In the above Arm Lift Before and After Pictures, it is easy to see the loose excess skin before and the tight firm arm after Brachioplasty.

The Top 5 Indications for Brachioplasty

1. Significant Weight Loss — This is one of the top reasons. After major weight reduction (through bariatric surgery, medications like GLP-1 agonists, or lifestyle changes), the skin often doesn’t shrink back fully, leaving behind loose, hanging folds on the upper arms.
2. Natural Aging — As people get older, skin loses elasticity due to reduced collagen and elastin production, leading to drooping or sagging in the upper arms—even in those who maintain a healthy weight and fitness routine.
3. Genetics or Hereditary — Some individuals are predisposed to excess skin, fat accumulation, or poor skin elasticity in the arms, regardless of diet, exercise, or body weight.
4. Aesthetic and Confidence Concerns — Many seek the procedure to achieve slimmer, more youthful-looking arms, reduce self-consciousness (e.g., avoiding sleeveless clothing or feeling uncomfortable in social settings), and improve overall body proportions.
5. Functional or Medical Issues — In some cases, excess skin causes practical problems like chafing, rashes, irritation, hygiene difficulties, discomfort during movement, or restricted arm mobility.

Who is a Good Candidate for an Arm Lift

Candidates for Brachioplasty are typically at a stable weight, in good health and bothered by the appearance or feel of their arms. Results are often described as dramatic, especially after weight loss, though it involves a scar (usually along the inner or back of the arm). If you’re considering this, consulting a Board-Certified Plastic Surgeon is key to discuss if it’s appropriate for your situation.

Arm Lift Consultations

If you are considering Brachioplasty in the San Francisco Bay Area, and want an experienced, board certified plastic surgeon, call (925) 943-6353. My Walnut Creek plastic surgery clinic has 30 years of experience with Post Bariatric Plastic Surgery, and can schedule a private consultation appointment.

Fifteen years in a row, we received the 2026 Talk Award for Plastic Surgery Patient Satisfaction.

15 Consecutive Years

I am proud and humbled to receive the 2026 Talk Award for Service Excellence again this year. Awarded for excellence in patient satisfaction as rated online by The Talk Awards, we have received 5 stars for fifteen years in a row.

The plaque above says it all:

• “Fifteen consecutive years of service excellence presented to Joseph A. Mele, MD, FACS, Cosmetic Plastic Surgery. Award category: Plastic Surgeons | Walnut Creek, California. Five stars awarded for excellence in patient satisfaction as rated online by the Talk Awards.”

What is a Talk Award?

The Talk Awards were created to calculate service satisfaction ratings for a variety of businesses, industries and professionals, including Plastic Surgeons, based on independent research. Receiving the award for Patient Satisfaction is amazing, because this means that my patients’ expectations are matched by their actual experience in our Walnut Creek Plastic Surgery Clinic.

Excellence in Plastic Surgery

Plastic Surgery Consultations

If you would like to experience Personalized Plastic Surgery from an award winning Cosmetic Plastic Surgery Team, call (925) 943-6363 today. My team and I are motivated to give you a five star experience. More information about specific procedures is available here on the San Francisco Plastic Surgery Blog and on my main site DrMele.com.

Who Are We?

We are a private, Plastic Surgery Clinic specializing in Cosmetic Plastic Surgery. For almost 30 years we have provided San Francisco Bay Area plastic surgery patients with our unique combination of the latest techniques and the tried and true cosmetic procedures. You will find us in the East San Francisco Bay Areas city of Walnut Creek, California, by appointment only.

After massive weight loss, Abdominoplasty tightens the skin and muscle of the abdominal wall. In this case, a Tummy Tuck was combined with a Thigh Lift for more complete lower body contouring.

The Tummy Tuck remains one of the most frequently requested cosmetic plastic surgery procedures. About 175,000 Abdominoplasties are performed in the US each year, making it the third most popular cosmetic surgery. 98% Tummy Tucks are performed for women, with 2% performed for men after weight loss. If you are considering a Tummy Tuck, what do you need to know? Today, I am answering the top 10 frequently asked questions about Abdominoplasty.

