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Local plastic surgeon assists community during pandemic by providing emergency services

A local dad has been providing small emergency services like stitches for Frederick County residents out of his plastic surgery practice. Dr. Guy Cappuccino sat down with ABC7’s John Gonzalez to discuss why he made a switch during the COVID-19 pandemic.

“It was actually my wife’s idea”, he says.

“She said people are so scared to go to the E.R, why don’t you open your office to bring people in for what we call lumps and bumps.”

The Maryland doctor of plastic and reconstructive surgery, Dr. Cappuccino, was forced to shut down his office during the peak of the coronavirus. He quickly scrambled to assist his community.

For months now, he has been providing small emergency services for residents who are fearful of hospitals and to help free up beds in emergency rooms.

“It’s not the typical when you fall off the monkey bars at school. It was more like we built a slide from a piece of plastic off the ottoman down the stairs. I’m not kidding, that’s a true story,” he chuckles.

Social media and word of mouth proved powerful. The loving husband and father of four, who is also the band director at his church, found himself very busy.

But he knows how important these services are for families.

“In light of what we see going on in the world, a lot of us feel powerless between the social issues and the pandemic. The one thing we always have control of is how we raise our family. And so I’m very proud to be a dad who is trying to raise children who are good loving members of the community.”

Dr. Cappuccino’s office is up and running again, but he plans to continue these medical services.

“It’s so efficient, we are going to keep doing it.”

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Frederick County residents who need stitches on a small laceration might feel wary to go to the emergency room during a pandemic – for fear of spreading or contracting the virus, or simply trying to ensure the hospital are not overwhelmed.

Now they can go to Dr. Guy Cappuccino, who has been providing small emergency services for Frederick County residents out of his plastic surgery practice.

Cappuccino’s practice had been mostly quiet in the last several weeks, after Gov. Larry Hogan ordered all elective surgeries to be postponed until further notice. The vast majority of Cappuccino’s procedures are elective, so he suddenly found himself with a lot of time on his hands.

“So it really effectively shut my practice down which… that was bad enough, but I really felt like I wanted to help,” he said.

Cappuccino sent out an email blast and posted on Facebook about his emergency services. While he didn’t have many clients at first, as the weeks went on, he found himself giving stitches to about a person per day.

“People are really happy to have this service. because they’re rightfully scared to have to go to the hospital at this point,” he said. “Especially for something minor.”

Most of the clients had heard about Cappuccino’s services through their neighbors and friends, not through social media.

“If you have a message that is worth sharing, it will be shared,” he said. “It’s very impressive, the power of it.”

Cory Watson, 6, needed stitches after the family dog scratched his cheek. The laceration was pretty deep, and his mother, Lisa Watson knew he would need stitches.

She had seen Dr. Cappuccino on Facebook and called his office to ask about bringing Cory in. Even with Dr. Cappuccino back at work with regular patients, they found time to tend to Cory, who received 13 stitches.

Cappuccino has a setup in his office that allows the patient, many of whom are children, to watch Netflix while he completes the procedure.

“The staff was amazing, Dr. Cappuccino was amazing, and for a 6-year-old to be able to walk into an office, get stitches, smile when he comes out, and be excited about a follow up is pretty unheard of,” Watson said.

Dr. Cappuccino’s office does not take health insurance besides Medicaid, but he has set up a system where he charges what the lowest out of pocket cost would be for an emergency room visit for the patient’s insurance.

“Honestly the care that we received was 100 percent worth everything that we paid out of pocket for,” Watson said. “The staff was amazing, Dr. Cappuccino was amazing.”

Dr. Cappuccino said he will continue to offer service as long as he feels necessary. For him, it’s been a rewarding experience.

“It had kind of reintroduced this element of trauma, and acute plastic surgery care that I hadn’t really done in a few years and I really missed,” he said. “So for me it’s been very fulfilling to be able to help people, and especially people in my own community where I live and work.”

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Amid the COVID-19 pandemic, a Mount Airy plastic surgeon is providing emergency services to help some of the traffic flow and taking patients into his own hands, literally.

