Ashlee Simpson's Nosejob?

I remain unconvinced of her having had rhinoplasty as I don't have good images to show it. If she has been operated, she is probably just lucky enough not to have many good public images taken prior to demonstrate the change. It is always possible that she hasn't yet had surgery, isn't it?

So my conclusion is that I can't make a conclusion.


Until Later,

-JPD

Ashlee Simpson - Already Post-op?

Could Ashlee's nose already have been operated? Everything is relative.

This is possible, but I have not found any images online large enough to evaluate.

Help a guy out and find me some.......nice frontal images two to three years old.


-JPD

Ashlee Simpson - Might she get [more] surgery?

With a sister like hers, it is a wonder that Ashlee hasn't been under the knife yet. Now that she is entering her own celebrity status it will be interesting to see if she gets a little work.

Here's a pic of her from the Duke's of Hazard LA Premiere that I saw online at a forum:



I wonder if that nose will be tweeked in the future. If so, I hope she doesn't do much....maybe just the tip.












We will see,

JPD

Cosmetic Surgery Secrets I: Weight Loss

Weight loss and plastic surgery are related, but they are not the same.

Cosmetic surgery will not make you lose a significant amount of weight. Liposuction removes fat, but fat weighs fairly little. A tummy tuck mostly removes skin with a thin pad of fat.

How they are related:

You want to do your cosmetic operation when you feel that you are at a weight that you feel you can maintain. Many operations will have a change in outcome if you gain or lose a significant amount of weight afterward. That's right: lose or gain. Additional surgery often follows in cases in which weight change occurs after surgery.

There is an ideal picture however before a given operation will have a given result. Patients are often asked to try to lose weight before a tummy tuck. If the tummy wall if firm, tummy tuck surgery won't get you far. If it is soft and there is tissue hanging, the results are generally quite good.



Until Later,

John Di Saia MD

Miss World wants to sue plastic surgeon

Are you kidding me?

Maria Julia Mantilla, the new Miss World, is thinking of suing her plastic surgeon.

So what else is new.

Plenty.


Apparently, her plastic surgeon did operate upon her under the terms of a promotional agreement (mistake #1). The article states that the young lady and her surgeon had an agreement that he could use her name and disclose information about her under the terms of this agreement. The terms supposedly had a time line associated with them. She is objecting stating that he is publicizing operations that he never performed upon her outside of that time line.

You see celebrity plastic surgery weirdness is not just a US problem. It is a worldwide problem.


Until Later,

John Di Saia MD

Acne scarring question from my forum

For those of you that are not aware, I have run a web site from which I have been answering questions (in a very general way) for years. I plan on posting a question and answer now and again here.


Question Posted 7/24:

Hello, Dr. Di Saia,

I've had acne for a few years (it is now almost completely gone) and I am now left with a few but noticeable facial scars. What is the best way to deal with them? What fillers would you recommend? Would a chemical peel or microdermobrasion be enough?? (I personally don't think it would be). I am 19, by the way. Thank you for your professional advice!

An Answer:

Acne scarring is an extremely variable problem. The treatment depends upon severity and skin type. A single facial peel with likely not be enough to improve any, but the lightest of cases. You really need an individual professional evaluation regarding peels, fillers, and other surgical options as they pertain to your specific case.

A simple synopsis regarding acne skin care that can help limit damage is posted here:

http://psinteractive.net/skincare.htm

Best Regards,

John Di Saia MD

Windows Vista hype

Cosmetic surgery and corporate America have something in common:

HYPE.

Microsoft posting it slowest growth since the company's 1986 debut decided to give it's latest Windows operating system a name. The project formerly known as "Longhorn" is now named "Vista."

OK, I am impressed.

They have named a product a year before its expected release date and before it is really even developed to beta status. What does that really mean?

Kinda like Cosmetic Surgery....


They think it is "new and improved."

OR wait a minute maybe it wil be new and improved

WELL, once they have it it will be "new."


Yeah, like Windows ME....Yuck.

We'll wait with baited breath.

I need some aspirin,

-JPD

"Too Much Implant"

A post at my web site's forum this morning reminds me how unusual some patient requests can seem. A woman apparently had D sized breasts to start and went to another surgeon who told her (by report) that breast implants would give her the "fake breast look" she desired. Why women with naturally large breasts want them to look "fake" has always fascinated me. They have the "real thing" already!

Neverthless, he placed 550 cc implants and now she states that she is a droopy EE cup three years later.

This woman will probably need a breast lift with removal of her larger implants and replacement with smaller ones. At the age of 25, this is a fair amount of surgery with a fairly high price tag.

Breast implants only give the appearance of a breast lift. Large breast implants tend to droop over the long term. Think about this if you seek breast augmentation. You may avoid additional surgery by thinking a bit on the front end.


