I Love Trashing Blue Cross

Healthcare insurance companies are on my short list for abuse.

They underpay, take forever to pay, deny after approval and rescind for fun. Why should I not pitch them the BS they deserve in return?

Today I received a particularly funny (and O-So-Typical) letter concerning a woman for whom I performed breast reduction a few weeks ago. This case was the largest I have done this year with over 4 pounds of breast tissue in the removed specimen. Her back pain is gone. She can stand up straight. And her husband looks like an worked-up fiancée (amongst the best compliments in my book).
Bottom Line: This case was medically-indicated. Sorry Blue Cross.

Nevertheless, Blue Cross via letter today is trying to deny/delay payment after the surgery has been performed (and after their own pre-operative approval). They are trying to make payment the responsibility of the HMO arm of her insurance plan. I am not an HMO provider. They know it won't work, but it will delay payment. This is Healthcare Insurance Company B.S. Maneuver #1 from the "We're Cornered But We Can Still Delay" chapter.

They are probably hoping that I will eventually drop them entirely and make all the patients pay cash. I can certainly see why many of my friends have done so.

More of that wonderful treatment from your insurance industry.

Until Later,

John Di Saia MD

Robert Redford's facelift, Joan Rivers' comments & my conjecture

I've been thinking about Joan Rivers' reported comments on Robert Redford's facelift. Then I searched the net a bit.

Maybe what Joan Rivers didn't like about Robert's facelift was his hypocrisy in having it in the first place? Possible. As he went on record just a few years ago with scathing words for all those "shallow people" who would have one:

"I'm not a facelift person. I am what I am. [The] trade-off is that something of your soul in your face goes away. You end up looking body-snatched in the last analysis. That's just my view. It's not necessarily a popular view."

-TV guide 2002

"Everyone in Tinseltown is getting pinched, lifted and pulled. For many it's become a sick obsession. They lose some of their soul when they go under the knife and end up looking body snatched. People should preserve their time in history. I'm happy to make the best of what I've got."

-US Magazine 2002

Joan is very pro-surgery...maybe a bit too pro-surgery. Could she have been offended by Robert's reported comments. Were additional comments directed at her? Is there a personal issue between them? I certainly don't know.

That which I know:

By the looks of things, Robert, you are just as shallow as those other Hollywood Celebs. This is of course assuming you had cosmetic work. It kinda looks like you have.



John Di Saia MD


P.S. I have nothing against people who don't want cosmetic surgery. I do not however like hypocrites.

Facial Wound Reconstruction - Not For The Timid

As summer begins, I am asked to do a whole lot more of the things that most of you don't think of as "plastic surgery." These include trauma and cancer cases.

Those of you with weak stomachs can simply surf away from these posts.

This gentleman came to me after visiting his dermatologist for a Moh's procedure. He had a fairly large skin cancer removed from his lip and chin. It left the ugly hole you see above on the left. I repaired his wound in the office under local (at his request). You see him three weeks later on the right. He healed very well for his years for which we were both thankful.

For those of you that would ridicule cosmetic patients, beware that they represent the subsidy upon which my reconstructive patients receive care. I would not even pay my rent if I were living solely on your insurer's excuse for reimbursement. And I can't afford to do much more reconstruction than I do.

So, when you all "tee hee" about the lady who may have looked fine (to you) before her cosmetic procedure, think of people like this man. He gets to have his face back.


Until Later,

John Di Saia MD

Reuters - Obesity costs soar tenfold to $36.5 billion in US

No kidding. Obesity costs money in poor health if you don't treat it and in surgery if you do. I see gastric bypass patients for body lifts, breast lifts with augmentation, thigh lifts and more. There is great evidence that patients live longer if you reduce their weight by bypass (or any other method for that matter).


Full Story (on Yahoo from Reuters)


My Cosmetic Procedures for Extreme Weight Less Patients Page


Best Regards,

John Di Saia MD

Cameron Diaz and Her Butt Scar

Looked at Conversations of Famous People Blog this evening to find a picture of Cameron Diaz's rear end. Celebrities really get no peace. Then again if they did, Blogs would probably lose big time in the material department.

