Medical Tourism and its’ disadvantages

Medical tourism is gaining popularity. If you are not familiar with the concept it boils down to this. Patients will travel internationally to a destination spot. They will then combine a cosmetic surgery procedure and spend their immediate recovery in this vacation spot. Typically the surgery is much less expensive than in the US and they get to go somewhere tropical. Sounds ideal. However…

The problems with this approach are two fold. First, the training of the surgeon and the quality of the facility where the procedure is performed may not be up to U.S. standards. Plastic Surgeons in the U.S. are overseen by the American Board of Plastic Surgery, American Society of Plastic Surgery, their State Medical Boards, and on the local levels the hospitals and surgery centers credential all of their surgeons. This may be true in other countries but there is no way to know. It is true in every American city.

Secondly, if after you come home, you have a complication it may be very difficult to find a surgeon willing to assume your care. In general, amongst surgeons, the general rule is that you handle your own complications. Plastic surgeons charge global fees that include your surgery and all aftercare. Thus, if you call on a plastic surgeon to handle your complication, you may find that they are less than enthusiastic and may charge you significant fees to assume you care.

Think carefully before you travel for cosmetic surgery.

Lee E. Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

How does SmartLipo tighten up the skin?

I have the Smart Lipo Triplex laser liposuction machine that I use for almost all of my liposuction cases. I used traditional tumescent lipo for years and my only complaint was my lack of ability to get good skin tightening particularly on the back of the arm, the inner thighs, or tummies on the female patients who had some stretch marks from having babies. Skin tightening on the 40 and 50 something patients can also be a challenge. SmartLipo offers several advantages over standard lipo but skin tightening is a main one. But why?

Smart Lipo, particularly the triplex, uses a blending of two laser beams to create heat just under the skin surface. It has a 3rd laser light that targets and melts your fat cells and this process creates heat too. All of this heat, when properly applied and when taken to the proper levels, serves to heat up the deep surface of your skin, the deep dermis, and this is what causes skin tightening. It basically helps to shrink wrap your skin. It is great for the neck, the back of your arms, the inner thigh area, and lower tummies.

Now, it’s not magic though. It will not tighten up skin that hangs or is covered with stretchmarks and it doesn’t work as well in smokers.

If you want to see if Smart Lipo might work for you please contact our office in Louisville at 502.721.0330

Lee Corbett, MD Medical Director of Corbett Cosmetic Aesthetic Surgery and MediSpa

What do you do when your results aren’t what you thought they would be?

I have recently begun answering questions on the Real Self website for prospective plastic surgery patients and patients who have already had surgery. A fair percentage of the patients who post are doing so because they do not like their results, are unsure of how things are going to turn out, or have had a complication. I am surprised that there are so many patients who are 4 or 5 days out from surgery and already are doubting their surgeons advice. So, I thought I would offer my recommendations on how to handle things if you find yourself in this situation.

First, understand that your surgeon wants you to have a ‘perfect’ result just as much as you do. Personally, my goal is perfection every time I step up to that operating table. Surgeons are an unusual breed. We are super Type A, detail oriented people. My point is your doctor wants great results just like you do. So trust him or her when they tell you things will improve/change. I realize it may seem like they are dismissing your concerns but they aren’t. They’ve just seen this scenario play out literally thousands of times and they are confident this, whatever ‘this’ is, will indeed get better.

Fact: There is no plastic surgery operation in existence where you will see your final result in less than 2-3 months. Soft tissue swells as it heals and so you will not see your final result until that swelling is gone and the tissues normalize.

If you see something you don’t think looks right, ASK YOUR SURGEON! Stay off of the dang internet, don’t call your niece who is a nurse, or the neighbor who knows someone in “whereever-ville”, ask your doctor. He or she knows your particular circumstance better than anyone else.

Now sometimes things don’t turn out as you or your surgeon expected. This can be due to unrealistic expectations on the patients behalf, miscommunication on what you expected from your procedure, or it can be due to the fact that what your surgeon saw in the operating room changed as you healed. In other words, sometimes revisions are necessary. No one likes revisions because they mean more surgery and recovery and costs. But sometimes it becomes the reality and if you are considering surgery you need to be willing to accept this reality. Revision rates are usually quite low with the things we do but they do occur. Your surgeon will be able to tell you early on if this is a possibility.

