So you want to get breast augmentation, but can’t decide between saline or silicone implants? Check out our interview with Dr. Rick Bosshardt, of Tavares, FL, as he fills us in on the differences between the two types of breast implants.

Give the interview a listen, or read through the transcript below.

Sharon Odom (SO): Hi everybody, this is Sharon Odom from CosmeticSurgeryToday.com and welcome to the call. Our special guest today is Dr. Rick Bosshardt, a board-certified plastic surgeon in Tavares, Florida, which is near Orlando, and one of my favorite places is Disney World. Hi Dr. Bosshardt, how are you?

Dr. Rick Bosshardt (DRB): Good afternoon to you, Sharon. How are you?

SO: I’m great. Well, thank you for joining us today to discuss a common breast augmentation question, and that is silicone gel versus saline implants, how do I choose? So I guess the first question is what is the difference between saline and gel implants?

DRB: Well, Sharon, the difference is basically in the filler. The implants are identical on the outside. Also all implants consist of an outside shell with the material that will fill the implant inside. Saline implant contains basically sterile saltwater and a gel implant contains a somewhat cohesive silicone gel. So the difference is actually in the filler. The outside is identical.

SO: Which one is more expensive?

DRB: The gel implants are significantly more expensive than the saline. Typically, they are about double the cost.

SO: Why is that? Is it because gel is more expensive to produce?

DRB: I suspect that’s the reason. I’ve never actually asked that question with the manufacturers, but saline is pretty inexpensive stuff. It’s just saltwater.

SO: Right.

DRB: So you can’t get much cheaper than that, and there is the whole manufacturing process that goes into producing the [silicone] gel, and I suspect that’s part of that whole thing and also there have been a lot of research over the years to modify the nature of the gel. The gel has changed over the years from a rather runny gel many years ago to what’s called a more cohesive gel today, which is not as runny, all the way up to a gel which is not yet available on the market, but is called a form stable gel where it’s even more solid, I would say, than the gel we have today, so some of that research probably translates into further expense with the implant as well.

SO: Okay, now, I’ve heard about saline implants leaking. Is that still the case?

DRB: Oh, all implants can leak. Even the new gel implants can leak, so anytime you have a thin, thin envelope containing any type of a fluid-like material, even a small hole in that will cause a leak. So yes, the implants are still subject to leaks today. We don’t have a leak-proof implant yet.

SO: So given the choice, how does someone actually make the choice between the two? I mean, do gel implants feel more natural?

DRB: Some people say they do. A lot of the decision making is going to be done probably by the surgeon because the surgeon will obviously have his bias and preferences. Patients are coming in much more well informed these days than in the past. They go into internet and they look up websites, and of course, they talk to friends as well, and so when they come in your office, usually they aren’t coming in cold. They’ve done some research on implants. They may have an opinion.

A lot depends on the actual circumstances. There are some circumstances in which the saline is much preferable, and others in which a gel may have some advantages. One very clear place where you have to draw a line is in patients that are less than 22 years of age. Gel implants are not at this point permitted for implantation with patients who are under 22 years of age at the time they have their surgery, so younger patients are going to have to go with the saline unless they want to wait until they are a little bit older.

SO: That’s interesting, but why?

DRB: There is a definite feel that the gel implants tend to reproduce the consistency of breast tissue more. The issue really is not that big of an issue, at least not in my experience because most of your patients who are good candidates for a breast augmentation will do very well with either one of those two implants, and I would suspect that in most cases unless you tell a patient what type of implant she has, she would not be able to know by the look or feel of that implant.

SO: So you decide for them?

DRB: Sometimes I do. If patients ask me my opinion, I would give them my opinion and I will always state very clearly that this is my preference and they may go to a surgeon who will express a different preference. My preference tends to be for the saline implants in most of my patients. I like the safety aspect of saline implants. It’s a little bit, I think, of an advantage over the gel implants.

SO: So is there a safety issue with gels? Are they safe as saline?

DRB: No implant is a 100% safe, Sharon. All implants carry potential for complications and risks and have limitations. Talking specifically about leaks, though, if the saline implant leaks, it’s absolutely harmless to the patient. The person’s body will absorb that saline solution. It will be eliminated from the body by the kidneys and the implant will simply deflate. They are very, very easy to replace and so a deflation of a saline implant is a bit of a nuisance, but it’s not really a major problem.

If a gel implant leaks, one of the problems we have is that oftentimes you don’t know because there maybe no external change in the look and feel of the breast, at least not for a long, long time. However, when the silicone gel gets out into the space around the implants, there are some things that can happen.

You can get some stimulation of scar tissue which may cause the breast to become firm feeling. You may stimulate the formation of calcium deposits around the breast implant and these maybe seen in the mammogram and they may create some questions and some issues that may have to be answered.

This gel can actually get out into the tissues as it is forcefully expressed from the implant. Let’s just say you get into a car accident and your air bag deploys and hits your chest and that can force silicone gel out into the muscle and into other tissues and there it can create irritation. It can irritate nerves and do some other things that maybe unpleasant and undesirable, and silicone is very sticky.

Once you get silicone gel outside the shell of the implant into the tissues, it’s next to impossible to remove it completely. So there are a few small issues there. Is it a big safety issue or when are they going to get sick because of this? All the data so far in the case of that answer is no, but that’s the big difference between the two is what happens when the material once it leaks out of the shell of the implant.

SO: Okay. Now, you said something I found to be interesting. You said that silicone gel is not allowed in patients under 22. Why is that?

DRB: That’s a good question. I don’t have a specific answer for that. I think it’s because the feeling is that these young women are going to have many, many years ahead of them. If they have implants put in an early age, no implant is expected to be there for a lifetime, and therefore the more years you have the implants in, the more potential there is for problems related to having those implants. Now, as to why that maybe the cutoff is 22 and not 23 or 25 or some other age, that I don’t know.

SO: I read somewhere that the silicone gel implants require a larger incision than the saline. Why is that?

DRB: That’s correct and the reason is that the saline implants, to begin with, when you remove a saline implant from its packaging, the implant is empty. It has a small valve. You insert a small tube into that valve and the implant can then be rolled up into a very, very tiny roll, almost like cigar and inserted through an incision.

The typical incision that I use for saline implant is less than an inch long. It’s barely enough to admit my index finger, and then when that implant is put inside the space for it, you simply use a tubing to fill the implant up. So the implant is filled inside the breast and the tubing is then simply pulled out. It has a self-sealing valve and you are on your way.