It seems that Cameron wore a revealing bikini bottom in Hawaii recently and the back of her right upper thigh / buttocks was visible. Photos were taken and it looks like she has a large wide scar there.

There is a site in which the picture of the scar is of better quality:

Cameron's Scar Picture

At the blog at which the post originated, the talk was that she had had liposuction. I very much doubt this is a liposuction scar. It looks lik a traumatic scar or a scar from the removal of a skin cancer (maybe melanoma). It looks like some kind of scar revision would be in order though if it is what it appears to be.


Until Later,
John Di Saia MD

Health Net Sued For Unfair Denials

I received another class action notice in the mail today. Lawsuits on behalf of physicians against health care insurers are becoming more common. As far as I am concerned, all insurance companies play games in the process of approvals and payment for care. I have not seen a notable exception to this statement.

Name another business in which payment for a service often takes months even when approval has been obtained in advance. How about a business in which the contractor cannot determine the rates for their services? Or better yet one in which the discount taken by the company (the so called Provider discount) is routinely two thirds of the charge. I honestly don't know how Provider doctors make a living!

These suits get me from two opposing viewpoints:

(1) Good. They (the insurers) are getting theirs.

(2) Bad. Funds that should have been paid to physicians are just going to lawyers. These suits generally enrich the law firms much more reasonably than they do the doctors for whom the suits are supposedly being filed.

I'll bet we will see more of these suits.


John Di Saia MD

Joan Rivers Plastic Surgery Critic?

I guess I have now heard everything as Joan Rivers (a veteran of a fair number of plastic surgery procedures by her own admission) is now a plastic surgery critic. She is reportedly bagging Robert Redford's facelift. A post at Cityrag has been quoted on several blogs including AwfulPlasticSurgery.com.

Looking at the pictures at Cityrag, he looks pretty good to me compared to his wrinkles of five years ago. I have not seen him in facial animation, but then again how old is he? A surgeon can only do so much to beat back the ravages of whatever he has done to himself over all these years....sun exposure, cigarette smoking, etc.

Take it easy Joan.


John Di Saia MD

Katie Holmes...Looks Like A Nose Job

Surfing SKIN DEEP revealed some images of Katie Holmes from 1998 and this year. Looking at her nasal tip, it seems evident that she has had a rhinoplasty. It looks like a good one to me. I don't even enjoy performing rhinoplasty, but appreciate a good one when I see it.

Until Later,

John Di Saia MD

Why Deny It?

I was reading SKIN DEEP .

The topic was:

"Why would a celebrity deny having had cosmetic surgery?"

Most people deny having had plastic surgery. Celebrities are only different in that there are multitudes of photographs publicly available to debunk their statements. Smart celebrities (in my opinion) simply admit to having had "a little" and leave people wondering.

Probably the most important issue for entertainers is that their image is their livelihood. They need the availability of good plastic surgery in many cases to stay marketable. Of course, that which is "good" is very much a matter of opinion.


Best Regards,


John Di Saia MD

Michael Jackson - Without Surgery?

I found this cool forensic rendering online from a South Florida news station. An artist M Mancusi tries to figure what Jackson would have looked like from his childhood photos if he had been left to normal aging.


>Go here and Click "Mancusi's astonishing rendering"

You gotta love this stuff.

I think it is safe to say that Michael Jackson is the poster child of eccentricity. His plastic surgery history (by inference of course) is likely voluminous. At least his legal troubles are over for now.


Best Regards,

John Di Saia MD

A New Species Of Fish?

Check this out:

http://elisita.blogspot.com/2005/06/hollywood-trout-pouts.html

or

The Original Post




Attack of the Hollywood Trout.....



