Long Island Plastic Surgery
Please feel free to ask any question that you would like related to plastic surgery. I will try to answer you within 24 hours. Ask Dr. Deane a question
3/27/07 Gynecologists and liposuction: I reviewed a recent case of a patient who didn't know that her 'cosmetic' surgeon was a gynecologist. Gynecologists have organized to train themselves to do cosmetic procedures, and patients should be aware of the 'training involved', namely a two day course:
http://aaocg.org/course_information_18.html
Notice that the 'surgeon' is trained in liposuction in the course of ONE DAY and then participates in 'live surgery' the next day, and then the course is over. It is up to the patient to determine whether the quality and safety of this training even begins to compare with that of a board certified plastic surgeon.
2/17/07 The latest info on silicone implants: In a way, the roughly eighteen years of experience that we have had with saline implants has taken the wind out of the silicone implant 'advantage'. Saline implants are quite successful and there seems to be little need to switch to silicone as a routine, unless the patient wants it. I will use either implant but see no distinct advantage for the silicone in in most women. This opinion is now summarized in the February, 2008 issue of Plastic and Reconstructive Surgery (our best known journal). Saline implants, the article says, seem to have an overall decreased rate of capsular contracture and rupture rates compared with silicone imlants. Primary breast augmentation is not an isolated operation and implants will need to be replaced at some point in a patient's life (most likely). This is easier with saline implants. Even though patient satisfaction is high with both types of implants, the cost of the slaine implants is roughly half that of silicone implants.
11/21/07 Reader Julia writes: "I noticed from your website that you have long known that Dr. 90210 is not board certified. I thank you for speaking out." Thank you, Julia, for reading. I have tried to tell everyone that anyone can call themselves a plastic surgeon, whether or not they are certified by the American Board of Plastic Surgery. Whether or not the surgeon feels he or she needs the certification, at least the patient should know.
10/22/07 www.bestnewyorkplasticsurgeons.com This is a bad site which has sprung up recently. Warning signs are early heavy marketing to all sorts of doctors who want to capture plastic surgery patients. Extra warning sign is the way that they will list all non-ABMS certified surgeons and will mix up all sorts of ' boards' to confuse the issue. Stay away. These people are out to make a fast buck.
10/21/07 Here today, and gone tomorrow. Funny how the experts where predicting that bringing plastic surgery to spas and medical malls would be the wave of the future. Heavy weight plastic surgeons, Klinger, and Johns Hopkins where all involved:
http://www.nytimes.com/2006/10/26/fashion/26skin.html?_r=1&oref=slogin
Now, it has all gone away. The Klinger Aesthetic stores have changed back to makeup and Klinger Aesthetics has suddently shut its doors. Either the business model did not work or the money behind it didn't like the idea. Be careful of pundits predicting the future when it comes to medicine.
8/22/07 Mesotherapy and Lipodissolve The American Society of Aesthetic Plastic Surgery has recently issued a warning against the use of injection fat-loss treatments, advising surgeons to avoid these procedures until more is known about their safety and efficacy. I know that 'centers' are springing up all over the place that offer these services but I would avoid them until more is known.
8/12/07 Dr. 90210. All of the plastic surgeons that I know (and myself included) do not take this show seriously, especially because we do not consider the 'surgeons' featured to be qualified. The ones that I have seen have no boards. I am always surprised that my patients don't know this, but perhaps surgeons certified by the American Board of Plastic Surgery should speak more often and loudly about this. "Dr. 90210" is entertainment only and is sad entertainment, because it implies that these surgeons meet standards that are not in evidence.
I came across a particulary good link to a colleague who spells out exactly what it takes to be board certified in our specialty:
http://www.cosmeticsurg.com/thousand_oaks_board-certification.html
7/22/07 The most popular plastic surgical procedure is. . .breast augmentation. The statistics are in and, nationwide, breast augmentation has become the most popular procedure. Certainly, in my own practice, this has been true. The age range covers young women through women in their late fifties. The goal should be to provide just the right amount of 'fullness' without an obvious 'augmented look'. Most of my new referrals seem to come from referrals from past patients.
5/26/07 We can't say it enough, apparently. This occured to me as a I helped to treat a patient with an unsuccessful breast augmentation done by her gynecologist. Although this is an extreme example, non-board certified 'plastic surgeons' fight for your attention daily and will want to do your surgery. American Society of Plastic Surgeons (ASPS) assure the public, on the other hand, that their surgeons:
-are certified by the American Board of Plastic Surgery and trained specifically in plastic surgery
-operate only in accredited medical facilities
-adhere to a strict code of ethics
-fulfill continuing educaton requirements, including patient safety techniques
As the ASPS says, plastic surgery is real surgery, and demand all of the precaustions and planning of any other surgery. This leads to the best chance, in my opinion, for an excellent outcome.
