Doctor808 Plastic Surgeon Honolulu Hawaii

Michael Jackson dies and the television and media go crazy. so what the heck …I might as well get my two cents in.

I personally feel very sorry for Mr. Jackson, as he in my eyes,  has been a tragedy. Its obvious to me he had body dysmorphic          disorder. Thats a condition where there are psychological reasons for wanting to change the physical self, thus all the physical  changes made , never are satisfactory the patient. Plastic Surgeons I believe can be enablers and codependent as well.

I don’t know  who did Michael Jackson’s Plastic Surgery or if many different surgeons participated, but basically I think they should be ashamed  of themselves. Thats my personal opinion and not some medical or expert opinion to be used by others. I have no data nor do I have any facts,  its simple conjecture and speculation.

As plastic surgeons,  we all have patients who demand more and more procedures to either make corrections on what we have done or to continue to try and improve another surgeons work. We have to recognize these patients as a problem, in that we see either something like a nose which looks good and they still are unhappy and want more surgery. Sometimes the patients become so convinced that there good nose job,  is not good they can start to convince the surgeon and he then becomes “codependent”. After all plastic surgeons always want to think they can make everyone happy and especially when a competitors patient comes in the door,  the tendency is to think you can always do better than the guy next door.  This ego effect can cause real problems.

Nine out of ten times if you operate you will not improve the other surgeons work and if not careful you can end up with a Michael Jackson situation. This is not the same as correcting obvious or major problems with previous surgery like a breast implant deflation or if you have a really bad outcome , then by all means it needs corrective surgery. The cases I am discussing are the cases where the work looks good and you try to make it better . I always remember the saying..”the enemy of good is better!” . That refers to someone coming in for a correction and it turns out worse. So I always make sure that its something that is realistic in my mind and the patients before proceeding.

One case comes to mind where I battled with a patient for serveral years in which she came to me because one breast implant was less than 1 cm lower on one side. No one would notice but the patient was seeing herself in the mirror and becoming rather obssessed with this very minor issue. Well I evaluated  her told her the other surgeon did what I would consider a good job. She still insisted and finally came back in almost begging me to fix what she thought was a disaster and I told her..NO. Its hard to do that as you know the patient will not be happy. I was strong and told her she was welcome to find someone else if she were not happy with my opinion. Well she did.

To make a long story short she was back in my office three months later complaining about the outcome of the surgeon she found to attempt to make such a correction. Unfortunately she went on to get an infection and overall the breast now did look bad. The well intentioned surgeon I am sure had thought he could help this patient and fell into that trap. Well at this point I told her she should return to him and see what he could do. Sad case but something we as plastic surgeons must be careful about.  I wanted to help her but felt the last surgeon should be given the chance to correct his own work. I have not heard back from her. If only Michael Jackson;s surgeons would have stopped earlier I suppose, but again I am only speculating.

Forest Gump

Well as Forest Gump would say  ”Thats all I have to say about that”.
Yet on this topic and with some interesting photos there is web site devoted to bad outcomes in plastic surgery. Mostly it looks to me like patients who had one plastic surgery too many.

This  is www.awfulplasticsurgery.com and they have discussed   the Michael Jackson issue and plastic surgery many times.

doctor808

Plastic Surgeon Dr. Pasquale

The latest buzz on the internet is Smart Lipo, or LASER Assisted Lipo which is a new fangled device where a small cannula is inserted through the skin and utilizes LASER technology to perform liposuction. Now as many of my patients know,  I am not one for “new fangled devices” having been in plastic surgery for twenty years. I have seen everything come and go ( mostly go). Check my web site  www.nerve.org.

As example,  after the silicone breast implant hysteria about  15 years ago they developed “soy oil based breast implants ” which were actually used in England for a while. These new fangled devices were the latest, the greatest newest technology to use on patients as advanced plastic surgery technique. After all the soy (yes from soy beans) was ORGANIC so it must be good right? Well shortly after serveral patients reported the leaking of smelly rancid oil from their breast. How could this be? The latest greatest technology was used and it was NEW so must be better. Well the fact is , this was a poorly conceived idea, brought to you by marketing and latest greatest new fangled plastic surgery technique promoters. My point is simply the newest idea is not always the best idea. I approach all new plastic surgery technology with a very critical eye. Maybe I am jaded after many years of listening to every salesman in the world come in my door and tell me “Doc this will change your practice and you will be ahead of your peers!!!”. Yet for me expierence with a procedure or technology says it all and that is why I don’t jump on very new bandwagon. Salesman and marketing hype says nothing, but does show you someone wants to sell you a new product or technology for good or bad.

