Doug Fister Skin Cancer

Washington Nationals pitcher Doug Fister recently had a skin cancer removed from his neck. Details are slim. The surgery sounds like a minor office operation as it did not delay his start on the Nationals pitching schedule. He appears with some sutures over a small incision on his neck in the link below reportedly two days after the operation. If the cancer was of the Basal Cell type (likely as 80% of skin cancers are of this “low strength” type,) then Doug is likely complete with his therapy for this cancer. That doesn’t mean his story with skin cancer is over though.

He does mention in his media coverage on the topic that baseball involves an occupational exposure to the sun and sun exposure is the main culprit in skin cancer formation. Baseball players should be disciplined in the use of sun screens and prophylactic therapy even though many prophylactic treatments are often not covered well (or at all) by insurance. They can certainly afford it. :)

Best Regards,

John Di Saia MD

Story Source: cbssports.com/mlb/eye-on-baseball/24676739/doug-fister-had-skin-cancer-removed-from-neck-before-fridays-start

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Mohs Surgery and Plastic Surgery – How Does This Work in Orange County?

Mohs surgery is surgery for the removal of skin cancer which is common in Orange County due to our “sun sitting tendencies.” It is mostly offered by dermatologists and is specifically designed to remove the cancer with a low recurrence rate. Derms generally perform it under straight local (numbing shots in the office) and it is quite profitable for them. In this case the procedure to make the hole (that is what Mohs does) pays much better than the surgery to repair that hole. Some Derms in Orange County try to use Moh’s for nearly everything as it is profitable. This is not always in the best interests of the patient.

At times a dermatologist will refer the patient to a plastic surgeon for the closure after the Mohs is complete. This can be upsetting to the patient because unless it is arranged ahead of time, the plastic surgeon may not be able to get the patient scheduled for a few days.

You may have seen people walking around with large bandages on their ears or noses. They may not have had accidents as you might have thought.

An alternative is to have the skin cancer surgery performed entirely by a plastic surgeon which can decrease the patient’s total expense and allow for anesthesia and completion of surgery in one day. The plastic surgeon may order a frozen preparation of the removed tissue in the operating room (called frozen section) and the results have a similar cure rate and often look a whole lot better. Many plastic surgeons will take cases like these as long as the cancer isn’t too small because we are paid less to remove the cancer with conventional surgery than the Derms get with Mohs.

Best Regards,

John Di Saia MD

Originally posted 2011-03-04 07:30:28.

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Tummy Tuck Redo – Orange County, California

Previously I discussed the relative reluctance of plastic surgeons to post images of revisions. Tummy Tuck Redo surgery can offer good results when the patients are properly chosen and the surgery is carefully focused. Not everything can be easily fixed of course.

tummy tuck redo

“M” is a lady who had had a tummy tuck twenty years prior. After she visited another surgeon she had additional upper abdominal liposuction some years later. She never got the tightness she had wanted from that liposuction so later she considered revision of her tummy tuck. She did very well with her redo tummy tuck. Her pre-operative skin excess was greatly improved and the hollows created by the prior liposuction were also corrected in part. Not seen well in these images is the “puffy pubis” (commonly called a Ken Doll) she had following her original surgery. This was also nicely improved via her revision.

She is quite pleased with her smoother sexier appearance.

Best Regards,

John Di Saia MD

Related:

Dr D’s Standard of Care for the Best Tummy Tuck

Originally posted 2011-12-16 07:30:06.

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Scan, Secure Horizons and the Medicare HMO Compromise

It is change your Medicare season so the advertisements are blaring for Scan, Secure Horizons and the other Medicare HMOS. Many Medicare patients do not understand how things change when they sign with a Medicare HMO. Regular Medicare patients have choices and do not need to wait for approval before receiving care.

I saw a Medicare HMO patient this month with a wound on his foot. The wound looked ready for skin grafting. As his HMO does not have a plastic surgeon under contract at the hospital where this patient was admitted, I was told he would have to wait for evaluation by their podiatry doctor. An operation I could have offered him in days waits weeks or longer. That is the HMO compromise. You wait for them to decide what you need.

Ultimately the podiatrist saw him and decided the wound would heal without surgery. It might, but it will take longer…maybe months longer. Then again passing on surgery will cost the IPA (HMOs usually contract with other health care companies called IPAs) less money and that is often the name of the game in health care.

When you change your health insurance you really don’t see the big picture unless you come to really need it.

Best Regards,

John Di Saia MD

Originally posted 2010-12-22 07:30:57.

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Leighton Meester Sues Mom Over Plastic Surgery

Leighton Meester just won her legal war against her mom — after the “Gossip Girl” star sued her last year … claiming the woman diverted money Leighton had sent to her little brother … and she spent it on things like plastic surgery, Botox, and hair extensions.

Leighton filed the lawsuit claiming her little brother has serious medical problems … so she sent home $7,500 a month to help cover his expenses. Leighton actually didn’t sue to recover any money from her mom.

Source: http://www.tmz.com/2012/06/06/leighton-meester-mother-
constance-lawsuit/

So mom takes the money sent home for a sick sibling and spends it on cosmetic work for herself. Kinda cold.

Best Regards,

John Di Saia MD

Originally posted 2012-07-09 07:30:36.

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Breast Implant Massage to Prevent Hardening Contracture : When, Where and How?