Dr. Guy Cappuccino wanted to find a way to help after his practice, Guy Cappuccino, M.D. Plastic and Reconstuctive Surgey, died down heavily since most of it is elective surgery. Before the pandemic, Cappuccino’s practice focused on cosmetic surgery of the face and body along with non-invasive procedures like Botox.

“After March 24, all elective surgeries and procedures were postponed in Maryland. So, the majority of my practice is elective, so I pretty much had to shut down operations,” said Cappuccino. “I felt pretty useless and I really wanted to be able to help, but as a plastic surgeon, there just isn’t a whole lot that I can do in a pandemic like this.”

It was then that Cappuccino said that he got the idea to offer his services to prevent people from going to the emergency room for things such as cuts, bruises, lacerations or broken bones as a way of preventing exposure to the COVID-19 virus, especially with children and the elderly.

Cappuccino posted on Facebook and sent an email blast to inform the public and he’s gotten a positive response from patients since then.

“It’s been great,” said Cappuccino. “People will often just text me and I’ll say send me a picture, tell me what happened and we can meet them at the office, usually within a half-an-hour, in and out. It’s just me, there’s nobody there. We keep everybody clean and safe and happy and it’s worked out to be a really nice situation. I’ve met a lot of really nice people and hopefully help keep people safe.”

What Cappuccino is doing has mainly been word of mouth.

Cappuccino set up a system where people can text his office number and it will go to his cell phone so he can respond back to them immediately without delay. He can see them fairly quickly since he only lives 10 minutes from the office.

Lyndsay Kuzmak, a dentist and mother of four, has seen Cappuccino’s work first hand. Cappuccino helped her 5-year-old son, Jonathan.

According to Kuzmak, on April 19, her husband made a homemade sliding board with a plastic slide from outside going from a sofa to a chair in their living room. She had just finished saying, “This isn’t going to end well,” when her Jonathan careened off the homemade sliding board and hit his head on the ottoman.

Being in the medical profession, after cleaning it, she saw that it was going to need stitches. She only thought about doing it herself for about two seconds before deciding against it.

“Once it goes past the lips, that’s where my expertise ends,” said Kuzmak.

Even still, she was apprehensive about going to an emergency room in the middle of the pandemic. She remembered someone telling her about Cappuccino and what he was doing, so she gave him a call and met him at his office with Jonathan.

“I’m so grateful to him that he could see [Jonathan] right away. I mean, it was probably 4 or 5 p.m. Sunday evening,” said Kuzmak. “So kudos to him for being a great doctor in general and for seeing someone on a a Sunday evening who isn’t even a patient of record.”

Not only did Cappuccino see Kuzmak’s son on a Sunday evening, he left the birthday party of one of his own four children to help.

“It was my son’s birthday and we took a little break in the middle of the party; we had dinner and cake,” said Cappuccino. “I said, ‘We’ll take a little break and then we’ll come back and open presents later.”

Cappuccino said the whole thing only took about an hour.

According to Kuzmak, Cappuccino was very good with keeping her son calm and let him watch Netflix while he was getting stitched up.

“I do everything I can to put every patient at ease because I know how intimidating and scary it is, because there’s something sharp involved,” said Cappuccino. “Whenever I have young patients, especially, first thing I do is bring them in, I usually sit them down, I let them play with the power chair themselves and go up and down, and let them get a comfortable position. Then, I have a giant 50-inch TV right in front of the chair and I have Netflix and Hulu.”

Kids get to watch whatever their favorite show is and they’re relaxed and distracted, according to Cappuccino.

Jonathan’s wound has healed nicely, according to Kuzmak.

Even though his practice has basically been shut down, he still has been able to do a lot of remote consultations and will have them send photographs ahead of time, all through his HIPAA (Health Insurance Portability and Accountability Act) compliance server.

Aside from the remote consultations, Cappuccino’s practice has changed in multiple other ways since the COVID-19 pandemic.

“While we usually do things like clean trays and clean exam tables and chairs, now we sort of took that to the next level,” said Cappuccino. “We would sanitize any contact surface, for example, any doorknob, any handle, any light switch, even the hand sanitizer, the counter tops, the keyboard the pens patients would use if they need to write something down.”