With the gel implant, those implants are provided prefilled. You don’t get a tube of silicone gel that you can then fill the implant with. So they come prefilled, and of course, if you can imagine, trying to stick an implant into a tiny, tiny incision that is prefilled, it can be next to impossible to do, so general rule of thumb is that you are going to require an incision about three times longer for a gel implant than a comparable saline implant.

SO: Well, that sounds like reason enough to go with the saline.  Why would someone choose the gel?

DRB: Again, there is a bias. Some people feel that the gel implants are still more natural. They believe that the breasts will look and feel more like a natural breast with the gel implant in there. The leak rate, even though we have issues with the leaks in gel implants, the leak rate for gel implant is actually a bit less than a saline implant. I think it’s just a lot of preference.

There are situations. I mean, there are women that have very thin breasts. They have very little breast tissue. They have thin skin and just about anything you put in them is going to be in some manner, seen or felt as being a device in the breasts. It’s not going to feel and look a 100% natural.

In those patients where you are more likely to see and feel an implant, there maybe an advantage of the gel over the saline implant because the saline in very thin women sometimes will tend to show a ripple or a wrinkle or fold or you maybe able to feel a little difference in texture in that breast than what a normal breast would have.

So it’s not to say that the implants are identical because they are not. Both can produce wonderful results in patients, but there are some women in whom a gel implants may be a little bit more of a good choice for her, and we use a lot of the gels in our reconstructive patients, with patients that have had their breast tissue removed and have nothing but skin there now. They seemed to do better with the gel implants.

SO: What about the different styles of implants? I’ve heard of tear shaped, teardrop shape, smooth, textured, what are all those styles?

DRB: The original implants, Sharon, were basically a smooth implant. They were just a very smooth, shiny silicone shell, and over the years, some of the issues with implants have led to the developments or some modifications to that implant shell.

One of the problems has been the tendency for some women to develop firmness of their breasts. This is caused by the scar tissue that naturally forms around the implant contracting and squeezing the implant and making the breasts feel hard, and one of the changes that was made to the other shell was to take that smooth shell and convert it to what we call a textured or a fuzzy shell. If you have a look at one, you will see the surface is kind of a fuzzy surface. The idea behind that is that it tends to modify how the scar formed and therefore patients don’t have a tendency to get firm.

Unfortunately, those textured implants have certain problems. They tend to be stiff. They are more likely to be felt, more likely to show ripples and they have a much higher leak rate than the smooth implants do, and so the textured shells really haven’t been shown to be as effective in doing what they were supposed to do.

The other issue was some women tend to have a rounded loop to their breasts, and of course, the breasts, if you look at a natural breast, is not a totally round shape. There is more like a pear shape to the breast. The breast is a little bit wider over the lower half than over the upper half, and so an implant was designed to mimic that. They are called anatomically shaped or teardrop shaped. The problem with them is that if you put a smooth one in, they tend to have a potential to spin and flip and because they are shaped implant, they can alter the shape of the breast and they can look a little bit odd.

So to avoid this, they would make these teardrop-shaped implants textured because they felt the texturing would hold the implant in place and then you have all the problems with the texturing because of the potential for leaks and things like that. So there has been all these modification with the implants, but in the USA today about 85% of breast implants that are put in are round, smooth implants because they have the fewest problems. They have the lowest rate of leakage. They happen to be the least expensive, so that’s a big plus, and they just work the best.

What’s interesting is this is that when they’ve done some studies, they’ve taken women that had implants and had done some x-rays on them and had the x-rays done in a sitting position and then laying down position and they find that when women lay down, the round implants tend to flatten a little bit on the chest the way a breast would and then when they sit up, the implants tend to naturally assume a little bit of a teardrop shape because of the effects of gravity and this is what happens with a natural breast.

If you have an implant that has a shape actually built into it, so the teardrop shape is there all the time because it’s built in, then you are not going to see those natural changes. So the long and short of this is that maybe some very unusual circumstances where the choice of a teardrop or a textured implant or both maybe an advantage, but for the vast majority of women, the round, smooth implant seemed to work the best.

SO: And how long do they last? I mean, they don’t last forever, I know, so how long do they last, and which one is likely to last the longest?

DRB: They can last forever. Of course, if you had your implants put in when you are 21 years old, your chance of it lasting forever, that is your lifetime, is less, and if you have them put in when you are 35 or 40 years old for obvious reasons, there is no implant that’s intended to be there lifelong because so many things can happen over the course of 20 or 30 years.

I tell my patients as long as your breasts look good and they feel well and they are happy with them, there is no reason to disturb those implants. There is a misconception by some patients that implants have to be replaced every 10 or 15 years. That’s incorrect. There is no expiration date on breast implants.

But women need to know when they put these implants in. The way I word is that there is a very high likelihood that sometime later in life they are going to be looking at, at least, one more operation on their breasts because of these implants. It may be to replace them if they have a leak or a failure of the implant. It may be exchange them. They may want it to be a little bigger as they get older. They may want it to be smaller.

But 10, 15 or 20 years from now, we could have a better implant out than we have today. And other things can happen to the breasts that may lead to some surgery, so women having the implants in at a relatively young age need to know that their chances are very high that they are going to have at least one more operation later in life for one of those reasons.

SO: Do they come with a lifetime warranty?

DRB: They absolutely do. I think the warranty on implants is really an excellent one. The two major manufacturers of implants in the USA today are Mentor and Allergan. They are very, very reputable companies. They have been there for, my goodness, I think over 30 years apiece. They both have what they call a lifetime replacement warranty. If you have an implant put in by the appropriate doctor, a board-certified plastic surgeon, and the implant is handled in the correct fashion, then that implant is warranteed for life from failure, which is to say that 10, 15, 20, or 30 years from now if that implant fails, that it has leaked, they will provide you with two new breast implants at no cost.

Now, for ten years what they will do is they actually have a situation where they will pay a surgeon to replace those implants for you. They provide a stipend of up to $2,400 to cover the cost of removing your leaky implant and the other implant. This is both implants now, even if only one leaks. They will pay the surgeon. So in most cases, the patient will have no out of pocket expense for replacing a leaky or failed implant for the first ten years. After ten years you will be paying for the surgery, but you are not going to have to pay for the implants.

SO: Great. Now, what about these new Gummy Bear implants I’ve been hearing about. What are those?

