The true cost of medical tourism

Dr. Larry Nichter of the Pacific Center for plastic surgery would like to make prospective patients aware of the risks and downsides of medical tourism (traveling abroad to undergo elective surgery).

Medical tourism has becoming increasingly popular in recent years; patients have been flying out of the U.S. for plastic surgery, lured by lower prices.

However, a parallel trend has also appeared: plastic surgeons in the United States are finding themselves treating an increasing number of patients who plastic surgery abroad, correcting complications and errors. A survey by the American Society of Plastic Surgeons found that 80% of the responding doctors had treated American medical tourists for complications including infection, contour abnormalities, and hematoma.

Medical tourists are often led to believe that they will receive the same quality of care for a lower price in a foreign clinic. But while it is true that the cost of plastic surgery in some foreign countries is lower, this is often because the quality of care and surgery is compromised. Such patients also seem to neglect the possibility of complications and the need for a follow-up visit.

In addition to the risks posed by sub-standard medical care abroad, medical tourists must consider the risks of injections and implants in other countries. The recent crisis with French breast implant maker Poly Implant Prothese (PIP) exemplifies this problem. PIP used industrial- rather than medical-grade silicone on their implants in an effort to reduce costs, a measure which probably increased the danger of rupture. PIP implants have not been used in the United States since 2000. Removal of these implants has been recommended by the International Society of Aesthetic Plastic Surgery.

It is often the case that medical tourists end up spending more money because they have to pay to treat complications from their overseas surgery.

Source: The Cost of Medical Tourism – Medscape Medical News
Source: Official Statement on Faulty PIP and ROFIL breast implants – ISAPS

Body Dysmorphic Disorder and Plastic Surgery

Dr. Larry Nichter of the Pacific Center for Plastic Surgery would like to inform prospective patients about the rising concern of Body Dysmorphic Disorder as it relates to plastic surgery.

An article from the Mayo Clinic on Body Dysmorphic Disorder describes the disorder:

Body dysmorphic disorder is a type of chronic mental illness in which you can’t stop thinking about a flaw with your appearance — a flaw that is either minor or imagined. But to you, your appearance seems so shameful that you don’t want to be seen by anyone. Body dysmorphic disorder has sometimes been called ‘imagined ugliness.’
The Mayo Clinic staff

Recent years have seen an increased awareness of plastic surgery patients with Body Dismorphic Disorder (BDD). One of the major concerns about patients with BDD is that they may not be competent to give an informed consent for the cosmetic procedures they elect to have.

A medical malpractice lawsuit involved a woman who, displeased with her abdominoplasty scars, claimed that she had been incapable of giving a genuinely informed consent because she had BDD. The case was later dismissed; the court ruled that the plaintiff’s surgeon had followed acceptable medical practice and did not have sufficient reason to refer the patient to a psychiatrist before surgery. The case does, however, highlight some of the problems BDD poses for informed consent when it comes to plastic surgery.

The legal definition of informed consent is rather broad, but it provides guidelines for determining the mental competency of the patient before they can consent to elective surgery. The law requires that doctors provide complete and accurate information about the procedure and its risks to the patient, and the patient must not be coerced or pressured in any way. Ultimately, a truly competent patient must be capable of refusing consent to surgery.

When a psychological disorder (such as BDD, dementia, a learning disorder, or a manic episode) prevents a patient from understanding the risks and likely result of a surgery they wish to have, the question arises as to whether their consent is legitimate. Although a patient’s consent cannot be retroactively revoked if they are diagnosed with BDD after surgery, plastic surgeons are always on the watch for signs of BDD when consulting with prospective patients. This is especially important in the field of plastic surgery because people with BDD are very likely to seek surgical solutions to what they believe is wrong with them.

At the Pacific Center for Plastic Surgery, our goal is to provide patients with lasting, satisfying results. An important step in achieving this goal is making sure that our patients are psychologically healthy enough to make an informed, rational decision in their choice to have plastic surgery.

Source: Informed Consent in Body Dysmorphic Disorder, Medscape Medical News

Smoking and Plastic Surgery: a Bad Combination

In addition to its adverse effects on general health, smoking tobacco increases the chance’s of a plastic surgery patient having complications and can negatively affect her results.

Dr. Nichter at the Pacific Center for Plastic Surgery would like to advise prospective patients of the dangers of smoking as they relate to plastic surgery.

