Doctor808 Plastic Surgeon Honolulu Hawaii

Life transitions amaze me. I graduated private catholic school, had my first date , army, college ,medical school and married lived through conflicts between countries and so on. Next was practice and for me next will be retirement. Life is quick , you blink and its over.

Front: Dr.Lee, Dr. Flowers-Back: Dr. Peterson, Dr. Pasquale

Tonight was one of those nights that make me think about   “the speed we go through life” and done. No more –game over!

One of my teachers who is also my friend is on his way to the next step which is retirement.  But first let me tell you who I am talking about my Dear Reader. In the picture above you will see three younger ( over 45 all of us ) and one older gentleman. The elder in the crowd the only one  world famous is Dr. Robert Flowers.  The Asian man is Beverly Hills Plastic Surgeon Charles Lee , behind him is Honolulu Plastic Surgeon Dr. Robert Peterson and then there is ME.

Now as I was saying life is stages and life is quick. Dr. Flowers is leaving Hawaii and entering his retirement phase. After becoming a true  icon in the world of Plastic Surgery he has decided to leave. Its a field he has loved,will always love and  one that he has made dynamically change and will forever live in plastic surgery history.  I can speak for the other two younger ones and we agree he has influenced our lives. We learned from him, we listened to him, talked about him and admired him. Sometimes even mad at him , or laughed with  him…….but always felt awe and respected him.

The reason us three Charlie, Bob and myself were out with him tonight is because of a special relationship from the last ten years. Charlie ( the asian ) Bob ( the one behind charlie)  and me have all “hung out” if that is what you call it. Like college roommates in the world of plastic surgery we chat all the time, compare notes, teach each other tricks and gossip behind each others back in good humor.  We were all in Dr. Flowers office as a group at one time. We know each other well. Dr. Flowers  was always the father figure to some degree to us. We were the prodigal sons at times, other times the we were the younger ones helping out the family or something like that.  In a nut shell we know each others secrets, strengths and weaknesses. Yet even when competitors in the same community I suppose it was never like that, never felt that and I appreciate that.

Dr. Charles Lee left the Hawaii family on to La and then to Beverly Hills , Dr. Bob Peterson  and I stayed as we have always been more established here as Dr Lee is the younger brother.  This is my take on things. What does it meant? It just seems interesting that many years ago we were planning a group practice which broke up for various reasons and now much later we are all sitting at dinner , as a family.  When a group practice breaks up to most doctors its like a bad divorce. When this group departed it was more like kids leaving home to make it on their own. The home being the group. That does not happen often in the medical setting. Yet it did this time and I think I know the reason. It has something to do with Dr. Flowers. His presence seems to prevent any bad feelings only good memories.

I recall one day I was in a local hardware store looking for some tool to fix my car. Up pops Dr. Flowers and with a grin on his face says to me….”Michael looking for some new instruments for surgery?”  Well funny I thought, many surgeons of his era proabally did just that. Found useful items to use in surgery in a hardware store back before it became a modern industry. When he started there was not much in the way of plastic surgery instruments and many like him fashioned their own. Today my generation has everything for them spoiled we are. Yet at the same time he was lucky, he did not have everything prepackaged so creative ability  was exercised more easily. Such  a great time in history to be a plastic surgeon.

Finally I am sad to have him leave Hawaii. He was great for advice for myself and Dr. Peterson as he was only up a 6 floors from my office and few blocks from Dr. Peterson’s Office.  We lose a senior surgeon locally but he has a phone where he is going I suppose.

Doctor808

American Eagle

Today we completed http://www.militaryplasticsurgery.com which is our newest web site creation for Plastic Surgery and Military Members ( yes including military discounts) . Appropriate I would say for the 4th of July!

Military Plastic Surgery Website

Many Americans hardly know anymore why we celebrate the 4th of July. This day in 1776 is thought (although there is some debate) that the Declaration of Independence was made and signed. The story is very interesting, in that the founding fathers of the USA were taking an extreme risk to  discuss such a thought as to gain independence from the British Empire. They easily could have been hung or drawn and quartered for such treasonous act.  We today in the USA forget how much freedom we have now ,to say what we want and to discuss freely ideas. This simply was not possible in 1776.  A person who spoke against the King of England at that time could have paid for his or her words with his or her life. It is unfortunate today we have taken our freedom for granted and there is high risk of  losing that freedom . President Reagen said we are only at any time one generation from losing our freedom.

Our military , the young men and woman who serve to protect that freedom seem to be a group who know well what freedom lost can mean. They have seen it with their own eyes and heard it with their own ears in Afghanistan,. Iraq and elsewhere,  the misery brought on by dictatorship and years of lack of freedom. We need to really look around and see the world as it is, learn history and current events and see what leads to loss of freedom to prevent that from happening here. It can happen and is happening as you read this. The Romans did not notice either,  until it was too late and they lost their republic. It seems a republic ( USA is not a democracy , never was but  a republic) like ours can only last maybe two hundred years…??