The Top 10 Frequently Asked Questions About Abdominoplasty

Below are answers to the top 10 frequently asked questions about Tummy Tucks (Abdominoplasty), based on common patient inquiries in my Walnut Creek Plastic Surgery office, the American Society of Plastic Surgeons (ASPS), and The Aesthetic Society (ASAPS):

#1 – Am I a Good Candidate for a Tummy Tuck?

Ideal candidates are in good health, at a stable weight (close to their goal), non-smokers (or willing to quit at least 4 weeks before surgery), and have excess skin, stubborn fat, and/or separated abdominal muscles (diastasis recti) from pregnancy, major weight loss, aging, or prior surgeries. It’s not a weight loss procedure; however, it’s best for those who can’t achieve a flat abdomen through diet and exercise alone.

#2 – What Does Abdominoplasty Actually Involve?

The procedure removes excess skin and fat from the abdomen, tightens weakened or separated abdominal muscles, and maintains the belly button for a natural look. A full tummy tuck uses a horizontal incision low on the abdomen (often hidden in underwear/bikini lines).

#3 – What’s the Difference Between a Full and a Mini Tummy Tuck?

A full Abdominoplasty addresses the entire abdomen (above and below the belly button), repairs muscles throughout, and removes more skin/fat. A mini tummy tuck focuses only on the lower abdomen, often with a shorter incision and no (or limited) muscle repair—it’s for milder cases with good upper abdominal tone.

#4 – Will I Have Visible Scars after Abominoplasty?

Yes, scarring is inevitable. The main scar is horizontal and low (bikini-line level), often hidden by underwear or swimsuits. A second small scar may be around the belly button. Scars typically fade significantly over 12–18 months with proper care, but they don’t disappear completely.

Abdominoplasty smooths the abdominal wall by tightening the muscles and removing excess skin and fat. In this case, fat from the belly was used to augment the curves of the buttocks with a BBL.

#5 – How Long is the Recovery After a Tummy Tuck?

Most patients need 2–4 weeks off work (longer for physical jobs). Walking is encouraged early, but full activity (including heavy lifting and intense exercise) usually resumes in 6–8 weeks. Swelling and bruising peak in the first 1–2 weeks and can linger for months; final results often take 6–12 months.

#6 – How Painful is Abdominoplasty Recovery?

Moderate to significant discomfort is common in the first week (managed with pain medication), due to muscle tightening and incision healing. Many describe it as tightness rather than sharp pain. Pain decreases steadily, and most patients feel much better after 7–10 days.

#7 – Does Insurance Cover a Tummy Tuck?

Rarely. Tummy Tucks are usually considered cosmetic. Exceptions may apply if excess skin causes medical issues (e.g., rashes, infections, or mobility problems after massive weight loss), but most cases are out-of-pocket.

#8 – How Long Do Abdominoplasty Results Last?

Results are long-lasting if you maintain a stable weight, healthy lifestyle, and avoid significant future pregnancies or major weight fluctuations. Aging and gravity continue naturally, but the improved contour and muscle repair typically endure for many years.

In this case, a Tummy Tuck is combined with Liposuction to both tighten the abdominal wall and contour the back fat.

#9 – What are the Main Risks of a Tummy Tuck?

Like any surgery, risks include bleeding, infection, poor wound healing, seroma (fluid buildup), numbness, asymmetry, or blood clots. Careful surgical technique and following post-op instructions minimize problems.

#10 – Can I Combine Abdominoplasty With Other Procedures?

Yes, Abdominoplasty is often part of a “Mommy Makeover” with Liposuction, Breast Augmentation/Lift, or other body contouring as shown throughout this post. Combining procedures can enhance overall results but may extend recovery time.

Tummy Tuck Consultations

The questions above represent the recurring topics which patients ask about. If you’re considering a Tummy Tuck (Abdominoplasty), a consultation with an experienced and Board Certified Plastic Surgeon is the best next step. For personalized answers based on your anatomy and goals, call (925) 943-6353, today, and schedule a consultation appointment.

Experience, Caring and Decision Making on the Individual Level

The clinical management of children and adolescents presenting with gender dysphoria or gender incongruence has undergone rapid change, and the American Society of Plastic Surgeons (ASPS) wishes to offer guidance to members providing gender surgery services for this population. This position statement discusses the views of ASPS on breast/chest, genital, and facial gender surgery for individuals under the age of 19.

