Archive for category Reader Question
Reader Question: Weight Loss Military Liposuction?
Posted by admin in Reader Question on May 20, 2013
Was reading your testimonials and like one of your patients who was overweight and the military, I am in the same boat. I was wondering what you could do for me to assist in my goals to stay in the military through liposuction or body contouring.
I’m not huge but all my dieting and exercise feels like it’s for nothing. I’m 225 and need to lose about 35 pounds. Is this the right move if traditional weight loss isn’t working?
Liposuction is a contouring procedure rather than a weight loss method. With the amount of weight you’d like to lose, liposuction is not going to deliver for you. I do not make it a practice of going for weight reduction with liposuction or body contouring surgery anyway.
I have performed liposuction occasionally to help military clients fulfill requirements, but focused on shape in close cases in which these men were a bit wide in the belly measurement usually. Any plastic surgeon promising weight loss from liposuction is “talking things up” rather than being truthful.
Best Regards,
John Di Saia MD
Reader Laura on Arm Lift (Brachioplasty)
Posted by admin in Reader Question on May 13, 2013
Reader Laura Question:
Last year over 15,000 Americans had either lipo or a surgical procedure (brachioplasty) to reduce the excess skin from their upper arms. Reports say the increase is due to the number of people having bariatric surgery and losing more than 80 pounds in a short period of time.
If people lose over 80 pounds in a slower amount of time will they have the same issues with excessive skin? Will the use of compression garments with exercise and diet help to reduce the need for surgery on excessive skin? Can anything be done beside surgery or should those considering bariatric surgery just assume that they will need additional surgery to remove excessive skin at some point in the future and plan for it? Also, is there any way to minimize the scars from brachioplasty? Not sure if having a large, long scar running from your arm pit to your elbow is really an improvement.
Arm Lift or brachioplasty surgery is more popular in the after gastric bypass plastic surgery patient group. The procedure is one in a family of operations called body lifts. Of the operations gastric bypass patients seek to mitigate their post extreme weight loss condition, brachioplasty is one of the least commonly requested. This is of course due to the nature of the scarring you have mentioned.
Extreme weight loss lends itself to skin laxity in the abdomen, arms, breasts and legs. The face tends to be preserved until these patients age. Whether the rate of the weight loss might retard the development of the laxity is not well known.
The scarring from arm lift surgery does improve over time but is hard to mitigate. The long incision length tends to be necessary to correct the laxity for which it is performed.
Best Regards,
John Di Saia MD
Related:
Botox Not Working? Reader Laura Question
Posted by admin in Dr D's Truth, Reader Question on May 6, 2013
Reader Laura Question:
Some scientists warn users that they have been using so much and so often that they are building up an immunity to Botox and it’s no longer as effective for them. That as many as 1 in 200 no longer can use Botox. Have you seen anything like this happening with patients coming to your office? Do you think this would be something that is permanent or would they be able to use it again after going without Botox for some time? Also, is there anything else they could use if they could no longer use Botox?
We have discussed the reasons why Botox results vary before. Amongst the ideas not elucidated there was the concept of antibodies. Botulinum toxins are foreign proteins to the human body, so it is only natural that at least some patients would develop these in response to the treatments. There are patients who over time experience decreasing effectiveness with Botox. Whether or not this is due to antibodies is debated. At times changing to another toxin can be helpful. There are however at times people in whom the alternatives still produce less than satisfactory results.
This is amongst the reasons I advocate the judicious use of these toxins in hopes of extending the period of usefulness to the individual. My opinion is of course only my own. 
Best Regards,
John Di Saia MD
Avoiding Breast Implant Problems – Reader Laura Comments
Posted by admin in Reader Question on March 26, 2013
Avoiding breast implant problems beats trying to live with them. Some can be fixed but the results vary and it is more expensive. This story features a woman who got more than her share.
Reader Laura Question:
“Doctors in the UK said that this was one of the worst cases of Capsular contracture they have seen. How common is this? Is there anything a woman can do to avoid this? If a woman were to have a leaky implant would she have to deal with the same thing?”
