Blog 03/2014

March 5, 2014

The California Society of Plastic Surgeons has been valiantly fighting for protections for plastic surgery patients, such as requiring surgery in accredited operating rooms, requiring insurers to cover breast cancer reconstruction, orthodontic treatment for cleft lip children, etc. 

In recent years we have been battling efforts to extend the licenses of relatively untrained personnel to perform more and more treatments with lasers, injections, and so forth.  We even lost a battle to protect patients from dentists doing facelifts.

The clear trend in California is to loosen training requirements and allow more people with inadequate training to dabble with lasers and fillers and botox.

In the meantime, regulators in the UK have recognized that they have a problem and are reducing what these unqualified people are allowed to do.

So while they are going in one direction, we are going in the other.

But plastic surgeons are but a small group.  There are more dentists than plastic surgeons, and far more nurses and cosmetologists in the state than plastic surgeons.  What does that mean? More votes.

So unless people speak up, things are going to get worse and worse until we have well-publicized disasters.  And those disasters will occur.  But just like the blind street corner that doesn’t get a stop sign until several people are killed, we are going to have to wait for more disasters until legislators to do the right thing.

March 5, 2014

The story of the young girl who died as a result of complications following a tonsillectomy is absolutely horrible.

But the way the flames were flamed by the media could be compared to, “Remember the Maine.”

The media kept referring to this, using some combination of, “…died following a botched routine tonsillectomy…”

But hemorrhage is a known complication of tonsillectomies; in fact I myself bled two days after mine and was rushed to the hospital. 

Was it “botched” because she bled in the hospital and wasn’t saved?  Getting an “airway” into a frightened and massively obese teenager bleeding from their mouth would be daunting for even the world’s best anesthesiologist.


Routine?  This girl had morbid obesity and had the surgery to correct sleep apnea.  That is a far cry from the typical tonsillectomy we all think of, an operation typically done on young healthy children suffering from chronic infections.


March 5, 2014


A recent study published in plastic surgery’s leading journal demonstrated that “trained listeners” heard changes after surgery, but there was no change with speech function.


The study was done on individuals in Iran having “ethnic rhinoplasty.”  I wonder whether the change in size of those noses is representative of what the typical rhinoplasty patient experiences.


I’ve done rhinoplasty for over 17 years, and no patient or patient’s family member has ever commented that they noticed a change in their voice.  So I think this finding is interesting, but probably not applicable to the population of rhinoplasty patients whom I see in my practice.


March 5, 2014


Obesity kills, yet food is obviously essential.  Why do we forget that sun kills?  I talk about sun exposure and tanning booths with patients all of the time.  Highly intelligent men and women somehow live in denial that their ongoing sun exposure can lead them to get melanoma.  Unless they had a family member die of it, the subject seems abstract. 


But if I tell a woman in her thirties that putting on sunblock every morning will keep her skin gorgeous for decades to come, I feel like I am getting some traction.  It is simply interesting to me that patients are more apt to make this connection.


What motivates people to wear sunscreen doesn’t matter, so long as they do it to themselves and to their children (especially their children.)


Though we’ve known that excessive sun exposure can lead to melanoma, a recent study has shown that the rate of melanoma has been growing in women 40-50 years of age.  Perhaps they had gotten too much childhood sun before the danger of sun tanning was fully appreciated.  Or maybe they are still getting sun.


If melanoma doesn’t motivate you, just remember that sun exposure will make your skin crepey, wrinkled, thin, loose, and saggy well before its time.


March 5, 2014

On February 10, a surgeon at Washington University performed surgery wearing a special pair of glasses that made cancer cells blue! This allowed the surgeon to distinguish the normal tissue from the cancerous tissue. Normally tissue needs to be removed and sent to pathology for a “frozen section.” But oftentimes healthy tissue is removed and sometimes bits of cancer remain behind. If this really works as touted, it may be one of the most important advances for oncologic surgery in decades. Wow!