Best Regards,

John Di Saia MD

Fake Bake Tans Humor

Gallery of the Absurd
has given me insight into how jaded I am becoming. This funny "wanna be" book cover relates to our melanoma and sun screens post.

Fake sun tanning agents are another experiment in my opinion. There isn't a ton of data telling us of their long term safety. It would be both ironic and tragic if they turned out to cause skin cancer too. We just don't know.

"Fake Bakes" don't look all that great either.

"Oh, yeah. Orange skin. How natural."




Until Later,

John Di Saia MD

Supreme Court Nomination

Well, the news services are all in a pre-seizure state over President Bush's statement tonight over a supreme court nominee. It is such a shot in the dark particularly for a conservative president. It seems that if you look at the history here, conservative presidents tend to nominate "closet liberal" supreme court judges.

The person nominated is not important. It is that which the person confirmed may do to the law as we know it in his or her (very long) tenure.


Keep your eyes peeled.

The [nomination / confirmation / congressional grandstanding] event will be at the very least entertaining....

Until Later,

JPD

CosmeticSurgeryDisasters.com - Follow-up

Comments following my post of the first case on CosmeticSurgeryDisasters.Com were varied. One comment doubted the hazards of surgery in third world countries. He employed the first debating countermeasure:

"This is only one case. It could happen anywhere."

OK, I need to elaborate:

This case is not my only experience. In fact, this case is not my case, but that of a woman I met on the internet. She lives in Wisconsin.

I see cosmetic surgery complications in my local region. Most of my direct third world country experience is from Mexico. I also see complications that find their way to me from local surgeons. I see some (fortunately much smaller in scope) from my own practice. And I review cases for the California Medical Board, so I see cases statewide.

Complications happen everywhere. It is the scope of those complications that is the main point. This case from Costa Rica is a catastrophe. It is much larger in scope than any other case of which I have even read. The management of the case from that which the patient tells me was peculiar relative to the standard of care we have in California.

Those wanting to make the case that this stuff happens everywhere are generalizing to an enormous extent. Diane's case is simply not typical of a wound complication seen in the United States. It isn't even close. It is very likely that the care provided in her case had a great deal to do with this.

How do I define a third world country?

You know places without resources, finances and infrastructure. Healthcare is a resource.

Like I have said before, if you want "cheap surgery," the third world is a good place to look. If you want "safe surgery," it may not be. It is your risk. You manage it.


Best Regards,

John Di Saia MD

Oh my God!

Elisa, the author of a great blog and a hound for celebrity plastic surgery excesses, posted to let me know about a funky site..MyFree_*_Implants.Com (I put in the _*_ for the search engine spiders....).

Knowing what it costs to provide the service they are speaking of...I surfed the site. A better name in my estimation is

HookingforImplants.com


Gimme a break. Photo exchange and conversation for $$$$. Sounds like Bonnie Lee Bakley's (Robert Blake's deceased X-wife) former job description and look where that got her.....


Until Later,

JPD

Am I running a Special on Melanoma?

OK, so my practice isn't Kmart, but Melanoma is seemingly on "Blue Light Special" and these recent cases are all on the right shoulder. I am sure somebody will say it has something to do with the stars. I saw two patients today and another scheduled for next week. Melanoma patients are not infrequently sent to plastic surgeons for reconstruction. The "removal" operations for melanoma take large portions of healthy tissue around the cancer to help deter recurrence. This works usually, but leaves large holes that we are asked to help fill. This is not cosmetic surgery folks....

Melanoma is the rarest of the skin cancers, but the only skin cancer that has a reasonable possibility of killing you. These things can be nasty like the alien in one of those Sigourney Weaver movies. It is summer, so don't just buy that sun screen....wear it! Skin cancers are a consequence of lifetime sun exposure and melanoma is thought to come especially from pre-pubescent sun exposure. So lather up the kids!

The melanoma picture you see pictured above is a past case from a few years ago. I'll take a better picture of one of these newer cases with my more recent (better resolution ) camera. See the irregular border? That's a sign of a mole possibly going toward the dark side.....



Until Later,

John Di Saia MD


P.S. I know this isn't a cosmetic surgery-related post, but this is my blog. Those not happy about it are advised to start their own blog and I'll come over and bitch about your posts there. LOL.....

Tara Reid Nipple Slip Video Clip

Thanks to an anonymous tip. Someone uploaded a video clip of the Tara Reid nipple slip at some awards show. Pretty good quality.

Take a gander before it goes down:

Tara Reid Nipple Slip Video Clip


We all need a little humor once in while....

