BREAST IMPLANTS LINKED TO SUICIDE

슈링크 효과 Ascend Media성형 LLC Plastic Surgery Products provides plastic surgeons with the latest information on clinical innovations, practice 성형외과management trends, and emerging products and technologies. About PSP Contact Us Subscribe HOME | NEWS | CURRENT ISSUE | BUYER’S GUIDE | ARCHIVES | RESOURCES BREAST IMPLANTS LINKED TO SUICIDE Article Tools » E-Mail This Article » Write the Editor » Print This Article8/18/06 A Canadian study shows that women with breast implants do not face a higher risk of cancer or other major diseases, but they may have a higher than average rate of suicide. Among the 40,000 women in the study, those who had received aesthetic breast implants had 눈성형 lower than average risks of dying from breast cancer, heart disease, and a host of other major diseases. Despite concerns that implants might be a risk factor for cancer or other major illnesses, researchers have generally found lower risks among breast implant recipients. “To some extent, what you’re seeing is a screening effect,” says Howard Morrison, MD, at the Public Health Agency of Canada in Ottawa. “That is, women who undergo 눈성형 효과 elective invasive surgery are necessarily in good health, and may have lower than average risks of various diseases.” The research also confirmed another finding—women with breast implants commit suicide at a higher than average rate. “These findings agree fundamentally with those of past reports,” says Morrison. “The one thing that lights up is this increased suicide risk.” Morrison notes that other studies have found poorer self-esteem and elevated rates of depression and other psychiatric 눈성형 비용 disorders among women who opt for breast augmentation. Compared with rates for the general population, women in both surgery groups were about one-quarter less likely to die of cancer, and their risks of death from other major diseases were similarly lower. Women with implants were, however, 73% more likely than those in the general population to commit suicide, while women who had other forms of plastic surgery also had an elevated suicide rate. The risk was not dramatic, Morrison notes, as few women in the study committed suicide—including 58 of the 24,000 breast implant patients. Still, he says it “seems reasonable” to suggest plastic surgeons refer implant seekers for mental health consultation when they suspect the patients are at high risk of a psychiatric disorder or suicide. [American Journal of Epidemiology, August 15, 2006]

WEIGHT LOSS REDUCES CELLULITE

A study in the August issue of Plastic and Reconstructive Surgery reports 눈밑지방재배치 that weight loss may decrease the severity of cellulite for some women—but may worsen the condition for others. “There is no answer for completely eliminating cellulite, however, it appears the more weight one loses, the better its appearance,” says John Kitzmiller, MD, a coauthor of the study. “Although the appearance of cellulite diminished for the majority of patients, weight loss did not totally eradicate the condition. The dimples appear to be permanent features that lessen in depth as the pounds come off.” The study examined 29 women who enrolled in medically supervised weight loss 눈밑지방재배치 효과 programs that included low-fat meals, liquid diets, medication, and bariatric surgery. Seventeen patients experienced an improvement in the appearance of their cellulite and nine worsened. The average weight loss was 30.5 pounds; the range was 2.3 to 102 pounds. Patients who lost larger amounts of weight and lowered the percentage of fat on their thighs experienced the greatest improvement in cellulite. These patients had a significantly higher starting body-mass index (BMI) and had more severe cellulite on average. Patients whose cellulite worsened started with a significantly lower BMI, lost smaller amounts of weight, and had no change in percentage of thigh fat. Skin elasticity after weight loss also played an important role in improving the appearance of 눈밑지방재배치 비용 cellulite. Cellulite worsened in those whose skin became significantly looser after weight loss. [www.sciencedaily.com, August 15, 2006]

IMPROVING GOVERNMENT–AESTHETICIAN COMMUNICATION

The National Coalition of Estheticians, Manufacturers/Distributors 쌍꺼풀 & Associations (NCEA) announced a plan to improve communications between state boards and licensed aestheticians across the country. According to the쌍꺼풀 수술 NCEA, state representatives will bring national standards to state board meetings to help educate state board members about the evolving 쌍꺼풀 효과 technologies in the industry. For more information, 쌍꺼풀 비용 visit www.ncea.tv.

BREAST AUGMENTATION WITH FAT GRAFTING

Manhattan-based surgeon, Sydney Coleman, MD, 쌍꺼풀 매몰법 is using a new technique for breast augmentation—fat grafting—that transfers fat harvested by liposuction from the waist and thighs to the breast. Augmenting the breast with the body’s own fat first became popular in the 1980s. Women loved the idea of using their own tissue to upsize and they were thrilled with losing girth from below the waist, while blossoming up top. However, the procedure largely fell into disuse after 1987 when the American Society for Aesthetic Plastic Surgery declared it should be 쌍꺼풀 절개법 prohibited because of side effects that included cysts, calcification, tissue scarring, and mimicked breast cancer. Coleman insists the official caution was all about politics. “The decision was taken for purely political and economic reasons,” he says. The delicate and demanding technique was threatening to people whose practices were based on implants. Surgeons doing breast implants got together and decided to eliminate the possibility of fat injections to the breast.” Coleman and others 세미아웃 quietly persevered, refining and improving the technique. Now, more precise and sensitive breast imaging, including ultrasound and magnetic resonance imaging, along with vastly improved techniques and skills of fat grafting, have paved the way for a resurgence of “lipomodelling” of the breast. Coleman says the technique won’t replace implants, but it will be a surgery performed commonly. An article on this topic will appear in the 세미아웃 쌍꺼풀 October issue of Plastic Surgery Products. [www.thestar.com, August 11, 2006]

