Posts Tagged surgery
I hear radio commercials with the smell good plumber. Why can’t you sneaky doctors learn to do that? I need to have a skin cancer removed from my face and went to a plastic surgeon. After arranging the surgery I called to ask what I would be paying after my insurance. They said they didn’t know. How can that be?
Health insurance is just as frustrating for your doctor’s office as it is for you. Believe it or not, when I do surgery under a patient’s insurance and bill a certain amount I really do not know what the insurer will pay on the case, when they will pay or what they will tell the patient to pay. Sometimes they assign most of the bill to the patient. Other times they try to discount the bill enormously. Still other times (really rarely) they pay the whole bill. Insurers actually pay variably for the exact same billing code between different patients and these differences can be huge. It plays out as a big game over months frequently.
When asked, my office staff can tell patients what billed surgeon’s fees for a particular insurance case will be, but prefaces that with the above facts. It is not fair, but it is not our fault either. If health insurers would pay reliably and consistently, we would not be charging patients as much and would be able to tell patients what their share of cost would be in a particular case. We might be able to use our insurance billing service less (which also costs us money) and simplify matters for everyone.
The way things are, the only way we can tell patients what their share of cost for surgical services will be is for cases in which their health insurance is not involved.
John Di Saia MD
Originally posted 2011-06-08 07:30:28.
Mohs surgery is surgery for the removal of skin cancer which is common in Orange County due to our “sun sitting tendencies.” It is mostly offered by dermatologists and is specifically designed to remove the cancer with a low recurrence rate. Derms generally perform it under straight local (numbing shots in the office) and it is quite profitable for them. In this case the procedure to make the hole (that is what Mohs does) pays much better than the surgery to repair that hole. Some Derms in Orange County try to use Moh’s for nearly everything as it is profitable. This is not always in the best interests of the patient.
At times a dermatologist will refer the patient to a plastic surgeon for the closure after the Mohs is complete. This can be upsetting to the patient because unless it is arranged ahead of time, the plastic surgeon may not be able to get the patient scheduled for a few days.
You may have seen people walking around with large bandages on their ears or noses. They may not have had accidents as you might have thought.
An alternative is to have the skin cancer surgery performed entirely by a plastic surgeon which can decrease the patient’s total expense and allow for anesthesia and completion of surgery in one day. The plastic surgeon may order a frozen preparation of the removed tissue in the operating room (called frozen section) and the results have a similar cure rate and often look a whole lot better. Many plastic surgeons will take cases like these as long as the cancer isn’t too small because we are paid less to remove the cancer with conventional surgery than the Derms get with Mohs.
John Di Saia MD
Originally posted 2011-03-04 07:30:28.
I have had a capsulectomy due to capsular contraction, but now it has returned. I want an explant because they are uncomfortable and look unnatural. My doctor said that since the capsulectomy did not resolve the issue, he recommends having an explant and waiting about 6 months to a year. After my body has healed properly, he said that I can get implants again and will not get capsular contraction again. Is this accurate? Am I less likely to get capsular contraction or will I be free of capsular contraction? I’m also looking for a doctor experienced in explants.
The subject of hardened breast implants (Capsular Contracture) comes up frequently as it is the leading cause of long term dissatisfaction with breast implants. If your breasts tend to hurt or look unnatural, you likely have severe encapsulation (Baker Grade III or IV.) When contracture redevelops quickly after capsulectomy (assuming the operation was thorough,) this is worrisome as it may indicate a high tendency for recurrence. The main question when severe contracture is present is whether or not a cause can be identified. Bothersome contracture doesn’t happen to all patients. This kind of reaction is associated with cigarette smoking, bleeding, infection, silicone gel implants, poor soft tissue coverage and radiation exposure as well as a previous history of contracture. Some of these issues can be minimized in an attempt to reduce the tendency for encapsulation. Preventing the problem is the best solution.
While removal of your implants for a time with later replacement might improve the problem, this is not a “slam dunk” nor is it guaranteed to completely solve it. The results vary substantially. Usually removal with a good capsulectomy is the best thing for comfort. Implant replacement at times is thwarted by recurrence of the contracture.
Then again if you leave the implants in place things will not likely improve as you have had a trial of capsulectomy and replacement already. It is true however that a woman who has had her implants removed and not replaced frequently has them put in once again down the road due to appearance issues. This is not invariably the case however. Some women actually like the look of their breasts without implants after capsulectomy and explantation. The results of such surgery vary though.
These cases need to be handled individually and with a fair amount of disclosure before surgery is performed, so that everyone comes out satisfied. I don’t have one treatment that goes for all patients on the issue due to their inherent variability.
John Di Saia MD
Originally posted 2011-05-31 07:30:35.