5/25/07 And the most popular surgical cosmetic procedure is. . . breast augmentation, with 329,000 breast augmentation procedures done by American Society of Plastic Surgeons (ASPS) last year. This was followed by rhinoplasty (307,000), and liposuction (303,000). A couple of things come to mind. It may be that over the last decade or so, the augmentation procedure has become very successful and therefore more popular. It also accounts for the tremendous push by Allergan and the implant manufacturers to have surgeons use the new silicone implants. I still think that saline implants continue to offer excellent choices and benefits.
4/7/07 "You can't make everyone happy"---So says a Manhattan doctor who tries to say that his 25 settled law suits in the last few years are normal:
New York Post ----- Don't you believe it. This doctor (a non-board certified surgeon) says that 'low self esteem' issues of his patients are to blame. The New York Post calls him one of the 'Scandal' Docs and I couldn't agree more.
3/14/07 Beware the 'double board certified' scam--On this website, you can find a link to www.abms.org which will tell you if any doctor is board certified by a recognized board of the American Board of Medical Specialties. An increasing common tactic for 'cosmetic' surgeons to confuse the issue (to their advantage, of course) is to combine their board certification as say, an otolaryngologist (ENT surgeon) with their non-ABMS recognized certification by the 'American Board of Cosmetic Surgery'. These boards are not the same: one is legit and the other is not, in my opinion. At any rate, it is clearly not 'apples to apples' as we say. Call or write me if any doctors qualifications are confusing, not matter what he or she may say.
3/4/07 Silicone breast implants are certainly available and approved for cosmetic breast augmentation. There are a few things, though, that are different from the saline implants that the patient will have to know about. For one thing, the patient must agree to be part of a new 'study' that follows that patients after their surgery. This is because the FDA approval is conditional on the companies providing more data over time. Therefore, there are informed consent documents that are additional and time that the patient and surgeon must spend to thoroughly review the risks and alternatives to the new implants.
1/26/07 I may have been right about the caution about the 'new' approved silicone breast implants. It seems that the public and patients considering breast implants are not necessarily convinced that they are the 'better' choice. My patients are considering the long (fifteen year) success track record of success with the saline implants and are overwhelmingly choosing the saline. Wall Street may be waking up to this fact too: Allergan and Mentor stocks have stalled. Allergan still remains an attractive company because it makes BotoxR but now analysts have recognized, I think, that silicone is not the 'replacement' for saline.
1/13/07 Silicone implants: Update. Now that the FDA has approved the use of cohesive gel implants for cosmetic uses, several things are become apparent as the issue settles a bit. First, the implants will be sold to anyone with a medical license. Initial hopes that only board certified plastic surgeons would be allowed to use the implants, which I believe would have led to more quality control, have caved to protests of any other type of 'cosmetic' doctor claiming 'restraint of trade' issues. Second, the use of these implants will continue to be 'studied' which will mean a significant burden of paperwork for the surgeon and an expense burden for the patient, who will be asked to get follow up MRI studies to look for 'rupture'.
My patients know that I believe that there is a lot of 'hype' about the silicone implants by the manufacturers, because they are at least twice as expensive as saline implants, and so they mean big business and big profits for Inamed and Mentor. I am not convinced at all that they are 'softer' or 'better', and, it seems, neither are my patients, who are still requesting saline implants. The advantages of saline implants (smaller incisions, ability to correct for small breast asymmetries) are there and there may be very little reason to consider silicone implants at all.
I will update you as I start to use the implants and the companies give us more information. Right now, Inamed and Mentor are in a full tilt 'PR' mode.
12/07/06 Who should be treating you with Botox and Fillers? There is a proliferation of medi-spas and 'treatment centers' with non-plastic surgeons and non-dermatologists treating patients with these drugs because their own training in obstetrics or family practice or whatever is not 'profitable' enough. I find this just as disturbing as gynecologists performing liposuction. This is fairly good article from the New York Times about the trend:
http://www.nytimes.com/2006/11/30/us/30plastic.html?ex=1165640400&en=9f37f455014af090&ei=5070&emc=eta
An added piece of information: many of these treatment centers are closing as well.
12/1/06 Breast implant approval: a nice article from the Chicago Tribune. This article puts the issue in perspective and discusses recovering from the 'panic':
www.chicagotribune.com/news/columnists/chi-611300043nov30,1,7797568.column?coll=chi-news-col
11/19/06 FDA approval...It is important and what does it mean to you? First, Food and Drug Administration (FDA) approval means that the drug or device is approved for marketing for a specific use. This does not mean that it isn't 'legal' to use the drug or device for another use, but then both the patient and doctor must realize that it is being used 'off label'. Common 'off label' uses of drugs include Botox for the mouth and Restylane for the area under the eyes. To check to see the current status of injectable fillers and Botox, see:
www.plasticsurgery.org/news_room/press_releases/Injectables-at-a-glance.cfm
11/18/06 Silicone breast implants are 'approved'...Now what? Yesterday, we were bombarded with the news from the implant manufacturers that silicone (gel) implants were approved by the FDA for use in cosmetic surgery. They are overjoyed, of course. I'm not so sure that you should be.
