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Quick update: For two weeks in mid-winter, I will be heading off to my sixth medical mission. These are the highlights of my year, as it is not only is a chance to give back and help those in dire need, but the satisfaction these missions provide is something that truly sustains my spirit and recalibrates my value system.

This year’s mission is to Vietnam, where we will be handling an array of birth defects, most notably cleft palate. Whereas past missions have been through non-profit I founded called Destination Hope, this time around I am joining ReSurge (formerly Interplast) as a volunteer on one of their missions. In reality, I am relieved to be joining and not leading / planning this time around!

Destination Hope’s past missions have been to the Philippines and Ecuador. I will provide a lengthier post of this mission, with photos and hopefully a link to a video, after I return.
As a physician I am well aware of the detrimental effect that habitual smoking has on the health of any individual, and when the subject comes up I’m always quick to remind my patients of how much they have to gain by giving up the habit.

However, when I have a patient planning cosmetic surgery, I bring up the subject for a very specific and particular purpose. I strongly advise my patients who smoke to quit smoking for 6 to 8 weeks prior to scheduled surgery and throughout the post-operative recovery period.

Many studies have clearly shown that non smokers or those who quit temporarily have a lower risk of complications from anesthesia and during the operation itself and also far fewer post-operative complications.

Smoking inhibits the flow of blood to the heart, a vital process during surgery when the body is under stress. Smoking is also counter productive when it comes to post-surgical healing.It reduces the blood flow to the cell, inhibits the ability of hemoglobin to carry oxygen, and it reduces the amount of oxygen released to the cells, all processes essential to healing.
An important subject that you should discuss with your plastic surgeon before scheduling any surgery is the type and quantity of medications you may be taking for conditions unrelated to cosmetic procedures or surgery.

I make a special point of asking my patients during a preliminary consultation what medication they now take, have recently used, or plan to use. Often they will reply no on a printed questionnaire regarding medicines forgetting that they may be taking aspirin, antidepressants, using birth control, or may be planning hormone therapy shortly.

Some medications – and even some health supplements – can have an affect on blood clotting or blood pressure. Even some medicated skin creams can cause unwanted side affects during surgery.

Don’t take chances with your health; be candid and open in discussing any drug use with your plastic surgeon before setting a date for surgery.
Everybody I know takes nutritional supplements of one kind or another, and many people are not aware that the frequency and quantities of vitamins and supplements taken on a regular basis can have an adverse effect on the body while undergoing surgical procedures. Often I find that patients while having a clear understanding of drugs and their possible side effects, tend to dismiss vitamins and nutritional supplements as non-drugs or “natural” and therefore harmless.

Any supplements, such as garlic, ginkgo, and ginger pills, that act to thin the blood should be discontinued a week before surgery. Don’t overlook ‘natural’ diet pills, hair loss prevention supplements, and special energy drinks that may include blood thinning products.

The trend to take megadoses of some vitamins can also have a potential negative impact that minor amounts of most vitamins wouldn’t have.

Discuss with your surgeon all medicine, health maintenance medications, and supplements you take in order to rule out possible side effects and make your surgery a positive experience.
Many people could use some help with thinking about how to choose a plastic surgeon. Being outside of the industry, they don’t know what to look for so they can be easily wooed by glitz and glamour that have nothing to do with the all-important doctor/patient relationship.

My advice would be simple: pick your plastic surgeon just as you would choose anyone you would trust as a partner on an extremely important business project. You want to see their qualifications (certification by the American Board of Plastic Surgery, in the case of plastic surgery) and you need to feel that your ‘partner’ is highly capable and good at listening to your priorities and making them his or her own. Finally, you certainly only want to partner with people who are good, thoughtful and compassionate at the core. We all spend a lifetime honing our ability to judge others soundly. Listen to your gut:if you check for Board Certification and also you really feel that you are in good, capable, compassionate hands then chances are that you’re making a sound decision.
In the old days of surgery patients were told to stay in bed, even for days after surgery. Not any more! We now know that people who act sick after surgery (i.e. stay in bed and pamper themselves excessively) get sick after surgery. While we certainly don’t want anyone over-doing it after a delicate procedure, it is important to be up and moving even on the very day of surgery if possible.

Really, I’m only talking about a basic level of activity necessary to move around the house a bit and take care of your basic food & hygiene needs. But even this will help greatly to keep fluid off the lungs, lower the risk of blood clots, and speed your recovery along as it should.
Most of my patients who benefit from Botox® Cosmetic treatments to smooth out facial creases and frown lines aren’t aware that Botox was not originally intended for this purpose.

In the 1960s, while being studied as a possible germ warfare agent, several serotypes of the bacterium Clostridium Botulinum – the cause of botulism poisoning in food – where found to cause temporary paralyze of nerves and muscles when used in minute amounts without negative side effects.

The use of Toxin Type A, the most studied of the seven different serotypes, as a therapeutic agent began in the late 1960s, first as a pediatric treatment for crossed eyes and later as a common medical treatment for blepharospasm and strabismus, two kinds of facial spasms that occur around the eye. It was first approved as a medical treatment in 1989.

It wasn’t until the 1990s that Toxin Type A was considered for cosmetic purposes, and was approved by the FDA in 2002.

Now, in addition to being one of the most popular anti-aging treatments, Botox® is also used to treat hyperhydrosis (excessive sweating) and migraine headaches.
The use of digital imaging in plastic surgery (that is, taking a photo and then changing it with a computer to show a patient what an example of a possible result looks like) is an area of great controversy. Proponents say that it is a useful adjunct to patient education, and opponents declare that it can seem like a false guarantee of results if not properly explained.

I have found digital imaging to be useful for a number of procedures in my practice, such as in rhinoplasty surgery, where imagining an appearance with certain changes can be difficult.Because we can control computer data more than real-world biological systems, I make it a point to remind patients that the images a computer produces are goals, and not an absolute representation of things to come. However this has been useful, when taken along with other means of communication, in continuing the dialogue that helps me learn as much as I can about a patient’s goals.
For me, the most satisfying part of plastic surgery (and life in general) is when things come together smoothly and harmoniously. As a plastic surgeon, sometimes this moment of exhilaration will come in the operating room at the end of challenging procedure, with beautiful and balanced results.

Sometimes, the best moment of my efforts is immediately after a bandage is removed and patient sees his or her results. There can be great joy in realizing that the goals we have set out to achieve are accomplished, and I never get tired of sharing this moment with a patient.

But final satisfaction can even come months or years later at a long-term post-surgical visit. Often it’s great to see that a patient is visibly more secure and relaxed as a result of living more comfortably within their own better-balanced bodies after surgery.
Did you know that legally, any doctor can perform any type of surgical procedure? There’s nothing in the law that says a foot surgeon can’t change out a heart valve, or an eye doctor can’t perform a liver transplant. Therefore, our society depends on patients themselves to learn about their doctors’ credentials and to ask about training and certification before they sign up for surgery.

Another thing you may not know is that many different groups of doctors have formed “boards” of this-and-that which have no national recognition whatsoever.

The highest authority in the country for medical education is called the American College of Graduate Medical Education (ACGME). This institution declares what boards are worthy of approval, and in a sense they are the most important line of protection for the public in medicine.Of all the groups that practice, perform and sometimes dabble in cosmetic surgery, only the American Board of Plastic Surgeons (ABPS) has ACGME approval to provide board certification in Plastic Surgery.There can be treacherous waters out there – remember to ask the questions necessary to make sure your doctor is qualified. Is he or she ABPS certified?