DRB: These are what they call form stable implants. This is the next phase, I guess, implants 3.0. The first implants were runny gel. The second set of implants was less runny. It’s what we [now] call a cohesive gel. And the third ones are the gels that don’t run at all. I mean, these are implants that you can literally cut the implant in half and the two halves would just sit there. The gel won’t run out. That’s where the term Gummy Bear came from, and the idea behind these, of course, is to eliminate the leak issue altogether from breast implants.

They are not yet available in the US market other than through some centers where they are doing the studies to obtain FDA approval to begin marketing these. I haven’t really heard from literature and colleagues as to when they expect these to be available on the market, but like anything else new, only time will tell whether the benefits of the Gummy Bear implants will actually be substantial enough to warrant that we start switching over to those.

SO: Okay, so for all the people that come to [CosmeticSurgeryToday.com] and looking for Gummy Bear implants, they are not available in the US yet.

DRB: Not yet. Not yet.

SO: No.

DRB: They can call some…, but I’m not even sure which medical centers I would point someone to, but if they call some of the major university medical centers with places like Mayo Clinic, Cleveland Clinic, and maybe even places like Shands up in Gainsville, Florida or Miami, Florida, University of Miami or those places. There you may find programs where the Gummy Bear implants are available as an investigational tool and then they would have to, of course, apply and qualify to have those put in. It’s probably a bit more involved than what most women are going to want to do for something. Of course, everybody wants the latest and best. Unfortunately, the best is not always really the best when you’ve used it for a while. Time will tell whether they really are a good implant or not.

SO: Now, I’m sure you have some great patient stories to tell. Are they any that you would like to share with us that someone has experienced with the saline versus silicone?

DRB: I could think of a couple. With respect to the whole saline versus gel situation, one patient comes to mind immediately, a young lady that I saw many, many years ago. I’ve been in practice now for 22 years and this is one of my early patients, and back when I just newly entered practice was about the same time that the moratorium on gel implants went into effect and you could not put gel implants in patients for breast augmentation for over ten years, so all patients received saline.

Back then this young lady received a saline implant for her breast augmentation and was very happy and had a wonderful result, and then I think about 15 years or more went by and during the course of those years, of course, she got a bit older. She had a couple of children. Her breasts underwent some pretty substantial changes and she came back in to see me, and at that point, she had a lot less breast tissue than she’d had many years earlier. The skin was thinner because of being stretched out from her pregnancies, and now the result that worked so great then, you could see rippling and you could see the implant very clearly and the result aesthetically wasn’t really as good as she or I would like it to be.

So in her situation, she basically changed over through the years from being a great candidate for saline to a better candidate for the [silicone gel implants]. So that’s exactly what we did. We took her back to surgery and we removed her saline implants and replaced it with a pair of gels. We did a little bit of clean-up work inside the breast because of some scar tissue that was there, and she got a very nice result and now she is back to enjoying the results of the surgery and very pleased. So that’s a situation where someone originally started as a good candidate for saline and in fact, under the circumstances we couldn’t even offer her the gel implant at that time, and then over the years she became a better candidate for the gel. So there are situations where one or the other may benefit a patient.

SO: That’s a really good story because it shows someone who has used both. So let’s just sort of summarize. If someone is still saying to themselves, well, how do I know which implant is best for me? Can you sort of summarize when you should choose saline versus gel?

DRB: Well, let’s see here. Let me see if I can put this into some kind of a reasonably logical thing here. In a patient who is young and has good, fairly firm skin, has a fairly, good quality breast tissue, she is on a budget, so she is just looking to not spend more than she needs to, would like to avoid more extensive scar issue, I should say you are going to have a scar either way, and is not looking for really big breasts, I think saline is the ideal choice. I think she’ll never regret making that decision for saline implants.

Another patient who maybe a bit older, the expense of a silicone gel implants may not be an obstacle to her. She may have relatively little breast tissue and thinner skin by virtue of having had children and nursed and so forth, and she can accept a little bit of a bigger scar and she wants a little bit larger breast maybe in the D or double D cup range, then that individual might be the best opportunity to putting on some gels.

SO: Excellent.  And if they are still unsure, then they can talk to their doctor or go online and do more research, right?

DRB: Well, nothing will ever supplant the face to face discussion with a plastic surgeon. The only way you are really going to know what’s the best implant for you and what would suit you best and so forth is to really have someone that hear what you want, who can take that information, who can tell you what the options available to you are and then can present you with a proposal that you can either accept or not.

But I think that face to face meeting is so critical. Even a good informative, I think, conversation like this can be really taken away in general terms and you have to be careful not to necessarily apply that to every patient specifically without a face to face consultation.

SO: Right. Well, thank you. This has been very informative. I hope that our listeners have gotten good use out of it. I know I’ve learned a few things. For instance, I thought that [breast implants] always had to be replaced and I found out that that’s not the case. So thank you very much, Dr. Bosshardt, and thank you for taking the time to talk to us! Would you like to tell our listeners more on how to get in touch with you or about your website?

DRB: Well, our practice is in Tavares, Florida, which is right and smack in the middle of the state of Florida. We do have a website as so many practices do, the website is www.bosshardtandmarzek.com. Dr. Marzek is my partner.

SO: Well, thank you very much and I appreciate your time.

DRB: My pleasure.

Dr. Charles Runels Talks to Cosmetic Surgery Today About His New Designer Procedure – The Vampire Breast Lift™

We recently got a chance to speak with the creator of the Vampire Facelift, Dr. Charles Runels. He speaks candidly on the differences between a simple Selphyl injection and his designer cosmetic procedure the Vampire Facelift. We here at CosmeticSurgeryToday are also the first to report on his NEW procedure, the Vampire Breast Lift!

Click the play button below to hear the interview, or browse through the transcript below.

Sharon Odom (SO): Hi everybody! It’s Sharon Odom from CosmeticSurgeryToday.com. As you know, a few months ago, we did a scoop on the Vampire Facelift™. As a result, we are now in contact with the designer of the [Vampire Facelift™] procedure, Dr. Charles Runels. Dr. Runels, are you there?

Charles Runels (CR): Yes. Hi Ms. Odom, thank you for having me. I’m so honored to be here. I know you have a lot of readers and listeners, and I want to tell you about my new designer procedure, the Vampire Breast Lift™. But first, I just want to tell you thank you for having me.