So I have some initial impressions I want to share after researching this new fangled procedure of Smart Lipo or any of the “me too” LASER Liposuction techniques. First what is this. Well according to one web site :

“SmartLipo is by far the best kind of liposuction available today. It is a method that offers the best results with less trauma and less downtime. It has a fast recovery time and the cost is very competitive.

SmartLipo uses laser technology to melt and liquefy the fat within the fat cells. In addition, it smoothes and tightens the skin to decrease the looseness that one sometimes sees with traditional liposuction. It can be utilized alone to treat smaller areas of fat, such as below the chin, or in combination with liposuction to remove larger areas of fat such as in the abdomen, flanks and thighs.”

In my analysis of this and knowing what liposuction really is in detail,  I have a few thoughts on this. First any web site that claims that something is the “BEST” as they do, is not medical advice but salesmanship. Plastic surgery be it liposuction or face lifting there is no such thing as “the best”. If there was truly the one and only “best” everyone would use that as plastic surgeons want the best. Its the same as those web sites that claim that transumbilical breast augmentation is the “best” procedure or this plastic surgeon is the “best” etc. To me this automatically tells me something is not right and I should look carefully and recoginze this all as marketing hype. Yes we all want to put our best face forward but come on “the best”.

Next I see a very key statement used: “It can be utilized alone to treat smaller areas of fat, such as below the chin, or in combination with liposuction to remove larger areas of fat such as in the abdomen, flanks and thighs” . Translation is simple, we can use Smart Lipo for very small area but we have to go back to traditional lipo for any area larger than under the chin or combine it.  That says it all. The great benifits they state such as quicker recovery time are nullified when you then have to combine it with traditional liposuction as the surgeon has to o over the same area with a regular liposuction technique. I actually spoke to a Smart lipo practioner recently and asked him as a peer what is the advantage of this then. I mean you take the smart lipo cannula and insert it and then imediately after that insert the traditional device so why in the world would you do that. Well he said “marketing and patients like that”. He then told me that the big advantage was that it does do some skin tightening under the chin in this small area it  can be used without combing it with traditional liposuctio technique.

Well to my way of thinking that seems reasonable under the chin,  but most patients need liposuction that I see in my Hawaii plastic surgery practice other areas such as the abdomen, flanks and thighs. So few patients need that I  cannot see buying an expensive machine to serve one small purpose maybe better. I suppose its a good idea for marketing —so you can say “Hey folks I have the latest greatest new fangled device” but I dont need that in my practice. People know me and know who I am which I try to have a consistent good quality reliable and ethical practice. I suppose if I was new surgeon and needed some gimmick to help my practice , maybe it would be worth it,  but I am not so for me ….its a no go at this point.

The problem with these newer technologies is that they have not been around for years and we really dont know yet all the effects. We do know with all the energy generating  liposuction devices they can burn the skin. Now Smart Lipo may be different, but the ultrasonic techniques ( we have treated complications of  this in the past ) were a energy generating in the form of  heat that could damage the skin and did in some cases. In the case of smart lipo the energy generated producing heat from the LASER is how the skin is tightened.

Patients write about this procedure , the Doctors who promote this procedure create the buzz around the internet. The smart lipo procedure is then a great marketing tool I suppose. Yet call me old fashion. I would have a plastic surgery procedure for result, proven safety and to do what I want it to,  not to have the  have the best marketing  as a consumer. Thats me.  As a doctor on the other hand maybe its good for their practice to be part of this buzz and brig in many patients.

Well these are some of my thoughts on this new fangled procedure. Its not that I am against anything new, its simply that I rather use traditional and proven technology which I have used for years and take a wait and see approach o the new stuff. As with the soy based breast implants, this  prooved to me the latest greatest and newest is not always the best. When something sounds too good to be true it probally is. So bottom line is do your research  and dont be a dumb consumer. Plastic surgery like any business is business which you need to be a smart comsumer with or without smart lipo.

Doctor808

Dr. Michael Pasquale

I have not written for a while about the progress our web development company is making. We have now a few clients,  as we expect a slow start and this is intentional. Our concept is to give a ethical quality product at a reasonable price to those in the beauty industry ( although we will take on other projects , this is our primary focus).

