Archive for July, 2009
Federal Cosmetic Surgery Tax? – WTF?
Posted by admin in cosmetic surgery tax on July 31, 2009
Desperate to generate revenue to pay for a historically aggressive outlay of government spending, the Senate is considering taxing the vanity of Americans.
Senate Finance Committee discussed today levying a 10-percent tax on all cosmetic surgery procedures except those necessary for medical reasons, reports Congress Daily.
Ladies, they are coming for your Botox. It is pretty funny actually that no one seems to look at how much we are currently taxed before trying to come up with a reason we should be taxed more.
They tried this on the State level in New Jersey a few years ago and patients ran out of state. Make it federal and they will probably just go out of the country. Great idea.
Best Regards,
John Di Saia MD
Surgical Tourism…a Bad Trip?
Posted by admin in surgical tourism on July 31, 2009
Sally Farmer was entranced by the slick e-brochure she received in 2005. Filled with enticing photos of Prague, it promised ‘cosmetic surgery of the highest quality, while taking in the historic, beautiful cities of the Czech Republic’.
Like thousands of women, Sally was unhappy with her face – a small bump in the bridge of her nose had bothered her since childhood.
Plastic surgical tourism is a popular alternative to the more expensive domestic option.
She booked a £2,000 package that included rhinoplasty (a nose job) and ten days at a local hotel for her recovery. In the UK, the operation would have cost about £3,000.
Price is the main allure. In this case a free vacation of sorts was added.
Yet, when the bandages came off, the bump had gone. She was thrilled. Even the fact that the tip of her nose felt soft to touch and almost hollow failed to dampen her mood.
‘Everything will settle,’ Dusan Vlcek, Sally’s Czech surgeon had said when she queried the peculiar sensation. ‘I was due to fly home that day so had to take his word for it,’ recalls Sally.
But it was to be the start of a four-year ordeal that would leave her disfigured and needing two repair procedures – as well as a sizeable bill.
When you go to the cut rate guy, there is risk. In this case, cheap got really expensive. It looks like she needed some tip work that wasn’t really done. Redos can be hard.
Best Regards,
John Di Saia MD
Related:
Disfigured By Fillers
Posted by admin in Lip Filler, soft tissue fillers on July 30, 2009
[T]he British Association of Aesthetic Plastic Surgeons (BAAPS) published statistics revealing that almost a quarter of their members had seen patients for surgery to correct problems caused by permanent fillers – injectable gels used to add volume to the face and, more recently, the body.
Permanent fillers are dangerous. Silicone gel was the prototypical “permanent filler.” No responsible plastic surgeons of whom I know offer it to their clients.
The good and the bad about the safe soft tissue fillers is that they don’t last too long. The newer Hyaluronic acid fillers (Hylaform, Restylane, Captique, Prevelle and the like) are probably the safest we have seen to date. They have the fewest reactions and problems, but last only a few months.
Stay away from permanent fillers.
Best Regards,
John Di Saia MD
Dr D on OCRegister Blog Chat 7/29/09
Posted by admin in Dr D quoted, OC Register on July 29, 2009
Thanks to Colin Stewart and the OC Register for the Online Chat earlier today on breast implants and re-operative surgery. A transcript of the chat is online for those who couldn’t make it. I announce these things via my twitter acct for those who might want to be there next time.
Best Regards,
John Di Saia MD
Reader Question: Does Zerona Work?
Posted by admin in Dr D Says No, Plastic Surgery Tech Gimmicks on July 29, 2009
Reader Question:
On twitter Zerona is marketing their laser device saying “If you need to lose inches fast, try Zerona! It is a non-surgical laser that will literally melt inches in 2 weeks.” Can you explain whether this claim is valid
Remember the old saying: “If it sounds too good to be true, it probably is?”
Those who advertise in such a fashion do so hoping to take advantage of people’s tendencies to want quick results without much effort. Even the best liposuction results take a few weeks to start to materialize and liposuction takes fat out of your body that you can actually see. From what I see clients are getting Zerona treatments in the offices of Chiropractors. If the product worked so well, the company would likely market it to plastic surgeons.
Zerona sounds like an advertising gimmick to me and there are plenty of them in liposuction and other “fat removal” modalities. We will see if it actually does anything. It is too new to have any real data yet.
Best Regards,
John Di Saia MD
Michael Jackson and Propofol Safety
Posted by admin in Not Plastic Surgery on July 28, 2009
Now that Dr Conrad Murray has reportedly admitted to giving Michael Jackson Propofol in his home,we need to dispel a few rumors:
Propofol is safe when given in an operating room. It is very commonly used in outpatient anesthesia as it has the benefit of wearing off quickly. It is very potent and needs to be given under the proper conditions.
