Archive for category Dr D article
Dr D Guest Blogging at the OC Register on Fat Busting Gizmos
Posted by admin in Dr D article on May 10, 2013
Today I did a guest blog over at the OC Register’s cosmetic blog. The subject is my reflections on the gimmicks within the liposuction and mad fat busting markets. Go on over and check it out:
Plastic surgeon: Beware ‘fat busting’ gizmo frenzy
Best Regards,
John Di Saia MD
Originally posted 2012-06-14 07:30:26.
Dr D Writes for CoedMagazine.com
Posted by admin in Dr D article on May 6, 2013
Dr D’s “What To Do When Your Girl Hints Breast Implants”
Here’s a piece I wrote somewhat in the style of a Maxim article. It might keep a few guys out of trouble. 
Best Regards,
John Di Saia MD
Originally posted 2012-02-29 07:30:16.
Dr D’s “Cheap Plastic Surgery”
Posted by admin in Dr D article, Dr D's Truth on April 22, 2013
Most people looking into cosmetic surgery soon realize that it is not cheap, but why? Why is it so expensive? There are many reasons. Most of them have to do with overhead. The discussion below is meant to give you some insight into the way plastic surgery is practiced. It varies quite a bit. Bargain Basement plastic surgery may not be the best idea when you look at the big picture.
Some of you out there are thinking: “Gimme a break! I have this ad right here saying that breast implants are only $3000. How can this be?”
You are correct. There are those that do this operation for less than it costs me to render the service. Then there are those who use ads to get you into the office and the story changes when you get there. How can they do this? Below we will lay out some possibilities. These may seem quite familiar to some of you:
Say you walk with ad in hand to see the doctor. You notice that the doctor’s name doesn’t seem to be listed in the advertisement. This is called a Bait and Switch Scam.
SCENARIO 1: “All things are not as they seem”
You find yourself in an examination room with a nurse who tells you that the doctor only meets with patients after they have signed up for surgery. This saves the practice money, but wouldn’t you rather meet your surgeon before you decide to make him your surgeon? She then explains that the price you saw in the advertisement is just the surgeon’s fee. The full price with anesthesia, the facility fee and implants is several thousand dollars more.
SCENARIO 2: “The surgeon and facility are not as they seem”
You meet the doctor and ask him about his training. You find that he trained as an Obstetrician or Head and Neck Surgeon. He started doing cosmetic surgery years ago. He is not board eligible or board certified in Plastic Surgery, but he is board certified in “Cosmetic Surgery.” He operates in his office, but hasn’t bothered to have it certified by any ambulatory care agency, so there is no facility fee. He does the procedure under “twilight sleep,” so there is no anesthesia fee.
I am not trying to say that you have to pay a fortune to have cosmetic surgery, but contrary to popular belief most plastic surgeons are not trying to rip you off. They have legitimate costs of doing business and pass these on to their clientele. By the same token if you see a few doctors and one has a “sky-high” fee, don’t think that an operation here is a guaranteed success. My suggestion is that you consider seeing a few surgeons. Take your cosmetic surgery fee quotations and throw out the really high and really low ones. Then choose one of the remaining surgeons.
When you go to have a cosmetic operation, you are paying for the expertise of your surgeon. You are also paying for every patient who has ever sued a plastic surgeon in Southern California, because this is how malpractice insurance premiums are charged. Malpractice insurance is one of the highest overhead items that plastic surgeons pay. Non-plastic surgeons who perform cosmetic surgery often do so without specific malpractice coverage meaning they pay cheaper malpractice premiums than I do. Finally, in choosing cosmetic surgery with a particular surgeon you are choosing a Level of Service. This often changes dramatically with the price tag.
Best Regards,
John Di Saia MD
I originally wrote this for my web site a few years ago. It still applies to this day however.
