Santa Barbara Cosmetic Surgery: Facial Augmentation with Implants

If a person feels that one of their facial features is “weak” and thereby creating an imbalance in their appearance then facial augmentation with implants may be a good choice for them. Facial implants are popular because they are a more permanent option for aesthetic improvement (as opposed to dermal fillers) and because they come in many shapes and sizes or can be customizable to individually suit the person’s face.

At our Santa Barbara Cosmetic Surgery Center, we can use facial implants for all areas of the face.

Cheek Implants add volume and contouring to the cheek area that may have lost the curvature due to genetics, age or extreme weight loss. When fat is lost in the cheek area, the hollows in the under eye area and the nasolabial folds may become more pronounced, making a person appear tired or unhappy. Cheek implants restore the volume and give the overall face a “lift”.

Chin Implants are used to strengthen a chin that has a noticeably weak definition. An under-projected chin can make the nose and/or neck appear larger than they are. The proper size and shaped chin implant will re-create definition. As an extra bonus, we often hear patients say the newly defined chin makes them look like they have lost weight!

Nasal Implants can be used to elevate the nasal bridge and/or improve the tip. The implant can be custom-sized to best fit the person’s face and compliment the other features.

Mandibular Angle Implants are used to create a stronger and more defined jaw. This surgery is more common for men because a wider lower face is seen as desirable.

There are many surgical and non-invasive augmentation options and combinations that can be done to improve one’s appearance.

Contact us at 805-563-0000 to schedule a consultation to discuss what options would be best for you.

Skin Care Tips by a Santa Barbara Cosmetic Surgeon

The new year is almost here and most of us will commit to starting (or continuing) healthy habits such as eating more veggies, going to the gym, and so on.  In my Santa Barbara cosmetic surgery practice I get a lot of inquiries about skin care and how to keep skin looking young and healthy. With New Year’s resolutions upon us, I thought this would be a great opportunity to suggest some skin care tips to incorporate into your list of resolutions. These skin care recommendations will help prevent accelerated aging and will encourage healthier skin in the coming year.

Use Sunscreen Daily
One of the top causes of premature aging that leads to wrinkles, fine lines, and “sun spots”  (hyperpigmentation) is the damage caused by UV rays. Use sunscreen daily – year round – with an SPF 30+ to help prevent sun damage. Reapply often if you are outdoors, sweating excessively, or swimming.

Avoid Trendy Products
Skin care products that promise you the moon usually don’t deliver. Do your research and buy your skin care products from a reputable place – such as a physician’s office or a medical spa. Physician-grade products contain higher quantities of potent ingredients that are often clinically proven to deliver results.

Encourage Exfoliation
As we age, cell turnover decreases and the “build up” of cells can leave your complexion dull. Exfoliate two times per week to encourage faster cell turnover.

Clean and Replace Skin Care Tools
If you’re using a Clarisonic as part of your cleansing routine, that is great! Allow the brush head to dry after every use (patting it dry immediately after each use helps) and replace the brush head every 2 to 3 months. Make-up brushes can cause more harm than good if they are not washed regularly. Use a brush cleaner solution or mild baby shampoo and commit to cleaning your brushes weekly.

Moisturize
Moisturizing hydrates and protects the skin. It also can improve tone and texture and can often mask imperfections. Moisturizing is good for all skin types even those with oily or acne-prone skin. For oily skin, choose a non-comedogenic and oil-free moisturizer.

Be Hands-Free
Commit to keeping your hands off your face. Dirty hands and nails can contaminate the skin you are working so hard to keep clear and clean.

“You Are What You Eat”
Consume lots of colorful vegetables and fruits. These are packed with antioxidants and will help your skin from the inside out. Fatty and greasy foods can upset the natural balance of your body and can cause your overall health – and your skin – to deteriorate.

Get Your ZZZ’s
While you “rest”, so does your skin. Sleeping lowers your metabolic rate so you’re not producing as many skin damaging free radicals. It also gives your skin a chance to focus on skin repair (instead of protection, as it does when it is being exposed to the sun or environmental pollution during the day).

Don’t Smoke 
One of the fastest ways to prematurely age you skin is through smoking. Nicotine causes narrowing of blood vessels and impairs blood flow to the outermost layers of the skin. Less blood flow means less nutrients and oxygen to your skin. The result is wrinkles and sagging of the skin.

