Dr D an Aging Athlete and the Statin Question – Statin Every Other Day? III

Statins are so positively heralded in the medical literature and had kept my LDL cholesterol low for eight years, it seemed that it made sense to try to stay on them. So one of my first manipulations to get rid of the muscle pain was to try to alternate a every other day Statin with an alternative drug:

So 20 mg of Atrovastatin every other day with alternative days on fenofibrate at 145 mg:

Total Cholesterol: 155
LDL Cholesterol: 86
Triglycerides: 140

HDL Cholesterol: 41

My Creatinine Kinase bumped to 222 (44-196) on this regimen though and my muscle pain was intermittent, but still present so the equation was not quite right yet.

Best Regards,

John Di Saia MD

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Reader Question: Breast Implants Under Local?

Reader Question:

A surgeon I’m thinking about seeing said on his site that breast implants were able to be done under local + intravenous anesthetic (like twilight). Can this really be done? I always thought it was too invasive for just twilight, especially if it is under the muscle. Is there an advantage to using twilight? After looking it up there are lots of differing opinions out there but I think that this may just be a way for the surgeon to cut costs. What is the cosmetic surgery truth here, Dr. D?

I am not a fan of local or twilight sleep for breast implant surgery except in rare cases (simple redos and such.) The reasons are patient comfort and practicality. I place most of my breast implants under the pectoral muscles and these muscles need to be relaxed for this to work out. That relaxation is suboptimal under less than a general anesthetic.

An interesting aside to the argument of sedation versus general anesthesia is the fact that under less than a general patients often need more medication to maintain them in a narrow range of alertness. This translates to more drugs for twilight sleep which is contrary to the reason many of these patients wanted less than a general anesthetic in the first place.

Best Regards,

John Di Saia MD

Related:

Dr D’s “Breast Surgery Index”

Originally posted 2010-12-09 07:30:25.

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Reader Question: Hips and Butt Getting Bigger After Tummy Tuck

Hi Dr,
I’m just wondering what your thoughts are on this. I am 5 months po from a FTT, MR (full tummy tuck with muscle repair). I have been working out and still eating healthy as I did b4 surgery, BUT my hips and butt seem to expanding. I’ve been going for lymph drain massages for my tummy and while it is helping that, I can’t help but wonder if it’s pushing fluid to other places. Not only can I not get back into my preop size 8 jeans, but I couldn’t even squeeze into a 12! I’m frustrated because I keep hearing different theories on this.

Prior to surgery did your weight fluctuate much? Patients like this following abdominoplasty can gain this weight in new places. This can become a problem.

At this point swelling is usually coming down, although in large cases it may not be completely gone for 6-8 months. Did you have much liposuction with your tuck? Liposuction frequently makes swelling more pronounced for a longer period of time. Also if you smoke, try to stop it or limit it as it interferes with wound healing. Assuming you went to a good surgeon, give it time. It gets better.

Best Regards,

John Di Saia MD

Related:

Dr D’s Tummy Tuck FAQs

Originally posted 2005-09-18 17:44:00.

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Secret Plastic Surgery

There are times in which a patient might seek to keep plastic surgery a secret; a secret from the public, a secret from her husband, a secret.

People have their own reasons for this. Sometimes it is the nature of the surgery concerned. Not many women share their desire to have their labia reduced with their mothers for example. The selection of my satellite office was in part devised to preserve discretion. That office certainly doesn’t look like a plastic surgeon’s office in any conventional sense. It does however lend itself to people looking to slip in and out with little notice. :)

There are of course times in which the illusion is that a patient wants things secret when she really wants to leak her plastic surgery to the press for promotional reasons, but that is another story isn’t it?

Best Regards,

John Di Saia MD

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

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Reader – “Help Dr D, My Plastic Surgeon is an ahole!”

Reader Question:

I know you can’t fix this but can you help me cope? My plastic surgeon is an ahole. He has no time for me now that he has operated. He just ignores my concerns. I look OK but I want to do what I can to get the best result possible. He doesn’t care about me.

I am in Orange County. I so wish I knew you before I let this toad touch me! He is a short arrogant little twit though in Laguna Hills. I don’t regret my plastic surgery just my choice of a plastic surgeon.

I frequently remind people to choose carefully when they are in the market for a plastic surgeon. Once surgery has been performed it is hard to switch. Many docs will not accept patients who present liability challenges from the onset. This includes fresh post-ops and people who look like they might sue someone.

The first thing is to try to deal with the surgeon you have. Try to get through to him. How was he when you first met? Docs who never have time for their patients before surgery frequently don’t afterward.

Maybe you can develop a relationship with a contact person in the office and get what you need from that person? Otherwise you can try to call around and find another local surgeon who can help you. Try to choose better this time.

