plastic surgery

Cosmetic Surgeon, Plastic Surgeon, and Credentials

Saturday, March 21st, 2015

A woman was found dead, lying on a massage table with bloody gauze on her buttocks inside a business that performs eyelash extensions in Dallas on February 19th. It appears that this woman had paid about $520 to have something injected into her buttocks as a buttock enlargement procedure. Exactly who injected exactly what is not clear at this point, but arrest warrants have been issued for Denise Ross, who goes by the name of Wee Wee, and her transgender companion Jimmy Joe Clarke, who goes by the name Alicia, for practicing medicine without a license (both are pictured above). This is such a tragic story, and unfortunately it's not all too uncommon. News reports keep popping up about people who have silicone injected directly into their buttocks or breasts, the procedure being performed by someone who may be in the area only for the weekend. Complications occur, and the injector has long-since vanished.

It is precisely because of tragedies like this that credentialing is so important. One type of credentialing is word of mouth. A friend or colleague went to this place or that place, had something done, was happy with the result, and she tells you about it or posts a positive review online. That type of credentialing can be very helpful and may (or may not) come from a trustworthy source. In medicine, another type of credentialing comes through certification by a Board recognized by the American Board of Medical Specialties (ABMS). This is an entity composed of 24 medical specialty Boards. The American Board of Plastic Surgery is one of the twenty-four. Doctors who are Board Certified by one of the 24 ABMS member Boards and who participate in the Maintenance of Certification program are part of a demanding process that repeatedly assesses and enhances their professionalism, judgement, medical knowledge, and clinical techniques.   ABMS and its member Boards establish lifelong learning standards that ensure physicians keep abreast of the latest practices and treatments.  Before becoming Board Certified by the American Board of Plastic Surgery, a candidate must have completed a plastic surgery training program at an accredited institution.  A list of those institutions reads like a Who's Who, including essentially every major university medical center you have ever heard of.  A surgeon cannot become Board Certified by the American Board of Plastic Surgery without completing training at one of these 100+ member institutions.

From time to time I'll Google some key words, like 'breast augmentation Fort Worth', just to see what pops up.  Occasionally I run across something unexpected, like a website of a surgeon that is new to the area, or at least new to me.  So, I'll look at the website and try to find out a bit about the doctor.  Who is he/she?  What type of practice is it?  Where did the doctor do his/her training?  What types of certification does he/she (I'll just use 'he' or 'his' from this point forward) have?  Sometimes the information is easy to find on the site.  Sometimes it's almost impossible.  As consumers we all want to know as much as possible about the products and services we buy.  With something as important, even 'intimate', as surgery, we have a right to know what qualifications a person who may be operating on us has.  One thing I've found as I've looked at these various websites is that a doctor who trained in plastic surgery will display that training proudly on the first page of the website and on his biography page.  It's not hidden in the website somewhere; you don't have to dig through pages of the site to find it.  A surgeon who is certified by the American Board of Plastic Surgery displays that information on page one.   On the other hand, another thing I see a lot on websites relates to doctors who say they are 'Cosmetic Surgeons'.  Frequently those sites look great.  Lots of animation on the site, lots of color, lots of pictures, even some nice testimonials.  All of this sounds and looks just great, and often these are very good doctors and surgeons.  Something that bothers me about many sites like this, however, is that it's often hard to find out the details.  What is the doctor's background, and where did he do his training? It may be surprising to learn that often these doctors originally did their training in something like family practice or radiology, then decided to start doing cosmetic surgery. In situations like that, it might be worth knowing how exactly the doctor got into doing particular procedures, for instance, liposuction or breast augmentation. Did he attend a weekend course and start doing it? On many of these types of websites that information just is not displayed. The websites look great, but the depth of content regarding training is lacking. And that, at least to me, raises questions.

I am not comparing these doctors to the unknown, non-physicians who inject unknown substances into people, similar to the situation mentioned at the beginning of this blog. To be a licensed physician in Texas, a doctor has to have undergone verified training and passed specific examinations. On the other hand a random person injecting unknown substances into buttocks in a nail salon...well let's just say his or her training is more suspect. What it really comes down to is this: credentialing matters. Word of mouth and positive online reviews are helpful. Board certification in Plastic Surgery or Cosmetic Surgery is, at least in my opinion, essential.