Dr D Guest Blogging on Marketing in Plastic Surgery
Posted by admin in Dr D article on March 23, 2013
Plastic Surgery Come-ons can be Absurd
This is a piece that ran on the OC Register’s “In Your Face” blog regarding my opinion on marketing in my fine field. Truth and sarcasm as is my custom.
Best Regards,
John Di Saia MD
Originally posted 2012-07-02 07:30:29.
When a Necklift Doesn’t
Posted by admin in Dr D article on February 4, 2013
An article I wrote for the Sun Post News……
When a Necklift Doesn’t
Extreme Makeover and other “fantasy” plastic surgery television has definitely had an effect on consultation traffic in my office. The notion that more than a few large operations can and should occur in one operative session has become almost commonplace. My own disagreement with the general premise has been the subject of this column more than once.
There are specific situations however in which one procedure can and does contribute to the success of another. Necklift surgery is a prime example. As of late I have seen a few consultations for necklift as well as a patient in whom another surgeon’s necklift left her nonplused.
In the vast majority of cases, a necklift and at least a minimal facelift go together. The reasons for this are practical. A basic facelift includes dissection and repositioning of the “middle” of the face and neck. These structures are in continuity with one another so movement of one affects the other. Patients with more than minimal banding (the famous “turkey gobbler” neck) require repositioning using a facelift approach. It is possible to not do a facelift at the same time, but this affects the ability to reposition the neck without a deformity at the jawline. When the tissue planes are exposed, correcting them both seems logical. My opinion is that the result is potentially more long lasting.
There are those surgeons who have chosen to work from the neck alone. The benefit here is that of less trauma from less surgery. The second opinion consultation patient I mentioned above had had a “neck only” neck lift by her former surgeon. The result by her estimation was less than wonderful. While I cannot comment on her pre-operative appearance (which is very important in judging the result of an operation), lesser surgery in the neck often leads to dissatisfaction.
“But my surgeon was on one of those ‘Extreme Makeover’ television programs. He came well-recommended.”
I’d wager that her case won’t be featured on an upcoming show. Television can be edited. Real life cannot.
The Advice:
Plastic surgery is surgery and there are different methods to obtaining a good result. Any surgical plan is an estimate based upon the experience of the surgeon concerned. Both patient and surgeon need to be on the same page before entering an operating room. If your surgeon offers lesser surgery, ask what you might expect in the way of an outcome. A few consultations are never a bad idea when coming to a decision in this regard.
Best Regards,
John Di Saia, MD
Originally posted 2005-07-01 19:47:00.
What’s Your Gimmick Doctor? Dealing With The Media
Posted by admin in Doctor's Corner, Dr D article on January 15, 2013
Anyone running a private practice in plastic surgery now should be quick to realize that the media can be a powerful resource.
The sad fact is that the public does not know of your talents unless you let them know about them. My father’s long held statement that “the cream floats to the top” is naive to say the least. People do not know the best. They only know the doctors of whom they have heard. They just assume that they are the best. Sometimes they are. Sometimes they aren’t.
Early in my interactions with the media, it was apparent that they prefer to feature “breaking news items.” Their definition of breaking news is something new and different. Most of us in medicine know that these “breaking news items” we see actually featured tend to more often be not-so-new news. Some are factually incorrect. You may also add some unadulterated bull pucky. Breaking this news to your friends in the media will get you rarely featured unfortunately. They want what they want.
When dealing with the media, they in essence want to know “what’s your gimmick?’ They want a pitch. They want a story. Those who are more successful with them give them what they want. I give them the truth branded somewhat with my opinion. So I have made the truth my gimmick. It may not be so frequently successful, but I sleep well at night.
[Originally written for and published on MedicalSpaMD.com:
http://medicalspamd.com/the-blog/2012/7/2/whats-your-gimmick-doctor.html]
Best Regards,
John Di Saia MD
Originally posted 2012-07-13 07:30:21.
Dr D’s “Does A Plastic Surgeon Ever Say No?”
