Photo of two capsules from a different patient, showing broken implant and chalky calcium buildup in the capsule that has been opened. The other capsule containing the implant is shown in the foreground.

Silicone may raise fears, but in practical terms, silicone is one of the safest, most inert substances for medical devices. That is why it is used in most joint replacements and pacemakers as well as hundreds of other medical devices. Furthermore, silicone is used as a lubricant in most syringes, such that you do get a little bit of silicone injected every time you get an injection (a flu shot, for example). Diabetics, who inject themselves with insulin several times per day may inject a significant amount of silicone every year. But, although silicone is safe, there are problems that can occur with breast implants. I will describe the important ones below.

Old implant, removed with capsule shown in other photo.

Capsule removed at surgery. Note some calcium build up inside this capsule. Newer implants do not seem to form this type of crunchy calcium buildup in the tissues.

The most common problem of breast implants is called ‘capsular contracture’. Whenever anything is inserted into the human body, the body wraps it in scar tissue. When the scar tissue is thin and loose, the implant will feel soft and will move a little bit when it is touched (that’s normal). If the scar becomes thick for whatever reason, the implant will start to change shape. All scars will shrink somewhat (you may have noticed that on your own body- a 5 cm cut will end up as a ~4 cm scar!).

The degree of shrinkage which occurs in this scar tissue will determine whether or not the implant feels soft. Capsular contraction can occur at any time, but most often it occurs within a few months of surgery. I have personally seen it happen many years after surgery, associated with a cold or flu, or sometimes after a mild to moderate injury to the breast, even after a routine mammagram.
The actual cause of capsular contraction is unknown, but recent work has strongly suggested a relationship to bacteria. Contamination of the breast implant, either during surgery or after surgery appears to be the most important factor (in fact, the patients most likely to have a capsular contracture are those patients who had one previously). How could a breast implant become ‘contaminated’ after surgery? It turns out that the breast tissue itself in many women is colonized by some bacteria that live inside the breast (for example, inside the little tubes that breast milk passes, the lactiferous ducts). These bacteria are usually harmless, like the ones that normally live in your skin, your mouth, and inside your intestines and everywhere else on our bodies (these are called commensal organisms, and they live with us our whole lives). However, in the presence of an implant, these bacteria can adhere to the implant and start to create a reaction (called a biofilm), and the body responds by building up more and more scar tissue. The final result is a breast that is too round (like a ball) and too firm. Some of these get so hard and firm that they cause discomfort. The treatment of capsular contracture is surgical, since none of the non-surgical methods ever tried has been effective in stopping the progress of contraction. Complete removal of the implant and the capsule is the treatment of choice. Whether or not to replace the implant is the important question. If you have bacteria that live inside your breast, then any implant will likely undergo the same process, and expecting a different result is not reasonable. There is a medication (called zafirlukast) which I have tried on occasion, but this has not been satisfactory in actual use (not to mention that Health Canada has issued a warning that this medication can cause permanent liver damage!). There is hope however, since some manufacturers are working on a special coating that will help put antibiotics on the surface of the implant, so that it slowly dissolves and releases a tiny amount of antibiotic into the surrounding tissue over a prolonged period. These are nowhere near actual clinical release however, and it will be several more years before we see this available for clinical use. For now, surgery is the best method of management, with one proviso. If you have had two capsular contractures following good surgery that was properly done, and you have had a contracture each time, ‘then three strikes and they are out’! The risk of getting a problem is about 3 in 100 patients in my practice. Most patients have a good outcome, and they don’t have any complications. But, what if you happen to be one of the three out of a hundred? Remember, that any operation can have complications, that is a fact of life. Calcium buildup inside the capsules of older implants was often seen (see photos). These can be of a chalky consistency, or sometimes of an egg shell (crunchy) consistency. I do not see this type of problem in implants inserted in the 1990′s and beyond, since a new type of barrier membrane was used in the shells of the implants.

Capsular contracture, resulting in rounding of the right breast. The right side feels too firm.

A: Dear Reader,
Clinical studies using corneal tracking devices have shown that people look at the ‘golden triangle’ of the face. This consists of the eyes, lips, and nose, in that order.

People notice eyes first, then lips, and finally the nose.

This was true of adults as well as children. In fact, when special tiny corneal tracking cameras were used on infants, it was found that even young infants tended to look at their mother’s eyes first, then the lips. This seems to be a ‘hardwired’ attribute, and appears to be true across age groups and across societies.