Cappuccino doesn’t accept all insurances but in the case that he doesn’t accept someone’s insurance, he finds out what the minimum charge for that procedure is at an emergency room is and charges them that.

“It might be a quarter of what I normally would get paid,” he said, “but I just accept whatever that reduced payment is so that they wouldn’t actually be charged anything more than if they went to the hospital.”

Cappuccino’s office is located at 1304 S. Main Street. The office number is 301-829-4110.

Dr. Cappuccino’s Summer Skin Care Approach

Summer Skin CareNow that it’s summer, we should consider skin care strategies to protect our skin as well as improve the health, quality, and appearance of our skin. When it comes to summer protection, I take a three-point approach: block UV light, hydrate, and use antioxidants.

When blocking UV light we should make wearing sunscreen a daily routine.   If you are going to be out in the sun remember to reapply at least every several hours, especially if you are in the water or sweating.  Wear a hat, a big hat.  I wear a ridiculously oversized hat when I play golf.  I know I stand out a bit, but I don’t care since I know my face, neck and chest are being protected from future wrinkles and skin cancer.  Try to avoid being exposed to midday sun (10am-2pm), and if you are, try to seek some shade.

Water intake and topical moisturizers are two forms of hydration for proper skin care.  Both are important.  Eight 8-ounce glasses of water are recommended each day to help maintain the critical fluid balance of our body and skin and assist in detoxification.  Topical moisturizers to hydrate skin before and after sun exposure are a good idea, especially ones that contain hyaluronic acid.

I use several different topical antioxidant skin care products yearly, but especially in the summer.  UV light causes creation of free radicals in our skin which can lead to photoaging and skin cancer. Use of topical products which contain antioxidants such as vitamin E, ubiquinone, and glutathione can help minimize this damage.

To learn more about summer skin care, contact Board Certified Plastic Surgeon Dr. Guy Cappuccino in Mt. Airy at 301-829-4110. For more information visit www.DrCappuccino.com, or our Facebook Page.

Top 5 Benefits of FUE (follicular unit extraction) Hair Transplantation

Here is a list of the top 5 benefits of FUE hair transplantation as compared with the older FUT method:

1. Office based procedure- FUE with NeoGraft is an office based procedure performed entirely under local anesthesia. Patients can drive themselves to and from the office and avoid the costs, inconvenience, and risks associated with the more invasive strip method required for FUT.

2. Quicker recovery time- FUE procedures such as NeoGraft allow patients to return to their normal daily activities in as little as 1-2 days. There are no staples or stitches to remove. The bandage is removed 24-48 hours after the procedure. Special care and washing instructions are given to each patient.

3. No linear scar- There is almost imperceptible scarring when compared to “strip procedure”, which may leave you with a very noticeable scar. This is important for patients who would like to keep a short hairstyle as the scar from the strip method is noticeable. The extraction sites from FUE range from 0.8-1.0mm which close up on their own in just a few days without a noticeable scar.

4. Less painful recovery- Pain is minimal following FUE procedures. Most patients report only needing Tylenol on the evening of the procedure. Long acting local anesthetics make the recovery process quite manageable without the need for narcotics. After 24 hours most patients describe no pain at all.

5. Higher graft survival rate- FUE has a 90-95% graft survival rate as compared with approximately 75% survival rate of FUT method. The precision harvesting of FUE allows less trauma or transection of the hair follicles during the harvesting process.

NeoGraft: A breakthrough in hair restoration

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* Individual results may vary. Refer to disclaimer below.

Hereditary hair loss is a medical condition that affects about 50 million American men and 30 million American women. By the age of 35, two-thirds of American men experience some degree of measurable hair loss, and by the age of 50, approximately 85 percent have significantly thinning hair, according to the American Hair Loss Association. This hereditary condition, clinically termed androgenetic alopecia, is characterized by a receding hairline as well as a loss of hair on top of the scalp.

