Mike Schmidt and Melanoma

Baseball fans take notice at times when disease falls upon Hall Of Fame players. Mike Schmidt of Philidelphia Phillies fame developed melanoma in a mole on his back that required some large scale therapy. That becomes a teaching moment so here we go:

Melanoma is the most rare of skin cancers, but is the only form of skin cancer with a fair chance of killing you. The more common forms of skin cancer are usually cured with small scale surgery often performed in your doctor’s office. Melanoma is a different beast entirely.

Melanoma like other skin cancers develops in skin damaged by sun exposure. Mike Schmidt “spent much of his life in the sun — not using sunscreen, trying to get tan….”

Not a good idea Mike.

Mike also had the tendency to developing melanoma in the family as he had a grandfather who lost an ear to melanoma. This was likely removed during surgery to attempt to cure him.

The bottom line is that melanoma and other skin cancers are caused by sun exposure, so people should seek to limit such exposure and use sun protective clothing and sunscreens when spending any more than a few minutes in the sun. Melanoma commonly develops in moles that we have had for a long time, so changes in color or shape of moles should alert us to the possibility that a doctor’s visit might be in order.

Mike appears to be doing well after a relatively large operation on his back which left an eight inch scar as well as radiation and chemotherapy.

Best Regards,

John Di Saia MD

Story Source: msn.foxsports.com/mlb/story/mike-schmidt-recovering-skin-cancer-hall-famer-philadelphi-phillies-031614

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Mini Tummy Tucks Do Not Tuck Much – A Story

I served an an expert witness for the California Medical Board recently in a case of a cosmetic surgeon who performed a mini tummy tuck that ultimately was re-operated by another surgeon. The patient noted that her tummy apron (pannus) was still there for the most part after her $12000 dollar operation by her original Newport Beach surgeon.

There may have been a few reasons for this:

(1) Mini Tummy Tucks don’t tuck very much even when done correctly. The smaller incision allows less tightening of the skin and muscle wall.

(2) The patient’s high priced Newport Beach surgeon had failed to use (in my opinion of course) proper sutures for her muscle repair. When the second surgeon re-operated six months later, the tummy muscle appeared as if it had not been tightened the first time.

Choose carefully when you choose your tummy tuck surgeon. In this case the woman paid top dollar and ended up doing it over six months later.

Best Regards,

John Di Saia MD

Related:

Dr D’s Tummy Tuck FAQs

Originally posted 2011-09-15 07:30:19.

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Reader Question: Is Filler Injection Safe?

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

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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Tummy Tuck Technique, Liposuction and Seromas

Prospective tummy tuck patients are often surprised by my advice that liposuction in the sides at the time of the tummy tuck surgery is more trouble than it is worth. That is probably because most of my local competition sells the liposuction as a good thing.

The bottom line is that tummy tuck surgery is a big deal and healing afterward as well as swelling (the accursed “Swell Hell”) can be limited. Technique to a large extent determines the outcome. Seroma refers to fluid collections that can be persistent at times after large scale operations. It has been my opinion that liposuction plus tummy tuck equals an unacceptable risk of seroma. Now a study has affirmed my position:

Conclusions: Patients should be counseled regarding an increased risk of seroma formation following abdominoplasty when combined with liposuction of the flanks. In addition, patients who are overweight are at increased risk for developing a postoperative seroma compared with patients with normal body mass indices.
Source: journals.lww.com/plasreconsurg/Abstract/2011/01000
/Comparison_of_Seroma_Formation_following.57.aspx

The actual incidence of seroma in the study was very high compared to what I see, but they did see fewer seromas with tummy tuck sans flank liposuction.

Best Regards,

John Di Saia MD

Originally posted 2012-10-02 07:30:58.

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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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Tummy Tuck and the Totally Flat Tummy

At an online forum, I responded to a post by a woman who had had tummy tuck surgery elsewhere (the famous Dr “X”) and was unhappy that her tummy was not “totally flat” afterward. She was asking whether this might represent fat that her doctor hadn’t removed. At this forum they refer to the after tummy tuck appearance as the “flatlands.” Kinda cute.

Tummy Tuck surgery results vary between surgeons and patients. The reasons for this are multiple:

(1) Different surgeons work with different techniques and spend more or less effort than others to get their best result.

(2) Some patient’s tissues stretch more after being placed upon tension than others. We see this over the weeks and months after an operation.

(3) Some people are more successful than others at pushing away from the buffet.

Is has been true for as long as there has been cosmetic surgery that the most important issue for a patient to comprehend relates to reasonable expectations.

Expecting “absolutes” in a world of “relatives” is an invitation to disappointment. “Totally flat” sounds great but might be off the charts for some patients. Some surgeons are going to make more of an effort to get you there though. And what is “Totally flat” for one patient might not be flat enough for another anyway. When plastic surgery doesn’t get you where you want to be there are several issues to address regarding the cause.

