Survey: Mastectomy patients prefer silicone implants over saline - Related Stories - Plastic Surgery SmartBrief

Survey: Mastectomy patients prefer silicone implants over saline - Related Stories - Plastic Surgery SmartBrief

Thank you to all my patients for coming to our recent events. There was one conversation that I think it's important to share. One of my old patients showed up today after about 3 years. When I asked where she had been, she admitted she had been to another physician for Botox treatments because the other physician was cheaper. He was also according to his website, the number 1 cosmetic physician in Bergen county. I know all the plastic surgeons in Bergen county and am pretty familiar with many of the dermatologists in the area. I had never heard of this physician and I found out he is a family practice physician. My patient complained about his technique, his attempts to sell every procedure/product he had, and the exorbitant bill she still got at the end of the treatment. She told me she looked horrible the two times she came out of his office. Yes, she went back a second time. Moral of the story, plastic surgery is not like Wal-Mart. Cheaper is not always better even if you think it's the same product. She was fooled by the packaging and ended up getting an inferior product which in the end was even more costly. I appreciate your trust in me and as I see so many of you time and time again I hope that you feel comfortable referring your friends so that they may have the best experience possible.

'Dr. Botch' settles in plastic surgery death of Irish woman | Irish News | IrishCentral

'Dr. Botch' settles in plastic surgery death of Irish woman | Irish News | IrishCentral

All Inclusive Vacation: Breast Implants Included? | Endless Beauty

All Inclusive Vacation: Breast Implants Included? | Endless Beauty

Spa Owner Charged With Nearly Killing Customer With Illegal Liposuction

NEW YORK — A spa owner is being accused of performing an unlawful liposuction on a customer and then re-injecting the fat into the client's buttocks, causing serious injury.

Queens District Attorney Richard Brown says 27-year-old Barbara Nieto, of Queens, was charged with assault, reckless endangerment and unauthorized practice of medicine.

Brown says Nieto, owner of Perfect Image Stethics, performed the procedure on the victim in March and several days later the woman experienced severe pain. She was hospitalized and underwent life-saving surgery.

Nieto, who was arraigned in Queens Criminal Court on Friday, faces up to seven years in prison if convicted. She was released on her own recognizance and is due back in court on April 27.

A call to her lawyer was not immediately returned.

Awake for Breast Implants? If You Wish

SOON after Jane Z. had her B-cup breasts augmented for the first time, she realized she hadn’t gone big enough. So the second time, Jane Z., who preferred to not have her last name mentioned, was thrilled that she could choose her implant size during surgery.

How? She was awake. Most women who get breast implants do so under general anesthesia. But Jane. Z.’s doctor was Dr. Robert L. True of Colleyville, Tex., one of more than 100 doctors nationwide who advocate local anesthesia and sedation for aesthetic surgeries like breast augmentations.

“They are talking to me the entire time,” Dr. True, an obstetrician and gynecologist by training, said of the 75 patients whose breasts he has enlarged in his accredited facility. Once the new implants are in, his patients are propped up on the operating table, look in a mirror and have their say. “They like that little bit of autonomy,” he said.

A lot of plastic surgeons consider it out of the question to do a breast augmentation without an anesthesiologist or nurse anesthetist on hand, partly because of the risk to the patient if something goes wrong. These doctors say they cannot do their best work — dissecting a pocket for an implant, then securing it — without total control.

But lately, a set of doctors, most of whom have not come up through plastic surgery, has been touting the awake option as a boon to patient choice and as a safer option than general anesthesia. Breast augmentation is often done in hospitals and accredited offices, but awake breast surgery is usually done in an office that might not have been vetted for safety by an accrediting organization.

“Problem is, doctors are doing large procedures on local with quote-unquote sedation to circumvent the need for accreditation,” said Dr. Lawrence S. Reed, the president of the American Association for the Accreditation of Ambulatory Surgery Facilities.

For most of surgery, Jane Z., 48, who reviews medical charts for a hospital, said she felt “pretty much out of it.” She added, “You’re technically awake, but you remember nothing.” In a more coherent moment, she did recall being asked, before Dr. True sewed her up, if her new breasts were adequate. She asked to go slightly larger, and got her wish for a DD cup.

“If you talk to 99 percent of women, they want input into what they are going to look like,” said Dr. Jeffrey Caruth, an obstetrician and gynecologist by training who now offers awake cosmetic surgery at his office in Plano, Tex. “People are not coming to me because it’s cheaper. They don’t want to be put to sleep.”

Doctors offering awake breast augmentation and awake abdominoplasty (a tummy tuck) advertise on YouTube.com and make the case for local anesthesia and sedation on their Web sites. In the last few years, marketing for awake breast augmentation has ramped up. No organization tracks how many doctors do the awake version of this surgery (or of tummy tucks).

Dr. Anil K. Gandhi, who performs both awake procedures at his office in Cerritos, Calif., said he had taught “more than 100 doctors” in two-day $7,000 seminars for the National Society of Cosmetic Physicians. His students are doctors who typically did their residencies in ob/gyn or family medicine and who take a weekend course (or two) to learn how to do aesthetic surgeries with local anesthesia and sedation.

This shortcut to practicing aesthetic surgery tends to outrage the traditionalists. After all, board-certified plastic surgeons spend five to eight years after medical school learning operations and then have their surgical skills vetted in exams.

