dr.kreidstein » “Secrets” of Cosmetic Surgery

Safety and Private Office Surgery

Dr. Kreidstein — Mon, 12 Dec 2011 05:14:17 +0000

Private offices have some distinct advantages over hospitals for cosmetic surgery:

1. The medical and nursing staff are specialized in cosmetic surgery
2. Special equipment unaffordable to hospitals may be available
3. Exposure to ‘hospital-grade’ bacteria is minimized
4. Privacy far exceeds what is available in hospital
5. Customer service can be embraced in a private facility. There are too many competing needs in a hospital, and patient care can be overlooked
6. Individual responsibility of the Medical Director, Surgeon and Staff ensure greater attention to every detail of a private office

A possible disadvantage of private office surgery is the isolation of surgeons and staff from the education, over-sight and resources available in hospital.
This can be overcome to some degree by choosing a cosmetic surgeon who also maintains a hospital-based practice. Patients who choose a surgeon with a hospital practice may enjoy the following advantages:

1. Larger procedures will be performed in hospital where they belong. Some patients benefit from more complex procedures that require longer OR times and over-night stay and a surgeon without hospital privileges may try to do this in a private facility and thus expose the patient to increased risks.
2. A patient who develops complications can be readily transferred to hospital to remain under the care of their original surgeon. A surgeon without privileges may delay transfer to another doctor for fear of criticism or investigation.
3. Surgeons who work in hospitals are exposed to education in current best practices.
4. Perhaps most importantly, hospitals privileges provide an important form of accreditation for your surgeon, as there is careful scrutiny of a surgeon’s hospital practice by independent doctors, nurses and administrators in the hospital.

The Out of Hospitals Premises Inspection Program (OHPIP) was established by the College of Physicians and Surgeon of Ontario to improve the quality of care in private offices. It will undoubtedly succeed in improving some practices, and may succeed in closing unsafe facilities. Unfortunately, this program may also create a false sense of security for patients, as patients may assume that OHPIP certification is a sufficient endorsement with which to choose a surgical practice. The OHPIP inspection process is very limited, and includes observation of as little as one operation on a single day of surgery. It provides only a small glimpse into a surgical practice, and in no way can substitute for the evidence of 5+ years training and testing that Royal College certification provides. The OHPIP also does not require Royal College certification for a doctor to work in private premises. Furthermore, the OHPIP does not require surgeons who work in private premises to maintain hospital privileges.

What does this mean for you, the prospective cosmetic surgery patient? Office surgery is safer than ever, but there are still traps out there. Ask if the premises have passed the OHPIP inspection, but also be certain of your surgeon’s Royal College specialty training, determine if your surgeon has hospital privileges, and use your consultation wisely as an important learning experience as you narrow your list of possible surgeons.

Reviews and Choosing a Surgeon

Dr. Kreidstein — Mon, 28 Nov 2011 22:19:59 +0000

Social media and message boards give each of us an unlimited opportunity to praise or criticize the people, products and services with which we interact. Unfortunately, this freedom and anonymity brings out the worst in some people. The ability to freely attack one’s business competitors is an overwhelming temptation for some. For others, any imagined slight or disrespect is enough to trigger a multi-pronged libelous vendetta.
As you browse through reviews, how do you know what to believe? A skeptical approach to any overly-passionate review is probably wise. People generally don’t get too excited in reviewing a coffee maker, and thus the reviews are likely to be pretty reliable. But when the topic is emotionally charged, like your result from cosmetic surgery, there is a tendency to become polarized in your thinking, and lots of ‘best ever/worst ever’ reviews are posted. These reviews (positive and negative) do not give a reliable picture of the results of a practice. Unfortunately, patients with good results that met their expectations don’t generally post reviews!
A negative review written by a patient who was declined surgery may say more about the patient than the surgeon. Patients occasionally present to the office with a problem that can’t be improved, they may have unrealistic demands, and there are patients who will clearly not be happy no matter what is accomplished through surgery. Declining to offer surgery is sometimes the best we can do for a patient.
Sometimes, a result from surgery is perceived as less than ideal. This isn’t necessarily the work of a ‘bad surgeon’, and it might just as well represent a case of unrealistic expectations. A good surgeon acknowledges the possibility of touch-up surgery at the original consultation. A good surgeon also recognizes when an outcome is 95% perfect, and when further surgery is likely to make the situation worse rather than better.
So what can you learn from negative reviews when they may represent a legitimate complaint, a nasty attack by a competitor, or an irrational response to a great result? You can learn what might be problem areas in a practice, and what type of questions to ask at your consultation with a cosmetic surgeon. If you read a review in RateMD or Google Reviews that a surgeon ‘has nasty staff and is unavailable after surgery’, make a point of sizing up the staff, and bring up your concerns about availability at your consultation. If you read that a surgeon doesn’t do surgery under OHIP, ask if this is true before you book your consultation. If there is a particular review that is bugging you, ask the surgeon to address the comments in the review and then decide if it is still a legitimate concern for you. Just because you read something doesn’t make it true, but it might be a clue to a problem that you should explore before making your final decision.

