The Unhappy Cosmetic Surgery Patient — Plastic Surgery Hawaii

Posted on July 11, 2013 by Michael Pasquale

Cloning is the new hope

There is not a month that goes by that I do not see a cosmetic plastic surgery patient in my Hawaii clinic raging about how they want to sue some physician in Hawaii, not limited to plastic surgeons,  but sometimes others as well. They claim the doctor is the Devil in the flesh and sometimes worse. My readers know I don’t mince words and one thing is,  I will tell my straight up opinion like it or not. I will say that I have not met a plastic surgeon who has been busy or in practice a while,  who does not have some unhappy patients–look at the ratings. Anyone with more than two ratings has some complaints. If not- then that is strange indeed because if they only have happy glorious ratings it could mean something else but at least here I have seen every ones unhappy patients as well as my own.

Yet I just want to share some thoughts on this aspect we have to deal with. Its rather interesting as 99.99999999% of the time its more emotional rather than really malpractice. In Hawaii due to competition pressures among plastic surgeons there is a very high level of care rendered here. That is to say, Hawaii does not really have a bunch of bad plastic surgeons. All are rather good and having seen so many across the world I would rate them in the top 5% or at least the top 10%. Competition means the bad ones are weeded out quickly and leave the islands. I can speak with some expertise as I have been here a very long time and seen physicians come and go.

Hungry Lawyers dont help

What I do see is the emotional component come into play along with an occasional hungry lawyer. Of course lawyers need to earn a living too, but at times it has become rather ridiculous. Take the case of a lawyer who sent me an evaluation of a patient who had a small burn on the leg from spilling some hot oil at work on their leg and wanted me to really stick it to the employer with my expert opinion,  about how total disability would be required, it was only a small second degree burn  a quarter size ……. sorry not my style. Can no do ! Unusual and thankfully I do not see that very often. Yet it illustrates my point.

Ok well my blog  is not to condemn lawyers . most here I know are rather good and do not par take in such gamesmanship. My purpose is to discuss briefly what and why the cosmetic plastic surgery patients become unhappy and want to “sue their plastic surgeon”.  The most prominent reason is the plastic surgeon did not explain or spend the time with a patient that they should have and it was basically a communication problem.  It has happen to me,  as well. So what I do is send the patient if they are willing,  back to talk to their former plastic surgeon as a general rule. I am always happy when they can work that out. In fact,  I have gone so far with the patients permission and called the doctor and said “Hey knucklehead your not listening to your patient !” and usually they are shocked to find me saying this. Well the reason is simple, we sometimes get so busy we overlook this aspect knowing in our minds the problem  was normal healing  and not really bad and will straighten out with time, but fail to relay that to a patient. Patients I have learned are not patient.

Real complications

When a “real complication” occurs such as caspusular contracture where the breast becomes hard,  we may quickly acknowledge that , make a plan with the patient and fix it. Yet its the lessor issues such as breast implant which is slow to fall into proper position which we know well  is routine and we ignore or fail to tell our patients in way they understand. That is when the patient gets upset and leaves the doctor especially after they have consulted their friends, family and the like and claim “my god I have never seen anything like that !!!”. Also they have gone to the internet and compared their results drawing all the wrong conclusions.  This is most of what I see when an unhappy patient comes to my office from another doctor.

We call it the “practice of medicine”  for a reason

What can we do ?  Well I think in my case I have slowed down my practice to where I can spend as much time with patients as possible. I have discovered something as well. I enjoy my practice more, enjoy getting to know my patients more and have less people complaining ” he never spends enough time with me” . I am in a good position for that having practiced over 20 years and not having to worry about high overhead and bills like when I was younger. Well my skills are better than they were from experience as well so that helps quite a bit as well.

Well these are my thoughts about unhappy patients. My advice is to really give your doctor a chance to address the issue, if you do not feel satisfied first make sure he or she hears you and don’t just go out the door and say to yourself what a jerk they are. Many times the ones who have complained about me for example left and seemed very ok with what I have said. Later I come to learn they were irate and thinking what I could not imagine.

Well this is some random thoughts to share about “unhappy plastic surgery patients”.

Till next time

doctor808

Posted in Author Dr. Pasquale, Plastic Surgery In General | Tagged , , | 9 Comments

Non Surgical Anti Aging Facial Shaping The new coming “art ” for plastic surgeon artist.

Posted on June 29, 2013 by Michael Pasquale

NonSurgical Self Rejuvination

Non Surgical Transformations and facial reshaping.

This is an experiment I started on myself over ten years ago to some degree. This is real,  the photo quality is indeed better at age 58, but the structual changes are shown from ten years ago, I learned a lot about looking younger in a nonsurgical way or at least minor ways. I have had no major surgery what so ever., I wanted to wait till now to compare and look back to illustrate what can be done. Some people need major surgery thats a fact.

This is the great stuff

I want to share with my readers some really great stuff we have been doing of late and with non surgical cosmetic procedures and my thoughts on that.  I kinda learned by studying myself and my appearance. Although,  we have been doing much of this for many years,  its the way we are starting to combine these non surgical techniques which is the new part. This is just what is on my mind tonight so I write it. I actually have a web site I am making which is more formal– with good graphics to explain and before and afters. That will be done in another few months  frankly I am too busy for now. Call  this human facial art skill or something…..who knows I am thinking what …

What can I call this ?