The subject’s wore special special cameras which could then accurately record the direction of gaze, even if the eyes were moving very fast. The computer programs recorded the actual object that the eye focused on, and it was found that a statistical (gaussian) distribution could be constructed from the data, showing where people look when looking at people’s faces. A graphic of this data is shown in the photo. The circles show where people looked when examining a face, with the eyes being the first, lips second, and finally the nose. This data suggests that the most important parts of your face are the central features, primarily the eyes and then the lips. It makes sense that this is where you should devote most of your attention. Get those details right, and everything else will fall into place.
Now you can see why mascara and lipstick are multi billion dollar industries. People seem to naturally be aware that their eyes and lips are the most important facial features, and they spend quite a bit of money making them look as good as possible. If you are thinking about surgery and you have some issues around your eyes as well as a bunch of other concerns, you might want to consider getting the eyes attended to first. That usually means not only the eyelids, but the eyebrows.

The eyebrows are critically important. In fact, most people will react to tiny changes in eyebrow position, where even a tiny change of a millimeter is recognizable, and causes a reaction in observers. Cartoonists have known this implicitly for ages, and they can convey a character’s emotion and intent with a single line on their drawing. Endoscopic brow lift is a method of altering the position of the eyebrows permanently. It is an excellent value operation, and almost never has to be repeated later on. Find out more by scheduling a consultation to find out if it is right for you.

Um, you look nice today!

Why is someone attractive? Why is someone beautiful? Why do infants in special corneal tracking studies spend a longer time looking at a photograph of a beautiful woman rather than a plain-Jane woman? Other studies show that infants and children prefer to play with dolls that are beautiful rather than dolls that look plain, even before they can talk! Remember, this happens before the age where socialization and societal norms have had any significant effect on the subjects. This is an inborn tendency, something that is hardwired into the way our brains work!! Why would this be? How could this be possibly explained? The study of evolutionary genetics provides some interesting answers to these fundamental questions….

Baby plays with pretty doll for longer period of time.

The most beautiful people will have the greatest possibility of mating, as well as the greatest number of options for choosing another mate. When groups of subjects were asked to sort men and women into the ‘correct’ couples, they showed a remarkable ability to sort out who was actually married to whom. Beautiful people tend to marry beautiful people. Beautiful people also end up in leadership positions, have more authority, have better jobs, and earn more money. And they tend to have way more sex! There are always some anomalies here, such as when you see the iconic beautiful bombshell model type with the old short bald fat guy (examples abound, look up Silvio Berlusconi)! Yes, money is an important factor, and I will reserve that discussion for another essay. The bottom line is that beauty is a sign of health, vitality, and wellness. Beauty signals to potential mates that the beautiful person has a ‘good’ set of genes, and will be highly likely to provide the necessary good genes to create a beautiful healthy baby. Carrying our genes into the future is one of our most fundamental drives, one that governs almost all of our activities.

Studies of paternity show that a remarkable number of infants are born to married couples where the actual father is not the man whose name is on the birth certificate. Women have urges, just like men, and it turns out that women are attracted to different types of men depending on the state of their fertility. During their most fertile period, at the time of ovulation, women are more attracted to rugged, virile, muscular types of men, whereas at other parts of the cycle, they are more likely to be attracted to stable, hardworking “good provider” types of men. Studies show that a surprisingly large number of these women have acted on their impulses, and many men have been thus cuckolded, since genetic studies have shown that the real husband cannot be the biological father of the child. I am not saying that this is good or bad, I am only reporting the results of these clinical studies.

A fundamental need...

There are elements of beauty that are ephemeral and very difficult to define in words, yet we know it when we see it. The most important interminable elements of beauty that are (relatively) easy to define include:

Symmetry -the left and right sides should be a good match, but are never identical mirror images. If you use photoshop to divide a photo in half and display a photo that is two rights or two lefts (after flipping the appropriate side over digitally), the two people always look like brothers or sisters, and the closer the photos look to twins, the better. The same is true of our hands, breasts, and everything else that is paired.

