Dr D on a “Ten Years With Botox Story”

May 17th, 2012 by admin No comments »

….10 years ago, to the U.S. Food and Drug Administration’s approval of Botox for treating frown lines.

Over the course of that decade, botulinum toxin, as it is technically called, has profoundly changed the work of dermatologists and plastic surgeons, and broadly expanded the use of cosmetic procedures by the general public.

Source: htrnews.com/article/20120513/MAN04/205130436/We-ve-
been-stuck-Botox-10-years

The most interesting things about botulinum toxins are not really mentioned in this article. It is true that a number of doctors realized far before Botox TM was FDA approved for cosmetic purposes that it could help with them. In 1997 in the Los Angeles area it was popular as an “off label” use drug for wrinkles. At first Botox TM was the only product of its type on the market. I was well aware of it before the FDA approved it for cosmetics and was using it in 1997 like many others.

What most people have only recently discovered is that there are several versions of botulinum toxin on the market. There are three botulinum toxin A products and one botulinum B product marketed under different trade names. These different products act slightly differently.

Another important point is that many others other than plastic surgeons and dermatologists are administering them. You can get them in Med Spas and the offices of doctors of all specialties looking to augment their bottom line with some easy discretionary cash. These toxins are not really all that dangerous as long as the injector is reasonably prudent but you can end up looking funny with the really inexperienced ones. At least it wears off even in this sad case. :)

Best Regards,

John Di Saia MD

Dr D in a Prius Poll?

May 16th, 2012 by admin 6 comments »

Hello all,

I am thinking of changing my ride. The idea of driving a Prius appeals to me. I get to use less gas which makes me feel a bit better about not contributing so much to our pollution and gas industry problems. There are a few environmentalist quirks I picked up as a Berkeley undergrad. :) The nerd in me likes efficiency and with the miles I drive I might need to stop less frequently. Some of the docs around me have commented that they are not so sure my clients will take well to their plastic surgeon driving a more green machine however.

So you can vote on it:

<a href="http://www.sodahead.com/fun/should-a-plastic-surgeon-like-dr-d-drive-a-prius/question-2259327/" title="Should a Plastic Surgeon Like Dr D drive a Prius?">Should a Plastic Surgeon Like Dr D drive a Prius?</a>

Best Regards,

John Di Saia MD

Originally posted 2011-11-03 07:30:41.

50th Aniversary of Breast Implants & Breast Implant Surgery Attitudes

May 16th, 2012 by admin No comments »

This year marks the 50th anniversary of the modern boob job — time enough to get used to the idea, surely — yet while other procedures have become accepted, implants remain the one surgery that still carries a stigma. The answer must surely be that in Western culture breasts are viewed as symbols of femininity and sexuality, so it follows that enlarging them can only be for the benefit of the opposite sex.

Feminist author Naomi Wolf even went as far as describing boob jobs as ‘sexual mutilation’ in her book The Beauty Myth. However, the rather more mundane reality is that the majority of women who have implants do so to boost their confidence, just like those having facelifts and other cosmetic procedures, and not, as widely thought, to appeal to men.

Source: dailymail.co.uk/femail/article-2137077/Do-YOU-despise-women-
breast-implants.html

The stigma of having breast implants doesn’t seem all that strong in Southern California. In some areas, breast implants are almost a rite of passage for young women who might feel they are lacking.

Going beyond a certain size might still be tattoo, but that doesn’t stop some women from going there. One of my patients who went on the larger side made a Youtube video about it, and the comments have varied from the snarky:

Try as you might,,,did you spend all that money to be perceived as “Umm like hi! My name is,,,OH wait,,,I forgot,,OH yeah No,,,Wait.” Who Am to judge. There is money in looking like an airhead, You got it!!

Then again when an automaker aligns itself with the idea of breast implant surgery, legitimacy is perceived in the populace at large.

Breast implant surgery attitudes are a bit polarized it seems.

Best Regards,

John Di Saia MD

Tickle Lipo – Breakthrough or Gimmick?

May 15th, 2012 by admin No comments »

Liposuction is plastic surgery’s “gimmick procedure” having had more angles applied to it than a child’s toy. There is however money to be made in fat reduction so the gimmicks will just keep coming.

Enter Tickle Lipo, a new technology superimposed on the liposuction game. In this newer version of the basic liposuction technique, the cannula, the instrument used to remove the fat, vibrates like a whip inside your fatty layers. This supposedly helps remove the fat more evenly and with less pain.

Tickle Lipo looks like a hybrid between two other forms of lipo already on the market – power-assisted lipo (Pals) in which a motorized cannula breaks up the fat and ultrasonic lipo in which sound waves do it. Will Tickle be better or worse than its fat sucking competitors? That will likely depend upon the technology and the skill of those who handle it.

A funky high tech instrument will not make a non-surgeon into a master plastic surgeon just like a hot race car will not make me into Jeff Gordon. Check the credentials of anyone who wants to use this thing on you and go from there. At this point I would consider Tickle an experiment.

Best Regards,

John Di Saia MD

Related:

Dr D’s Website “Liposuction Index”

Originally posted 2011-02-07 07:30:59.

Hysterectomy and Tummy Tuck Together Safe?

