From my Instagram here is a series of images of a man’s thigh with wounds from drug abuse and infection over years.
“Skin popping” refers to the practice amongst drug users of “popping” the skin with needles filled with their drug of choice. The needles these people use are often not very clean and result in skin infections and at times open wounds. This man’s legs show years of wounds with poor quality healing resulting in scarring (white spots) mixed with newer open wounds from more recent injury.
Two wounds on the pictured leg were cleaned surgically (debridement) and grafted with shavings of the patient’s skin. In one image the grafts appear covered with foam dressings (stents) awaiting adherence before stent removal. The third image is of the newly adherent and healing grafts. Without graft surgery these wounds would have taken months if cared for properly under ideal conditions to heal. This is not pretty cosmetic plastic surgery, but is rather a needed and underpaid aspect of plastics that fewer and fewer plastic surgeons practice.
John Di Saia MD
Originally posted 2012-08-17 07:30:12.
New Botulinum toxin patients come with varying experiences with Botox and the other available toxins on the market. A natural question is:
How long should Botox last?
We have addressed the question indirectly before in stating that there are reasons Botulinum toxins might not work.
Patients often are at a loss to understand why the effects of the toxin might not be as pronounced as they had been before with continuing use. Even when the injections are properly performed, the bodies of some patients (more than others) can “get used to” the effects and continued injections might have diminished effects or duration compared to past treatments. These toxins are proteins and the human body makes antibodies to protect itself from foreign proteins.
Suffice it to say the effects of Botulinum injections will probably last 2-3 months on average and the duration will vary and might decline over time with continued treatments.
John Di Saia MD
Originally posted 2011-04-28 07:30:37.
I got breast implants from a well known doctor, but now that I am having problems he doesn’t want to see me. Do I try to go to another doctor? When I call other doc offices for an appointment, they tell me to go back to the doctor who doesn’t care. What do I do?
Perhaps the only time you really know you have chosen the right doctor is when things are not going well. Many doctors who perform cosmetic work are not so great about after care and patients who are not happy are the hardest to resolve after surgery. Some docs therefore delegate this duty to others in their offices. If your doc handles a bad situation like this personally, he is really good. It doesn’t sound like you are in that position unfortunately.
You are best served by making it work with your current surgeon as he knows the most about your case. Try to sit down and in a very non-accusatory fashion lay out what you see as wrong with your result. If you can’t get to a reasonable place with your original surgeon, you will have to try to get a second opinion. As you have surmised, may docs may not want to be that second opinion doctor.
Having seen “problem cases” originally operated elsewhere over the years, I can understand why others docs may be hesitant to get involved. Most outside docs feel like the problems of other docs should be fixed by those other docs. Secondary surgery can be harder or relate to things that cannot be fixed. There is also the possibility that second opinion patients might be looking to get legal with their original surgeon. Any doctor may worry about getting involved in that. Time is money.
I do hope you are able to get the problem fixed to your satisfaction.
John Di Saia MD
Originally posted 2011-08-04 07:30:57.
I have been considering fixing my saggy sad boobies (two children, breastfeeding – blah. blah. blah.) Then I find this image online of a woman who had a lift with ugly scars and a new lump in her breast. This scares me. How do I get pretty boobies without the scars and lumps this lady got?
Plastic surgery comes with risk. Although the scarring you see here is not typical, it can happen and require surgery to fix. Of course poor scarring occurs more in certain practices than others and in patients who are less healthy and/or smoke more than in others. Compared to what we see in this case, the Katie Price breast lift scar drama kinda pales in comparison. All things are relative when we look closely enough anyway.
This lady you mention has two issues… scars and lumps. They may or may not be related.
(1) Scars – She shows her right breast in your image with a thick irregular scar in the healed incision at the inflamammary (under breast) fold. This looks amenable to scar revision. Her vertical scar between her areola and her lower breast scar is a bit wide as well. I would probably recommend scar revision surgery once these scars had matured and softened. Widened scars are particularly amenable to well performed scar revision more than some of the other treatment options.
(2) Lumps – Breast lift and reduction can result in scarring under the skin and in the breast that feels lumpy. These need to be carefully evaluated to make sure they are really just scar and not cancerous lumps. Fat necrosis after a breast reduction in particular can manifest in lumpy scars that become smaller over the first year from surgery. They can be removed if need be to prove that they only represent scarring and not something more worrisome.
How do you avoid these?
You can limit the problem by picking the right doctor, not smoking and having the right genetics.
John Di Saia MD
Originally posted 2011-06-27 07:30:15.
I put this together for HealthTap, another health web site to which I contribute. Happy New Year.
John Di Saia M.D.
Originally posted 2012-12-31 07:30:14.
I have long warned of skin cancer risk with tanning booth use here. Now MSN is getting in on the action quoting a study:
Guys, this news is so crazy and disturbing that we’re just going to jump right in: Every year, indoor tanning causes more cases of skin cancer than does smoking for lung cancer.
Let us repeat: The number of skin cancers we can blame each year on indoor tanning is higher than the number of lung cancers we can blame on cigarettes.
