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Reader Question – I am 30. Recommendations?

July 13th, 2010

Reader Question:

I have just hit my magic number 30 birthday and am looking into fillers, lasers, and/or botox for my face. I have fine nose/mouth lines and between my eyebrows and on my forehead and crow’s feet. These are fine lines. I am not a smoker and I am pretty good about using sunscreen, but I would like to do something about the damage already on my face and preventative maintenance for the future. Any thoughts?

Happy birthday Becca. My general recommendation is to stay conservative in the strength and amount of work that is done for prevention. There are no good studies showing how people age with these treatments over time. There are well publicized cases however of people who have clearly gone too far and/or tried unadvised treatments. New is not always better or even safe in plastic surgery. Seek expert advice and treatment.

That translates to perhaps some light facial peels, a little botulinum toxin between the eyebrows and maybe a touch of filler at the upper lip line. I would need to see you to specifically make recommendations for you in particular, but these would likely be my starting points.

Best Regards,

John Di Saia MD

Originally posted 2009-11-24 09:00:44.

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Don’t Want Your Breast Implants Anymore? – Have Them Out

June 24th, 2010

In the office we have had a noticeable increase in requests for breast implant removal without replacement. Women are naturally concerned about what things will look like afterward and this does vary quite a bit.

Not everyone needs or wants a breast lift afterward. If the patient’s implants are not too large and are saline-filled, often the operation is quite simple and leaves nice results. On the other hand, old silicone gel implants or their remnants can leave a mess in there. This can require more surgery to repair.

Best Regards,

John Di Saia MD

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Reader Question – Scar Improvement When to Seek Surgery?

June 16th, 2010

I have a wide scar on my leg that I got years ago. I have tried creams and stuff. When is surgery a good idea to improve a scar? Can a cream or a laser make it thinner?

Scar improvement has several phases and the condition of your body and how the wound occurred have parts to play. Early on after wounding there is the question of whether or not to have surgery to repair the wound. If the edges are clean and close together, then surgery is not always beneficial. If they are apart or the wound is dirty a proper medical evaluation and/or surgery can make things better down the line. When in doubt, get that evaluation.

Once the wound has started healing, if the edges are were not put together or were traumatized then scar tissue will form along those areas. Scar tissue doesn’t look like regular tissue. It doesn’t tan like regular tissue and it can be lumpy or obvious.

Surgery can improve a scar at this stage, but that scar should be allowed to mature before surgery is performed in most cases. The tissue softens and this makes the results of scar revision surgery potentially better.

In your case if a year has elapsed I would say have a good plastic surgeon look at your scar to give you an opinion on the potential for improvement. Many small scar revision procedures can be done under local (numbing only) shots in the office to keep the cost down.

Best Regards,

John Di Saia MD

Related:

Scar Revision

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Hospitalist? What’s a Hospitalist?

April 20th, 2010

On my way to the gym recently they were talking on KABC talk radio about Hospitalists. They left out a few cogent points and I couldn’t get to them before they switched topics.

Hospitalists are doctors who specifically care for hospitalized patients. The problem as I often see it is how they work and more specifically for whom they work.

Generally Hospitalists work for an IPA or HMO. They are hired to facilitate efficient (read “Cheaper”) Care. They get patients in and out of the hospital operating primarily to make it cheaper for their employer.

When you are admitted to the hospital and you are an HMO patient, if that HMO has a hospitalist program, the hospitalist on duty takes care of you. They work in shifts. You regular doctor is often not even informed of your hospital visit.

This is just another ding to the continuity of care that used to be one of the best aspects of a great Health Care system.

Best Regards,

John Di Saia MD

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Nipple Reduction or Areola Reduction?

April 2nd, 2010

Patients occasionally come in asking about nipple reduction. There is frequently confusion regarding what is to be reduced.

The nipple is the protruding central part of the breast (usually.) It is adjacent to the pigmented surrounding area, the areola. Sometimes the nipple protrudes too much or the areola seems too wide. A nipple reduction is technically the reduction of the central nipple. The areola can also be reduced and this is sometimes done at the time of a breast lift or reduction. Nipple reduction can result in some numbness, but can frequently be done as a small scale procedure under local.