A good plastic surgery result relies on good blood flow. The nicotine, carbon monoxide, and hydrogen cyanide in the blood of smokers inhibits their blood’s ability to deliver sufficient oxygen to their healing tissues. Thus, patients who smoke are at greater risk of complications and poor wound healing.

A long history of medical studies have shown revealed the risks patients take when they smoke. A 1984 study, which followed 1,100 face lift patients, “found that a smoker was 12.46 times more likely to suffer skin loss than a patient who did not smoke.”

A more recent study in 2003 reviewed 132 abdominoplasty patients. The study “showed wound healing problems in 47.9% of smokers versus 14.8% of non-smokers.”

Whether a plastic surgery candidate smokes or not is a big factor in whether a surgeon will perform surgery on that person or not. At the Pacific Center for Plastic Surgery, patients will be asked about their smoking habits, if any, which will be factored into the doctor’s decisions in her/his case.

Source: Bulletin of the American College of Surgeons

Updated guidelines for avoiding skin cancer

The U.S. Preventative Services Task Force (USPSTF) recommends counseling to children and young adults (ages 10-24) with fair skin on the effects and dangers of ultraviolet (UV) light exposure.

Dr. Nichter of the Pacific Center for Plastic Surgery would like to make blog readers aware of this new recommendation, which is an update to USPSTF’s 2003 guidelines for physicians on counseling skin cancer patients.

Since 2003, the USPSTF has found evidence that counseling for children and young adults on the risks of UV light exposure is beneficial.

From the USPSTF:

Convincing evidence relates UV radiation exposure during childhood and youth to a moderately increased risk of skin cancer later in life; for adults, adequate evidence links UV radiation exposure to a small increase in the subsequent risk of skin cancer […] Individuals with a fair skin type are at greatly increased risk of skin malignancy.

Counseling encourages people to engage in behaviors that mitigate their UV exposure such as wearing effective sunscreen, reducing midday outdoor activities, wearing hats or UV-protective clothing, and avoiding the use of tanning beds.

Dr. Larry Nichter would like readers and patients to note that although questions remain as to the direct relationship between sun exposure to an increased skin cancer risk, the risk of premature skin aging (laxity, wrinkles, and an eventual leathery appearance) seems to be directly related to cumulative sun exposure without protection for all ages.

Prospective patients who are concerned about UV-induced skin aging should take a look at the skin rejuvenation treatments available at the Pacific Center for Plastic Surgery.

Related internal links:

Source: Medscape Medical News

Women under 50 benefit most from maintenance facelift

Patients under 50 years old have a consistently higher rate of satisfaction with their facelift results than patients over 50, a new study from California Pacific Medical Center has found. This study was conducted by Dr. Tom Liu and Dr. John Owsley, who compared short- and long-term satisfaction ratings of patients in under-50, 50–60, and over-50 age groups. The doctors also factored in expert analysis of patient photographs for a more objective analysis of surgical results.

The findings are consistent with previous research as well as the experience of most surgeons.

The study concluded: “Younger patients (younger than 50 years) with mild or early signs of facial aging have the highest and most consistent satisfaction and the most natural long-term results.”

The study also concluded that younger patients are ideal candidates for what is called a maintenance lift or maintenance facelift. The reason is that patients under 50, essentially because their skin is younger, will have a better result that will last longer than it will if they choose to have surgery later. Furthermore, their results will look better in the long-term.

If you’re under 50 and would like to find out if a maintenance lift would be the ideal option for you, call our office at (949) 720-3888 to book a consultation.

Dr. Nichter would like to assure patients over 50 that they can still get dramatic and highly satisfying facelift results. The Pacific Center for Plastic Surgery has numerous video testimonials from patients over 50 about their LiteLift™ surgery.

Source: Aesthetic Surgery Institute, California Pacific Medical Center

The importance of choosing a qualified plastic surgeon

American Board of Plastic Surgery

Last month’s news covered a slew of patients turning to illegal cosmetic surgery practices, many of them unaware of the dangers in being treated by someone not licensed to practice medicine.

Dr. Larry Nichter of the Pacific Center for Plastic Surgery would like to make prospective patients aware of the dangers of having surgery with someone who is not a surgeon. Patients can risk not only a bad result, but their health or their lives in the hands of someone who is not a licensed and certified plastic surgeon.

In Las Vegas last month, 55-year-old Jing Qu was arrested for operating an underground cosmetic surgery practice. The makeshift operating room was discovered when a neighbor knocked on the door and got a look inside. The woman Qu was performing a facial surgery on could have gone blind. Qu is in jail and is charged with two counts of practicing medicine without a license.