LOL,

JPD

Bad Drug versus Off-Label Use - More on Botox Cosmetic

Looking into some articles in the press on Botox and "Bad Drugs," there is a misconception that warrants explanation. Allergan and other drug companies have a significant market interest in their products. Their marketing will of course imply that their drug is superior or that alternate drugs are unsafe. For better or worse, this is the nature of advertising.

Let's look at the history of Botox Cosmetic TM:

Botulinium Toxin A (at the time named Botox TM) was approved by the FDA for use in blepharospasm (to decrease spastic movements of the muscles of the eye) in 1989. It was used "Off-label" soon thereafter by plastic surgeons and other physicians to effect cosmetic muscle paralysis.

What is "Off-Label?"

The "Off-label" use of a drug is utilization of a drug for a purpose for which is not FDA-approved. Between 1989 and 2002, Botox TM was used "Off-label" by a number of physicians essentially every time it was used for cosmetic purposes prior to being FDA-approved.

Since Botox TM was FDA-approved for cosmetic use in 2002, Allergan has promoted it over other competing products as the "only FDA-approved" Botulinium toxin for cosmetic use. The inference is that other products are unsafe. To berate non-FDA-approved Botulinium products ignores the history of Botox Cosmetic TM.

Myobloc TM is Botulinium toxin B. It is currently FDA-approved for cervical dystonia (to diminish neck spasms). It is currently being used "Off-label" for cosmetic purposes just as Botox TM was for years. It is as safe now as Botox was when it was being used "Off-label."


Until Later,

John Di Saia MD

More on Off-label uses of drugs


P.S. Interestingly enough, I saw some of the writing on the wall on the marketing of Botox Cosmetic Tm back in 2002. I will post the text from my article from the "Sunpost News" from 8/27/02 to my web site in the editorial section soon for those interested.

Lindsay Lohan at Liquid Generation

This poor gal really gets beat up online! Then again I guess that is the price of celebrity combined with obvious physical change. Liquid Generation has produced a number of flash pieces on Ms Lohan. The Lindsay Lohan Boob Song might be the funniest.

Best Regards,

John Di Saia MD

~Start Tirade~

P.S. The link above is a joke from another web site. Those that cannot take a joke or are genetically-deprived of a sense of humor have my condolences and are advised to NOT CLICK THE LINK.

~End Tirade~

Misconception Correction - Liposuction is not a Weight Loss Procedure

A woman called today asking if she could plan on losing ten pounds with liposuction. This not an uncommon request warrants a "common sense" revisitation of liposuction and that which one might reaonably expect.

If fatty tissues are available, liposuction can reduce them. Most patients do not lose much (if any) weight with liposuction.

"How can this be? You remove fat, right?"

Yes, fat is removed during liposuction, but fat doesn't weigh much. You need to remove a lot of fat to see a weight change.

Removing a lot of fat with liposuction converts a small operation into a large operation with more risk.

Unless you want your post-operative course to become a newsworthy item, large scale liposuction operations are not reasonable in my opinion.

Your body is not a "fat tank." We cannot just keep removing fat without some pretty ugly consequences. There is a limit.

Contour change with liposuction is a reasonable target. Weight loss is not. Reasonable expectations are to fit better in those pants or look better in that swimming suit. Changing the reading on your scale is another story.


Until Later,

John Di Saia MD

Allergan Threatens Physicians to Force Use of Botox Cosmetic TM

From my press release going out in the next few days.

JPD
***


San Clemente, CA (PRWEB) -- Allergan, makers of Botox Cosmetic TM, have started a cutthroat campaign in which their representatives leave threatening messages and their attorneys imply legal action.

Case and Point: "I have offered Botox TM since 1998 before it was FDA-approved for facial wrinkles and re-named Botox Cosmetic TM," Dr John Di Saia, an Orange County California Plastic surgeon explains. "After FDA-approval and the advertising blitz, the price has increased and competing products have entered the marketplace. I offer Myobloc TM as I once offered Botox TM as an "off-label" product. The price differential and similar results make my patients happy. My orders of Botox Cosmetic TM have fallen off substantially as a result." Botox TM was FDA-approved a few years ago for use in facial wrinkles. Prior to this, it was used off-label for this purpose for years in millions of applications.

