Posts Tagged prevent
Fixing Implanted Breasts in the OC
Posted by admin in Dr D's Patients on February 27, 2013
Redo Breast Implant Patient by Dr D - Orange County California
Breast implant surgery does not always go as planned. The reasons vary from patients seeking poor surgical talent at their local $3000 chop shop, smoking too many cigarettes or just plain having bad luck.
Much of this can be fixed or at least improved with additional surgery.
This young lady found me after having had four operations with her prior surgeon at which point he uttered those unforgettable words: “This is as good as it is going to get.”
She had poor scarring partially due to her genetics, but the poor shape and firmness was correctable. She found her way to my practice after a friend with whom I had worked in the past referred her to me. We performed a modified breast lift and implant exchange with capsule removal in a local Orange County surgical center and she achieved a nice improvement.
Fixing Bad Plastic Surgery:
** Get into the best hands you can afford and check into your surgeon’s qualifications before you let him operate upon you. Understand that redos are harder and less predictable than first time surgery.
Best Regards,
John Di Saia MD
Related:
Cosmetic Breast Surgery at Dr D’s Practice Site
Originally posted 2010-10-12 07:30:51.
SmartLipo Isn’t Always So Smart – You Need To Be Smarter
Posted by admin in Dr D's Truth on December 21, 2012
It frequently amazes me how patients can be wowed by technology and advertising hype. The attraction of newer technology in particular helps part many people from their money at times. The Smartlipo system is one of the laser-assisted liposuction systems on the market. I have blogged on it before having used it quite a bit a few years ago.
The system is being marketed with phrases like “almost anyone can be a good candidate for Smartlipo.” That is simply BS.
I saw an attractive young woman in the office who had had Smartlipo on her lower back. It looked like the Geiko Gecko had done it. Her smooth contour had been made irregular and discolored despite the fact that the surgery had happened quite a while prior. Her ribs had been a bit exposed by the loss of some of the fat that would normally have laid over them. Early lipo results do change, but this wasn’t something that was going to improve over time. I have seen worse but this was so unnecessary.
SmartLipo Led to a Dent
Why did this happen?
Marketing has oversold the Smartlipo unit in a huge way to both doctors and the public in general. Patients come to the office convinced that it will cure that which ails them. Unfortunately they many times assume the fancy laser system does the surgery like in some high tech Sci Fi movie from years gone by.
At times prospective clients don’t have enough fat to treat and a surgeon is faced with two not-so-attractive alternatives:
(1) Advise a patient against surgery. This by the way, is the worst nightmare for many a surgeon as we are paid to operate not to talk.
(2) Operate and accept the risk that surgery might not improve the patient or worse yet might leave a dent.
This of course assumes that the patient sees a doctor who knows the difference. Many doctors offering Smartlipo are not trained plastic surgeons. Some picked up a Smartlipo system to replace revenue lost in their original practices outside of plastic surgery. For all you know last week your Smartlipo doctor might have been delivering babies.
The bottom line is that when you go to a less than smart doctor and have liposuction, the fancy Smartlipo laser-assisted system will not save you. You pay for experience and skill first and foremost, so I just hope my consult patient here hadn’t paid too much.
Preventing Bad Plastic Surgery:
** Know what you are seeking – a qualified and skilled ethical surgeon – not a smart looking advertisement promising the impossible
Best Regards,
John Di Saia MD
Originally posted 2011-05-03 07:30:48.
Reader Question: Ugly Breast Lift and a Mass – How to Avoid / Fix?
Posted by admin in Dr D's Truth on October 31, 2012
I have been considering fixing my saggy sad boobies (two children, breastfeeding – blah. blah. blah.) Then I find this image online of a woman who had a lift with ugly scars and a new lump in her breast. This scares me. How do I get pretty boobies without the scars and lumps this lady got?
