Posts Tagged review
Those of you who know me know that I practice both cosmetic and reconstructive surgery and have done so for years. For about a decade I have maintained an office and a relationship with the hospital in San Clemente, now a Memorial hospital. Part of that relationship has been covering their emergency room and repairing what I believed to be my fair share of wounds in that environment. The hospital has had a mandatory call policy for plastics and a few other surgical specialties such as orthopedics and ENT. The hospital had not paid for this privilege or at least had not disclosed that they had.
Several things have changed in the last few years:
(1) Memorial bought the hospital. Their administration has a poor relationship with the majority of the medical staff to say the least.
(2) I moved to Long Beach, fifty miles away.
(3) I became aware that “under the table,” the hospital had been paying orthopedics to take call from 15 minutes away. (The two pods live closer to the hospital than I do.)
(4) A staff member from ENT was released from call after he made a request a few years ago.
So I made a request to be released from call and was told….if you want to keep privileges at the hospital you will take emergency room call. I informed the ever so considerate (note: sarcasm) medical staff that I would be dropping their hospital effective January 1 2011. Taking call from fifty miles away for free is BS, no matter how you slice it.
My belief is and has been that doctors accept way too much bull and rarely if ever do anything about it. Time to put my money where my mouth is. I will still maintain my San Clemente office, but not see patients at the hospital. If you are a physician considering privileges at this hospital, don’t expect them to be either forthright or honest. If you are looking to see Dr D, don’t go to Saddleback to do it.
John Di Saia MD
Originally posted 2011-01-05 07:30:48.
Liposuction is plastic surgery’s “gimmick procedure” having had more angles applied to it than a child’s toy. There is however money to be made in fat reduction so the gimmicks will just keep coming.
Enter Tickle Lipo, a new technology superimposed on the liposuction game. In this newer version of the basic liposuction technique, the cannula, the instrument used to remove the fat, vibrates like a whip inside your fatty layers. This supposedly helps remove the fat more evenly and with less pain.
Tickle Lipo looks like a hybrid between two other forms of lipo already on the market – power-assisted lipo (Pals) in which a motorized cannula breaks up the fat and ultrasonic lipo in which sound waves do it. Will Tickle be better or worse than its fat sucking competitors? That will likely depend upon the technology and the skill of those who handle it.
A funky high tech instrument will not make a non-surgeon into a master plastic surgeon just like a hot race car will not make me into Jeff Gordon. Check the credentials of anyone who wants to use this thing on you and go from there. At this point I would consider Tickle an experiment.
John Di Saia MD
Originally posted 2011-02-07 07:30:59.
Non invasive technologies are all the rage. It is still amazing to me that companies can release a new product with no proof of efficacy, a slick name and a marketing line of copy and expect to make money. Still more amazing is the case in which they actually do.
From the looks of the web site the i-Lipo system looks like a laser shined on your skin claiming to encourage fatty tissues to shrink. The images on their web site show modest if any results that might be accomplished “when paired with a change in lifestyle to maintain your results, typically just simple diet and exercise.” I’d bet much of the change they show might be accomplished with exercise and diet modification alone.
And if that is not enough Bob look behind curtain #1 to find the new and improved i-Lipo Ultra Plus system. This incorporates vacuum massage ( a la endermologie) and infra red skin tightening (a la Thermage) to the system. This might be their “everything but the kitchen sink” product.
I would not be spending money you can’t afford to lose on these. I doubt they work very well at all. But who knows our immediate gratification hungry public might just make them some money. It has happened before.
Originally posted 2012-05-22 07:30:02.
Looking to obtain a break on my practice’s botulinum toxin of choice (Myobloc) I yielded to curiosity and ordered from a Canadian Pharmacy…Northwest Pharmacy.com. I figured we would try to break the price point of this popular product. Thankfully I used my credit card.
Botulinum toxin must be kept cold to retain its potency. We traditionally receive this product on dry ice and have never had much of a problem with effectiveness. I was promised by the pharmacy rep that this product would arrive cold within 2-5 days of shipping. Only after I gave her my credit card information did she share with me that the product would be coming from Great Britain. This was not welcome news. I was reassured that the product would be cold and usable.
The product arrived ten days later at room temperature, a completely questionable situation. The pharmacy rep said to go ahead and use it. I said nope. As I was summarizing the dispute, it occurred to me one more reason why patients having their botulinum toxin elsewhere sometimes describe such a variation in their experiences. Other practices might actually use this rotten Botox. Mine doesn’t.
For other docs thinking of ordering from Northwest Pharmacy: They were way too Type B for me. You have been warned.
John Di Saia MD
Originally posted 2011-01-13 07:30:09.
As I perform Scar Revision surgery and deal with scar treatment not infrequently, people ask about over the counter scar treatments. Do any of them work?
As we have discussed before scar healing occurs in phases and treatment to minimize scars should only be done after the wound is closed and without scabbing. If you have had surgery, you should ask your surgeon when the best time to begin scar therapy has arrived. I like early treatment once the wound has achieved early healing.