Many in the beauty industry such as Cosmetic Surgeons, Plastic Surgeons and Spa and Skin Care professionals are actually very naive about the internet. Consequently we see a lot of our friends being taken advanatge of by unethical internet hawkers. As example , one of our clients was paying her “internet guy” about 300 dollars per month for web site maintenance and putting a few pictures up. 

She was a real estate agent and she asked me to look at her web site and see if  i could make any improvements. I set down with the client and she tried to pull up the site. Suddenly she says “Oh thats right my internet guy told me hackers had gotten into it and messed it up”. I then asked the client when this occured and she told me about two months ago. I inquired further and asked her why was it not back up after 2 months. She explained that her internet guy had told her it was French Hackers who really destroyed a lot. 

Well that is one of the best song and dance routines I have head from an “Internet guy ” yet. Those french must be pretty good hackers to keep a web site off line for two months. Two months of maintenance fees to her Internet guy with out any web site visible??? Needless to say that seems very odd indeed. 

The point I am making is that to someone without much Internet knowledge, such tactics to get paid for not actually doing some work can and do work. Yet I think as professionals , these unethical types stain all of us and make us look bad. I told her to give me his number and I would happy to help him for free  get rid of these “french hackers”.  

There are so many victims of if not down right fraud , lazy excuses and needless delays. Who knows how much money she lost in those two months? In her business one sale could be 100,000 us dollars as she dealt with high end properties. I know I have in my early years lost quite a bid of money by simply listening to my “web guy”.  

I am not sure what advice to give to new people who are starting to realize how much a good web presence can add to a business to avoid scammers. Yet i think the best is….if it does not seem right it probably is not. What to do? Well just like in medicine get a second opinion!! This could save you thousands of dollars. If the second opinion is different than the first , well then get a third opinion. I know I get questions all the time and have no problem with a “free consultation” if you will. 

Our company is taking things slow, declining a few clients for reasons that we know we cannot offer them anything of value at this point. We are taking on clients who we feel confident we can benefit. That is our approach , slow steady growth. We try to under promise and over deliver. I hope that will make for a successful formula. 

Doctor808

 As I mentioned last post,  I would give you some details on Thailand. specifically Bangkok,  instead of about my reasons for going. To review–I go to train in Muay Thai and to reassess my life and changes-much like a retreat. Yet many of you may not be interested in that. So you want to know more about Bangkok? Well allow me to be your eyes.

First Bangkok,  Thailand is huge population, Estimated people in the city during business hours is 15 million ( yes the official census is  8 million, not counting ilegals). Its a city of where you can find anything….legal, illegal, moral , amoral what ever your fancy. You want high class —well its there, you want low class scum its there too. Yet most Thai people are like anywhere else. They go to work , come home and see their families and then go to work again.

A lot has been written about the sex trade,  but that is probally less of a percentage than any other American or European City probably , its  just more open and visible. One of my plastic surgery colleques wife has claimed she will never allow her husband to go Thailand becasue of the sex trade. Well I have news for her, go down to Wakiki in Honolulu and anything you have in Thailand is right here. Even though that is what many times is written about, believe me its not what Bangkok is about. 

In the many years I have been going there,  I have met some of the most interesting people on earth. These range from local Thais,  such as our friend who is the daughter of ex-Thai diplomat who speaks 3 languages fluently, educated in the best American and European Universities to my Muay Thai instructor who has no education except Muay Thai and his one travel experience is to fight in Switzerland. Japanese business people to American retiree’s are all there. They come for the change and to do business in the Kingdom. A Kingdom it is ..do not speak in negative manner about the King or his family or you may end up in jail.

Yet I think the best way to understand this place is to see photos. A picture is worth a thousand words they say, so I will show you some with some comments.

Beggars are seen as with most of South East Asia on the street.

The poverty around is seen , yet when you think about it its not a “bad poverty”.Many of these beggars are actually brought in by Asian mafia to work and earn money from other countries. Sad to see, but at least they are not starving as you will see in some African countries. Most Thais have an excellent diet. Fruits and street food such as grilled chicken are abundant and very very cheap. No one starves in Thailand. The weather is tropical so no one freezes and did you know the government clinics provide health care at least  the basics. Yet at the same time there is no welfare as we know it in the west so everyone works or there is no help except from churches or the like. This I think is good, they do not have generations of welfare recipients who are dependant on the State as virtual slaves.

