Truth In Cosmetic Surgery Blog: May 2005

Pamela Anderson Bags Kentucky Fried Chicken

PETA is against animal cruelty. OK, but I can't help but think of perhaps how many cows might have given their skins to fill Pam's lips over the years. Collagen, once a very popular soft tissue filler, is derived from cow skin. She probably uses a hyaluronic acid-based filler now as these are more popular. Most of these are not naturally-derived, so she would be "off the hook" for now anyway if this were the case.

Pam's video clip is here at a PETA website.

I love ethical confounds like this in celebrities. Maybe she should look into the sourcing for that cow skin?

Until Later,

John Di Saia MD

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Movie Star Plastic Surgery - Lindsay Lohan Deflation?

More like explantation. Looking at Awfulplasticsurgery.com, Lindsay has lost a ton of weight and round "implant-looking" breasts have virtually disappeared.

The breast picture has changed between June 2004 and May 2005. Weight loss can shrink breasts pretty substantially, but those June 2004 pictures look very implant-like.

I tend to agree wuith the suggestion that breast implants have very likely been removed.

Until Later,

John Di Saia MD

P.S. I think she looks too thin now personally.

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Everything is Relative

The problem with assessing movie star plastic surgery is that your average movie star has a lot of it. Yesterday's Awfulplasticsurgery.com post of Jessica Simpson looks into her upper lip. From the looks of it, it has probably been augmented. She has likely had more than just that in the seven year span between the images presented.

Soft tissue fillers are very popular particularly for lips. Collagen used to be the top dog here (or "Cow" as it was derived from cow skin). It is still used by some, but swells excessively upon injection and goes away quickly. Today Hyaluroic acid-based fillers are more popular and there are many others. Some surgeons will use the patient's own skin as a filler. It requires a small operation, but lasts a bit longer and looks more natural. Almost nothing lasts forever in the lips. The stuff that does is a worry as it can become infected. Patients frequently desire progressively larger and larger lips. I offer some soft tissue fillers, but am conservative in amount, so I get to hear about how they aren't large enough.

BTW - Looking back at the Jessica Simpson 2005 image at Awfulplasticsurgery.com, did anybody notice her forehead. I'd wager there's some Botulinium toxin in there....look ma...no wrinkles.

Until Later,

John Di Saia MD

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Good Cosmetic Surgery - "Saddle Bag" Liposuction

OK, back to balance. Cosmetic surgery usually works out well. Most plastic surgeons pride themselves on their work and I am no exception. Judicious liposuction does not leave a "moth eaten" appearance.

I treated this young woman several years ago. The sides of her thighs had bothered her for years affecting choices in bathing wear and other clothes. I performed liposuction of the sides and back of the thighs.

Two months later, the improvement is apparent.

Best Regards,

John Di Saia MD

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Another Porn Star Plastic Surgery Adventure

I "borrowed" this image of before and after from another blog. It shows another porn star reportedly before and after facial plastic surgery. It is a sad state of affairs when a woman looks better before plastic surgery than after. We all like to avoid this occurence.

From the looks of things, she probably had a forehead lift (the brows are raised) with or without upper eyelid surgery. Her hairline may have been raised which some forms of the operation can do. She appears to have had a large amount of lip filler (probably collagen or a hyaluronic acid formulation).

I am unsure at what point she started. She may have had cosmetic surgery prior to the "before" image, but it seems that she may have had too much.

Yes. You can have too much cosmetic surgery. There is a "happy medium" at which improvement has been obtained. Pushing it beyond this point can lead to problems.

In related news, you can see Lindsay Lohan sporting that which appears to be a serious over application of a filler to her lips at awfulplasticsurgery.com. Even "real" stars can get a little carried away it seems. Fortunately, the majority of soft tissue fillers absorb eventually.

Until Later,
John Di Saia MD

P.S. It appears that many of my readers know alot about porn stars. Keep the blog post tips coming.

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Porn Stars and Their Boobjobs

I wrote an article for "Exotic Dancer" magazine a few years ago in which I discussed the problem with many adult entertainer / porn star breast augmentation outcomes. The funny thing (when looked from outside the practice) is that women in general come to plastic surgeons wanting pretty large breasts. At times, the requests are destined to look unnatural or perhaps even freakish.

Personally I turn away the freakish ones. When women "go really large" and have little of their own tissues available to cover the implants they not only end up looking unnatural, but also have a higher chance of hardening (capsular contracture), rippling (showing signs of the underlying implant) as well as other complications. These complications can mean more surgery.

This is all relative; relative to the amount of tissue you have over your chest to begin with (skin, breast, and muscle) compared to the dimensions of the implant you'd like placed. Many women can get the size they want and not end up with problems. If you are very thin though, maybe those full D's should be off the menu.

Really pretty women can end up with funky-looking breast implants. A surfer pointed out the breasts of a porn star Jesse Jane that are the subject of an Awfulplasticsurgery.com post today. I provided commentary as well.

These kinds of outcomes can be avoided by simply choosing smaller implants (or avoiding high profile implants) in my opinion. It is simpler to avoid the problem than become a Fixmyboobjob.com patient.

Until Later,

John Di Saia MD

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Good Cosmetic Surgery - Weight Loss Tummy Tuck

As we have been leaning on the "warning side," it seems fair to feature some positive cosmetic susgery outcomes.

Here we have images of the oldest patient for whom I have ever performed abdominoplasty. She was 73 at the time of her tummy tuck, but a very healthy 73. She had of her own accord lost some 65 pounds and wanted the "fat apron" lifted from her abdomen. After her internist cleared her for surgery, we went ahead.

