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In Your Face ~ How celebrities and ordinary people use cosmetic medicine, in Orange County and elsewhere.

Archive for the 'When things go wrong' Category

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New feel-good plastic surgery law is pointless

October 19th, 2009, 6:42 am by Colin Stewart

donda-west-200w-022006-apRapper Kanye West, state legislators and Gov. Arnold Schwarzenegger might feel better about themselves now that the Donda West Law has been enacted.

But the law is pointless. It will make no one any safer.

All it accomplishes is a bit of emotional catharsis by enacting a tribute in memory of a woman who died from complications related to plastic surgery.

What it requires is already routine among good doctors, yet bad doctors don’t have to worry about it. The law imposes no punishment on those who ignore it.

Passed in response to the 2007 death of Donda West (pictured), mother of Kanye West, the law requires a doctor to perform a physical examination before cosmetic surgery. It also applies to dentists who recently gained the right to perform cosmetic facial surgery.

The same bill was passed last year, but at that time it was rejected by Schwarzenegger, who said he was refusing to sign non-priority legislation because of the state’s budget crunch.

As this blog commented last year, passing a law requiring doctors to examine their patients is like mandating that surgeons wash their hands before an operation. Anyone who would ignore such a basic safety precaution isn’t likely to worry about the prospect of a technical infraction, yet violating the Donda West Law would not be a criminal offense.

At the Irvine Plastic Surgery Center, for example, the sort of screening required by the new law has long been standard practice, said plastic surgeon Dr. Tenley K. Lawton:

Anyone over the age of 45 must undergo a physical examination and clearance from their primary medical doctor (PMD) prior to proceeding with surgery. This applies even to healthy individuals with no history of medical problems. Patients under the age of 45 with any medical problems are also screened by their PMD.

Patients can find clues about which plastic surgeons to trust by checking to see which doctors are board-certified in plastic surgery and which are the target of consumer complaints. See the post “How to avoid bad doctors” for specifics about identifying inadequately trained, careless surgeons.

That post includes information on the California medical board’s disciplinary action against Dr. Jan Adams, the plastic surgeon who lost his license several months after he operated on Donda West.

West, 58, died Nov. 10, 2007, while recovering from breast reduction, tummy tuck and liposuction procedures. An autopsy report found that West likely died of heart disease coupled with complications from the plastic surgery.

West’s family says Adams did not perform a physical exam that would have revealed that she had coronary artery disease, which made the surgery hazardous.

If West had checked up on him before her surgery, she would have seen information such as this: “Adams, Jan. Plastic surgeon in Los Angeles. … Malpractice judgments — $23,438 in October 2007; $288,147 in December 2007; $217,337 in September 2001; and $250,000 in August 2001.”

Plastic surgeon / blogger Dr. John Di Saia of San Clemente and CosmeticSurgeryTruth.com said  “legislators probably felt impelled to appear as if they are doing something even if it really does nothing.”

Plastic surgeon / blogger Dr. Tony Youn said:

Instead of enacting unnecessary laws, why not limit plastic surgery to those who are actually trained at it?

The California legislature has recently approved a bill allowing oral surgeons (DDS dentists) to perform all sorts of facial plastic surgery. How ridiculous! You wouldn’t want me performing your root canal, so why have an oral surgeon do your facelift?

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Posted in: Plastic surgery • When things go wrong • • | Post a Comment »

Liposuction patient dies in Florida

October 15th, 2009, 6:17 am by Colin Stewart

rohie-kah-200w-nydailynewsdotcomLegal and medical authorities are still working to understand why a 37-year-old nurse died in connection with liposuction treatment at a Florida med spa.

Rohie Kah-Orukotan (pictured) had been declared brain dead after the Sept. 25 surgery. This week, the medical examiner in Broward County, Fla. announced that she has died.

The Miami Herald’s account of her death did not mention an exotic type of treatment that was previously considered as a possible cause of her death. That treatment, carboxytherapy, involves an injection of carbon dioxide gas under the skin to reduce the appearance of cellulite or stretch marks.

The operation was performed by Dr. Omar J. Brito Marin, an occupational medicine specialist who had taken a three-day intensive course in cosmetic surgery procedures, his attorney said.

The attorney, Brian Bieber, said the doctor “committed no malpractice, and this is a tragic consequence of a routine surgical procedure. Unfortunately, medicine is not an exact science.”

He has done about two dozen liposuctions, the attorney said.

(Photo of Rohie Kah courtesy of NYDailyNews.com.)