It is far more productive to look at degrees of improvement and focus your pre-op conversation on what you might be able to achieve. Picking the right surgical talent never hurts either. :)

Best Regards,

John Di Saia MD

Related:

Dr D’s Practice Web Site Tummy Tuck Section

Originally posted 2011-07-25 07:30:16.

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Good Liposuction Results – Woman Minus Baby Weight

Good liposuction results are nice smooth contours in the right client. Here is a young OC mom who wanted to get a few post-baby areas trimmed.

 

Good Liposuction Results

Good Liposuction Results Orange County California

She works out several times a week and is not fat by any means, but had some small problem areas that would not get better with exercise. Her biggest problem area was her tummy bulge and part of that was fatty. Here she is in the image before and 6 weeks after tumescent tummy liposuction with a nice result. Remember liposuction just trims the fat, but doesn’t do much to the skin or muscle wall. This is a good liposuction result showing not lumps or surface irregularities.

Best Regards,

John Di Saia MD

Originally posted 2012-11-01 07:30:57.

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24 Year Old Stole 46,000 Pounds For a Boob Job and Liposuction

A young bank clerk who stole £46,000 from her employer to help achieve her dream of becoming a model told police she had earned the money from working as an escort. Mother-of-one and law graduate Rachael Martin, 24, ‘spent money like water’ after getting a job with Barclays in Liskeard, Cornwall, where she was responsible for dealing with cheques.

The stolen cash paid for a breast enlargement, thought to be worth £4,000, dental work worth £1,700, and liposuction, as well as nights out, drink and drugs. She has now been jailed after stealing £46,000 in just two months from her employers.

Source: dailymail.co.uk/news/article-2206764/Bank-worker-24-stole-
46-000-fund-boob-job-party-lifestyle-told-police-earned-money-
working-escort.html#ixzz279qusl6O

This 24 year old law graduate stole from a bank to fund plastic surgery and nights on the town. Interestingly she by report told those who asked about the source of the money for her indulgences that she worked as a prostitute. The judge apparently had pity on her when he sentenced her. I am sure that will make the bank that is out the money quite happy.

Best Regards,

John Di Saia MD

Originally posted 2012-10-03 07:30:49.

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Tanning Salon Owners Mislead Clients

Many tanning salons are downplaying the health risks associated with indoor tanning while claiming that time in a tanning bed offers an array of health benefits, according to an investigative report from Democrats on the House Energy and Commerce Committee. Committee investigators, posing as fair-skinned teenage girls, called 300 tanning salons across the country, and found that 90% said that the use of tanning beds did not pose a health risk. When pressed about skin cancer risks, some salon employees said the link to indoor tanning was “hype” or “a big myth.”
Source: skinandallergynews.com/newsletter/the-skinny/singleview40946
/tanning-salons-mislead-teens-congressional-probe-
finds/4aaea3a6b8.html

Studies showing tanning bed use is associated with increased risk of skin cancer and even melanoma skin cancer are now plentiful. It is funny though to expect businesses outside of medicine to discuss risk much. Does it really surprise anyone that tanning salon management downplays the risk of the services they provide?

As far as I am concerned tanning salons are cancer traps. They should have warnings similar to those on cigarette packages proclaiming the absolute foolishness their patrons have in using their services. I will even donate to the hypothetical copy of such a statement:

“To our Clients,
While we appreciate your patronage please be advised that tanning beds have been associated with increased risk of skin cancer and premature aging. The money you are pouring into our pockets might be better spent on sunscreens and sun avoidance clothing. By using these facilities you have decided to go against your better interest and as such the ownership takes no responsibility for the cavernous wrinkles, cancer and even death you might receive in the bargain.
Thank you.”

Best Regards,

John Di Saia MD

Originally posted 2012-02-09 07:30:06.

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A Fixin’ Your Thighs – Inner Thigh Lift

Body Lift Surgery

After reading a post at a forum that I occasionally visit, I figured an explanation of what thigh lifts can (and cannot) do was appropriate. Many plastic surgeons look at thigh lifts with a degree of exasperation. They not infrequently require revision. Those in large weight loss or gastric bypass patients can be a big job.

The amount of excess skin that so unattractively jiggles in the inner thigh is the question. To reduce said jiggling requires incisions. If the excess is mild to moderate, we can usually get away with just an incision in the crease between the thigh and groin. Gastric bypass and extreme weight loss patients often require an additional incision vertically down the leg. These incisions heal with variable scarring. The scars can migrate down the leg although this is less frequent than it was years ago.

We pull and often liposuction to make the tissues as tight as we can. Then to an extent they loosen over a year or so then we see how we did.

Best Regards,

John Di Saia MD

Originally posted 2005-10-24 09:56:00.

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