I am not sure what name to give the series of procedures as a group, which I am discovering are changing many of my patients into a more youthful appearing look as well as myself.  In my headline I call it “Non Surgical Anti Aging Facial Reshaping” . Sooner or later I will come up with that name–some fanciful name which we can all communicate what we are talking about. I named one procedure I do called the “aloha lift” which is a technique to give a very slight lift to the facial skin by injection. It kinda stuck and at least my patients know what I am talking about. Not many here do that technique as it comes from Asia and no one here can pronouce that name so I really renamed it “aloha lift”. I did not invent it I just learned it in Korea.  Yet that one technique the “aloha lift” is only one part of a combination of things I do.

Propaganda is not what I am talking about.

The LifeStyle lift did that,  made an entire propaganda campaign about it on TV and made Debbie Boon the spokes person. When I looked into this from a plastic surgeons perspective, I in my opinion found the name is 99% hype, its a face lift not even a good one–but its branded and repackaged and sold. New and Improved — I hate that. Its not new,  but a face lift simple renamed.

Proven techniques like Botox

Yet what I am talking about is not hype,  but a combination of very proven techniques combined to really give the illusion of a younger more youthful facial appearance. I say a “combination of techniques”  because although each technique does help alone, it is only when they are combined does one see much more benefit than the sum. That means the sum is much greater than the whole.

Abstract thought made simple

Let me explain this way. If we give a pretend “youth point” for each technique and that point represents a degree(s) of making someone look younger., then we can add the values. To illustrate to you what I mean I use this arbitrary scale of “youth points”.

Botox around eyes — 3 youth points

Filler ( restylene, juviderm etc) in  mouth lines – 4 youth points

Fat transfer to face cheek  area- 7 youth points

Stem cell transfer – 8 youth points

In this example we explain  how the combination is better than  simply adding up the effect of each individual procedure and the expected “youth points”.

The total effect is more

So in normal totals if we did all of these things we would help someone by 22 youth points. That is if we add all of these individual points together we get 22 points.  Yet what really happens is when combined in the proper way , with an artful eye the improvement we will actually see  for example is 35 points. So they look 35 points younger than the expected 22 points younger when using a combination of procedures properly.

Artful way is KEY

So when you combine these procedures (all are non surgical ) the final result is looking much younger than if you did these individually I believe and have observed. Even more so if its done with proper balance meaning each procedure is used to correct just enough then the results are fantastic. This makes it an art and something we would use like an artist who knows what media to use, combination of colors or types of paint etc.

How I do it

In the meantime,  I can summarize for you what I do overall so until I can come up with a name.

First I  look at patients face, from my perspective and study of aging,  it is my experience which tells me what to do,  not some formula telling me what I need to do. I then look at each component which makes someone look older. Is it lines here or there? Is it sunken eyes? Is it the sunken cheeks, or the too flat in cheek area. Are the forehead muscles too tense looking. Are the eyebrows too thick. All of this is taken in and I have face diagram that I sketch on making notes to myself. I then take all these notes about what non surgical things needed to correct this and that and make a plan. Then I tell the person, add up the cost and explain the expected result, recovery etc or stages we need to do. It may involved surgery, but like in my case no major surgery, no face lift etc.

Summary

Today we have so many nonsurgical techniques or minimally invasive techniques to use the best results are obtained when we combine them artfully,  not by some simple recipe or formula. This is the trick , the plastic surgeon needs to have the talent to see this and see what he or she will do and visualize what the final combination will be. Not every surgeon can do this. Its a talent more so then some standard plastic procedures which  can be measures or a recipe followed. So I think this will be the new art for plastic surgeons,  but like art one must have the eye for that. I dont know how to teach that like I have taught breast implant surgery or face lifting, its more of a “gestalt and art” .

I have used myself as an experiment and I think I look much younger than ten years ago. Each person I evaluate must have a customized treatment plan , my was different than yours will be.

till next time

Doctor808

 

Posted in Author Dr. Pasquale, Facial Plastic Surgery, Plastic Surgery In General | 41 Comments

Buttock Augmentation — a good operation with a bad reputation Dr. Michael Pasquale Speaks out

Posted on June 25, 2013 by Michael Pasquale

Buttock Augmentation– the butt of jokes.

This post I write as its something that really really bothers me as professional. I am speaking from my heart and trying to be as objective as a reputable surgeon with many many years of experience.

In recent years like the last 3 I have seen Youtube after Youtube video surface about the procedures if you can call them procedures done by people ( many not even doctors)  resulted in deforming  people who have a strong desire to improve the appearance of their buttock. Yes exercise is best,  but to some of these individuals both female and male there simply are not enough exercises or techniques to make a buttock genetically destined to be small that much larger or shapely.

Most people don’t understand I know

Its so easy for the critics to say –oh buttocks can be controlled with squats or who cares? Yet having experience with these patients for over 20 years I can tell you that its not that easy. These individuals are driven to obtain what they perceive as good derriere and its important to them no matter what others think. They will go to all effort to obtain this and you will not be able to stop or fix that desire. Sorry but I know these patients.