Medical Tourism and Plastic Surgery

Wednesday, February 11th, 2015

One of the great things about Fort Worth is the ease of access to the world afforded by DFW airport. American Airlines has its headquarters here in town and DFW is its largest hub. With U.S. based airlines like United, Delta, and Spirit, it's easy to either fly here from anywhere in the country, or to fly from here to anywhere else. DFW now even has nonstop flights to and from Australia on Qantas, the UAE on Etihad and Emirates, Seoul on Korean Air, and a number of carriers to many places in Europe.

So, why am I talking about this on my plastic surgery blog? Because of medical tourism. It has become all the rage. Forbes magazine estimated that 1.25 million Americans would travel abroad for some type of medical care in 2014. That number seems a bit high to me, but it's Forbes and they seem to know a lot about numbers. The point of the Forbes article is that Americans are traveling to other countries for care. Costs for many treatments and many surgical procedures are higher in the US than many other places in the world. If quality of care is high, outcomes are good, and cost is low, why not go?

Seoul, South Korea, is one of the "hot spots" listed in almost any article about medical tourism. Apparently Chinese citizens are traveling there in throngs to undergo cosmetic surgery. The Ritz Carlton in Seoul even partnered with hospitals there, offering an "anti-aging beauty package" for a mere $88,000 (US dollars). Sounds like a bargain! Other popular places people are going for surgical procedures include Costa Rica, India, and Mexico. To see what all the fuss is about I thought I'd check into what it would cost for a woman to undergo breast augmentation in each of these four hot medical tourism destinations: Seoul (Korea), San Jose (Costa Rica), Mumbai (India), and Monterrey (Mexico). As a comparison, breast augmentation in Fort Worth typically costs somewhere between $4,000 and $5,000, depending on the specific breast implants used. This cost includes the breast implants, surgeon's fee, facility fee, anesthesia, and preoperative and postoperative visits. Different surgeons charge different amounts, but I believe the total cost of $4,000 to $5,000 is about right for Fort Worth. If you travel to Seoul, be prepared to pay about $6,000 for your augmentation. Monterrey Mexico? About $4,000. Mumbai: about $3,800. Costa Rica will also cost about $3,800. Interestingly when looking at websites that promote international medical tourism, I found that those websites typically list the "average" cost of breast augmentation in the US to be $9,000. Gulp. $9,000!! So of course it seems like $3,800 in Costa Rica is a huge bargain when you compare it to $9,000. There probably are places in this country that charge $9,000; I just don't know where. Maybe Manhattan? But really, when you compare the cost of breast augmentation in Fort Worth, Texas to those four "hot spot" medical tourism destinations, it almost makes me wonder why anyone from North Texas would travel to one of those places to undergo this type of cosmetic surgery.

Having been a plastic surgeon in Fort Worth for 20 years, I have had the privilege of performing cosmetic surgery for women not only from all areas of Texas but also from places like California, Canada, New York, and Florida. DFW airport makes the travel easy, but it's our outcomes that make it even possible. I do surgery in hospitals and ambulatory surgery centers that undergo strict accreditation processes. If you want to see a hospital administrator sweat, tell her that The Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO) is coming to do an inspection of the facility. The Joint Commission has created and continuously improves strict sets of standards and clinical practice guidelines that hospitals and other facilities must meet or exceed if they want to continue providing care for patients. Failing a Joint Commission Survey means a facility may have to close. Facilities are inspected every three years. It is through inspections like these that surgical facilities in the United States maintain some of the very highest standards in the world. The Joint Commission doesn't just look at the physical layout of a surgical facility. It also inspects things like the credentialing process the facility uses to make sure that the doctors who work there are qualified to do the things they are doing. For instance, if I want to do breast augmentation surgery at a facility, the facility needs to make sure that I have completed appropriate training and have met certain national and community standards. Board certification by the American Board of Plastic Surgery is one measure that facilities use to help them make sure a surgeon is qualified to perform cosmetic surgery. The facilities also request information about where a surgeon did his or her training, about malpractice suits, and about having a medical license to practice in that state (in my case, Texas). The American Board of Plastic Surgery has its own rigorous process regarding certification of plastic surgeons. This all sounds great, but if you are still reading you're probably getting a little bored by now. The point of all of this is that if you undergo breast augmentation in Fort Worth, Texas by a plastic surgeon who is certified by the American Board of Plastic Surgery, you have a pretty good idea about the qualifications of the facility and the qualifications of the surgeon who is doing your surgery (preferably me!). Can you really say that about undergoing breast augmentation in Costa Rica or Mexico or some other country? Maybe, maybe not. Certainly different countries have requirements regarding who can do what as far as surgical procedures are concerned. One of the biggest problems is that we, as consumers, don't really necessarily understand what those qualifications are. Are standards regarding sterilization processes of instruments the same in India as in Dallas? Maybe. What about standards regarding immunization status of the personnel who will be taking care of you? The same in all places, or different, and does that really matter? In the U.S., you know that there are amazingly high standards of care. There may be similar high standards in all of these hot spot medical tourism destinations as well, but it's just not as clear.