BOTULINUM TOXIN HELPS FACIAL SCARS HEAL BETTER

Researchers at Mayo Clinic have found that treating a facial wound in the early 세미아웃 연예인 healing phase with botulinum toxin Type A improves the appearance of a scar later. “Our findings show that botulinum toxin Type A offers an additional tool in preventing the formation of bad scars,” says Holger Gassner, MD, lead study researcher and former Mayo Clinic ear, nose, and throat surgical resident who is now a fellow in facial plastic surgery at the University of Washington. “It will give us the option to optimize healing of forehead wounds in the first place and possibly allow us to avoid later.” The researchers found that an injection with botulinum toxin Type A early after the occurrence of a wound—such as trauma from a dog bite, motor vehicle accident 쌍수 절개 or assault, or from a skin cancer biopsy or removal—paralyzes the region, creating a smooth surface in which the wound can heal. This prevents muscle movement from wrinkling the wound site, allowing for a flat surface for healing and leaving a smoother final scar. The same process also could work if an unsightly older scar is surgically removed, and then botulinum toxin Type A is injected into the wound at the time of the scar revision surgery. According to David Sherris, MD, study investigator and former Mayo Clinic ear, nose, and throat specialist who is now professor and chair of Otolaryngology at the University of New York, 쌍꺼풀 절개 Buffalo, side effects with the botulinum toxin Type A injections were minimal, including an occasional small bruise at the injection site or a headache. The largest potential risk in injecting this substance in the facial area would be transient paralysis of an important function. Patients in the trial also experienced positive side effects,눈매교정 such as a “good wrinkle benefit.” [www.newswise.com, August 8, 2006]

FDA APPROVES “GUMMY BEAR” IMPLANT STUDY

8/08/06 The US Food and Drug Administration has recently approved a study for a 눈매교정 효과 cohesive gel implant, called a “gummy bear.” Manufacturers are conducting trials in the Hampton Roads, Va, area and other locations. “You can literally cut across the implant, squeeze it, and it kind of bulges out just like “gummy bear” candy would do,” says Mike Zwicklbauer, MD, a plastic surgeon at the Plastic Surgery Center of Hampton Roads. “Then it goes right back in.” Bonnie Tomlin, who received her “gummy bear” implants in May, is one of 18 women participating in the study. “First thing I thought was, oh my gosh, they look so natural,” Tomlin says. 눈매교정 비용 “Because they sit the way real breasts are supposed to sit. They didn’t sit like softballs on your chest, like the other ones had become.” Plastic surgeons say the “gummy bear,” which is currently available in Europe, is a good implant for breast reconstruction patients. [www.wtkr.com, July 19, 2006]

LOUISE CAOUETTE LABERGE TO RECEIVE CMA MAY COHEN AWARD

8/10/06 On August 23, Louise Caouette Laberge, MD, of Mont-Royal, Quebec, will receive the 트임수술Canadian Medical Association 2006 May Cohen Award for Women Mentors. The May Cohen Award is awarded annually to a woman physician who has demonstrated mentoring abilities, such as encouraging, facilitating, and supporting mentored physicians in career and leadership development and acting as an effective role model in medicine or medical leadership. “I have been lucky to enter into a career that I truly enjoy and where I can contribute to the training of future surgeons,” says Laberge. “Teaching is more that the simple transmission of knowledge—rather, it is the ability to develop in others enthusiasm and love of learning. And learning by example, be it with students or with one’s ownchildren, is often more efficient than lengthy speeches.” Laberge is currently the chief of plastic surgery and director of the cleft lip and palate clinic, at Ste Justine’s children’s hospital in Montreal. A clinical professor at the University of Montréal, she wasdirector of the plastic surgery residency training program from 2000 to 2006.트임성형 [www.newswire.ca, August 9, 2006] «BACK

AACS RELEASES 2006 GUIDELINES FOR LIPOSUCTION SURGERY

8/21/06 The American Academy of Cosmetic Surgery (AACS) has released its 2006 guidelines for liposuction surgery. 트임수술 효과 The guidelines serve as recommendations for physicians and confront the important issues in liposuction surgery today. The new key points of the 2006 guidelines include: • information on anesthesia and research showing that tumescent anesthesia is safer for patients than general anesthesia alone; and • a statement on advances in laser light technologies and the importance of physicians to stay up-to-date on new techniques and to acquire proper training on the techniques. For more information, visit www.cosmeticsurgery.org. [www.cosmeticsurgery.org, August 10, 2006]

