Posted in "Secrets" of Cosmetic Surgery, December 12th, 2011 | Posted by Dr. Kreidstein

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.

Posted in "Secrets" of Cosmetic Surgery, Answers to your questions, November 28th, 2011 | Posted by Dr. Kreidstein

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.

Posted in "Secrets" of Cosmetic Surgery, Breast, November 15th, 2011 | Posted by Dr. Kreidstein

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.

Posted in Rejuvenation (anti-aging), October 25th, 2011 | Posted by Dr. Kreidstein

Scars after facelift surgery can sometimes be conspicuous, and this would be a particular problem with little or no hair to provide coverage of the scars. A popular option in this case is the anterior neck lift, which puts all the scars in the skin creases at the front of the neck. Although these scars may be visible, they are not recognizable as cosmetic surgery scars and may be preferred to the typical facelift scars around the ears.

Posted in "Secrets" of Cosmetic Surgery, October 23rd, 2011 | Posted by Dr. Kreidstein

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.

Posted in Answers to your questions, Surgical Procedures, May 16th, 2010 | Posted by Dr. Kreidstein

Fewer consultations in our practice are as emotionally charged as the patient seeking hymenoplasty.  Patients seek this procedure for many reasons, but most commonly it is to physically reverse an unwanted sexual encounter, or to enable a marriage which requires virginity as a precondition.

Our patients are often surprised to find themselves in a Plastic Surgeon’s office, not associating plastic surgery with a gynecologic procedure.  It so happens that reconstruction of female genitalia, either following cancer surgery (vulvectomy) or in transgender surgery is a common part of plastic surgery training, and repair of a torn hymen is extremely simple relative to these other reconstructive procedures.  An office like ours is also able to provide the privacy and confidentiality that is impossible to offer in a general hospital.

Does hymenoplasty ‘work’?  Sutures used in the repair have fully dissolved by 3- 6 weeks following surgery, and the hymenal membrane heals without visible scar making detection of surgery impossible.  Bleeding and pain during intercourse has been described to us as ‘ a bit more than the first time’, but that was not seen as a negative characteristic.  No doubt confidence in one’s ‘virginity’ is the most important criteria for a successful performance.

Is hymenoplasty immoral? We are in no position to give advice here, but until men are required to be virgins at marriage it seems hypocrisy to expect that of women.  What of beginning a marriage with a lie?  Not ideal, but every relationship has its share of deceptions, and it is for you to decide if this one is necessary.

Posted in Breast, November 17th, 2009 | Posted by Dr. Kreidstein

Liposuction is a very attractive option for breast reduction, primarily because it spares the breast from conspicuous scars.  It is most successful when the breasts have a good shape with little ptosis (the areola is not too far below the inframammary fold), the breast tissue is not dense (gland can’t be reduced by liposuction), and the amount of reduction required is not more than one or two cup sizes.  Be sure to discuss this option with your plastic surgeon if you are considering breast reduction.

Liposuction for Breast Reduction

Posted in "Secrets" of Cosmetic Surgery, Non-surgical procedures, November 4th, 2009 | Posted by Dr. Kreidstein

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!

Posted in "Secrets" of Cosmetic Surgery, Body Contouring, October 21st, 2009 | Posted by Dr. Michael Kreidstein

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.

Posted in "Secrets" of Cosmetic Surgery, Rejuvenation (anti-aging), Surgical Procedures, September 28th, 2008 | Posted by Dr. Michael Kreidstein

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. Read the rest of this entry »

« Previous EntriesNext Entries »