On one of the forums at which I occasionally contribute the question came up of breast implant massage for textured implants as a preventative measure to avoid hardening (Capsular Contracture.) The question was under what circumstances does it make sense to massage textured implants within breasts to prevent hardening. As is frequently the case, the answer relates to the history of breast implants and hardening:

To make a long story short, one of the most frustrating issues when working with breast implants is the tendency over time for them to harden within the breast. To be more correct, the breast tends to harden around the implant. This is more often the case with silicone gel breast implants, implants with relatively little soft tissue coverage, in smokers, and in cases in which infection, radiation treatment or bleeding have been involved. Back in the seventies and eighties, there were studies with differing methods of decreasing these tendencies. The studies had varying results (unfortunately) showing loose associations with implants with textured surfaces and patients in whom breast massage was used showing inconsistently favorable results.

Surgeons do not all do things exactly the same and frequently a surgeon’s experience affects his or her practice. Breast implant surgery is no exception to the case. Some surgeons will tell you that there is no need to massage textured implants. Others will tell you the opposite. There is no consensus here.

Many surgeons will look at issues with a particular patient to determine what to advise. If patients have had more issues with capsular contracture, then massage and/or textured implants might be advised. Many of us rarely if ever use textured implants for other reasons (for example they are more often associated with rippling.) Suffice it to say following your surgeon’s advice and having follow-up visits with that surgeon is probably the best strategy to try to avoid capsular contracture. I tend to use more saline filled implants and moderate sizes and have had very low contracture rates over the years in my practice. If you are going to massage your implanted breasts, have your surgeon show you how he or she would like you to do it. The method is debatable as well.

Best Regards,

John Di Saia MD

Related:

Your Options With Capsular Contracture / Rock Hard Breasts

“I Have Hard 20 Year Old Breast Implants?”

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Reader Question: Who is the Best Orange County Plastic Surgeon?

Reader Question:

I am in Orange County and have heard that you are a very good and honest plastic surgeon. I want to get my breast implants and saw one of your examples and she had boobs like mine are now. How do I know the best Orange County plastic surgeon when I see him?

Thanks for the kind words. To address your question, the Orange County Register InYourFace Blog, did a “tongue-in-cheek” post regarding which of two Hollywood plastic surgeons is best. [http://inyourface.ocregister.com/2010/08/30/hollywood-plastic-surgery-contest-whos-best/20553/] This underscores the point of what it really means to be the best. The best according to whom and at doing what?

The practice of plastic surgery varies quite a bit. Different practices vary regarding what they offer and at what price point. Some try to make it cheap and you get an “Assembly line” concept. Others (like mine) spend more individual time with the clients (in surgery and in the office) and target quality.

Some patients like an intimate environment with a few office staff. Others like to see an office full of people and are OK about less “face time” with their surgeon. In this regard, my office runs small and intimate.

Best Regards,

John Di Saia MD

BTW – The example you mentioned involved a full lift with implants. Implants alone will not give you the same result.

Originally posted 2010-10-07 07:30:29.

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Reader Question: Mold in Saline Breast Implants?

I read online a woman telling about how her saline breast implants got mold and she had terrible problems. Does this happen very often?

A few years ago I put up a YouTube video of my experience with silicone gel breast implants. Now every year or so somebody posts a comment about how saline implants are just as dangerous. A frequent feature of these responses is a statement about a moldy saline implant. My response is and always has been, if saline implants are so often affected by mold, then why have I never seen it?

I have been implanting (and at times removing) breast implants for over 15 years. You would think if something was a dangerous and common phenomenon that I would be seeing it. I haven’t. Not even once. I have seen occasional implant infections but they have always been bacterial, not fungal.

Breast Implant Infections

Breast implant infections can be a big deal. That is the main reason that doing what we can to minimize them is important. When an implant within a person’s body becomes infected by bacteria or fungus, simple pharmacological treatment is usually not enough to stop it. The implant must usually be removed. An infection affecting a breast implant will therefore plague the patient until that implant is removed and the body can clear the remaining infection. A moldy breast implant is fortunately a rare problem and we would like to keep it that way. :)

Breast implants have risks, but these risks can be minimized by making good choices….choose good surgical talent and facilities, don’t go too large, put your implants under good soft tissue coverage and stay with saline over silicone implants in most cases.

Best Regards,

John Di Saia MD

Originally posted 2011-06-29 07:30:11.

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Brachioplasty – Arm Lift – The Truth

Brachioplasty surgery has been called the “Arm Lift” and it kinda does “lift” the arm. The areas treated in the upper arm have been called amongst other things “Bat Wings.” Surgery tightens the skin around the upper arm which can hang unattractively in those who have lost a good deal of weight. This varies of course.

Traditional brachioplasty surgery is performed through an incision (and leaves a scar) from the arm pit to the elbow. Care is taken to try to make the scar fall into a less often seen area when the arms are at the sides. The scars from surgery take a year or more to mature and are often not the prettiest even when efforts are made to make them so at surgery.

Short scar techniques have come around, but in many cases either fail to fix the problem adequately or bind the arm to the chest in a disabling manner.

The bottom line on brachioplasty is that the “short scar” methods are probably more risky than they are worth and the scars from surgery take a year or more to mature in many cases. Still for the gastric bypass patient these operations are occasionally desirable.

Best Regards,

John Di Saia MD

Related:

A Nice Breast Lift/Implant and Arm Lift “Before & After” from the practice

Originally posted 2011-07-27 07:30:28.

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Nice Lip Filler Result

lip filler

Here is a modest lip filler case before and five days later from my Orange County practice. Not every patient wants “Trout Pout meets domestic violence” on her lips. In this case we used Prevelle.

The exact filler choice is not as important (as long as a quality cosmetic material is used) in avoiding the trout pout as the quantity and technique. I recommend hyaluronic acid types in the lips to avoid unsightly lumps and bumps. Good technique limits the bruising.

Best Regards,

John Di Saia MD

BTW – A Dr D Comedy Podcast is on the subject of Celebrity Lip Fillers a la Dinosaur Lips.

Originally posted 2010-06-21 09:00:57.

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