When hair loss is first noticed, initial therapies are aimed at preventing further hair loss. For women a dermatologic workup may be indicated to determine if there is an underlying medical cause of hair loss. Medical therapies include topical Minoxidil and/ or oral Finesteride. Another new and promising treatment is PRP (platelet rich plasma), which uses a patient’s own activated platelets injected into the scalp, to slow and even reverse hair loss. However, once hair follicles are gone for more than a few years, the only method of restoration is hair transplantation. Over the years, hair transplantation has developed a negative image in popular culture due to early poorly executed “hair plug” procedures which left people with a “corn row” or “doll’s hair” appearance. This sends shivers down my spine when I hear patients say these words because for decades now FUT (follicular unit transplantation) has provided very natural appearing hairlines. The FUT method required taking a strip of hair from the back of the scalp and cutting it into individual follicular units and then transplanting them. Due to the invasive nature, this procedure was typically done in an operating room under anesthesia and was both costly and uncomfortable. Many potential patients shy-away from (or are not candidates for) the traditional FUT or “strip method” of hair replacement because of the slow recovery time, the loss of feeling at the incision site, the linear scar on the back of the head, or the amount of post-operative pain involved.

The Maryland Hair Center is excited to announce our newest offering, NeoGraft®. NeoGraft® introduces the “state-of-the-art” solution for hair loss. This game-changing technology automates the Follicular Unit Extraction (FUE) method to give patients more natural looking results with minimal downtime, no linear scaring and no stitches. It is a minimally invasive procedure where individual hair follicles are extracted from the back of the scalp via the NeoGraft machine and then implanted into the areas where hair loss has occurred. The entire procedure is done with local anesthesia only in the comfort of our office while patients binge watch a Netflix series! There is almost imperceptible scarring when compared to “strip procedure”, which may leave you with a very noticeable scar. NeoGraft has a greater that 90% take rate, so pretty much every single hair follicle that is taken out will grow. There is very little downtime after your procedure when compared to strip procedure. Patients can usually resume normal activity within 48 hours excluding strenuous exercise when done via NeoGraft. We incorporate all the latest techniques in hairline design to ensure your transplant will look natural, after all, as you know, the best transplants are the ones you cannot tell are transplants.

We recommend a full consultation with Dr. Cappuccino to ensure you are a good candidate for the NeoGraft procedure and to see how many grafts you would need in order to get the best results. We have a cutting edge simulation visualizer on our website which allows prospective patients to virtually “try on” a full head of hair before their consultation by uploading their own picture. On Thursday March 2nd, The Maryland Hair Center, located in Mt. Airy will be having its annual NeoGraft open house with individual consultations by appointment only and 20% off all procedures. For more information on NeoGraft or for a free simulation, visit www.marylandhaircenter.com or call Dr. Cappuccino at 301-829-4110

Botox Bargain: Buyer Beware

In 2015, nearly 7 million Americans received Botox or similar neuromodulator treatments. Approximately 2.5 million dermal filler treatments were done in the same year. With the overwhelming success of cosmetic injectable treatments, they have become broadly accepted by the American public. However, with this rise in popularity has come the unfortunate emergence of non-core specialty practitioners trying their hand at injectables. When I say “non-core” I am referring to all doctors who are not Board Certified plastic surgeons or dermatologists. Only these specialties include specific didactic and practical training in the use of cosmetic injectables as a part of their board certification process. That is not to say that other doctors cannot get trained later at a training course; however, when your pediatrician or ER doctor offers you Botox, or your hair salon suddenly starts offering Juvederm injections, you should understand that this was not part of their medical training, and you may be putting yourself at risk for more than just an undesirable cosmetic result. Imagine if one day I started offering to color my patients’ hair- the results would be disastrous. Many an unsuspecting person has fallen victim to bargain basement prices on such treatments, but the old adage applies here more than ever, you get what you pay for.

As a Board Certified plastic surgeon I feel it is my obligation not only to provide the highest level of treatment, but also to educate the public on what may or may not be correct for them. Often a patient will come to me asking for Botox for their forehead lines, but the problem is actually a heavy brow or excess skin of their upper eyelids. After explanation of the dynamics of facial aging and anatomy, I make the appropriate recommendation, which often is not an injectable at all. Routinely I see an unhappy patient come to my office complaining how their doctor did Botox in their forehead and now they look unhappy and mad all the time, and ask me if I can fix it. Botox and fillers can provide an amazing non-surgical result when used correctly, but knowing when and how takes correct training and years of experience. This is as much an art as it is a science. It has taken me more than a decade and tens of thousands of injections to master the art of injectables. I have compiled a list of questions that you should routinely ask when you go to a new provider for injectable treatments. My savvy new patients sometimes ask me these questions, and I am more than happy to answer to put their minds at ease.