Complications. There is an old saying in surgery. “The only surgeon who doesn’t experience a complication is the surgeon who doesn’t operate”. This is true. It could be a bleed, or an infection, or a thick scar etc…In these cases trust your surgeon and communicate with them. We train 7 or 8 years to be Plastic Surgeons. I could teach just about anyone how to technically do any operation I do in a week or two. So why do we train for 8 years? Because we have to know how to handle every complication that can possibly occur from an operation. The Chairman of my General Surgery residency had this philosophy: “As a surgeon, you are not qualified to perform an operation until you are expert at every aspect of the pre and post operative care for that particular operation, including any complications.” My point in telling you all of this is if you do have a problem, your surgeon is well trained to help you and get you to where you want to be.

So when in doubt, go see your doctor. I guarantee you your doc would much rather see you lots than have you home worrying, stressed out that things might not be ok.

Lee E. Corbett, MD

Board Certified Plastic Surgeon.

What makes laser liposuction different from traditional liposuction?

With traditional tumescent liposuction the process goes as follows: Very small incisions are used to access the treatment area. Then a saline (salt water) solution is pumped into the area. This process is where the word “tumescent” comes into play, it refers to the infusion of the water into the area. The tumescent fluid does 3 things for us. It causes the fat cells to swell and plump so they are easier to break down, there is lidocaine in it to numb the area, and there is epinephrine in it to constrict the blood vessels. We then wait about 15 minutes to let the epinephrine take effect. Then a hollow tube called a cannula is inserted and moved in a to and fro motion to break up and suction out the fat cells.

Laser Liposuction works a little differently. The incisions used are smaller because of the effects of the laser. 1-2 mm incisions are made and the tumescent water is placed. With the laser we don’t have to wait the 15 minutes because the laser will seal the blood vessels so that saves us some time. So the 1 mm laser wand is inserted and the laser turned on. The laser wand shoots out blended combinations of laser light that target the water in the fat cells and literally melts the fat. So the fat cell is being melted away instead of being physically disrupted as with traditional lipo. The laser also creates heat which is beneficial because it heats the under surface of the skin causing it to tighten more than is possible with standard lipo. The laser also coagulates blood vessels so there tends to be less bruising than we get with standard SAL (suction assisted lipectomy).

Both techniques will result in swelling so that part of your recovery should be the same with each method but most patients report less bruising, pain, and down time with the laser lipo vs standard lipo.

Lee Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

“Are those real?” How do you spot augmented breasts?

I get this question all the time on a social level, from both men and women, and I certainly hear this during my breast augmentation consultations. What makes an augmented breast look natural vs “fake”? The answer to this question is multifaceted.

The first consideration is size of the implant. The more modest the implant size choice the more natural your look. It’s really that simple. If you choose a really large implant it’s not really likely that you wont look augmented. An implant size that just doesn’t fit your frame is a dead giveaway.

The second point is how much breast tissue do you have to begin with. The more of your own tissue that drapes over the implant the more natural you will look. So this becomes a problem for my more petite patients with an A cup breast. When we put the implant in there is nothing to hide the contours of the implants because there is hardly any tissue on top of it. This is the case where you see the “too round to be true” upper pole of the breast. Now I can help with that by shaping the implant pocket to allow for a more smooth transition of the muscle onto the top of the implant and you can help by choosing a smallish implant. But if you see a breast that looks like there is half a grapefruit behind it, you are looking at an augmented breast.

A large gap between the implants. This may or may not be a sign. A lot of women just have widely spaced breasts. So this can be a natural thing. It can look fake when you have a widely spaced breast and then place a large implant. When the breasts are widely spaced there tends to not be a lot of tissue along the breast bone and you get the ‘half grapefruit’ contour there is the implant is larger.

Movement. Natural breasts move more. Augmented breasts still move because the implants are not attached to you. They float around in their pockets and move with you. The problem again is when you use a larger implant. These have no room to move and tend to always point straight out even when you are laying down. When I place the implants, no matter the size, I make the pocket just the size of the implant so that they will always stay on the front of the chest. I know this doesn’t look as real but my patients love this look and they really, really hate when their implants slide to the side and leave a hallow in the middle of their breasts when they are laying down.

