Aesthetic Surgery & Medicine

Dr. Angelo Cuzalina was recently asked to serve on the editorial board of a new publication; Aesthetic Surgery & Medicine. Dr. Cuzalina is honored to be part of a distinctive group of physicians who comprise this editorial board. The new publication is dedicated to exploring the art and science of Aesthetic Surgery through the scope of various specialties. Continue to watch our blog site as we will be posting articles of interest.

SLACK Incorporated Announces Editorial Board for its Newest Publication, Aesthetic Surgery & Medicine

The newspaper will bridge the gap among the specialties of dermatology, plastic, cosmetic and dermatologic surgery

THOROFARE, N.J., Dex. 23, 200800SLACK Incorporated is pleased to announce the editorial board of its newest publication, Aesthetic Surgery & Medicine. Launching February 2009, Aesthetic Surgery & Medicine will be a monthly newspaper that will explore the art and science of aesthetic surgery through the scope of various specialties. Led by Chief Medical Editor, Ronald L. Moy, MD, the editorial board is composed of the following members:
Richard L. Anderson, MD
Lawrence S. Bass, MD, FACS
Brian Biesman, MD
Jean D. A. Carruthers, MD, FRCSC(Ophth)
Donn R. Chatham, MD
Edwin A. Cortez, MD
Angelo Cuzalina, MD, DDS
Lara Devgan, MD, MPH
Jeffrey S. Dover, MD, FRCPC
Kay Durairaj, MD, FACS
Jeffrey E. Epstein, MD
Edgar F. Fincher, MD, PhD
David J. Goldberg, MD, JD
Robert Goldberg, MD
Derek H. Jones, MD
Corey S. Maas, MD
Alan Matarasso, MD
Seth Matarasso, MD
Patrick McMenamin, MD
Harry Mittelman, MD
Rhoda S. Narins, MD
Jeffrey A. Nerad, MD
Joseph Niamtu III, DMD
Gordon H. Sasaki, MD
Stuart R. Seiff, MD, FACS
Robert A. Shumway, MD, FACS
S. Randolph Waldman, MD
Woffles Wu, MD
This group of experienced medical leaders will play a vital role in the development of the publication by researching content, reviewing articles, providing their expert perspective on relevant topics and representing all of the aesthetic specialties. Aesthetic Surgery & Medicine will reach more than 21,000 U.S. physicians with an interdisciplinary platform designed to serve as a primary information source for busy aesthetic medicine physicians and surgeons. Articles will focus on clinical skills, the art and science of aesthetic medicine, cosmeceuticals and other products that complement aesthetic medicine, and practical information physicians can use to run a more efficient practice.
With a reporting style designed to develop a deeper connection with readers, Aesthetic Surgery & Medicine will engage readers’ interest while presenting the news in a time-saving format. An integrated daily Web site, AestheticSurgeryandMedicine.com, will offer interactive forums, blogs, podcasts and breaking news to further satisfy the informational needs of physicians. John C. Carter, SLACK Incorporated’s Chief Operating Officer, said, “Each issue of Aesthetic Surgery & Medicine will present original reporting and the expert analysis of our highly specialized editorial board,putting the news in perspective for the reader’s practice.”

As most of you already know, Dr. Cuzalina has written many articles on cosmetic surgery that he performs at Tulsa Surgical Arts. One thing that you may not be aware of is that Dr. Cuzalina is also frequently asked to speak at national cosmetic surgery meetings on the topic of simultaneous Breast Lift and Augmentation! What this means for the patient is one less surgery, one less anesthesia fee, and less overall downtime. This blog includes his latest article in Surge Magazine, a quarterly magazine distributed to members of the American Academy of Cosmetic Surgery.

Challenging Cosmetic Surgery
‘Simultaneous Mastopexy and Augmentation’

Angelo Cuzalina, MD, DDS


Cosmetic surgery of the breast often involves treatment of both breast hypoplasia as well as ptosis. Many women have a combination of breast problems and desire simultaneous breast lift and augmentation. An isolated mastopexy or basic augmentation with implants can be relatively straight forward in select patients; however, combining mastopexy with implants during the same surgery can be a daunting and risky task for even the most experienced surgeon.

Regnault Classification of Breast Ptosis

Pseudoptosis: Nipple is above the fold & loose breast parenchyma hangs below the IMF
Grade 1 Ptosis: Nipple is at the fold
Grade2 Ptosis: Nipple is 1-3 cm below the fold, but above the lowest contour of the breast
Grade 3 Ptosis: Nipple is located at the lowest contour of the breast >3 cm below the fold

The Regnault breast ptosis classification system was developed in 1976 to demonstrate various breast shapes that help guide a surgeons’ decision making process with regard to augmentation and mastopexy. Unfortunately, the grade of ptosis is only one small aspect for determining the ideal procedure for each patient.

