lower lip with Restylane®.

Dr. Moss will often ask the patient to take a look in the mirror at the result so far, during the injections. He then will ask the patient where they want more of the product injected. This way the patient has a better chance of getting the correction of wrinkles and the fullness to the lips “where they want it.” Some patients want fuller lips than others and Dr. Moss always wants to accommodate what a patient wants concerning the final result. In addition, some wrinkles bother patients more than others. It is important that Dr. Moss address those first in order to ensure that there is enough injectable material to handle a patient’s concerns.

Dr. Moss then injects Carla’s nasolabial folds with Radiesse®.

Some patients choose to have Restylane® or Perlane® injected in their nasolabial folds. Patient choice usually dictates what product the patient wants injected. Dr. Moss reviews each product and its characteristics with every patient.

Dr. Moss tries to even out the nasolabial folds. Most patients have one side that is more pronounced than the other.

This picture shows Carla immediately after all of the injections. There is very little indication of the BOTOX® injections while there is some swelling and bruising evident from the Restylane® and Radiesse® injections.

This shows Carla Moss the day after injections. There is some bruising but it can be covered with makeup.

The before and after pictures! The after pictures are taken about 1 week later.

Forehead before	Forehead after
Brow before	Brow after
Crow’s feet before	Crow’s feet after
Lips and nasolabial folds before	Lips and nasolabial folds after

Moss prides himself with the quality of service offered to his facial injectable patients. All facial injectable treatments are performed by Dr. Moss himself. He prides himself in the attention given to the details of both the injection itself and the numbing process. “Even though it takes a little longer, we have the patient wait 15 minutes after the injection of the “dental block” and the application of the numbing cream to make sure they really are anesthetized, before I inject the facial fillers,” says Dr. Moss. “All injectable material is company name branded product meant for use in the United States. I provide only the top level of service when it comes to injections of BOTOX®, Restylane®, Perlane®, and Radiesse®, Dr. Moss exclaims!

Reunion Ready! Two weeks after her injections!

In this day and age it is no longer just about losing that extra ten pounds you put on or buying a fabulous dress, or telling your spouse to be on his best behavior. It’s also about making your face as young looking as possible. And with injectables such as BOTOX®, Restylane®, Perlane®, and Radiesse®, Boston facial injectable expert, Dr. Richard A. Moss, can help most patients who want a fresher, younger appearance.

Carla Moss was delighted that their high school reunion patient had called for an appointment two weeks in advance. “This is the ideal time to be injecting a patient for an important event. BOTOX® takes four to fourteen days to take effect. And while the results of facial fillers such as Restylane®, Perlane®, and Radiesse® are apparent immediately, two weeks provides a very secure window for all bruising to disappear. Most patients find that the bruising from the facial fillers is gone within a few days, but occasionally there can be a pesky small bruise that takes its time to totally disappear. And with a very important event, we want no signs of bruising. BOTOX® does not usually cause any bruising, but again there can be that occasional patient who ends up with a small bruise from her BOTOX® injection.

Forehead Before	Forehead After
Brow Before	Brow After
Crows Feet Before	Crows Feet After
Platysma Before	Platysma After
Nasolabial Folds Before	Nasolabial Folds After

One thing patients will find when they obtain their services from a plastic surgeon who has as much expertise as Dr. Moss has is that results are not over promised and complications such as bruising are not unrealistically minimized. “We want to provide realistic expectations both in the area of results and healing. While there is virtually no down time with facial injections such as BOTOX® and Restylane® it is important that patients understand what they might have for bruising. That way they can schedule their treatments so that they fit into their busy schedule,” states Dr. Moss.

If you are interested in a fresher appearance give Dr. Moss’ office a call at 508-747-1322 or 781-337-2421 to schedule a consultation. You can have your treatment on the same day as your consultation if you so desire or come back at a later date for treatment.