When you look at a breast from the side an un-augmented, mature breast will have more volume below the nipple than above. Now an augmented breast can look this way as well because over time implants assume a tear drop shape with more of the filler (gel or saline) settling to the bottom of the implant. Again, it’s all a question of size. If you choose a larger implant it will give you an unnatural fullness at the top of the breast. Size matters.

I found this question in Allure Magazine and added my own two cents to their answers.

Lee Corbett, MD

www.corbettcosmeticsurgery.com

How many cosmetic procedures can I have done at one time?

There are several factors that you and your surgeon need to consider if your are thinking of having more than one procedure. Patient Safety is our primary concern. The primary issue is “How healthy are you?”. The reasons that people have serious complications around the time of surgery is because they have a bad heart and/or bad lungs. So if someone comes to me with emphysema from smoking their whole life I tell them no. If someone has active chest pain or a heart attack history I’m not operating on them either. People with a history of a blood clot that required blood thinners is also a “no go”. Now, if your lower back hurts everyday, and you had a hysterectomy, and you are hypothyroid, well none of that really factors in. None of those issue will affect how you do during anesthesia so they aren’t relevant. The summary statement is we need to look at your combination of medical problems and see if any of the constitutes a ‘red flag’. The second issue is time under anesthesia. Most plastic surgeons that I know will call it quits after about 6-7 hours for elective cosmetic procedures because after this point complications rates can go up. The third issue is “What are we combining?”. I’ve had patients request 5 or 6 things be done at once and we did them all because they were relatively small operations. Usually it is a breast & tummy combo, the Mommy Makeover, and I do those all the time. That being said I’ll never combine a thigh lift or a body lift with anything else because they are significant operations. So the answer is we have to look at the scope of procedures and base our answer off of that.

So, combining procedures is fine and we do it everyday in plastic surgery. We just need to make sure, as with any surgery, that you are a good candidate based on the factors described above.

Lee Corbett, MD

Medical Director, Corbett Cosmetic Aesthetic Surgery and MediSpa

How long will the swelling last after my surgery?

Well, it obviously depends on what type of surgery you have and on what part of the body, but there are some general guidelines that we can talk about. First, any time we operate on soft tissue be it a breast surgery, liposuction, or a tummy tuck or any facial surgery, we are wounding your tissues. Now we are wounding them under the most ideal circumstances e.g. anesthesia, sterility etc… but we are still doing surgery and this causes some trauma to the tissues. Our bodies are programmed to heal via a pre programmed cascade of which Inflammation is a key component. Now, the irony is that most hear the word ‘inflammation’ and have negative connotations, but inflammation is a normal and very critical component of tissue repair. What happens is that within and adjacent to the area where the surgery occurred, the blood vessels become leaky, like a soaker hose. Blood vessels are tubes with lots of holes in them to allow the cells that promote healing to be delivered to the injured area. As the cells escape the blood stream to heal, they pull water with them. That is called osmosis, think back to Biology 101. So there is extra water in the area. Now, to compound the problem, when there is extra water/swelling fluid the body gets rid of this via the tiny venous and lymphatic channels that course through our body. Well, the surgery usually disrupts these channels and new ones have to form. This process usually takes a several weeks to months. That’s why after cosmetic procedures, your surgeon will usually caution you to expect some swelling for at least 6 weeks and probably for 3-6 months post operatively. Areas that are particularly prone to swelling are the extremities, especially the legs. Anatomically, your leg is technically from your knee to your ankle. Because of gravity, this area swells the most and heals the most slowly. The head and neck areas also swell because the blood supply to this area is very robust and so there are just more ‘soaker hose’ vessels to leak during the inflammatory phase of wound healing. The take home message here is that swelling is a normal healthy part of healing. Your surgeon will discuss how much swelling and for how long based on your planned procedure and area to be treated.

Lee Corbett, MD

Who is your Cosmetic Surgeon?

