Although sex symbol Marilyn Monroe’s time preceded that of widespread breast implantation by a decade or more, there is growing evidence that she was no stranger to cosmetic plastic surgery.
The medical notes of Hollywood Plastic Surgeon Michael Gurdin are soon to hit the auction block and Reuters shares:
The set of six X-rays and a file of doctors’ notes that offer a partial medical history of the actress from 1950 to 1962 are expected to fetch between $15,000 and $30,000 at auction on Nov. 9-10, said Julien’s Auctions in Beverly Hills, Calif.
The notes written by Hollywood plastic surgeon Michael Gurdin appear to confirm speculation that Monroe, who epitomized glamour and set a standard of movie star beauty during the latter part of Hollywood’s golden era, went under the knife for cosmetic reasons.
Gurdin’s notes include references to a 1950 cartilage implant in Monroe’s chin, which he observed to have slowly begun to dissolve.
The X-rays include Monroe’s frontal facial bones, a composite right and left X-ray of the sides of her nasal bones and dental X-rays of the roof of her mouth.
A set of three chest X-rays of Monroe from 1954 sold for $45,000 at a 2010 auction.
A self-published memoir by Beverly Hills plastic surgeon Norman Leaf in 2010 claimed that Monroe underwent cosmetic surgery on her chin in 1950, citing the same notes made by Gurdin, Leaf’s medical partner.
Leaf also states in his memoir that Monroe underwent a slight rhinoplasty procedure on the tip of her nose.
So the survey seems the indicate conservative rhinoplasty and a chin implant of cartilage. As the others indicated cosmetic work at the time was pretty rare.
John Di Saia MD
“Extreme Makeover,” “The Swan” and similar media have increased the number of potential cosmetic surgery clients. These people are not always good candidates for surgery however. Some need to come “Down to Earth” before they can have surgery.
“Reasonable Expectations” Still Reign Supreme
The vast majority of patients want to have a pleasant encounter with cosmetic surgery. The problem is trying to figure what patients expect. Communication is important. The problem is magnified when their potential surgeon doesn’t care to inquire or doesn’t make time to evaluate.
Face it. Surgeons Get Paid To Operate.
In my local practice environment, I have amongst the longest cosmetic surgery consultations and I meet all my potential surgical patients personally. This has been the source of grief between prior office mates and me (I am now in solo practice). Most of my prior office mates were primarily fixated on the bottom line. Many plastic surgeons simply do not make the time to talk with their potential patients for more than a few minutes. This makes it pretty hard to figure a patient’s options, motivations or expectations. I don’t claim to have a 100% success rate, but the vast majority of my patients are happy. Then again if I get the impression that a patient is set up for disappointment, I will not recommend surgery.
Why would I say “NO?”
When patients seem fixated upon operations which will lead down a path of complications or problems, I tend to say “No.” When patients have had too much surgery and appear distorted or strange, I say “No.” What one patient finds undesirable, however another will want. I operate if it seems I can deliver what the patient will want and I will be OK with it after I am done. Every surgeon draws his or her own line here. Being one of the few that will lose money in recommending against an operation makes me pretty unusual in my locale. To many of the surgeons practicing in Southern California, this is akin to heresy. I look at this as having integrity and proving myself trustworthy. Having predominantly happy patients makes my patient referral rate very high. My practice grows by referrals. I do very little advertising compared to other surgeons.
Be Very Careful Of Looking Too Hard
When an honest surgeon says he doesn’t feel that he can help you, it is not the end of the world. It does complicate things a bit however. You have to worry that if another surgeon offers you surgery, that he may be simply operating for the money. I have had patients for whom I recommended other than what they said they wanted. Some have come back after they had surgery elsewhere and looked pretty awful. Sometimes I can fix these things, but not always. In Southern California, there are so many plastic surgeons that even a poor surgical candidate will find one willing to operate if he or she keeps looking. Caveat emptor.
John Di Saia MD
I originally wrote this for my web site a few years ago. It still applies to this day however.
Originally posted 2013-01-14 07:30:12.
Good Thigh Lift Results
can be yours if you are the proper candidate and you have quality surgery.
The operation is designed to correct loose fatty skin along the inside of the thighs. As I have previously posted images of such operations in which things did not turn out well, here is an example of the other side of the coin.
This pretty forty something was in good shape, but had gained and lost a good deal of weight around the time of her pregnancies years prior. The result was that her inner thighs kind of touched and when she ran she felt them swinging around and slapping one another at times. The skin was loose and wrinkles were apparent. She found this inconsistent with her self-image and wanted it corrected.
A year after thigh lift surgery (upper right in the image) the problem was greatly improved (good thigh lift results.) In cases like hers the scar can be carefully hidden in the groin crease. Larger cases (such as after gastric bypass) with more loose skin can require extended incisions.
John Di Saia MD
Originally posted 2012-11-15 07:30:44.
As plastic surgery becomes increasingly common in our society, more and more individuals are electing to have cosmetic surgery to turn back the clock, eliminate unwanted fat and enhance their figures. Some couples have begun having plastic surgery together; and now, it seems that mother daughter plastic surgery may be the latest trend among prospective patients. Plastic surgeons throughout the country are seeing more and more mother-and-daughter pairs coming in together as a team – and helping one another through the healing process by providing support through shared experience.
