Monthly Archives: April 2010

It's All About Great Cosmetic Surgery Patient Care

Posted on by
Reply

It’s All About Great Cosmetic Surgery Patient Care

Several weeks ago, I was in the Palm Beach, Florida area visiting friends and my parents who are snowbird-refugees from the Upper Midwest.

We discovered that my father was having difficulty with one of his teeth and a root canal problem was suspected. We called the endodontist or root canal specialist to whom we were referred by my father’s family dentist. Understanding the urgency because there were some corollary medical issues involved, the dentist’s staff was extremely accommodating and made room in their schedule for the consultation on a relatively short notice.

I knew I was dealing with a first class office when I called and requested driving instructions to get to the office since I wasn’t familiar with the Palm Beach area. The staff was happily helpful and understood my plight as a visitor. When we arrived, we received a warm welcome and my dad was promptly seen by the doctor. He made his assessment and agreed with the diagnosis of the family practitioner that the cause of the pain and possibly a lurking infection was a root canal problem. He recommended that a root canal procedure be done but graciously offered my dad the choice of either having it done by him or by a similar specialist in his home town. When we decided that we were comfortable and that the time was short to correct the problem and hopefully avert any further infections, the dentist staff changed their schedule for the afternoon to allow the additional time necessary to perform the procedure.

Following the procedure, the dentist called my father’s family dentist back home to report on what he had found and made some recommendations. He then dictated a report that would accompany a portion of the tooth that had to be removed for the benefit of both the general dentist and the endodontist specialist who would be seeing my father when he returned home.

Everything was done so smoothly, efficiently and with the interest of the patient at heart.

I have always felt that dentists excelled in the management of their professional practices. I suspect that is because their curriculum in dental school includes courses and instruction on practice management. In the world of medical education, we do not have parallel education experience.

I relay this information to you because you are always entitled to receive the best from professional offices and you can usually tell from the very first phone call how welcome you will be and how attentive to your needs both the doctor and his staff will be. If at any point in the relationship with the doctors office you are not comfortable because you feel that you are “being treated like a number” or there only as a dollar sign to be posted to the bank account, my suggestion is that you respectfully decline further care, ask for copies of your medical records and move on to another specialist.

Kudos to the Dentist in Palm Beach, Florida for the excellence of his professional services and being an inspiration for this blog.

Septoplasty Specialist

Posted on by
Reply

Specialist in Septoplasty Surgery

Internal nasal surgery to correct a deviated septum is called septoplasty.  The root words are “septum” which means partition and “plasty” which means changing form or shape.

The object of a nasal septoplasty is to correct a deformed, crooked or perhaps broken nasal septum which is blocking the airway.  The end game is to make it straighter with fewer curves, baffles, angles, all of which contribute to blocking the airflow. 

It takes considerable skill and dexterity to do an operation entirely through the nostrils.  One has to conduct the operation with the same steps that are done in any operation:  There is an incision, there is work that has to be done, then the wound has to be closed and stitches placed to assure satisfactory healing.  Yet all this must be done through the nostrils; as if the surgeon is operating through a keyhole.  Often the nasal septoplasty is accompanied by reduction of the turbinates.  The turbinates, numbering three within each nasal passage, add to the surface area of the nasal interior and, therefore, multiply the humidification, purification, and warming functions of the inside of the nose.  Some turbinates become too large, particularly the inferior turbinate, or lowest turbinate, and when the turbinate becomes enlarged from allergy or even other unknown stimuli, it is necessary to reduce the size.  This can be done by many means, including standard surgical excision or laser treatment or other means to reduce the bulk. 

Since airflow through the nose is related to the fourth power of the radius of the air passage (Poiseuille’s law, well known to students of physics), a slight increase in the functional diameter of the nose by relieving the blockages yields a huge differential increase in air flow.

It behooves the patient who is consulting for cosmetic nasal surgery to ask the surgeon to evaluate the breathing.  It makes sense to correct the blocked nose at the same time that one is having cosmetic nasal surgery or rhinoplasty.   Why not have two operations at the same sitting with one anesthetic and have the economy of one recovery period and, often, you can save considerable money since the second and third procedures when added on to the primary procedure are generally significantly discounted by the surgeon’s office.

