An Open Letter to Tom Price MD , Secretary of HHS re healthcare

Mar28

From one AMA member to another. I am embarrassed that you stood there supporting Trump’s plan to replace the ACA with another terrible piece of legislation. I am delighted that it failed.

Like it or not, the ACA provided health care for millions of American who did not have it. Was it great – no, it needed to be fixed and still does. What you tried to do was ram through a terrible bill in 18 days when it originally took a year and a half to formulate and get passed – the ACA- and even then it was imperfect.

If you want to improve healthcare in the US, you need to sit down with all parties involved — ie Democrats and Republicans. Your plan alienated many of those who voted for your boss, Trump.

You know as well as I do, why the 65 yo male has to pay for maternity care, because the 23 yo female pays for his prostate care. The well finance insurance for the sick – if not the government pays for it.

So when you were an orthopedist – a non insured 23 yo male came in with a fracture? Did you send him out because he had no insurance — no the hospital had to eat the bill and you gave care for free. We all need to be insured or no one is safe. Today 60% of individual bankruptcy filings are because of medical bills due to lack of insurance.

On your web site it says that you are” dedicated to advancing the quality of health care in America – both as a physician and policymaker.” Prove it by working across the aisle to improve our system not destroy it. You know as well as I that we need to get rid of for profit insurance companies – all Americans should be able to afford insurance – not make insurance company CEOs get rich. The cost of drugs needs to be brought down too. Why is one drug in Canada or Europe half the price of the same drug here. Also the costs of medical malpractice insurance needs to be reduced with tort reform.

Although I hate to admit it, Medicare does a good job of covering me. The overhead for the insurance is low and it gives me peace of mind that my care will be covered and even though I maintain a catastrophic insurance policy, I know that my doctors and hospitals will receive payment.

In doing your job, you should re look at the Hippocratic Oath — do no harm is a main tenet – you would have harmed over 12 million persons by removing their insurance.

As a doctor, I have learned from my mistakes and have always been inclusive when making important decisions — I hope you can do that too.

William Rosenblatt MD
AMA Delegate from New York State 1983 – 2013

Round or Shaped Breast Implants: How to Decide

Feb26

I am often asked by my patients contemplating breast augmentation whether should they get anatomically shaped implants rather than round implants, with the thinking being the shaped implants would improve the visual result.  I am not a particular fan of the anatomically shaped implants because I don’t think this type of implant actually improves the result,  and only costs patients more money for no increased benefit.   I believe that the results of mammoplasty, as in most cosmetic plastic surgery procedures,  are directly related to the skill of the surgeon.

Now there is a study that supports my thinking.  Recently, plastic surgeons and nurses were asked to look at both pre- and post-operative photos of patients who had either smooth round implants or anatomically shaped implants. They were asked to decide which type of implant they thought the patient had received.  The result of the study was that they were unable to differentiate between the two.  They had a 50% chance of guessing right or wrong, just like a coin toss. The authors concluded that there was no justification for the systematic use of anatomically shaped implants. You can read the results of the study here: https://www.ncbi.nlm.nih.gov/pubmed/28027228.

So, I am delighted that there is now evidence in the literature supporting my opinion that it is a waste of money to the patient to implant anatomically shaped implants for routine augmentation mammoplasty.

New nonsurgical way to LIFT sagging facial contours

Aug4

We have recently introduced Silhouette InstaLift™, the breakthrough facial rejuvenation procedure that lifts sagging facial skin without the need for surgery, scars, or general anesthesia. I received comprehensive training on this new facelift alternative (for those not ready for a complete facelift), and this procedure is available at our NYC office.

instalift-patient-suture

In this in-office procedure, we insert fine Silhouette InstaLift sutures to lift the deeper layers of the skin in your mid-face or cheek area. The treatment is comfortable for our patients, only requires local anesthesia, and typically takes 45 minutes. The good news? You will see results right away. There may be some mild swelling or redness for just a few days, and you can get back to your normal routine with minimal downtime.

The unique Silhouette InstaLift sutures are naturally absorbed by your body over time. This process stimulates the production of your own collagen, one of the building blocks of skin that diminishes with age.

Contact us at 212-570-6100 to schedule your complimentary consultation to find out if Silhouette InstaLift is right for you.

BOTOX® vs. XEOMIN®: Is one better than the other for frown lines?