Lauren Yardley had always dreamed of having a more curvaceous figure. So at 25, and tired of her ‘boyish’ shape, she decided to buy what Mother Nature had not given her. She paid almost £4,000 for a breast implant operation, increasing her A-cup size breasts to DD. But to her horror, just two months after the surgery, her body started to reject one of the implants. Weeks later, it actually started protruding from her chest and came through the skin.
Source: dailymail.co.uk/health/article-2295139/Boob-job-horror-woman-
25-implant-fell-OUT-chest–leaving-lopsided-seven-months.html
This woman’s problems probably amounted to selecting too large a set of breast implants and/or employing less-than-talented surgeons.
Breast implants are not rejected very often really, but they can become infected if tissue coverage is too light relative to their size. This case was likely a poor coverage and infection issue. It could have been avoided by choosing more wisely on the smaller side. These problems tend to happen far less often and to a lesser extent when better planning is employed.
Best Regards,
John Di Saia MD
Related:
Flame facials – Reader Laura Comments
Posted by admin in Reader Question on March 18, 2013
Reader Laura Question:
“This has to be one of the scariest things I’ve heard about in awhile: flame facials. I can’t see any benefits from setting your face on fire and many ways to harm yourself.”
Women will always seek out the hottest new beauty treatments in the pursuit of youth. But a new fire facial being performed in Chinese beauty salons means treatments are literally hotter than ever. Therapists at the salons are offering women the terrifying new treatment – dubbed the flame facial, also known as Huǒ liáo – where open flames are used to stimulate cell regeneration and youthify the complexion. The therapists apply a towel soaked in alcohol and a so-called ‘special elixir’ to the skin before setting fire to the area.
Source:dailymail.co.uk/femail/article-2289665/Would-set-FIRE-face-
look-younger-Disturbing-new-treatment-sees-women-flames-pursuit-
eternal-youth.html
The idea that people will put themselves at risk doing that which seems crazy is hard to swallow. Using flame on the face looks like movie sideshow antics. It makes for flashy news copy, but I wouldn’t recommend it.
The Chinese apparently thought this one up.
Best Regards,
John Di Saia MD
Reader Question: Massage for Hardened Breast Implant?
Posted by admin in Dr D's Truth, Reader Question on December 21, 2012
I’m a Licensed Massage Therapist. One of my clients had Breast Augmentation 4 months ago, and now 1 breast became hard like a rock. My question is: How can I help her with that issue? She doesn’t want anymore surgery.
Please take this in the way it is intended: You need to get her back to her surgeon. A rock hard breast four months from implant surgery is a sign something potentially correctable with surgery is wrong. She at the very least needs consideration of surgery to remove the implant.
Capsular contracture is the medical term for implant associated hardening. “Rock hard” as you describe is uncommon in well performed breast surgery when complications are not present. Four months is really really early for it to occur without a surgically addressable cause. I suspect infection and/or bleeding is/are likely.
Massage can help implanted breasts soften in the absence of infection, bleeding or other contracture stimulators (radiation exposure, cigarette smoking, poor soft tissue coverage, etc.) For severe hardening as you describe to occur so soon after surgery, it is very unlikely things will get better without at least a little surgical help. Try to encourage her to at least get assessed for that potential help.
Best Regards,
John Di Saia MD
Reader Question: Is Mohs Surgery A Gimmick?
Posted by admin in Dr D's Truth, Reader Question on November 20, 2012
Reader Question:
“I live in Florida and it seems like the dermatologists here are doing an extremely high number of Moh’s surgeries. I’m wondering if this is becoming a money making enterprise at the patients’ and insurance companies’ expense. I’m 50 y.o. and recently had a tiny crater in the corner of my nose, diagnosed as nodular BCC.
I did the Moh’s surgery, which was more invasive than I had anticipated (supposedly was very deep once they got in there) and there will be a small scar. The derm I went to does Moh’s surgery 3 days a week with at least 3 people on the table at once. She sometimes does additional ones on a 4th day. This seems to be typical of all the derms down here that do Moh’s. “
I have written about Mohs surgery here before with overtones that hint towards answering your question. Medicine in 2012 has become a group of niche markets as it is no longer a solid business strategy to just take care of people. This is sad but true. It took me years to come to this realization which has without question cost me in the big picture.