I just hope our young people will take the time to really learn something about our history, not just about what is cool or the trend of the day. I do both so can you. You can do cool things and learn history , keep current at the same time.

Plastic Surgeons 4th of July

On the fourth of July, this plastic surgeon does what many Americans will do, that is barbecue outdoors. In fact,  I just finished two of the most juicy hamburgers I have ever known. I cooked them myself on my lanai on a charcoal grill. I dont care for the gas grills which are popular, it just does not taste the same. Also we had pork-n-beans and potato chips with a side of pickles,,,hmmm good.

I don’t eat that way often,  other wise I would need liposuction myself,  but on occasional holiday its fine. Its a sorta of traditional issue on the 4th of July for this plastic surgeon in  Hawaii. I wonder if the military in Afghanistan and Iraq are having hamburgers and hot dogs too?

I think many are and we hope they are safe!

So for any of my readers who follow this blog either for Muay Thai Kickboxing , for Web design or Plastic Surgery in Hawaii—yes its cool,  but lets take a minute and really appreciate what today is. Take a few minutes and look up some facts about Thomas Jefferson, John Adams, Ben Franklin and others who signed that declaration on this day in 1776. It a day that changed  the world.

doctor808

Military Plastic Surgery and Plastic Surgery In Hawaii

Many of you may not known I was in the military for many years. I spent most of time  in the reserves. In fact, I spent a lot of that time with the 20th special forces group which at the time was a reserve unit (NG) and we were based out of Maryland. During my time I met some of the greatest people anyone could meet, dedicated, smart. most spoke at least two languages.

As a plastic surgeon in Hawaii I meet many military members and their families from the marines , the army and navy as well as special operations. I always share with them war stories and understand their military life. It was some of the best experiences I have had. As a Hawaii plastic surgeon we also have patients from Guam, Japan and Korea who are in the American Military. Interesting to note we have many patients who fly back in have their plastic surgery in Hawaii and fly back to their Pacific bases.

I think one of the most interesting time,  was when we received 6 emails from Afghanistan from 6 female soldiers who some how had heard about us. They all flew back at the same time when their tour of duty ended and we performed 6 breast augmentations,  Wow —talk about beautifying the country. In a more serious light my hat goes off to these dedicated individuals who sacrifice for our freedom in some of the most harshest conditions on earth. I think 4th of July coming up is an excellent time to salute them. They are in hearts and minds as they serve heroically.

Our web development company has even devoted a web site specifically to these service members about plastic surgery and we offer a discount. This can be found at www.militaryplasticsurgery.com . This web site about military and plastic surgery will offer discounts and address some of  the issues we have seen. So Please take a look.

doctor808

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

I will board a plane for two days in Japan and then on to Thailand,  tomorrow. First , is the night of panic before I go, this is routine before I leave, according to my spouse. Did I make sure I have a doctor to cover my patients? Yes. Did I make sure I have no other obligations to take care of like some last minute paperwork? Yes. Do I have all my patient care duties taken care of and no one needs me?  Yes. What about staff –does everyone know what they are suppose to do while I am gone? hmmmm  maybe.

Muay Thai Fight Thailand

I have tickets , passport and laptop. I have clothes clean underwear and what I need for living. Ok i think I am ready .

Well what I need to do when I travel is three things

1. Learn new techniques or discuss old ones with plastic surgery colleagues in other parts of the world.

2. Spend time working online with my web development company, serveral meetings planned in Thailand to hire some new employees. 

3. Check out some new gyms for Muay Thai training and attend my regular gym in Thailand.

A cosmetic surgeon in Korea who does botox in chin "a chemical chin implant?"

Many of my staff say well the doctor is on “vacation”. This is certainly not true , as all my travel is working time away from the office. I own a web development company so I spend much of my time meeting with people about this. I spend  time planning , catching up on company emails, with clients and our company employees around the world.  The techniques I learn about I bring back to my practice such as the one I learned from the above Korean cosmetic surgeon which is to place a small amount of botox in the mentalis muscles which relaxes it can gives the appearance of a larger chin. Thus a “chemical chin implant” . So these journeys are always helpful to my patients here in Hawaii.

Crowded Streets from High Rise View

This journey will be a little different in that I will write about my travel in detail on this blog and perhaps it can be if some use to other travelers. The secret to good travel in my mind is to continue learning and what i do most days here in Hawaii only in a different location. You become refreshed and your mind is stimulated. I suppose others take the complete vacation , get away approach to travel but somehow I have never been able to do that, I start to feel guilty i suppose. My way to travel works for me. 

Well now I have last minute things to get done as I leave in less than 15 hours. I will let you know as I go along.

doctor 808

Well the recent troubles with Ushers wife going to Brazil and having a cardiac arrest make this a very topical topic. Many people travel to places other than their home towns to have  procedures. Here in Hawaii I have spoken to many patients who come to my office after travel for cosmetic procdures. Some go to Korea, Thailand and other parts of Asia. Recently a woman told me she was going to Mexico to have the procedure we discussed at half the cost. 