A NICE FIT

Allison t. Pontius, md, and Alain Polynice, MD, marry their facial and body plastic surgery talents트임수술 비용 Oil and water. Cats and dogs. General aesthetic plastic surgeons and facial aesthetic plastic surgeons. None of these pairings are known to coexist particularly well. Except, perhaps, the physicians at Plastic Surgery Associates of New York on Manhattan’s fashionable Upper East Side. There, one finds a perfect match between facial plastic surgeon Allison T. Pontius, MD, and practice partner Alain Polynice, MD, a classically trained aesthetic plastic surgeon who specializes in body work. “You don’t often find plastic surgeons from our respective subspecialties 트임성형 효과 getting along as well as we do,” says Pontius, a board-certified otolaryngologist. “For a lot of facial plastic surgeons and general plastic surgeons, there are substantial turf issues at stake.”트임성형 비용 Pontius and Polynice (who is certified by the American Board of Plastic Surgery and maintains memberships in the New York Regional Society of Plastic Surgery, the American Society of Plastic Surgery, and the American Burn Association) have resolved their turf issues simply by marrying their talents. “The way I see it, if you have practitioners from these two areas of subspecialization, and both are well trained, there is no reason they should be antagonists,” Polynice says. “There is instead every reason they should work in tandem, combine forces, and so be able to provide the best possible care and results.” PRACTICE PROFILE Names: Alain Polynice, MD, and Allison T. Pontius, MD Location: New York City Specialty: Facial and body plastic surgery; nonsurgical procedures Years in practice: 7 Number of patients per day: 10 Number of new patients per year: 250 Days worked per week: 5 Days surgery performed per week: 3 Number of employees in practice: 7 Office square footage: 2,000 Pontius concurs. “As an ear-nose-and-throat [ENT] specialist, my training for 6 years was the face. Nasal anatomy. Sinus surgery. 앞트임 Rhinoplasty. Facial trauma. These are all part and parcel to what an ENT deals with. Accordingly, those in my field bring to the table a different realm of knowledge about facial anatomy. “However, there is no question but that the future direction of things is moving our respective academies closer together. I think surgeons in the two subspecialties are realizing that neither is the enemy of the other.” A Marriage That Works At least for Polynice and Pontius, this marriage of face and body specialists works because Polynice and Pontius are married to each other—literally—and have been since 2003. “The best thing about being husband and wife and practicing together is that we always have someone to bounce ideas off or to get help from in the operating room,” Pontius says. “My husband and I get along well, and patients pick up on this, which helps them feel comfortable with us. They know intuitively we are going to work together to solve their concerns.” The partners complement each other’s personal qualities as well as their clinical skills: Whereas he is the more artistically minded, she is better equipped for organization. “Dr Polynice is the spontaneous one. For me, I like there to be a plan of ac­tion before I do anything,” Pontius shares. They each operate 3 days per week, working side-by-side on one of those days. 앞트임 효과 “The vast majority of our surgeries are performed on-site,” Polynice says, indicating that his plush, 2,000-square-foot office features two state-of-the-art operating rooms and a recovery area. “How­­ever, if the surgery involves procedures that call for an overnight recovery, then it’s performed in the hospital—usually at St Vincent’s Hospital, which is nearby.” It is noteworthy that the physicians have elected to situate their practice amid some of the world’s biggest names in aesthetic plastic surgery. “This neighborhood is seen as the place to go for plastic surgery, because it’s where all the best doctors are,” Pontius says. “Yes, it was a major financial investment for us to set up shop here, and we are taking a huge risk,” she continues. “But we feel it’s entirely worth it. We felt the timing was ideal for bringing new faces like ours into the area. And we’ve found that, even in New York, people are looking for new talent.” Discovery of Plastic Surgery Asso­ciates of New York by those new-talent-seeking patients most often occurs as a result of word-of-mouth promotion spread by satisfied patients and augmented through favorable mentions by important and influential media voices.앞트임 비용 “We’ve spoken with a public-relations [PR] agency to help us increase our exposure,” Pontius says. “PR professionals have the ability to get your name out. They can get news about you placed in the magazines most responsible for shaping perceptions of what’s hot and what’s not. PR is a lot more effective than paid advertising—at least it is for us in this particular market.” Plastic Surgery Associates of New York attracts mainly women, perhaps more than it might if the physician team were composed solely of men. “It’s a definite plus in the eyes of women patients that I’m a woman,” Pontius says. “There are surprisingly few practices in this neighborhood where the plastic surgeon is a woman.” A Holistic Approach Even so, a key selling point for the practice is its use of holistic treatments. “We believe in offering not only the surgical procedure but also a wide variety of adjunctive services that address the total 뒤트임 효과 person so that our patients can look and feel as best as possible,” she says. “A lot of patients fall into the trap of not seeing the big picture. They might come in for, say, a facelift but don’t realize the harm they do to themselves when they sunbathe and bake their skin, or smoke cigarettes. or have a poor diet. We try to help patients deal with these wrong lifestyle choices in order to achieve the best possible results from what we offer.” Working with patients preoperatively in this manner does not—as might be imagined—raise expectations beyond reason. Instead, its primary effect is to convey the notion that the physicians deeply care about them as human beings. “Patients usually appreciate that I’m concerned about the harm they’re doing to themselves by smoking or eating poorly, and they appreciate that I’m interested in their entire well-being,” Pontius says. In some instances, patients are referred outside the practice to other types of physicians for physical examinations, blood work, and cardiac testing to ensure safety and to help determine the most appropriate surgical plan or alternative interventions. Many of these patients are also seen by providers of 뒤트임 비용 acupuncture and other alternative medicine, sciences that Pontius and Polynice support as elements of their own practice’s holistic approach. Part and parcel of this approach is the use of supremely high-quality skin care products. Those available at Plastic Surgery Associates of New York are custom formulated using a process that Pontius oversees. “Skin care has always been a passion of mine,” she says. “There are a lot of good skin care products out there, but what makes ours better are, first, the fact that they