Lovely Leanna Pareja

Lovely Leanna Pareja modeling one of our new workout tops. :)

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Best Regards,

John Di Saia MD

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Dr D in “Plastic Surgery and the New Year’s Resolution”

I put this together for HealthTap, another health web site to which I contribute. Happy New Year. :)

Best Regards,

John Di Saia M.D.

Originally posted 2012-12-31 07:30:14.

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Woundscare.org & Infected Sternal Wire From Previous Cardiac Surgery

WoundsCare.org logo

Not all surgery that a surgeon (even a plastic surgeon) performs is particularly glorious. In this case a patient had had cardiac surgery prior to his admission to the hospital at which I saw him. This involved the division and later repair of his breast bone (the sternum.) The patient had had a delayed healing of his chest incision and a few months later the infection showed extension to one of the wires that had been used to repair his chest wound. In this case, the wound kept getting infected intermittently until the wire was identified and removed.

As usual the image will be placed after the page break for those who would rather not go there. :)

Best Regards,

John Di Saia MD

Originally posted 2014-01-15 07:30:58.

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Non Provider Non Elective Plastic Surgery – Your Health Insurance May Pay

The games that many health insurance companies play make doctors wary of becoming a “Provider.” Provider status is nothing more than a contract in which the doctor relinquishes quite a few rights, for example the right to determine what a service should be paid. I am selective about contracting with health insurance companies for this reason. And I still do some work for insurers to which I am not contracted.

How can this work?

Some of the surgery I perform is not elective. It involves hospitalized patients who have wounds that won’t heal (or haven’t healed) without surgical help. In some of these hospitals I am the only plastic surgeon on staff.

Why does this make a difference?

If you need surgery and the only available surgeon is not a provider for your insurer, you will find your insurer may be willing to make an agreement with the surgeon for that one case. My office interfaces with the insurer and often we come to an agreement and are able to do the operation as a covered benefit. Some insurers are more receptive than others. Others simply offer an unacceptably low rate knowing no good surgeon will take it.

This is not 100%, but can work. Some patients have actually called their human resource departments at work and helped the process along too. The fact is that surgery costs your insurer money and without some pushing you might not get it. Be prepared to get involved if you want better care.

Best Regards,

John Di Saia MD

Originally posted 2011-05-05 07:30:55.

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Dr D’s No Bull Blog Magnets

I have been designing some new blog-related swag and came up with this magnet. Over the top maybe?

Best Regards,

John Di Saia MD

Originally posted 2012-06-25 07:30:22.

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Giveaway Patient #2 – Discounted Redo Breast Implant Surgery

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This frequent commenter got a phat discount off her redo breast implant surgery. She had had breast implant surgery with yours truly 13 years ago. Commenting here frequently got her a nice $1500 discount on her redo:

“At almost 13 years post-op I had a redo because I didn’t want to push my luck having them in too long past what I thought was safe.”

I believe she was worried about rupture although her original saline implants were still soft. She also wanted a little lifting. :)

Best Regards,

John Di Saia MD

P.S. Keep an eye on the Giveaways Page to comment your way to some free goodies too. :)

Originally posted 2013-08-19 07:30:31.

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Breast Implants and Boobie Greed

Breast implant forums have really expanded since the first ones at which I contributed a decade ago. Some of the newer terms we use to discuss breast implant surgery and a patient’s adjustments to it have been propagated on these forums.

Boobie Greed is a term referring to a woman’s dissatisfaction with her current breast implant size with a continuing desire to “go bigger.” This can span several operations and at times take the patient into risky territory.

In years gone by a surgeon was taught in residency to suppress these kinds of desires gently and wait for most patients to decide to leave well enough alone. Many patients after breast implant surgery at least have a passing thought of going larger. This has been the case for decades. Doing something about it in the way of more surgery has become more popular with the passage of time however.

The relative permissibility of more extreme sizing coupled with the fear of losing the patient (the surgeon’s fear) have put many surgeons in the position of yielding to the patient’s desire without much discussion. The world of plastic surgery continues to evolve. It has become more tolerant as societal attitudes change.

Best Regards,

John Di Saia MD

Originally posted 2010-10-22 07:30:03.

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Reader Question: Hard Breast Implants – Will Capsulotomy Help?

I had breast implants and they have become hard over the last few years. Will capsulotomy surgery help?

Breast implants can harden (actually the tissue around the implants can harden) resulting in distortion of the breasts and at times pain. We have discussed the problem (Capsular Contracture) here before.

Significant breast implant hardening does not complicate all breast implant patients, but when it does additional surgery is the only good solution. The process involves the formation of a “capsule” of scar surrounding the breast implant. At times this capsule has an elastic consistency and at other times it can be “studded” by deposits of calcium that make it really rock hard.

Surgery to soften the hardened breast can involve scoring the scarred capsule to release the tension (Capsulotomy.) When the capsule is quite firm or studded with calcium, more involved surgery is in order. Capsulectomy involves the removal of all or parts of that scarred capsule.

Whether either of these treatments will work depends upon the cause of the contracture. Usually the implants can be replaced, but in really severe cases they need to be removed.

What you really need is a good evaluation by an experienced plastic surgeon to figure your best course of action.

Best Regards,

John Di Saia MD

Related:

“What Do I Do With These Old Breast Implants?”

Originally posted 2011-07-06 07:30:03.

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How Long should Botox Last?

New Botulinum toxin patients come with varying experiences with Botox and the other available toxins on the market. A natural question is:

How long should Botox last?

We have addressed the question indirectly before in stating that there are reasons Botulinum toxins might not work.

Patients often are at a loss to understand why the effects of the toxin might not be as pronounced as they had been before with continuing use. Even when the injections are properly performed, the bodies of some patients (more than others) can “get used to” the effects and continued injections might have diminished effects or duration compared to past treatments. These toxins are proteins and the human body makes antibodies to protect itself from foreign proteins.

Suffice it to say the effects of Botulinum injections will probably last 2-3 months on average and the duration will vary and might decline over time with continued treatments.

Best Regards,

John Di Saia MD

Originally posted 2011-04-28 07:30:37.

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WoundsCare.org & Dog Bite Plastic Surgery

It has been mentioned to me more than once that my blog covers a good deal that is not cosmetic surgery despite the name. My practice site has also straddled the boundary between cosmetic plastic surgery and the less attractive reconstructive surgery.

To address the issue I am starting a new site WoundsCare.org:

WoundsCare.org logo

This site (which at present is just a tack on to my practice site) will center upon the wound patients I see and the surgery that often follows. The images will be somewhat graphic but will go to illustrate important points for those faced with less than cosmetic reconstructive plastic surgery. The first image will be placed after the page break for those who would rather not go there. :)

Best Regards,

John Di Saia MD

Originally posted 2014-01-07 07:30:08.

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