May 15th, 2012 by admin No comments »

New research suggests that combining two very different surgeries — a hysterectomy and a tummy tuck — is relatively safe, with no major complications seen in 65 women who had both procedures at the same time. The rate of complications the researchers considered minor reached 32 percent, however. “Transfusion is a major complication, and it occurred in 3 percent of the surgeries…

The overall complication rate among these procedures was 32 percent. Ten percent of women had a fever, 8 percent had wound complications and 2 percent had a urinary tract infection. Three percent had to have a blood transfusion, and 9 percent of the women had atelectasis, which is a partially or totally collapsed lung.

Source: health.usnews.com/health-news/news/articles/2012/05/11/is-
combining-hysterectomy-and-a-tummy-tuck-safe

This study is not definitive as the number of women studied is pretty small. Considering that I do not combine the operations and have had no need for blood transfusion in any tummy tuck case in over 14 years, I think the separation of the procedures is definitely safer.

It is important to mention that the real nasty complication of deep venous thrombosis (dvt) was not seen in this study. That potentially fatal problem was seen in three times the number of women when the surgeries were combined than when they were separated in another study years ago.

Suffice it to say that I do not recommend combining these operations and have lost financially by standing on these principles over the years. Being principled costs a surgeon money these days. Then again my safety rating with the operation is excellent. :)

Best Regards,

John Di Saia MD

Finding the Best Plastic Surgery Online

May 14th, 2012 by admin 2 comments »

Just for the sake of comparison I did some web searching looking into the blogosphere for the “best plastic surgery.” What I found were spun articles and nonsensical gibberish probably created to capture the computerized eye of the search engines. It seems that these days all anyone is trying to do online is capture search engine results. The problem when you are an actual person interested in plastic surgery is that searching “best plastic surgery” might just give you the worst.

First of all, when looking into the “best plastic surgery,” you are really better served by looking into your procedure of interest as we do not all specialize in everything. Who does?

What is not always so evident is the online recommendations (and negative tirades as well) can be faked. So can the appearance of that doctor who looks like a rock star online on his site. Remember Lifestyle Lift and the State of New York? The company paid a $300,000 fine for faking reviews on the internet. It still amazes me that they are still in business. Their site looks pretty slick though.

Do you honestly think the Google knows the difference between a good tummy tuck and a not-so-good tummy tuck? Search engine results are a keyword mediated computerized lottery. Some of those results are paid results too and appear higher not based on quality, but based on dollars. The bottom line is that you can get starter information from searching online, but then the work really begins.

I have written online on how potential patients might screen a potential plastic surgeon. Please do so before consenting to surgery rather than trust the veracity of a potentially fateful search engine result.

Best Regards,

John Di Saia MD

Originally posted 2012-01-05 07:30:25.

Fiat Boob Job Commercial

May 14th, 2012 by admin 1 comment »

I have been asked how to talk your girlfriend into getting breast implants. This is the only way…by having her want them for herself in the first place.

What this has to do with the car is beyond me, but it is a funky idea for a commercial.

Best Regards,

John Di Saia MD

Breast Implants and Boobie Greed

May 11th, 2012 by admin No comments »

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.

University Surgery Professor Naive Of The Outside World?

May 11th, 2012 by admin No comments »

Wesley Thayer, M.D., Ph.D., assistant professor of Plastic Surgery, and of Orthopaedic Surgery and Rehabilitation, surveyed 119 Tennessee hospitals that have both an operating room and an emergency room and found that 58 percent of these hospitals do offer at least basic emergency coverage for hand injuries while 42 percent offer no emergency coverage at all for these injuries. Thayer added that roughly 80 percent of the hospitals surveyed offer elective, or non-emergent hand surgery. “I was surprised that most Tennessee hospitals are able to offer elective hand surgery but only 7 percent of them have a hand specialist on call 24/7 to treat emergency injuries to the hand,” Thayer said.

Why is he so surprised? Emergency care doesn’t pay Dr Thayer. That is why I stopped doing it for the most part. Running around at 2 o’clock in the morning and doing sometimes difficult work at little or no pay is simply not acceptable.

I still do reconstruction in addition to cosmetic work, but at more civil hours under more controlled conditions. I still get screwed by insurance companies but less often. Many doctors working for the university system on salaried compensation plans are still unaware of how things work in private practice. We don’t get paid when patients are not insured in emergencies and get paid poorly and inconsistently even when they are. Those are just the facts of life in medicine right now. And that is why you see less emergency specialty care. Uncompensated liability is not well received in any business including medicine. We have discussed this before.

Don’t you think that if these things paid well doctors would line up to do them?

Best Regards,

John Di Saia MD

Good Plastic Surgery in the OC – Tummy Tuck

May 10th, 2012 by admin 4 comments »
good tummy tuck Orange County California

Good Plastic Surgery Orange County California Tummy Tuck

Here is a nice woman who exercised constantly but could not lose the “pudge” in her tummy. The lower portion of this near the panty has been called fat apron, mother’s apron, but the medical term is pannus. This patient did not have a very loose or prominent pannus, but was bothered by it nevertheless. Upon examination, a belly button hernia was also found with a lot of muscular wall thinning nearby – likely a derivative of child bearing. A tummy tuck with abdominal hernia repair was performed and at 5 months she looked quite good.

Best Regards,

John Di Saia MD

Originally posted 2010-12-20 07:30:45.