The subject of aspirin used before surgery pops up in the news now and again. The use of drugs that “thin the blood” is dangerous before cosmetic surgery as it increases the chance that you could bleed shortly after your operation. Bleeding can lead to hematomae (blood collections under the skin) that can ruin cosmetic surgery results and lead to the need for additional surgery. You should always inform your doctor of the medications or supplements that you take before surgery so that the list can be reviewed and modifications (if needed) can be made:
My DO NOT TAKE drug list (don’t stop any medication without speaking with your doctor)
Note that the list of medications that “thin the blood” to some extent is long. It includes common over the counter drugs such as ibuprofen, and naproxen and even some supplements that you might not expect.
John Di Saia MD
Originally posted 2005-11-20 08:35:00.
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
Herbal supplements and even over the counter medications can screw up your cosmetic surgery. They can interact with anesthesia or increase the chances of bleeding.
For example, Vitamin E, Marine Fatty Acids, Omega-3 Fish Oil Supplements may increase risk of bleeding with surgery. I recommend my patients to stop them 2 weeks prior and for about 1 week after surgery.
I have a “Do Not Take” List for my practice on my website for those interested.
John Di Saia MD
Originally posted 2006-02-22 16:30:00.
Sometimes if you cough or sneeze a bit of wee comes out! I just have to cross my legs and hope it doesn’t trickle down my leg.
Well, leaking urine when coughing is called stress incontinence. My father fixes those. He is a Gynecological Oncologist. She is really not looking for vaginal surgery at all. She is looking to fix her bladder. This has nothing to do with cosmetic reduction labiaplasty. I do those.
John Di Saia MD
Originally posted 2007-06-17 13:50:00.
“If I see something sagging, bagging, and dragging, I’m going to nip it, suck it and tuck it. Why should I look like an old barn yard dog if I don’t have to?” and “It takes a lot of money to look this cheap.”
Source: Oprah Interview
Dolly Parton has been an entertaining celebrity known for her curves. Relatively recently she admitted to the world that she had breast implants although to most plastic surgeons that had been obvious for years.
In 2002, she told a European magazine that her first breast implant surgery was in the 1980s at which time she lost weight and didn’t like what it did to her bust. She has had them done roughly every ten years afterward most recently to downsize (mis-represented as a “reduction” online) due to pain. She was already known for her curvy figure before the surgery, but got increased attention as she increased her bust size further.
Ms Parton is an excellent example of a woman with larger implants over a thirty year period and the related need for “maintenance” operations over that time. Dolly is also uncommon as a celebrity in that she has been pretty forthcoming on the issue (at least over the recent years) which has likely helped younger women looking into cosmetic surgery with real world experience.
John Di Saia MD
I have a wide scar on my leg that I got years ago. I have tried creams and stuff. When is surgery a good idea to improve a scar? Can a cream or a laser make it thinner?
Scar improvement has several phases and the condition of your body and how the wound occurred have parts to play. Early on after wounding there is the question of whether or not to have surgery to repair the wound. If the edges are clean and close together, then surgery is not always beneficial. If they are apart or the wound is dirty a proper medical evaluation and/or surgery can make things better down the line. When in doubt, get that evaluation.
Once the wound has started healing, if the edges are were not put together or were traumatized then scar tissue will form along those areas. Scar tissue doesn’t look like regular tissue. It doesn’t tan like regular tissue and it can be lumpy or obvious.
Surgery can improve a scar at this stage, but that scar should be allowed to mature before surgery is performed in most cases. The tissue softens and this makes the results of scar revision surgery potentially better.
In your case if a year has elapsed I would say have a good plastic surgeon look at your scar to give you an opinion on the potential for improvement. Many small scar revision procedures can be done under local (numbing only) shots in the office to keep the cost down.
John Di Saia MD
Originally posted 2010-06-16 07:30:09.
Catherine Kieu Becker, 48, was booked for aggravated mayhem, false imprisonment, assault with a deadly weapon, administering a drug with intent to commit a felony, poisoning, and spousal abuse. She was being held at the Orange County Jail. The woman, who was later identified as the suspect, called 911 to report a medical emergency at about 10 p.m. When officers arrived, they found the man tied to a bed and bleeding from the groin area. He told officers the woman had given him a drug in the dinner she had made for him. Investigators said she tied him to the bed after he fell asleep. When he awoke, the woman grabbed his penis and cut it off with a 10-inch kitchen knife, according to police. She then threw it in the garbage disposal and turned on the disposal, police said. The 51-year-old man was hospitalized at UC Irvine Medical Center in Orange. He was listed in serious condition. Pieces of the penis were taken to the hospital, but it remained unclear whether surgeons were able to reattach it.
Replantation of a severed part (that what we call it) is possible dependent upon the condition of that part, the skill of the available microsurgeon and the quality of the facilities. I trained at UC Irvine Medical Center and at the time they had a very skilled microsurgeon available. Many good microsurgeons have started doing less of this kind of work due to the stress on their lives (These cases tend to occur at late hours) and the poor reimbursement. As we have discussed here before not all plastic surgery pays well. I do far fewer emergencies than I used to due to these very facts.
The part in this case having been treated to a presumably working garbage disposal was likely not be found suitable for replantation.
Staying with your not soon enough to be ex in the middle of your divorce can have nasty consequences.
John Di Saia MD