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Posted in: Plastic surgery • When things go wrong • | Post a Comment »

Tough-looking rival to Juvederm and Restylane is failing

October 9th, 2009, 4:00 pm by Colin Stewart

Jenny McCarthy‘Botoxed beauties’ slide show

Evolence injectionONE YEAR OLD

A year ago, the new collagen filler Evolence was the new kid on the block — and looked tough.

Backed by health care giant Johnson & Johnson, Evolence seemed likely to pose a strong challenge to the market-leading dermal fillers, Juvederm from Allergan of Irvine and Restylane from Medicis Pharmaceuticals of Scottsdale, Ariz.

But sales have been so slow that J & J plans to sell Evolence’s manufacturer, the Israel-based subsidiary, ColBar, according to a business newspaper in Israel. The Globes business daily reported:

Sales of Evolence amount to only $25 million a year, far below Johnson &
Johnson’s expectations.

There are several reasons for this. First, Johnson &
Johnson does not specialize in aesthetic products, so its sales network,
known as a powerhouse in other fields, is weaker in this one. Secondly, competition in the wrinkle removal market is fierce and steadily intensifying.

J & J purchased ColBar for $159 million in late 2006 and now wants to shut it down or sell it for $20 million, Globes said.

J & J declined to comment on the report.

As Evolence hit the U.S. market in September 2008, several doctors surveyed by this blog predicted that it would account for 20 percent to 50 percent of their filler business within a year, if it performed as expected. If those predictions had proved true throughout the market, Evolence sales would total roughly $80 million to $200 million.

Some doctors say they’re fans of Evolence, but many dislike it or at least worry that it might cause allergic reactions because it’s made from pig tendons. For example, plastic surgeon Dr. Andrew Smith of Irvine and Corona said:

It didn’t offer enough of an alternative, because not many people use collagen
anymore. A softer filler like Evolence that doesn’t have anti-rejection (allergic) problems has potential advantages, the long-lasting duration of it is appealing, but it just didn’t catch on quite yet.

You risk something when you try something new. I’ve had a high degree of success with my current round of fillers so it’s always risky to try something new and have it not quite be perfect.

On the cosmetic medicine Web site RealSelf.com, Evolence is one of the lowest-rated injectables in the site’s unscientific but useful patient surveys. Only 39 percent of the site’s readers said the procedure was worthwhile.

Dermatologic surgeon Dr. David Sire of Fullerton had high hopes for Evolence a year ago, but was disappointed. He said:

When Evolence was first released it was presented as a safe and effective porcine collagen that did not need skin testing and had a very low incidence of bruising and pain upon injection, which was an advantage over the hyaluronic products [such as Restylane and Juvederm] that were then on the market.

They promised to market it aggressively — which they did not do — and early results were disappointing. … We have been sort of neglected by Johnson & Johnson. I would not be surprised to see it sold by Johnson and Johnson.

Dermatologist Dr. Lorrie Klein of Laguna Niguel said she hasn’t tried Evolence, but “From my research on it and hearing other physicians speaking about it, … it’s not any better than any other filler, plus it comes from an animal (pig) which makes it more likely to cause an
allergic reaction, although very rare.”

Plastic surgeon and blogger Dr. John Di Saia of San Clemente and OCBody.com said its derivation from pig tendons was “kinda ironic” for a product from traditionally pork-shunning Israel. Further, he said, “As the movement within the facial filler market has been ‘less animal-derived and more human-compatible,’ the product was poorly conceived for the U.S. market.”

New York-based cosmetic medicine consultant Wendy Lewis is an advocate of a finely textured version of Evolence, called Breeze, which is used to fill out the lips.

But it has not been approved for sale in the United States because clinical trials needed for FDA approval were postponed, she said.

“Unfortunately, there were several strikes against Evolence’s success — the global economic crisis being one,” Lewis said.

“Injectors who use it love it,” she added, and it has “high patient satisfaction too.”

Photos below (courtesy of Johnson & Johnson) show Evolence patients before and after treatment.

evolence-450pxw-before-and-12-mos-after-ortho-dermatologics

Related links:

Slide shows:

Posted in: Non-surgical treatments • When things go wrong • • • • | Post a Comment »

Experts focus on brain-dead cosmetic patient

October 5th, 2009, 1:38 pm by Colin Stewart

rohie-kah-200w-nydailynewsdotcomLegal and medical authorities are working to understand how a 37-year-old nurse ended up brain dead as a result of cosmetic procedures in a Florida med spa.

Part of the uncertainty is whether Rohie Kah (pictured), a patient at the Weston MedSpa in Weston, Fla., had liposuction under a local anesthetic or underwent carboxytherapy, an injection of carbon dioxide gas under the skin to reduce the appearance of cellulite or stretch marks.

Plastic surgeon and blogger Dr. John Di Saia of San Clemente and OCBody.com speculated that the carbon dioxide “probably was inadvertently injected into a vein resulting in a fatal air embolism.”

Plastic surgeon and blogger Dr. Tony Youn of Michigan focused on the experience and credentials of Dr. Omar J. Brito Marin, an occupational medicine specialist who performed the operation.

“What’s an occupational medicine physician doing performing cosmetic treatments anyway?” Youn asked. “Just as I, a board-certified plastic surgeon, have no place performing brain surgery, this doctor (and so many others like him) has no place performing plastic surgery.”

Youn also told AOL Health:

“If she just had carboxytherapy — which is a fringe procedure that is not FDA-approved — it would be very difficult to understand why that would cause actual death. But any time liposuction is done, lidocaine is used and it’s possible to overdose on lidocaine, which can cause a sudden cardiac event and cause someone to die.”

Di Saia said the death showed that supposedly non-invasive procedures such as carboxytherapy can be hazardous:

I do not believe many doctors are offering the treatment in Orange County. A search of the Web shows one in Beverly Hills.

The research on the procedure is relatively sparse. … This is not compelling evidence that it is effective. It is not FDA-approved.

An underlying assumption in the realm of non-invasive therapy is that these treatments are less risky than conventional cosmetic procedures. Now that this treatment has an associated death, hopefully it will fade into even more obscurity.

He added on his blog:

People need to realize that funky injection therapies are not FDA-approved and that means you are experimenting with your body. When you let someone at a MedSpa near you with a needle, consider what might be in there and the reputation and training of your injector. It is not natural to inject carbon dioxide in your body.

Carboxytherapy is  offered by Dr. Raphael Nach, a Beverly Hills doctor who is board-certified in treating ears, nose and throat and who also practices cosmetic surgery.

In a recent article in Cosmetic Surgery Times, he said that carboxytherapy was developed in France. Injected carbon dioxide destroys fat cells and strengthens blood flow, which delivers more oxygen to tissues and eliminates built-up fluids between cells, he wrote.

The therapy can be combined with liposuction, he wrote, “dissolving remaining areas of fat and correcting irregularities left at the time of the initial surgery.”

“Although I have used carboxytherapy in the treatment of stretch marks and cellulite with encouraging results, it’s not the basis of my practice,” Nach wrote.

(Photo of Rohie Kah courtesy of NYDailyNews.com.)

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Posted in: Plastic surgery • When things go wrong • • | Post a Comment »

Doc gives up license after allegedly botching breast implants

October 1st, 2009, 7:53 am by Colin Stewart

An Anaheim Hills doctor has surrendered his medical license in response to extensive allegations of botched operations, including shoddy breast implant procedures.

Dr. Harrell Edward Robinson, who was trained as a head and neck surgeon rather than as a plastic surgeon, was also accused of performing a facelift and liposuction on a patient who wanted a tummy tuck.

After Robinson replaced a woman’s breast implants, the patient was admitted to a hospital with an open wound in which an exposed implant was visible, O.C. Register reporter Courtney Perkes wrote. Perkes reported:

One of Robinson’s former patients, Michele Fernandez, 32, of Hemet said he gave her breast implants and a breast lift. She said she has had two infections, one implant is deflating, and her nipple looks like “a rat chewed it.”

“I regret it. I’ve had nothing but problems,” Fernandez said.

Robinson was also accused of illegally purchasing an addictive painkiller and selling it to a local clinic. CLICK HERE for the full story, “Doctor gives up license for selling drugs.”

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Posted in: OC • Plastic surgery • When things go wrong | Post a Comment »

15 ways to spot a bad doctor

September 2nd, 2009, 3:00 am by Colin Stewart

stitches-medium-in-lv-breast-implant-ktnvdotcomA local woman entered a Huntington Beach medical office to treat her acne and came out with laser scars.

A woman in Las Vegas won a contest last spring that offered free breast implants as a prize.  The operation left her with amateurish stitches (pictured) and misplaced, deflated implants that weren’t even fully covered by her skin, a local TV station reported.

Such problems highlight the importance of this question:

How can a patient stay out of the clutches of an incompetent plastic surgeon or dermatologist?

Lots of ways, according to experts on the Sept. 2 online “In Your Face CHAT.” The chat’s online guests, plastic surgeon Dr. Steven Dayan (pictured) and his marketing director, Tracy Drumm, had many suggestions for avoiding trouble.