Shape- In youth, we have a triangular facial outline, with quite a bit of fullness in the upper face, and very little or no excess fullness in the lower face. In old age, our upper face looses much of its fullness in the forehead and temples. If you think about your grandparents, you may realize that you can almost see the skull shape under the skin of their scalp (the so called “peanut head”), and often the temples will be sunken in. In comparison, your children will have a full upper face, and the temple area will be full, round, and smooth. Older people will have some fullness under their chin, and they may have jowls that make the face a rectangular shape. Children on the other hand will have a slim chin and neck area and their shape will be triangular, with most of the fullness at the top. Similarly, the shape of the body has importance in signalling our health and ability to procreate. Fat is really beautiful. It is padding, it is storage, it is soft, and we really, really need it, despite the bad rap that fat gets. The shape of your face is primarily due to the shape, size, and position of the fat pads over the bony skeleton. The human breast is primarily made of fatty tissue, and we all know how much time and money is devoted to shaping, firming, and displaying them. Mind you, the very same amount of fat, positioned about 10 inches lower in the tummy is considered ugly! Shapely breasts and buttocks are in this category, signalling good health and nutrition.

Your shape signals your potential mates about...your potential to procreate!

Texture, Tone, and Colour- Smooth, evenly coloured skin, is a sign of good health, good nutrition, and vigor. These are signals to potential mates that the individual has good genes and will make good babies. Tone refers to the firmness and healthy quality of the body, both muscles and skin. Skin starts off as a smooth, evenly coloured, tight covering. As we age, we start to notice some changes in the pigment. Small brown spots develop in white skin. These are called solar lentigo, or solar lentigines. These are small accumulations of too much pigment within the skin. Another important component of skin, the elastic fibers (primarily elastin) also undergoes changes mainly due to exposure to ultraviolet light. If you leave a pair of Spandex tights sitting in sunlight for a prolonged period of time, the elastic fibers will break down and the tights will no longer be tight. Similarly, when we stay out in the sun, our body will make more pigment called melanin, which absorbs the light waves in the ultraviolet range to protect the important skin structures (including the DNA) from the harmful effects of UV light. Melanin is like a tiny built-in umbrella, protecting the delicate molecular DNA bonds from damage by UV radiation. That is why your body tans- to protect your body from UV radiation damage!

Personality- Although personality is difficult to define, it does play a critical role in attraction, but for the purposes of this essay, I am only considering physical attributes here. Athough ‘Beauty and The Beast’ and ‘Phantom of the Opera’ type stories abound, they are mostly found in story books, not real life.

Beauty and Surgery
If beauty is so important for attraction, how does surgery fit into the equation? How do you feel when you see someone who has “obviously had something done”? It probably makes you think “Ew, something is definitely wrong with that person”, so the natural response is to reject that person because they would not make ideal mates for procreation. That is why natural results are critical in cosmetic surgery! Any signal that your beauty is not genuine, signals to potential mates that your genes are defective, and even worse, that you are trying to hide your defect!

Whenever you consider surgery, make certain that the plan is not to “over-do” anything. The ideal result is the one that looks natural. The best results in cosmetic surgery are NEVER noticed, thank you, thank you very much. You only notice the surgery that was done poorly. A good result is “an undetectable result”.

Beauty is all biology, after all!

Claudio DeLorenzi MD FRCS
Copyright 2012

The standard procedure, if an implant has been determined to be infected, is to remove the implant and irrigate the pocket and to wait several months until the tissues have returned to normal, usually using a drain to remove any excess fluid which may develop within the pocket. The standard practice may result in 6 months or more of inconvenience for the patient, since usually only one side is infected, and therefore the patient will have a significant imbalance to her figure during that period of time.

However, I did publish a case report some years ago in one of our scientific medical journals showing that there is sometimes another way to treat these. I reported that, in selected cases, it was possible to wash out the pocket with a special pulsatile washer (a bit like a fancy pressure washer) with antibiotics, and then to re-prep and re-drape, and, using fresh instrument set, immediately inserting a new implant into the freshly irrigated pocket.

This was done to save the patient from the issue of having only one implant for several months while the infected side healed. In this case, I was able to put in a new implant immediately using this special technique, and it was successful. The patient made a full recovery, and she did not get a capsular contracture. I followed her clinically for several years, and she otherwise made an uneventful recovery. This technique cannot be used on everyone. It is only meant to be used in specially selected cases. I mention it here because some surgeons may not be aware of this technique, and I sometimes get calls or emails regarding this particular article (patients are sometimes amazing in that they often do more research than their own surgeon!).

