Lovely Leanna Pareja

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


Best Regards,

John Di Saia MD


Dr D’s “Cheap Plastic Surgery”

Most people looking into cosmetic surgery soon realize that it is not cheap, but why? Why is it so expensive? There are many reasons. Most of them have to do with overhead. The discussion below is meant to give you some insight into the way plastic surgery is practiced. It varies quite a bit. Bargain Basement plastic surgery may not be the best idea when you look at the big picture.

Some of you out there are thinking: “Gimme a break! I have this ad right here saying that breast implants are only $3000. How can this be?”

You are correct. There are those that do this operation for less than it costs me to render the service. Then there are those who use ads to get you into the office and the story changes when you get there. How can they do this? Below we will lay out some possibilities. These may seem quite familiar to some of you:

Say you walk with ad in hand to see the doctor. You notice that the doctor’s name doesn’t seem to be listed in the advertisement. This is called a Bait and Switch Scam.

SCENARIO 1: “All things are not as they seem”

You find yourself in an examination room with a nurse who tells you that the doctor only meets with patients after they have signed up for surgery. This saves the practice money, but wouldn’t you rather meet your surgeon before you decide to make him your surgeon? She then explains that the price you saw in the advertisement is just the surgeon’s fee. The full price with anesthesia, the facility fee and implants is several thousand dollars more.

SCENARIO 2: “The surgeon and facility are not as they seem”

You meet the doctor and ask him about his training. You find that he trained as an Obstetrician or Head and Neck Surgeon. He started doing cosmetic surgery years ago. He is not board eligible or board certified in Plastic Surgery, but he is board certified in “Cosmetic Surgery.” He operates in his office, but hasn’t bothered to have it certified by any ambulatory care agency, so there is no facility fee. He does the procedure under “twilight sleep,” so there is no anesthesia fee.

I am not trying to say that you have to pay a fortune to have cosmetic surgery, but contrary to popular belief most plastic surgeons are not trying to rip you off. They have legitimate costs of doing business and pass these on to their clientele. By the same token if you see a few doctors and one has a “sky-high” fee, don’t think that an operation here is a guaranteed success. My suggestion is that you consider seeing a few surgeons. Take your cosmetic surgery fee quotations and throw out the really high and really low ones. Then choose one of the remaining surgeons.

When you go to have a cosmetic operation, you are paying for the expertise of your surgeon. You are also paying for every patient who has ever sued a plastic surgeon in Southern California, because this is how malpractice insurance premiums are charged. Malpractice insurance is one of the highest overhead items that plastic surgeons pay. Non-plastic surgeons who perform cosmetic surgery often do so without specific malpractice coverage meaning they pay cheaper malpractice premiums than I do. Finally, in choosing cosmetic surgery with a particular surgeon you are choosing a Level of Service. This often changes dramatically with the price tag.

Best Regards,

John Di Saia MD

I originally wrote this for my web site a few years ago. It still applies to this day however. :)

Originally posted 2013-04-22 07:30:37.


When to Fire the Patient

There are good and bad aspects to running a small practice like mine. Information containment for example is easier when fewer people handle that information. But there are limits to what any practice can or will provide.

An example:

A potential client e-mailed inquiring about a procedure upon which I have good online reviews. :) This person e-mailed four times in a few minutes. The same message was sent so I figured it was an honest mistake and thought nothing of it. Then I started getting a number of phone calls from the same number that left no messages. The first day I received about eight of these phone calls. These calls were made to our “urgent phone line.” The latest was at 9:00 PM. I do not make it a habit of calling back unknown numbers from my urgent phone line particularly when no message is left. Time has taught me this is a safe plan of action.

The next day the multiple calls from that same number continued sans messages. I called my office gal to find that a patient called that first day for an appointment and complained that his call was not returned for a few hours. My office gal herself had had surgery that day. As I said before, we are a small outfit.

A light went on in my head. I asked her: “From what number did that person call?” Of course it was the frequent urgent phone line caller’s number. Even after getting that appointment, the caller continued to call multiple times on the urgent line without leaving messages the second day.

See the problem?

A doctor’s office is geared to answer urgent calls urgently, but calling to the point of harassment to schedule an appointment and/or getting testy about a reasonable delay in calling you back is a good way to become a fired patient.

In this kind of case, your doctor looks at an unreasonably high potential for an unhappy client and avoids it before it happens. We only have so much time in the day to handle quite a few patients. When they are reasonable we do it gladly. When they are not, some of them have to go.

Best Regards,

John Di Saia MD

Originally posted 2013-08-05 07:30:34.


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.

Comments & Infected Sternal Wire From Previous Cardiac Surgery 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.


Giveaway Patient #2 – Discounted Redo Breast Implant Surgery


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.



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


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

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

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