SO: Well, thank you for being here. It’s very exciting to understand that we are getting a scoop on a brand new procedure, and that we’re the first to report on it. So I am very excited!

CR: Well thank you. I think it’s something that is going to fill a need that has not been addressed yet, in the appearance and the shape of the breast and the way it is sculpted, in a way that’s quick and easy and less risky. But if you don’t mind, I’d like to talk about this idea, about what I think about when I think of a designer procedure. Is that OK? Can we just go over that and what I was thinking when I created the Vampire Facelift™?

SO: Yes, what is a designer procedure exactly?

CR: The way I thought about this is that I think there is an underestimation about what’s really required to create a more beautiful appearance. Especially in the face, where just a millimeter or two can make a huge difference.

I remember as a child watching an interview on television with this famous model. I was just a little kid, so I don’t even remember what her name was, I just knew she was literally on the cover of one of my mother’s magazines. And someone asked her in the interview about her beauty. She was humble enough and wise enough to say something that has stuck in my brain for 40 years, she said, “The only difference between me and most women is just a few millimeters here and there.”

That is so true on the face. So what I had seen happen with too many women and men is that when they have a filler or a procedure done, rather than have a millimeter or two changed to enhance what’s natural about their face, they have too much changed. The problem might be better. Like a fold or a wrinkle may have improved, but now they have an appearance that can look foreign to their face, at best. And at worst, can look foreign to this planet!

SO: (Laughs)

CR: (Laughs) And so the idea was, instead of thinking about folds and wrinkles, to back off and just think, how can I design… instead having someone just coming in and ask for BOTOX. That’s like walking into a restaurant and saying, “Get me a hamburger.” Would you mean a Big Mac? Or do you mean a… I mean, what do you mean by that? Or do you mean a gourmet meal? What are you looking for?

Well, I wanted it where someone walked into a cosmetic physician’s office and asked for something, instead of asking for a tool, they would understand and ask for a particular way of thinking about their face. So, I’ve looked at, and actually combined at least two tools, and in some people, three tools, using a hyaluronic acid filler like Juvederm or Restylane, combining it with a platelet rich plasma or growth factor derived from the blood, and sometimes with BOTOX.

Doing that in a way so it enhances a woman or a man’s face, and brings it back to the way it looked when they were younger, and perhaps de-emphasizes things that are less attractive about their face. There’s a way to think about that, create that, and teach it. I created this designer procedure in the same way, again, as when you walk in and ask for a cotton shirt. Do you mean a cotton t-shirt, or do you mean a Calvin Klein designer shirt?

I wanted a way that people could know whether they walked in a doctor’s office in New York City or Southern California or anywhere in between, or in another country, if they visited a physician that I taught these ideas to that they would know they would get this result. Does that mean that they are going to be smarter than the physician next door? Not necessarily, but they will at least know this person they are seeing is going to be thinking about it in the same way.

SO: I see. Let me ask you a question about the Vampire Facelift™. We’ve heard so many people talking about it all over the country, were these people trained by you?

CR: Some were, some were not. It’s interesting, this trademark (™) /service mark (®) idea is something that people are used to in other businesses, but the physician and the medical community is not as used to it. We see it in weight loss programs, like MediFast or Weight Watchers. You know when you walk in; certain things are going to happen no matter where you are in the country.

SO: Correct.

CR: With cosmetic procedures, it’s not so standardized. A similar thing happened, it’s an odd comparison, but it’s a good one, but think about what happened when Roller Blades first came out. Where other people started making skates that were in a line instead of four wheels like a car, and wanted to call them roller blades. But they weren’t the same thing. They didn’t work as well, or sometimes they worked better, but they didn’t work the same as the Roller Blade. Roller Blades said, “No, you can’t use our name, you have to call yours ‘inline skates’.”

The same thing happened when I saw platelet rich plasma and growth factors and how powerful they were to improve the face. I thought I need to use this as part of a trade secret or the way that I’m thinking about the face, combining Leonardo all the way up to present computer analysis of the face and what makes it beautiful. I need to think about how to combine this with other things that I know like the fillers and the BOTOX into something that works. I deemed the procedure the Vampire Facelift™.

Unfortunately, just like with Roller Blades, the press picked it up, and some physicians thought it was synonymous with using growth factors in the face and got reported that way. The New York Times covered the story, the Doctors show covered the story, Kelly and Regis…it’s been all over. Sometimes they got it right and sometimes they didn’t, which is a common problem with the trademark. But, I was the first to use it, I defined it, and it’s taking some education of some physicians that you can use platelet rich plasma and growth factors in the face, but you can’t use my name because you can confuse people.

It’s such a small world, somebody can go on a blog and see where someone in another state got the Vampire Facelift™ (where someone uses my name inappropriately), and they may have gotten something that’s not what I do. Some people are using growth factors combined with a laser and calling that the Vampire Facelift™, some are combining it with fat and calling it the Vampire Facelift™, some are just using a little bit in one area and calling it that. None of those are the Vampire Facelift™.

They may be wonderful procedures in some people, but it’s not what I meant in the Vampire Facelift™. If someone gets a result that’s not as good as what I would have achieved, then it’s confusing. Whether it’s good or bad, it could be that it works better than what I had in mind. I want it to be that it works to everyone’s benefit, so the patients know exactly what to expect, and the physicians who are doing the procedure, they will have more people coming because it has a reputation, it’s a brand name. Just like any other brand name, whether it’s a type of pizza or a type of designer dress.

That’s the idea behind it. The physicians and practitioners that are there are all expert injectors who have either come to see me, or they are already good. It’s like putting music in front of a concert pianist. They may already know how to play the piano, but I wrote them a new score. In the same way, some of the people there were expert injectors already, I just had to explain how to combine these and think about the face. Others were adequate but came to personally train with me to become better than adequate. So everyone [listed on my site] has my stamp of approval.

SO: Excellent! I’m happy to help get the word out.

CR: Thank you.

SO: And also very excited to get the word out on the newest procedure. Actually, it’s two procedures, correct?

CR: Yes! And I’m so happy that [we spoke], the timing is perfect because there are so many people, because they’re busy or they’re working, and they can’t afford to be away from work for six weeks, two weeks, or even one week because of surgery. Or it’s a money problem, or it’s because they don’t want to be as aggressive with their bodies, they want to be gentler with their body. A lot of people are opting NOT to have surgery.

