What our office does if we have a request from somebody say from Australia that wants to come is we exchange a series of e-mails because we want to be specific about what procedure they would like to have done and whether or not they are a candidate for it and often I will ask them to send me photographs and talk about their health in general and make sure that if they do come there is a high probability that the surgery can be performed and we will arrange for accommodations here in Santa Barbara. We have several B&Bs that we work with. There are several wonderful hotels right on the water and we can help arrange the accommodations that are appropriate for that person and the person who is traveling with them. So, once we have determined that there is a high likelihood that the patient can come and be seen and operated on the next day or two, we will go ahead and schedule the visit. We will examine them when they arrive and then we will proceed with surgery the next day or the day after. We will have already arranged for accommodations for the next usually 10 to 14 days because I would like people to come and I like them to stay so that I can ensure that they have an uneventful recovery and what I do not do is let people fly in, have a big operation, fly home two days later, and say I will have the doctor at home take my stitches out. I just do not think that is good medicine. People come, they stay for a couple of weeks, and then they will leave and they will return home and usually I ask them to send me via e-mail photographs at about a month and to e-mail their photograph if there are any questions or concerns, and we usually follow up with e-mails and phone calls for a period of two to three months after surgery to make sure that everything is okay.

We have a wide variety of patients who come and many patients are local patients and they like to stay near home and have their surgery done. Some people come from a distance. We have had engineers come from Germany. We have had patients from Canada, from Mexico, from Australia, from a distance and usually the reason that people were coming from a distance is that they value a certain expertise that I have and they want me to do their particular type of surgery. Having said that, in virtually all the major cities of the world there are talented, conscientious, hard-working physicians and that is a choice that people have to make personally. Some people come to Santa Barbara because they want to have the Santa Barbara experience, by that I mean they would like to be recovering down by the beach and listening to the waves in a pleasant place that is sunny most of the time as opposed to in a hotel room somewhere in a big city. So those are sort of personal choices and it has to do also with the spouse or the friend that is coming to be with him and it is sometimes more fun for them if they can be in a resort area than in a city situation. So there are lots of ways to look at it and we have as I say local patients, patients from all over California, the West and then we have you know occasionally patients who come from Europe as well.