Low Maintenance Breast Implants – Are They Doable?

Low Maintenance Breast Implant

Surgery – Is this achievable?

Reader Question:

I am looking into getting breast implants but want to keep redo surgeries to a minimum. Some of my friends have had 2-3 boob jobs in ten years, so I am not going to their doctor. I saw a few of your patients online saying that the implants you put in they kept for ten years. I want to get a worry-free boob job. How about these natural looking breast implants? http://www.psinteractive.net/boobex1.htm

Thanks for the compliment.

There are several things you can do to reduce your risk for the need/desire for re-operation after breast implant surgery:

(1) Have surgery by a good qualified surgeon. In my book, that means a good ABPS board-certified plastic surgeon.

(2) Request guidance from your surgeon regarding the volume to which you can go safely. The leading cause of poor outcomes with implants that I see is the placement of implants too large for a woman’s available soft tissue coverage. Good surgeons know this although many fear “losing the case” if they share their concerns. The patient to whom you refer had a small C cup result that many women would consider too small. Then again she has kept her implants for nearly twenty years without (as far as I know) any additional surgery.

(3) Consider saline-filled implants and have them placed beneath your pectoral muscles. Silicone gel is another option but I feel the breast hardening rate (capsular contracture} is higher with them. Capsular contracture is also higher in some other cases that you may want to review before surgery. If you have to have silicone gel, get cohesive gel implants as these probably have a bit of a lower contracture rate compared to other silicone gel models.

(4) If you have any degree of breast sag, talk about breast lift surgery as an option before you have your operation.

Best Regards,

John Di Saia MD

Originally posted 2011-04-22 07:30:34.

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Botulinum Toxin Injections… A Conservative Rationale?

I had a return patient come in today to consider more Myobloc (the Botulinum toxin that I use in the office the most frequently). Her friends at her office had had alot of Botox…in their foreheads, in their eyelids, in their Crow’s feet… Another doctor had done this. She wondered if she “needed” more. Well nobody “needs” this. The real question is whether or not she might benefit from more.

I discouraged her from using it for more than the central forehead (base of the nose) and a little at the crow’s feet.


(1) I like people to have some facial expression. Blunting some wrinkles is OK. I don’t like “Stony” faces.

(2) There is some evidence that injecting too much into the entire forehead can drop the eyebrows and lead to the desire to have a forehead lift. I am not comfortable about causing the need for a cosmetic operation that a given patient may not want.

Botox and/or Myobloc is/are fine, but there is definitely a place at which too much makes you look kinda foreign.

Remember my blog = my opinion

Best Regards,

John Di Saia MD

Silly Disclaimer…..like a real commercial (LOL):

The foregoing message has not been approved by any company making outrageous profits from the sale of Botulinum toxins. They would rather you inject every square centimeter of your body on daily basis until you are broke or dead.

Originally posted 2005-09-15 21:07:00.



Dr D’s Hack Plastic Surgeon Report #1 – Beverly Hills Edition

As a medical expert for the California Medical Board, I occasionally have the opportunity to delve deeply into the qualifications and exploits of some of the doctors you might know and choose. This section is a primer for the potential plastic surgery patient to show you the doctors you might not want doing your surgery. More importantly it shows you how you can check before one of them becomes your surgeon.

While we can’t share their names (as some threaten law suits and such,) we can clue you in on the red flags you might identify as you are vetting your potential surgeon. We will review the publicly available verifiable information on a chosen doctor and point out the things that might help you choose whether or not to choose this hypothetical surgeon. These are real doctors and the information is correct according to the sources we share.

Doctor #1 – Beverly Hills

Dr X is a board certified Beverly Hills plastic surgeon who claims on his web site to be the plastic surgeon for numerous Playboy models.

His California Medical Board License Information sheet reads:

License Status: License Renewed & Current

Public Record Action(s): Probation Completed
Public Reprimand
Malpractice Arbitration Award
Hospital Discipline
Disciplined By Other State/Govt

The Arbitration award was for $550,000 and the Hospital Discipline was that he was thrown off the medical staff at a local hospital. His license is another state was placed on inactive status based upon the action taken by the California Medical board.

The American Board of Medical Specialists web listing indicates:

He is board certified in plastic surgery and does not participate in Maintenance of Certification.

I have not reviewed this doctor for the California Medical Board, but came to know of him when one of his prior patients came to me for repair after he’d operated upon her three times and left her disfigured. His last comment to her was that “this was as good as it would get” for her.

Case and Point: If you are looking into plastic surgery a quick review online (my link below tells you how) can tell you a great deal. These information sources are not all inclusive of problems a doctor might have experienced. They can be the “Tip of the Iceberg.” A completely clean medical board record of your prospective surgeon is ideal, but more than one or two actions, a large malpractice award or lack of proper certification in my opinion should put doubts into your mind regarding any surgeon.