Today’s release is very similar to guidelines issued two years ago, and has been reinforced with continued clinical research into the well being of our patients.

It should be noted that ASPS members do the vast majority of gender affirming surgery for men and women, cis and trans. This position takes into consideration both the benefits and harms that irreversible medical decisions have, specifically for the treatment of patients below the age of 19.

Clinical and Policy Evolution

Treatment models for the clinical management of children and adolescents presenting with gender dysphoria have increasingly included psychological assessment, social transition, endocrine interventions such as puberty blockers and cross-sex hormones, and surgical procedures.

Clinical practice progresses amid growing patient demand and an evolving understanding of the evidence base, particularly with respect to long-term outcomes in pediatric and adolescent populations. More recently, a number of international health systems and professional bodies initiated formal re-examinations of earlier clinical practice assumptions in response to changes in patient presentation and a growing uncertainty about the benefits of medical and surgical interventions. Systematic reviews and evidence reassessments have subsequently identified limitations in study quality, consistency, and follow-up alongside emerging evidence of treatment complications and potential harms.

ASPS Past Position

In August 2024, ASPS communicated to members that the Society had not endorsed any external organization’s clinical practice guidelines or recommendations for the treatment of children or adolescents with gender dysphoria. At that time, ASPS recognized that the evidence base informing medical and surgical interventions in this population was limited and characterized as low quality/low certainty (i.e., there was limited confidence that the intervention’s reported effects reflected the true effects). This understanding was informed by new systematic reviews published in Europe as well as the 2024 Independent Review of Gender Identity Services for Children and Young People: Final Report commissioned by NHS England and authored by Dr. Hilary Cass.

ASPS’s understanding has continued to evolve in light of additional comprehensive evidence reviews, including the 2024 Plastic and Reconstructive Surgery article Mastectomy for individuals with gender dysphoria younger than 26 years: a systematic review and meta-analysis and the 2025 report from the U.S. Department of Health and Human Services (HHS) titled Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. These reviews have not resolved earlier uncertainties regarding treatment benefit.

Weighing New Evidence

In some areas they have contributed to a clearer understanding of potential harms, while also highlighting limitations of the available evidence. This includes gaps in documenting long-term physical, psychological, and psychosocial outcomes. For an evidence summary, ASPS directs members to Appendix 4 of the HHS report, which details the types of interventions (medical, surgical, psychological), reported outcomes, magnitude and direction of effects, and overall certainty of evidence available in the published literature.

Relevant to ASPS’s position and understanding of the larger patient assessment process, both the Cass Review and the HHS report emphasize that the natural course of pediatric gender dysphoria remains poorly understood. Available evidence suggests that a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention. Evidence regarding adolescent-onset presentation, which has become increasingly common since the mid-2010s, is more limited but similarly does not allow for confident prediction of long-term trajectories.

Predicting Future Emotional Responses

Importantly, clinicians, even those with extensive experience, currently lack reliable methods to distinguish those whose distress will persist from those whose distress will remit. The HHS report underscores that this uncertainty has significant ethical implications: when the likelihood of spontaneous resolution is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and non-maleficence (i.e., promoting health and well-being while avoiding harm) requires a precautionary approach.

The concept of “patient values and preferences” has been cited as sufficient rationale for the treatment of children and adolescents in the face of very low/low certainty evidence; however, high-quality research on patient values and preferences is missing in this area of medicine. For example, it is unclear whether fully informed patients and their caregivers would endorse the current values and preferences framework that places a higher value on achieving more favorable aesthetic effects in adolescence and places a lower value on avoiding potential harm from early pubertal suppression.

Addressing Adolescent Autonomy

Respect for emerging adolescent autonomy is also cited as a rationale for the provision of care in the face of low certainty evidence. However, patient autonomy is more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk–benefit profile, particularly in adolescent populations where decision-making capabilities are still developing. In pediatric contexts, the threshold for intervention must be higher and safeguards more stringent.