are medical-grade products and, second, the fact that they employ only those ingredients scientifically proven effective. “We start with ingredients such as retinoids, antioxidants, and glycolic acid. Then, we combine them with the latest technology—peptides, green tea, and neurotransmitter inhibitors, for instance. Patients who use them notice improvement after about 2 weeks.” Currently, the skin care line is sold only in-office, but the couple is sizing up the possibility of someday developing nonmedical formulations 밑트임 효과 that could be distributed through high-end department stores and other exclusive outlets. All About Breasts Many of the clinical philosophies embraced by Plastic Surgery Associates of New York are on display in a recent book Polynice cowrote, titled Your Complete Guide to Breast Reduction and Breast Lifts. Released in May, the 110-page paperback, published by Addicus Books, is a consumer reference written in lay language that details everything a woman might conceivably need to know about how a naturally massive bosom can be attractively downsized and reshaped. “Although our 상안검 culture admires females with large breasts, some women whose breasts are large without benefit of enhancement procedures sometimes are very embarrassed by them,” Polynice says. “But the leading reason they seek breast reduction is not because of embarrassment but because they want relief from physical suffering—they want to put an end to the back and neck pain they experience and the problems associated with poor posture resulting from all that weight they’re carrying on their chests. “This is a condition that affects quite a few women. Last year, more than 114,000 women had breast-reduction surgery—a 35% increase since 2000, according to the most recent statistics released by the American Society of Plastic Surgeons.” Your Complete Guide to Breast Reduction and Breast Lifts covers such topics as choosing a plastic surgeon, preparing for surgery, undergoing surgery, pain management, and follow-up care. Contained in its pages are dozens of before-and-after photos of women who have undergone breast reductions and breast lifts. Polynice authored the book with Aloysius Smith, MD, a partner in Plastic Surgery Associates of New York. (Smith splits his time between his well-established practice in Westchester County and the Manhattan office.) Polynice—fellowship-trained in aesthetic plastic surgery at the Mayo Clinic in Rochester, Minn—was introduced to Mayo alumnus Smith in 2000 by a mutual friend, the chairman of the plastic surgery department there. The two hit it off, and Smith—who had completed his training 15 years earlier—invited Polynice in early 2001 to join him in his New York City practice. The Big Apple was a very different place from the locales Polynice remembers from his youth. “I grew up all over the Caribbean. My dad was in the hotel business, and we moved from one resort to another during my childhood,” says Polynice, who is fluent in French and Spanish as a result of his island-hopping upbringing. At about the time he was 8 years old, Polynice decided to become a plastic surgeon. “I’m sure I didn’t know what that meant then, but I must have been on to something, because that has been my focus since before going to medical school,” he says. Polynice was an undergraduate student in France. From there, he went to medical school in the Dominican Republic, finishing in 1989, then back to France for a year of general surgery training in Toulouse. He completed his general surgery training at North Shore University Hospital on Long Island, NY. This was followed by a burn fellowship at New York Cornell (now New York Presby­terian) Hospital. In 1998, Polynice began his Mayo Clinic plastic surgery fellowship, a 2-year experience that subsequently led into a traveling fellowship that took him to Australia, Hong Kong, Taiwan, Italy, France, England, and South America. Saving Face It was at the Mayo Clinic that Polynice met Pontius. He caught sight of her on Pontius’s first day of surgical internship and was immediately struck by Cupid’s scalpel—er, arrow. “I knew right away that she was the one for me,” he says. Pontius concurs. “ It was pretty much a case of love at first sight,” she tells. “Dr Polynice was my senior resident—the first stitch I ever placed, he was the one who taught me how to do it. We worked really well together, and we knew we had something special. That’s why we decided to go into practice together.” Pontius arrived at the Mayo Clinic by way of the University of California, Santa Barbara, not far from where she was born and raised. Interestingly, a career in medicine is not what she intended for herself. “I was going to become an environmental-protection attorney. I wanted to save the planet,” she says. After receiving her diploma with highest honors in environmental studies in 1993, Pontius began to realize that she might be more effective at helping improve the world’s ecology by narrowing her focus from the global to the personal. It was at that point she decided to go into medicine. “I came to the conclusion that if people felt better about themselves, they would treat each other better; and if they treated each other better, they would also be more inclined to treat the environment better,” Pontius says, confessing that she was influenced in her choice by her father, a respected Southern California physician. Pontius then enrolled at Tulane University School of Medicine in New Orleans, completing that program in 1999 (she was in the top quarter of her class). Her general surgery internship at the Mayo Clinic started that same year. In 2000, she advanced to otolaryngology residency at the University of Texas Southwestern Medical Center in Dallas, and finished that portion of her training in 2004. With that behind her, Pontius next undertook a yearlong facial plastic surgery fellowship with Edwin Williams III, MD, at the New England Laser and Cosmetic Surgery Center in Latham, NY. Now in practice with her husband, the ideas about environmentalism that preceded her shift into medicine remain intact. “I suppose in some sense I’m still saving the planet. But instead of doing it one piece of litigation at a time, I’m doing it one face at a time,” she quips. Incorporated within Plastic Surgery Associates of New York is a hair-restoration clinic that Pontius runs, and plans call for adding a wellness center. Mean­while, there is no shortage of interesting cases coming through the doors. Of those, the ones Polynice and Pontius enjoy most involve a total transformation of face and body. These tend to be their most complex cases, and they afford the couple the opportunity to demonstrate why it is possible—desirable, even—for facial plastic surgeons and general plastic surgeons to work as a team. “We each bring to the table a set of special skills and insights that complement those the other one possesses,” Polynice says. “Independently, we’re each very good plastic surgeons. Together, we’re an unbeatable combination.” Article Tools » E-Mail This Article » Reprint This Article » Write the Editor » Print This Article Rich Smith is a contributing writer for Plastic Surgery Products.