Conduct Self-Screening
Before putting on make-up, take a close look at your skin and note any changes, discoloration, funny looking moles, or abnormal looking skin. Follow up with a dermatologist to further assess the condition. It’s a good idea to see a dermatologist annually for an overall skin check.

A New Year is the time to make changes and improvements. Following these skin care recommendations will give your skin the opportunity to be healthier and more youthful-looking in 2015 and years beyond.

All of us at Cosmetic Surgery Center in Santa Barbara wish you (and your skin) a happy, healthy new year! 

Skin Care Products for Hyperpigmentation

As a Santa Barbara cosmetic surgeon who also specializes in skin care, I get a lot of patients who inquire about reversing hyperpigmentation. They may call them sun spots, “liver spots”, or “age spots”, and essentially what they are referring to is the darkening of their skin that appears over time and can look like freckles, patches, abnormal pigment clumps, or “stains” on the skin. Most hyperpigmentation is the result of sun damage (or photodamage) which is repeated and prolonged exposure to the sun’s UV rays.

There are different ways to address sun damage and pigmentation issues, but I will devote this blog post to the products that I have seen to be the most effective at reducing unwanted pigmentation. While many mass market skin care products that are available from drug stores to high end department stores make claims to reverse or fade spots, their effectiveness is not as great (if they are effective at all) as medical-grade skin care products. Mass market products contain lower active ingredients so they can be used by a large audience without many unwanted problems. Pharmaceutical grade skin care products, on the other hand, have higher active ingredients which renders them more powerful – and more apt to get the job done!

My recommendation for the skin care products listed below stems from their excellent reputation, their high therapeutic value, and our clients’ satisfaction. Also, at some point, these products have all been used by me and my staff at Evolutions Medical & Day Spa in Santa Barbara and we have personally witnessed positive changes in the skin from them.

NIA24
The entire line of NIA24 products are designed specifically to address photodamaged skin and to help prevent future damage. They contain a patented molecule called Pro-Niacin, derived from Niacin (Vitamin B3), that utilizes a MicroNutrient Delivery system which allows it to cross the epidermal barrier and penetrate the epidermis in a continuous release fashion for up to 24 hours. This is what makes these products different from any other Niacin containing products. NIA24 truly creates healing from within and will lessen pigmentation, brighten and firm the skin. 

OBAGI
Obagi is one of the most recognized skin care names globally. They are known for their prescription-strength product lines that truly transform the skin. Obagi is offered in many physicians’ offices worldwide. Obagi has an array of products for different skin concerns. Hyperpigmentation would be best addressed by Obagi’s Nu-Derm System. This system contains several products that help normalize the skin as it increases cell turnover, lightens or erases dark pigment spots and other photodamage, improves skin elasticity, lessens the appearance of fine lines and wrinkles, and brightens the overall complexion.  

PCA SKIN
This scientifically advanced skin care line provides the most technically researched, results-driven formulations available today. PCA products are only available through licensed skin health professionals that have been trained and certified by PCA Skin. PCA has a Pigment Gel with Hydroquinone (HQ) or a Pigment Gel HQ Free (no hyrdoquinone but other ingredients such as kojic acid, azelaic and lactic acids to encourage an even skin tone) that are less aggressive than Obagi’s Nu-Derm system but give an alternative way to decrease the formulation of melanin (the brown pigment) over time.

TRETINOIN CREAM
Tretinoin is the chemical name for retin-A (retinoic acid) and is a vitamin A derivative that has been shown to have many beneficial effects on the skin such as 1) increasing cell turnover, 2) decreasing pore plugging (which means fewer pimples, white and blackheads), 3) decreasing abnormal cell differentiation (which means less likelihood of skin cancer) and 4) anti-aging effects. Retinol is a “cousin” of retin-A that is converted to retinoic acid in the skin but at a much lower concentration. Retin-A is best used on a regular basis at night for the long term and is known for gradually fading hyperpigmentation spots over time.

There are faster ways to fade pigmentation (such as non-invasive aesthetic treatments) but if you choose to use any of the above products and give them some time and patience, I think you will be pleased with the result.

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I am a Santa Barbara cosmetic surgeon who specializes in facial rejuvenation cosmetic surgeries and skin care. If you are interested in scheduling a consultation, call my office at 805-563-0000.