Other Parameters as Important as Ptosis Grade for Treatment Planning

Current breast volume: The current cup size the patient believes she has
Firmness of breast tissue: Chiefly at the inframammary fold to avoid a ‘double bubble’ deformity
The patient’s vision of the ideal breast: especially related to roundness or natural contours
The amount of size change required: Ideal cup size
Areolar diameter: desired areolar width
Breast dimensions: especially nipple to fold distance and base width

No easy or dogmatic method for simultaneous mastopexy and augmentation exists. This is why cosmetic surgery is artistic. Yet, a few rules (or suggestions) can help one avoid problems. First rule, significant ptosis with a nipple to fold distance greater than 10 cm will be difficult to treat without a horizontal incision such as with an inverted T mastopexy unless the surgeon is extremely experienced in a Lejour mastopexy or using a very large implant. Personally, adding a short horizontal incision or lateral curve at the base of a borderline vertical mastopexy case can make the result turn out better with only a small extra scar in the crease. Second rule, a periareolar mastopexy cannot produce major lifting particularly on heavy, dense breast, must less a smaller areolar diameter when simultaneously placing an implant (eventually the smaller circle created will stretch). If the patient has large areolas and wants a smaller diameter at the same time as augmentation, adding a vertical component (scar) will actually improve the areolar scar and can lend to smaller areolas by placing suture tension inferiorly and not around the areolas.

The tendency early in one’s cosmetic breast surgery career is at times to be too conservation with the incision choice and the amount of breast parenchyma and fat excision during simultaneous mastopexy and augmentation. This can be especially true for the type 2 or 3 ptosis patient who is already a C or D cup and desires to be a ‘full C’ with more ‘rounded or upper pole fullness. These are particularly difficult because often a reduction of significant breast tissue and placement of a larger implant is needed to increase the ratio of implant volume to breast volume to achieve the look the patient hopes for. Basically, the more percentage of natural breast tissue, the more natural the breast. And, often more ptotic relapse will occur in women with naturally large, dense breast than one with large breasts due to implants (i.e. reducing natural breast tissue weight in exchange for implant volume will improve long term results).

Another surgical pearl to remember is that you can always remove more skin if needed during the procedure but it is hard to put it back if you remove too much. Having said this, a more conservation incision such as a periareolar or ‘donut only’ type incision for the heavy breast or type 2 or 3 ptosis very often leads to less than ideal results. An inverted T or vertical (Lejour type) mastopexy may be a much better choice for this breast type particularly if the patient wants significant parenchymal elevation. These larger incisions do have the potential for minor wound dehiscence at the trifurcations. So, another nice technique that two of our past presidents (Dr. Bob Jackson and Dr. Claude Crockett) have employed routinely for years is to place the implants in a ‘total submuscular’ position (diagram). The coverage of the lower half of the implant gives added protection particularly if the incision breaks down at little or a lot. Ultimately, the simultaneous mastopexy and augmentation can be very rewarding to the patient and surgeon, but will always remain a challenge.

Fractional Laser Skin Resurfacing

Tulsa Surgical Arts offers the newest technology in skin rejuvenation!

We are very excited to offer this new technology to Tulsa. CO2 laser skin resurfacing is not new, however with this new technology, the procedure can be done with improved safety and results and with potentially less downtime. Fractional CO2 laser resurfacing can improve age spots, sun damage and wrinkles on the face, neck and chest.

For patients that are looking for improvement in fine lines, wrinkles and age spots the Active FX mode can treat this with an average downtime of 3-5 days. For patients seeking treatment of deeper wrinkles and acne scars, the Deep FX mode or preferably a combination of Active and Deep FX will give the most improvement.

To learn more about this procedure contact our office at 918-392-7900 for a complimentary consultation. You can also Click Here to see what is being said about Active and Deep FX in the media. 

Lumenis Laser

Tulsa Surgical Arts is pleased to announce the new Lumenis UltraPulse Encore Laser, a CO2 fractional ablative laser that zaps off the top layers of skin to trigger new collagen growth. A single session minimizes fine lines and wrinkles and restores plumpness and perkiness to skin tone.

Dr. Angelo Cuzalina and Dr. James Koehler are the first Tulsa physicians to have this technology available to their patients. The exciting part of this technology is that the healing is much more rapid and downtime is minimal especially when compared to traditional CO2 laser treatments.