An IV drip of Propofol allows a constant, steady infusion of the drug for a period of time determined by the person administering it.
It is considered reckless in the medical community for a doctor to administer an IV drip of Propofol without the patient being monitored by an EKG, which sounds an alarm when the patient’s pulse drops too low. No EKG was found in the house.
Another device — known as a pulse oximeter — is used to determine the oxygen saturation in the patient’s blood. If the patient’s breathing slows to a dangerous level, an alarm alerts the treating physician. Again, no oximeter was found in the house.
I would add that more equipment to support and monitor breathing should also be there as a minimum.
Last week I did a case in which the patient received Propofol and was worried. Of course there was no problem because it was administered by an anesthesiologist under the proper conditions.
Propofol is not approved for home use.
The real shame about this is that Jackson had the resources to put the proper equipment and expertise together and although Propofol is not a sleep medication, he probably could have had it safely administered.
Best Regards,
John Di Saia MD
Reader Question: Suture Granuloma? My Suture’s Spitting Out!
Reader Question:
I had a Tummy Tuck and my doctor told me that he used dissolvable stitches. I am 5 weeks out and have formed a few painful little bumps along the scar line. My doctor removed a clear stitch from one of them that looked like fishing line with some pus today and I am freaking out!
When do these hellish dissolvable stitches dissolve? What in God’s name is a Suture Granuloma?
Long term dissolvable sutures used underneath skin closures (you probably have Monocryl, Maxon or PDS) have good points and bad points. They help control the width of scars making them stay thinner via holding the tension of a tight closure. Eventually these sutures dissolve in two to six months or more (depending upon the type.) The bad part is that some patient’s bodies can react to them like yours seems to be and form little pus pockets in response to some of them. The body kinda “spits” some of these sutures through the scar which can seem scary.
Not all of your sutures will do this, but you might have a few problems over the next few months and your surgeon may want to take note of the suture type to which you seem to be having the problem to avoid it if you are to have any more surgery. Patients seem to react to the individual types differently and some might work better for you than others. Stay close to your surgeon’s office and wait out the next few months.
Best Regards,
John Di Saia MD
Reader Laura’s Question – Body Mods and Corrective Surgery?
Posted by admin in too much hurts on July 27, 2009
Reader Question:
A new “beauty” fad in Tokyo clubs has teens injecting themselves with bags of saline, disfiguring their heads! They call themselves “Bagel Heads” or “bagelheads.”
This website made me wonder if you’ve seen an increase in patients seeking corrective surgery for the body modifications that seem to be getting more extreme (and stupid) every day.
I have not seen request to fix these kinds of body mods. I frequently see corrective surgery patients for scar revisions. These extreme injection mods would probably just stretch out the facial skin resulting in early sagging faces. If plastic surgeons are to see requests for fixes I would imagine it will be in 5-10 years or longer. We’ll see how long the fad persists.
Best Regards,
John Di Saia MD
P.S. Laura has posted a bunch of good blog topics, so she should start getting some credit.
Related:
Reader Question: Should I Have My Lipoma Removed?
Reader Question:
I went to my doctor and was told I have a Lipoma? What is a Lipoma? Should I have it removed?
A lipoma is a noncancerous fatty tumor usually found in the fatty layer under the skin. They grow slowly and are usually no more than a nuisance; that is unless they have been growing for a while. They usually appear as a kinda soft lump under the skin.
As they grow, the displace and occupy the space of tissues around them (usually fat.) They can become quite large over the course of years. There is the other potential problem; namely that you can’t be 100% sure that your “lump” is a just a lipoma until you remove it and send it to the pathologist. Some lumps are cancerous.
The bottom line is that I usually recommend removal.
Try to have it removed while it is small so there is less of a “dent” and the surgery is usually pretty low key. Often small ones can be done in the office under local anesthesia. And consider sending the removed lump for pathology just so you know what it was.
Best Regards,
John Di Saia MD
Related:
New Credit Law
On May 22, President Barack Obama signed into law the Credit Card Accountability, Responsibility and Disclosure Act of 2009. Under the new law, no one under age 21 can get a credit card unless a parent, guardian or spouse is willing to co-sign or unless the young adult has proof of sufficient income to cover the credit obligations.
I rarely agree with the President these days but this actually might be a good thing depending upon how it is implemented of course. It might cut into some cosmetic surgery practices, but mine does not specifically cater to the really young.
Best Regards,
John Di Saia MD
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