Skin cancer is the most common cancer. It is so common that the CDC excludes it from their cancer statistics probably so the numbers don’t dwarf those of other cancers. Most skin cancer doesn’t kill, but it can make you look pretty ugly. Take a look at a few skin cancer surgery pictures.
Tanning beds work by separating the wavelengths of ultraviolet light that cause tanning and sunburn, so you can tolerate more ultraviolet exposure and get a better tan. Sunburn is your bodies’ way of telling you that you have had too much sun exposure. Tanning booth use means you get more ultraviolet light with less sunburn. Of course, that light exposure is related to skin cancer risk as well as wrinkles. Check this post with the image of a man who had advanced sun related aging on the left side of his face from driving a car over many years. Drivers get more left sided than right sided exposure over years of driving.
The bottom line is that you might want to pass on that tanning bed. Remember it is always better to want plastic surgery than to need plastic surgery.
John Di Saia MD
I hear radio commercials with the smell good plumber. Why can’t you sneaky doctors learn to do that? I need to have a skin cancer removed from my face and went to a plastic surgeon. After arranging the surgery I called to ask what I would be paying after my insurance. They said they didn’t know. How can that be?
Health insurance is just as frustrating for your doctor’s office as it is for you. Believe it or not, when I do surgery under a patient’s insurance and bill a certain amount I really do not know what the insurer will pay on the case, when they will pay or what they will tell the patient to pay. Sometimes they assign most of the bill to the patient. Other times they try to discount the bill enormously. Still other times (really rarely) they pay the whole bill. Insurers actually pay variably for the exact same billing code between different patients and these differences can be huge. It plays out as a big game over months frequently.
When asked, my office staff can tell patients what billed surgeon’s fees for a particular insurance case will be, but prefaces that with the above facts. It is not fair, but it is not our fault either. If health insurers would pay reliably and consistently, we would not be charging patients as much and would be able to tell patients what their share of cost would be in a particular case. We might be able to use our insurance billing service less (which also costs us money) and simplify matters for everyone.
The way things are, the only way we can tell patients what their share of cost for surgical services will be is for cases in which their health insurance is not involved.
John Di Saia MD
Originally posted 2011-06-08 07:30:28.
Most patients are comfortably oblivious to the wide open nature of cosmetic surgery and the doctors who perform it. There are no laws against doctors of any level or type of training in cosmetic surgery opening their private clinics to the masses and performing surgery. The question of what training is really needed to entitle a doctor to perform this kind of surgery is hotly argued in many cases by the same doctors who wish to garner your business.
Board certification often comes into play. The problem is that there are many boards and relatively little oversight. I have been criticized by those representing cosmetic doctors for my lack of respect for their prowess. It is often hard to respect a doctor with little if any verifiable training who purports to be my equal. Unfortunately for consumers their experiences often can be subject to trial and error as they wade through the marketplace.
My point of contention is and has been that doctors who have not completed residency training and have not been certified by verified ABMS (American Board of Medical Specialists) boards that include cosmetic work in their residencies are not good bets for their patients. Inspection of your prospective surgeon regarding qualifications before surgery is an absolute must if you want to maximize your potential for a good outcome. News stories that have run recently have reinforced this point a great deal.
John Di Saia MD
Originally posted 2011-01-07 07:30:03.
For some women, trying to bounce back into shape after a baby is akin to dreaming the impossible dream. Impossible without a little surgical help, that is. Enter the “mommy makeover,” a phrase that has taken off in the plastic surgery field over the past few years. Typically consisting of breast augmentation, a tummy tuck or liposuction — or a combination of the three — the procedures are designed to reverse the wear and tear that having babies can sometimes cause.
Although there are plenty of questions to ask before anyone considers cosmetic surgery, local doctors say there’s no questioning its popularity. Angela Aguirre is a believer. The Rockwall mom of two kids, ages 8 and 4, started working out in December 2010 and lost 30 pounds, “but my stomach didn’t look any different,” she says. “There was loose skin, and it kind of had a round, potbelly appearance to it. I’d been working out really hard for a year and three months, and thought, ‘Surely by now it would be tighter.’”
We have discussed the emergence of the term “Mommy makeover” before. As a workout conscious man with a gourmet cook for a wife, I have issues with telling people that no amount of exercise will help a problem. Recovery from pregnancy optimally includes diet and exercise. A doctor in this story kinda downplayed the importance of diet and exercise in the picture, so I kindly edited him out of the quotation.
With this being said, there is a point particularly with woman who have had their tummies stretched beyond a certain point at which diet and exercise alone hit an impasse of sorts. Tummy tuck surgery frequently helps women here if they choose to explore the option.
Mommy makeover frequently includes tummy tuck surgery, breast enhancement and/or liposuction. The exact operation varies with the individual. This is amongst the reasons I do not use the term “Mommy makeover” in the office except in passing. The term does not exactly describe an operation. It refers to a family of operations in a colloquial sense.
John Di Saia MD
Originally posted 2012-12-19 07:30:11.