-JPD

P.S. The stills show her (what I believe to be) modified breast lift scar better. It isn't the greatest-looking scar. I posted on this a few months ago. Someone indicated that she is a big smoker. This can encourage the scar to heal poorly. I had never seen video from the event however. She just kinda "slipped out." Oh well. Other than the scar, it seems like a nice breast to me.



Tags

tara reid nipple slip
celebrity plastic surgery

CosmeticSurgeryDisasters.com

Hello all,

Sorry that I have not been blogging much as of late. I have been putting together the beginnings of a new web site...

CosmeticSurgeryDisasters.com

This new site is designed to be a learning experience to help those looking into cosmetic surgery. There are choices made early on that have a great deal to do with improving the possibilities for a successful outcome. The first case featured is online. Others will follow. Some of the cases have been revised and improved. Others still need help.

Best Regards,

John Di Saia MD

Another Porn Star Plastic Surgery Tragedy....

Ouch. Looked at AwfulPlasticSurgery's article on porn star Tabitha Stevens. She looks particularly scary. I met her many years ago. No, I haven't operated on her, but by the looks of things somebody has and I'll bet a few times at that.

As I recall, she was quite thin with really big porn star-sized breast implants. I think the lip fillers have been used to excess and her nose looks thinner at least from that which I remember. I'd wager that she got cheek implants as well. They seem too large for her face. Thin soft tissue cover over big implants leads to a "fake" appearance.

She looks very over done now, which in my view is always a shame.


Until Later,

John Di Saia MD

Taken Out Of Context

One of the nasty things about blogging or dealing with media of any sort is the potential that you may be mis-characterized. Well today I took at look at Technorati to see who's linking the blog. I got one link stating:

"Truth In Cosmetic Surgery - an interesting website about how bad plastic surgery is."

Well, is that what this is all about?

Funny. When I wrote this stuff, that is not what I was thinking.

I'd like this nitwit to take care of himself the next time his (or his family member's) head gets split open in the midst of the drunken stupor in which he undoubtedly spends a great deal of his existence. Plastic surgery is so bad that his wife should forego breast reconstruction when she requires mastectomy for breast cancer. What an imbecile! Brain power like this could not spawn a coherent thought without developing a headache.

Then he doesn't let me hammer him back by disabling comments in his blog. Makes we wanna go all cosmetic and make my accountant happy!

~End Tirade~

Later,

John Di Saia MD

Misconception Correction - Liposuction Doesn't Firm Up Your Skin

If fatty tissues are available, liposuction can decrease them. You stand to get "thinner" with liposuction, but you don't want to be too thin. A thin and even pad of fat on the skin flap is needed to keep you from looking wierd.

Patients that have been "oversuctioned" tend to look "moth eaten." The skin's surface loses its even contour. In some cases a "cobblestone" appearance is seen. This is very hard to fix. Avoid it.

If you are looking for tightening of the tissues, liposuction isn't it. In this case, skin resection and /or muscle tightening (like a Tummy Tuck) might be in order. Body Lift surgery is the category of skin tightening surgery in which tummy tuck surgery belongs. There are other body lifts named for the area in which they are employed.


Until Later,

John Di Saia MD

More On Body Lifts - http://psinteractive.net/bodylift.htm

More On Tummy Tucks - http://psinteractive.net/abdex.htm

London Bombing Reminds Me Of Traumatic Plastic Surgery

Mass casualty events like the terror bombing in London make surgeons busy. I'll bet seeing as most of the injured were not killed that plastic surgeons too are busy over there. Everything from facial wounds to severe open fractures.





Here's an example from my own practice a few years ago. This was a motor vehicle accident in which a pretty young girl received multiple wounds around her left eye. Her post-operative image (above right) depicts her appearance two years later. She healed very well.




Best regards and good luck to the British surgeons working to repair the damage of today's mayhem.


John Di Saia MD

Watch Out For The FeatherLift TM

OK. Call me an old "stick in the mud," but I am not so sure about this Feather Lift TM. Those that offer the technique will say I am protecting my interests.

Sorry, but I just don't like taking chances with your face.

The concept is to provide face lift type improvement without the surgery. The method is the placement of a number of funky barbed sutures that hold the face up internally. This is done under local anesthesia in the office. Check out the section at the Prollenium website.

I will be interested to see how these patients do over the long term. As far as I know there are no patients ten to twenty years out yet. A newly-operated patient was found frightening a mammography tech at my local hospital. It seems that one of the local internists is offering the technique to supplement his income. There may be good outcomes here. The real question is how are the statistics and how difficult might it be to fix one that goes bad?

If board-certified plastic surgeons thought this procedure would be so wonderful, we would offer it as well. A quick perusal of the internet finds the majority of practitioners offering this procedure are not plastic surgeons. We must just want to work too hard I guess.

Perhaps we will just have to wait ten years to see how the patients do long term. I would look at this procedure as an experiment folks.