My favorite compliment is for a patient to tell me they went home and nobody knew they had had anything done. They just all knew that they looked more beautiful for some reason. I love it when a woman tells me she went home and her lover said, you look gorgeous, did you get new hair? Did you get new make up?

SO: (laughs) Right!

CR: To me, that’s a compliment! If they go home, and their lover says, what did you do to your cheek, what did you do to your mouth, that’s no good to me.

SO: When it’s obvious that they’ve had something done…

CR: Yes, and so in the same way I thought there was a need. I had a lot of women coming to me saying, I like my breasts, but I just need a little more cleavage or they’re starting to fall a little bit, if I just had a little more volume here. Well, I already do laser liposuction; I can take fat from the abdomen, and inject it into the breast. That’s a very safe procedure. But, you’re out of commission for at least a few days, and it’s more aggressive than most people want or need.

I thought why can’t you do the same thing with the breasts that you’re doing with the face? In Europe, they’re already using hyaluronic acid fillers like Restylane, just injecting it into the breast and augmenting the breast without any surgery at all. The downside to that is that if you do a lot of injecting there, sometimes you can have some nodule formation and then it’s a more aggressive procedure. I wasn’t after that. I just wanted to take the same ideas that I had for the face, and how to look at the breasts, and do the same thing that a good bra would do. Add a little more cleavage in the center, add a little more volume in the upper part of the breast, not really thinking about size. And I call it the Vampire Breast Lift™ for the same reason; I’m getting growth hormones out of the blood like the mythological figure of the vampire which uses blood for a more youthful appearance.

And breast lift, as in not changing size or augmenting, just giving the appearance of a more youthful, healthy breast. The good part about the Vampire Breast Lift™ is unlike the surgical procedure which can cause decreased sensation; the nipple actually rejuvenates because you get better blood flow. You’re activating unipubsin cells, which causes growth of new, healthy tissue. Just like it causes a better appearance, just like that rosy glow that children have in the face, you get the same look to the breast. Nipples become healthier, loss of sensation from breast feeding or breast augmentation can come back, the stretch marks improve, it just looks like a healthier breast.

It’s around the edges of an implant; it’s around the edges of someone who has not had an implant. That’s the Vampire Breast Lift™. It takes about 30 minutes including centrifuging the blood, person’s talking with you, use a needle that’s a very thing gauge needle just like you would use to give Juvederm in the lips, and a topical anesthetic so there’s no severe pain. The person looks beautiful that night because the volume’s there, and it improves over the next three months as the new blood vessels and the new collagen and fat gets healthier and juicier like when the woman was [younger].

SO: Let me ask you about the process. Do you use the exact same process for the Vampire Facelift™ as Vampire Breast Lift™? Is the process the same and you just inject it into a different place? How is it different?

CR: The processing of the blood is the same. I’ll even use small amounts of Juvederm with the growth factors derived from the blood. The only difference is that it’s not so much millimeters. In the face you’re sculpting shapes that are critical millimeters. Especially around the mouth, cheeks and eyes. With the breast, it requires more of the blood product. It’s still not a huge amount drawn, it’s about 4 tablespoons. It’s still more than you would use in the face, and you’re creating a roundness instead of sculpting a shape, so it takes more volume. But the way I process the blood is the same.

You take blood the way you normally would if you were having a blood test to check your cholesterol, or something. Then I run it through a centrifuge for a particular length of time. Take the serum part out that has the platelets in and leave the red cells behind. Activate them with calcium chloride, it’s just like salt with calcium, it’s in Smart Water, an electrolyte, that’s normally mostly inside the cell. When I put it around the platelets, they think a cell has been damaged, and they release all these growth factors. Essentially, I’m creating that yellow goo that everybody remembers…when you scraped your knee as a child, and you look at the scab and picked at it, even though your mother told you not too, and you looked around the edge of it, do you remember that yellow goo?

SO: Yea, I remember that gold stuff!

CR: Yea, everybody remembers that! Well that yellow goo is what I’m making. That is platelet rich fiber matrix. If you just make the growth factors in there liquid, well they just wash away. Our creator knew to put that in some sort of yellow thing, and it holds the growth factors there, and that brings in all these unipotent stem cells. It’s like bringing in seeds that can grow new, healthy tissue, improving blood flow. That’s why you get a rosy glow after the Vampire Facelift™ and the Vampire Breast Lift™.

Pretty much anything you can do to the face, works on the breast. You can use your Retin A there, you can use your cosmetics there. The reverse is true, if you smoke, in the same way that will age your face, it will age your breasts. It’s a little bit different, but the idea of doing this in such a way that you’re shaping and creating beauty, rather than just changing size. Beauty has four things involved: shape, size, color, and texture.

You can get $10 worth of cosmetics at the drugstore, and change color and texture. You can give the illusion of changing shape. But if I want to truly change shape and change color and texture, with a cosmetic procedure, you’re going to spend. The Vampire Facelift™ costs between $1,500 – $2,000 at most places. It better be a lot better than $10 worth of cosmetics at the drugstore!

SO: For sure.

CR: It is because you’re getting not just a change in shape, or the illusion in change in shape, you’re getting real change in shape, both in the breast and face as thought about from the standpoint of an artist. Along with that, the blood vessel growth, you get a change in color and texture and the skin literally looks younger, because it is! You have new growth. Chronologically I have not de-aged you. You still were born on the same day.

SO: That’s too bad! (Laughs)

CR: (Laughs) I’ll think of that one!

SO: People would line up around the block for that one! Let me ask you this… Who is the ideal candidate for the Vampire Breast Lift™?

CR: The ideal candidate is not someone who needs to change size dramatically. The ideal candidate is a woman between the ages of 30-55. On the other hand, I have seen some 80 year old women who have taken really good care of themselves, and their breasts look like an 18 year olds!

SO: How old were these women, did you say? 80? Eight zero?!

CR: I saw a lady in the ER who fell off of her house while she was repairing the roof, and she had breasts that looked like an 18 year old. When I saw people like that, I would interview them, and ask how’d you stay so gorgeous? Invariably, they would say, I stay around young people, I have something I want to do, they were walkers, or they had some higher power that they felt connected to and they did not smoke. Those were the things that came from everybody.

Back to ideal candidates… It’s not just 35-55, but for most people, by the time they get around 60 or 70, it may be that there’s more loss of volume. It may be that they need a fat transfer along with it, or they need an implant along with it, or a true surgical lift. They’ve had those procedures and maybe they want to augment or shape, or they had their procedure a few years ago and the edge of their implant is showing through, or it’s shifted. So I can change things and reshape them so they don’t need another implant or I can put it off. They’re thinking, ‘I’m not happy but I’m not really ready to have a surgical augmentation yet,’ I can bring it back out so they are happy with it for longer.

