There has been a lot of news recently about PIP implants and concerns that not only do they rupture at a rate higher than other implants but the silicone inside may not be medical quality. Fortunately these implants were never sold in the United States. PIP did sell prefilled saline implants in the United States for a while (apparently about 35,000 were sold). However when the FDA asked the three implant companies ( Inamed -now Allergan, Mentor , and PIP) in 2000 to submit a formal application (known as pre-market approval) only two of the companies received approval. The two companies that received approval - Inamed (Allergan) and Mentor- are still the only two companies selling silicone implants in the United States. PIP has stopped selling its prefilled saline implants in the U.S.A.
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There were several reports over the holidays about the numbers of cosmetic surgeries and even reconstructive surgeries going up. Is this just a typical cycle or is this an indication that the economy is improving? It is true that all hospital admissions went down during the past few years - a direct result of the recession. When you are worried about the stability of the job market you are unlikely to take time off from work for an elective procedure or want to dig deep to pay those deductibles. There for it is a good sign that elective procedures were up in December. There is also the timing factor though. Although there is no “convenient’ time to schedule an elective procedure - there are less inconvenient times. Timing a surgical procedure around a holiday can allow you to “steal” some more time off work. A lot of offices are closed between Christmas and New Years which can allow you to to recover without sick days. There are other times during the year when you can “steal “ extra time off – long weekends such as Memorial Day, Labor Day or even the 4th of July are examples. Often people expect offices to be closed or at least not fully staffed so your absence is not questioned. Plan ahead though as lots of other patients might have the same idea!
The American Society of Plastic Surgeons released their statistics for 2010 yesterday. The overall number of cosmetic procedures increased 5 % in 2010. This may represent some pent-up demand as patients return who had put off cosmetic work when the economy was so unstable. Reconstructive procedures also increased 2% in 2010 with breast reconstruction up 8% ! This puts breast reconstruction into the top five reconstructive procedures for the first time . The other top reconstructive procedures were (1) tumor removal (2)laceration repair (3)scar revision and (4) hand surgery. Good news ! Hopefully this means that our work to get the word out to patients undergoing mastectomies about their reconstructive options is working!
Dr Jorge Palacios just gave me the most wonderful Christmas present. I was with Dr Palacios in Ecuador on a visiting educator trip where we were training young surgeons to do cleft lip and palate surgery. One of the patients was a 45 year old woman with an unrepaired cleft lip. Dr Palacios assigned her care to me. in 45 minutes I was able to repair her lip- a 45 minute operation for which she had waited 45 years !! I am so grateful that I was able to do this for her. She will be able to smile at her children and her husband for the first time . To be given a chance to help another person like this is priceless.
I just got back from spending ten days in Ecuador. I was a visiting Educator with Resurge( formerly known as Interplast). This was my fifth trip to Ecuador and my third as a visiting educator. Most medical missions that I have been on we are just trying to get as much surgery done as well and safely as we can in our limited time. A visiting educator trip is different - on these trips we are trying to teach local doctors to improve their techniques and help improve through our training the outcomes of many surgeries after we leave. It is exactly like the old adage - give a man a fish and your feed him for a day, teach a man to fish and you feed him for a lifetime! I always get so much more out of these trips than I give - we are so lucky in this country with all that we have . I am very gratefull that I have the opportunity to give back in even a small way.
A most interesting article was in last months Plastic and Reconstructive Surgery journal. I don’t ever remember having taken an article to show my staff but this time I did. The article described observations at the annual identical twin conference., Twins were photographed and then asked questions about their lifestyle choices. The twins were then rated as to whom and appeared older - remember these were identical twins - and then the twins that looked older were evaluated. The results were amazing - identical twins who looked 10 -20 years older than their twin!!!! I tell you - look at these pictures and not only will you never smoke you will never go outside without sunscreen !!! However a little good news for us - a few extra pounds helped the twins looked younger - YES! OK the bottom line - sunscreen, don’t smoke and don’t get too skinny!
The media has been all over the recent statistics released from the American Society of Plastic Surgeons showing the number of cosmetic surgical procedures done in 2008 to be down 9%. However as always when one looks closely at the statistics this is not the whole story. Overall cosmetic procedures ( not just surgical procedures) are up 3%! This includes Botox and fillers such as Restylene , Juvederm and Evolence. And Reconstructive procedures are up 3% as well. Not bad for the worst recession since the great depression! I was very pleased to see that breast reconstruction was reported up by 39% - this means to me that women are getting offered breast reconstruction and as they should ( there is a Federal law mandating that insurance companies cover reconstruction after cancer treatment) insurance companies are covering the procedures. There was also an increase in lower body lifts and buttock lifts both of which are procedures often done after patients have lost a lot of weight - both by diet as well as by bariatric surgery. The news is not always that bad it matters what you are looking for!
It started out as an ordinary call. “Dr. Downey, can you help a colleague of mine?” But then the inquiry became anything but ordinary. The patient in question had traveled to Mexico for cosmetic surgery. Now back in Los Angeles she was having complications. The patient’s anxiety level was sky high. She had spent all her available cash on the surgery in Mexico and she had a high deductible on her insurance plan. The first plastic surgeon she had seen had proposed another surgery which was way out of her range financially. Fortunately I was able to hold her hand through several weeks of healing and then do a small procedure to minimize the scarring.
Medical tourism is a term which has been coined by the media to describe a rapidly – growing trend of patients traveling to other countries to obtain health care. Cosmetic surgery tourism is a price driven phenomena. Elective cosmetic surgery procedures are not covered by insurance so cost is the major selling point for patients of cosmetic surgery tourism. In my practice I have noticed that the complication rate or at least the patient’s anxiety over a possible complication is directly related to the distance traveled. How easy it is when a patient calls and says “Is this normal?” To have the patient come in and take a look when they live in the LA area. However if they have returned home many miles away things become much more difficult. Patient’s descriptions can be difficult to understand, emailed photos can be blurry and anxiety levels ride high. Even if I am sure that all is okay and what is being described is a normal or expected part of healing, I never feel as if I can calm the patient down and reassure them over the phone ( not to mention I never feel as confident ) as I would in person.
Follow-up care is an important part of any surgical procedure. In the United States the fee paid for a cosmetic surgical procedure covers the postoperative office care. If a patient needs to return to the operating room, the plastic surgeon may absorb the cost or there is even insurance specifically designed to cover complications after cosmetic surgery. Patients who have traveled outside the United States and then experience a complication on their return home may, as my patient did, find themselves facing additional costs which can be substantial. In addition it can be difficult for the plastic surgeon in the United States to figure out what procedure had been done without any records. Revisonary surgery is rarely as satisfactory as surgery done without complications the first time.
Cosmetic surgery is elective. If one cannot afford the procedure then it should be put off until one is in a better financial position. If a patient does consider doing plastic surgery in another country to save money, they should understand the additional risks that they may be undertaking. At the very least I would recommend budgeting additional money to cover the possibility of complications. Preferably I would recommend finding a qualified Board Certified Plastic Surgeon close to home, discussing the procedure you are interested in, finding out the cost and then saving money and planning for the surgery. It may take a while but taking unnecessary risks with your health are too dangerous. Safety and quality should not be compromised by cost.
These are exciting times for our practice! After years of our tiny office in the Larchmont medical building we have finally moved into a new suite just one floor below. Our new suite (#800) is much more open and Irma even has her own office! My good friend Jeff Bradley is of course in charge of decorating and the colors are great. Wait until you see the walls painted “melted chocolate”! Stop by and see our new space.