Santa Barbara Eyelid Cosmetic Surgery

Eyelid rejuvenation surgery is one of the most popular facial cosmetic surgeries done today. In the 2013 statistics on cosmetic procedures (published by the American Society of Plastic Surgeons) eyelid surgery (blepharoplasty) ranked third (behind breast augmentation and rhinoplasty) with over 215,000 surgeries performed in the United States.

Patient of Dr. Terry J. Perkins
Some people equate eyelid surgery with cat eyes or “surprised” (overly rounded) eyes. That type of surgery is a thing of the past. Most surgeons, including Santa Barbara cosmetic surgeon Dr. Terry J. Perkins, opt to give patients a much more natural look. Eyelid surgery can be done on the upper lids, lower lids, or both. This blog post will concentrate on the upper eyelids. Our blog post from July offers more information on lower eyelid surgery
Most people who are interested in eyelid surgery are interested in making their eyes look more youthful. As age sets in eyelids can become heavy, droopy, or saggy which can make a person look permanently tired, unhappy, or unapproachable. Upper eyelid surgery can correct these problems to restore a rested, youthful appearance. 
Blepharoplasty of the upper eyelids addresses the overhanging/excess eyelid skin as well as the inner corner fat bulges. Incisions are nicely hidden in the natural creases of the eye. General anesthesia is not needed for this surgery. Upper eyelid surgery can be performed under local anesthesia combined with oral sedation alone or together with IV sedation. Most people take one week off from work to rest and recuperate. Contacts and make-up may be used after 10 days and it is advisable to purchase new eye make-up so as to not introduce any bacteria into the healing incisions. For most patients, aerobic exercise can be resumed at three weeks post surgery. Sun glasses and a wide-brimmed hat should be worn for all outdoor activities. 
A successful upper eyelid surgery can make a positive difference in a person’s overall appearance. 
For more information on upper eyelid surgery in Santa Barbara, contact our Cosmetic Surgery Center practice at 805-563-0000.

Santa Barbara Cosmetic Surgery Center on How to Look Young

Many people are on a quest to retain their youthfulness – or at least to look younger than they are. Facelifts, chemical peels, Botox, and many other cosmetic surgery procedures offered by Santa Barbara cosmetic surgeon Dr. Terry Perkins can keep a person looking refreshed and, perhaps, even looking like they are a decade younger than their true age. But, alas, there is more to staying youthful than plastic surgery.

Dr. Perkins has seen many patients over his three decades of cosmetic surgery in Santa Barbara. He will readily admit that it is not just surgery alone that keeps people “young”. Here are his top ten (non-surgical) tips for defying age:

  • Be happy. Being happy, not just on the outside, but also on the inside, is key. Being content with who you are can unburden you from all the stressors of wanting more, wanting something else, or wanting to be someone that you are not. 
  • Protect your most delicate skin. The skin around your eyes is the thinnest and most fragile and can be the first to show signs of aging – i.e. wrinkles, crepey skin, and age spots. Moisturize and apply an SPF daily to protect this skin. Eyes are often what people notice first and you want your eyes to be surrounded by healthy, glowing skin with little to no wrinkles.
  • Laughter is good medicine. Laughter can improve your mood and induce changes in your body such as stimulating your heart, lungs, and muscles with extra air intake. It also increases the endorphins that are released in your brain and acts as a tension reliever. You have lots to gain from laughing. 
  • Sweat regularly. Walking and cycling are great, but give your body a boost by adding short, intense bursts of exercise. When you do this, the growth hormone – which is the most powerful way to cut body fat, tone muscle and promote anti-aging – is naturally produced by the body.
  • Feed and protect your skin. Keep your skin nourished and looking plump by moisturizing daily. Always use a sunscreen, year round, to ward off the UV rays which are known to cause wrinkles, age spots, fine lines, and cancer.
  • Embrace tomatoes.  Lycopene, found in the red pigment of tomatoes, is a powerful antioxidant that protects cells from damage caused by sun exposure. Research has shown that adding just 5 tablespoons of tomato paste daily to your diet may reduce sun damage by 35%. Cooked tomatoes are more potent because the heat liberates three times the amount of lycopene from the plant’s tissue. 
  • Breathe deeply. Ten slow and deep breathes a day can make a remarkable difference in your life. Breathing deeply massages vital organs and improves circulation in them. It also relieves tension and removes toxins. It slashes cortisol levels and lowers blood pressure. This is just the tip of the iceberg. There are many more benefits to breathing deeply (we could write a whole blog post on that alone).
  • Put your best brow forward. As we age, eyebrows tend to gray and/or thin out. Brows “shape” your face so keeping them full and colored helps. Eyebrow tinting is available at many salons or coloring them in with a specialty eyebrow kit will add back the definition that was there in your youth.
  • If you snooze you … win.  Seven to nine hours of solid sleep every night helps your body and skin to regenerate. It also allows your facial muscles to relax (softening potential wrinkles) and helps to prevent bags from forming under your eyes. There are also a whole host of benefits that getting a good night’s sleep brings including boosting the immune system, relieving chronic pain, and better weight management, to name a few!
  • Don’t let age stop you. Don’t succumb to the number of candles on your cake! Make your age an attitude. Do what you like to do and don’t stop just because you’ve reached a certain number. 
Practicing a few – or all – of the suggestions above will help anyone to feel “young at heart”. If you still feel like that is not enough to keep your skin from sagging, your eyebrows from covering up your eyes, or your neck from wobbling, know that we are always here to help! 
Facelifts, brow lifts, neck lifts and more at Cosmetic Surgery Center in Santa Barbara. For a Santa Barbara cosmetic surgery consultation, contact us at 805-563-0000. 