Photo of patient before surgery

Photo of same patient one year after immediate implant replacement after infection.

Remember, I am not saying that this will work on everyone. This is a very special technique that can be used only on rare occasions. You must listen to your own surgeon who knows you, your body, and your circumstances. Your own surgeon is the one best equipped with the knowledge to treat you appropriately.
Claudio DeLorenzi MD FRCS

Remember that any costs that you pay up front for a consultation with me can be then deducted from the cost of any surgical procedure that you subsequently book with me, so in effect, it is a free consultation if you decide to have surgery with me. I had to start charging for consultations because many patients were coming in to see me to get a thorough consultation and get educated about their problem, then they would go out shopping around for a slightly cheaper price from other doctors who were not providing the same level of care or spending the same amount of time to educate their patients. I am honest and I tell you the truth, and I do not ever recommend surgery to anyone who will not benefit from it. If you have a consultation with me, you will be informed about your options in a clear and straightforward way, and I have no “hidden agenda”. I promise never to lie or to try to ‘upsell’ you or talk you into something that you do not want. In fact, I am a terrible sales man- I am a surgeon first, and I care about your well being much more that I care about your pocket book! Even if you decide to have surgery somewhere else, you will at least have the benefit of having critically important information given to you that is personalized, honest, and valuable, and it is well worth the money spent. I have decades of experience in treating patients, and I am involved in education, training, and quality initiatives all over the world. My expert opinion is very valuable, and the price you pay is far less than what it is worth to you. In fact, a consultation may save you thousands of dollars if it helps you avoid procedures that are not appropriate for you. I have been invited to give hundreds of lectures, workshops, and training courses to plastic surgeons, dermatologists, and nurses all over the world, including almost every continent on Earth (you are welcome to have a look at my extensive resume when you drop into the office). There is an old joke about an engineer who was consulted about a multimillion dollar machine that was not working properly. He walked up to the machine, studied it for a moment, and turned a single screw, and then billed the owner for a thousand dollars. The owner complained, saying that the engineer only took two minutes and turned a single screw to fix the machine. The engineer revised the invoice and sent it back to the factory owner, and it stated “Turning one screw: price 99 cents, knowing which screw to turn, $999.01″. This joke illustrates the point that knowledge and experience is what you are paying for when you pay for a consultation, and knowledge is everything.

When you are going to sit down and consider your options, you should first be prepared with an open mind to look at all the different options that are available to you. You are probably not a surgeon, and it is difficult for you to make sense of the thousands of different published studies in medical journals. You need help in deciphering the vast pool of information and mis-information available in your local library or on the internet. Be honest with yourself, and write down on paper the top things that are bothering you. On this list, try to make clear the main motivation that prompted you in the first place. Did someone make an off hand remark that hurt your feelings? Did you notice that it is more difficult to get the look that you are after? Is it harder to make your eyes look the way you want them to? Is diet and exercise failing to provide you with the shape that you want? Be as blunt and clear as you possibly can. Once you have your wish list in order, it is then time to seek help in clarifying your options. Some patients come in asking for a procedure. They have outlined their problem, then done some research on the internet, and decided which procedure is best for them. That is fine, but most of the time, they are wrong! Why? It takes years of training and experience to know what works on which patients, and there is no possible way for a lay person to make a correct diagnosis and a surgical plan just from reading a few articles and blogs on the internet. Instead, you should consider making a list of what you don’t like (ie, a list of problems), then seek out some opinions about the solutions from people that you trust. Which option is best for you has to be determined by someone who can synthesize the information regarding your current health status, your current medications, if any, and your goals or wishes. Be honest with yourself, and be honest with your surgeon. Don’t try to hide your medical conditions from your surgeon! That is a dangerous road, and one that can lead to heart break.
Let’s take a moment to consider the real case of S.G., a 50-something bank manager, who was having some issues every morning while getting ready for work. Apart from some thyroid problems, she is otherwise healthy and fit. Others have commented to her that she ‘looks tired’, even when she has had a perfectly good night’s rest. It is difficult to put makeup on her eyelids. A bright and happy person, she always dresses nicely and likes to wear a tiny bit of makeup for her work as a business professional. Her eyes used to be her ‘best feature’, but now the makeup cakes in the lines around her eyelids and smudges on the upper eyelids, so she avoids using any. No one compliments her anymore, and although she hates to admit it, she misses the attention that she used to get from men.
She makes a list of the things that bother her the most, noting that she a) looks tired, b)has bags under her eyes with some dark circles underneath, and c)has so much fullness in the upper eyelid area that she can no longer put any makeup in there because of the skin folds there, and d) she has deep wrinkles on the forehead and around her eyelids. She shops around for a solution, and finds an ad for special creams that promise to tighten the skin. Hundreds of dollars later, her skin is not really any tighter, and she feels ripped off yet again by the cosmetics industry. She sees another ad for non-surgical skin tightening, and she goes into that clinic for a series of treatments that cost a couple of thousand dollars. She is disappointed again, since her eyes are really no better, and the skin tightening was just barely noticeable on the before and after photographs.