“Two-day courses, it’s just crazy,” said Dr. William P. Adams Jr., a plastic surgeon in Dallas who teaches residents at the University of Texas Southwestern Medical Center. “It took us six years to fully train plastic surgeons to do breast augmentation.” He said it was irresponsible to let fuzzy-headed patients choose their implants. “They don’t let people drive after a six-pack of beers,” said Dr. Adams, who is an investigator for Mentor and Allergan, makers of breast implants (and a consultant for Allergan). “How well will people choose an implant size after narcotics?”

Dr. Adams and other plastic surgeons say that mid-surgery consultations can be harmful if the patient chooses implants too large for her chest. Overaugmentation can produce unsightly rippling, said Dr. Mark L. Jewell, a plastic surgeon who does breast augmentations with local anesthesia and intravenous sedation in an accredited facility in Eugene, Ore. “Decisions should be made ahead of time,” said Dr. Jewell, an investigator for Mentor and Allergan as well as a consultant for Allergan.

Several doctors said that promoting local anesthesia and sedation for aesthetic surgeries was just a gimmick that played down the risks. “Promotion of these surgeries as so easy that only local anesthesia is required, it’s intended to make someone think, ‘It’s not serious,’ “ said Dr. Douglas R. Blake, an anesthesiologist in Providence, R.I., who specializes in office-based procedures. “The promise to get by with just local anesthesia may in fact be shortchanging the patient.” Say a patient feels faint, or has a panic attack mid-surgery, “who’s there to attend to the patient?” he asked.

Practitioners of awake breast augmentation offer patients sedation and then pump in a numbing fluid. This liquid — which has been used for years in a kind of liposuction called “tumescent” — includes lidocaine, an anesthetic, and epinephrine, which controls bleeding.

Cosmetic surgeons without residencies in plastic surgery say that using local anesthesia for breast augmentation promotes a faster recovery, but plastic surgeons tend to dispute that. “No surgeon who performs awake augmentation has ever proven in an independently monitored study that their patients can be out to dinner that night and return to full normal activities in 24 hours,” said Dr. John B. Tebbetts, a plastic surgeon in Dallas.

Jane Z., who had her first breast augmentation with Dr. Tebbetts, said her recovery after that 2004 operation and the recent one with Dr. True took roughly the same time. After general anesthesia, she said, she felt woozy but not nauseated.

Aspiration — when stomach contents return to the mouth and are inhaled — is one rare complication of going under. But under sedation, Dr. Blake said, the protective reflexes in the airway may be reduced, making aspiration a possibility.

Dr. Keith J. Ruskin, an anesthesiology professor at Yale University School of Medicine, said doctors using tumescent anesthesia must avoid an overdose, which can lead to seizures and abnormal heartbeats. Dr. Caruth gives his breast augmentation patients 5 to 10 milligrams of Valium and some Ativan (anti-anxiety drugs) for minimum sedation. If a patient wants moderate sedation, she must pay $600 for an anesthesiologist. But not every doctor sedating patients for breast augmentations believes less is more. Dr. Caruth said, “I see these guys that say they do ‘awake’ and they slam the heck out of these people with drugs.”

Dr. Gandhi, who trained as a general surgeon but is not board certified, said his patients get minimal sedation. He wants them alert. “It’s more safe,” he said. “Patients can scream and you would know, I can’t be doing that, I can’t be putting my needle there,“ said Dr. Gandhi, whose office is not accredited. Later, he clarified by e-mail: “For breast augmentation the technique that I have implemented and teach for tumescent anesthesia infusion results in excellent numbness, that the patients do not feel a thing while I am operating.”

Study blasts lack of training in cosmetic surgery marketplace

April 2, 2010 | 11:38 am

Cosmetic procedures like Botox, facial fillers and liposuction are big money-makers for physicians. Not surprisingly, doctors other than plastic surgeons and dermatologists also offer cosmetic treatments. According to a new study, nearly 40% of doctors offering liposuction in Southern California had no specific surgical training.

The study, published in the April issue of the journal Plastic and Reconstructive Surgery, examined 1,876 cosmetic practitioners from San Diego to Los Angeles. Only 495 of them were trained in plastic surgery. Primary care physicians made up the fourth-largest group of liposuction providers following plastic surgeons, dermatologists and otolaryngologists.

There is no law to prevent doctors from offering these services, especially in a doctor's office (doctors need to apply for privileges to perform services in hospitals). Many non-surgeons take a course or participate in some form of limited training to perform liposuction or inject fillers. But such training is not required and is often inadequate, according to the American Society of Plastic Surgeons.

Though providing Botox or facial fillers is unlikely to be dangerous, liposuction can result in serious complications, the authors state. "We feel that the provision of such a potentially hazardous treatment by physicians with no training in surgery poses a genuine threat to the safety of patients."

Further, the authors state, aesthetic franchises have sprung up that have no association with one particular provider, making it more difficult for patients to know just who is responsible for their care.

"The practices are often named after a geographic location with a cachet of affluence,such as Rodeo Drive, Beverly Hills or La Jolla. In these practices, the practitioners are employees of the owner of the clinical facility, and are pushed to produce revenue. The divorce of the practice from the name of the responsible physician has the potential to have a profound impact on the doctor-patient relationship and how patients select a provider," the authors state.

Still, the authors say more legislation is not what's needed, calling government meddling "a guest who may never leave." They suggest more effort to educate the public on who is or isn't qualified to perform various cosmetic procedures.

I vote for whichever method -- education, legislation or perhaps both -- will protect consumer health and safety regardless of professional turf wars.

-- Shari Roan