Non-Invasive Treatments for Sun Damaged Skin

This Fall in Santa Barbara we were treated to an extended summer. Lots of clear, sunny and warm days drew us outside for beach days, backyard barbecues, and hikes in our local mountains. While we were enjoying our beautiful weather, many of us were unknowingly exposing our skin to photodamage (sun damage) due to repeated and/or prolonged exposure to the sun’s rays.

For some of us, the sun damage appears almost instantly (usually in the case of a bad burn) while others may not show any “damage” for many years. The photodamage can present itself in different ways:

  • Abnormal pigment clumps (often referred to as “age spots” or “liver spots”)
  • Wrinkles and sagging of the skin (caused by damage to the collagen and elastin network in the dermis)
  • Neoplastic changes (such as pre-cancerous or true skin cancer)

As winter approaches, some people may notice more “freckles” or discoloration on their face, shoulders, chest, and hands (the places that are exposed to the sun most frequently). As a Santa Barbara cosmetic surgeon, I will receive lots of inquiries about how to reverse the sun damage and/or prevent further damage from taking place. The good news is that there are now a number of way to erase sun damage that ranges from medical grade products all the way to the operating room.

While many people would love to have the majority of their sun damage, acne and/or facial scarring, skin irregularities and pre-cancerous lesions removed in one process (via a cosmetic surgery procedure called Chemabrasion), the reality is that many people do not have the downtime required for healing and/or the financial means to have this done. If this is the case, then there are non-invasive medical procedures that require little (or no downtime) that give a nice result. Some of these procedures take a series of treatments to yield the maximum result desired.

These are the non-invasive aesthetic treatments that I recommend for treating mild to moderate sun damage:

Chemical Peels
Before lasers were available, photodamaged skin was often treated with chemical exfoliation in order to cause the surface damaged tissue to peel off exposing cleaner, fresher, and younger skin underneath. Peels involve the application of an acid solution to the skin and are still appropriate treatments today – especially for larger areas on the body that may be relatively expensive to treat with light energy alone. More aggressive peels (using stronger acids) may also help fine lines and wrinkles. At my Santa Barbara cosmetic surgery office we have some protocols that combine both peels and light-based modalities to get the best of both!

FotoFacial RF
This non-ablative procedure uses both intense pulsed light (IPL) and radio frequency (RF) to improve the color imperfections of your skin. The inventors of this treatment found that combined IPL and RF give better results than IPL alone and patented the name spelled with an “F” – FotoFacial. So any procedure spelled with a “Ph” – PhotoFacial – uses only IPL energy. A FotoFacial will improve the skin’s texture and appearance through reduction of redness, age spots, sun damage, liver spots, and uneven pigmentation. There is no downtime after a FotoFacial and it can be used on the face, neck, chest, and backs of the hands.

