Archive for September, 2012
Initial Post 9/25/12 7:30 AM -
Courtney Stodden came up again online and the question was whether or not she’d had plastic surgery. Well of course. These questions always come up.
Here is an image of Courtney before she married Doug Hutchinson (so at least two years before the more recent “After” picture.) Besides the metric increase in makeup, her nose seems to have changed. These changes do not happen with aging alone, so as far as Dr D is concerned I think I’d put her down for at least one nose job. The images are pretty low resolution so this is only my guess. When she might have had such work is again anyone’s guess.
It is also pretty likely that she uses facial fillers by the looks of her facial folds.
Update 9/25 9:30 AM – Only 2 hours after this was posted, I received a call from Courtney’s mother/manager indicating that they wanted the post removed. I should be clear that this is my opinion, and I am not defaming Ms Stodden in any way. I do think the majority of what is going on in her case would probably qualify as procedural (fillers, make-up, etc) and not surgical, but we have discussed that before.
I find it interesting that people feel that a blog post is somehow actionable legally particularly this one.
Update 9/26 2:00 PM – After offering to evaluate Ms Stodden in the office for a follow-up “Plastic Surgery or Not” post, her manager has tentatively agreed to such a meeting. Details to follow….
Update 9/28 10:00 AM – Seeing as we hadn’t heard from Courtney’s people, we called her mom/manager this morning. They have decided to have another doctor examine her seeing as they want her to have a completely “plastic surgery free: report and they believe I am biased. Not surprised.
Translation: She has probably had something done.
John Di Saia MD
Blepharoplasty is upper and/or lower eyelid cosmetic surgery usually performed for redundancy of the skin and fat of eyelids. Insurance companies may pay for upper lid surgery if the lids get in the way of the patient’s vision. The rate they pay for the surgeon is usually pretty poor.
This young woman came for cosmetic blepharoplasty of the upper and lower lids. This was performed through traditional trans-cutaneous incisions allowing the removal of skin and fat. At 6 weeks she was pleased.
John Di Saia MD
Sometimes the nature of liability forces medical care that does not seem all that compassionate. Not long ago I had a patient with a charted allergy to lidocaine, a drug that numbs the sensation of pain at surgery.
Dangerous allergies to drugs are far more common with some drugs that others. Most good plastic surgeons use a lot of lidocaine and related drugs to make surgery a less uncomfortable experience. This patient needed a pretty large skin graft and could have used that pain relief.
Almost invariably when patients are documented to have allergy to lidocaine, it is a mistake. Allergy is not the same as a less dangerous drug reaction. A common scenario is a trip to the dentist at which time a closely related drug novacaine is injected. The drug is applied too closely to a blood vessel and the patient experiences a few heart palpitations. This is a drug reaction. Most often it is documented as an allergy however.
All it would have taken to prove this would have been a small injection of lidocaine at surgery. Such a trial might indeed have been performed twenty years ago, but the medical malpractice landscape is different now. A mistake like this could easily be a slam dunk malpractice lawsuit, so a test like this is not advisable. It is simply not worth the liability to even bother.
While I have never seen a true allergy to lidocaine, any additional risk in an operation is not something a smart doctor entertains. We have enough uncompensated liability in medicine as it is. So practically-speaking the patient needed more narcotics during his post-operative period. He needed more during surgery. Thank a lawyer.
John Di Saia MD
Originally posted 2012-04-17 07:30:35.
Dr. Robert Cattani “committed sufficiently egregious misconduct” warranting the revocation of his license, according to a report issued this week by the state Health Department’s Office of Professional Medical Conduct. “The committee concluded that the only way to ensure the safety of the public is to revoke [Cattani's] medical license,” said the report, issued after a hearing at which Cattani testified. “Any other penalty would risk a recurrence of this behavior. The public should not bear that risk.”
Cattani, 71, who has been licensed to practice medicine in New York state since July 1968, had been the subject of more than 40 malpractice lawsuits over the years.
The plastic surgery marketplace is studded with the best and the worst surgeons. I have seen this time and time again as I participate as a case reviewer in my State’s Medical Board Expert program. This doctor was obviously evaluated by New York State’s medical board. In this particular case, all I have to read is the same information that you can peruse from this article.
Any surgeon who has been sued 40 times is doing something wrong however, even if it is just choosing patients poorly. In this case there is at least one blind woman, and one patient who bled to the extent that a blood transfusion was needed after Dr Cattani operated.
That is not so standard.
I suggest that those of you in the market for a plastic surgeon check his or her credentials and at least do a brief medical board search to screen for problems before having surgery.
John Di Saia MD
a man who did liposuction and other cosmetic surgery without a medical license faces six months in prison and payment of $8,700 in restitution. Carlos Arango pleaded guilty to a single felony count Friday for procedures he performed on several New York women in 2011. The attorney general’s office said Arango has admitted recruiting women from a spa in Queens and doing the procedures in Stamford, Conn., and Manhattan.
In a criminal complaint filed in April, authorities accused Arango and William Ordonez, who are not licensed doctors, along with Dr. Marlon Castillo of performing cosmetic surgeries without general anesthesia and leaving some women disfigured.
It is no small wonder why so many play plastic surgeon without training or in this case without even a medical license. This guy operated upon people and reportedly left some of them disfigured. I think if he wants to play plastic surgeon, he should be accountable at least as much as a plastic surgeon might have been…to the tune of hundreds of thousands of dollars. Sure he stands to serve six months in jail, but that doesn’t seem right either. If indeed women were disfigured by improperly performed liposuction some of those defects might not even be subject to repair. So they potentially serve a lifetime of disfigurement and he only gets six months. Ridiculous!