In a highly publicized case, Oneal Ron Morris was arrested in Miami—also for practicing medicine without a license. A woman came to Morris, who was actually posing as a real doctor, seeking buttock enhancement surgery. Morris filled her buttocks with cement, mineral oil, and flat-tire sealant. The truth about the victim’s surgery came to light when she went to the hospital with severe abdominal pains and sores on her buttocks.

There has also been an increasing trend of illegal buttock silicone injections. Plastic surgeons no longer use injectable silicone in any procedures today because of the health risks it poses. Underground practitioners often use silicone purchased from home improvement stores. Kimberly D. Smedley, of Atlanta, was arrested in Washington in October this year for injecting silicone into the buttocks of exotic dancers in a Baltimore hotel.

Many of these patients-turned-victims opted for an underground practice for financial reasons. But these patients often end up paying even more than they would have for a legitimate surgery; the illegal procedures leave them with serious medical problems that require expensive treatment. The risk they take with their health and their lives is not worth it.

At the Pacific Center for Plastic Surgery, our doctors are the polar opposite of the criminals in these news stories. Dr. Nichter is board-certified by the American Board of Plastic Surgery, the highest standard of certification for plastic surgeons. They stand among the most experienced and talented surgeons in the country.

To become a board-certified plastic surgeon, a doctor has to not only complete medical school and a residency, but also a plastic surgery-specific residency as well as intensive further education. In addition, doctors must keep up to date on the latest medical research and techniques in their field.

At the Pacific Center for Plastic Surgery you can expect the highest standard for surgical procedures and medical care.

Women over 50 more prone to complications

Dr. Nichter at the Pacific Center for Plastic Surgery would like to make his patients aware of the results of new medical research.

A new study from Johns Hopkins Medical Institutions has shown that women over 50 years old are more prone to complications—especially infections—following breast reduction surgery.

The study, which involved 1,192 women of various ages, showed that the infection rate in women over 50 was 2.7 times higher than for women under 40.

The cause of this trend is thought to be the changes in hormone levels that occur naturally with age. Infections were found to be less likely in women undergoing hormone replacement therapy. Women who had undergone surgeries like hysterectomy, which cause drops in hormone levels, had higher infection rates.

Women over 50 also showed a slightly increased rate of wound healing problems.

With this new knowledge, Dr. Nichter at Pacific Center for Plastic Surgery can provide the best post-operative care for our over-50 female patients so that they can avoid complications and infections.

Liposuction may lower your risk of heart disease

Patients who have had liposuction or liposuction with abdominoplasty may be likely to experience a reduction in their triglyceride levels, making them less susceptible to cardiovascular disease.

These findings were the result of a new study of 322 fat-reduction patients (270 women and 52 men). The review of the data found that the triglyceride levels of many of these individuals dropped from dangerous levels to normal ones.

Medscape Medical News interviewed a plastic surgeon involved in the study:

“Patients with normal triglyceride levels experienced no significant change after liposuction. […] However, patients with levels of greater than 150 mg/dL demonstrated a 43% reduction. In fact, 62% of these patients whose levels were at risk before liposuction had normal levels after liposuction.”

Triglyceride levels over 150 mg/dL are considered a risk factor for stroke, type 2 diabetes, and a host of other medical problems.

From the same article:

“We do know that the drop in triglyceride levels we found in these patients actually exceeded what can be accomplished medically, so it may be that there is a therapeutic benefit.”

Doctor Nichter is one of the most experienced, well-trained plastic surgeons in the United States. With 27 years of experience in liposuction, education in the latest techniques, and a multitude of satisfied patients, Dr. Nichter is the trusted choice when it comes to fat-removal procedures.

Source: Does Liposuction Offer More Than A Cosmetic Benefit? Medscape Medical News

California bans use of tanning beds by minors

Ultraviolet tanning bed

Governor Jerry Brown has signed a new bill into law which will prohibit the use of ultraviolet tanning beds by people under the age of 18 in California.

California is the first state to ban minors from using tanning beds. The law is intended to protect minors from the harmful effects of ultraviolet light, especially the associated increased risk of skin cancer.

“Skin cancer is a rising epidemic and the leading cause of cancer death for women between 25 and 29,” said the bill’s sponsor, state Senator Ted Lieu.

The new law goes into effect January 1, 2012.

Information and quote from State bans use of tanning beds by minors –Reuters