Warning Doctors – Do Not Send A Check to the California Medical Board

License renewal has been a pretty much routine albeit expensive endeavor over the last twenty years or so. The renewal comes by snail mail. You will out the forms and mail a check and a few weeks later your license comes. Simple.

Well no more my friends. Now the California Medical Board’s new “BreEZe” system has arrived. And believe me it is no breeze.

February 2015

Renewal paperwork arrives and the option of online renewal is offered. I figure there is plenty of time so I will just mail a check. Bad move. The instructions indicate that mailing a check is still acceptable. Nowhere on the renewal paperwork is it stated that a mailed payment is not supported. It did say that it would take weeks to process.

March 2015

No new license yet. I hear from some hospital medical staff people that the renewals are taking longer now.

We call the medical board office and they ask to which address we mailed the renewal. I just mailed it to the address indicated on the paperwork. I didn’t record the address. We are told that one of the two addresses involved a 4-6 week wait and the other was 7-10 days. They could not confirm that they received the check.

We are referred to the online Breeze system to check for the renewal. No further assistance is offered. The Breeze representative tells us that the best option is to go online and pay with a credit card. She tells us that the check will be cashed and we will have to seek reimbursement afterward. Now that’s service.

So after another 7-10 phone calls over the next week the check still had not arrived and my license was on the cusp of suspension. So I went online and paid a second time to renew my license. The good news is that it was renewed immediately.

The moral of this story: Do not pay for you medical license renewal with a check. It is slow. It is not supported. And you may end up having to do it again with a credit card online anyway and deal with the possibility of paying twice in the bargain. Time to cancel that check.


Best Regards,

John Di Saia MD


Third Degree Murder and Fatal Booty Silicone

I have expressed my angst regarding butt injections many times before at this fine blog. This recent story however had me looking up the definition of third degree murder and redoubling my cynicism on the topic:

PHILADELPHIA (AP) — A former madam has been convicted of third-degree murder in the death of a British dancer who got silicone injections to enhance her buttocks at an airport hotel. The 45-year-old Windslowe describes herself as a former madam and hip-hop performer known as “the Black Madam.” Police say she fled after a botched injection killed the 20-year-old London dancer in 2011.

Source: msn.com/en-us/news/crime/black-madam-convicted-of-murder-in-fatal-buttocks-injection/ar-BBijFhZ

As I have said before:
Silicone injections are scary. No reputable plastic surgeon offers them to my knowledge. Do not submit to them.

Why someone would submit to injections of any sort provided in a hotel room still puzzles me. I know of no doctors who operate in any hotel. Then again I am not on freiendly terms with any Quacks. :)

When you let a non-physician perform a procedure on you you accept risk; more risk than you might have encountered when you had a skilled physician as your service provider. Sometimes that risk manifests as something truly tragic as in this case.

Apparently third degree murder is murder that occurs due to indifference or negligence. It will be interesting to see if this woman gets any significant jail time or anything even close to that which a physician would have received for doing something similar.

Best Regards,

John Di Saia MD



Why Celebrities Deny Plastic Surgery

Many people deny having had plastic surgery. Celebrities are only different in that there are multitudes of photographs publicly available to debunk their statements. Smart celebrities (in my opinion) simply admit to considering it and leave people wondering. Maintaining public interest is always in a celebrity’s best interest.

Probably the most important issue for entertainers is that their image is their livelihood. They need the availability of good plastic surgery in many cases to stay marketable. Of course, that which is “good” is very much a matter of opinion.

Best Regards,

John Di Saia MD

Originally posted 2005-06-22 19:49:00.



Good Thigh Lift Results – Orange County California

Good Thigh Lift Results

can be yours if you are the proper candidate and you have quality surgery.