Best Regards,

John Di Saia MD

P.S. I think I know who you might be writing about, but I can’t put his name here for obvious reasons.

Originally posted 2011-03-17 07:30:34.

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Dr D’s “Kim Kardashian – 3 Plastic Surgery Stories”

Kim Kardashian – 3 Plastic Surgery Stories Mp3

Kim Kardashian has been doing a media tour and her story on plastic surgery keeps changing. A little comedy seemed only fair.

Best Regards,

John Di Saia MD

Originally posted 2010-05-28 07:30:04.

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Dr D versus the V-Loc: A Patient Story

I had a patient come for scar revision surgery who had previously some scars revised by another surgeon using the V-Loc suture device. This resulted in wide (nearly 2 cm wide) wounds at the site of groin scar revisions. I do not use these contraptions as I do not see them making me better than I am already. :)

What is the V-Loc?

The V-Loc is a barbed suturing device made to save the surgeon time in closing wounds. Barbed sutures have been popular developments in the past five or so years. I have been reluctant as I have said in using them. Why change things that are working well? The V-Loc uses polyglyconate suture material (Maxon TM) which is actually a pretty good material when used properly.

I revised one of the patient’s scars using my own technique. We will see how the wound heals. Maybe the patient will allow me to share his images as his scar matures.

Best Regards,

John Di Saia MD

Originally posted 2012-01-27 07:30:13.

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Non Provider Non Elective Plastic Surgery – Your Health Insurance May Pay

The games that many health insurance companies play make doctors wary of becoming a “Provider.” Provider status is nothing more than a contract in which the doctor relinquishes quite a few rights, for example the right to determine what a service should be paid. I am selective about contracting with health insurance companies for this reason. And I still do some work for insurers to which I am not contracted.

How can this work?

Some of the surgery I perform is not elective. It involves hospitalized patients who have wounds that won’t heal (or haven’t healed) without surgical help. In some of these hospitals I am the only plastic surgeon on staff.

Why does this make a difference?

If you need surgery and the only available surgeon is not a provider for your insurer, you will find your insurer may be willing to make an agreement with the surgeon for that one case. My office interfaces with the insurer and often we come to an agreement and are able to do the operation as a covered benefit. Some insurers are more receptive than others. Others simply offer an unacceptably low rate knowing no good surgeon will take it.

This is not 100%, but can work. Some patients have actually called their human resource departments at work and helped the process along too. The fact is that surgery costs your insurer money and without some pushing you might not get it. Be prepared to get involved if you want better care.

Best Regards,

John Di Saia MD

Originally posted 2011-05-05 07:30:55.

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Reader Question: Acne Scarring Treatment

Hello, Dr Di Saia,

I’ve had acne for a few years (it is now almost completely gone) and I am now left with a few but noticeable facial scars. What is the best way to deal with them? What fillers would you recommend? Would a chemical peel or microdermobrasion be enough?? (I personally don’t think it would be). I am 19, by the way. Thank you for your professional advice!

Acne scarring is an extremely variable problem. The treatment depends upon severity and skin type. A single facial peel will likely not be enough to improve any, but the lightest of cases. You really need an individual professional evaluation regarding peels, fillers, and other surgical options as they pertain to your specific case.

Best Regards,

John Di Saia MD

Related:

Basic Skin Care

Originally posted 2005-07-24 15:35:00.

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Safe Breast Augmentation – How To Get Yours.

Safe Breast Augmentation?

The level of confusion regarding breast implant surgery is enormous. Can you get implant surgery without the drama?

safe breast augmentation

There are sites with scary stories of women (including this one) who went to horrifying B movie type doctors and had horrendous results. There are also stories of women who went bigger and bigger and bigger until their breast tissue just gave out and failed.

Safe Breast Augmentation is possible as long as you exercise proper judgement. Suffice it to say there are plenty of women who have had safe breast augmentation:

“Dr. D!!! They are still so awesome! They aren’t hard or sagging, almost 16 years later. Unbelievable! They look great and feel like a part of my body. You are the best and you can tell everyone I think so!!”
-G: Los Angeles, Ca. – Breast augmentation patient 2013

This woman had her breast implants placed in 1997 by yours truly. They were placed in an operating facility under her pectoral muscles and were saline-filled models of a moderate size. Now fifteen years later, she has needed no additional surgery and feels and looks great.

Beware advertising gimmicks and promises of the extreme. Choose a qualifed board certified plastic surgeon and moderate enhancement guided by his or her advice. That “happy medium” might just last you ten or more years. :)

Best Regards,

John Di Saia MD

Originally posted 2013-04-01 07:30:53.

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