Posted by admin in Dr D article on January 14, 2013
“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.
Best Regards,
John Di Saia MD
I originally wrote this for my web site a few years ago. It still applies to this day however.
Dr D Writes for Medical Economics
Posted by admin in Doctor's Corner, Dr D article on December 31, 2012
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. 
Best Regards,
John Di Saia MD
Originally posted 2012-02-07 07:30:45.
My Problem With Extreme Makeover
Posted by admin in Dr D article on July 19, 2012
This piece was originally written for the local press. It was published in Beach Cities Style in the July 2004 issue. It may be helpful for those trying to assess reality versus hype in cosmetic surgery.
What could a plastic surgeon possibly have against “Extreme Makeover?” After all, the show has certainly increased the awareness of the average American to cosmetic surgery in general. Doesn’t this translate into more business? The surgeons on the show have very likely enjoyed some degree of market advantage from their involvement. Isn’t this true for cosmetic surgery in general?
If the show didn’t seem to affect the average patient coming into my office for cosmetic surgery, I wouldn’t have a problem. I notice in my patients that have seen the show however, impressions that confound successful encounters with cosmetic surgery. These impressions revolve around the concept of “unrealistic expectations.”
Best Regards,
John Di Saia MD
Originally posted 2005-05-07 15:34:00.
Doing the Wife’s Tummy Tuck
Posted by admin in Dr D article on March 30, 2012
One fine fall morning last year my wife turned to me and said: “I want a tummy tuck. There are no rules against you doing that for me are there?”
We had talked about tummy tuck surgery for her several times over the years. She had had a gastric bypass a decade before we had met and was a pretty good candidate. No cigarettes. Well she did have a few surgical scars. Her gastric bypass was via the older “open” approach. It pre-dated the emergence of laparoscopic surgery by about five years.
I had some dim remembrance as a medical student of being told that surgeons did not operate upon their wives. But I also knew that my program director in plastic surgery had done his wife’s facelift. I also recalled asking him when I found out why he had done this…in a very non confrontational way of course.
He said spryly: “She deserved the best.” OK. I do a pretty good tummy tuck. If wifey wanted a nose job, I would have declined. I don’t do noses really.
So in investigating the big picture on the topic I started as I do for everything else: a Google search. This led me to the AMA web site and:
Interestingly, the American Medical Association in its initial, 1847, “Code of Medical Ethics” addressed treatment of physicians’ families when it said of the physician, “the natural anxiety and solicitude which he experiences at the sickness of a wife, a child, or anyone who by the ties of consanguinity is rendered peculiarly dear to him, tend to obscure his judgment and produce timidity and irresolution in his practice.”
So the AMA warned that my objectivity might be compromised. The more I thought about it I wanted to do it. Despite the fact that it might make me sound arrogant, I wouldn’t want anyone else doing it. Then again if I did it and there was a problem, might it mar an otherwise good marriage? If someone else did her surgery and there was a problem, would I feel guilty for not having done it myself? This was a catch 22 for sure.
The day of surgery was weird. The anesthesia and the skin incision were especially surreal. Operating upon loved ones feels different. Fortunately once the operation got going I snapped out of it and got into the flow of things. Pain was not a problem either. Thank God for the pain pump. Those things work well.
So at the end of the experience, while I better understand the issues about which the AMA warns, I was satisfied that I had done the right thing. Kim did well with surgery and has a nice result. I would be dishonest not to admit that it was a bit more “wear and tear” on me than the average case. Keeping the family surgery to a minimum is my recommendation for those who may follow.
I wrote this one for Kevinmd.com. It will appear at this link once posted.
Best Regards,
John Di Saia MD
-
You are currently browsing the archives for the Dr D article category.
Dr D – Your Orange County Surgeon
PAGE STATS:
scrolling="no" frameborder="0"
style="border:none; width:300px; height:60px">
MORE ONLINE Dr D
Dr D on Instagram