Best Regards,

John Di Saia MD

My Practice

In an attempt to defeat what I am now going to call the "Nonsense Blogs," I am going to list some of my practice information stuff here. If you are looking for one of these things, I am going to link the pertinent sections of my web site. For those just here to read the editorials, please just skip this post:

Orange County California Breast Augmentation - San Clemente, Mission Viejo, San Juan Capistrano, Dana Point, Laguna Hills, Laguna Niguel, Anaheim

Orange County California Breast Reduction - San Clemente, Mission Viejo, San Juan Capistrano, Dana Point, Laguna Hills, Laguna Niguel, Anaheim

Orange County California Liposuction - San Clemente, Mission Viejo, San Juan Capistrano, Dana Point, Laguna Hills, Laguna Niguel, Anaheim

Orange County California Tummy Tuck - San Clemente, Mission Viejo, San Juan Capistrano, Dana Point, Laguna Hills, Laguna Niguel, Anaheim

Orange County California Cosmetic Surgery - San Clemente, Mission Viejo, San Juan Capistrano, Dana Point, Laguna Hills, Laguna Niguel, Anaheim

Orange County California Body Lift - San Clemente, Mission Viejo, San Juan Capistrano, Dana Point, Laguna Hills, Laguna Niguel, Anaheim

After Gastric Bypass Cosmetic Surgery


My reasoning:
I searched Technorati for some plastic surgery procedures and found tons of "nonsense" blogs (word collections making no sense and leading nowhere). The results I found appeared to be from marketing types taking you to sites having nothing to do with the terms searched. My practice is actually in orange county california and I offer the procedures indicated. In addition, my sites actually give potential patients useful information regardless of whether they choose to have me involved in their care. In plastic surgery on the internet, this is a rarity.


Best Regards,
John Di Saia MD

News - Feds Warn Against Risky Silicone 'Pump Parties'

Found this on AOL.

We have known that silicone gel injections were a dangerous proposition for years. Why is it that people still seek them?

I remember as a resident a patient who had had silicone gel injected into her breasts. This left her with breasts filled with nodules that felt like rocks. These hurt her a great deal. We ended up reconstructing her breasts utilizing her tummy tissue (Free TRAM) following mastectomies. Her results were numb breasts, but the pain was gone.

A high price to pay for being stylish. Please research that which seems "new and different" before having it. You might find that it is neither new nor different. It might also not be desirable.

Until Later,

John Di Saia MD


Tags

silicone injections

Sun Post News "NeckLift" Piece - 7/1/05

For those interested, I write for my local newspaper approximately every 5 weeks. This article was published today.

Enjoy,
JPD

When a Necklift Doesn’t

Extreme Makeover and other "fantasy" plastic surgery television has definitely had an effect on consultation traffic in my office. The notion that more than a few large operations can and should occur in one operative session has become almost commonplace. My own disagreement with the general premise has been the subject of this column more than once.

There are specific situations however in which one procedure can and does contribute to the success of another. Necklift surgery is a prime example. As of late I have seen a few consultations for necklift as well as a patient in whom another surgeon’s necklift left her nonplused.

In the vast majority of cases, a necklift and at least a minimal facelift go together. The reasons for this are practical. A basic facelift includes dissection and repositioning of the "middle" of the face and neck. These structures are in continuity with one another so movement of one affects the other. Patients with more than minimal banding (the famous "turkey gobbler" neck) require repositioning using a facelift approach. It is possible to not do a facelift at the same time, but this affects the ability to reposition the neck without a deformity at the jawline. When the tissue planes are exposed, correcting them both seems logical. My opinion is that the result is potentially more long lasting.

There are those surgeons who have chosen to work from the neck alone. The benefit here is that of less trauma from less surgery. The second opinion consultation patient I mentioned above had had a "neck only" neck lift by her former surgeon. The result by her estimation was less than wonderful. While I cannot comment on her pre-operative appearance (which is very important in judging the result of an operation), lesser surgery in the neck often leads to dissatisfaction.

"But my surgeon was on one of those ‘Extreme Makeover’ television programs. He came well-recommended."

I’d wager that her case won’t be featured on an upcoming show. Television can be edited. Real life cannot.

The Advice:

Plastic surgery is surgery and there are different methods to obtaining a good result. Any surgical plan is an estimate based upon the experience of the surgeon concerned. Both patient and surgeon need to be on the same page before entering an operating room. If your surgeon offers lesser surgery, ask what you might expect in the way of an outcome. A few consultations are never a bad idea when coming to a decision in this regard.


John Di Saia, MD is a double board certified Plastic and Cosmetic Surgeon practicing in Talega. He can be found online via his web site at: www.ocbody.com or via his office at (949) 369-5932.