SO: Can you get a touch up? How long do the results last until they need to get something else done?

CR: I’ve only started doing this about a year ago, but my prediction is going to be about what it is in the face. If you look at Juvederm, it’s good for a year in most parts of the face, sometimes longer. If you look at the PRP, it starts to fade. It’s not like it goes all the way away. Even with the hyaluronic acid, it produces new collagen growth. Most people are starting to see it fade around 9 months to 18 months.

It’s sort of like sprucing up your garden. I like to think of the health of your face like a garden. You don’t just do a one-time thing and say, ‘OK, I’m done, I don’t want to think about it’. No, you’re sort of tending it. My patients get that idea. They’re tending their health, tending to their beauty. They listen to you, they read the health magazines, reading the beauty magazines, and they’re not overboard, making themselves look like they come from another planet.

But they are doing little things all along instead of waiting until things are gone and having to do something drastic. In the same way, with these procedures, probably it will need some touching up, like the woman on VampireBreastLift.com. She had 3 children, she had no sensation, she could not get her nipples to ping up, they were just kind of there.

SO: OK.

CR: After the [Vampire Breast Lift™], the sensation came back, the roundness came back. In a year, sensation was still there, and they were still better than before we did the procedure. But, it had started to fade some, so we touched it up. It may look a different way when you’re 80 than when you were 20, but there’s still a way to bring out some beauty and help it blossom more.

And with these new ideas like using growth factors and these new ways of thinking… Now we have peptides, we have new ways of using Retin A, new ideas in nutrition, new ideas in hormonal replacement, all of it comes together to make this way of nurturing and bringing out the best beauty, not just keeping things from falling apart. Of course, that’s going to happen, it depends on what level of health and beauty people are looking for. This idea of, ‘I’m just going to age gracefully.’… Who says that with their house? You’re just not going to paint it? Let it fall down? That’s not aging gracefully! That’s aging tragically.

But if you think about it as maintenance, as a nurturing, from the inside out… When I do a BOTOX party, I flat out say, OK, we can have this BOTOX party, but some of you, I will trick into getting healthier than you are. By the time they come see me a few times for BOTOX, and they’ve heard me tell them how much more beautiful their skin and their breasts are going to be if they quit smoking. Then six months later, they hear me talk about walking… And by the end of two years, their whole life is different and everybody on their block has started walking. It really is a nurturing.

Health is beauty. The most beautiful thing… think of any body type, any race, any color, any place on this planet…think of them as healthy, and automatically you think of beauty. They are so inter-related. That’s why I like these procedures, the Vampire Facelift™ and the Vampire Breast Lift™. They are getting more to the core of what beauty is about, all the way down to the stem cells, generating new tissue. It’s phenomenal what we’re seeing these days.

SO: OK, what can go wrong?

CR: So far, there’s never been an allergic reaction, but there is a needle. I suppose if I were in a drunken state… I don’t drink alcohol, another thing that can help keep you young… I suppose I could puncture an implant, I could cause an infection. But all those things are rare things. The good thing is there are actually growth factors there to help fight an infection. I use a local anesthetic, but you could have some pain. I don’t have people yelling and moaning in pain, but they feel the needle go in.

You can use these procedures to bring an inverted nipple back out, sometimes for about a week, the woman will actually produce breast milk. Not a lot, but if you squeeze the nipple, you can get a few drops of breast milk because you’ve activated those cells. To me, that’s fascinating!

SO: It is.

CR: Those growth factors are that powerful that she’ll get a little breast milk. If someone had am implant, and their doctor was very careless, he could certainly puncture the implant and make it deflate. The physician can push [the implant] a little out of the way. It’s a big target, which makes it easy to miss. So it would be hard [to puncture an implant], but it is possible. There’s never been fibrosis from the growth factor, there have never been nodular formations, or allergic reactions because it’s your blood. But those are the main side effects.

SO: Interesting. Now that we’ve talked about the Vampire Breast Lift™, and we’ve got everyone more interested in it, how do they get more information? If someone was in Houston, Dallas, New York, how would they go about getting this since it’s so new?

CR: As I said earlier, I’m excited about it, I’ve just released it. I’ve been thinking about and designing this procedure for the past year, but I just released it this week. I have a group of physicians I’ve already trained with the Vampire Facelift™, and some of them are interested and some are not. Others are calling and being trained, and so this group will grow very quickly. The [physicians] will be listed at http://www.VampireBreastLift.com very soon.

SO: Excellent! I know I promised to keep this short and be respectful of your time, is there anything else you’d like to say about the Vampire Breast Lift™ or the Vampire Facelift™ or the Vampire Nipple Lift? Or any of your other procedures?

CR: The main thing is just to come back to the idea that, I think if I want to do one thing before I leave this planet, it would be that health is like grabbing an awkward piece of furniture. Say it’s a table that’s shaped oddly…how do you pick that thing up? Health and beauty is the same way.

People look at their body and they think about all the things that are going wrong, where do you start? What do you do first? If I could do one thing before I leave this planet, I would like people to get the idea that it’s all inter-related. Health, beauty, spiritual, physical, mental…it’s all inter-related. And just grab something and start with the easiest thing. Then culture it.

Be persistent, be consistent, and do something. Then do the next thing, whatever that is that feels easy to you. With time…it’s amazing, I’ve seen so many people change their life and change their appearance and maintain these amazing healthy lifestyles into old age and still looking gorgeous. If I could do one thing, that would be it: Think about the whole thing.

SO: Excellent. Now where can people get more information about you? I know you mentioned VampireFacelift.com and VampireBreastLift.com, is there another website?

CR: My main website, which if it looks homemade it sort of is, I just use it like a blog to talk to my patients is http://www.TempleRepair.com. As in your body being a temple.

SO: Great! Thank you very much for talking to me, this has been very enlightening for me as well. I really didn’t know you could use fillers in the breast! This is the first I’ve ever heard of it since I talked to you. I just thought they went in the face. I didn’t think about them going in the breast. This has been great and I really appreciate it. I hope that you’ll come back and do a follow up interview with any of your other procedures!

CR: Anytime. CosmeticSurgeryToday.com is beautiful, and I’m glad you thought my procedures were worth sharing with your readers.