Overall, and consistent with long-standing frameworks in medical ethics, including those articulated by Beauchamp and Childress in 2019 and the American Academy of Pediatrics Committee on Bioethics in 2016, ASPS recognizes that surgeons should offer treatments that are medically indicated and supported by an expectation that the anticipated benefits outweigh potential harms. The patient education and informed consent process, which incorporates patient values and preferences and acknowledges emerging autonomy, operates within – not independently of – this evidentiary threshold.

Purpose and Scope of this Statement

This document is not a clinical practice guideline. ASPS has not undertaken a formal guideline development process, including independent systematic evidence assessment, consensus panels, or strength-of-recommendation determinations.

Instead, given the current state of the evidence and variability in legal and regulatory environments, the ASPS/PSF Board of Directors determined that a position statement, rather than a clinical practice guideline, was the most appropriate mechanism at this time.

The ASPS/PSF Board of Directors issues this position statement to provide professional guidance to ASPS members in a rapidly evolving and controversial clinical area; to clarify ASPS’s interpretation of the current evidence base as it relates to the integration of surgical care into a larger care pathway; to support members in navigating informed consent, patient selection, institutional policy, and medico-legal risk; and to articulate principles that prioritize patient welfare, scientific integrity, and professional self-regulation.

Other Important Aspects of the Position Paper

Several other important positions were restated in this paper, including respect for patient dignity, respect for the practice of plastic surgery, and opposition to criminalization of medical care.

The ASPS Code of Ethics holds that “all patients should be treated with full respect for human dignity. ASPS Members should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion.”16 ASPS affirms the inherent dignity of every patient and supports the rights of all individuals to privacy and humane medical care. This includes pediatric and adolescent patients who present with gender dysphoria, those who identify as transgender and gender non-conforming, and those who experience regret, cease treatment, or later detransition. Recognition of patient dignity is not contingent upon pursuit of a specific clinical pathway.

This position statement does not seek to deny or minimize the reality of any patient’s distress, and it does not question the authenticity of any patient’s experience. Instead, ASPS affirms that truly humane, ethical, and just care, particularly for children and adolescents, must balance compassion with scientific rigor, developmental considerations, and concern for long-term welfare.

The Final Summary, At Least for Now

Consistent with ASPS’s August 2024 statement that the overall evidence base for gender-related endocrine and surgical interventions is low certainty, and in light of recent publications reporting very low/low certainty of evidence regarding mental health outcomes, along with emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population, ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents. ASPS recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.

I encourage every plastic surgeon and interested member of the public to read the entire ASPS position paper.

Disclaimer: The American Society of Plastic Surgeons (ASPS) is committed to patient safety, access to care and the highest quality standards of patient care. The contents of this post, selected from the ASPS Position Statement on Gender Surgery for Children and Adolescents, are not intended to serve as a standard of care or legal advice. Information and regulations may change over time and Practitioners are solely responsible for complying with current applicable law and standards of care. Practitioners are encouraged to consult legal counsel in the state of practice regarding local standards and responsibilities.

Choosing the best Plastic Surgeon is important, but it doesn’t have to be complicated.

Plastic Surgery includes a large variety of elective procedures designed to enhance appearance. Procedures like, Liposuction, Facelifts, Eyelid Lifts, Breast Enhancement and Tummy Tucks can improve self esteem, but how do you pick the best Plastic Surgeon? One that listens to your concerns and helps you achieve your desired results.

American Board of Plastic Surgery

The logo above may only be used by surgeons certified by the American Board of Plastic Surgery.

The Gold Standard organization certifying qualified Plastic Surgeons is the American Board of Plastic Surgery (ABPS). This ABMS certified board certifies the Plastic Surgeons have:

1. The proper prerequisite training by checking training programs
2. The proper knowledge base through written and oral examinations
3. Continued learning through CME requirements and yearly testing
4. Patient safety by requiring all certificate holders to operate in certified centers

You can check the board status of every currently certified Plastic Surgeon on the ABPS website.

Professional Society Active Membership

The majority of Board Certified Plastic Surgeons are also members of the two major US plastic surgery societies.

The American Society of Plastic Surgeons (ASPS) represents over 11,000 members worldwide, with roughly 92% of all board-certified plastic surgeons in the United States belonging to the organization. As of early 2025, there are approximately 7,752 active diplomates certified by the American Board of Plastic Surgery.