THE PATIENT COORDINATOR

She is the lifeline of today’s aesthetic surgery practice One of the most critical 하안검 roles in an aesthetic surgery practice is your go-to person—also known as the patient coordinator or cosmetic coordinator—who manages the consultation process and the surgical patients. A good patient coordinator can make or break a plastic surgery practice. However, with the relatively low pay scale in most medical offices, the long hours, and the lack of incentives or room for advancement, it is often difficult to attract the best candidates for this position. Highly skilled patient coordinators generally stay with one surgeon for many years if they make a good match. Fostering a continuity of care is comforting to repeat patients, and knowing that the surgeon has a loyal staff is equally reassuring to new patients. Frequent 상안검수술 turnover, however, signals to patients that the office is disorganized and inefficient, and that the surgeon is hard to work for. A savvy patient coordinator is worth her weight in gold. In fact, the return on investment can far exceed that of the purchase of a piece of capital equipment or an expensive medical device. If you are fortunate enough to have a stellar patient coordinator on your staff, hang onto her, because this treasure is becoming increasingly hard to find. Don’t risk losing a trusted senior staff member to another surgeon if you can 하안검수술 avoid it. As William P. Adams, Jr, MD, an associate clinical professor of plastic surgery at the University of Texas-Southwestern Medical Center in Dallas, and a private practitioner, says, “The patient coordinator is the cornerstone of any practice. She is the first voice a potential patient hears, the initial bond of your practice to the patient, and the person patients turn to when questions arise. A great coordinator is an invaluable asset to a successful practice.” Natural-Born Multitaskers American Society for Aesthetic Plastic Surgery President James Stuzin, who has a private practice in Miami, says, “The role of the patient coordinator in the plastic surgeon’s practice cannot be underestimated. She can serve as a vital link and liaison between the surgeon and the patient. Patients often perceive the patient coordinator as being more approachable than the surgeon. Even after their consultation visit with you, patients will often tell the coordinator information that provides the surgeon added insight into 상안검 효과 their personality.” A good patient coordinator is a natural-born multitasker. The typical job description may include: explaining procedures, answering questions, offering guidance, quoting fees, and scheduling surgery dates. It may also include taking patients’ histories and performing physicals, reviewing preoperative and postoperative instructions, collecting fees, and interfacing with patients’ families. It should ideally include a high degree of hand-holding and personalized attention to the details of the entire patient experience in your practice. In a busy aesthetic surgery practice, it is common to enlist the patient coordinator to perform a preliminary consultation with new patients before they see the surgeon. This serves the dual purpose of preparing the patient for what to expect during the consultation, and saving valuable surgeon-to-patient face time. Many surgeons also use their patient coordinators to manage their internal and external marketing programs and community-outreach efforts. It is always preferable to have a dedicated person assigned to this critical role. The patient coordinator who is too encumbered 하안검 효과 with a multitude of responsibilities cannot dedicate the time and effort it takes to appropriately manage potential patients. If she feels overburdened and pulled in too many directions to give patients the individual attention they expect, her effectiveness will be limited. It is virtually impossible to act as a true patient coordinator when one is answering the phone and scheduling appointments while explaining the complexities of a facelift procedure. Patients will also find these interruptions to be rude and inconsiderate of their time. To do the job to the best of her ability, it is also important that the patient coordinator has a proper office or private area in which to counsel patients. Whenever possible, an office with a door that can be closed to preserve the patient’s privacy is ideal. This atmosphere fosters an aura of intimacy between the patient coordinator and the patient. In this era of medical-privacy regulations, an office should really be considered mandatory. Good patient 안검하수 coordinators should be incentivized in a manner that reflects the culture of your practice, and without making it seem that they are commissioned salespeople. Compensation packages may be based on performance, patient satisfaction, and revenue stream. It has become commonplace for patient coordinators to receive a quarterly or semiannual bonus based on how well the practice is doing. A common error that surgeons often make is to employ a patient coordinator without empowering her to do the job she was hired to do. You will undermine her authority if patients sense that they can bypass her to get to you directly to negotiate fees and discuss scheduling issues. Hiring a Great Coordinator The concept of 눈썹거상 a patient coordinator is no longer specific to the practice of plastic and reconstructive surgery. Dermatologists, cosmetic dentists, refractive surgeons, and other specialists are increasingly embracing the idea of having someone on staff to fill this important niche. It is also not limited to private practice; university and hospital settings are becoming more aggressive about capturing a greater share of the aesthetic market. Therefore, the sooner you can hire a dedicated person in this position, the faster you can grow your aesthetic practice. For young surgeons just starting out in practice, it may be acceptable to have an office manager or nurse handle these responsibilities during the first few years. But eventually, a necessary step for