Overall to be a “poor person” in Thailand is not that bad from what I can see. Maybe you will not own a car, but people are happy for the most part , eat well and respect each other. Certainly most of us  would rather have that,  then be a member of some street gang in L.A. California. Life is simple and its a world of difference here to be poor than to be some inner American City poor. At least that is the way I see it.

The life in Thailand is easy going, land of smiles most happy. Seems it has never changed much in many many years. 

Little Fish drying in sun

There is food all over Thailand sold on the street and cheap. I calculated to survive you can live on about 1 us dollar a day. Not at Starbucks or the fancy places but you can live. That’s for food. Rent I do not know what the cheapest way to go is for living.

Communication is easy,  they are used to tourist and English is spoken by enough. Yet to accomplish something complex maybe need a good translator. Most activities do not require complex language. All the street vendors and sales people know how to tell you english numbers like “thirty two baht” instead of ”sahm-sip sorng baht” which is 32 in Thai. So that money is not a problem when you want to buy something. 

You can buy anything in Bangkok. They have the best department stores with all the brands if your into that or the weirdest stores and street shops in the world with everything from fried insects to your favorite flavor in ice creme. Its all there and if you look you can truly find anything you could possibly want.

One area which is easy for new tourist is called Kao San Road and this is shown in the picture below. This is one of the main “back packer” areas with all types of tourist. There are lot of hostels there and the crowd is mostly Caucasian hip types and a few from Korea and Japan. The Thais there are mainly to sell what they can to these tourist. I don’t care for that area much because its a tourist spot and I like the natural environment of the Thais.

Want to buy sunglasses??

Yet there is a lot for tourist to do. Temples are all over the place and historic places to see.  The textile industry with Thai silk is excellent as is the gold and precious stone shops all over.  You can check any travel book on Thailand and find the current districts to shop in for what you want. 

As for me,  I do not buy much so I can not offer such advice and if I were to buy gold or jewels I would probably be ripped off. I don’t know that industry so I stay away but for people who do know it can be a bonanza.

Its a circus like atmosphere in some places day and night

The places you go will depend on what you want to do. The tourist areas are like a three ring circus. So many people selling the strangest stuff and westerners drinking beer.  This will be 24 hours a day in some places as with so many people arriving at all times of day and night it never stops.

The night life as in night clubs and discos etc are endless as well. There are the “entertainment districts where you can buy ladies ( if they are ladies) such as nana plaza a real western man hang out for those seeking cheap female company.  There are traditional disco and DJ music places for Thais and westerners to enjoy music and drink. Personally when I travel I prefer the places that the local people go. There are two night clubs I have found suitable to my taste. One is the Q-bar and the other is Hollywoods. The Q bar is owned by a guy from New Jersey who opened his first club in Viet Nam until he was run out of there and now he is Bangkok. We have had drinks together a few times and his place does sport some of the best Dj’s in South East Asia. The HollyWoods is almost 100 percent Thai.  I go sometime and have been welcomed by the Thais. Its fun to watch the Thai Stage show with their version of go go dancers  ( not nude) and music and light show is very good . The most unnerving thing is to to the rest room. There a guy will come up to you as you stand in front of the Urinal doing your thing and he will give your back a massage. Its weird but apparently accepted by the Thais. You must tip him of course. For you that are less adventurous stick to the Q bar. Yet for me what is the point in traveling if your going to a place you could go to a similar place like in your home town.

HollyWoods Night Spot

There are so many bars and night spots in Bangkok ranging from the  most eloquent sophisticated to the most simple girly beer bars.  The variety in my opinion surpasses New York and Tokyo where I have spent a lot of time.  So like shopping in Bangkok, the night life is ….what ever you want to find its there–its there!

My advice to you don,t be afraid to check out some place which is not for tourist. You should be polite and when in Rome live like the romans not like the American ,Japanese or European that you may be.  Thais are very nice people but of course always use common sense as far as safety goes, I have found Bangkok safer than most American cities by far.

How to get to various places is the huge challenge for most visitors. Try to get some help to explain to Taxi drivers where your going. The sky train is excellent and easy to use, but is very limited on where you can go in Bangkok. The water taxi is little more difficult to use but its what so many Thais use and I found it cuts hours off my travel time.  The Thai people get a kick out of watching an American travel by Water Taxi.

Well there is so much to do in Bangkok and so much written on the internet I do not want to bore you with these things yet I hope I gave you a little insight into Bangkok. As stated the pictures tell more than my words So here are a few more….

draw your own conclusions