Plastic surgery comes with risk. Although the scarring you see here is not typical, it can happen and require surgery to fix. Of course poor scarring occurs more in certain practices than others and in patients who are less healthy and/or smoke more than in others. Compared to what we see in this case, the Katie Price breast lift scar drama kinda pales in comparison. All things are relative when we look closely enough anyway.
This lady you mention has two issues… scars and lumps. They may or may not be related.
(1) Scars – She shows her right breast in your image with a thick irregular scar in the healed incision at the inflamammary (under breast) fold. This looks amenable to scar revision. Her vertical scar between her areola and her lower breast scar is a bit wide as well. I would probably recommend scar revision surgery once these scars had matured and softened. Widened scars are particularly amenable to well performed scar revision more than some of the other treatment options.
(2) Lumps – Breast lift and reduction can result in scarring under the skin and in the breast that feels lumpy. These need to be carefully evaluated to make sure they are really just scar and not cancerous lumps. Fat necrosis after a breast reduction in particular can manifest in lumpy scars that become smaller over the first year from surgery. They can be removed if need be to prove that they only represent scarring and not something more worrisome.
How do you avoid these?
You can limit the problem by picking the right doctor, not smoking and having the right genetics.
Best Regards,
John Di Saia MD
Originally posted 2011-06-27 07:30:15.
Reader Question: Is There Ever Good Botox?
Reader Question:
All I see online is bad Botox stories. Can this ever be done well? Why is it so popular?
Botulinum toxin injections temporarily paralyze muscles where they injected. While this sounds scary, it can be done to reduce certain facial movements that make people look concerned (the look of consternation,) and older (crow’s feet,etc). As is usually the case in plastic surgery, too much of an otherwise good thing can make people look weird. Just look at a few celebrities who look like they might have had too much like Teri Hatcher maybe?
As the market movement with Botulinum injections has been toward less and less experienced injectors and decreasing price points, the landscape has changed. People are paying for it based upon the quantity injected now more and more, so some injectors are injecting more and more into areas other than the standard Glabella (the spot to reduce the look of consternation). This leads to stone faced outcomes or zombie faces and these of course are prominently featured in the news outlets.
To answer your question, you need to define your goal. If that goal is to look natural, reduce the amount you have injected and target fewer areas. In most patients I like to inject the Glabella plus or minus the Crow’s feet. Also seek an experienced injector (like maybe a real Plastic Surgeon?) or at least try to avoid the “Dr Cheapies” who can’t be doing it right.
Best Regards,
John Di Saia MD
Related:
Dr D’s Philosophy on Botulinum Toxin Injections
Originally posted 2009-10-26 07:30:54.
Top 10 Bad Hollywood Boob Jobs – Really?
Posted by admin in celebrity plastic surgery club on March 19, 2011
10. Audrina Patridge
9. Jewel
8. Jenna Jameson
7. Paula Abdul
6. Vivica Fox
5. Donatella Versace
4. Pamela Anderson
3. Victoria Beckham
2. Tori Spelling
1. Tara Reid
Source: celebslam.celebuzz.com/2009/04/top-10-bad-hollywood-boob-jobs.php
CelebSlam posted these picks for the top ten bad Hollywood boob jobs but compared to what I have seen, many of them are not that bad. I did make a few comedy bits out of my list of the “Top Ten Celebrity Boob Jobs on the Net” and some of these women were featured. These celebrity breast implant examples do illustrate common problems that can occur with breast implants and are at times avoidable:
Audrina Patridge just went a bit large, but that is the trend these days as implant size requests seem to be on the rise. Women who want to look more natural (and limit the need for further surgery over time) are advised to stay with the smaller implant sizes.
Jewel looks kinda deflated, but then again I believe she may have had her implants removed. Removal without replacement of breast implants can create that appearance.
Jenna Jameson was featured before her implant downsizing. Seeing as she was so thin with such large implants, the distortion was to be expected.
Paula Abdul is listed, but we have discussed her chest wall deformity Pectus Excavatum before. Breast implants do not fix this, but can camouflage it somewhat.