Dr. Cuzalina and Dr. Koehler are both extremely experienced in laser treatments, they continue to strive to provide their patients with latest in Facial Rejuvenation treatment options! They are excited to now have the latest in CO2 fractional lasers at Tulsa Surgical Arts!

As always consultations are complimentary!!! From now until the end of 2008 we are offering $500.00 off this treatment, please call (918) 392-7900 and find out more about UltraPulse fractional laser treatment!


To learn more about Tulsa Surgical Arts please visit our website at www.tulsasurgicalarts.com, you can also visit the Lumenis website at www.aesthetic.lumenis.com.


We will look forward to hearing from you!!!!

This year was the first of many for The Annual Davenport Golf Classic, and it was a huge success!

The Davenport Golf Classic was created to help support a dear friend to many, Randy Davenport. Randy served as a McAlester Police Officer before suffering a gunshot wound which left him paralyzed, and unfortunately he has minimal support for his children and close family.

To show his support for a close friend, Dr. Cuzalina held the 1st Annual Davenport Golf Classic at Arrowhead Golf Course in Canadian, Oklahoma. The day consisted of 18 holes of golf, great friends, lasting memories, and all for a great cause. There was an awesome turnout, and everybody was excited to be there supporting such a great cause.

Although the dates for next year have not been set, you are welcome to email us with your information so that we may contact you as soon as the time becomes available.

Please email your request to : kendal@tulsasurgicalarts.com

For information on donating year round, please contact:

First National Bank
Attn. Betty Jo
PO Box 948
McAlester, OK 74502
918-426-0211

Cosmetic Surgery National Meeting January 2008

January was a busy month for our doctors.  In addition to caring for our patients, Dr. Cuzalina and Dr. Koehler took time out of their schedules to lecture at the American Academy of Cosmetic Surgery National Meeting in Orlando Florida.  They lectured along with the internationally recognized plastic surgeon Dr. Oscar Ramirez.

At this meeting, Dr. Cuzalina was elected by the Board of Trustees as the next Treasurer for the American Academy of Cosmetic Surgery.  Dr. Koehler was named as Chairman for the Fellowship Training Committee.  Both our doctors are actively involved in the American Academy of Cosmetic Surgery.

Overall, the meeting was a great opportunity for doctors from around the world to share their experiences and learn about the latest advances in the field of cosmetic surgery.  Dr. Koehler and Cuzalina stayed for a couple of days after the meeting to give review lectures to surgeons preparing for the American Board of Cosmetic Surgery examination.

Look Your Best for the Holidays - Mention this Special Internet Offer.

Want to get rid of those frown lines and crows feet? How about improving those lines around your mouth? Botox is an easy and effective way to treat those expression lines between your eyebrows, on your forehead and at the corners of your eyes. For some of the deeper lines around the mouth, fillers such as Juvederm Ultra Plus can be used to soften these lines and make them less noticeable.

At Tulsa Surgical Arts, we are offering a Holiday Special on Botox and Fillers. Until December 31, 2007 we will offer Botox at $200/area (regular $275/area) and Fillers at $575/syringe (regular $700). To take advantage of this, call us at 918-392-9988 and mention you saw the promotion on our blog page.

If you would like to share this promotion, we can arrange a Botox party at our office for you and 6 of your friends. We will supply hordeurves and beverages, and you will receive one area Botox at no charge. Your friends will get Botox and Fillers at this promotional rate.

To learn more about Botox and Fillers, check out my video on The Cosmetic Channel.

Smart Lipo - Liposuction

One of the latest advances in liposuction combines traditional liposuction with the use of a YAG laser. The main advantage is that a smaller liposuction cannula is used, there is potentially less bruising and bleeding, and their is possibly better skin tightening. Dr. Koehler and Cuzalina were recently interviewed on fox news regarding this new technology. They were the first doctors in Tulsa to use this technology. You can check out their interview by clicking on the fox news banner.

Currently, the laser is most effective in treating small deposits of fat. Traditional liposuction or ultrasonic liposuction using tumescent anesthesia is still frequently used, especially when large amounts of fat need to be removed. To learn more about liposuction check out our website at tulsasurgicalarts.com.

Best of the Best in Cosmetic or Plastic Surgery

Welcome to our blog page at Tulsa Surgical Arts. We are proud to announce that we were voted as Best of the Best in the category of Cosmetic or Plastic Surgery in the July 2007 Oklahoma Magazine.

It is our hope this blog will provide you with current and accurate information regarding cosmetic surgery. For more information please visit our website at www.tulsacosmeticsurgery.com or call us at 918-392-7900.