Jun1

It used to be that BOTOX® (onabotulinumtoxinA) was the only kid on the block for treating the those deep frown lines between the eyebrows that many of us have from a lifetime of worrying or just genetic bad luck.  Now, doctors have XEOMIN® (incobotulinumtoxinA) as an alternative treatment. XEOMIN was FDA-approved in 2011 for the temporary improvement in the appearance of moderate to severe glabellar (frown) lines in adults, so there is already a lot of experience with it.

A recent head-to-head study of 547 female adults (mean age, 41 years) with moderate to severe frown lines examined  the effect of BOTOX or XEOMIN at 1,2,3, and 4 months.  Both an independent review panel AND the treated patients reported similar satisfaction with the results at all times points.  For both BOTOX and XEOMIN, the median onset of effect was similarly reported to be 3 days.

And there was no difference in “peak effect,” which is medical researcher talk for the time is takes for the full effect to become obvious.

peak-effect

Now that BOTOX has some competition, it’s possible to get the benefits of BOTOX at lower cost.  XEOMIN is less expensive and also has an ‘Xperience” program than can save you even more money.  Check it out here:  http://www.xeominaesthetic.com/xperience-program/  and stop frowning about the cost of BOTOX.

Cosmetic surgery can change what people think of you… and it’s more than your attractiveness

Mar5

Research from Georgetown University and published in JAMA Facial Plastic Surgery, suggests that facial profiling can change following facial plastic surgery.  The study involved rating personality traits, attractiveness, and femininity using before and after photos of white female patients who underwent facial rejuvenation surgery (face lift, upper or lower blepharoplasty, eyebrow lift, neck lift, and or chin implant).  The traits rated were aggressiveness, extroversion, likability, trustworthiness, risk seeking, social skills, attractiveness, and femininity.

Of the 8 traits evaluated, the following 4 traits had significant ratings improvement: likability, social skills, attractiveness, and femininity.

Plastic surgeons have always felt that cosmetic surgery improves more than one’s appearance.  This study finally confirms that belief. So, don’t expect the world to radically change for you with cosmetic surgery, but with the improvement in your appearance, you may find there will be some benefits beyond what you see in the mirror.

 

Think Tummy Tucks Are for The Vain Only? Think again…..Tummy tucks can have health benefits

Mar15

A resolution of mine is to regularly clean out my email inbox. I usually just click on all the old emails and boldly hit DELETE.   But I was glad I didn’t do that this month, as I came across this news item from the Wall Street Journal about the “healing” effects of a tummy tuck. I had originally saved it because I wanted to blog about it, but never got around to it….until today!

Tummy tucks (abdominoplasty), or other body-contouring procedures such as a panniculectomy, are often sought by people who are able to keep a common New Year resolution—to lose weight via diet and exercise.  One side effect of major weight loss of, say, 50+ pounds, can be excess skin that is not only unattractive but can have physical ramifications. Tummy tucks are also sought by patients after pregnancy to help get back a flat stomach, and after bariatric surgery to lose that excess skin that doesn’t snap back. Sometimes a tummy tuck is performed at the same time as a tubal ligation, hernia repair, hysterectomy or other abdominal surgery.

Even though vanity may be the primary reason to have a tummy tuck or panniculectomy, new research shows that there may be some significant health benefits to these procedures beyond just motivating patients to maintain their weight.

  • Tummy tuck/abdominoplasty: a surgical procedure that removes extra skin and fat in the abdomen
  • Panniculectomy: a surgical procedure that removes the sagging skin (“apron”) below the belly button

A study in Plastic and Reconstructive Surgery by Swiss researchers found that patients who have bariatric surgery are more likely to keep weight off if they have a body contouring procedure that removes excess skin at the same time.  Patients who had bariatric surgery with a body contouring procedure regained an average of 1 pound/yr vs. 4 pounds/yr gained for bariatric patients who didn’t have contouring procedures.  Because of this long-term weight control, the authors conclude that body contouring surgery “must be considered as a reconstructive operation in the treatment of morbid obesity.”  You can read about it here.

Another study in Plastic and Reconstructive Surgery reported that patients with a body mass index (BMI)  >24.5kg.m2 who only had an abdominoplasty were more likely to have sustained weight loss.  The authors hypothesize that the increased satiety in their patients and subsequent weight loss was possibly related to changes in the neuroendocrine system. You can read about it here.  If you want to find out your BMI, you can easily do so here.

Like all surgical procedures, tummy tucks and panniculectomies carry risks–among them infection and blood clots. But combining two procedures (eg, a tummy tuck and a tubal ligation) may reduce the risks of a second procedure requiring anesthesia.