Vivica Fox just went a bit on the large side for her available tissue coverage. This is the most common correctable problem in the land of breast implants.
Donatella Versace is very very thin. It can be hard to get good breast implant results in such patients. All things considered, she doesn’t look bad implants-wise.
Pamela Anderson has had many breast implant operations and is our favorite example of “all implant” breasts again with large implants and little tissue covering them. This commonly leads to distortion.
Victoria Beckham has had her implants removed or reduced. She had signs of capsular contracture for quite a few years beforehand.
Tori Spelling has two problems. She has a degree of the chest wall issue that Paula Abdul has and went for larger implants making it look more obvious (especially after child bearing with implant descent.)
Tara Reid went large on her implants and smokes. Smoking and plastic surgery together can lead to some pretty large scale problems. She only realized a few of these problems and has had secondary surgery to improve her situation which seemed successful.
Take into account that many women come to consultation asking to look like some of the women on this list, so a great deal of this is a matter of individual perspective. A central focus in cosmetic breast surgery is and always has been what the patient sees as wrong with her breasts and what she would like to do about it. Most women want volume, often more volume than the average woman without implants wants or would find attractive. The distortion seen with increased volume beyond a point may make other people cringe, but some patients actually want that. Re-operation particularly multiple times with increasing implant size can lead to a very fake appearance.
Staying moderate on the volume leads to better long term results meaning less surgery. Capsular Contracture (especially with silicone gel implants) can lead to hardening of the breasts and the desire to re-operate fix things however.
Commonly placed breast implants do not repair chest wall deformities like Pectus_Excavatum, a congenital “dip” in the breast bone that affects many women usually in minor degrees. Some of the women on the list have a bit of this going on and I can’t fault them for that.
The list at CelebSlam is not Hollywood’s worst, but may include Hollywood’s most noted Boob Jobs.
Best Regards,
John Di Saia MD
Reader Question: Accolate Cures Implanted Breast Hardening?
Posted by admin in breast implant pre-op tutorial on January 4, 2011
Reader Question:
I just had a breast augmentation a week ago. The saline implants were placed under my muscle. My doctor keeps pushing Accolate on me even though I tell him I don’t like the way it makes me feel and I don’t like about the potential dangers of the drug. What do you recommend to your patients? I massage regularly and am starting to take vitamin E. Is there anything else I can do because I do not want to take this potentially harmful drug.
Breast hardening after the placement of implants is referred to as capsular contracture. It can be more of a problem with patients who smoke cigarettes, have had radiation treatment, have bled or had implant infection after surgery, and/or have had silicone implant placement. The use of moderate sized saline implants under the muscle is not commonly associated with severe contracture, but there are patients who have had repeated problems with it.
Accolate is an asthma medication in the class called leukotriene inhibitor. There have been a few studies showing some decrease in contracture in high risk groups on the medication. There is a small risk of liver problems. Some doctors are using it as prophylaxis in patients at high risk for developing contracture.
Unless you are in such a high risk group, I would likely not put you on it. This is something to discuss with your surgeon. A discussion before placing a patient on a drug with more than a small risk is my practice. The handling of patients does have something to do with your doctor’s philosophy of course.
I usually recommend massage for my normal risk breast implant patients and enjoy a low capsular contracture incidence.
Best Regards,
John Di Saia MD
Cheap Plastic Surgery Leaves Woman With Rock Hard Breasts
Posted by admin in plastic surgery news on December 6, 2010
People undergo cosmetic surgery for a variety of reasons, but they all do it to look better. However, some patients get the opposite result, KPRC Local 2 reported Wednesday. As a professional makeup artist and spa owner, Gina Hern knows firsthand the high cost of beauty. “People come here wanting to be the best that they can be,” Hern said. So, when she decided to get breast implants, she went comparison-shopping only to find the average price was $6,000 to $8,000. “I went online and did some research to find a less expensive way to get what I wanted,” Hern said. She found the best bargain over the border at a clinic in Mexico. Hern got her implants at the rock-bottom price of $2,000. But when she returned home to Houston, the implants turned rock hard.
