Archive for March, 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.
John Di Saia MD
On Saturday I will be speaking to Cal HOSA at their State Leadership Conference in Anaheim. The topic is “From Training to Practice in Plastic Surgery; Not Dr 90210.” I have been serving as a Cal HOSA adviser after being recruited by my wife for the past few years. The workshop will be similar to the talk I gave at HOSA’s Sacramento conference last year. I will also be helping judge some of the competition.
Cal HOSA for those who may not know is the California Chapter of a National organization (Healthcare Occupations Students of America.) This organization serves as a steward for students at various levels seeking potential careers in health care.
Maybe I will see some of you there.
John Di Saia MD
Ann Arbor, Mich. — Though it’s known that a simple plastic surgery procedure can help some migraine headache sufferers, relatively few U.S. plastic surgeons are performing it, a new study reports. Researchers from the University of Michigan surveyed nearly 3,500 members of the American Society of Plastic Surgeons about their knowledge, attitudes and experience related to migraine surgery. After analyzing responses from nearly 200 surgeons, investigators found that only 18 percent had performed migraine surgery — and that of that group, more than 80 percent said the surgery improved their patients’ symptoms.
Among the survey’s findings:
• Sixty percent of respondents said they would be interested in offering migraine surgery if an appropriate patient were referred to them by a board-certified neurologist.
• Many surgeons surveyed said they didn’t feel familiar enough with migraine surgery techniques — or with migraines in general — to perform the procedure.
• Most respondents said they were unaware that migraine surgery is covered by some major health insurers, including Medicare.
I find the lay press impressions of why plastic surgeons do or do not choose to do certain operations amusing. The key item that neither the ASPS survey nor the lay press impressions of it have addressed is the issue of risk versus benefit.
If this procedure was well-covered by any payer then plastic surgeons would be lining up to perform it. If it had a good risk: benefit profile, the same would be even more true.
Most surgeons trained in programs in which key principles were taught regarding operating for pain. Operations for pain tend to hurt the surgeon more than they relieve the patient.
It was not really mentioned in this piece that a relatively easy alternative to surgery for migraine headaches is Botulinum toxin injections. They work well and are much lower risk than any surgical procedure. I perform them for my wife and they relieve her headaches a great deal.
John Di Saia MD
The Oscar winner, 66, says she hasn’t had any plastic surgery yet, but based on other things she’s sworn off in her life, it could eventually happen. “Never say never,” Keaton tells AARP magazine for its April/May issue. “Because when you do, you are definitely going to go there.”
Diane Keaton says she’s not yet had any plastic surgery yet, but her nose tells a different story. This older image of her features a “boxy nasal tip” that more recent images show thinner. That means at least a tip rhinoplasty to me. Nasal tips do not thin themselves over time without some help.
As usual with celebrities it depends when you ask the dreaded “plastic surgery question” on what they want to tell you and/or what they count as plastic surgery.
Since they are so pervasive in Hollywood, maybe nose jobs don’t count there?
John Di Saia MD
A report of a Kardashian reality show plastic surgery session had me curious:
Right off the bat, Malika admits to Khloe that she wishes she had bigger boobs. It starts out as kind of a joke at first, but later on, Malika announces that she has scheduled a consultation for breast implants. Looks like it’s time to “get a new set of twins.”
Although Khloe’s not opposed to the idea of plastic surgery, she’s worried that her bestie is going under the knife for the wrong reasons. She brings up the fact that Malika just broke up with Adrian — roll the montage of cute moments, followed by tears — and explains that she’s worried that this is about her break-up.
We have spoken of reality stars and their plastic surgery exploits here on a number of occasions. Being of the opinion that reality shows are scripted to excess, plot twists really do not surprise me much.
Still it might seem more than ironic to many that a Kardashian would have anything to say about plastic surgery except “Go! Go! Go!” That is probably the reason this reality was scripted for your enjoyment.