growing your practice is to hire someone whose main function is to educate your patients, promote your skills, and schedule procedures. If you are a more established surgeon, the best patient coordinator may already be on your staff. She may be your administrator, receptionist, medical assistant, nurse, or aesthetician. She may 눈썹거상 효과 have a surgical, medical, or dental background—or no medical experience whatsoever. In today’s competitive market, the rules have changed. In fact, many busy surgeons are looking outside the medical field to identify good candidates for this key position. They are seeking patient coordinators who have backgrounds in customer service and know how to be an advocate for patients and make them feel welcome. One noteworthy strategy that has gained attention from plastic surgeons in many markets is to recruit candidates from the hospitality or retail industry. Look for people who are accustomed to working with customers or clients on a one-on-one basis. For example, a personal shopper who has worked for a high-end department store may have many of the attributes necessary to be an excellent patient coordinator. The concierge at a luxury boutique hotel may also bring sophistication and a well-established service mentality to your practice. What to Look For Ideally, a patient-coordinator candidate should be a well-spoken, computer literate college graduate. She should also possess a professional demeanor and an outgoing personality. The image of key staff members in an aesthetic surgery practice is always a factor. She should be nonthreatening to both women and men, and mature enough to make menopausal women feel at ease disclosing their concerns about the aging process. She should also be appropriately dressed in businesslike attire, which can vary depending on the practice’s geographical area. If she does not dress professionally, she will not be taken seriously by patients and her authority will be questioned. In some offices, the patient coordinator will wear a crisp lab coat with the name of the practice embroidered over the breast pocket. In other cases, a patient coordinator may be offered a clothing and grooming allowance as part of, or in addition to, her compensation so she can dress for success. Along with her intelligence, skills, and poise, she will be expected to put in long hours, get along well with the rest of the staff, and keep the surgery schedule full and the patient flow efficient. In addition to her administrative skills, an effective patient coordinator also needs to be attuned to the nuances of conversation. A soft-sell approach is usually preferable to an overly aggressive demeanor, which can turn many patients off. She should be adept at establishing a bond with patients during the consultation that will enable her to guide them through the surgical process and beyond. Communication skills are of paramount importance. Above all, a patient coordinator should be able to handle the most difficult and demanding patients with a smile and never lose her cool. You need a real people person to assume this role. You can’t train people to be nice; you have to hire nice people from the start. Previous aesthetic surgery experience could be a positive attribute, but it could also be a negative one if she has worked for several other surgeons in your community and has picked up bad habits. Delivering Patient-Focused 코성형 Care According to Debbie Doyle, practice administrator for Nashville Plastic Surgery in Nashville, Tenn, “Cosmetic surgery patients want to feel that they are in good hands, and in a safe and nurturing environment. The staff is a reflection of the surgeons.” The patient coordinator must be able to connect with patients on an intensely personal level to instill trust and confidence, and to “sell” the surgeon. She can promote his credentials, training, and expertise with patients much better than the surgeon can. She can also present the practice’s surgical results in the best possible light. A weak or ineffective patient coordinator may be subconsciously sabotaging your practice by her apathy toward your patients. Patients today are very sophisticated and can pick up on the signs. Therefore, when evaluating your patient coordinator’s effectiveness, ask yourself the following questions: • Does she keep patients waiting too long? • Is she detail-oriented and good at follow-up? • Does she return patients’ calls in a timely fashion? • Is she a good listener? • Does she communicate with patients effectively? • Are patients coming to you with questions that should be directed to your coordinator? • Does she rush new patients? • Does she encourage patients to ask questions? • Is she knowledgeable enough to address patients’ concerns? • Does she have a warm and nurturing demeanor? • Does she get too friendly or personal with patients? • Is she too pushy or aggressive? “Patient coordinators must make people feel like their concerns are important, and the best way to do that is to genuinely believe that their concerns are important,” says Charles H. Thorne, MD, an associate professor of plastic surgery at New York University School of Medicine and a 코성형 효과 private practitioner in New York City. “It also helps to have intuition. My patient coordinator knows instinctively how to interact with different people. Not everyone responds in the same way, and therefore, everyone should be treated as an individual,” There is no universal blueprint for managing the patient relationship within your practice. However, it is imperative that you address this key role as early as possible in order to grow a successful cosmetic practice. Ultimately, how comfortable prospective patients feel in your practice factors into their decision to have surgery with you or with someone else. Wendy Lewis is a contributor to Plastic Surgery Products and the author of nine books, including America’s Cosmetic Doctors (Castle Connolly). She is also editorial director for www.MDPublish.com , 코성형 비용 a medical publishing group. She can be reached at wlbeauty@aol.com

