Misconception Correction - Silicone Gel Breast Implants Do Come With Risk

Looking at the online forums, it seems that the prevailing attitude is that if you are having problems with your saline implants, a switch to silicone gel is the universal cure.

Although I am not in total agreement of the FDA position on the matter, I believe that silicone gel implants pose a long term risk to the patient. In my experience, they tend to harden much more readily than their saline-filled counterparts. The newer cohesive gel types are just that: "new." There is no long term data showing us how patients implanted with them will do. They are probably better than the older gel implants, but they will leak to some extent and the outcomes of this are not as of yet known.

Hardening in the case of silicone gel frequently involves calcification. Your body deposits calcium inside a scar tissue shell around the implant. It looks like egg shells:



This patient had had silicone gel implants for twenty years before I removed them. The white layer in the picture is calcium.

Saline-filled implants do not tend to do this.

Therefore, I tend to use silicone gel implants as a last resort.


Until Later,

John Di Saia MD




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cosmetic surgery
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Sharon Osbourne's Had It All

Sharon is talking about her "way too personal" life and her cosmetic surgery procedures in The Sun Online.

"I’ve had so much plastic surgery, face, neck, breasts, lip and leg lifts, a bum implant and a tummy tuck. I’ve had it all and it’s fabulous."

While I am not so overwhelmingly positive about a woman that has had so many operations, I am happy that she is happy about it. I wonder what her "Before and Afters" look like?

Best Regards,

John Di Saia MD




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celebrity plastic surgery

New Digital Mammography - Will It Be Used?

This Forbes article discusses a new digital mammography unit. The sad part about technological advances in mammography is that local hospitals really don't profit by mammography business. I can't see how a hospital will find a reasonable investment of the upwards of $500,000 quoted to buy a unit for a service that loses money.

Medical technology is like that of any other business; it needs to be a reasonabale expense. Now I don't know if these new machines are all that much better than the current units, but it would be a shame if they were a marked improvement and were not utilized becase of cost concerns.

Best Regards,

John Di Saia MD

Aetna shares Pricing Information With Consumers

Aetna this last week issued a press release. The company will place online its fee schedule for provider physician services so that consumers may price shop.

The funny thing is that physicians have been asking for such a list for years with no response. The patients are the clients in health insurance. Physicians are vendors.

I am happy I am not an Aetna provider.


John Di Saia MD

Has Natalie Glebova had plastic surgery?

Geez. This lovely young lady wins the 2005 Miss Universe contest and the e-mail starts flying.

I don't know if she has had plastic surgery or not. She has probably not as she is so young, but models in the United States can seek surgery at a very young age. This is of course another story all together. If someone has pictures from a range of dates, I'll take a look as usual.


Best Regards,

John Di Saia MD

California and the French Fry Lawsuit

The article


The law is making our lives amusing to say the least. Bill Lockyear, the Ca attorney general, has filed a lawsuit against many of the fast food companies to make them put a warning on their french frys. Apparently scientists in 2002 found detectable levels of Acrylamide in french frys. There is at present no good evidence that this poses a health threat, but Lockyear has apparently succumbed to pressure from some special interest groups to file the suit.


I would like to know when people started defining french frys as health food. It seems we need tort reform in more than medical matters. How can we hold businesses accountable for problems when we haven't determined that there is even a problem yet?


I am continually disgusted with the waste in our legal system and its ramifications upon our lives.

My suggestion for the fast food companies is binding arbitration at the check out lines:

“Our food-like substances are cooked at high heat in oils and may contain substances that cause cancer (but more likely may just make you fat). This is a fast food establishment, not Trader Joe’s.”

John Di Saia MD

Anti-ageing Gene In Mice?

How is it that the UK news is faster than our domestic agencies in reporting US science news? Maybe it is because that news is really really preliminary.....


Anti-ageing Gene Story

We know very little about this gene and it needs to be pursued before we all start jumping up and down about it.

Anti-ageing medicine is a real hot topic with an aircraft carrier full of junk science as far as I am concerned. There are more than a few "snake oil salesman-types" selling anti-ageing pills, creams and whatever to whomever will pay. It would be nice to see a little real proof before the cash registers start a'rolling.


We will wait on this one,

John Di Saia MD

Home Skin Care Article

In Seattle a reporter writes of a consumer trial with some of these "too good to be true" over the counter skin care products. You know the ones that claim to be better than treatment by a plastic surgeon.


The Article

The results read to be less-than-stellar. Products that guarantee results that sound "too good to be true" usually are in my opinion.


Until Later,

John Di Saia MD

Americans Getting Fatter Faster

How about this folks:

BBC News article


Americans are getting fatter faster and the lady in New Hampshire is mad (look at the post below) because of the way her doctor helped her lose 150 pounds.