Dr Di Saia’s web site constitutes his only advertising. It states clearly that his practice offers Botox Cosmetic TM as well as Myobloc TM. The price differential and Myobloc's better stability decreases the price to keep it on hand for patient use. "We offer Myobloc TM at a significantly lower price." Patients are informed and then they choose. "No one is ever treated with a mystery product. There is no false advertising here." Allergan must not be happy with the patient's choice. "If patients wanted Botox Cosmetic TM enough, we would obtain it for them. They just don't seem to care."

Allergan’s local representative Lori Lorge started hostilities a few weeks ago at which time she left a business card underneath the Dr Di Saia’s office door stating: "You cannot advertise Botox unless you order and use Botox." The doctor wrote a letter to the company. He advertises only on his web site and for both products. A reply from Assistant General Counsel Steven A. Johnson threatened a referral to State and Federal enforcement authorities claiming false advertising.

Botox Cosmetic TM is a Botulinium toxin A product made by Allergan pharmaceuticals. Myobloc TM is a Botulinium toxin B product originally made by Elan pharmaceuticals. The product has been recently sold to Solstice Neurosciences. The Botulinium toxin protein has several subunits. We may be seeing more Botulinium toxin options in the marketplace as these are evaluated for clinical use.

"These tactics are not the way to get Botox Cosmetic TM into more frequent use in my practice or that of any other plastic surgeon. Treating physicians like criminals is not good business. Maybe Allergan is losing market share. They are certainly losing mine," Dr Di Saia commented.

About John Di Saia MD

John Di Saia MD is a board certified plastic surgeon practicing in San Clemente, Ca. He is very active online as the author of Plastic Surgery Interactive and his weblog Truth in Cosmetic Surgery . He also contributes to several online plastic surgery forums and writes for his local newspaper "The Sun Post News."

Has Jennifer Aniston had Plastic Surgery?

Well that depends on what you wish to count. Reports are that she had been spotted entering a cosmetic surgery "clinic" in Beverly Hills. She has probably dabbled as many young women do with soft tissue fillers, botulinium toxin and/or mild facial peels. This is really "skin maintenance" particularly for a woman who is constantly being photographed. Years ago I remember looking at her face on the cover of a magazine and noticing that her nose looked a bit wide at the tip. This may have been reduced a little. If so, it was certainly not done poorly.

Now she is recently separated, so statistically she will be more likely to consider other cosmetic procedures as many women do "between men."

We will see,

John Di Saia MD

Los Angeles Times Article 6/11/05

How about that?

We got a mention in the Los Angeles Times today on the blog....on my comment regarding Lindsay Lohan's breasts...Calendar section page E17.

A one liner....but thanks.

John Di Saia MD

Good Plastic Surgery - Simple Blepharoplasty

Blepharoplasty is upper and/or lower eyelid cosmetic surgery usually performed for redundancy of the skin and fat of eyelids. Insurance companies occasionally pay for upper lid surgery if the lids get in the way of the patient's vision. The rate they pay is usually the problem. It is pretty low in Southern California.



Click the thumbnail for Larger Image



This young woman came for cosmetic blepharoplasty of the upper and lower lids. This was performed through standard trans-cutaneous incisions allowing the removal of skin and fat. At 6 weeks, she was pleased.

Chloe Jones Dies

When 29 year old women passes away you can't help, but think:

"What is going on here?"

Chloe Jones was a pretty blonde who years ago was complaining about her breast implant surgery on one of the television "tabloid" shows. She looked as if she went too large, but that is not really all that unusual. A few years later, she moved from "adult" modeling to adult videos. Considering that she was the mother of three children, she looked pretty great.

The cause of death has not been released. She died in her hometown of Houston, Texas.

I would say that at least cosmetic surgery didn't do her in, but we don't know that yet.