I wonder when I read “stories” like this one as to whether even the writers believe them to be truthful or not. There is no great trend to mother and daughter plastic surgery. It is an occasional issue. This is a fluff piece as far as I am concerned. Not being familiar with the online source, maybe it is a spam farm.
Then again we have seen similar fluff pieces from larger media whenever a plastic surgery society puts out statistics in which someone tries to infer something larger from relatively small numbers. I have made my personal position statement of sorts on these. OK, just call me jaded.
John Di Saia MD
Originally posted 2013-01-21 07:30:35.
I am in Orange County and have heard that you are a very good and honest plastic surgeon. I want to get my breast implants and saw one of your examples and she had boobs like mine are now. How do I know the best Orange County plastic surgeon when I see him?
Thanks for the kind words. To address your question, the Orange County Register InYourFace Blog, did a “tongue-in-cheek” post regarding which of two Hollywood plastic surgeons is best. [http://inyourface.ocregister.com/2010/08/30/hollywood-plastic-surgery-contest-whos-best/20553/] This underscores the point of what it really means to be the best. The best according to whom and at doing what?
The practice of plastic surgery varies quite a bit. Different practices vary regarding what they offer and at what price point. Some try to make it cheap and you get an “Assembly line” concept. Others (like mine) spend more individual time with the clients (in surgery and in the office) and target quality.
Some patients like an intimate environment with a few office staff. Others like to see an office full of people and are OK about less “face time” with their surgeon. In this regard, my office runs small and intimate.
John Di Saia MD
BTW – The example you mentioned involved a full lift with implants. Implants alone will not give you the same result.
Originally posted 2010-10-07 07:30:29.
Sometimes the nature of liability forces medical care that does not seem all that compassionate. Not long ago I had a patient with a charted allergy to lidocaine, a drug that numbs the sensation of pain at surgery.
Dangerous allergies to drugs are far more common with some drugs that others. Most good plastic surgeons use a lot of lidocaine and related drugs to make surgery a less uncomfortable experience. This patient needed a pretty large skin graft and could have used that pain relief.
Almost invariably when patients are documented to have allergy to lidocaine, it is a mistake. Allergy is not the same as a less dangerous drug reaction. A common scenario is a trip to the dentist at which time a closely related drug novacaine is injected. The drug is applied too closely to a blood vessel and the patient experiences a few heart palpitations. This is a drug reaction. Most often it is documented as an allergy however.
All it would have taken to prove this would have been a small injection of lidocaine at surgery. Such a trial might indeed have been performed twenty years ago, but the medical malpractice landscape is different now. A mistake like this could easily be a slam dunk malpractice lawsuit, so a test like this is not advisable. It is simply not worth the liability to even bother.
While I have never seen a true allergy to lidocaine, any additional risk in an operation is not something a smart doctor entertains. We have enough uncompensated liability in medicine as it is. So practically-speaking the patient needed more narcotics during his post-operative period. He needed more during surgery. Thank a lawyer.
John Di Saia MD
Originally posted 2012-04-17 07:30:35.
I have had a capsulectomy due to capsular contraction, but now it has returned. I want an explant because they are uncomfortable and look unnatural. My doctor said that since the capsulectomy did not resolve the issue, he recommends having an explant and waiting about 6 months to a year. After my body has healed properly, he said that I can get implants again and will not get capsular contraction again. Is this accurate? Am I less likely to get capsular contraction or will I be free of capsular contraction? I’m also looking for a doctor experienced in explants.
The subject of hardened breast implants (Capsular Contracture) comes up frequently as it is the leading cause of long term dissatisfaction with breast implants. If your breasts tend to hurt or look unnatural, you likely have severe encapsulation (Baker Grade III or IV.) When contracture redevelops quickly after capsulectomy (assuming the operation was thorough,) this is worrisome as it may indicate a high tendency for recurrence. The main question when severe contracture is present is whether or not a cause can be identified. Bothersome contracture doesn’t happen to all patients. This kind of reaction is associated with cigarette smoking, bleeding, infection, silicone gel implants, poor soft tissue coverage and radiation exposure as well as a previous history of contracture. Some of these issues can be minimized in an attempt to reduce the tendency for encapsulation. Preventing the problem is the best solution.
While removal of your implants for a time with later replacement might improve the problem, this is not a “slam dunk” nor is it guaranteed to completely solve it. The results vary substantially. Usually removal with a good capsulectomy is the best thing for comfort. Implant replacement at times is thwarted by recurrence of the contracture.
Then again if you leave the implants in place things will not likely improve as you have had a trial of capsulectomy and replacement already. It is true however that a woman who has had her implants removed and not replaced frequently has them put in once again down the road due to appearance issues. This is not invariably the case however. Some women actually like the look of their breasts without implants after capsulectomy and explantation. The results of such surgery vary though.
These cases need to be handled individually and with a fair amount of disclosure before surgery is performed, so that everyone comes out satisfied. I don’t have one treatment that goes for all patients on the issue due to their inherent variability.
John Di Saia MD
Originally posted 2011-05-31 07:30:35.
Dr D’s “Liability Call For Your Plastic Surgeon” was published.
I am doing a bit more Op Ed writing these days. This is a piece that was written for Medical Economics regarding liability in a surgeon’s practice. This post was originally linked to the piece on their site but they took it offline.
John Di Saia MD
Originally posted 2012-02-07 07:30:45.
@VariantVal Question About Good Botox
“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.
John Di Saia MD
Originally posted 2010-08-24 07:30:12.