MALE LIPOSUCTION

Men have this procedure in different places from women—and often for different 가슴성형 reasons In 2005 alone, according to statistics from the American Society of Plastic Surgeons, 1.2 million aesthetic procedures were performed on men in the United States.1 That dramatic figure represents a 44% increase from 2000. Today, more than ever, male patients are open to the idea of aesthetic surgery to eliminate a bump in their nose or to remove some fat from their waist. Interestingly, most men that visit an aesthetic surgeon are under the age of 45. Younger men are more inclined to see a plastic surgeon than older men—even for gynecomastia, a condition that presents more frequently in older men. Because most of today’s male 가슴성형 비용 patients are young, their numbers will only increase due to the combination of repeat business and future new patients. Liposuction was the third most popular surgical procedure for men in 2005.1 As plastic surgeons continue to see an increasing number of male patients who request liposuction, it is important to recognize some fundamental differences in treating this population compared to females, who still represent almost 90% of patients who have this procedure. Men, unlike women, do not typically present with fat in the thighs or the upper back. The most common areas addressed by liposuction in men are the waist, abdomen, lower back, breast, and neck. While not impossible, it is unlikely that a male patient would require liposuction in 가슴성형 효과 the upper back, arms, or legs, which are all common fat-collecting regions in females. Another key difference between men and women concerns the makeup of the fatty tissue itself. Adipose tissue in women is softer and less fibrous than that found in men. Consequently, liposuction in men presents greater physical demands on the performing surgeon. Nevertheless, liposuction produces successful results in men, particularly in the waist. Dealing With the Male Patient As with female patients, males come with their unique set of pros and cons. With men, the advantages are seen early on, whereas the downside of treating this population emerges more frequently in the postoperative stage. Men can be better candidates for liposcution than women, because, in my experience, men tend to take fewer medications. The male patients I see are less likely to take aspirin or suffer from migraines. Obviously, liposuction cannot be effective if a patient takes blood thinners, a major contributor to bleeding. So, I find that men are more reliable with respect to surgical precautions. Other­wise, before performing liposuction for male or female patients, a blood workup is needed to assess the patient’s likelihood of bleeding. This includes testing platelet count and checking prothrombin and partial prothrombin. Postoperatively, it is difficult to manage male patients’ impetuosity. As we know, optimal recovery requires considerable rest, and males are less likely than females to be inactive. Staying sedentary is especially important in gynecomastia cases that incorporate a combination of liposuction and tissue excision. In these cases, it is crucial that the patient comply with the standard regimen of bed rest and light movement for about 1 week, avoiding even a trip to the mall. I have seen men who disregard this 배꼽성형 postoperative advice develop hematomas and seromas, which often need to be drained. Whereas I generally perform liposuction on overweight men under age 45, there are male patients who simply have a history of fatty breasts, waists, abdomens, or necks in their families. Many of these patients exercise and have been able to lose weight in other parts of their bodies. Still, they cannot rid themselves of fat in their body’s unique “Achilles’ heel.” In addition, I see a considerable number of overweight patients who do not exercise. In these cases, liposuction can motivate the patient into maintaining a healthier diet and perhaps even beginning an exercise regimen. I have found that abdominoplasty is much less frequent with my male liposuction patients than with their female counterparts. For every 20 or 30 female abdominoplasties I perform, I do only one on a male patient—in these cases, the patient is very obese.배꼽성형 효과 The Procedure Liposuction is performed in the same manner in male patients as it is in females. There are a few approaches, but we mostly use a tumescent method, in which a saline solution of lidocaine, epinephrine, and bicarbonate is injected into the area where liposuction is to be performed. The tumescent formula works as a local anesthetic, but also, importantly, it provides hemostasis by constricting the small blood vessels. As a result, more fat can be removed. Fat is suctioned using the syringe–cannula method. Other suctioning methods, such as 배꼽성형 비용 ultrasound, are also available. Waist and lower back. I begin posteriorly, placing the patient in the prone position. To avoid creating too many scars, I make one small incision, about ¼ inch long, in the middle of the lower back. From there, I suction into the waist as much as possible. Because there is a limit to how far one can reach, the patient must then be turned to the supine position. Here, I make two small incisions in the folds in the groin area—one on the left side and one on the right. I have seen physicians 배꼽성형 재수술 make several incisions, but this should be avoided. Strive to make as few incisions as possible in the least-noticeable areas. On the back, where there is no choice because there is no fold, a conspicuous incision must be made. However, on the patient’s front side there are many folds and, therefore, many options for concealing a scar. From these two frontal incision points, you can suction the rest of the waist and lower back. If necessary, you may also reach the abdomen from the same two points. Closing the incision sites requires one suture each, to be removed 5 to 7 days postoperatively. Figures 1 and 2 illustrate the results of waist and back liposuction on patients with different body배꼽성형 방법 types. Abdomen. One may think that liposuction is a good way to extract fat from a male patient’s abdomen. In truth, this can be one of the trickiest areas for performing liposuction on a man. Men may have some fat above the rectus muscle, but they may also have internal fat, found