Now, suppose you take the next step and actually go to another country to undergo breast augmentation. Maybe you're thinking, hey, it costs a little less (excluding the travel, of course), you've researched what you can, and what the heck, there's a little vacation thrown into the mix. After all, travel to Costa Rica can be pretty exciting. Monkeys, exotic butterflies, rain forests...just an amazing place. But when you are being wheeled into the operating room, do you know what implants are going to be used? Different countries have different implants available. Just ask women in France how they liked their PIP implants. That company used industrial grade silicone rather than medical grade silicone for their implants, the implants had twice the rupture rate of other implants, and the head of the company was sentenced to four years of prison for fraud. While those implants are no longer even available, they were available and being used at one time. Knowing specifics about the breast implants that will be used is really important. Also, will there be a warranty with the implants being used? Probably, but you better make sure. And making sure might be kind of difficult. While your surgeon probably speaks and understands English well, most of the staff responsible for getting you safely through surgery and the recovery area probably don't.

Medical tourism is a growing industry. Travelling abroad is exciting, and people usually have good results. There are some uncertainties, though, that are worth considering as discussed above. Here in Fort Worth we see patients from all areas of Texas as well as from all over the country. The distances some of these people travel make this, too, a form of medical tourism. However, undergoing surgery in the U.S. does provide some certainties regarding standards. Language is not usually an issue. Cost definitely varies around the country. In my experience costs for cosmetic surgery are lower in Fort Worth than almost any other city of similar or larger size in the U.S., and similar (at least for breast augmentation) to costs in the international hot spots for medical tourism. So, skip the passport and the immunizations! Jump on American Airlines or Delta or United or Spirit or load up the car and come on down/over to Fort Worth. It's a great city with a vibrant art scene and cool downtown, nice places to stay, and all kinds of interesting places to eat. My office is in the downtown medical district and we would love to have the opportunity to help you fine tune your image!

Fat Grafting of the Breasts

Tuesday, January 27th, 2015

While it may sound crazy, fat grafting of the breasts is the real deal. Suctioning out unwanted fat from one area of the body and adding it to specific areas in a breast helps create a more refined, sculpted look. Initially used for breast cancer reconstruction, techniques continue to evolve and the technique is now being used more and more in cosmetic breast surgery as well.

Fat grafting of the breasts is not new. In 1895, a German physician named Vincenz Czerny described breast reconstruction of a 41 year-old singer. She was concerned about how she would appear on stage after having to have a breast removed. She had a large lipoma (fatty tumor) in her lower back, so this was taken and placed in the mastectomy defect. In 1919 another German doctor, Erich Lexer, published "Free Transplantations", a 2 volume text about grafting. In this text he described some clinical applications of fat graft breast augmentation and reconstruction. Melvyn Bircoll, a Los Angeles surgeon, published his experience with breast augmentation using liposuctioned fat in 1987. Emmanuel Delay in Lyons, France began using fat grafting for breast reconstruction in 2000. Gino Rigotti, in Verona, Italy, presented a large series at a 2007 European aesthetic plastic surgery meeting. Over the last 10 to 15 years fat grafting has been championed in the United States by Sydney Coleman in New York, Daniel Del Vecchio in Boston, Roger Khouri in Miami, and Kamran Khoobehi in New Orleans.

Methods for obtaining the fat, processing it, and placing the fat into the breasts are changing all the time, allowing for ever-improving shapes and contours with enhanced safety and predictability. One of the early concerns about fat grafting was that it may make mammograms more difficult to interpret. Clinically this has not been found to be the case. Del Vecchio and others have published their experiences, with a very low incidence of oil cysts and calcifications seen after fat grafting. Peter Rubin in Pittsburgh also reported a study showing that mammograms of women who have undergone breast reduction surgery are actually more difficult to interpret than mammograms of women who underwent fat grafting.