SO: Thank you! Thank you very much.

Our plans may not always go exactly the way we want. Dissatisfaction with a cosmetic procedure is inevitable. Certain complications may arise regarding breast implants. This is why women sometimes do not feel happy with the outcomes of undergoing breast augmentation.  Coincidentally, women may undergo a particular surgery to rectify the unwanted results of a breast implant.  To help women with this problem, there is breast implant revision.

Women may experience plenty of complications following a breast implant.  An example of these complications is the improper positioning of the implant.  A result of this is the awful appearance of the breast, a scenario women hated much.  The wrinkling of the skin below the breast is also a consequence.  After the breast implant, your breasts may also look unnatural.  It’s a known fact that women are not against the idea of improving their looks but they want it to look natural.  The implant might also leak or cause ruptures.  Breast augmentation corrections can solve all of these problems.

Women have two options when it comes to eliminating these problems.  The two options are breast implant removal or breast implant revision, also called a breast implant exchange.  Of course, the choice will be dependent on the woman’s needs and preferences. Oftentimes, breast implants cause pain to women that’s why they have to undergo certain revisions in order for them to feel more comfortable.

A consequence of breast implants that leave women disappointed is breast deformity.  Their self-esteem diminishes.  By correcting the mistakes of this procedure, the self confidence of the patient improves.  Because of this, the bad experience with breast implants is in turn converted to something positive.  Moreover, women are given the chance to undo the results of a botched boob job.

Many factors surrounding breast augmentation correction should be considered first prior to undergoing the treatment.  For this treatment, the most eligible are those who are in good health condition.  The treatment disqualifies pregnant or nursing women.  Being unsatisfied with the results of breast implant qualifies one for the procedure.  The same thing applies to women who have been through surgical complications from breast implants.

To know what other reasons that prompted women to have breast implant removal is likewise necessary.  Breast cancer is an important reason for such removal.  Although breast implants do not lead breast cancer, removing them would facilitate the treatment.

Another reason women would have is being displeased with the size of their breasts.  Genuinely, mistakes are hard to avoid that’s why the treatment might cause unpleasantness for women.

Breast implant revisions lead to breasts looking more natural.  Furthermore, your breasts will appear more improved.  One of the outcomes of the treatment is the slimming down of a woman’s waists.  A benefit that cannot be disregarded is the good feeling a woman will have about herself.  In spite of the complications that may arise from a breast implant, there are procedures that will help to solve such problems.

Breast cancer is a common disease in women that is caused by increased amounts of cancerous cells in the area.

The Dangers of Breast Cancer

The loss of life is the worst effect of breast cancer. The cancer cells will migrate from the breast area to other parts of the body. The organs that are affected by the cells will deteriorate if neglected. Most patients are usually treated through surgery, chemotherapy, and radiation therapy. There are more options nowadays, though, like hormonal and targeted therapy. These remedies involve risks and side effects.

The Usual Victims

The risk for breast cancer is largest for more mature women, usually over the age of sixty. Over time, though, the average age for women with breast cancer has decreased.

Male breast cancer patients are not unheard of; in fact, the number of male cases of the disease has risen as well. Other risk factors include genetic predisposition and family history.

Prevention Tips

The wide array of treatment methods offer bigger odds of survival for patients.

But the best remedy for this is still, as with all other illnesses, breast cancer prevention. Age and genetics are some of the factors that is beyond one’s control. There are factors within control as well, like lifestyle habits and choices, that help in breast cancer prevention.

Breast Cancer Awareness

Breast cancer awareness is the most important step to prevention. Getting an idea of the causes and symptoms provides better chances of preventing the disease. In fighting breast cancer, awareness is the chief weapon.

The Right Food

A healthy diet is another way to prevent the development of breast cancer. Fats that have anti-cancer benefits are excellent improvements to a diet. The increase of fruits and vegetables in the diet can also decrease the risk of the disease. Breast cancer development can also be prevented through eating more food rich in fiber which checks the estrogen levels in the body.

Exercise

Exercising regularly promotes breast cancer prevention. In addition to boosting the immune system, exercise also regulates estrogen exposure by lengthening the gap between menstrual cycles.

Smoking and Drinking Ban

Harmful activities such as smoking and drinking can lead to breast cancer. Cutting back on or getting rid of these habits helps prevent the onset of the illness. Furthermore, stress management should also be regularly applied in order to better prevent the disease.

Breast cancer isn’t as scary as it once was, but this doesn’t mean that vigilance and clean living aren’t important anymore. People have to be just as, or even more, careful to keep this illness away from them.

It is a common notion that breastfeeding will lead to unflattering or unattractive changes in the shape of the breast. In fact, it is this belief that keeps many women from breastfeeding. Unfortunately the health benefits of breast milk for a developing infant are many supported by volumes of scientific evidence. No formula can do for baby what breast milk does.

A study published in the Aesthetic Surgery Journal (Vol 28, Issue 5, pages 534-7) casts doubt on the widely held belief that breastfeeding leads to ugly breasts. Drs. Rinker, Veneracion and Walsh reviewed the charts of 93 women who sought aesthetic breast surgery after pregnancy for breast ptosis (droop).

Just over half of women reported breastfeeding while the rest did not. While several things correlated with an increased occurrence of breast ptosis like older age, smoking, and higher body mass index, breastfeeding was not correlated.

In other words, in women who have decided to have a baby, breastfeeding does not affect the aesthetics or look of the breasts. Other factors can affect breast appearance after pregnancy, including the pregnancy itself, but breast feeding is not one of them.

While a larger, prospective study (one that follows women over time rather than looking back into medical charts) would provide better clinical data, new mothers that are concerned about what might happen to the appearance of their breasts if they breastfeed may not need to worry. When you consider the many health benefits of breast milk for baby, the decision to breastfeed should be even easier.

Former Miss Argentina and mother of twins, Solange Magnano, died Sunday from complications arising from a gluteoplasty (better known as a “butt lift”). The apparent cause of death was a pulmonary embolism (blockage of an artery in the lungs) that was caused by the injectable filler used in the procedure. In this case, the filler material that was used traveled to her lungs and brain, eventually resulting in her death, after three days in critical care in a Buenos Aires hospital.

Magnano won the Miss Argentina crown in 1994, and had remained popular throughout the country with a runway show scheduled for December. She leaves behind her 7-year old twins with family and friends saddened and shocked by the news.