Mohs surgery is pretty profitable particularly for Dermatologists who have relatively low overhead as compared to a surgeon anyway. Many Derms local to me do them in numbers like you specify in a way that is similar. It is like an assembly line.
It is not invariably the case that when Mohs is being performed you are being fleeced, but it can be the case in some practices. Dermatologists do carefully protect their Mohs monopoly as at one point I tried to seek training in Mohs and was basically told to take a hike.
Skin cancer in the position you indicated can be difficult to cure without Mohs and deformities in that location can be difficult to repair. There is a need for Mohs, but it is totally unregulated and some practices take advantage of that to make money.
Best Regards,
John Di Saia MD
Reader Laura on Reconstructive Nipple Surgery and Tattoo
Posted by admin in Reader Question on November 1, 2012
Reader Laura Question:
“There have been a couple of stories this week on women (after breast cancer surgery) getting nipple tattoos. Some of the women have opted to not have implants and just want the nipples so that they look more normal and others are getting the tattoos after getting the implants. When you are doing reconstruction surgery what do you do to reconstruct the nipples? Do you do anything beyond adding the implants? What options are there for women getting reconstruction surgery?”
After breast cancer surgery women often feel less than feminine. Some will look into reconstruction to regain some semblance of normalcy. Most breast reconstruction cases involve multiple stages (operations) and some women will opt to have mound reconstruction with their own tissue and/or implants. The nipples are usually reconstructed with a combination of skin grafts and local tissue re-arrangements at a later operation once the mound reconstruction is stable. In this type of surgery time between stages is optimal to allow the operation to mature before introducing another change.
After the nipples are in acceptable shape, tattooing can be performed to re-establish proper color. Some surgeons do the tattoo themselves. Others send it out to tattoo artists. The tattoos over time fade and need to be redone to maintain the change.
More on breast reconstruction after mastectomy is available on my practice web site.
Best Regards,
John Di Saia MD
Reader Laura on Kyle Richards and the Galvanic Facial
Posted by admin in Dr D's Truth, Plastic Surgery Tech Gimmicks, Reader Question on October 25, 2012
Reader Laura Question:
“Kyle Richards of “The Real Housewives of Beverly Hills” fame recently tweeted this picture of herself getting an galvanic current facial. Do you see any benefit from these kinds of facials?”
The idea with this “gizmo thingy treatment” is that electric current placed across your skin might have a beneficial effect. The problem (as is frequently the case) is no one has actually shown this to a fact. I have not seen such a machine and without some pretty good science behind it, I will certainly never use one. I have facial resurfacing treatments in my practice that perform well. Why mess with a good thing?
Perhaps this was just meant to put a charge into Ms Richards’ PR efforts?
As you can see I have added this galvanic facial post to my category of Plastic Surgery Tech Gimmicks.
My advice: Use it at your own risk. I do not recommend it. There is no evidence that this does anything and if done with too much current, you could very well get an “electric chair effect” and end up on the news. Not so hot.
Best Regards,
John Di Saia MD
Reader Question: Free Plastic Surgery? Pick Me! Pick Me!
Posted by admin in Reader Question on October 9, 2012
I’ve stumbled upon this site n it really excited me.
I have been wanting and in very much need of plastic surgery. I am 21
years old n my body looks older. I’ve given birth to one child n it
looks more like twins. I want my body back plus some lol bigger boobs
lifted rounder buttocks. I want to be a beautiful work of art. So if
you could pick me for the free plastic surgery make over it would mean so much to my self esteem my ego my life.
When you offer something free, you are going to get inquiries. I have had a “free plastic surgery giveaway” going for a while now.
Some of the people coming to the site though are wishing for “Pie in the Sky” and do not read the particulars of exactly what is being given away and what needs to be done to get it. They seem to believe I am a television show when I am a solo practicing surgeon. It is not feasible for me to give away large scale surgery. The American Board of Plastic Surgery would likely frown on me if I did.
I suggest those of you interested in my little giveaway read the giveaway page carefully to realize that I am giving away small scale services to local people who can come to the office to receive said services. The task that needs to be fulfilled is quite small. Now get to work!
Best Regards,
John Di Saia MD
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