Laser Genesis
The Cutera laser company developed a unique treatment for “ruddy” skin called Laser Genesis. This Nd:Yag laser delivers thousands of low energy pulses to the rosy skin and gently causes the small vasculature to “seal off”, resulting in a more normal appearance without any downtime.
Sublative Rejuvenation + DNA Repair. This radio frequency skin resurfacing series is great for ALL skin types. It will improve the skin’s appearance and tighten skin. The DNA CryoStem Therapy that accompanies this treatment gives the skin an additional boost. The flawless stem cells that are introduced right after the resurfacing will influence the older cells to replicate healthier, stronger, more youthful-looking skin cells, repairing sun damage, acne scars, and mild wrinkles.

Fractional CO2 Skin Resurfacing
Laser energy is delivered to the skin in thousands of tiny pulses that create minute holes and injure only a fraction of the skin. These holes cover over very rapidly so “downtime” is usually short. As the spacing between the holes and the depth of each hole can be controlled, this type of resurfacing can be “titrated” to the problems being addressed. One treatment can produce a 40% improvement. The procedure will not only address pigmentation but it can also improve fine lines and wrinkles, textural irregularities, and acne scars. The resurfacing procedure also encourages new growth of elastin and collagen which will tighten the skin.

Sun damage happens to everyone – sometimes even more so living in sunny Southern California and in Santa Barbara where I practice. Treating sun damaged skin helps to reverse hyperpigmentation as well as improve the overall appearance and health of the skin. This holiday season give yourself the gift of renewed skin that will last you through the winter and beyond!

All of these medical aesthetic treatments can be done at Evolutions Medical & Day Spa in Santa Barbara. Contact Evolutions Medical & Day Spa at 805-687-0212. 

Santa Barbara Neck Lift Surgery by Dr. Perkins

Botox and dermal fillers are a great way to “defy” the aging process on your face but your neck may be giving away your “true” age. Unfortunately our necks are also susceptible to loss of collagen and the effects of gravity, which may leave you with a “turkey waddle” that certainly doesn’t match the rest of your look.

If this is the case, you may want to consider Neck Lift surgery by Santa Barbara cosmetic surgeon Dr. Terry Perkins. When the neck area has succumbed to the aging process, three issues may be involved: sagging skin, muscle banding and local fat accumulation. Dr. Perkins will address each of these problems in order to make the neck contour what it once was. This can be done using incisions behind the ears and a small incision under the chin. If necessary, Dr. Perkins will tie the muscles together to create a “sling effect” for even better support.

Is there anything you can do to stave off aging of the neck? If your neck isn’t quite at the point where a Neck Lift surgery is necessary than consider yourself lucky to be reading this post! Keep your neck area looking young by giving it the same treatment as your face. When you are cleansing, applying moisturizer, antioxidants, serum, or sunscreen, remember to feather it down your neck. Although your neck has fewer oil glands than your face, it is still exposed to the same elements so proper skincare and protection will do it a world of good – and may give you ten more years before a Neck Lift is necessary.

Schedule a cosmetic surgery consultation with Dr. Perkins by calling Cosmetic Surgery Center in Santa Barbara at 805-563-0000.

Santa Barbara Eyelid Surgery by Dr. Terry J. Perkins

As we age, many aspects of our face and body begin to relax downward, including our forehead and eyelids. A heavy eyelid can make a person appear to be tired or angry when they are not. Eyelid surgery, or blepharoplasty, can help resolve this issue.

Eyelid surgery can be done on the upper lids, lower lids, or both. It is important to pick a cosmetic surgeon who is an expert in this field because blepharoplasty requires small, precise incisions to remove and/or reposition tissue and fat.

In an upper eyelid surgery procedure excess/overhanging upper eyelid skin as well as inner corner fat bulges are treated. Incisions are made in the natural creases of the eye and hide well when healed. A more conservative approach needs to be made for men to avoid too much lid show (which can give the face a feminine appearance).

At Cosmetic Surgery Center in Santa Barbara, eyelid surgery does not need to be done under general anesthesia. The surgery can be done under local anesthesia combined with oral sedation alone or together with IV sedation. Pain is usually minimal and can be controlled with Ibuprofen or Tylenol. Cool compresses and head elevation help bruising and swelling to subside quickly. Sutures are in place for 7 days so most people take one week off from work for healing. Returning to makeup and contact lenses usually can be done at 10 days post-op and we advise to buy new makeup so as to not introduce any bacteria from old products into healing incisions.