I ask this question because most patients don’t realize that there are no regulations on who can claim to be a “cosmetic surgeon“. Your ‘cosmetic surgeon’ might be a plastic surgeon, an ENT surgeon, an Ob-Gyn, a dermatologist, an ER doc, or a Family Practice doctor. Any doctor with a medical license can advertise to be a ‘cosmetic surgeon’. And that doctor can make that claim having worked not even a single day as a surgery resident. Now, the majority of ‘cosmetic surgeons’ are Plastic Surgeons and Otolaryngologists (ENT) doctors. Most plastic surgeons are fully trained general surgeons(5-6 years of residency) who went on to a plastic surgery residency (2-3 years). The ENT doctors typically train 5-6 years and a lot then did an extra year of just facial cosmetic training. If your cosmetic surgeon has either of the above qualifications, you are probably in very good hands.

The problem is doctors incomes have plummeted, especially in the past 10 years, and so doctors in other specialties are becoming “cosmetic surgeons” to replace that lost income. The issue is that as a Dermatologist, ER physician, or family medicine doctor these physicians have no formal surgical training. They go to weekend long courses and learn how to operate. Well, your plastic surgeon and ENT doctors did 6-8 years of training working 100 hour weeks to learn to operate. We trained that long for a reason. There is a whole lot to learn about surgery and its effects on the body. I’m not sure a Friday and Saturday seminar can replace my 7 years of residency.

Now, I am not discrediting all non plastic surgeons and ENT’s. We certainly don’t ‘own’ the rights to cosmetic medicine. In my community there are Derms who have done lipo for many years and do a nice job and are good doctors. My advice to you as the patient is to look at your doctors back ground training. Not all ‘cosmetic surgeons’ are made the same. Look at what specialty they did their residency in, if it wasn’t surgical in nature I think you need to ask some serious questions.

Herbal Supplements: Helpful or Harmful?

In a Study published in the journal of my society, the American Society of Plastic Surgeons, it was shown that almost 50% of patients who were planning to undergo some type of facial cosmetic procedure (facelifts, blepharoplasty, rhinoplasty) were taking some from of herbal supplement. The problem is that many of these supplements can have adverse effects for a surgical patient.

In the study, it was found that 49% of patients were using at least one supplement, usually vitamins. In all there were about 53 different supplements that were used and the average number of supplements used was about 3.

The problems we see as surgeons that are supplement related are that many patients don’t really know what is in these things and they can cause problems. Bleeding is probably the most common problem and is related to bilberry bromelain, fish oil, garlic, MSM, selenium and Vit E.

What I recommend to my patients is to stop taking all supplement 2 weeks before surgery. And, don’t be tricked into thinking that these supplements are always safe. A lot of my patients, when they fill out their intake paperwork, will omit their supplements because they are not prescriptions. This is a mistake and can lead to post operative complications.

Lee Corbett, MD

How much weight can I lose with Liposuction?

I was seeing a patient this week for a Smart Lipo consultation and she asked me this question. She was quite surprised by my answer which was, “not much”. So, I thought this might be a good topic to blog about so that you might better understand the role of liposuction.

First, conceptually, think of Liposuction as a shaping tool, a sculpting tool. It is a way that I can restore balance to your figure. Another way of saying it, and I tell every patient this, is to think of liposuction as you would a nail file. It is a tool we use to smooth out a rough edge. For instance, take your back as an example. Say you are OK with your bra line area and you are OK with your tush, but right above your buttocks, lets call this area your hips, you have a bulge. I use this as an example because it seems like every woman who has had a baby has a little extra fat right there. Well, using the nail analogy, I want to use liposuction to ‘file down’ your hips so that they blend more smoothly with your bra line above and your buttock below.  So we are shaping/sculpting your figure to give you a smoother,  better curve. This doesn’t mean I am trying to remove every fat cell in the area, if I did that I would leave you with a dent that doesn’t match what’s around the area. I just want to remove enough to improve your figure. Now, if I am doing liposuction on your tummy, I am trying to remove every fat cell that I can possibly get out as no one has ever complained that their tummy is too flat!

As far as weight loss goes, fat is not a very dense tissue. It falls into the “pound of feathers” category. In other words, it takes a lot of fat to weigh even a pound. With most of my liposuction cases the patient might lose between 3 to 5 pounds, but that’s about it. Now, losing 3-5 pounds might very well enable you to drop a dress size or two. If we get rid of the bulge on your hips or your tummy your clothes will fit much better and you might not have to buy that larger size just to accommodate your problem area. But the idea of liposuctioning off 20 or 30 pounds or more is simply not possible and not done.

Dr. Lee Corbett

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa