VA Doctors Sued Over Mocking in the Operating Room

Reston, Va. — “And really, after five minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit,” a doctor can be heard saying in a recording at the center of a lawsuit.

A patient in Virginia received $500,000 after the operating team mocked him while he was under anesthetics during a routine colonoscopy.

The patient said he had his phone set to record the post-operation instructions given to him before he was put to sleep. He forgot to turn off his phone during the procedure, though,


It is true that some doctors make not-so-wonderful comments about their patients in the operating room. Usually the caliber of the comments does not rise to wholesale mocking though. A technical cell phone mistake on this patient’s part netted him a half a million dollars. Without the recording it is doubtful that he would have proven anything.

Best Regards,

John Di Saia MD


Tsa Body Scanners, Exposure and Cancer

Amongst those issues argued as the tsa body scanner debacle ensues is risk. The bottom line is that to expose the public in a massive way to radiation exposes them to risk. Widespread and frequent radiation exposure of this type has not been implemented before, and the effects will likely take many years to reveal themselves. In essence if we continue this policy, we won’t know the long term effects until decades later.

We have a historical example however; that of “low dose” radiation exposure for acne. In the 1950’s, it became popular in some countries to submit people suffering form acne to “low dose” radiation exposure as treatment. It worked in many cases. Here is an Australian case example of a patient who later developed many cancers.

I have seen occasional patients (it wasn’t as common in the US) who had had radiation treatment for acne as children and without much history of sun exposure developed massive numbers of skin cancers as well as other malignancies. There is also some evidence of increased risk for breast cancer and sarcomas. At the time of the actual “treatments,” these risks were of course unknown. Who is to say our current tsa scanner policy is not going to produce another such group of patients in the decades to come?

Profiling might not be politically correct, but massive scanner exposure even in minute amounts seems likely to increase cancer rates. Profiling will not. This is simple folks.

Best Regards,

John Di Saia MD

Originally posted 2010-11-24 09:00:07.

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Nasal Mohs Patient & The Politics of Doing The Right Thing

Recently I saw a patient with a small superficial basal cell cancer on the rim of her nose (the Nasal Ala.) She was referred by a dermatologist who had scheduled her for Mohs Surgery and wanted my help with reconstruction of the wound that would result from the Mohs surgery. I saw her before her Mohs surgery.

It is true that reconstruction in this area frequently leaves less than attractive results and that there are alternatives that might obviate her need for surgery namely topical chemotherapeutic creams. They only work for superficial disease which her biopsy indicated she had. I have used them before and they have worked pretty well but they do require a lot of follow-up visits.

At the risk of angering the local dermatologist I suggested that the patient speak with her about this possibility before her scheduled Mohs operation. It is true that that a surgeon working with his mind as opposed to with his hands makes less less money, but it is the right thing to do. The patient actually decided to have the Mohs surgery anyway.

I always wonder when I do these things if I am annoying the referring doctors and I may do so on occasion. The focus should be on what’s best for the patient, but business can distort that in some cases.

Best Regards,

John Di Saia MD

Originally posted 2010-08-23 08:00:27.

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SmartLipo Isn’t Always So Smart – You Need To Be Smarter

It frequently amazes me how patients can be wowed by technology and advertising hype. The attraction of newer technology in particular helps part many people from their money at times. The Smartlipo system is one of the laser-assisted liposuction systems on the market. I have blogged on it before having used it quite a bit a few years ago.

The system is being marketed with phrases like “almost anyone can be a good candidate for Smartlipo.” That is simply BS.

I saw an attractive young woman in the office who had had Smartlipo on her lower back. It looked like the Geiko Gecko had done it. Her smooth contour had been made irregular and discolored despite the fact that the surgery had happened quite a while prior. Her ribs had been a bit exposed by the loss of some of the fat that would normally have laid over them. Early lipo results do change, but this wasn’t something that was going to improve over time. I have seen worse but this was so unnecessary.

SmartLipo Left A Dent

SmartLipo Led to a Dent

Why did this happen?

Marketing has oversold the Smartlipo unit in a huge way to both doctors and the public in general. Patients come to the office convinced that it will cure that which ails them. Unfortunately they many times assume the fancy laser system does the surgery like in some high tech Sci Fi movie from years gone by.

At times prospective clients don’t have enough fat to treat and a surgeon is faced with two not-so-attractive alternatives:

(1) Advise a patient against surgery. This by the way, is the worst nightmare for many a surgeon as we are paid to operate not to talk.

(2) Operate and accept the risk that surgery might not improve the patient or worse yet might leave a dent.

This of course assumes that the patient sees a doctor who knows the difference. Many doctors offering Smartlipo are not trained plastic surgeons. Some picked up a Smartlipo system to replace revenue lost in their original practices outside of plastic surgery. For all you know last week your Smartlipo doctor might have been delivering babies.

The bottom line is that when you go to a less than smart doctor and have liposuction, the fancy Smartlipo laser-assisted system will not save you. You pay for experience and skill first and foremost, so I just hope my consult patient here hadn’t paid too much.

Preventing Bad Plastic Surgery:

** Know what you are seeking – a qualified and skilled ethical surgeon – not a smart looking advertisement promising the impossible

Best Regards,

John Di Saia MD

Originally posted 2011-05-03 07:30:48.

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Reader Question: Labiaplasty? – I’m Scared

I want to get the [labiaplasty] surgery because I’m really embarrassed about the way I look… but I’ve read online that some experienced really bad results and ended up having pain for the rest of their lives… due to nerves getting trapped and stuff… how common is this? Do you make sure that no nerves get trapped? Because I believe that sensitivity is more important than the look… and how much do you usually remove? the bare minimum or…? I’m afraid of being embarrassed that I got this operation if I go through with it.

Labiaplasty is a serious consideration. The online reflections of all patients who have had surgery however encompass a multitude of different operations.

It is my belief that the majority of the scary outcomes are the result of inexperience, surgery with too wide a scope or unfortunate situations.

When the surgery is performed with the simple goals of reduction of outer structures within conservative limits using the right techniques, sensory problems are extremely rare. If you are asking though how do you eliminate any risk, the only answer is not have surgery. To limit risk, you need the best hands you can afford and design your surgery conservatively. This has worked very well for my patients.

I put together a YouTube video outlining the key points for the woman considering reduction labiaplasty. Check it out if you wish.

Labiaplasty doesn’t have to be scary and doesn’t have to take sensation away from sensitive body parts. You have to be careful about what exactly you have done and what you expect it to accomplish if you want a successful outcome with surgery.

Best Regards,

John Di Saia MD

Originally posted 2011-06-16 07:30:34.

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Tanning Industry Fights Image Problem – Dr D’s Take

The tone is tongue-in-cheek but it’s part of a defiant campaign to defend the $4.9 billion industry against mounting evidence of its questionable business practices and the harm caused by tanning. And, in an extraordinary touch, it is portraying doctors and other health authorities as the true villains – trying to counter a broad consensus among medical authorities that sunbed use increases the risk of skin cancer including melanoma, the most lethal form.

For a surgeon who has cared for a fair share of skin cancer over the last twenty years, this campaign by the tanning industry is a bad joke. While I understand that money is being made in tanning, it is in my eyes undeniable that tanning causes cancer.

Parts of the article bother me more than others. There is apparently a “Breast Cancer Natural Prevention Foundation, which promotes vitamin D for breast cancer prevention:”

The founders include Dr. Sandra K. Russell, an obstetrician-gynecologist who appeared in advertisements for Smart Tan wearing her lab coat and a stethoscope.

One such ad features a picture of the doctor in her white coat saying: “It’s more sensible for me to tan in a controlled environment.”

Wow. I wonder if she is a paid endorsement or she owns tanning salons. I think of her as a Judas priest. You can get Vitamin D in a pill that doesn’t cause skin cancer. Trying to promote tanning as healthy is like trying to promote cyanide as good nutrition.

Tanning and the use of tanning beds are a risk. If you want to take that risk fine, but some of you are going to get cancer.

Best Regards,

John Di Saia MD

Originally posted 2012-08-23 07:30:11.


Why Dr D Dropped Saddleback Memorial Hospital

Those of you who know me know that I practice both cosmetic and reconstructive surgery and have done so for years. For about a decade I have maintained an office and a relationship with the hospital in San Clemente, now a Memorial hospital. Part of that relationship has been covering their emergency room and repairing what I believed to be my fair share of wounds in that environment. The hospital has had a mandatory call policy for plastics and a few other surgical specialties such as orthopedics and ENT. The hospital had not paid for this privilege or at least had not disclosed that they had.

Several things have changed in the last few years:

(1) Memorial bought the hospital. Their administration has a poor relationship with the majority of the medical staff to say the least.

(2) I moved to Long Beach, fifty miles away.

