Non-Cosmetic Surgeons Doing Cosmetic Surgery?

Posted on August 27, 2010 by admin

Non-Cosmetic Doctors Profiting by Doing Cosmetic Procedures?

A recent article in USA Today described a situation not unknown to those of us who are long-time cosmetic surgery-only practitioners.

Writers Jayne O’Donnell and Jillian Berman did a nice job of pointing out what many people in the public don’t quite know or understand: there is a migration across specialty lines by some practitioners anxious to augment their income by performing elective cosmetic plastic surgery procedures that are beyond the usual boundaries of their specialty.

Writers O’Donnell and Berman reported the history of a patient who stated that “…her OB/GYN offered to do a tummy tuck after she delivered the lady’s third child.”

Next, the same patient reported that her eye doctor suggested injectables to the wrinkles between her brows when she went in for an eye exam.

The patient couldn’t quite figure out what was going on.

Traditionally cosmetic plastic surgery procedures on the body have only been performed by plastic surgeons. Surgeons who pass the test of the American Board of Plastic Surgery are expected to be the only specialists who are duly qualified to perform tummy tucks. While OB/GYN specialists have knowledge of the anatomy of the lower abdomen, tummy tucks and liposuction are not taught in obstetrics and gynecology residencies. They are not considered part of the specialty.

What about an eye doctor suggesting injectables for the wrinkles between her brows, such as Botox or Dysport? If the doctor is a subspecialist in ophthalmic plastic and reconstructive surgery, those injections are properly part of his toolbox. But, the average ophthalmologist may not have the training and experience to be a superstar at it. Patients need to know that.

In my book, Secrets of a Beverly Hills Cosmetic Surgeon, I discuss this migration across specialty lines and why prospective patients must be on the ball when evaluating an offer from their doctor that seems unusual and at odds with respect to the typical scope of that specialty. Understand that because of the inequities and burdens of dealing with health insurance companies, many doctors are so frustrated and fed up that they look for an alternative form of practice. It is not always practical or possible to go back and take a full six or seven year residency, so many of them decide to try to master some of the techniques that have been perfected by other specialities.

This is not to say that an ophthalmologist would necessarily be incompetent at doing Botox or Dysport. Know that there is not much downside to these procedures; difficult to get into major trouble.

However, an obstetrician/gynecologist doing a tummy tuck enters a whole different realm and I would be very skeptical, as a patient, before signing up to have the procedure done by that doctor. The more appropriate doctor is one who is board certified by the American Board of Plastic Surgery and has long-time experience performing a procedure after the prescribed period of education and training.

Today, unfortunately, it is a matter of Caveat Emptor. Buyer beware.

Cosmetic Plastic Surgery Questions

Posted on August 27, 2010 by admin

Got a Question? Ask it! Why Worry?

I like for patients to have every question answered. Before surgery, it is very appropriate to have questions about anesthesia, recovery, pain. Even worries of nausea and vomiting, which are now rare, should be addressed.

After surgery there are questions such as “When can I resume my exercise?”, “When can I start nursing my baby?”, “When will the bruising and swelling be gone so I can return to work?” “When can I start to have sex again?”

These are important questions and deserve answers. Sometimes patients are reluctant to ask these questions because they “don’t want to bother the doctor”, or they are a little shy about asking questions, particularly the “sex question.”

I encourage patients to ask questions at any time during their care with us; before surgery, after surgery, day time and evening time. There is no reason to worry. There is no reason to fret. Often concerns and worries are exaggerated and may even keep people from sleeping.

This post was inspired by a conversation I had this morning with one of our patients who lives in another city. She came to us to have upper and lower eyelid cosmetic surgery or blepharoplasty plus brow lift and had cosmetic nasal plastic surgery or rhinoplasty. And, incidentally, at the same sitting, with a plastic surgery colleague who is a superspecialist in body procedures, she had tummy tuck and breast reduction.

She was concerned that her smile had not returned in full force. Her fear was that somehow this would be permanent. I quickly reassured her that after her particular type of rhinoplasty, or cosmetic nasal surgery, it wasn’t unusual that the smile would be limited because of some temporary swelling and malfunction of the upper lip muscles. That function always returns. I reminded her that I witnessed it in my own daughter whose rhinoplasty I did when she was 16 years old.

Being a doctor is a 24/7 job. Your doctor should be available. If you have a question make the phone call, get the answer and sleep tight.

Why Breast Implants are Big

Posted on August 20, 2010 by admin

Why Breast Implants are Big

Figuratively, not necessarily literally.

My point is that breast augmentation surgery is popular because women desire to have as fine a figure as possible. I think it is a great idea. Some women are born with breasts that are too small. Others have breast asymmetry. Some have problems with nipple inversion. Some people need to have breast surgery to reduce over large, pendulous, supersized and therefore not particularly pretty breasts.