This sounds typical for us in the US. We complain when about that which is being done when it turns out that not enough is being done.

Until Later,

John Di Saia MD

Obese Woman Angry At New Hampshire Doctor

Read FoxNews


Political correctness will soon keep doctors from doing their jobs. We are supposed to at least try to get you to do the best thing for your health.


This lady asked the medical board to investigate the doctor because of the way he expressed his concern over her obesity. Sounds like an overly sensitive patient to me. Sure, I have seen insensitive doctors with patient issues. I have also seen patients take things out of context to make trouble. I used to see this a fair amount as a general surgeon at the university. Then I stopped doing general surgery.

If you don't like your doctor, get another one.

I'd love to know what the medical board expected the attorney general to do. Are they going to arrest the guy for doing his job?

The article admits that the doctor helped the patient lose 150 pounds. Maybe he should be more callous as it seems to be working.

LOL,


Geez,

John Di Saia MD

How Medical Malpractice Rates Are Really Your Problem

John Wagner wrote a piece in the Washington Post Friday about the medical malpractice crisis. Many of the usual arguments were raised. Medical malpractice rates have gone up for two consequative years by 28 and 33 percent in Maryland. Increases in other states have been smaller.

When a single company doubles its malpractice awards for a given year (2003), they need to refund the corpus of their accounts to pay for additional awards. They do this by increasing rates to the physicians under the plan.

There has been some legislation bandied about such as decreases in pain and suffering awards. The trial lawyers are fuming. They want their multiple million dollar per case fees to keep coming in. They say they are protecting their clients. Then agree to take less of the money. They can never seem to do that.

Here's how the whole mess affects the consumer:

When overhead becomes unaffordable (including malpractice premiums), doctors limit their low paying insurance business. I have dumped all my HMOS. If you are an HMO patient, you can only see me as an emergency in the local emergency room (that is if you want your insurance to pay any of the bill). I have also dumped provider status for all the PPOs. This means patients pay more out of their own pockets to see me. Seeing as I am one of the few plastic surgeons doing any insurance business in my local area, this is more of a problem for the consumer than it is for me. I simply got tired of losing money.

Possibly worse is that patients with difficult problems with which liability is associated have a harder time finding doctors to care for them. Doctors start looking at some patients as potential sources of additional liability and rid themselves of such patients. Doctors in my local area "fire" patients when they refuse to follow recommendations mainly to limit their liability in caring for them. You didn't see this happening as frequently in years gone by.

Even worse is the case in which doctors find "the grass is greener" in another state. Then they pick up and leave. Our local hospital is about to lose it's third general surgeon in three years. This one has been in practice in the area for over ten years.
He is moving to Texas. He will see increased revenue and a better lifestyle from the day he arrives. The So Cal weather he might miss.

It is a very big issue when you need health care. You are going to see less care and pay more for it out of your own pocket unless something substantial is done.

Until Later,

John Di Saia MD

A Real Life Ken Doll

I have been looked at by some of my colleagues as a bit of an ingrate at times. Cosmetic surgery puts food on all our tables and I on occasion have the nerve to toss a bit of dust on that shining plate. Well lovely Elisa has again e-mailed me to tell of another cosmetic surgery oddity.

He is named Steve Erhardt. By report he has had some 30 cosmetic operations. While I believe he should have the right to do that which he wants with his body, I am always somewhat dumbfounded when I consider the motivation in such an undertaking.

The vast majority of my cosmetic patients have one or two operations (with the exception of the gastric bypass patients that have several usually) and then are pretty much done. If a patient were to come in requesting numerous operations I would more likely than not be scared to operate upon him or her. The main question when I agree to operate is:

"Can I make this person happy?"

With Mr Erhardt, I don't know if I could answer "Yes."


Best Regards,

John Di Saia MD

Health Insurance - Force Employers to Pay or Single Payer System?

As usual government, this time in New York, fails to focus on the problem. Instead they plan to just pass the bill. In Long Island, legislation to force large retailers to pay for employee health insurance is in the wings.

Health insurance costs are a big problem in the United States and the States have been taking a beating. Well, let me tell you doctors and hospitals are taking a beating as well. Emergency room call panels are poorly and under staffed as doctors realize that they can spend all night working to be paid nothing. This does not sit well with high overhead. Essentially that is paying to work.

Government should focus on why the problem exists and not put up more legislation to make "big box" retailers fund health insurance companies. These retailers will just respond by sticking it to the consumer. Health insurance is a shell game of sorts anyway. No surgeon I know makes good money with insurance business. The insurance companies make the money here. Why force Walmart to pay for health insurance? The government should not be in the health insurance business in the first place. Government's meddling starting with Medicare has lead to insurers getting richer, and hospitals and doctors having a hard time staying open.