Many women come to the office with a desire to have more shapely breasts. An area that almost all want to have addressed is the flattened area at the top of the breasts, where the chest transitions to the breast. Breast implants help fill that area and may be all that's needed. Sometimes, however, adding a little fat to the upper breast may create an even more subtle transition and more filling in that area. Fat may also be added in other areas as well, depending on the specific findings and desires. A woman who is thinking about breast augmentation who also happens to have fullness in her thighs or abdomen may be an ideal candidate for fat grafting of her breasts. Using slightly modified liposuction techniques, the fat is removed from the areas where contour improvement is desired. The fat is collected and cleansed of oils and blood cells. The cleaned fat is then injected into the desired areas of the breasts.

The surgery may take two or three hours to accomplish. Recovery is similar to that of a typical liposuction operation. For a few days there is some soreness at the sites from which the fat was taken, and the breasts feel fairly tight. Swelling begins to subside after five or six days but the final shape of the breasts and the suctioned areas won't be seen for a few months.

Fat grafting of the breasts is an exciting, evolving technique. Women now ask about it frequently when they visit the office. If you have been thinking about changing the shape and appearance of your breasts, fat grafting is something you should at least know about. Call the office and come learn about this intriguing procedure!

Microneedling

Tuesday, July 8th, 2014

We are excited to introduce microneedling (also known as collagen induction therapy, or CIT) to the practice!  This evolving technique uses an electronic device to create controlled channels or microwounds into the skin.  These micro-passages stimulate the normal wound healing cascade by releasing growth factors, leading to the production of new collagen, elastin, and microscopic blood vessels (capillaries).  The micro-channels may also be used to aid delivery of cosmeceuticals, growth factors, and bioactive peptides into the dermis.  Microneedling has many uses, including improving scars (acne scars, surgical scars), reducing stretch marks, improving fine lines, and helping create more even skin pigmentation.  Unlike laser treatments and deep chemical peels, microneedling causes minimal injury to the skin.  This makes microneedling a versatile technique, being able to treat areas that lasers cannot like the neck, chest, and hands.  Collagen induction therapy is an area of growing interest in cosmetic plastic surgery. Come visit and learn more about microneedling!

Thursday, June 26th, 2014

I just came back from a fantastic meeting in Las Vegas.  This was a multidisciplinary meeting with plastic surgeons, dermatologists, ophthalmologists, and ENT facial surgeons from around the world.  I was looking for an opportunity to see how physicians in other specialties address issues that I see as well.  For instance, how do ophthalmologists who do cosmetic eyelid surgery treat patients with baggy eyelids?  How do ENT facial surgeons do facelifts?  I have been to many, many meetings in the past where plastic surgeons talk about how they do things; this was an opportunity to meet with many types of doctors.  I spent time talking with a doctor from Dublin, Ireland who gives talks around the world about research showing that Botox may actually be medically helpful in patients with depression.  Another interesting doctor I spent time with was an ophthalmologist from Beirut, Lebanon.  We talked about fat grafting around the eyes, as well as life in Lebanon in general.  The meeting exceeded my expectations.  So much information!  The only 'downside' is that now my office staff will have so many new things to integrate into the practice!

Wednesday, April 9th, 2014

Each year in April Fort Worth, Texas magazine publishes its list of Top Doctors.  The magazine sends a survey to 4,500 local physicians and asks them to submit the names of the physicians in each field that they think are the best in Tarrant County.  I am once again honored to be selected to the list for 2014 (my 14th time!).  Texas Monthly magazine similarly publishes a list of Texas Super Doctors in its November issue, and I have been named to that list 10 consecutive years as well.  More than just me, however, these awards are a reflection of my entire office staff and their dedication to outstanding outcomes and experiences for our patients.  There are certainly other excellent plastic surgeons in Fort Worth.  Call around, then call us.  Visit with them, then visit with us.  Come experience how and why this practice has been selected to so many Top Docs and Super Doctors lists!

Tummy tuck: get ready for summertime in Fort Worth!

Friday, March 28th, 2014

 

(Tummy tuck patient from 2013)

In North Texas, when your children are young it's almost impossible to avoid the pool in the summer.  And for many women, therein lies the conundrum.  They love their kids and the whole pool scene, yet they're uncomfortable with how they look in their bathing suits.  Looking around, seeing so many tan, fit bodies, wondering what happened to them.  Why all the stretch marks, the pooch that falls over the top of the bikini bottom, the loose skin just above the thigh crease?  Where has the belly button gone?  WHAT HAPPENED?