My Spring Resolution?  I could use a little weight loss myself, but my resolution is to make more time to blog about important and interesting plastic surgery issues that I think my patients, friends, and colleagues would like to know about.  I will also be blogging about what you need to know about operating room safety, how medical malpractice laws affect health care, and the how the current health care insurance climate affects patient care.

Be an informed medical consumer.

Don’t Be Deceived by “Top Doctor” Lists

Sep23

In her article Top Doctors, Dead or Alive  in the August 12, 2014 edition of the New York Times, Abigail Zuger, MD talks about the “Best Doctor” lists that are published yearly. Many patients read New York Magazine and Castle and Connolly’s lists of Best Doctors, and either check for their physician or look for one to go to based on these lists.  But is that the best way to go about finding a doctor that is right for you? One fallacy of these lists pointed out by Dr. Zuger was a physician who had died 16 years earlier but was still listed as a “Best” doctor.

There are many ways to get onto one of these lists and each source lists how they go about selecting physicians. Often referrals from other physicians help a doctor get onto these lists. Sadly, one of the ways physicians can increase their chances of being selected is by hiring  a publicist to get his/her name circulated in the news media—both television and print.  This form of “advertising” can boost a person’s opinion of a particular doctor. Even another doctor’s opinion.

I have been on Castle and Connolly’s Best Doctors lists for many years, and have once again been chosen as a Top Doc for 2014. New York Magazine has also selected me for their Best Doctors list from time to time. Why I make it one year and not the next is not clear to me.   What I do know is that I don’t have a publicist, and perhaps that is one of the reasons.

How to Really Evaluate a Physician

I believe that when one searches for a physician, these are the things to look for.

1. Board certification in their specialty. Check out the doctor online. In New York State it is easy. Just go to the New York State physician profile site here. You can learn where your doctor went to school, where he or she trained, and their board certification. If the doctor has a bad malpractice record, you will learn that as well. Also, any problems with professional misconduct will be listed. In addition the American Board of Medical Specialties Website here will give you additional information on the board certification of your doctor.

I don’t believe that many of the popular patient Website reviews are valuable to patients. Why? Because the patients who write reviews are usually those who are either very happy or very annoyed. Thus,  reviews are often skewed either low or high. I would worry if all the reviews you read of a particular physician are great, as someone may be falsifying them.  Just as there is no way that everyone loves the same restaurant, it is not possible that everyone loves the same doctor. Remember, there are no perfect physicians, as there are no perfect patients.

 2. The feeling you get when you see your doctor. Does your doctor answer your questions and spend adequate time with you? It is true that today’s health insurance pays so little that it is often hard to get everything in during your 10-minute slot, which is why clear, concise communication is very important by both the physician and the patient. Will the doctor be around on weekends and nights if you have an issue? Does s/he look at you when you are talking or is s/he engrossed in the computer, charting your data in their electronic record. Charts were much more personal, whereas computers are impersonal; this puts a large electronic wedge between the patient and the physician (you’ll hear more from me on this topic at a later date).

3. Is your doctor affiliated with a good hospital network? If so, your doctor’s credentials have been vetted by hospital administration and s/he should be well qualified. This also gives your doctor a large network of specialists to choose from in case you need other specialized care. Also, you don’t always need to see the “Chief.” Often they are chosen more for their administrative skills rather than patient care skills, so don’t be swayed by that credential alone.

So find a doctor you like, who is kind, gives you time, answers your questions. If s/he are on someone’s “Best” list, all the better, but don’t make that your only selection criterion.

Gynecomastia: Male breasts are common but easily reversed

Jun16

Gynecomastia, ie, male breasts, can be an annoying, embarrassing condition for men.  It is commonly found in men at all stages of life, with up to 25% of men  having some enlargement of their breasts. Usually, there is no cause and it is easily reversed with liposuction.

Gynecomastia can often be seen at puberty, but may go away spontaneously.  If it doesn’t, a medical evaluation of the teenager is in order. Usually,  no hormonal imbalance is found, and in these cases of benign breast enlargement, surgery may provide a solution.

In addition to weight gain, various changes that occur as men age may contribute to breast enlargement.  For example, the use of certain medications can cause the breasts to enlarge, such as anabolic steroids given to body builders. Prostate medications, some antidepressants, and alcoholism can also contribute to gynecomastia.