Best Regards,

John Di Saia MD

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Reader Question – Breast Reduction and Post-op Fullness

March 31st, 2010

I am going to have a breast reduction soon but have always loved my breast fullness. Is there a way that they can be reduced and remain full?

Young women with particularly large breasts retain some of that fullness after breast reduction, but it does vary with the technique and target size. This is something to discuss with your surgeon before surgery and to confirm with some images of patients he or she has previously operated.

Take into account that larger reduction results have more of a tendency to become droopy as well. Gravity has a tendency to win if things are left too large.

This one like many thing in plastic surgery is relative….relative to how
small you go and how exactly it is done.

Best Regards,

John Di Saia MD

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Tax Deductible Plastic Surgery?

March 8th, 2010

From Philly.com:

Dear Harry: When I was about 12 years old, I was injured in a bike-riding accident. For the last 10 years, I have had a scar above my right eye that I feel certain has hampered me socially. Last summer, I paid a substantial fee to a plastic surgeon to get rid of it. The surgery has made quite a difference in my life. My tax preparer said that cosmetic surgery is not a deductible medical expense. My surgeon said that it is. IRS gave me a bunch of ifs, ands, and buts. What is the story here, Harry?

What Harry says: Cosmetic surgery is deductible if it is to repair a disfigurement. Such a scar on a young lady is certainly within those bounds.

Philly.com

Scar revision might be tax deductible, but it is always best to check with a tax professional. I never tell a patient something is tax deductible. I am a surgeon not an accountant. Surgery that is not strictly cosmetic to correct pre-existing problems is more likely deductible however.

Best Regards,

John Di Saia MD

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Tumeric as a Wound Dressing?

February 19th, 2010

This nice elderly Chinese gentleman with a hand wound became a patient over a month ago. Like many Asian patients he uses some Eastern remedies in his daily life.

I have not seen the use of tumeric before for open wounds. This gentleman has been using it regularly for this hand wound as a dressing. He does not wish to have the wound treated with a skin graft. It is taking a while to heal and it is hard to tell if this is because of the tumeric, his age or use of the hand as he walks with a cane.

Some Eastern remedies seem to work pretty well. I am not sure this is one of them, but it is his hand.

Tumeric at Ehow

Best Regards,

John Di Saia MD

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Exercise Instead of Breast Reduction/Lift?

January 29th, 2010

Women sometimes are sold on the idea that exercises will lift their breasts so breast reduction or breast lift surgery can be avoided.

Exercise can lead to weight loss and weight loss can hep reduce breast fullness. This will not lift the breasts however. Sometimes weight loss will make the breasts droop more, but it will not lift them. Exercise does not tighten the skin.

I usually recommend that my patients get their weight into a range that they can maintain, then consider whether or not surgery might be a good thing for them.

Best Regards,

John Di Saia MD

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Reader Question: Scar Improvement

December 22nd, 2009

Reader Question:

Is there anything to do for white pigmented scars post surgery, do they usually resolve themselves? Is cortisone cream helpful? Also a small strip of skin going down from incision has turned whiter, perhaps from tension?

You have several issues here:

(1) Pigment – The color of scar tissue and normal skin is different. Trauma and bleeding in the tissues can also introduce color changes. The lack of pigment is a white color which is probably scar (if you are Caucasian.) If this area is wide you might be a candidate for a scar revision.

(2) Timing / Non Operative Care- Scars do improve over the first year or so after the wounding that caused them to form. They do so better if kept out of the sun or if sun screens are applied. Silicone sheeting and/or massage can be helpful as well as the scar matures or remodels.

(3) Tension – Tension usually does not cause long term color changes in a scar unless there is quite a bit of it.

(4) Steroids – Steroid creams are not always helpful. I would avoid them unless professional advice recommends their use.

It sounds like you need an evaluation to figure your next best move.

Best Regards,

John Di Saia MD

Related:

Dr D’s Scar Revision Website Section

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