Those who are seeking rejuvenation in the eye area come see Santa Barbara cosmetic surgeon Dr. Terry Perkins because he specializes in facial plastic surgery that gives a natural, rested, “non-operated” look.

Schedule an appointment with Dr. Perkins by calling 805-563-0000. 

New Day Spa in Santa Barbara at Evolutions

Santa Barbara cosmetic surgeon, Dr. Terry J. Perkins, is the founder and Medical Director at Evolutions Medical Spa. He is directly involved in the operations at the facility, treats clients there a few days per week, trains new nurses and clinicians extensively, and provides on-going education and training to the staff about treatments and skin care. So when the opportunity arose to open up a day spa side to complement the medical spa services at Evolutions, Dr. Perkins, who also has an active Santa Barbara cosmetic surgery practice, was enthusiastic, despite his busy schedule. He felt that the addition of day spa services – such as massage, waxing, rejuvenating facials, and body treatments – would allow Evolutions to serve even more of the community as well as visitors of our beautiful city.

The Day Spa business, which officially opened last month, came on the heels of the relocation of Evolutions Medical Spa to a larger location on Chapala and Gutierrez Streets in downtown Santa Barbara. Evolutions Day Spa is conveniently located next door to the medical spa and is accessible through the medical spa. The combined businesses offer 15 treatment rooms in a 6,000 square foot space and is known as Evolutions Medical and Day Spa.

Evolutions Day Spa Tea Lounge

If you haven’t seen the new medical and day spa yet, it’s worth a trip (and a treatment!). The medical spa side offers state-of-the art services in more spacious treatment rooms. Step into the adjacent day spa side and you will be enveloped in a serene atmosphere that relaxes your mind and soothes your soul. Guests who have scheduled appointments are invited to arrive early (or stay after their treatment) to enjoy a cup of tea in the tea lounge or use the dry eucalyptus saunas. Full shower and locker facilities are also available for men and women.

Vichy Shower Treatment Room

The Day Spa menu offers something for everyone including Body Treatments – wraps and scrubs – that are exfoliating, hydrating, and blissful. The Vichy Shower treatment – seven treatment shower heads located over the treatment bed that jet soothing warm water is a wonderful complement to any of the body wraps and scrubs.

Various types of Massage Treatments are also available in 60, 75, or 90 minute increments in private massage huts. There is an extra large room dedicated to Duet Massage where a couple, friends, or family members can receive massages next to each other.

The Facials menu has expanded to include an organic facial and an age-defying oxygen facial that delivers a pure oxygen infusion to minimize fine lines, restore resiliency and suppleness. Waxing is also available for women and men.

Evolutions is offering a Special Introductory Offer of 20% off all Day Spa services during the month of April 2013. Contact Evolutions Medical and Day Spa at 805-687-0212 to book your appointment today! 

Cosmetic Surgery in Santa Barbara with Dr. Terry Perkins

Santa Barbara cosmetic surgeon Dr. Terry Perkins has always made education a priority for himself and his patients.  Throughout his practice, Dr. Perkins is continuously researching and implementing the latest surgical techniques and using the most advanced technology.  Along the same lines, he believes in educating his patients so that they feel comfortable and confident in their decision to have plastic surgery and/or non-invasive treatments like Botox or fillers.

During a cosmetic surgery consultation with Dr. Perkins he will ask you what your main concerns are. Dr. Perkins will then offer his opinion about what may best correct the issue. He firmly believes that there is always more than one way to solve a problem, so he will most likely offer a few options and will help you make an educated decision on what would give you the best result.  Dr. Perkins may also offer solutions that extend beyond the operating room. As the founder and Medical Director of a Santa Barbara medical spa, Evolutions, Dr. Perkins may refer a patient to Evolutions for pre-operative care to prepare the skin for surgery and post-operative care to help expedite the healing process.

Dr. Perkins is a specialist in facial rejuvenation cosmetic surgery such as facelifts, rhinoplasty nasal surgery, forehead lifts, eye lift surgery and more.  He also specializes in body sculpting through liposuction and was the first specialist in the Santa Barbara-Ventura area to offer the liposuction surgical procedure.

“Meet” Dr. Perkins in this informative video:

Schedule a cosmetic surgery consultation with Dr. Perkins by calling 805-563-0000.