If you have a unilateral breast enlargement, nipple discharge, a firm nodule, or breast pain, a medical evaluation is important as there can be an underlying problem that needs to be addressed. Breast cancer is uncommon in men, but does occur; 1% of all breast cancers occur in men.

For most cases of common benign male breast enlargement, liposuction provides a simple, almost scarless treatment. A small incision at the junction of the areola and chest skin allows the plastic surgeon to get rid of the excess fat and breast tissue, thus flattening the appearance of the chest. Men do not usually need to have external incisions to remove excess skin, since the chest skin shrinks and flattens out when the breast is reduced. However, in some cases, the skin might not have enough elasticity to shrink, in which case some external scars may be visible, until they mostly fade away.  After surgery, a vest is worn  for a few weeks, and return to work and the gym is rapid.

When seeking help for this condition, make sure to go to a board-certified plastic surgeon with experience in treating gynecomastia. Male breasts are easily taken care of and do not need to be a source of embarrassment to you anymore!

28-Year-Old New York Woman Dies After Plastic Surgery in the Dominican Republic

Apr10

Please read this Plastic Surgery Smart Brief if you are thinking about going to a foreign country to have cosmetic surgery because it is cheaper. Your life may depend on it.

 Plastic Surgery SmartBrief 
“A 28-year-old New York woman died following plastic surgery in the Dominican Republic, prompting authorities to close the operating room where she was treated. The State Department’s website cites several similar cases, and the CDC issued an alert last month after receiving reports that at least 19 women developed mycobacterial wound infections after receiving cosmetic procedures in the Dominican Republic. Even if doctors in other countries are certified, staff and facilities might not meet U.S. standards, warns plastic surgeon Braun Graham, past president of the Florida Society of Plastic Surgeons.”

In the US, office-based operating rooms are usually certified (and you should always ask your surgeon if his or hers is).  In this country, board-certified plastic surgeons practice at a very high standard. Standards can vary in foreign countries.  Is losing your life worth saving a few dollars? Even in the best foreign facility has an excellent safety record, patients may develop a post-operative complication.  Here are some questions you should ask yourself before becoming a plastic surgery tourist:

  • What will you do if you have an urgent problem and you have already returned home?
  • Are you going to go back to that foreign country to have your complication cared for?
  • Could your condition become life-threatening because you can’t get back in a reasonable amount of time?
  • Who will take care of you here?

Here’s my advice. Have surgery where you live, it is safer. 

You can read more about it here: http://www.huffingtonpost.com/2014/03/31/beverly-brignoni-dies-plastic-surgery-dominican-republic_n_5062327.html

 

Cosmetic Botox Reported to Improve Depression

Apr2

Since Botox® first came on the market, it has been used to treat far more than facial wrinkles (frown lines and crow’s feet). Its other uses include:

  • Eyelid spasm
  • Severe neck & shoulder muscle spasms
  • Chronic migraine
  • Excessive sweating
  • Crossed eyes (strabismus)
  • Post-stroke limb spasticity
  • Urinary incontinence/overactive bladder
  • Off-label uses such as cerebral palsy, sphincter dysfunction, et al.

But now it seems that DEPRESSION may be added to this list.  How is this possible, you may ask? In a study authored by Eric Finzi, a cosmetic dermatologist, and Norman Rosenthal, a professor of psychiatry from Georgetown University,  74 patients with major depression were randomly assigned to receive either Botox or saline injections in the forehead muscles whose contraction enables frowning. Six weeks after the injection, 52% of the subjects who got Botox showed relief from depression, compared with only 15% of those who received the saline placebo.

According to a recent article on the subject that appeared in the New York Times, you might think that patients would easily be able to tell whether they got the placebo or Botox. But it wasn’t the case. Only about half of the subjects getting Botox guessed correctly. And knowing which treatment was received had no significant effect on treatment response.

This was not the first study to report the positive effects of Botox on mood. The Botox studies suggest a circuit between the brain and the muscles of facial expression whereby the brain monitors the emotional valence of the face and responds by generating the appropriate feeling.

Dr. Richard Freedman, a professor of clinical psychiatry at Weill Cornell Medical College who authored the NY Times article, noted that “whether Botox will prove to be an effective and useful antidepressant is as yet unclear. If it does prove effective, however, it will raise the intriguing epidemiological question of whether in administering Botox to vast numbers of people for cosmetic reasons, we might have serendipitously treated or prevented depression in a large number of them.”

You can read more on this fascinating subject here.