(3) I became aware that “under the table,” the hospital had been paying orthopedics to take call from 15 minutes away. (The two pods live closer to the hospital than I do.)

(4) A staff member from ENT was released from call after he made a request a few years ago.

So I made a request to be released from call and was told….if you want to keep privileges at the hospital you will take emergency room call. I informed the ever so considerate (note: sarcasm) medical staff that I would be dropping their hospital effective January 1 2011. Taking call from fifty miles away for free is BS, no matter how you slice it.

My belief is and has been that doctors accept way too much bull and rarely if ever do anything about it. Time to put my money where my mouth is. I will still maintain my San Clemente office, but not see patients at the hospital. If you are a physician considering privileges at this hospital, don’t expect them to be either forthright or honest. If you are looking to see Dr D, don’t go to Saddleback to do it.

Best Regards,

John Di Saia MD

Originally posted 2011-01-05 07:30:48.

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How Much For Your Botox?

A woman stopped by my South Orange County office a few times over the last few days somewhat bewildered by the staff’s reluctance to give her an exact Botox price without an appointment. The ranges she was offered were not to her liking.


Botulinum toxin and filler services can get a bit complicated. It is true that the industry marketing for these products has been in a retail format. Clients are naturally under the impression that they can price them like this week’s market special. While it is good for sales to quote a price cheerfully when asked it frequently leads to misunderstandings.

Not every client coming for these items is actually treated as she might have foreseen. Buying Botulinum toxin injections is not like buying an eyeliner. Different people are served differently by different amounts of the treatment and the treatment’s effects do not mature for a few days afterward. This hints to the potential benefit of an evaluation by an experienced injector and in this case a board-certified plastic surgeon. If you price these clients without specifying their exact treatment first, you are guessing. The actual numbers end up different than initially quoted and people feel ripped off.

In addition, some clients are looking to get these services on the cheap and that is not my schtick anyway. I am not a nurse clinic in a strip mall. I am a plastic surgeon and while I am good I have overhead.

Suffice it to say I prefer to evaluate people before pricing them for anything. It is more accurate and leads to fewer misunderstandings.

Best Regards,

John Di Saia MD

Originally posted 2012-08-09 07:30:53.



Northwest Pharmacy Experience from Hell

Looking to obtain a break on my practice’s botulinum toxin of choice (Myobloc) I yielded to curiosity and ordered from a Canadian Pharmacy…Northwest I figured we would try to break the price point of this popular product. Thankfully I used my credit card.

Botulinum toxin must be kept cold to retain its potency. We traditionally receive this product on dry ice and have never had much of a problem with effectiveness. I was promised by the pharmacy rep that this product would arrive cold within 2-5 days of shipping. Only after I gave her my credit card information did she share with me that the product would be coming from Great Britain. This was not welcome news. I was reassured that the product would be cold and usable.

The product arrived ten days later at room temperature, a completely questionable situation. The pharmacy rep said to go ahead and use it. I said nope. As I was summarizing the dispute, it occurred to me one more reason why patients having their botulinum toxin elsewhere sometimes describe such a variation in their experiences. Other practices might actually use this rotten Botox. Mine doesn’t.

For other docs thinking of ordering from Northwest Pharmacy: They were way too Type B for me. You have been warned.

Best Regards,

John Di Saia MD

Originally posted 2011-01-13 07:30:09.

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Reader Question: Is Filler Injection Safe?

Hi Doc,
Just want to know if filler injection is safe or not.

We have discussed the injection of fillers here a fair amount before. Fillers are commonly used to decrease the appearance of facial wrinkles.

Your question is very general. You could ask: “Is an aspirin safe?” Well that depends doesn’t it?

A common problem with fillers that we have underscored here has involved a questionable choice of the actual filler used (especially silicone gel.) Many times unqualified injectors were involved. And some entertainers in particular have gone out looking with blown up lips and faces (the dreaded trout pout) looking like they might be afflicted by some East Asian virus. Maybe they might have had too much?

Here are some important points to cover when considering filler injections:

(1) Your face is not a balloon. When you inject too much filler material you may look like a cherub or a fish. Some people might not find this attractive. There may also be consequences to injecting large amounts over time. Take it easy on volume.
(2) All Fillers are not the same. I tend to recommend the hyaluronic acid based fillers as they are the safest. They also dissolve the fastest. That may be the price of relative safety.
(3) Stay away from silicone injections.
(4) Choose a qualified and experienced injector.

Best Regards,

John Di Saia MD

Originally posted 2011-05-16 07:30:17.

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