I have used some of these products with my own wounds particularly after I had my triceps repaired a few years ago. The silicone sheeting products tend to be my favorites here as they do not make a mess and can be re-used. They also cover the scar keeping it away from sunlight.
Don’t be fooled by cheap sheeting products or gels. They don’t work as well.
John Di Saia MD
Originally posted 2011-02-21 07:30:43.
Hi I just felt like I should post this based on my horrible experience with the “my choice medical” company. I would not recommend their services even if I hated you. First off when I called the 1800beyourbest.com website was different and could have been held for false advertising because they did not clearly indicate that you save 1000 for each procedure only if paid in cash or credit not through their financing plan. So if you finance not only do you pay financing interest but then an extra 1,000. It did however mention the small operating room fee and that there were no gimmicks. Well the Breast Aug. was 2999 pre-fee and if you got the 1,000 off. You pay 500 for a consult which they wouldn’t give back but if you go ahead with the procedure it gets applied to it. So the real cost of the procedure ended up being around 4,999 except that Dr. they sent me up with (note there’s few options in each area) works out of a house with an operating room within (shady as hell), the guy was very unfriendly barely uttered a word just took a picture and I was warned prior that he was very particular and did things only one way, his, or wouldn’t do it.
Cheap cosmetic surgery may not be. Read the fine print.
I am very selective about the use of finance companies in my practice and don’t associate with funky companies. They can be very sneaky. When they don’t make their money the old fashioned way many resort to tricks. The “surgeon doing your breast implant operation in his house” thing was hilarious.
John Di Saia MD
Originally posted 2007-08-07 08:45:00.
We have discussed liposuction and the multitude of gimmicks that have been applied to it before. Over the years, I have used a fair number of liposuction modifications to see if the results were worth the expense.
In 2008, I performed over a hundred Smart Lipo procedures while contracted to a marketing company. While I do not think Smart Lipo is any worse than tumescent liposuction, I did not find it to be any better. I am able to get the same results with the modified tumescent liposuction set up that I have been using for years. The “Skin Tightening” aspect of the Smart Lipo system was vastly overstated by the product representatives by my evaluation anyway.
Smart Lipo and some of the other liposuction modifications are in my opinion more marketing gimmicks than ground shattering technological advances. If you want to spend your money on them, that is fine. Your ultimate results however are more a function of your surgeon’s skill and the problem for which you seek surgery than the technology that may have attracted you.
That is Dr D’s truth.
John Di Saia MD
Originally posted 2010-12-17 07:30:55.
I saw a Scarguard product on sale at a drugstore locally. The claims on the packaging were over the top as usual:
(1) “Guards against New Scars Forming” – Difficult to Prove.
(2) “Flattens and Shrinks Old Scars” – Not really.
(3) “Scarguard is the #1 Choice of Plastic Surgeons” – Really. Nobody asked me.
Scar treatment is pretty simple. Avoid wounding if you can. If you have plastic surgery seek a talented surgeon who will spend the time to do the best. After surgery, avoid sunlight, smoking and consider scar massage as directed by your surgeon. This stuff is not going to make a bad scar much better unless it is applied early and even then the results are debatable.
John Di Saia MD
Originally posted 2010-07-06 07:30:48.
“I had been consulting with many local plastic surgeons to revise a wide, dented scar that I had on my leg. One doctor suggested tissue expanders but the price was ten thousand dollars which was too much for me, so then I consulted with another doctor which convinced me to have Restylane injected in my scar to improve the dent but that still made no difference. I continued to consult with other doctors that gave me no hope because they would tell me that my scar was too wide for revision.
I was ready to give up when I found my Dr’s web page and saw he had revised a scar similar to mine. I am really glad that I went to him. I will always be so thankful to him since he was the one that was able to improve the appearance of my scar after the scar excision, now my scar is as thin as a pencil line and there is no more dent and it is already fading away. He is the best of the best.”
Wow. Here’s a nice review of a scar revision operation I did for a patient on Real Self. How kind. Restylane really does very little for depressed scars. Wide scars are best addressed by revision in my opinion.
John Di Saia MD
Why is it that only extremes make it today? This book review features lines like:
“One must suffer to be beautiful.”
and stories of the author Alex Kuczynski and her encounter with Restylane:
“In 2004, in quest of that Angelina Jolie suck-the-chrome-off-a-trailer-hitch mouth, she had her upper lip stuffed with Restylane, a mucus-like synthetic form of hyaluronic acid. It gave her a yam-sized Donald Duck disaster zone below her nose that kept her housebound for several days.”
as well as statements making plastic surgeons the demons:
“Second, many surgeons and dermatologists actually prefer big-bucks, high-satisfaction cosmetic work to, say, cancer surgery.”
Well Alex, I do both and cancer surgery frequently loses me money. Are you familiar with the concept of profit and loss?
Again we sensationalize plastic surgery and surgeons making them villains ignoring the sobering reality of moderation that virtually removes the potential for disaster.
You can have good results with plastic surgery despite the tone of this Miami Herald book review. I am not going to read the book. From the looks of this it likely reads like a Batman comic book.
John Di Saia MD