John Di Saia MD
In one of the largest psychological studies ever conducted, an intriguing difference between male and female views on what is attractive has emerged. A total of 34,015 participants – 16,686 men and 17,329 women aged between 15 and 98 years took part – rendering this one of the largest psychological studies ever.
The majority of men and women were found to prefer female ﬁgures of medium or low body weight with medium-sized hips and a narrow waist. However, a striking gender difference emerged over breast size, with 40% of men preferring a large bust size, in comparison to only 25% of women. Prantl and Grundl argue that this difference between men and women is surprising because women theoretically ought to have the same beauty ideal as men.
I always enjoy the idea that some believe they can easily predict how other people will think. Personally, I have always been a believer in multiple “types” of people. There are free thinkers and then there are those who believe what others tell them without much critical thought in between.
Why should men and women have the same ideals of beauty? The fact that many women have their own ideas of what makes for an attractive form or breast is no surprise to me. I have been helping people re-invent their bodies for 15 years. I know that different people have differing desires in this regard. I listen to them regularly.
John Di Saia MD
Relatively newly practicing physicians may not know that the Medicare physician payment system changed pretty substantially in the early nineties. This was by design.
The perception of those who designed this new system was that certain services were overpaid and others underpaid. It likely had much more to do with ratcheting down the costs of health care. As physician fees constitute only 10-20% of the entire equation, the wisdom of concentrating on physician’s fees to change the system is perhaps questionable. This is what was done nevertheless.
A cornerstone philosophy of the new system was that procedure-based specialties were overpaid. The physician fee system prior to this was based on usual and customary fees. This newer one based payments on a model that paid for a service at a uniform rate regardless of who performed it. While this seems fair on the surface, it had predictable effects.
Why would a surgeon with much higher overhead remove a lump in a patient if the new payment system put the procedure in a revenue negative position? The practice of surgeons removing certain lumps gave way to family practice and dermatology physicians removing many of them. These were the only specialties that under the newer system could turn a profit doing so.
The Medicare fee schedule economically regulates procedures in medicine. It also indirectly fed the growth of cosmetic medicine and surgery as this was the escape hatch many practitioners sought as the Medicare boom fell upon us. Surgeons interested in turning a profit quickly figured on what paid adequately and more importantly on what did not. As my grandfather told me as a young child, everyone needs to make a living. It is perhaps unfortunate that doctors do not discuss these matters with patients when telling them why they cannot offer a service. Is it really ever wrong to tell your patients the truth?
[Originally written for and published on FreelanceMD.com:
John Di Saia MD
Originally posted 2012-05-28 07:30:52.
Plastic surgery goes through periods in which things are fashionable and then not long later unfashionable. Some developments are presented as “epic” as if plastic surgery as a science and art steps forward with their introduction. Suffice it to say, the “hype factor” can be huge in plastic surgery.
I do a fair number of tummy tuck operations and have for quite a few years. My results are very good and my patients have greatly reduced discomfort from those I did even ten years ago. Much of this is due to my technique of pain pump placement. I modified that which I have been taught and it works very well.
On the issue of drains I am old school. My seroma rate (fluid collection rate) after tummy tuck surgery has been very very low for years. This is one of the reasons I am not a fan of the “no drains” progressive tension suturing technique that has become popular in some circles.
Drains are an inconvenience, but with the addition of pain pumps are more needed than ever before. The pain pumps also make them much less uncomfortable than they were a decade ago.
John Di Saia MD
Originally posted 2011-05-13 07:30:11.
Gwyneth Paltrow has revealed that she is not opposed to plastic surgery. The 39-year-old said that she has no plans to go under the knife anytime soon but has not ruled out the possibility for the future. Paltrow is quoted as telling Stv: “Everyone is asking me about my thoughts on plastic surgery. Do I look old or something?!
“I’m not opposed to it but I want to move my face because I’m supposed to convey emotion in my job. “But I have wrinkles so I don’t know – I’m not going to say that I’ll never do anything, but I would always want to look like myself.”
More celebrity half truths about plastic surgery are no surprise really. We see that Gwyneth has seen her share of quality knife work if we take a peek at some old images:
As we have said here before nasal tips do not get thinner as we age without some help. Gwyneth’s eyelids and mid-face look a bit improved as well…very nicely of course.
So the assessment here is at least a nose job and eyelids with a possible mid-face lift as well.
John Di Saia MD
California has filed suit against a South Pasadena plastic surgeon for her aggressive billing tactics, including lawsuits, taking out liens on clients’ homes and damaging their credit, according to the Los Angeles Times. Jeannette Martello, who owns a private practice and used to provide emergency services to Huntington Memorial Hospital, is being accused of using unlawful methods to obtain “reasonable and customary” pay for out-of-network services. The California Department of Managed Health Care called the suit against Martello the first of its kind. State officials allege that she collected or attempted to collect more from patients than insurance companies paid. Martello’s lawyer said she was “very persistent” about collecting bills, but added that she lawfully pursued her rights to recoup fees for her services.
I live and work in a crazy state. Authorities in California have validated this statement by suing a plastic surgeon for trying to get paid. Dr Jeannette Martello was foolish enough (as I was for over a decade) to offer emergency plastic surgery services and believe that she might be paid fairly for them.
I have discussed before the process I went through for the fourteen years before I gave up emergency room call. Dr Martello went another route by more aggressively seeking payment when services were not reimbursed fairly. Take into account that medicine unlike most other businesses is afflicted by the notion that a third party should decide what a service should be paid. Insurance companies pay what they want and the government has supported them.
Most good plastic surgeons eventually figure that emergencies are a ridiculous proposition and stop accepting them. After all, who seeks to run around at ungodly hours and not be paid reasonably or consistently? No one who is sane or solvent.
I can’t help but root for Dr Martello on this one.
John Di Saia MD