Basically there are good plastic surgeons all over the world which is not the problem. You can find good surgeons in Mexico or in any of the other countries I mention no doubt. The problem is when there is some difficulty. Not only are you miles away from family or any support, but the money you would have saved now is lost  and most likely has become so much more than the original cost quoted locally.

What comes to mind was doctor and her husband who went to Brazil to have the LASIk procedure done to correct some vision problem. She and her husband both had the procedure at a substantially reduced cost,  than they would have in the States. Yet she had a problem after surgery which she had to travel to London eventually to correct. As london indeed had the only expert in her problem. Although she saved money with the initial surgery it cost her over 8 times more and she is still receiving treatment.

This story has been repeated many times in my practice a girl who traveled to Thailand who had some rubber unknown sack used as a breast implant which I took out for example. She wasted her money. Even when people have quality plastic surgery done away from home if they have a problem they have to fly back to the place which cost additional money.  It can work but dont think you will save in long run , the numbers do not work out.

I have patients fly in to see me as well. Yet we require them to stay till everything is ok. Even then we tell them that if they are from Japan for example  we may have a doctor they can see there,  but it may require a plane trip back to Hawaii. Its not that I condemn the practice,  but I want to make sure they are appraised of the risk and know that in long run saving money will not be one of the benefits.

Well these are some of my thoughts Summary: You can fly far away to have plastic surgery and it may be good idea if you find the right surgeon. Yet do not think you will save money and you best be able to be prepared if something goes wrong to pay extra. The only reason I can see to take this risk is that you are traveling for special expertise. You pay for that, so going for cheap is not a good reason.

Doctor808

I have been trying to find use for twitter which is the MicroBlog or semi instant messages service which people sign up for and send each other quick and short phrases. The web community sends a lot of messages about Internet stuff. Typically seo types send messages about their business and offer help on optimization of web sites. You click on the message called a tweet and it may take you to the persons twitter profile. From there you may click to a real web site or other information. It is somewhat but limited customizable. Others tweet back and forth personal messages about their lives” I just finished my second load of laundry” and other tid bits of info. Now who exactly is interested in that I am not sure but when I look at twiiter I see that type of thing all the time.

Well my purpose is to promote both our web site business and plastic surgery. So I am thinking about how to apply this media. I send some facts about plastic surgery sort of a factoid which may interest people like “breast augmentation by silicone is increasing dramatically” if they read this and are interested they can drill down to my web site eventually etc.  Other ideas are news blurbs about plastic surgery or maybe something interesting I have come across. I placed on the side of this blog a twitter widget which list some of my recent twits and you can follow my twits by clicking there as well.

Where this will all go I am not sure but it is interesting to try and figure how to use this in promotions or just fun. Recently I was following the twits from Bangkok when they had the political unrest which provided a new perspective as things happened. So I guess I had a ring side view from people on the streets of Bangkok.

More information can be found at www.twitter.com .

Well 3d-plasticsurgery.com ( one of my web companies)  just finished a project for a plastic surgeon in Portland. This doctor is a very good plastic surgeon whom I have had personal expirence with. His technique is meticulous and he is a trained microsurgeon such as myself. In fact that is how I know him from our microsurgery training in one of the most difficult fellowships of our generation. This was with Dr. Julia Tezis at the microsurgical institute in Virginia. 

The problem is that he does not believe in showing pre and post op photos of his work on the internet. Bad choice I believe but never the less its his decision and one he has to make. Patients these days from my experience are even taught to ask to see the photos. We have them all over our sites. Its great marketing and the consumer of plastic surgery services wants this. 

Well we compromised and simply added a link to his web site which shows generic before and after photos from the main plastic surgery societies web site. This was my stroke of genius in that we also clearly added a disclaimer stating his position. We solved two problems at once, respected our clients wishes and gave the consumer what they wanted. Such a fine line we walk in advertising and trying to do our best for our client.

If any of you want to see the web site  www.fortesplasticsurgery.com .  Comments to me are always welcome.

drmap

As a plastic surgeon performing surgery for over twenty years I thought I had heard everything. Well a few years ago I was suprised. A 64 year old Japanese lady came in my office sit down at the consultation and I asked her how I could help. Without a blink or stutter she asked quickly ” doctor can you cut my nipples off?”. Well my first thought, great my receptionist let a mentally I’ll person through the gate. Every plastic surgeon has people come to their office who are better served by psychiatrist, but we all try to screen ahead of time. My receptionist is pretty astute so maybe she slipped up I thought.

Well after examination I noted the woman indeed had nipple length of 2 centimeters. So after all she was right. We preformed the reduction later and she was happy.

The punchline is I asked her why she waited till age 63? Her answer was she just left her husband of 40 year marriage and wanted to find a new boyfriend !