That aside, it is true that women often seek plastic surgery when they are “between men.” Paradoxically, cosmetic patients are happier when they have surgery for reasons that are internal.
It was traditionally part of plastic surgery training to assess the motivations of a patient coming for cosmetic surgery. Such an evaluation itself in practice however probably happens much more infrequently than it did in years gone by. The competition element discourages this kind of dialogue.
John Di Saia MD
In a new interview, Angela “Big Ang” Raiola dishes on wanting more surgery. The 52-year-old breakout star of the season says, “I would like to have other surgery, like my eyes done and a slight face lift and my love handles removed by liposuction… I just need to get this liposuction fast around my bra and my backsides, and I’ll feel much better after that cause my age is kicking in.” Her sister even found her a doctor–on Facebook of all places!–who she will be consulting with this month. No stranger to procedures, Big Ang confesses that her first foray into plastic surgery was in 1985.“I had a tummy tuck, liposuction, my lips injected and my breasts done three times,” Big Ang said. “The first time I had my breasts done was 27 years ago, and they put sponges in them. That was in 1985.”
Reality stars run at opposites with conventional Hollywood types in many ways. One of them is admitting (well OK bragging about) plastic surgery. And that is good for us here!
There are a few worthwhile points to this dish session. Firstly breast implants are not forever. Ang reports on three boob jobs starting in 1985. That figures correctly as about one on average every ten years.
Going to J cup size with breast implants is not possible or practical for most women, but it obviously works for her.
One other point: She talks about her age “kicking in.” It happens and fat can start piling up if diet and exercise are not implemented. Also sponges were not standard breast implants in 1985. I wonder where she had her original surgery.
John Di Saia MD
Elle Macpherson believes not going under the knife is her ”trick” to looking good. The 47-year-old supermodel insists she has not turned to plastic surgery, and argues she looks better for it.
She said: ”I’m a 34C [bra size], absolutely natural. The face looks like the face I have, very natural. Not falling into the plastic surgery thing is my trick.”
She told The Sun newspaper: ”It didn’t really work for me. I tried a bit of everything. You name it, I’ve tried it. This is as about as natural as you can get.” Dubbed ‘The Body’ in honor of her toned figure, Elle confides she has to work out in order to counteract her love of food.
Now that is a celebrity plastic surgery statement! How do you refute that? Either she is smart and/or has a good publicist.
She admits to trying everything but not liking it. Then there is an adjoining statement saying she hasn’t turned to plastic surgery. Her statement has undertones of not overdoing it, which of course is popular with yours truly.
Artful dodging aside, she has probably done some smaller scale stuff (including her nose at least once probably many years ago) and had it done very well. The work looks good with her features. There is no substitute for good genetics. Staying in shape is never a bad thing either.
Is she entirely plastic surgery free? That all depends upon what you consider plastic surgery.
John Di Saia MD
A plastic surgeon made a woman he had performed a $31,000 facelift on feel inadequate, humiliated and insignificant, the patient says. Health and Disability Commissioner Anthony Hill has censured the doctor for his treatment of the 49-year-old woman, Mrs A, who had the surgery in September 2008 because she was concerned about her “prematurely aged facial appearance”.
Mrs A and her husband travelled five hours for a 45-minute consultation, during which Dr B examined her and advised on what he believed would be the best surgery. He made no clinical record of the consultation but wrote to her summarizing the consultation and their discussions, and quoting $31,000 for the procedure.
She accepted, and about two months later Dr B performed an endoscopic brow lift, limited incision facelift, necklift, pinch lower blepharoplasty and upper eyelid blepharoplasty at a private hospital. Mrs A was initially happy with the results, emailing after a week to say she was “fascinated observing the changes”.
However, by January she was concerned about the skin on her cheekbones sagging and asking whether it was likely to tighten with time. Mrs A attended her follow-up appointment a year after the surgery and said she found Dr B “intimidating” when she said she was not happy with the results.
“… the consultation, which was conducted in a treatment room, made her feel inadequate, humiliated and insignificant,” Mr Hill said in his report, released today.
“He was vague about the causes of the poor outcome and told her it was not a ‘biggie’, that he would ‘sort it out’ and would ‘see her right’.” However, he then sent her a quote for $19,000 to carry out another surgery, when she had expected he would do it for little or no cost. She asked for a full refund of the initial $31,000.
Mrs A said in her complaint to the Health and Disability Commission she felt like a “financial commodity”.
“The unexpected results of this surgery have had a huge impact on my confidence and well being. [Dr B] has failed to realize this and continues to respond without genuine consideration of what impact this has had on me.
“I cannot adequately express the distress that this experience has had on myself, or my family. It has been a devastating time. I have felt devalued, disregarded and disrespected by [Dr B].”
Mrs A had further surgery performed by a different surgeon.
Dr B told the commission he did not believe a technical error was made, or that his technique or patient care was inappropriate.
Mr Hill found Dr B did not give Mrs A an adequate explanation of the options available regarding facial rejuvenation surgery, including an assessment of the expected risks, side effects, benefits and costs of each option.
She was therefore not in a position to make an informed choice and give informed consent, meaning Dr B breached her rights.
Mr Hill recommended Dr B apologize to Mrs A.
It is interesting for me to see reports of plastic surgery from other countries. Here a woman had a pretty significant facelift which in her eyes did very little despite the high price tag.
It sounds like her doctor (who was not named) was less than adequate (by US terms anyway) in maintaining a proper medical record. He saw a patient who came from many hours away and recommended a large amount of surgery for her. When she was not pleased a year later and requested more surgery, she became angry when he wanted to charge her even more money for it. The report says the surgeon humiliated the patient, but did not provide details of this so it is hard to characterize.
The local authorities investigated and censured him, but did not return her money or accuse him of poor quality care. They recommended he apologize to her. They noted the doctor’s lack of informed consent. Medical records issues are often the easiest upon which to find fault in medical cases such as these.
You have to wonder what really happened here. In the US, the doctor’s name would have been printed whether nor not he was at fault. It seems probable that this surgeon was at the very least not the kindest man. Other than that this is a case with few facts to review. It is the lack of facts that makes it so interesting relative to a domestic case.
John Di Saia MD
Although he has never really spoken of it publicly, Bruce Springsteen has obviously had some work. This image from the late eighties shows some pretty prominent facial folds that are not really seen much after 2008.
He at the least has had some facial fillers and botulinum toxin. Add probably hair transplants to blunt his rising hairline. At the 2009 Golden Globes his eyelids looked potentially ripe for a blepharoplasty as well.
John Di Saia MD
BTW – At least one prominent plastic surgeon in New York lists the Boss as a client according to internet sources. Then again not all plastic surgeons brand themselves as the tellers of the truth.
After becoming more famous for her botched plastic surgery and hard-partying than her sporadic movie roles, Tara Reid has made a refreshing comeback as a beautiful blonde again, and RadarOnline.com has exclusive details on her stunning transformation.
Troubled Tara has not been afraid to open up about her past plastic surgery nightmare after a bad boob job and messy liposuction left her horribly scarred and scared to go under the knife again.
“I became known as having the ugliest breasts in the world,” Reid lamented in 2006, according to MSNBC.com.
Well I never said she had the ugliest breasts in the World and we have discussed her plastic surgery here before. The images at Radaronline look pretty good, but then again the reasons for this are probably multiple.
Tara is a bit dramatic when she discusses her plastic surgery past. Not that she accepts any responsibility for even her choice of surgeon the first time around. I don’t think he put a gun to her head. She similarly doesn’t talk much about the potential effects for a plastic surgery patient of partying like a rock star, smoking and sun exposure. This by report was her post-operative care program the first time around. As I recall, it didn’t work out so well.
An improved life style and some good plastic surgery have likely contributed to her current improved appearance.
John Di Saia MD