SG finally gets enough courage to book an appointment with a plastic surgeon, a step that she has been dreading for ages. She books an appointment to see me, Dr. DeLorenzi. After listening to her problems and examining her facial features and the shape and function of her eyelids, as well as double checking her lab reports, I make a diagnosis for her. She has compensated brow ptosis and upper and lower eyelid dermatochalasis with fat herniation and mild Grave’s Ophthalmopathy. What!? I explain that there have been several changes which have occurred over time, including the loss of volume on her forehead in conjunction with changes in her skin due to sun exposure, and all made worse by her thyroid condition. The forehead, having lost some of its volume, has dropped down somewhat, resulting in some fullness in the upper eyelids. But that is only part of the problem, since when her eyebrows are supported at the correct height, the eyelids are still full. There is also too much upper eyelid tissue present, a feature that was also prominent in SG’s mom. The lower eyelids are also covered with some fine crepe paper type wrinkles, and the dark circles under her eyes are caused by the shadow of the fat bulging from her lower eyelids, compounded by the folding of the muscle which lies immediately under the skin around the eyes. I recommend that SG consider having an endoscopic browlift, upper and lower eyelid tucks, and a full face laser resurfacing procedure. Each component of the surgery is tailored to suit her particular situation. The browlift holds the eyebrows in the correct orientation as well as the correct height, and the excess skin of the upper eyelids is removed. The fat bulges from both the upper and lower eyelids are contoured and repositioned to support the skin smoothly. The lower eyelids are tightened so that they no longer sag. The facial wrinkles, including the fine lines around her lips and the small age spots which have also bothered her are all treated lasers. These other problems had not even made the top items on her list, but they had been bothering her for years. Correction of these problems was an unexpected bonus.
After healing, SG looks at least 10 years younger. Her eyelids and forehead are once again her best feature, and the quality of her skin is much better. Getting ready for work in the morning is a snap, and she once again enjoys a bit of makeup. If SG had come in for a consultation before trying to find a solution on her own, she would have saved a lot of money and a ton of disappointment. This case illustrate why a consultation with a plastic surgeon is often the least costly way for you to determine your best course of action to get treatment that really works for you.
Many patients admit their fears to me about looking ‘fake’ or ‘done’, and I completely empathize with this. In fact, good surgery is never noticeable! You never notice good surgery because it looks natural. I call it the ‘un-detectable result’, and that has been my signature look. When you see celebrities with noticeable surgical ‘tells’, with the obvious ‘post-surgical’ look, you are not seeing good surgical results, you are seeing the worst (think Michael Jackson, RIP). My patients are concerned, rightly so, because if they see a famous person (who can presumably afford to go anywhere in the world) that just looks weird post surgery, what chances do they have of getting a good job done, locally no less? Please rest assured that many of these famous celebrities are authors of their own misfortune, because they force their surgeons to make things so tight that they no longer look normal. These people go around from doctor to doctor, until they find someone that will do what they want done. I do not play that game! I will not do that, and I tell you up front what I can and can not do for you, depending on the quality of your tissues and your health status. For many years, I have provided thousands of patients with realistic results that look natural, and in fact, you probably have met some of my patients and not known that they are my patients. The natural look is what I am best known for.
In summary, make a list, check it twice, and make an appointment. It will not be as scary as you thought, and you will not be disappointed. It will probably save you a lot of time, money, and aggravation, getting the information that you need to make the right decision that is tailored specifically for your situation. I don’t bite, promise.

