February 25, 2014

It is important that patients have a detailed record of every medical device implanted in their body. That’s why every breast implant patient is given a card with all the details of their implant, we keep it on record in the office, and it is kept on file with the device manufacturer.  That’s a system that has a double back-up.

Just because we have the technology to encode electronic information does not make it necessary.  Not only is it not expensive, but any such technology itself introduces risks to the durability of implants.  Even something as simple as thickening or reinforcing one area to hold the device in place risks causing failures at the margins of those reinforcements.  Nearly every effort to do so on an implant in the past eventually led to an increased rate of early failure.  At best it would take decades to know that this wouldn’t happen.

KISS: take your device card, make a couple of Xeroxes, and put it in a couple of safe places in the house.  Done.

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November 26, 2013


In the past year, I've diagnosed six patients with breast cancer. That might not sound like a lot for a doctor, but I am a plastic surgeon. This isn't supposed to happen. My patients see me voluntarily and our interactions are full of happiness and optimism. It is wrenching to tell just one patient they have cancer, so this cluster has overwhelmed me.

All of these women scheduled plastic surgery and their cancers were detected during their pre-surgical work-up. Several were diagnosed by mammogram; another had a mass that had been dismissed; one traveled from a country with socialized healthcare where she had been waiting months for an MRI; and on another I biopsied a suspicious lump.

What does this mean for them? It meant breast removal rather than breast enhancement and becoming a cancer patient. For some it will mean chemotherapy. But for all it will mean a better chance at a cure than if it had not been diagnosed.

What do I mean? Over the years, pre-surgical testing has revealed patients of mine with abnormal clotting problems, kidney disease, impending cardiac events, colon cancer, and a variety of other problems. Those patients thereby had treatment initiated sooner, which gave them a better chance at life.

But it should never be forgotten that plastic surgery itself has significant risks, including even death. According to the AAAASF, the premiere accrediting body of operating rooms, there were 23 deaths in 1.14 million plastic surgery procedures.

The American Society for Aesthetic Plastic Surgery (ASAPS) is focused on lowering that number. Research funded by the Aesthetic Surgery Education and Research Foundation (ASERF), provides data upon which to upgrade those standards. As knowledge grows and operating room technology develops, AAAASF updates its requirements.

No data is collected on problems found during the preoperative work-up, but in speaking with colleagues it is clear that my experience is typical amongst board-certified plastic surgeons. One can only imagine how many diseases were discovered during preoperative clearances on those 1.1 million patients. No doubt there were more than 23. Conscientious plastic surgeons save lives.

This emphasizes the importance that plastic surgeons be well-trained. Did you know that a plastic surgeon does not even have to be board certified? The American Board of Plastic Surgery (ABPS) is the only board that counts. Fortunately there is an easy way for patients to check on their doctor here

It is crucial that a surgeon have a deep knowledge of the anatomy and pathology of the body part upon which they are operating; no one should do cosmetic breast surgery unless they are experienced treating breast cancer. While plastic surgeons are portrayed as artists and sculptors, all American Society for Aesthetic Plastic Surgery (ASAPS) surgeons are thoroughly trained in breast augmentation surgery and are steeped in knowledge of breast cancer.

In any case, no one should be waiting for plastic surgery to be screened for cancer. Indeed saving these lives is not a justification for plastic surgery. Everyone needs a great internist, and all must follow through on their doctor's advice. Living in denial only results in a greater problem in the future. Your doctor won't force you to return to their office for a follow-up. You are responsible.

My quixotic view is that our culture will evolve to the point that we speak to one another as much about health issues as we do about Snooki and Honey Boo Boo.

October 28, 2013


Here are eight people who have had plastic surgery to look like their favorite celebrity:


The one thing that does stand out to me is that not a single one of these people remotely resembles their celebrity “twin.”  Plastic surgery has a long way to go…but then again, making someone look like someone else has never been our goal.


In the immortal words of Gaspar Tagliacozzi

, the father of plastic surgery in 1597, “ We restore, repair, and make whole those parts…which fortunate has taken away, not so much that they may delight the eye, but that they may buoy up the spirit and help the mind of the afflicted.”


Surgery can’t cure all afflictions.  And I don’t think that even Sigmund Freud himself could help the mind of someone afflicted with the incomprehensible objective of looking like Michael Jackson


October 25, 2013

Men lose their butts after 40?  It certainly isn’t happening to me.  As a matter of fact, I see the same guys in synagogue every year.  Last month at Yom Kippur services I didn’t notice any men with diminishing buttock girth.   I wonder if this study applies to Jews…

October 24, 2013

This report claims that an “unlicensed cosmetic surgeon” in Vietnam threw a patient’s body into a river after she died on the operating room table during a “breast enhancement procedure.” 

If true, this story is so repulsive that no elaboration is needed.

While I’ve never heard of a surgeon dumping a body in the United States, we also have a crisis of unlicensed cosmetic surgeons.

While your state licenses a plumber to only do plumbing and an electrician to only do electrical work, the state gives all doctors the same medical license.  Nothing prevents any doctor, no matter the type of training or even in absence of any training, from performing surgery.  Indeed, a doctor does not even have to be board certified to practice medicine or surgery.

There is only a single board recognized to credential plastic surgeons: The American Board of Plastic Surgery

There are many bogus, mail-order, and unrecognized boards, so it is important to be certain your surgeon is a member of that board.

All doctors can call themselves a plastic surgeon.  But in general – only in general – those calling themselves cosmetic surgeons are not boarded certified by the ABPS.   Like the case of this Vietnamese surgeon, the non board-certified doctors tend to call themselves “cosmetic surgeons.” Real plastic surgeons will typically (but not always) call themselves “plastic surgeons”. 

So be particularly cautious of any surgeon calling themselves a “cosmetic surgeon.”  But it is wise to be sure that any surgeon is certified by the ABPS.  Another way to check that your surgeon is an expert in aesthetic surgery is to be sure that they are a member of the American Society for Aesthetic Plastic Surgery