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When The Less Invasive Alternative Means Lower Satisfaction

Online resources for tummy tuck information suffer with a great deal of misconception. Even surgeons may disagree regarding choosing between different tummy tuck operations for a given patient. Reduced cost, pain and extent of surgery tend to push patients toward lesser surgery. These days “less invasive” is a popular selling point. As my practice has progressed, however, I have found the satisfaction rate of mini tummy tuck to be too low to support doing many of them. I do “minis” only in rare circumstances these days.

Mini tummy tuck surgery corrects much less than more involved full versions of the operation. If there is any significant looseness above the belly button, the mini will not address it much. If there is any more than a tiny bit of excess skin, the mini will not touch it much at all. The feeling of having been “under corrected” is common after mini tummy tuck surgery. If patients are unhappy with the results of a mini tummy tuck it is not always possible to Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

When Are Pain Pumps Useful Following Plastic Surgery?

About ten years ago plastic surgery had a nice little advance- the advent of the disposable pain pump. Breakthroughs in medicine are far fewer than advertising copy would have you believe, but this one is real. Unfortunately some practices use them like a marketing ploy in all cases and really don’t spend the time to make them work well or minimize their risk. Others don’t see the benefit and don’t use them at all.

Pain pumps are quite useful in some cases when used correctly. Plastic surgery is a technical specialty and some surgeons are more adept at making things work than others. There are risks with them and cases in which the benefit is harder to measure.

How Does a Pain Pump Work? Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

Surgeons Should Understand What Type Of Patient They Have

Over the years, I have found that patients can be loosely grouped into 4 different types. Nothing particularly wrong with any type, but it does help me to approach patients appropriately if I can get a sense of what type they are.

The four types are:

Type A: If a surgery can “fix” or “cure” me such that I won’t have to take medications every day of my life, than let’s do it.

Type B: I will never consider surgery unless it is a life-threatening situation. If a medicine can help, why do it???

Type C: I will consider surgery only as a last resort when all else fails.

Type D: Read more »

*This blog post was originally published at Fauquier ENT Blog*

Weight Loss Encouraged Before Breast Reduction Surgery

Many women with large breast and weight issues seek breast reduction.  I was taught to encourage them to lose weight first.  Now there is a very small study that backs this up  (full reference below).

The American Society of Plastic Surgeons issued a press release entitled “Breast Reduction and Bariatric Surgery—Which Should Be Done First?” and provided the answer “Final Results May Be Better When Weight Loss Comes First.”  I agree, but find it odd that such a small study was published.  There should have been more patients included.

Jeffrey A. Gusenoff, MD, and colleagues reviewed two groups of patients who sought consultation for body contouring surgery August of 2008 and February of 2010 after massive weight loss (defined as a weight loss of greater than 50 pounds).

Group I (n=15) included Read more »

*This blog post was originally published at Suture for a Living*

Infection From Plastic Surgery: Who’s To Blame?

When things are done properly, infection is pretty uncommon in a plastic surgery practice. Surgery and infection are unfortunately related however and will co-exist at least occasionally even when everything is done correctly. This is just a fact of life.

People interestingly enough seem to believe that an infection is evidence of malpractice. Infection can be present when malpractice has occurred but by itself is not evidence of anything.

Minor infections can often can be treated and cause no long term problems. More serious infections can Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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