Approximately 2,600 to over 5,000 board-certified plastic surgeons are members of The Aesthetic Society, formerly the American Society for Aesthetic Plastic Surgery (ASAPS). While there are about 8,000+ board-certified plastic surgeons in the United States, about 2,600 of these specifically hold membership in the Aesthetic Society (ASAPS), which focuses on aesthetic/cosmetic procedures.

If you are having Cosmetic Plastic Surgery, you will want to choose a plastic surgeon specializing in Cosmetic Surgery. The Aesthetic Society is the only national society of plastic surgeons dedicated to cosmetic surgery.

Experience and Specialization

After ascertaining a plastic surgeon’s training and certification, the next most import ingredient to success is experience. A surgeon who specializes in the specific procedure you want and who performs it regularly is a must. Ask for a portfolio of before-and-after photos to confirm their aesthetic style matches your goals, most plastic surgeons have these on their website.

Patient Safety

Safety & Facility Accreditation are often overlooked by patients. The operating facility should be accredited (e.g., AAAASF, AAAHC, JCAHO), ensuring high safety standards for anesthesia, sterility and equipment. Be certain your Plastic Surgeon operates in an accredited facility. If you choose a Board Certified Plastic Surgeon and ASPS or ASPAS member, these are requirements for membership, so these organizations have checked for you.

Communication & Rapport

Ensure you feel comfortable with the surgeon. It is important that you are on the same page and can communicate well. A good rapport leads to better care and superior results. They should be honest about risks, realistic outcomes, and provide personalized treatment plans. If you’re not feeling it, get a second opinion.

Friends or family members who have had plastic surgery are great referral sources. They can give you an in to an experienced plastic surgeon whom they trust. If you don’t know anyone who has had the procedure you are looking for, the national professional societies offer surgeon finders. The Aesthetic Society has a list of plastic surgeons specializing in Cosmetic Procedures.

A Real Patient Speaks

To hear the experience of my patient Colby, click to view an episode of Beyond the Before and After which is featured on the The Aesthetic Society website here: Dr. Mele’s patient on Beyond the Before and After

Cosmetic Plastic Surgery Consultations

In the San Francisco Bay Area call (925) 943-6353 to schedule a private consultation appointment in our Walnut Creek Plastic Surgery office. For a list of the procedures we offer and before and after pictures search this blog by category or visit our main website at DrMele.com. En Español: Cirugía Plástica San Francisco Bay Area.

Breast augmentation continues to be one of the most popular cosmetic procedures.

Breast Augmentation continues to be one of the most popular cosmetic procedures, with continued refinements specifically on safety, natural appearance, and personalization as of 2025-2026. Today, on the San Francisco Plastic Surgery Blog we are discussing the key recent developments and trends:

A Shift Toward Natural-Looking Results

Patients increasingly prefer more proportionate implants over dramatic sizes. This includes popular nicknames like “yoga boobs” and “ballerina breasts” for subtle enhancements that fit active lifestyles and leaner athletic body proportions. Big, bold looks are declining in favor of individualized outcomes. Many opt for modest sizing based on chest width, tissue thickness, and shape rather than cup size alone.
Hybrid approaches are also becoming more popular. Combining smaller implants with fat transfer (autologous fat grafting) for a more organic feel, shape, and modest volume increase, often avoiding overdone, rounder results.

Advanced Breast Implant Technology

Highly Cohesive Silicone Gel Breast Implants remain the dominant choice. These implants offer improved safety profiles with lower rupture risks and no routine 10-year replacement needed in many cases. Monitoring is still advised, with noninvasive imaging methods like MRI and high resolution ultrasound.

The four FDA approved Breast Implant manufacturers in the US are Mentor, Allergan, Tiger (formerly Sientra) and since 2024 Motiva. All offer a range of highly cohesive breast implant shapes and sizes. Mentor and Allergan also offer Saline Filled Breast Implants, though these have become less popular since silicone implants were placed back on the market.

Improved Safety and Techniques

Overall Breast Implant safety has advanced through better materials, shell designs, and surgical precision. The increased variety of available profiles allows for implants more proportional to the chest. Today’s Breast Augmentations emphasize fit and function for active women, with better long-term outcomes and easier recovery.

Breast Augmentation Volumes

The number of Breast Augmentations performed each year remains high and stable (hundreds of thousands annually), though the focus has shifted qualitatively toward subtlety and safety.

For Breast Reconstruction (e.g., post-mastectomy), new, larger implant volumes are helping to improve available options and results for patients with naturally larger breasts. While breast implant volumes used to top out at 800 cc, six new sizes were recently FDA approved: 930 cc, 1030 cc, 1135 cc, 1240 cc, 1340 cc, and 1445 cc.

Breast Augmentation Consultations

If you would like more details on your new Breast Augmentation options, call (925) 943-6353, and schedule a personal consultation appointment in our Walnut Creek, CA, plastic surgery clinic. We will be happy to provide you with the information needed to make an informed decision.

A lot has happened in the field of gene therapy in the last two years. This year, gene therapy has become more personal, quicker to develop, and it is done in vivo, with the editing infused directly into the patient.

Life saving express personalized gene therapy is now available.

Incurable Disease Cured

Earlier this year, an infant with a previously incurable and deadly genetic defect was cured by personalized gene therapy treatment. The infant was diagnosed with carbamoyl phosphate synthetase 1 (CPS1) deficiency. This enzyme is required to detoxify the byproducts of protein metabolism. Without CPS1, ammonia levels climb causing severe damage to the liver and brain.

Treatment of CPS1 deficiency includes a low protein diet until old enough for a liver transplant. While waiting, however, there is a significant risk of organ failure, brain swelling, irreversible brain damage, coma and death.

CRISPR to the Rescue

A team of researchers at the Children’s Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, and with the support of the National Institutes of Health, saw this as an opportunity. Using the CRISPR gene-editing platform, they targeted the specific gene mutation in the baby’s liver cells that led to CPS1 deficiency. This is the first known case of a personalized CRISPR-based medicine administered to a single patient and was carefully designed to target non-reproductive cells so changes would only affect the patient.

What is CRISPR?

CRISPR is a gene editing platform, built on reusable components. This allows for rapid and individualized customization. This type of therapy could lead to the rapid and early treatment of hundreds of rare “incurable” diseases.

According to an article on the NIH website:

• “The child initially received a very low dose of the therapy at six months of age, then a higher dose later. The research team saw signs that the therapy was effective almost from the start. The six-month old began taking in more protein in the diet, and the care team could reduce the medicine needed to keep ammonia levels low in the body. Another telling sign of the child’s improvement to date came after the child caught a cold, and later, had to deal with a gastrointestinal illness. Normally, such infections for a child in this condition could be extremely dangerous, especially with the possibility of ammonia reaching dangerous levels in the brain, but the baby just shrugged the illness off.”

Rapid Response

One of the most amazing aspects of this treatment is the speed with which it was administered. The in vivo CRISPR therapy was developed and delivered in just six months. This opens the door for early intervention for genetic diseases that lead to rapid decline early in life.

CRISPR Plastic Surgery

Currently, genetic therapy is used to correct genetic abnormalities, but one day it may be available for general health maintenance. It seems unlikely that this type of intervention would be used for cosmetic purposes in our lifetime, but options exist for other congenital abnormalities and changes that occur with life.

To schedule a Cosmetic Plastic Surgery Consultation call (925) 943-6353, today.

In California, only licensed physicians may use the term doctor.

What is a Physician?

California’s 90-year-old statute is designed to prevent patients from being misled into believing a practitioner is a physician when they are not. Physicians have more extensive training than any other health care professional. When non-physicians use the term doctor, a patient is led to believe they have equivalent training, but this is not the case.

The latest assault on California’s Business and Professions Code BPC § 2054 came from three nurses, who wanted to call themselves doctor by nature of their “doctor of nursing practice” degrees.

Truth-in-Advertising Under Attack – Palmer v. Bonta

The three nurse practitioners (NPs) argued that the California Truth-in-Advertising law violated their First Amendment rights. On September 19, 2025, U.S. District Judge Jesus G. Bernal rejected their claim. He ruled that the use of “Dr.” or “doctor” by non-physicians in clinical context is misleading commercial speech, and not protected speech under the Constitution of the United States of America.

Even the plaintiffs acknowledged that patients often assume “doctor” means physician. Judge Bernal stated, “The record indicates that Plaintiffs’ particular form or method of advertising has in fact been deceptive, and thus the speech enjoys no First Amendment protection.”

What Does the Law Require?

Healthcare providers are required to clearly state their licensure (e.g. MD, DO, RN, PA, NP) alongside their title in all marketing and patient communication to comply with the law. The intended goal is that patients can understand that “Doctor” in California’s clinical setting means an MD or DO. You should ask about a provider’s specific license and training if you’re unsure. These can also be confirmed on the California Medical Board’s website.

What is a Plastic Surgeon?

Similar laws apply to the use of the terms Plastic Surgeon and Cosmetic Surgeon. California’s truth-in-advertising laws for “plastic surgeons” aims to prevent consumer deception by requiring doctors advertising “plastic surgery” and “cosmetic surgery” procedures to be legitimately board-certified in plastic surgery (by ABMS-recognized boards like the American Board of Plastic Surgery). The law specifically bans misleading terms like “cosmetic surgery” for those not trained in plastic surgery, though it’s still legal for any licensed MD to practice it, creating a key distinction and focus for truth-in-advertising laws. Key rules include no guarantees, no altered before/after photos, no showing another doctor’s results, labelling models when they may be confused with patient outcomes, and accurately stating credentials.

White Coat Deception

All the above are to help combat “white coat deception” and protect patients from unqualified providers. If a provider states they are “Board Certified” they must also include the ABMS Board which has certified them. Non-ABMS Boards, such as the American Board of Cosmetic Surgery (ABCS), have been deemed not equivalent, and cannot be used for advertising in California. No “Cosmetic Surgery” representations can be made, although the ABCS still states on their website that they are the specialist and Plastic Surgeons are generalists because we also do hand surgery, reconstructive surgery, trauma surgery, congenital defect repair and a class they call “disorders”. Seems misleading.

Plastic Surgery Consultations

If you are considering Plastic Surgery, especially Cosmetic Plastic Surgery, be certain you consult with a Board Certified Plastic Surgeon. As a Board Certified Plastic Surgeon and Board Certified General Surgeon, I appreciate the amount of time and effort it takes to maintain certification.

In the San Francisco Bay Area, call (925) 943-6353 today to schedule a private consultation appointment in our comfortable East Bay Area Walnut Creek Plastic Surgery Clinic.

The American Society of Plastic Surgeons is leading a bill to expand breast reconstruction access and options.

Laws requiring insurance companies to cover Breast Reconstruction after breast cancer treatment are more than 25-years-old. While the science of breast reconstruction has advanced, and today’s options are more expansive, the laws guaranteeing coverage are outdated.

ASPS and Breast Reconstruction Legislation

American Society of Plastic Surgeons (ASPS) members were instrumental in passing legislation that required insurance coverage for Breast Reconstruction. Prior to this, breast reconstruction was usually denied by insurance companies as “cosmetic” and unnecessary.

ASPS Members testified in front of congress impressing the physical and emotional benefits of breast reconstruction after breast cancer, at that time often done without reimbursement. A second round of testimonies was needed to also include nipple reconstruction and matching procedures for the opposite breast, as these were often denied by insurance.

The Benefits of Breast Reconstruction

Breast Reconstruction benefits patients physically and emotionally. The physical benefits are obvious. The ability to fit comfortably in clothing is taken for granted, until after a mastectomy. While external padding can work for some patients, these can be hot and sweaty against the skin, and do not permit the showing of cleavage.

The emotional boost after Breast Reconstruction is undeniable. It provides women with a sense of control and the ability to take back their body. While some patients are very happy without reconstruction, the majority deserve to have this option to help them get past cancer and on with their lives.

Advancement in Breast Reconstruction

Over the last 25 years, the laws have not kept up with science. Medical advancements are not always covered, and patients are losing access to excellent choices. Even when access is available, insurance companies often unnecessarily prolong the process with denials and delays designed to demoralize.

Even with advancements, recognized complications occur. Some due to cancer, some due to the treatments and some due to reconstruction. These should all be covered.

What Can You Do?

The ASPS works at local, state and federal levels with government and private insurers to protect your rights as a breast cancer survivor. Patients, doctors, health care providers, and advocacy groups are working together.