Always ask your doctor about their experience with injectables: How and when were they trained, how many years of experience they have with each individual injectable as they are all different in their required technique.

Ask if your doctor has reversal agents for hyaluronic acid fillers (such as Juvederm or Restylane) in the event of less than desirable outcome or adverse event.

Ask your doctor if they are able and willing to help you in the event you are not satisfied with your results. I always ask my patients to call me in a week or stop back if things don’t look the way they expect. Often, if there is any issue, it is an easy fix that I don’t charge for.

Always ask to see the actual bottle of Botox or syringe of filler being used. Ask your doctor if they buy the products directly from the manufacturer or if it is obtained from the grey – or worse, black – market where quality control is suspect. Look for the holographic seal on the Botox bottle ensuring it comes directly from Allergan the manufacturer.

Ask how many units of Botox or Dysport are being administered. Dilutions may vary, but units are consistent.

Ask your doctor when the bottle of Botox was opened. Did you know that once opened and reconstituted, Allergan recommends the Botox be used within 4 hours to ensure potency? In a busy injectables practice like mine, that is no problem as we go through multiple bottles daily, but in a slower practice, beware.

Ask to see your doctor’s before and after pictures, especially of his or her injectable filler patients. Nothing gives a prospective patient a better idea of how they will look than seeing the doctor’s actual work!

The most important thing is to seek out a well qualified doctor you trust who has the full compendium of knowledge and tools to help you achieve the best possible result. Most of the time, injectable fillers give a beautiful, near immediate result. But even in the best of hands, aesthetic medicine can have less than perfect results, and those are the times you need your doctor and their office to be at the top of their game.

For more information about cosmetic injectable treatments call our Dr. Guy Cappuccino at 301-829-4110 or visit www.DrCappuccino.com

What is KYBELLA?

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* Individual results may vary. Refer to disclaimer below.

What is KYBELLA?

KYBELLA® is the first and only FDA approved injectable drug that contours and improves the appearance of submental fullness. A common cosmetic complaint, submental fullness or lipodystropy, is excess fat in the anterior neck under the chin. Up until recently, the only effective way to remove the fat was liposuction. While effective and economical, some people are opposed to invasive procedures, even minimally invasive techniques like liposuction.

KYBELLA® is an injectable treatment from Allergan. KYBELLA® is a formulation of deoxycholic acid, a naturally-occurring molecule in the body that aids in the breakdown and absorption of dietary fat. When injected into subcutaneous fat, KYBELLA® causes the destruction of fat cells. Once destroyed, those cells cannot store or accumulate fat.
Basically, what it’s doing is disrupting the fat cell membrane. After that, the fat cell releases its fatty contents and the body metabolizes and disposes of the fat. As for the recovery itself, there is an inflammatory component immediately following the injection. There is some swelling and some discomfort for a few days because the body is cleaning up the cellular debris and creating some contraction in the skin.

Typically 2-4 treatment sessions are required to achieve desired results. Each treatment is spaced at least one month apart. After the aesthetic goals are achieved, re-treatment with KYBELLA® is not expected. The cost of KYBELLA varies based on how much fat there is to treat and what your doctor charges, depending on the area in which you live. Each treatment session ranges in price between $800-$1600. Adverse effects include possible numbness, swelling, and bruising.

Are you afraid of needles? COOLMINI™ from CoolSculpting by Zeltiq is achieving good results as well. Zeltiq boasts “no needles, no surgery, no downtime”. COOLMINI™ is FDA cleared for the treatment of submental fat. It was designed for small areas of fat including submental fat, axillary fat (the fat in front of your arm pit), knees and other smaller bulges of stubborn fat. On average patients can expect 20% reduction in fat after each treatment. Typically 2-3 treatments are required for optimal results. Each treatment session is approximately $1000. Adverse effects can include post-treatment discomfort. No bruising or swelling is expected.