The most common operation is the breast augmentation. It is a good operation because it is successful and has a low complication rate.

Women like to look good, that’s why clothing styles and hair and makeup are important. For those who are self-conscious, or carry a lack of self confidence because of small breasts, this one- hour operation can literally change their life. In that regard, I liken it to rhinoplasty, one of my specialty procedures, for teenagers. Both of these operations give lifelong satisfaction and an increase in self-satifaction and self-confidence. I have witnessed it for my entire career.

If breast augmentation sometimes gets a bad name it is only because of bad judgement on the part of either the patient and/or the doctor. The classic example is Heidi Montag, the aspiring actress-personality. Common sense was thrown out the window when her reasonable looking breasts were replaced by gigantic and unnatural breast implants. She became a poster girl for bad cosmetic surgery. Frankly, I blame the patient for that unrealistic desire which, by the way, in Heidi’s case was followed by some period of pain and unhappiness as reported in the media.

Cosmetic plastic surgeons have a responsibility too. They need to do the right thing and to be proud of their work. When such oversized implants are stuffed into the chest, there is a greater chance of problems and complications. Problems that discredit the specialty and the medical profession. There is nothing wrong with breast augmentation that delivers natural-looking, properly sized and proportioned breasts. With today’s terrific implants that come in various sizes and shapes, there is ample opportunity for body cosmetic plastic surgeons to do great work. And, by and large, they are doing great work. That is why the operation is so popular.

As I said, breast implants are big. I didn’t mean to imply they were oversized. What I am really saying is that the subspecialty of breast implant augmentation is popular and well accepted and that is what young people call “big.”

Unhappy with Your Cosmetic Surgery?

Posted on August 13, 2010 by admin

What Do You Do If you Are Unhappy with Your Cosmetic Surgery?

Some patients will not be satisfied with their cosmetic surgery. In many cases, their dissatisfaction is warranted; in other cases it is not – the patient may not have been realistic about what results could be achieved.

In any event, the dissatisfied patient has the right to have a detailed conversation with her or her surgeon and ask why things did not go well and what can be done to improve the situation. I also believe a second opinion, from an objective outside source – ideally a superspecialist in the procedure – is extremely valuable. I always make this recommendation: “When in doubt, seek a second opinion.”

I have had occasion in my practice where neither the patient nor I were completely satisfied with the result. He is what I say to the patient, “Frankly, I’d like to have some input from a colleague and get an opinion as to what the best step would be going forward.” Patients very much appreciate the offer. I see to it that there is no charge made to the patient for that. And often the patient and I both learn something. All this is done in the spirit of preserving a good, solid professional relationship, with the object being to have a satisfied patient and a gratified surgeon.

One thing that is very important is that the consulting doctor have access to all the medical records including pre-and post-operative photos. Remember, regardless of the state of friendliness between the patient and the original surgeon, the surgeon is obliged to provide these records to the patient. Medical ethics, and state laws governing medical practice, demand that all must be done in the interest of the patient and, therefore, any and all medical records including the photographs, x-rays or whatever, must be available to ether the patient or to a physician of his/her choosing.

The reason to have the medical records at hand during the second opinion consultation is to understand the history and to see what the pre-operative state was and make a realistic judgment as to what could be reasonably achieved and what could not be achieved. It is also important to read the operative report to see if there are extending circumstances to compromise the result. Were there complications after surgery that had a bearing on the outcome? All these things are best understood by a thorough review of complete records.

You are entitled to have the best service possible. Don’t be shy. You are entitled to the records and you are entitled to the input from another doctor who may well say that the best was done that could be done. But in any event, you will feel better about hearing it from a second source.

The Best Ethnic Rhinoplasty Surgeon

Posted on August 6, 2010 by admin

The best ethnic rhinoplasty surgeon is the surgeon that can operate on an ethnic patient and yet deliver a nose that looks as though that patient were born with it. Natural. Fitting the facial features and not resembling other noses, as if it were picked from a catalog.

Patients are very concerned about maintaining their ethnicity, as they should be. They are proud of it. They feel that it is very important, while improving their nose, to not have a nose that looks operated and obviously done.

There is a big difference between nationalities, and therefore a difference in what a typical nose should be on the face of a patient of a particular nationality. We see patients of Asian ancestry, including Vietnamese, Chinese, Japanese, Cambodian and Thai. We see many people from the Middle East; people from Syria, Lebanon, Iran, Saudi Arabia, Kuwait, Israel and Turkey.

My aim is to study the face and deliver a nose that is an improvement and yet carries no sign of cosmetic plastic surgery. Remember, if the nose is unnatural it becomes a neon sign.

If the nose is well done, and looks natural and un-operated, it speaks for beauty, but without a voice.