According to the ASPS posting, you can help by taking the following actions:

• Share your story – help show lawmakers why the Women’s Health Coverage Act (WHCA) needs to be modernized.
• Learn about state-specific coverage laws and how they impact access to care.
• Endorse the legislation – if you or your organization would like to formally endorse the Advancing Women’s Health Coverage Act, please email the ASPS directly at: advocacy@plasticsurgery.org

Plastic Surgery Consultations

Dr. Joseph Mele is a double Board Certified Plastic Surgeon in the San Francisco Bay Area specializing in Cosmetic Plastic Surgery. Call (925) 943-6353 to schedule a private consultation appointment.

GLP-1s have taken the world by storm with the promise of quick reliable weight loss. There are some side effects, so it should only be taken with close medical supervision. Sudden weight loss has also been associated with hair loss.

Losing Weight and Losing Hair

There is no direct evidence that GLP1s are toxic to hair follicles; however, this class of medications can cause rapid weight loss, which can cause telogen effluvium (TE). TE is not male pattern hair loss, in fact there is no pattern to it. TE is global. It affects the entire scalp.

How to Recognize Telogen Effluvium (TE)

Normally 5-10% of our hair follicles are resting (in telogen). These are the follicles which shed, and at 5-10% we usually do not notice. In TE, defuse shedding occurs as a result of a much larger percentage of hair follicles go to sleep. Typically this occurs a few months after a trigger.

Telogen Effluvium from GLP-1s typically occurs two to three months after starting, or significantly increasing, the dose of the medication. You may notice more hair in the shower or on your brush. The loss is diffuse, and not in spots or a pattern like along the anterior hairline or the vertex of the scalp.

How to Treat Hair Loss

Prevention is the best medicine. TE is triggered by rapid weight loss. The best way to prevent it is to use a low-and-slow approach to weight loss. This allows your body to adapt, and decrease the metabolic stress these drugs may cause.

If you think you have hair shedding from your GLP-1, the first step is to schedule an appointment with a Board Certified Dermatologist to rule out other causes. Prevention of hair loss in general includes attention to your nutrition:

• Avoid aggressive calorie restrictions
• Maintain adequate protein intake
• Attention to vitamins and minerals: Vitamin D, B-12 Iron and Zinc
• Scalp massages
• Topical Minoxidil (available over-the-counter)
• Medical grade laser caps (requires frequent use and results vary)
• Prescription Meds: Oral Minoxidil (though this can increase body hair)

How NOT to Treat Hair Loss

Hair loss associated with weight loss affects the entire scalp. The good news is it is usually temporary, but recovery can take nine months.

Biotin sold as a hair growth helper, has shown no benefit for TE. It can interfere with labs results used to rule out other causes of hair loss.

Scalp Exfoliation is also promoted as a hair growth promoter. Over exfoliation can cause inflammation and breakage, leading to thinner hair.

Heavy Scalp Moisturizers, like coconut and castor oil, can obstruct the hair follicles and worsen seborrhea. Light oils, jojoba and argan, can be used for massage before washing your hair.

Does GLP1 Hair Loss Stop?

Even for those on long-term GLP1 use, the shedding does usually subside. It is thought that the shedding is due to the stress of starting the meds, rather than the medications themselves, causes the TE.

Recovery after hair loss is normally six months, but it may be nine months before the hair density returns to normal. If you are still shedding after a year, it’s time to revisit the dermatologist and recheck your thyroid and hormones.

Post Weight Loss Plastic Surgery Consultations

I normally get involved after weight loss with a wide range of Post-Bariatric Plastic Surgery procedures to tighten the skin. Additional information is available here on the San Francisco Plastic Surgery Blog and my main website DrMele.com. While it is advisable to wait for one year after massive weight loss before having any elective surgery, it is never too early to have a consultation. Consultations give you more time to consider your options, and for your plastic surgeon to plan your procedure(s).

In the San Francisco Bay Area, call (925) 943-6353, and schedule a private consultation appointment in our Walnut Creek Plastic Surgery Clinic. There is no substitute for an in-person consultation when it comes to skin laxity. And there is no substitute for an experienced, board certified plastic surgeon, dedicated to Post Bariatric Plastic Surgery.