The above doctor is practicing at the time of this writing and charging pretty large scale fees. Do you want him operating on you?

Best Regards,

John Di Saia MD


Dr D’s Quick Check Links for Your Surgeon

Originally posted 2012-11-14 07:30:03.



Porn Star Style Boob Job – Do You Want One?

Once in a while prospective patients inquire asking whether or not I can do a “porn star style boob job.” We usually answer the question with a few questions:

How Large Are You Looking to Go?


How Do You Want To Look?

In looking into larger breast implant sizes and the way you want to look, there are a few things that come into play:

Your current breast tissue: How much is there? Some women want a very high round fake look that their current breast tissue works against. Normal breast tissue tends to look natural. It hangs a bit. Some women like this “natural look.” Others don’t.

Your willingness to risk things going wrong: The larger you go the more the chance that implants will droop, ripple, “firm up” or hurt. These chances get larger as the implant size gets larger.

There are ways reduce some of this risk and they generally involve doing a few operations to slowly increase the breast size and stopping at some point.

I look at these cases relative to the risk and how reasonable the patient seems. Many ladies just want moderately large and this is quite doable. My prior patient at the bottom of the page here is a good example of going to the edge of huge  without too much risk. It is always relative. :)


Best Regards,

John Di Saia MD

Originally posted 2011-07-28 07:30:10.

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Large skin cancer arm before shaving hair #plasticsurgery

Large skin cancer arm before shaving hair <a href='http://twitter.com/search?q=plasticsurgery'>#plasticsurgery</a>

This man had a large skin cancer concealed under the hair of his forearm. More images will be posted soon including the appearance after the hair was shaved, marked after the hair was shaved, after the lesion was removed and after the wound was reconstructed. Stay tuned :)

Best Regards,

John Di Saia MD

Originally posted 2013-08-19 08:37:38.


Why Women are Private About Labiaplasty


While it is kinda humorous, it does kinda tell the story doesn’t it?



Best Regards,


John Di Saia MD


Our History with Free Cosmetic Consultations

Once in a while (fortunately very infrequently in my practice) people get bent when they get a bill. I used to offer free cosmetic consultations, but people often came to just “talk” which became too much of a waste of time. My overhead does not stand silently in the corner while people just talk. Some people may have also had a hard time understanding what a cosmetic consultation is exactly. Now I do free consultations as occasional promotions, but generally we charge something.

For the purposes of a “Cosmetic consultation:”

If your health insurance is involved, it is not cosmetic. Health insurance excludes cosmetic surgery except under very specific circumstances.

Some women have initially come in for a cosmetic breast consultation and then tried to switch when they were in the office to having their insurance cover their breast reduction. While this is not a problem for the office, it does make the issue non-cosmetic because you are telling your insurance company you “need” your breasts reduced for medical reasons.

We don’t charge much for cosmetic consultations and credit this towards a patient’s surgery if one follows the visit. The charge is actually much less than we bill insurance for a regular consultation although the paperwork and hassle is of course much more with an insurance company.

Best Regards,

John Di Saia MD

Originally posted 2011-09-29 07:30:03.

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Question About Good Botox @VariantVal

@VariantVal‘s Question:
“Have you ever done a “signs you should start having Botox” blog?”

The tweets went back and forth after this one. I am always blogging about those who have had too much, but not about those who are done well. The biggest problem with Botulinum toxin use in Southern California is “overuse.” People start looking freaky when they have had too much. When people get too much, their faces don’t move quite right. When used selectively this doesn’t happen.

Here’s an example in which just one muscle was treated:

This woman was treated with Myobloc (Botulinum Toxin B) to decrease the appearance of one wrinkle at the upper part of her nose (where her Procerus muscle was causing a fold.) The rest of her face as preserved so she would not look like a Botox freak. The key to a pleasant experience with these toxins is a conservative approach unless you want to look more foreign that is.

Consider having Botulinum toxin when there are folds that you feel contribute to an older or more troubled appearance. The folds that seem to respond the most favorably are those near the upper nose and the sides of the eyes. Seek an experienced injector who will tell you when the areas you are considering are not well-advised and will treat to preserve as well as take away. If you go too far, learn from the experience and use less the next time.

Best Regards,

John Di Saia MD

Originally posted 2010-08-24 07:30:12.

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Dr D in “Plastic Surgery and the New Year’s Resolution”

I put this together for HealthTap, another health web site to which I contribute. Happy New Year. :)

Best Regards,

John Di Saia M.D.

Originally posted 2012-12-31 07:30:14.


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.