My condolences to her family and friends,

John Di Saia MD

Anna Kournikova Plastic Surgery ?

Celebrity plastic surgery has become a favorite blog topic has it not?

My e-mail as of late has been filled with questions such as:

Has Anna Kournikova had plastic surgery?
Has Carrie Underwood had plastic surgery?

Let me help you all with one simple statement:

I don't know.

If so, their surgeons did a nice job. Personally, I like plastic surgery that is not so obvious that it offends.

The cases in which it seems likely (at least to me) that someone has been operated are those in which the changes are "night and day." This (as we have seen) is not always a good thing. I don't personally know if any of the people about whom I blog have had surgery. I usually have suspicions however. :)

If I did operate for a famous entertainer, I would certainly not blog about it.

Geez, let a guy have a little class.


LOL,

John Di Saia MD

Plastic Surgeons and Health Insurance - Part I

One of my favorite topics upon which to gripe is insurance. Plastic surgeons tend to dislike intensely the treatment of their work by the insurance industry. The reasons are pretty simple:

(1) We pay a ton in malpractice and other liability insurance.

(2) Our services for the most part are paid at a pittance by the health insurance industry.

Take into account a "pittance" is not relative to what you make, but relative to what it costs to stay in business. Collecting funds is not really all that special unless they exceed your overhead. This is not even addressing how long your insurance company drags out paying for anything or the denials and other BS. The bottom line is that I did not go to school for years and endure two surgical residencies to pay to work.

It is indeed ironic that the rate I pay for practice insurance premiums makes my overhead so high that health insurance payments are frequently "revenue negative."

Surgeons in my region tend to "walk away" from real medicine as they get farther away from training as they see the fury of their accountant's "red ink." Losing money is not conducive to staying in business.

As I see bloggers whine about cosmetic surgery, I opine on how it is the revenue from that surgery that subsidizes my practice so that I can afford to take care of some trauma and reconstruction. Maybe I'll show you pictures of some of this a little later. Anybody need an appetite suppressant?

I find reconstruction gratifying and it frustrates me that I need to limit that portion of my practice to make a living. My accountant would like me to do less.


More on this later,

John Di Saia MD


Want to read more of my health insurance editorial?

Bra Sizes Humor

Have you ever wondered why A, B, C, D, DD, E, F, G, and H are the letters used to define bra sizes? If you have wondered why, but couldn't figure out what the letters stood for, it is about time you became informed!

{A} Almost Boobs...
{B} Barely there.
{C} Can't Complain!
{D} Dang!
{DD} Double dang!
{E} Enormous!
{F} Fake.
{G} Get a Reduction.
{H} Help me, I've fallen and I can't get up!

[A friend with "store bought" breasts that I did not place e-mailed me this one. Thanks Val.]

P.S. For all those bloggers without a sense of humor...THIS IS A JOKE! It does however touch upon the subject that there is a point at which things get ridiculous.

Where exactly that point may be however is open to debate....

Until Later,

John Di Saia MD

Tara Reid Areola Scars - Modified Breast Lift?

Tara Reid's breasts have been the rage of several blogs since her "nipple slip." Look at awfulplasticsurgery.com and Truth, Beauty, Love and Elisa . The scars shown around one areola may be those of a modified breast lift. She may be in the position of needing a larger version of the operation (full breast lift) to make things work. I would be looking to revise her if these pictures are any reflection of how she looks naked. Some women won't have a full breast lift worried about the scarring. Another issue might be her smoking history. I am not sure if she smokes or not. Smoking can encourage poor scarring.

Her surgeon might be in a catch 22 here:

If he does the full lift operation there are more scars. If he does the lesser operation, she may look distorted. A full lift is more risky for smokers which might also be a factor.

It's hard to tell with the "nipple slip picture" as the only one we have for evaluation. We don't know much of what she looks like now much less what she looked like before her operation.


Until Later,

John Di Saia MD

My Website's Breast Lift Section