Claudio DeLorenzi MD FRCS
Plastic Surgeon

Chemical Structure of HA

These materials are synthesized and specially prepared for use in human skin and subcutaneous tissues. Although some companies use animal derived sources for their HA, at my clinic we ONLY use synthetically manufactured HA. Animal sourced products may be contaminated with tiny amounts of animal proteins as unavoidable contaminants, which may in turn cause unwanted side effects, and that is why I avoid these products. We use products that are synthesized in the lab in special cultures, rather than products which are collected from animal parts. These are safe and effective in maintaining volume and moisture in the lips and elsewhere when used correctly. Unlike other compounds which must cause a reaction within human tissues to create volume, HA’s do not react, and they are simply placed where needed to create volume and plump up wrinkles and dry skin. They are chemically a complex sugar and they slowly dissolve away in months to years. Some patients want a permanent solution, and therefore seek out permanent fillers. That is not always a good idea, because if problems arise with permanent fillers, there are very few practical methods available to remove them. If you use a permanent filler, you may be stuck with a permanent problem that is very difficult to treat! In contrast, dissolving HA’s is relatively simple, and if a problem arises we can simply ‘erase’ it, solving the problem, so that we can come back another day and start all over again with a fresh start.

The other issue with permanent fillers which you may not think of immediately is that your face will change as it ages, but the permanent filler does not change. So you may end up with an unfavorable situation if the filler becomes more noticeable over time, because it is impossible to remove it easily. We do not recommend their use except in exceptional circumstances. We would be pleased to provide you with some options if you are considering a quick pick me up to help fill out some problem areas that are superior to permanent fillers.

I have been involved in the research and development of these fillers for many years, having participated in the original clinical studies and FDA trials in the 1990′s, and I have treated thousands of patients with these fillers since the beginning. I have visited some of the main manufacturing facilities where these products are made, and I have been involved in the training of physicians, surgeons, and clinical nurse injectors for many years. If you would like more information about these products and services, please contact us to book an appointment. Some products are better than others, and certain formulations may be better for you than others. Whether you need some help with acne scars, or whether you would like slightly fuller lips, or to perhaps fill out some deep lines, we can advise you about the best option for you. Make sure you are properly informed about the materials being used for your care. We are here to help you look your best!

Many patients have called our office regarding the recent PIP breast implant scandal in France, wondering if I had used these devices for their surgery. Because you may have checked off a box stating that you do NOT want to be contacted by postal mail or email on your intake form at the office, I cannot write a personal note to you regarding this issue, thus my only recourse is to write an open letter here. By the way, if you now realize the importance of approving communication from my office, you can give us a quick call or drop us an email at info(at)delorenzi.ca to get put put back onto the mailing list. We use a safe unsubscribe service, so you can quickly remove your name from the list if you change your mind later! We do not send out emails more often than once every three months, so you will not be bombarded with stupid garbage in your mailbox if you sign up for this free service (I absolutely despise spam email, and I would rather be damned in hell than be responsible for creating it!!!) I only send out information that I think will be valuable to you, and I only send these out two to four times per year.

Please note that I have NEVER used PIP brand implants on my patients, ever! Any of the thousands of patients who has had breast augmentation done by me will have either Mentor (now J&J) or Inamed (now Allergan) implants. I have personally been to the Mentor manufacturing facility in Europe, and I have personally inspected the research labs in California and Texas. I can personally assure any of my patients about the quality of the devices used by me. Every single implant that I have used has been approved by health authorities and further, been inspected by me personally before being used. I would never use any device or procedure on a patient of mine that I would not also use on a member of my own family. Rest assured that if you have had any surgery or procedure done by me, any materials used will be of the highest quality and will have been approved by both health authorities and by me personally.
Furthermore, for the last 20 years, it has been my policy to give patients an Implant Data Card at the time of surgery which records both the serial number and lot number of each implant. You would have been instructed at the time both verbally and in writing to keep your Data Card with your important papers in a safe place. The information on the data card comes directly from the manufacturer. During production, the information regarding the materials and date, lot number, and so forth are recorded and printed on a set of stickers that are then packaged with the implant. When I open the sealed carton at the time of surgery, one set of stickers are placed on your data card which is given to you at the time of discharge, and I keep the other copy with your medical records. We also keep a record of this information on our clinical database (in the event that you should lose your data card) for a period of time in far in excess of that required by law.