Doctor808 Plastic Surgeon Honolulu Hawaii

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 !

Well one secret to staying fit and youthful is not plastic surgery in itself. Though I should be saying plastic surgery is your answer to all of life’s problems, I can’t.

plenty of water during exercise

So many of my patients expect me to change with one operation years of neglect, but it’s not going to happen. As I have learned good exercise and diet can do more than I can. Plastic surgery can help, but a sound foundation of a good lifestyle cannot be beat.

My personal reccomendation is to mix up your program with cardio, resistance training and a stretching such as Yoga. It takes time and discipline but will take years off of you. I kick box muay Thai style 3-5 times a week and weight lift 3-4 times a week.

Diet I keep on the high protein low carb. This keeps my weight down. I actually had some liposuction around my mid line which allowed me get a six pack finally. I could lose the fat around my belly but when I did my face looked hollow. So liposuction did the trick.

Dr. Pasquale thinks this is Dumb

Transumbilcal Breast Augmentation Hype without Sanity

A blog like this is more casual and of course , these are opinions of one Plastic Surgeon. Although  in a different forum I may be demonized and my argument rebutted profusely, here I take the liberty to say what I want.  This is definitely not  a scientific forum,  thus I can mutter under my breath very effectively and without fear.  I recall when I hear about placing a breast implant through an incision at the belly button.  Like many at first I thought how clever and how technology has advanced.

Then after seeing this procedure and trying two myself  ( on patients not me)  I realized that this is the dumbest operation in cosmetic plastic surgery.  I mean the entire argument used to promote the procedure is a falacy. The central theme of those who claim this to be the greatest idea since adding creamer to Starbucks coffee is patently absurd.  They claim it is “scarless” . Well this is a bold lie. As anyone with a small amount of surgical knowledge knows it is impossible to cut any skin without leaving a scar. Yes its true it is far away from the breast, but there is still a scar and also a scar inside the tissues which were transversed with the pipe used to insert the implant.  Those who promote the procedure also fail or withhold the information that a properly executed breast augmentation procedure through the axillary or para-areola (around the nipple) scar should be practically invisible as well. 

The other fact that I realized is that when we as plastic surgeons try to create a beautiful breast for our patients its much like an artist or sculpture.  One does not create art working as far away from the art work as possible. I mean how stupid would you think someone was who tried to sculpt a statue 20 feet away from the stone. Same principle applies here. Why would someone want to create a breast from 1 foot away when they could do so right at the previous breast area?  Well i think anyone who stops and thinks for minute could easily conclude the obvious.

All this rambling does not mean that it is impossible nor have many patients had nice outcome from a the belly button approach. Yet just because something is possible does not mean we should do it. I mean it is easier to walk up one flight of steps to the second floor than it is to scale a the wall with a pick and ropes.  You could do that but why would you want to?

Finally another point I find silly about this belly button approach is the concept of placing a silicone shell implant through a metal tube. Then  pushing it thorugh with another metal tube to the position a foot away. Plastic Surgeons  are taught to minimize the amount of touching of the implant when they place it in the tissue which is known as a “no touch technique”. This is thought to prevent micro scratches or contamination of the implant. Well how many scratches on the implant do you think are made when we shove it through a metal tube for distnace of  over one foot. This could lead to early deflation as thsoe micro scratches leave potential weak points in the shell of the implant. Hmmm does this make since to you?

If you want to see a more formal opinion please see my newsletter here : http://www.nerve.org/doctor808/beautygram002.html   there are some great photos of the result of this  approach as well.

So these are my ramblings on this procedure as one of the dumbest things I have seen.

what me worry?

Well I have been in cosmetic surgery now for over 20 years, but only in the last 8 years have I limited myself to cosmetic surgery. This is considered by some to be a waste of talent and training. Yet I do agree that it is somewhat of waste of my years of  formal training in microsurgery and hand recostruction. Yet I definetly disagree that somehow cosmetic surgery requires less skill or training. In fact my knowledge gained by microsurgery is one reason i get referrals from other plastic surgeons for facial cases where the facial nerve has ben damaged. So this has helped my face lifts, borw lifts and other facial cosmetic surgery practcie. So nothing could be further from the truth.  The problem is  there have been few surgeons formally trained in microsurgical reconstruction in the  Hawaiian Islands. In fact Queens Medical Center did have  a shortage where they could not find a hand surgeon to come in and replant a finger. That is better now.

Well the truth of the matter is that if a surgeon was paid appropriately for this type of work they would have no shortage of hand or micro-surgeons.  I recall spending 12 hours in the operating room with one such case and when I received my check from the insurance company it was $500.  My god any plastic surgeon can spend less than an hour injecting BOTOX  TM and earn that. Well that is society where values are dictated by bling. I cant fight it so I just do the best I can….drmap