Archive for February, 2010

“But I Wanted The Bubble Look…”

Posted by admin in breast implant pre-op tutorial on February 26, 2010

I have attached a picture from your website of what I had hoped my breast augmentation would have looked like. I went from a 36-38 C to a 38 D. I have 450 cc Mentor silicone smooth implants which have been placed under the muscle accompanied by a lift. I had surgery in October 2007 and provided my first complaint to the doctor who completed the surgery in January 2008. She indicated should could pull more skin off the breast and place a larger implant to better achieve the look I wanted but also wanted me to pay close to what I had already paid. I feel she did not listen to what I wanted and instead used her conservative approach.

When I went in for my surgery, I expressed to my doctor that I really wanted to have a very full look (with the bubble up top) accompanied by firmness. While my breast look very natural, it was not what I expected nor what I asked to have accomplished. I have been dissatisfied from day one. Although my breasts are larger, all of the fullness appears to be at the bottom of the breasts. I am hoping larger implants will provide more overall fullness and firmness.

I appreciate the compliment on my patient’s results. We were able to achieve some upper pole fullness that persisted. Then again she had very different breasts than the ones you describe before your surgery.

The truth of the matter is that the condition of a woman’s breasts before surgery has a large impact on what they will look like after surgery even when everything is done correctly. Breasts that are already moderate in size with established sag can be improved by breast lift surgery. This does not make them into the breasts of a twenty year old woman with no sag at all however.

Having low lying fullness after a breast lift and augmentation when there was significant droop in the natural breast tissue beforehand is pretty common. Larger implants and more lift surgery may improve this but only to an extent. It might also provide only short lived improvements as gravity acts on the larger heavier implants. This is something to discuss with your surgeon before surgery of course.

Best Regards,

John Di Saia MD

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Tracy Plastic Surgeon Sexual Battery Case

Posted by admin in plastic surgery news on February 25, 2010


A civil case filed by 37 patients of a Tracy plastic surgeon accused of sexual battery involving dozens of women has been settled in San Joaquin County Superior Court for $1.8 million.

Record Net

When I read things like this I think: “Another reason for my malpractice insurance premium to rise.”

Risk as such is pooled by specialty by insurance companies and the way this story reads, this guy was a plastic surgeon. Why all in plastic surgery should be held accountable in any way for the acts of this crazy man is beyond me.

Best Regards,

John Di Saia MD

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“Can You Do My Boob Job for $3000?”

Posted by admin in breast implant pre-op tutorial, cheap plastic surgery on February 24, 2010

I hear you are very good, but I hear you are expensive. I saw a billboard that said $3000 breast implants? Are they any good for us girls without so much money? Do you know any good cheap doctors?

I know plastic surgery is expensive. With the credit crunch of late, more women are saving up for those breast implants at least if they want to go to good board certified plastic surgeons. I decided a long time ago that I would not be the “chop shop” guy. My philosophy is not to rush through surgery and use bargain basement operating facilities. I took the time to obtain proper residency training and board certification and have a spotless record. I am quality over quantity all the way.

You have to decide what is important to you in choosing the environment in which you might have surgery. Surgeons are not the same. Results vary as well. You are value shopping.

A related question is what do breast implants cost and who collects what:

Surgeon’s fee: ~$3000-6000 (on the lower side for no breast lift cases)
Anesthesia Fee: ~$ 500-1000
Surgery Center Fee: ~$1100-2000
Implants: ~$1200-2000 (depends upon style and type)

Bottom Line: An average saline implant breast augmentation (without a lift) in good hands at a good center runs about $6000 in the OC.

So when you read that billboard, call and ask what the $3000 covers. Then look at where your surgery will happen and who will actually do it. (Then look him or her up.) Will you see that doctor for follow-up appointments? Are there any follow-up appointments? Can you see images of your doctor’s work (and not the center’s?) This is usually a level of care issue.

Good luck to you.

Best Regards,

John Di Saia MD

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Reader Laura on Katie Price’s Worst Breasts in the UK

Posted by admin in breast implant pre-op tutorial, celebrity plastic surgery on February 23, 2010

Reader Laura’s Comment:

A poll from The Sun in the UK voted Katie Price’s implants the worst in Britain. Do you think that the trend for having the largest breasts is now going away?

News

To an extent, breast augmentation goal sizes go in and out of fashion. If you look at Heidi Montag’s recent surgical fiasco however, you’d see that extremes still play in the media. Whether or not that shows signs of trends in popular culture is questionable.

Reality television types seek extremes to stay newsworthy. In this sense, Katie Price and Heidi Montag have succeeded. In my practice I do not see people specifically looking for other people’s breasts or anything else for that matter. Women have widely variable desires regarding their breast implants and reality television types do not typify the public to any significant extent.

Regarding the classification, Katie’s breasts are not that bad. There are far worse out there. Katie just went really large at one point and has had many operations following that…which is pretty typical of the larger implant patient.

Best Regards,

John Di Saia MD

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MakeMeHeal Question: Zerona?

Posted by admin in Dr D Says No on February 17, 2010

MakemeHeal Question:

I’m a reporter with makemeheal.com, looking to write an article on Zerona, and I just wanted to drop you a line to see if you might have some insight on the subject.