For more information on KYBELLA and other treatments we offer, contact Board Certified Plastic Surgeon Dr. Guy Cappuccino in Mount Airy at 301-829-4110.

Treatment of Acne Scarring

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* Individual results may vary. Refer to disclaimer below.

Acne can leave noticeable scars that are damaging both cosmetically and emotionally. This has traditionally been a vexing problem for patients and doctors alike. Fortunately there have been recent advances in treatment. Current options for correction of acne scarring include: microdermabrasion, microneedling, laser resurfacing, platelet rich plasma (PRP), highly focused radio-frequency microneedling (INFINI), and certain dermal fillers (Bellafill). All of these treatments are aimed at smoothing the contour of the damaged facial skin.

The acne treatments can be broken down into 4 categories:
1: dermal abrasion (sanding)
2: CIT (collagen induction therapy) healing from within
3: Subcision (surgically releasing the depressed scar)
4: Dermal fillers-filling the scar depressions

1: In the dermal abrasion category we have traditional dermabrasion and microdermabrasion. Microdermabrasion uses a fine spray of crystals with suction to gently sand the outer layer of skin cells. It is a less aggressive version of dermabrasion, once the primary treatment for acne scarring, but now almost abandoned due to it’s significant recovery period. Microdermabrasion is often used in conduction with other modalities to boost effectiveness. When used alone the results are modest.

Fractionated laser resurfacing, (PIXEL) uses beams of laser energy from a carbon dioxide laser to burn tiny channels in the skin. Using varying depths and power levels, impressive smoothing of the outer layer of skin can be achieved with minimal downtime, usually just 2-3 days. When applied deeper, these lasers can also stimulate collagen production adding to the result.

2: Collagen induction therapies involve stimulating the body to heal the scar by developing new collagen and elastin where the damage occurred. Microneedling is a minimally invasive procedure that involves the use of a mechanized device that contains fine needles. The needles are use to puncture the skin to create a controlled skin injury. Each puncture creates a channel that triggers the body to fill these microscopic wounds by producing new collagen and elastin. New collagen and elastin production can improve acne scars, reverse years of sun damage, and enhance the overall appearance of aging skin. Micro-needling also helps the skin absorb treatment serums (such as hyaluronic acid or vitamin C) 80% more effectively deeper into the skin. Think of it like aerating your lawn when fertilizing.

Platelet rich plasma, or PRP, is an adjunct to microneedling. PRP harvests the patient’s own activated platelets and then directs them to the site of the scarring. The activated platelets cause a significant boost in collagen production when combined with microneedling. The PRP can also be injected directly into the depressed scar to stimulate healing and smoothing.

INFINI is highly focused radio-frequency microneedling. It adds RF energy to the tips of shielded micro needles to apply heat at deeper levels in the skin. The heat causes thermal micro-injury to the skin and boosts the body’s healing process to tighten skin and fill scars. This is the most recent advancement to collagen induction therapies. Downtime is 2-3 days and the results have been impressive.

With any of the collagen induction therapies, results will take time to be noticeable. Rebuilding your collagen will take up to 6 months so your skin will continue to improve over 6-12 months.
The number of sessions required depends on the condition of your skin and your desired outcome. On average for mild acne scarring we recommend 3 to 4 treatments. Deeper scars and stretch marks may require upward of 5 treatments. An interval of 4 to 6 weeks between treatments is typically recommended.

Subcision is simply using a needle or sharp instrument to undermine, or release the tethered scar. When performed alone the results are less than ideal, but when combined with PRP or a dermal filler, it is a powerful tool.

Dermal fillers are the last treatment option for acne scarring. Recently the FDA approved Bellafill for the treatment of some types of acne scars. When combined with subcision, the undermined acne scar is back-filled with Bellafill to immediately smooth the scar. As the Bellafill is dissolved by the body, new collagen is deposited in its place, making the results near permanent.

For more information on the treatment of acne scarring, contact Dr. Guy Cappuccino in Mt. Airy at 301-829-4110 or visit us at www.DrCappuccino.com