Plastic Surgery 101 takes on the big apple + Alloderm and breast surgery

Sorry for the gap in posts! It's been almost 2 weeks and I just haven't been "feeling it" for updating the blog.

Presently I'm in lower Manhattan at a symposium on the use of Alloderm in breast reconstruction surgery. Alloderm is produced from human skin where the proteins which would ordinarily cause you to reject the tissue graft have been removed. What's left is a "living prosthetic" that can be used to reinforce the body's tissues.

Alloderm has gained popularity in breast reconstruction as it allows us to bridge the concepts of traditional reconstruction with techniques we use in breast augmentation. I was kind of an early adopter of using Alloderm over 3 years ago in response to some of the limitations of the techniques I was taught during my training. At this point, Alloderm (or related products) are used not infrequently by many surgeons.

I'd like to briefly mention two restaurants here in NYC that my wife and I had wonderful dinners at

Bouley - where I'd strongly recommend the 5 course Chef's tasting menu. Magnifique!

The Tribeca Grill - Great steak! Very affordable for a nice restaurant in NYC.


Doctor Shopping - Finding the doctor you need

So I'm sitting in Starbucks near my house with my kids when this group of joggers comes in for a post-run sit around. They immediately get off into some discussion about orthopedic sports medicine and their various injuries, complete with editorials about how their doctor is wonderful, how they were "misdiagnosed", and wondering how different specialists gave them contradictory advice or opinions.

I kind of felt sorry for them. Picking a doctor is tricky, even for doctors. As I work doing surgery at half a dozen hospitals, I have a general idea of the reputation of different surgeons' abilities and personalities in several parts of town.

When I was a resident working with dozens of different attending surgeons, I definitely felt like I could get a feel for who was outstanding or poor. However, when my wife had musculoskeletal back pain, I was left to kind of "guess" at the competence of a neurologist (whom I really respect BTW) who was treating my wife. Some of their field is just too removed from my scope of practice to be fluent in.

Eavesdropping on the joggers reminded me of a letter in the New York Times health section on an article about picking doctors, "You Can Find Dr. Right, With Some Effort". There was a really insightful letter from an ER doctor that stood out to me which I think is worth republishing:

As an emergency physician for 32 years, here is how I would and would not go about finding a personal physician:

1. Chronic medical care: choose primarily based on personality, secondarily on skills. All doctors are smart, in the top 1% of the population, which makes them abnormal to start with. For ongoing care, you need the minority with great personalities. For skills, just make sure they are ABMS ( board-certified.

2. Surgical care: Choose primarily based on skills. Ignore their personality. Here you want the best technician with the best judgment, not Marcus Welby. It will usually be a short-term relationship for a problem that requires invading your body and significant medical judgment issues. It’s not worth trying to find someone who combines both skill and personality; if you get both, it’s a bonus.

3. Acute care: You’re at your most vulnerable and have no time to research. Your regular doctor rarely can see you for acute care: you end up in an urgent care center or ER. Choose based on skill and judgment only, which must necessarily be based on quickly accessible reputation and qualifications.

OK, how do you find someone based on skill/judgment, or based on personality?

1. Personality: Here’s the only place to use friends, neighbors, and trusted acquaintances. These people are qualified to judge this aspect of a physician. This is totally unrelated to a physician’s skill or competence, but this is important for chronic medical care.

2. Skills/judgment: Never use the recommendations of non-medical personnel. They have no basis on which to judge. Avoid online evaluations: they are statistically prejudiced and don’t account for individual practice variances. Instead, use trusted medical acquaintances such as physicians or nurses to make recommendations. They have both the personal experience and medical sophistication to make such recommendations.

I'd agree in general with the insights of this doctor, especially with surgeons. For instance, there were some grade-A sociopaths I knew/know in various specialties whom are outrageously gifted surgeons. I'd be happy to let them do my liver resection, organ transplant, aneurysm clipping, etc... as long as I did not have to speak to them ever again.


Breast Implants Help a Rare Heart Condition

What would you do -- total panic notwithstanding -- if doctors were to find your heart beating under your kidney?

In a case so rare it has no medical name -- but is being described only as “a floating heart,” -- a Florida woman’s heart was found to be shifting around in her body. Doctors found it stuck in her rib cage under her kidney.

According to news reports, the 35-year-old woman’s right lung had been removed long ago, leaving space for her heart in which to wander around.

Having never seen the condition before, physicians were at a loss to come up with a treatment. One doctor said the patient was the only person in the world with the disorder.

The treatment? Breast implants!

Robert Rey, M.D. of Dr. 90210 fame shows a breast
(Photo, courtesy of Dr. Rey.)

It required a four and one-half hour operation, but breast implants -- used in the standard breast augmentation procedure -- filled the space where the lung used to be and holds the heart in the correct position.

“Clever idea, actually,” says Robert Kotler, M.D., a board certified Beverly Hills cosmetic surgeon. “The chest surgeons used the breast implants as a large-space ‘filler’.”

Editor’s note: Dr. Kotler is one half of the Tuck ‘n’ Stitch bloggers.

Top 10 Cosmetic Surgery Lawsuits

Taking Botox to court is something akin to suing Santa Claus. Almost everybody likes Botox as much as Santa, so how would you get a jury to vote against either one? Only time will tell….about Botox, that is.

Three months before Christmas, Santa is certainly on safe ground.

So nobody is suing Santa. Yet, anyhow. But in January, all bets are off!

Given the number of lawyers looking for something to do, the Momma-put-a-lump-of-coal-in-my-Xmas-stocking class action lawsuit is just around the corner.

(Pamela Moore photo)

Patrick Hudson, M.D., a plastic surgeon in New Mexico, located some insider statistics that show which plastic surgery procedures are most likely to lead to the court house.

Here are the top ten litigated procedures, along with the percentages of actions the procedure draws. More.

1. Nose surgery……………………..22 %
2. Breast reduction………………….17 %
3. Eyelid surgery……………………16%
4. Breast enlargement……………….13%
5. Face lift…………………………… 9%
6. Various………………………… 7%
7. Breast reconstruction…………..… 6%
8. Tummy tuck……………………… 5%
9. Liposuction……………………….. 3%
10. Facial resurfacing………………. …2%

Nose surgery heads the list because it’s the most difficult plastic surgery procedure to learn and perform. More.

Breast reduction involves removing a lot of tissue; however, eyelid surgery is a surprise because it is supposed to be one of the easier procedures to perform. Breast enlargement made its way onto the list because it’s very popular, with 329,000 patients undergoing the procedure in 2007, the most recent year for which statistics exist. A tummy tuck involves a long incision across the abdomen so insurance companies should be thankful the percentage is relatively low. Ditto breast reconstruction.

Hint: If, for some reason, you aren’t satisfied with the outcome of your plastic surgery, two eminent Beverly Hills cosmetic plastic surgeons, Drs. Robert Kotler and Stuart Linder, tell the top five constructive things to do if your procedure does not go well.

Read their blog, Top 5 Remedies for Unsatisfying Plastic Surgery.

BOTOX on the brain - You know you're a plastic surgeon when....

You know you're a plastic surgeon when you watching the press conference tonite by the US Senate leadership about passing the $700 billion USD bailout bill and not being able to take your eye's off of Sen Mitch McConnell's BOTOX'd brow!

Sen. Mitch McConnell (R-KY)

Other pols who stand out for BOTOX

Hillary Clinton (D-NY)

Nancy Pelosi (D-CA)

Nancy Pelosi's Cat :)