Money corrupts and the predators come out

This is exactly why the vultures and frankly greedy evil people come out of their predator’s den to take advantage of these individuals and prey on their desire to improve the rear end. Thus you see these procedures done by God knows who,  in hotel rooms and dark corners of the earth, injecting God knows what into these victims. I know I speak harshly,  but I feel strongly as I have watched a pretty successful operation when done correctly  been turned into a circus side show by these unqualified,  if not criminal people to their victims. For one reason and one reason only -money.

You pay for quality in workmanship

I am not an altruistic soul, although I have done many charity cases for years, where I have not charged for my services. So I believe a surgeon should be paid for his talents and expertise. Yet no one should be paid for what disasters I have seen on Youtube and in fact in some cases should be prosecuted for assault. That is not too strong of a view.

I am not talking about the cases where a legitimate plastic surgeon has had a bad outcome such as an infection or other “normal” complication such as asymmetry or such. There is no such thing as a perfect complication free surgery, doubt there ever will be. I am talking about such things as severe scar and deformity seen or floppy implants done by whomever where the result is entirely the result of poor technique and in most cases doing things like injecting liquid silicone into someones butt. Thats crazy and is well known to be a disaster ! I mean these people doing these things in many cases are not even licensed to practice medicine must less qualified as a plastic surgeon.

See a qualified plastic surgeon with buttock augmentation experience.

Yet for the few of us who have substantial actual experience and are fully qualified plastic surgeons these disasters paint anything to do with this procedure questionable. Its a sad state as the public in general does not know and simply think its a bad procedure. This is what I mean by ” a good operation with a bad reputation” . When performed by someone who knows what they are doing, it is a good operation for the most part, though more complex than what surgeries most plastic surgeons perform. In some ways it has less complications than the widely accepted breast augmentation. The difference is people do not go to hotel rooms for breast augmentation or some back alley yet for reasons that mystify me,  they will for buttock augmentation.

Thus ends my rant about that aspect. It truly upsets me to hear these horror stories or see them on Youtube.

So allow me a few minutes to explain the procedures and very simply and brief as possible

There are only two ways to surgically enhance a buttock.

A. Fat transfer from one part of the body to the buttock. This is by liposuction then the fat processed then injected through a cannula to the area to shape and increase volume. Typically this may require more than one treatment. Yet some of the fat remains permanently.

B. Use of a silicone implant, not the liquid but solid implants approved in the USA.  This should never be done under the skin as skin is not strong enough to support the implant. Its should be done within the gluteus or under the gluteus muscle for covering the implant and making it appear smooth and natural, One has to know exactly how to do that and frankly even most plastic surgeons do not do the procedure , as they simply do not have the experience nor are schooled in the correct technique– good they should not.

Brief History of the procedure of buttock augmentation in the USA

When I started doing this procedure over 18 years ago I guess , not sure maybe  20 ? I learned on my own with just some advice of the of the few people in the world who were doing this regularly. There were only few in the USA. Now many elsewhere in the world.

That is factual, there simply were not that many plastic surgeons who knew how do to do this. We originally did this procedure above the muscle and after one case , I decided never again to do it above the muscle , as the results were not great, not a disaster,  but not what I wanted to see. So I tried to place the implant under the muscle (over simplified for clarity) and it worked marvelously. It was a trial and it turned out quite well. Looked great and though it was not a fast recovery I was happy and the patient was very happy.

Buttock Web site 1999

I decided to build a web site called www.greatgluts.com about buttock augmentation when google was first starting , one can find that in the internet archives today. The attention I received was remarkable people were calling me from all over the country, thus the number of cases I was doing increased phenomenally and so did my experience. I then perfected my technique, I was not doing thousands as this was not as popular a procedure like breast augmentation,  yet I was doing hundreds over a period of a few years. Then the Buttock augmentation craze hit with everyone wanting a Jennifer Lopez butt. Next thing I know is everyone and their brother qualified or not,  was declaring themselves a buttock augmentation expert in the internet. This included plastic and cosmetic surgeons as well as unqualified people.

So when these “everyone and their brother” had poor results and now we include the people who in recent years were injecting substances and they are not even doctors , buttock augmentation has a bad reputation when these horrid deformities are shown in Youtube. Its sad as this is far from the reality of the what results to expect. That is if the surgeon knows what they are doing.  By no means have a I said its perfect operation and that  I have never had one of my patients with a unhappy outcome . I have , as I have as with any surgery such as breast implants, but I can say that the vast majority have been happy and had good results and its a shame so many now are discouraged from considering this procedure. Its not for everyone,  but it has changed a lot of people lives  for the better as done by plastic surgeons who know what they are doing.

If you want to know more , see photos, and speak with real patient who have had the procedure by me, give my office a call. Also if you were a victim of these predators have a deformity or some disaster contact us, I will see what can be done at a cost that is reasonable as my heart really goes out to you. I may not be able to help you but I will tell you the truth and my honest and experienced opinion.

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Doctor808

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