Instead government might want to take a look at tort reform to make the cost of care less. Another suggestion would be to allow doctors faced with "no pay" emergencies to do something with this "unrealized gain" like a tax break. Then you can get doctors back into emergency care and fewer quacks will be out playing plastic surgeon without the proper training.


In New York, they will just try to make the "big box" stores pay the bill.

Typical,

John Di Saia MD

Addendum (8/21/05):

In the San Francisco Chronicle (8/21/05), Steve Lazarus agrees that employer-based healthcare is no longer adequate. Then he talks about a single-payer system; that's national healthcare. Speak to the Canadians and the Brits about this one. The main reason national healthcare limits cost is that you get less care. Tort reform in this country should come before that in my book.

I Need To Take Some Vioxx - $253 Million!

OK Opinion Time - Mine!

***
This has nothing to do with cosmetic surgery, but you are in my blog here friends, so.....

***


For God's sake, soon there will be no drugs in this country! A brain dead Texas jury awarded $253 Million to a widow after her husband died supposedly related to Vioxx. Watch the lawyer feeding frenzy begin....

Reuters Release On Yahoo

There is no rhyme or reason to jury awards in this country. I would love to see the accounting that resulted in such a ridiculous figure. It will supposedly be knocked down because of limitations upon punitive awards in Texas (to 26.1 Million). This is still too much! We need tort reform.....


Then again maybe I just need to take some Vioxx and my family can cash in!


OK, I am disgusted!


~End Tirade~


-JPD

Jude Law Caught With His Pants Down

Apparently, Jude Law was caught changing his clothes at his parents place in Europe. The photographers captured the tiny little moment and captions are starting to flare:

"He's no Tommy Lee."

Well, I do not know of a technque of penis enlargement that actually works, but it sounds like the poor guy might be in the market. Some doctors have put in fat from other areas of the body and others have cut ligaments thinking that the organ might "hang lower."


Poor guy,

-JPD

"Bother With Exercise" - Another Question From My Forum

The thoughts of those that post at my forum frequently leave me wondering:



Question Posted August 10:

Hello Dr.,

I am scheduled to have a TT in December. I have been working out and I am trying to loose 20 pounds before the tuck. My question is, should I even bother with doing stomach excercises since I will be getting a TT? Will the surgery take care of everything? I would rather focus on other body parts since I will be getting the tuck anyway. What is your opinion on this?


An Answer:

Being an exercise nut produces only a small bias here. I have seen the results of cosmetic surgery in patients who exercise regularly and others who do not. Those of the patients that exercise are always better.

Cosmetic surgery does not take away (or substitute for) the benefits of exercise. The results of exercise and cosmetic surgery are usually complimentary.


Best Regards,

John Di Saia MD

Could Cindy Sheehan Use Some Plastic Surgery?

It amazes me how regular people are elevated on occasion to celebrity status. This Cindy Sheehan lady elevated herself following the death of her son [I originally thought it was her husband] in Iraq by making comments about the President to the media. Now people start to wonder about her as they do about celebrities. She has in fact become somewhat of a celebrity in this process.

Could she use plastic surgery? Well, this again becomes a matter of philosophy. By definition, no one needs plastic surgery. I would predict based upon her philosophy that she may very well consider cosmetic surgery an abomination as many of the left do. I don't bind patients to perform elective surgery upon them. This would violate my philosophy.

By the looks of her skin, she could use some sun screen. If she smokes, she might want to quit that as well.


Until Later,

John Di Saia MD

Misconception Correction - Liposuction CC's Removed

I was creeping around some plastic surgery forums and reading the posts. The liposuction section was full of posts in which gals were indicating how much fat their surgeon had removed.

Time to open your eyes again:

The volume removed can be whatever he wants.

What do I mean?

The Secret:

Most surgeons inject fluid into the areas to be treated before sucking out the fat. At least a third of the fluid injected is removed by suctioning. By injecting more fluid, the unscrupulous surgeon can make the amount of material removed any volume he wants. It really makes no difference in your result.

That which really matters is that which is left. This is hopefully a thin fairly even pad of fat on the skin over the surface treated.

We already discussed that liposuction is not weight loss.

The bottom line: Target an appearance and not a goal weight lest you be unhappy at the end of the line.

Until Later,

John Di Saia MD

Lip Fillers - Hylaform - A Modest Enlargement

The most common Lip Fillers (Restylane, Hylaform, Captique) are all composed of hyaluronic acid, a naturally occurring substance in skin. I see little difference in handling the three compounds.