They were responding, in part, to this woman’s sad tale about her experience in Huntington Beach, which she submitted to this blog so it could be discussed in the online chat:

“While under [the doctor's] care, my skin got 10 times worse than it ever was in my entire life. Acne along with many permanent crater scars were left on my skin.

“She told me I needed to buy more laser and facial steven-dayan-200wtreatments from her as well as ‘her’ own special creams that she supposedly concocted.

“I spent thousands here and every time I complained that my face was getting worse. She made me buy something else. If I did not comply, she would say my problems were because I did not follow her instructions, so I did as I was told.”

After she changed doctors, she said, “My skin cleared up dramatically after less than the first month!”

Dayan commented, “If you are not content with your treatment I think it is always a good idea to get a second opinion. That goes for all of medicine.”

Drumm (pictured) added, “As a rule of thumb, we advise patients to always ask their cosmetic physician/surgeon the following 15 questions before having a procedure performed.”

These are the 15 questions for patients to ask before going to a doctor, which can help you identify an ill-prepared doctor or a cosmetic procedure that’s not right for you:

1. How long have you been performing the treatment I am interested in?

2. Do you have hospital privileges to perform the treatment I desire?

3. How often do you perform the treatment I am interested in?

4. How mtracydrumm-200w-of-chicago-not-docany treatments are needed?

5. If considering a new product or device: How long has it been used?

6. Can I see before and after photos?

7. Can I speak with individuals who have had this treatment done?

8. What are the possible complications?

9. Have you see any complications?

10. If you have seen complications how were they treated?

11. Will you perform the treatment or will it be delegated to someone else?

12. How available are you after the treatment?

13. Are you affiliated with any academic institutions?

14. Are you board certified?

15. What does it mean to be board certified?

Separate from the chat, blogger and plastic surgeon Dr. Tony Youn commented on the complexities of spotting an unqualified doctor. In the Las Vegas case, Youn noted:

- The doctor’s website had stated he was board-certified.
- He was not certified by the American Board of Plastic Surgery, but by the Family Practice board.
- Still, his website listed him as an associate member of the American Academy of Cosmetic Surgery, the American Society of Laser Medicine and Surgery, American Society of Liposuction Surgery, and the American Society of Cosmetic Dermatology and Aesthetic Surgery.

This is another terrible incident where the patient didn’t do her homework and was the victim of a phony plastic surgeon. This unfortunately happens more often than most people realize. Always choose a surgeon certified by the American Board of Plastic Surgery and a member of the American Society of Plastic Surgeons. As you can see above, a doctor in a bunch of other societies isn’t the same.

The Las Vegas doctor’s license has been suspended, pending an investigation by the Nevada State Board of Medical Examiners.

The Sept. 2 chat continued on the same topic. Here is a gently edited version of the rest of the discussion:

In Your Face: That’s similar to some longstanding advice from Kiplinger’s about selecting a cosmetic doctor:

No matter how many certificates you see on an office wall, you need to determine whether a doctor’s training in a particular procedure reflects serious study. It has become more common for physicians to take a weekend course or to read a book on, say, liposuction and set themselves up as practitioners.

If you decide to go surgery shopping, first ask friends and your primary-care doctor for recommendations. Then check whether the doctors they suggest, including ophthalmologists and dermatologists, are certified by a board recognized by the American Board of Medical Specialties (800-776-2378; www.certifieddoctor.org). Certification by the American Board of Plastic Surgery, for instance, requires at least five years of training beyond medical school, including two years in plastic surgery.

But board certification is only a starting point. Also ask whether the doctor has privileges at an accredited hospital, which means he or she has been judged acceptable by medical colleagues. If an outpatient surgical center is involved, find out whether it is approved by the American Association for Accreditation of Ambulatory Surgery Facilities (888-545-5222; www.aaaasf.org).

Daniel R. Carmody, M.D.: Well, I’m a surgeon and I do agree with you Dr. Dayan. Patients need to do their research and make sure [that a doctor is] experienced in their field.

In Your Face: Perhaps this problem wouldn’t have happened if she had asked your 15 questions ahead of time.

Tracy L. Drumm: Good point!

This is one of several posts based on the Sept. 2, 2009, online “In Your Face CHAT” with plastic surgeon Dr. Steven Dayan of Chicago and his marketing director, Tracy Drumm. They are the authors of “Thrive,” a book for cosmetic doctors about how to please patients and keep them coming back for more treatments and spreading positive word of mouth. For more information, see the transcript of the full session.

Surgery photo courtesy of KTNV.

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Slide shows:

Posted in: In Your Face CHAT • When things go wrong | 1 Comment »

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