Plastic surgery has become increasingly popular in Argentina as well as in many other areas of the world. With the costs of cosmetic procedures significantly lower in other countries, there has also been a rise in “cosmetic surgery tourism” for those in the U.S. seeking less expensive cosmetic procedures. Problems that can arise from this practice are directly related to the less stringent safety regulations found in certain parts of the world.

However, it should be noted that with all surgical procedures, there are standard risks that are inherent. These risks can be in the form of infection and other complications that have, in the past, even resulted in the rare possibility of death.

Just two year’s ago, the mother of hip-hop artist Kanye West, Donda West, died after complications arising from cosmetic surgery involving liposuction and breast augmentation. In this case, there were pre-existing conditions that were ignored, even with her original doctor’s advice.

Because of this, in honor of her death, California governor Arnold Schwarzenegger passed the “Donda West Law,” a legislation which makes it mandatory for patients to provide medical clearance for elective cosmetic surgery.

The important thing to remember is that even though these examples of tragic deaths are extremely rare, there are certain guidelines that should be followed when seeking a cosmetic surgery procedure.

Choosing the right doctor is critical to reducing potential surgical risks and complications. Your criteria should involve the surgeon’s experience (how many surgeries of that type has he or she performed?). What percentage of patients experience complications in that particular practice? What are those complications? Has the doctor’s license or malpractice insurance ever been revoked?

Also, you should be in good health with no pre-existing conditions that might put you at risk. Lastly, it is of the utmost importance that you follow all of the instructions and advice given by your doctor. By being diligent in your research of a reputable physician and understanding the potential risks of your procedure – the safety factor of the surgery increases by a substantial margin.

Breast reduction is a common surgical procedure among women. It involves the reduction of breast size by removing fat, skin and tissue.

Who are the candidates for the surgery?

Although the procedure is typically performed on women, it may also be done on men who are afflicted by gynecomastia – a condition of men’s breasts wherein they resemble that of women’s in size.

Women seek this kind of surgery usually because of oversized breasts, especially if they have gigantomastia – a condition where women have large, pendulous breasts. They may face the problem of experiencing pain in the head, neck, back and shoulders because of the weight of their breasts. Plus, the size can also lead to circulation and breathing problems.

Even if the enormity does not cause physical discomfort, some women have breast reduction surgery because of the disproportionate breast size compared to other parts of their body.

What you need to know before the procedure

It is important to be knowledgeable about the possible side effects, risks and benefits of the surgery. Doing so can help in you decide whether or not to go ahead with the procedure.

Although the reduction surgery is typically a successful procedure, there are potential side effects, just as with any surgery. The risks include difficulty when breast feeding, scarring, asymmetry and delayed wound healing.

Another thing to consider is choosing a surgeon you can trust. Perform research on several doctors. See if the surgeon has enough experience and training, operates in an accredited medical facility and adheres to a strict code of ethics.

Furthermore, when discussing the breast reduction procedure with the doctor, talk about your full medical history so that the surgeon will give you the most appropriate treatment.

You can also talk to other patients who have gone through the surgery. This way, could know what to expect.

It is also important to know that it may take a few weeks for initial recovery. However, it could take six months to one year for your body to completely adjust to the new breast size.

Many women seek breast reduction surgery for a variety of reasons. For one, the weight of oversized breasts can cause pain in the head, neck, back and shoulders. Some women may also experience breathing and blood circulation problems.

Although this surgical procedure is very helpful, there are some risks that women may encounter with the reduction surgery. One of them is having difficulty when breastfeeding.

Surgeries involving the breasts – such as reduction, augmentation, lift and nipple surgeries – tend to affect the lactation capability of most mothers. However, it is still possible to produce some amount of milk.

There are so many issues concerning breastfeeding after breast or nipple surgery. Breast reduction is seldom an easy process for women who are willing to abandon breastfeeding in favor of formula feeding. However, if you are dedicated to provide the benefits of breastfeeding to your baby, there are other options and supplements you can use:

• Increase milk production. There is a variety of methods that can let mothers produce sufficient amounts of milk even after the surgery. These methods include pumping, breast compression and galactagogues (substances that increase milk production).

• Use at-breast supplementation products. These are containers that hang around the neck, with tubes that supply pumped milk or formula. This device can be effective, but may pose as a problem if the baby is not able to remove milk effectively.

• Use baby bottles to supplement. Choosing bottles does not impact breastfeeding in a negative way. There are mothers who have used bottles and have had successful breastfeeding experiences.

More importantly, successful breastfeeding after breast reduction surgery does not necessarily mean producing a continuous supply of milk. Rather, the successful is defined by the degree of satisfaction the mother and her baby get from the breastfeeding experience.

Each woman’s breastfeeding success varies – some may breastfeed successfully, while others may have to supplement the baby’s entire nutritionally requirements.

Breast implants have recently made national headlines for the most unlikely reason.  Not for being too large, or bad for your health, not being a problem in the objectification of women.  No.  They have been part of due process.  Apparently, implants can identify you even if nothing else can, and may bring a man to justice.

Who knew?

Ryan Alexander Jenkins, a wealthy reality TV contestant, was served an arrest warrant for the alleged murder of his wife Jasmine Fiore, a swimsuit model.  Jenkins was featured in the reality TV show, “Megan Wants a Millionaire.”

The two had a stormy relationship:  Jenkins was charged in June with domestic violence for allegedly striking her with his fist. Jenkins also had a history of violence and sex addiction from 2007, which led to questions about his involvement in Fiore’s disappearance.

Fiore lived in L.A. and had last been seen in San Diego on August 13th.  She had been with Jenkins.  Jenkins reported her missing Saturday night.

Jasmine Fiore’s nude body was found stuffed in a bloody suitcase in a dumpster behind apartments in Buena Park, California on August 15th.  Her body was so badly mutilated that the body was unidentifiable.  According to preliminary reports, cause of death was strangulation.  Someone had gone to extreme lengths to hide her identity:  her teeth had been pulled and all her fingers had been removed to prevent the body from being identified by dental records or fingerprints.

However, the culprit was not aware that implants have serial numbers on them.  The detectives were able to trace back to the manufacturer, the surgeon, and ultimately, the patient – Jasmine Fiore.  Without her implants, the body would have never been identified.  However, the implants have possibly been a key step in the criminal process.

A warrant was issued, bail was set at $10 million, but authorities assume that Jenkins has already crossed in Canada.