I’m interested in what those in the industry think of the procedure — what you know about it, what you’ve heard about it and how patients have responded to it.

Zerona is looking like a gimmick procedure thus far. I first posted on it in the middle of last year. Currently at realself.com, the procedure is rocking a 22% favorable rating which is not so hot.

The Pro is pretty much that it does not involve traditional surgery. It is a laser treatment typically offered as six treatments over two weeks or so.

The Con is that it seems to do little if anything.

I admit that I am a traditionalist in the sense that I do not try new things until there is some objective evidence that they work. I will be unlikely to try Zerona for that reason.

Although this procedure seems low risk, my patients do actually expect treatments I offer to work and I am the Cosmeticsurgerytruth.com guy. I offer appropriate patients liposuction and those with too little to warrant surgery are advised accordingly.

Best Regards,

John Di Saia MD

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Heidi Montag v 2.0 in Playboy?

Posted by admin in celebrity plastic surgery club on February 12, 2010

Heidi Montag isn’t done showing off her newly enhanced assets. The reality-turned-surgical star is currently in talks with Playboy for a deal that could earn her more than a million dollars.
MSNBC

Well that is interest on her $30,000 marathon makeover. Who else thinks this deal was in the works before the surgery?

Best Regards,

John Di Saia MD

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Bill Handel, Weight Loss Endorsements and the Truth?

Posted by admin in Advertising Truth on February 11, 2010

I spend far too much time commuting these days and listening to talk radio. The other day I was dial surfing and listening to Bill Handel on KFI AM 640 in Los Angeles. Over the past few weeks, he has been endorsing a bariatric surgery company hyping the weight loss it afforded him. OK. I have some experience with bariatric surgery patients. When operated properly these patients tend to lose weight.

Ten minutes after one of these spots runs, another Handel spot comes on. Now he is pitching a diet program for weight loss again proclaiming to the heavens about the weight loss.

OK Bill, don’t you think that is a bit bogus to be hocking both of these at the same time? Bariatric surgery patients hardly need a diet plan to lose weight as the surgery provides them that low body fat.

Do any of you take endorsements seriously? Am I just jaded?

Best Regards,

John Di Saia MD

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The Dawn of the Mommy Makeover

Posted by admin in Advertising Truth on February 10, 2010

In the last decade or so plastic surgery has seen an increase in the “marketing BS factor” with the propagation of quite a few terms more geared toward promotion than medicine. “Mommy Makeover” is one of those terms. It does not refer to any particular operation, but to any of a series of procedures usually geared toward the correction of the changes of pregnancy.

These can include Tummy Tuck, Liposuction, Breast Augmentation and Breast lift.

If you go to a number of surgeons for consultations for such surgery be sure that you get details of the individual operations planned and more importantly a clear description of risks and benefits of the planned procedures. The price will vary by the exact nature of the operations performed and the practice in which they are offered.

Best Regards,

John Di Saia MD

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Lindsay Lohan – Scar Treatment?

Posted by admin in celebrity plastic surgery on February 9, 2010

Lindsay Lohan has developed some scars by the looks of these images at Daily Mail. Even a scratch can get ugly if not treated right. She needs to keep these wounds out of the sun and get some sun screen on them once they have healed over or she might be a scar revision candidate soon:

Daily Mail

Best Regards,

John Di Saia MD

Related:

Dr D’s Scar Revision Page

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Reader Question – Poor Wound Healing Mastectomy

Posted by admin in Picture Warning, plastic surgery complications on February 5, 2010

Dear Dr. I had a double mastectomy in mid December. I had tissue expanders and alloderm put in right away. My problem is I am not healing. I had surgery six weeks later to try to close the wounds again but here I am with open wounds again. You can see the alloderm. It is very painful also. I am so afraid because it has been so long. I see a regular surgeon and a plastic surgeon. Do you have any thoughts that might help! Please I am so afraid. Thank you so much.

After mastectomy breast reconstruction can be challenging. It is usually performed in multiple operations or Stages. In these cases the overall goals of surgery are to remove all the cancer but still leave enough tissue to allow for a good reconstruction. When tissue expanders are chosen for that reconstruction, the condition of the remaining tissue after the mastectomy is crucial to the success of the operation.

Your images (which I placed on the following page for those who may not want to look) show that soon after the mastectomy and tissue expander placement surgery skin necrosis appeared. When this develops it is concerning as it indicates that the wound may have the blood flow needed to heal. You show this problem on both sides.

At six weeks following your first operation, the skin necrosis started separating from the other tissues and the wound seemed to open on at least one side. Your surgeon at that point decided to go back to the operating room to try to remove this non healing tissue and salvage the reconstruction. In cases like these my concern is whether or not these wounds even if they are able to heal can do so without excessive scarring and hardening. Depending upon how things looked on examination, I would consider removing your expanders to allow the wounds to heal and the tissues to soften to allow reconstruction at a later date. This is a clinical judgment that your surgeon needs to make. He or she may have discussed something like this with you already.

Although I have not been involved in your care I am sorry you have had such difficulties and hope that things can be improved later down the line.

Best Regards,

John Di Saia MD

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