Source: click2houston.com/health/6842979/detail.html
When you make a run for the border for plastic surgery you are taking a risk. There is a price at times for that which is cheap. And fixing that cheap surgery may be very expensive if it is even possible.
Preventing Bad Plastic Surgery:
** Know what you are seeking – a qualified and skilled surgeon – this might cost you some money, but the “cheapie version” might leave you deformed or worse
Be careful.
Best Regards,
John Di Saia MD
Originally posted 2006-02-17 11:40:00.
Caution with Threadlifts
Posted by admin in Dr D Says No on November 19, 2010
OK. Call me an old “stick in the mud,” but I am not so sure about these “Thread Lifts.” Those that offer the technique will say I am protecting my interests.
Sorry, but I just don’t like taking chances with your face.
The concept is to provide face lift type improvement without the surgery. The method is the placement of a number of funky barbed sutures that hold the face up internally. This is done under local anesthesia in the office.
I will be interested to see how these patients do over the long term. As far as I know there are no patients ten to twenty years out yet. A newly-operated patient was found frightening a mammography tech at my local hospital. It seems that one of the local internists is offering the technique to supplement his income. There may be good outcomes here. The real question is how are the statistics and how difficult might it be to fix one that goes bad?
If board-certified plastic surgeons thought this procedure would be so wonderful, we would offer it as well. A quick perusal of the internet finds the majority of practitioners offering this procedure are not plastic surgeons. We must just want to work too hard I guess.
Perhaps we will just have to wait ten years to see how the patients do long term. I would look at this procedure as an experiment folks.
Best Regards,
John Di Saia MD
Originally posted 2005-07-06 14:58:00.
Tummy Tuck in Malaysia – Yuck Tuck!
Posted by admin in bad plastic surgery, Sloppy Plastic Surgery on October 28, 2010
People are going to third world countries for plastic surgery. The reason is cost. It is cheap there. At the minimum, the cost of the hidden price is frequently mediocre (or lower quality) work. Sometimes there is tragedy. This one falls under the category of sloppy work or a “Yuck Tuck.”
A tummy tuck shouldn’t have a deep crease at the closure. This case wasn’t made very tight as the excess on the top hangs over the closure. There is also no dip at the belly button.
Cheap Price = Low Quality.
Best Regards,
John Di Saia MD
Botched Tummy Tuck? – How to Avoid One.
Posted by admin in tummy tuck pre-op tutorial on November 18, 2009
People contact me occasionally to ask whether they might be the victims of a “bad tummy tuck.” Here is a pre-op and a several week post-op image. I very much doubt that a real plastic surgeon did this:
-
- Before Surgery
-
- 3 Weeks Later
When you go to a doctor for a consultation and he comes back with a quotation that is half of the others you are getting, consider that you may be in the presence of a novice. If a non-plastic surgeon says he will fix your hernia only, you aren’t having a tummy tuck, so don’t expect it to look like one.
If you have the wrong surgery or only part of the right surgery, the result might not be entirely fixable later. This lady probably needs an extended tummy tuck and with that maybe she can get to look somewhat normal again. In her first operation, the tissue planes were likely not separated adequately to allow redistribution the skin after repairing the problem on the muscular layer. This looks like much less than a tummy tuck to me.
Preventing Bad Plastic Surgery:
** Know what you are seeking – a qualified and skilled plastic surgeon – when a non-plastic surgeon does the job don’t expect it to look like a good plastic surgeon’s result.
Best Regards,
John Di Saia MD
Dr D – Your Orange County Surgeon
PAGE STATS:
scrolling="no" frameborder="0"
style="border:none; width:300px; height:60px">
MORE ONLINE Dr D
Dr D on Instagram