 

 

Successful Plastic Surgery

Posted on by
Reply

Plastic Surgery’s Batting Average

“Some turn out great.  Some turn out lousy.  You win some, you lose some.  Every doctor makes mistakes.  If they tell you they have never had an operation that turned out like they did not want it to, they are lying.”*

I find the above statement preposterous.  It is not good enough for us to turn out anything but the very highest percentage of excellent and patient-satisfactory results.  It is not a matter of a flip of a coin as if “you win some, you lose some”.  That would imply a 50% percent ratio, which is abominable.

In any other specialty, such as neurosurgery, orthopedic surgery or eye surgery, do you think surgeons would casually state that they succeed only half the time?  Of course not.  Obviously, each case is different because there are factors that weigh in such as the nature of the operation, the strength and texture of the tissues, and even whether or not there have been one, two or more surgical visits to the area.

Nonetheless, I believe that a cosmetic surgeon should not undertake an operation unless the prospects for success or what is known as the risks/reward ratio is very favorable.  Patients would not like to gamble on an outcome or spend their hard earned money with only a 50% or less chance of success.

In the end, like all things, the core of the doctor patient relationship is forthrightness on the part of the patient and integrity, honesty and capability on the part of the doctor.

*From Plastic Surgery Hopscotch, A Resource
Guide For Those Considering Cosmetic Surgery by John McCabe

 

Cosmetic Surgery Dangers

Posted on by
Reply

Dangers Lurk When Surgery Is Performed in an Inappropriate Location

Recently, the news about some cosmetic treatments has not been good.  Non-physicians injecting non-medical grade silicone - the equivalent of WD40 – into women’s buttocks. What is going on here?

The common denominator in some of these stories of outlandish and non-professional conduct is that procedures, which may not be surgical,  and yet have the potential for problems, are being performed in inappropriate locations.  Why is that?

One reason is that these practitioners do not have the qualifications to do the procedures in a facility which is accredited or licensed. A quality facility that has “ passed the tests” has quality control certain standards that apply to its physician staff. The outlaws will not be accepted onto the staff because they lack the proper credentials. 

It is never appropriate for non-physicians to perform any medical procedures, of course. It is equally improper for physicians to perform procedures for which they are not qualified. To do so is evading the stringent requirements of an official and accredited surgical facility.  There should be no “underground” procedures.

Prospective patients need to ask, “Where will my procedure be performed?  Is the facility licensed by the state, certified by the United States government or accredited by an independent accrediting organization?”  In my latest book,THE ESSENTIAL COSMETIC SURGERY COMPANION, Don’t Consult A Cosmetic Surgeon Without This Book!,  we list the organizations which act to credential surgical facilities.

Cosmetic Surgery Safety Is Very Important

Yes, this seems like a lot of work and, yes, it takes a little bit of time but is anything more important than getting the proper care in the right and safe location? The consequences of not doing your homework are painful, expensive and sometimes, catastrophic.

Sinus Infections and Septoplasty

Posted on by
Reply

Sinus Infections And Septoplasty

Unfortunately, the sinuses are the much maligned and much blamed subjects of advertisements for decongestant and allergic nose sprays, pills and an assortment of over-the-counter medications.  The reality is that the sinuses are dependent on the nose function. They need to be filled with air that flows into them from the nose. So it is the nose that really deserves our attention.  Consider the sinuses as anterooms that sit astride the nasal passage as a hallway.  You cannot get into your room if the hallway is blocked.   So if the nasal passages are blocked, you cannot expect the sinuses to function normally.

What happens in the case of abnormal nasal architecture such as the presence of a deviated septum (the vertical partition that separates the right and left nasal passage) is that the airflow is inadequate.  When the airflow is inadequate, then the sinuses do not aerate properly.  They may begin to fill with fluid and ultimately cause symptoms.  The symptoms of true sinus infections are hard to ignore:  headache or facial and tooth pain.  The signs are thick and often pus-like drainage from the nose into the throat. Sometimes bleeding.  Patients have a temperature and even nausea and vomiting. A sickness far worse than a “head cold”.

The best way to keep the sinuses healthy and out of trouble is to not smoke and make sure that your air passages are functioning well.  This calls for an examination by a specialist.  It may be that only allergies need treatment with a prescription steroid or cortisone nasal spray.  But for some patients, surgery is necessary.  The surgery takes less than an hour, has been done for over 100 years and is very well established.  The definitive operation is nasal septoplasty to correct the deviated, crooked or broken nasal septum as well as trimming of the inferior turbinates which are normal outpouchings inside the nasal cavity subject to enlargement either from allergy or other stimulations.

Finally, when patients tell me that they have “three to four sinus infections every year” I know they need help. That is not a normal condition.  True sinus infections should be very rare.