Here's a little secret:  all those fit bodies?  Well, a lot of them look so good because they've had a little help.  Tummy tucks, for instance, can make a huge difference.  I often refer to this operation as, "the return of the belly button".  Look in the photo gallery section of the website in the Abdominoplasty section.  Women frequently choose us because they have seen a lot of pictures and think we create some of the best belly buttons.  All of those nagging issues described above can be addressed with a tummy tuck ("abdominoplasty").  It is common for a woman who undergoes a tummy tuck to end up with a "Wow!" type of result.  It's a difference-maker.

Come see us.  Spring is a great time for an abdominoplasty!

Breast augmentation: Now's the time!

Tuesday, February 11th, 2014

This unusually cold North Texas winter will soon be a memory. Spring is just around the corner! Temperatures warm, heavy coats are put away, and warm weather clothing makes its way to the display racks. It's a perfect time for breast augmentation! Contrary to what a lot of people think, most women who come to see me for breast augmentation surgery don't want really big breasts; they just want to wear great tops. Most of these women have never felt comfortable in cute tops or bathing suits and they want to feel confident wearing sleeveless and strapless clothing.

One of the best things about breast augmentation is that there are so many shapes and sizes of breast implants available. We can help you choose an implant that enhances your figure without making you look disproportionate. In our office the Vectra 3-dimensional imaging system is used as part of the consultation to help you find the look you want. The Vectra system takes photographs of your torso with 6 cameras, and the computer blends these photographs into one three-dimensional image. We can choose any implants available in the US today, click a mouse, and like magic the software creates a simulated image of your breasts with those exact implants in place. Rather than seeing before-and-after pictures of other women who have undergone breast augmentation, this system lets you see what you may look like after an augmentation. The software even includes bikini tops and sleeveless tops that may be superimposed on the image to show you how you might look in those.

Spring is a fantastic time for breast augmentation. Be ready for the summer! Come visit with us and see what you might look like after an augmentation. The Vectra technology is way cool. Check it out!

Facelift surgery: away with those jowls!

Thursday, November 7th, 2013

I love doing facelifts. There's some real art and finesse involved. Every millimeter counts. Usually a person considering facelift surgery notices loose facial skin, jowls, and a loss of the youthful neck contour. During the procedure tissues under the skin are lifted and tightened, then excess skin is trimmed away. The incisions are placed in inconspicuous areas, with the result being a refreshed, rejuvenated appearance. As with most cosmetic procedures several different techniques have been created, each technique trying to address particular anatomical areas differently. If you watch much television you've probably even seen infomercials about one of these techniques. However, no matter which technique is used, the concepts are similar: the tissues under the skin are tightened first, then the excess overlying skin is removed. This allows the fatty tissues in the jowls to be re-positioned and trimmed, neck muscles tightened, and tissues in the cheek elevated. It sounds kind of scary, but really most people have minimal pain and are very happy with their results.

If you're thinking about this type of surgery, come visit. We use Vectra 3-dimensional imaging to help identify what areas are of most concern to you. The image on the right is an example: while we can easily see the jowls and loose skin, areas of sun damage, pigment changes, and subtle contour irregularities may also be more readily assessed. You'll love the staff in the office, and we can help visually restore that beautiful inner you!

Plastic Surgery Board Certified

Wednesday, September 11th, 2013

Board certification in plastic surgery is not easy. To become Board certified a surgeon initially has to pass a written examination. If he (she) passes the written examination he is then asked to take an oral exam. Each of these exams typically has a failure rate of about 20%. Put another way, for each 100 surgeons going through the process, only 64 are successful the first time around. This failure rate is the highest among all the surgical specialties' certification processes, indicating that certification in plastic surgery may be the most difficult of all Boards.

After becoming certified, the plastic surgeon then has to submit information to the American Board of Plastic Surgery every two or three years indicating what scientific meetings he (or she) has attended, what types of cases he has performed, and even examples of the advertising he does. This year (2013), for instance, I had to submit a list of every case I performed from January 1st through June 30th to the Board (names of patients were removed). The information included how long each case took to perform, what hospital or surgery center was used, what complications (if any) took place, and the number codes used for each diagnosis and each procedure. That's pretty detailed information that other Boards often do not require.

It's a lot of work to obtain all the information requested by our Board. I'm proud of our Board, however, because they really do have our patients' best interests in mind. The American Board of Plastic Surgery wants to make sure that its members are practicing safe surgery, obtaining excellent outcomes, and are doing this in an ethical way. I have been Board Certified since 1996 and have never failed a Board exam. Maintaining certification in plastic surgery indicates a high level of commitment to our specialty, and ultimately to our patients. Make sure you visit with a surgeon certified by the American Board of Plastic Surgery. Certification matters.

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