Top Ten Poor Results
July 8th, 2009
Poor results are different from complications, although they can be related. A poor result after cosmetic surgery has an unacceptable physical appearance. It detracts from the visual or functional goal of the patient and surgeon. A complication is a negative event which occurs adversely affecting the recovery. Some complications like skin loss can lead to unacceptable scarring, a poor result.
- Breast Too Small Some 80% of women feel their breasts are too small after breast enlargement surgery. About 10% of these women act on their concerns and have a second and sometimes third surgery to increase their implants size.
- Unacceptable Scar As noted above, an unacceptable scar can be the result of skin loss and slow healing of the skin. Unfortunately, poor placement of a cosmetic surgery scar will make it unacceptable, as well. This is particularly true when clothing, hair style or makeup are unable to conceal the scar.
- Asymmetry All of us are different from one side of our bodies to the other. This is the normal human condition. Some argue this is an integral part of beauty. Cosmetic surgery can reduce differences that are more significant, but never eliminate them completely. After cosmetic surgery, some asymmetry usually remains.
- Skin Lightening Skin responds to scarring with changes in color. Color changes are a result of a disruption of the color producing and color containing cells in the skin. Some procedures have a high risk of skin lightening. The most notable of these procedures is skin resurfacing. The treatments which superficially burn or damage the skin can also bleach the color of the skin.
- Irregularities Beneath The Skin Much of cosmetic and reconstructive surgery involves rearranging skin and the underlying fat. Liposuction involves only removing fat. Scarring beneath the skin does lead to lumpiness which can be felt and sometimes seen.
- Skin Sagging Skin stretching procedures tighten the skin at first. During surgery every effort is made to remove as much skin as possible safely. Depending on how much the skin has been stretched in the past, sun damage, and genetics may contribute to skin can sagging after surgery.
- Unnatural Appearance I believe all plastic surgery results should look natural. My philosophy is not widely held by other surgeons or patients. The unusual results witnessed in celebrities bears this out. If a patient looks like they have had surgery, such that you look so different or comments range from what happened, or worse, who are you? The result may not be as natural as you had hoped.
- Functional Changes Cosmetic surgery is usually done to improve physical appearance. Every effort is made to allow normal body function after surgery. However, anatomical variability can change the way a body part will work. Inability to close the eyes after upper eyelid surgery, genital distortion after inner thigh lift surgery and inability to breast feed after breast surgery are all examples of functional changes.
- Poor Implant Position Implants are a part of cosmetic surgery. Breast implants are the best known but facial implants and injectable materials are also used. Each implant has to be placed according to the specific patient anatomy to yield the desired effect. Breast implants placed too high look like “porn star” breasts. We’ve all seen poorly placed cheek implants, where the patient looks more like a chipmunk.
- Insufficient Improvement Surgeons have an understanding of what may be accomplished through surgery. It is important for a patient to have a good understanding of what can be done and what realistic change might be expected. Patients with unrealistic or misunderstood expectations can express feelings of insufficient improvement after cosmetic surgery.
All of the poor results that I have mentioned may lead to correction with secondary surgeries. Many times these procedures are successful. Unfortunately, after each revision surgery is completed, some additional scar tissue is added. This subsequent scar tissue reduces the chances of success with each additional revision surgery.
Recreational Diprovan
July 6th, 2009
General anesthesia is used in my operating room to complete cosmetic surgeries like breast enlargement, tummy tucks, and liposuction. There are many drugs used in during these cases. They can be categorized by how they work. Muscle relaxants paralyze muscle tissue. Narcotics help reduce pain. Vasopressors restore low blood pressure. General anesthetic agents induce sleep and maintain the sleep state during anesthesia.
There are two main general anesthetic agents that I use. One is a gas called Ultane (sevoflurane). It is administered by trained professional medical staff through a breathing tube through the lungs. The other is Diprivan or propofol.
Diprovan is administered through the vein. It is frequently used to induce sleep in the operating room, intensive care unit, and emergency room. Patients may stop breathing when Diprovan is given. In all of the settings where Diprovan is used appropriately, the medical staff has the training and capacity to care for this cessation of breathing when it occurs. Accredited surgical facilities must have this capacity.
Prior to this past week, I was unaware of ANY use of Diprovan outside the clinical settings that include access to immediate breathing support. We procure this drug through our medication provider. It is certainly not part of any formulary outside hospitals or surgery clinics. You simply cannot go to your local pharmacy to fill a prescription for Diprovan. They do not have it! So, how Jackson supposedly gained access to it remains for law enforcement to figure out.
Recreational use of Diprovan obviously is extremely dangerous. Yet I can understand its appeal. Many patients who awaken after surgery where Diprovan was the only general anesthetic agent used, report extreme euphoria and pleasure. Still, I am shocked at the reports of the possible use of Diprovan by Michael Jackson. I will be truly dismayed if his personal medical staff were complicit in accessing the drug and facilitated its use by Jackson. It is my opinion that this would be a devastating embarrassment for most American physicians who take an oath when becoming doctors, “to do no harm.” Jackson’s untimely death is a tragedy that most likely could have been prevented.
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