While we have all seen the freakish outcomes in celebrities, I thought I'd present a case of a modest enlargement. In this case I used Hylaform. This patient was injected twice two weeks apart with about half a single unit each time to get the results you see a week after the second injection (after image is at bottom right). She had no bruising and was out and about the evening after each injection. There is swelling that resolves, but in modest enlargements, the freakish celebrity results are nowhere to be found.







Until Later,

John Di Saia MD

Jessica Simpson- Celebrity Plastic Surgery - Part II (Breasts)

Jessica went through some changes around 2003. These images (again supplied by Elisita) are estimated at before 2003, around 2003 and after 2003.


Before 2003 Jessica was pretty flat chested (but great abs). In 2003 or so, she got quite busty and after 2003 she kinda lost some of this.

Several things could be going on here:

(1) As she seems pretty favorably disposed to cosmetic surgery, she could have had breast augmentation. Many women prior to having their breasts done start stuffing their bras, so that after the surgery they don't look so changed. Also right after surgery, the breasts swell quite a bit which could explain how she became really large in 2003 and later the change was present but less noticeable. She might have also had surgery and decided afterward that they were too large and went back to the opoerating room to get smaller implants (very likely the Pamela Anderson story).

(2) Jessica stuffs her bra alot and the stuffing changes.

(3) Both


Until Later,

John Di Saia MD

Jessica Simpson - Celebrity Plastic Surgery - Part I (Nose)

Lovely Elisa provided these pics for analysis and entertainment. These are her images and dates (estimated as PRE and POST 2000). Jessica Simpson has seen my breathren before I'd estimate from these pics. We will start with her nose:





She appears to have had a rhinoplasty (nosejob). The tip and nasal dorsum are thinned. Noses are pretty easy to analyze as they are not hidden by clothing.




Her breasts have also very likely been operated (at least once). Because we are not afforded the opportunity to examine her sans clothing, we are unable to be as certain about her breast surgery (one or more operations). We'll look at those later.

Have a good weekend everyone,

John Di Saia MD

Plastic Surgery Blog Nonsense

I scanned Technorati this morning looking for plastic surgery-related posts. Most of the search results that returned were BS ads. One such ad caught my eye and then proceeded to make me nauseated. It read something like:

"Dr X has devised new breakthroughs in skin care...."

Does anybody actually believe these kinds of BS posts. At least my posts have actual readable content.

His ad might just as well read as:

"Dr X thinks you are a freaking idiot. He would like you to come to his skin care salon and spend as many of your hard-earned greenbacks as you might imagine. He doesn't know jack.... about skin care, but would say his father was Jesus Christ if it would make you more likely to visit. SPEND. SPEND. SPEND. SPEND. SPEND."


Maybe technorati should filter their search results to try to get rid of some of these BS Blogs. Do these BS Blog results bother anyone else?


John Di Saia MD

Hunter Tylo at Awfulplastic surgery.com

Hunter Tylo is the topic of note at Awfulplasticsurgery.com.

Pictures of her chest and face are posted from years ago and at present. By the looks of things, she has had a lot of work.

Her breasts seem too large for her frame making her look kinda "matronly." While we are limited by the clothed images we have for comparison, I'd wager she would benefit from downsizing or removal of those implants and a lift. Maybe the reason that her implants are as large as they appear is that she was trying to avoid lift surgery. The "fill'em up" concept of breast augmentation as a method to avoid the need for a lift works in a limited fashion for borderline cases only. When taken to extremes (like many things in plastics,) the result can be quite unnatural in appearance.

For the doubters out there, there can be little doubt that she has been operated.



Until Later,

John Di Saia MD

"Liposuction and Fat Returned" question from my forum

Another question posted by a surfer at my forum board raises a common liposuction issue:

Liposuction does not make you thinner by itself.

Question Posted 7/30:

I had abdominal liposuction in Los Angeles last year. Almost all the fat has returned to my entire trunk area. The Dr that performed to procedure did not advise me on how to eat or diet. What can I do now? I paid $4500 last June do I have to do it all over again or is there something else that would help my abdominal area? Please help!!


An Answer:

Liposuction removes fat but is not weight loss surgery. Some patients are better candidates for it than others. People in whom large weight swings are common have a high redo rate or are just plain unhappy. The best patients for this procedure are those with stable weight (remember this post?)

Technically, the fat doesn't "return." The cells that were removed during surgery do not come back. Common thought is that new fat cells are not produced in the body after a patient's twenties. You can however fill the fat cells that remain after surgery with more fat depending upon diet, exercise and your metabolism.

If you are looking for liposuction to take away your need to watch your diet and exercise levels, think again. In conjunction with sensible diet and exercise, it is a procedure with a very high satisfaction rate.



Best Regards,

John Di Saia MD

BTW - Plastic surgeons rarely counsel you on eating or diet. This is not part of the considered norm for liposuction surgery.




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liposuction
liposuction fat returned