As you know, gel implants have been off the market for at least a decade but ultimately the dangers were overblown. The nice thing, however, is that the quality of the saline implants got so good and our experience with them grew, so that it's hard to imagine going back to silicone. Silicone may have an advantage in thin women with very little fat 'padding' but we have used saline implants in these patients over the last ten years with great results.
So, keep in mind:
1. The companies that make the implants would like to sell them. In this country they cost much more than saline and this means greater revenues for Allergan and Mentor.
2. A larger incision will be needed for silicone implant insertion
3. Silicone patients will still have to be on a type of 'study' and will be asked to get follow up MRI exams at intervals.
In other words, there are conditions regarding the use of silicone implants that should give both the surgeon and patient pause.
10/28/06 Vitamin E and Scars--Does it help? The short answer is, ''probably not". This means that Vitamin E applied topically to scars has a reputation of helping scars to 'fade' but there is very little support in either animal studies or human studies to support this (Journal of Plastic and Reconstructive Surgery, July 2006). Some of use actually think that it can make scars become wider than they would normally. Vitamin E may have benefits as an antioxidant when taken orally, but this has no effect on scars.
10/11/06 Surgery in another country outside the United States. I know that it's tempting to have your plastic surgery in another country, because of the huge cost savings. I must admit that the general costs I've heard of are one to one-third what they are here. Many doctors abroad are well trained and I'm sure that they can name many happy patients. Then, you may ask, what's the problem? To be fair, I'll say that there isn't one as long as you realize that the controls, accreditations, board certifications, peer reviews, malpractice pressures, etc. that a patient takes for granted in this country are very different outside of our boundaries. This effects everything from the sterility of the gauze to the regular review of the surgeon by his peers. To be sure, this adds to the cost of surgery here, but at least you know why. In addition, you have the advantage in the US of having the surgeon in close proximity to you if there's a problem. Even if things are going well, good follow up for most of us involves seeing patients at regular intervals for at least six months to a year after surgery. Sometimes, little things (and reassurances) are important. Even when I have patients from out of state, I see them at regular intervals or, at the very least, have one of my colleagues see them in their home state. There is a great deal of 'added value' in having your medical care and surgery at home. (Also see the plasticsurgeryhelp FAQ section). I, myself, have had patients from outside the United States, especially Europe, and presumably these patients travel here for the expertise we provide and the standards present in the United States.
10/6/06 Mercedes and Botox. Did you know a Mercedes dealership was planning on offering Botox? Botox (for wrinkles, frown lines essentially) and Restylane (for wrinkles and lip contours) are very popular and good products, however....I'm upset with the present trend to have them used in treatments outside of the doctor's office in hairsalons, strip malls, 'day spas' (what are these really?), and anywhere else the patient can lie down. The truth: the companies that make these products will sell them to any type of doctor (ob/gyn, family practitioner, even someone who isn't 'anything', just a licensed doctor) and then the doctor can decide who (nurse practitioner, RN, or him/herself) will administer the meds. So, here's my bias, and I admit I'm old school, 'conservative', but I'm also safe, and my standards are very high. These medications should only be used in a doctor's office and I don't mean his office in a hair salon!! Recently, here on Long Island, a Mercedes dealership advertised that Botox and Restylane would be done at an office in the dealership! Some experts think that within five years, every pharmacy and 'spa' will have a nurse in the corner injecting things into peoples faces. Just beware.
10/3/06 The new restylane. Restylane treatment as a filler for the upper lips and forehead is very poplular now in my practice and others. You will be reading and hearing a lot about 'longer lasting' fillers in the near future that may be better. This may or may not be true. Restylane has the advantage presently of lasting for 6 months to one year (in my hands) and there is the addtional 'safety' of it being largely reversable if there is a correction that the patient doesn't like. Feel free to contact me with any questions about the 'latest' filler if it sounds too good to be true. And, by all means, avoid injectable liquid silicone.
9/30/06 No more doctors for children? Did you know that doctors in many specialties, not just plastic surgery, are choosing not to treat young children anymore? This is strictly a function of the overwhelming burden of a 'statute of limitiations' that, in New York State, makes a surgeon legally vulnerable to lawsuits until the child is 20 years of age. Therefore, an infant's parents have roughly twenty years to sue the surgeon. Many surgeons of all kinds that I have spoken to have said 'enough is enough' and are saying that this is just too much risk for themselves and their families. Fight for medical malpractice reform!
Leland M. Deane M.D. FACS
Long Island Cosmetic Surgery
999 Franklin Avenue
Garden City, NY 11530
(516) 742-3404