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.
On Oprah’s Web Site is a post entitled:
I have mixed feelings about plastic surgery statistics. As most who have spent any time doing scientific studies know, statistics can often be presented in such as way as to support almost anything an author wants. Quoted statistics can therefore fail to show important facts.
Specifics (to this post and certain points:)
Overall: Most of the statistics quoted by this Oprah post refer to information from the American Society for Aesthetic Plastic Surgery (ASAPS.) The members of the ASAPS are only a small group of the total population of surgeons performing plastic surgery. They do not even represent all board certified plastic surgeons. A good question when looking at such statistics is to what extent do they represent the national picture of plastic surgery as a whole?
Percentage of patients with breast implants who will need them removed within ten years because of rupture, hardening of the tissue around the implant, and other complications (according to a recent FDA report)
This point is from the FDA and includes their data from “breast implant patients.” At a 20% re-operation rate, it must include reconstructive patients (those have implant surgery after breast cancer surgery.) Breast cancer reconstruction patients have a very high rate of rupture and hardening which is many times that seen in carefully operated cosmetic patients.
My point is that women looking into cosmetic breast implants are not doomed to this high rate of re-operation; at least not if they are done properly anyway.
Percentage of cosmetic surgical procedures performed on women in 2010
This actually follows roughly what I see in my practice. It is still mostly women having cosmetic procedures.
Percentage of members of ASAPS who are women
I am not a member of the ASAPS, an organization that does not really even represent the landscape of board certified plastic surgeons. This figure is not all that important.
Dollars that Americans spent on cosmetic procedures in 2010
This number could be based on anything. If just based on ASAPS member data, the number is far too low. It could also be some kind of estimate. I would not put much stock in this number.
John Di Saia MD
Originally posted 2012-01-16 07:30:17.
Surfing online I found this image of a woman with breast implants under a thread entitled “Worst Boob Jobs:”
She is of course not my patient, but looking at her it made me think how misconceptions can lead people into trouble. When women shop for a “boob job” they frequently do not realize that all boob jobs are not entirely accomplished by simply placing breast implants. And not all surgeons know the difference.
When you have tuberous breasts, frequently the simple placement of breast implants is not adequate. The woman in the image above appears to have had exactly that and she looks pretty badly.
Tuberous breasts are a bit of work to correct and can at times need more than one operation to get right. Doing less than the right operation in the first place of course increases that possibility.
Here’s a woman with tuberous breasts whom I operated a few years ago. She got a good result with one operation but that operation was not just a simple boob job.
She had saline implants and a modified breast lift.
Screen your surgeons ladies……
John Di Saia MD
Originally posted 2012-01-17 07:30:51.
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.