She did very well post-operatively and was pleased with her outcome.

Best Regards,

John Di Saia MD

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Tara Reid at Awfulplasticsurgery.com

The May 10 2005 post at Awfulplasticsurgery.com
features an image of Tara Reid with a ripply stomach. The supposition is that she may have had liposuction.

Overzealous liposuction can indeed leave marks like those we see in the image posted there. This is really irregularity in the fatty layer beneath the skin. In order to maintain a smooth contour to the skin, there needs to be fat between the skin and muscular layer. Preferably, this layer should be even.

Here is an image of a woman that came to the office requesting that I repair her abdomen after a well-known plastic surgeon had performed liposuction:

Her smoking history made surgery ill-advised, therefore I was unable to help her.

The bottom line is that it is best to be conservative in liposuction cases. We don't want to take all the fat. You need some.

Until Later,

John Di Saia MD

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Tummy Tuck Drains

A major source of pre-operative dismay with tummy tuck patients is the issue of drains.

Tummy Tuck patients need drains. Drains help decrease the potential for seroma formation (fluid collecting between the skin flap and muscle). Seromas can really make post-operative care difficult especially if they become infected. Longer use of drains really decreases the potential for seromas.

Personally, I use drains until fluid output pretty much ceases. This is usually 1-3 weeks. Larger cases/patients can require them longer. Other surgeons take drains out sooner and tolerate a higher risk of seromas. This is a matter of opinion.

Here is an image of the abdomen of one of my tummy tuck patients five days from her surgery. The drains are the tubes leading to the larger bulbs at the patient's sides. The thin tube is the pain pump catheter.

The drains really don't cause much discomfort although they are unsightly and patients usually are relieved when they are removed.

Best Regards,

John Di Saia MD

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Misconception Correction - Tear Drop Breast Implants Can Look Pretty Awful

Women frequently come to consultation interested in anatomic or tear drop shaped breast implants to look more "natural." A case in which I was asked to repair a woman who had had five operations by another surgeon actually involved removal of her tear drop shaped implants and replacement with round implants in addition to a modified breast lift:

These original tear drop implants don't look so great. After her repair operation, she was nicely improved:

http://www.psinteractive.net/baug93.htm

Until Later,
John Di Saia MD

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Dr 90210 Turns Away Smoking Porn Star

Saw Dr 90210 last night. Dr Rey was presented with porn star Vanessa Lane to redo her breast augmentation. He turned her away because she was smoking or so he said. From what I saw this wasn't too bad an idea as having seen her breasts online before she would likely be a hard redo:

Vanessa Lane after boobjob #1

She was talking about larger breasts on the show. I thought she should go smaller and maybe have a modified lift. She would certainly have to be off the cigarettes to make this "do-able." Her skin envelope looks pretty contracted...probably worsened by those cigarettes. She has a tiny frame and her implants don't have enough skin around them to look good. The other woman on the show that she thought looked nice had breasts that hung maybe too much and were quite fake looking. If she wants to look like this other woman, she would be unlikely to get close.

Dr Rey probably turned her away as she had unrealistic expectations. Smoking was part of the problem. I had heard that this guy was a jerk. Didn't seem so to me. He seemed to act responsibly on this show. From that which I could tell, turning her away was a good way to avoid an unhappy patient.

You'd rather have them unhappy because of your choice not to operate as opposed to unhappy because of the results of your operation.

My 2 cents,

John Di Saia MD

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Misconceptions - Cosmetic Surgery In A Foreign Land

Cosmetic surgery is expensive, so it is understandable that patients may seek to limit that cost. Some have gone to other countries in which overhead is not as high and surgery is cheap. Beware the case in which it gets too cheap however. Repair is not very cheap.

A woman posted the story of her friend on my forum board. This poor lady went to Costa Rica for her tummy tuck. She developed a horrendous wound infection and was left disfigured. A week in Costa Rica became three months. She is currently on disability.

The thread at my forum.

Her pictures

Now don't get me wrong: I review cases for the California Medical Board. I have seen domestic malpractice and poor outcomes. This Costa Rica case is the worst Tummy Tuck nightmare I have ever seen.

You can go to other countries to get your surgery much less expensively than in the United States. Some of this cost difference is malpractice insurance, rent and other things about which you may not care. Other cost differences have to do with the quality of the medical care with which you are provided. Powdered sugar on an open wound may be the quality of care in Costa Rica (read her story) but that doesn't pass muster here.

Many patients leave the US and have successful outcomes. Just take into account the risk: benefit profile before you jump.

Best Regards,

John Di Saia MD
San Clemente, Ca.
www.ocbody.com

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My Problem With Extreme Makeover

This piece was originally written for the local press. It was published in Beach Cities Style in the July 2004 issue. It may be helpful for those trying to assess reality versus hype in cosmetic surgery.

What could a plastic surgeon possibly have against "Extreme Makeover?" After all, the show has certainly increased the awareness of the average American to cosmetic surgery in general. Doesn’t this translate into more business? The surgeons on the show have very likely enjoyed some degree of market advantage from their involvement. Isn’t this true for cosmetic surgery in general?

If the show didn’t seem to affect the average patient coming into my office for cosmetic surgery, I wouldn’t have a problem. I notice in my patients that have seen the show however, impressions that confound successful encounters with cosmetic surgery. These impressions revolve around the concept of "unrealistic expectations."

- The Whole Piece -

A great place to start,

John Di Saia MD

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