The operation is designed to correct loose fatty skin along the inside of the thighs. As I have previously posted images of such operations in which things did not turn out well, here is an example of the other side of the coin. :)

Good thigh lift results Orange County California

This pretty forty something was in good shape, but had gained and lost a good deal of weight around the time of her pregnancies years prior. The result was that her inner thighs kind of touched and when she ran she felt them swinging around and slapping one another at times. The skin was loose and wrinkles were apparent. She found this inconsistent with her self-image and wanted it corrected.

A year after thigh lift surgery (upper right in the image) the problem was greatly improved (good thigh lift results.) In cases like hers the scar can be carefully hidden in the groin crease. Larger cases (such as after gastric bypass) with more loose skin can require extended incisions.

Best Regards,

John Di Saia MD


Dr D’s Website Body Lift Section

Originally posted 2012-11-15 07:30:44.

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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.


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.


Extreme Makeover – What Part The Makeup?

A friend with a gift for producing more e-mail than your friendly neighborhood surgeon can read e-mailed me a few pics including this one.

It spurred a thought:

“What part of Extreme Makeover results are the makeup?”

This lady apparently had just makeup. Well maybe in addition to more flattering camera-work for the after image.

Having been a photographer in years gone by, I make a concerted attempt to make my before and after images honest. Not all surgeons agree. Many have patients come for their before pictures without makeup and take their after images with soft studio lighting and makeup. This is cheating. Any photographer should be able to use camera tricks (and now Photoshop) to make their results look better than they are. You are not at your surgeon’s office to see how good the photography is, are you?

The bottom line is that you should look carefully at the pictures at your surgeon’s office before you have surgery.

Best Regards,

John Di Saia MD

Originally posted 2005-10-26 20:18:00.



Boob Job Cost – What Should A Good Breast Augmentation Cost Anyway?

Cleavage can Cost $$$$

Cleavage can Cost $$$$

Boob Job Cost

Recently a nurse at one of the hospitals in which I do wound work asked me what a boob job costs.

This is a question without a simple answer so let’s share:

A “boob job” is a generic term for cosmetic breast surgery. Cosmetic breast surgery can have a number of different operations involved. The main items that are associated with expense in cosmetic breast surgery are degree of work, the location and who is doing that work.

I have made light of the cheapie boob job bulletin board ads we see in areas of Southern California. The quotation of a price without knowing who will be doing the surgery or what exactly will be the nature of that surgery is an invitation to misunderstanding. Some of these cheapie boobjobs end up looking like novice surgeons indeed were involved. Take my word on that. :)

The simplest of all boob jobs is solely the placement of breast implants. If this is done by a reasonably experienced surgeon using saline filled implants, an average cost in Southern California is about $5000-6000; yes, roughly twice the cost quoted on that cheapie plastic surgery sign. If the implants are silicone gel types add another $1000.

Breast lift surgery can be simple or complicated. Some women have significant degrees of breast droop that putting implants in alone may not improve. Breast lift surgery in addition to breast implants can double the price of the surgery.

So you see the cost of a boob job requires a visit to a surgeon’s office for an examination to be followed by a quote for the work you might want performed. You would do this for your car before repair work. Why not do at least the same for your body? :)

Decide before you go if you want a bargain basement job or custom work.

Caveat Emptor.

Best Regards,

John Di Saia MD

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

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Reader Question – Best Price for Liposuction in Orange County

Im looking for a practice that can offer me the best price for liposuction. There is a very small area just below my belly button I would like to have done. What would be a rough estimate for that procedure?

I get e-mail like this now and again. When you go about looking to go on the cheap for liposuction, you are going to find your way to a non-plastic surgeon for it. There are many other types of doctors who perform liposuction and the non-plastic surgeons have lower overhead. I am not saying I would recommend it or that they are very good at it, but they are cheaper.

Just be aware of what you are seeking because you just might find it…and end up in a bad place because of it.

Best Regards,

John Di Saia MD
an Orange County Plastic Surgeon

P.S. By the way, when you receive a price on an operation without being examined first, that is a red flag too.

Originally posted 2011-03-10 07:30:08.

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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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