Breast Augmentation in Toronto

Dr. Kreidstein — Wed, 16 Nov 2011 03:05:56 +0000

It’s natural to want the best, especially when it comes to something as important as your health. But unless you can define ‘the best’, it will be hard to recognize it when you find it. There are several criteria to look for in a surgeon, but perhaps the two most important are the quality of the consultation process and the technical skill of the surgeon. Breast augmentation, also known as breast implant surgery, is a good example of surgery that can be mastered by even an average plastic surgeon. Creating a pocket and putting in an implant is not a difficult procedure, and so it is the consultation process that allows a top surgeon to shine. It’s at a consultation that the patient explains their goals, learns about the options available and the risks and benefits of each option. This consultation must take place entirely with the cosmetic surgeon doing your surgery. It is a lengthy process, and there are many consultations that take place over a series of visits before a final decision is made. If you feel rushed, or uncertain, try to understand why you feel that way and explain your insecurities at the consultation. By confronting these issues, you will improve your chances of getting the best result possible.

Consultation fees for Cosmetic Surgery

Dr. Kreidstein — Mon, 24 Oct 2011 03:49:31 +0000

Why should you see a surgeon who charges a consultation fee when some surgeons give free consultations? Your consultation is the most important step in having a successful surgery experience. If you see a surgeon who doesn’t charge a consultation fee, the consultation becomes primarily a screening process for finding candidates for surgery. As a result, if you are not someone who is a good candidate, you can count on a quick ending to your consultation. More importantly, the surgeon may become financially biased towards talking you (and himself) into your suitability for surgery, and receives no reward for reassuring you that surgery is unnecessary, or advising you that someone else may have something better to offer. Just as surgeons receive a fee for consultations for insured (OHIP) covered procedures, a consultation fee for cosmetic procedures allows the surgeon to dedicate the consultation to simply giving good advice.
Problems occasionally will arise, as some patients assume that paying a consultation fee obliges the surgeon to operate on them. As much as you may be measuring up a surgeon to decide if you want them to do your ‘work’, the surgeon is also deciding whether you are likely to be happy with typical results, and will properly refuse surgery if you aren’t a good candidate. We will occasionally see a patient who has nothing to gain from a consultation, and offer to interrupt the consultation and return the consultation fee. We see many patients who ultimately can’t be offered surgery or one of our other treatments, but are rewarded by the knowledge gained from a full discussion of their complaint and the alternatives for management. We are connected with a vast professional network, and can often recommend someone with expertise in areas outside our practice.

Costs for Botox injections- Why do some practices charge more?

Dr. Kreidstein — Thu, 05 Nov 2009 03:15:56 +0000

The effectiveness of Botox depends on many factors, and you should consider more than the cost of the Botox in choosing a clinician. Cost per unit of Botox is a good starting point in comparing prices. $12 per unit may prove cheaper than $8 if the same effect can be produced with a lower dose of units. A practice that uses Botox frequently will have a fresher stock that may be more effective. Syringes that are designed to minimize loss can make a big difference, especially in small volume injections. A GP or dermatologist may never have actually seen the muscle they are trying to inject, whereas a Plastic Surgeon will have great experience in locating the muscle during surgery and will have greater success in placing an injection in the right spot. A second advantage of treatment by a plastic surgeon is that you want your treatment from a clinician who can give an unbiased opinion of whether Botox is the right solution, or perhaps surgery is more appropriate. It is very difficult for a clinician to give a fair comparison of all the options if he is limited to offering only one of them!

Drains and Abdominoplasty/Tummy Tuck

Dr. Michael Kreidstein — Thu, 22 Oct 2009 03:10:35 +0000

Patients often express surprise that they will not require drains after their abdominoplasty/tummy tuck. Although some surgeons continue to use drains, our experience over the past 10 years matches published reports in which drains can be eliminated if certain steps are taken during surgery. Most importantly, we place ‘progressive tension sutures’ to attach the skin back to the muscle layer. Not only does this close the space that would otherwise accumulate blood/fluid, but it allows the final wound edge closure to occur without tension. This helps to prevent the scar from riding up (above the bikini line)after surgery, and may prevent scar problems that arise from excessive tension.

Are all facelifts the same?

Dr. Michael Kreidstein — Mon, 29 Sep 2008 01:51:18 +0000

There are few procedures in plastic surgery with more variations than the facelift. Understanding something about this operation may help you to understand the controversies, and may help you to ask the right questions when you meet with a prospective surgeon.With dozens of variations, the facelift is a fascinating operation for plastic surgeons. Surgeons may modify their technique over the years, or do the same operation for 40 years. What follows is a summary of some important decisions a surgeon must make in developing their technique.
1. incisions: if placed behind the hairline, the scar is better hidden, but the hairline is pulled back and can create deformity, especially if the procedure is repeated. So called short scar techniques minimize the scar behind the ear, but are less effective at correcting loose neck skin.
2. mini-lift vs formal facelift: Some procedures involve simple excision of skin from in front of the ear and possibly a suture hitching up the deep tissues. Results from such a procedure will be quite temporary, as there is little to stop the tissues from stretching out. If your surgery will take less than two hours, it is likely there is insufficient work to provide a durable result.
2. volume correction: A youthful face is not an old face with tight skin! Ask your surgeon to explain what efforts they will take to re-establish youthful contours in your face.
Understanding these issues will help you to understand why results, costs, and surgical recovery times can vary widely from surgeon to surgeon.