inside the intestine, that obviously cannot be suctioned. Consequently, the abdomen is a much more difficult area to treat. In many cases, only about ½ inch of fat will be removed. In certain patients, this may not be enough to produce satisfactory results. The Case of 케이스성형외과 the “Fat” Bodybuilder I see many bodybuilders on whom I perform liposuction in the belt, neck, and breast areas. These patients tend to be “in shape”- not overweight-and yet they still show fat accumulations in these areas. I remember a case in which the patient was 32 years old. He had been a wrestler and a bodybuilder. He was in great shape, but he suffered from gynecomastia and fat in the waist area. As a result, he was uncomfortable taking off his shirt in public, essentially making his goal of becoming a bodybuilder nothing more than an 엑소좀 unfulfilled dream. I performed liposuction around his belt line and removed the gynecomastia. Surprisingly, there was almost pure fat in the waist area. After the fat was removed, the contour of his waist changed dramatically. Now a professional bodybuilder, the patient exhibits a lean chest and a taut waist along with his six-pack abs and impressive biceps. -MB Breast. There is true gynecomastia, which is enlarged gland or breast tissue, and there is what is known as “pseudogynecomastia,” which does not involve breast tissue. Gynecomastia is literally “woman’s breasts,” from the Greek gyne and mastos. In men, this refers to the tissue, and many true gynecomastia cases are found in athletes or bodybuilders who take steroids, which produce real female breast tissue. If you were to send this tissue to a pathology lab, you would find that it is exactly the same as female breast ductile tissue. Overweight men have pure fat in their breasts, and you can literally suction it out. I make an incision about ¼ inch long between the dark and light parts of the areola. Through this incision I suction one breast and am able to suction the contralateral breast through the midline as well. Next, I move to the other breast and do the same thing. I find it more efficient to suction the same areas from two different points. This way, there are only two incision points that heal well and are very inconspicuous. Many physicians place their incisions in the the axillary fold or, worse, in the middle of the chest, because these incisions are easier to make. I suctioned through the axillary fold before I began using the areola method, which I now find delivers the best intraoperative and postoperative results. The trick with liposuction in the male breast is that many men have a combination of fat and true gynecomastia. These cases require both liposuction and excision of the breast tissue. Performing only liposuction will remove the fat, but it will leave the gynecomastia breast tissue behind. Gynecomastia tissue looks and feels different from fat. Whereas fat is soft, gynecomastia tissue is more fibrous. If you grab the areola between two fingers and feel hard tissue, you know that excision will be a necessary adjunct to liposuction. In my experience, about 80% of the male patients who have liposuction performed on their breasts also require excision. You may use the same incision points, under the areola, to perform liposuction and gynecomastia-tissue removal in the same procedure. Performing liposuction alone without removing gyne­comastia breast tissue will generally result in an unhappy patient. Carrying out these procedures concomitantly should take between 1 and 2 hours. Be very careful to ensure hemostasis; otherwise, your patient may return within a day or two with huge breasts—the result of hematoma. Neck. While it is true that you often do not remove much fat from the neck area, you can nevertheless effect a vital aesthetic change here. If enough suction is applied, the neck’s contour will improve. You may suction only the portion of the neck that is above the platysma muscle. Going below that line starts to become risky. When I first removed fat from the neck, I entered from the hairline posterior to the ear. Now, however, after marking the area, I make my incision for the procedure at the midline of the neck, 1¼2 inch posterior to the front of the chin. On men, there is a fold suitable for a small incision here. Through this hole, you may liposuction both the left and right sides of the neck. When I used the behind-the-ear incision, some patients had a temporary weakness in the facial nerve. Their mouths were a little bit crooked on one side for a few weeks. This was the result of disturbing the facial nerve, which extends behind the ear to under the mandible and up into the corner of the mouth. Indeed, the mandibular branch of the facial nerve is so sensitive that in some cases, you may harm the nerve by simply getting too close to it. I have been making my incision under the chin for the last 5 years, and I have yet to see this type of injury. That said, a combination of the two approaches may be used if you determine that it is necessary. In many cases, not much fat will be removed—and yet, surprisingly, you will notice the neck’s contour improving. Remarkably, you will see the neck taking shape before your eyes. If you do not see a change at this stage, your patient may not notice a difference down the road. When you think that sufficient fat has been removed from one side, proceed to the other side of the neck. A word on skin around the neck: As you would expect, if your patient is relatively young, and he is only a little overweight but shows excess fat in the neck area, the skin is usually elastic and the neck’s contour will improve even more. If, however, you are dealing with a person older than 45, the change in the neck’s contour will not be quite as dramatic. This is illustrated in Figure 3, in which the patient is 30 years old. Removal of small amounts of fat makes a noticeable difference in the neck’s contour. Compression. Any time you perform liposuction, it is wise to use compression. Years ago, people wore compression garments for 3 months. That became 6 weeks, and nowadays most people use compression from 3 to 6 weeks. I believe that between 10 and 20 days is sufficient to reduce swelling and bleeding. In the first few hours after surgery, you may put an ice compress on the neck or the chest to alleviate any initial swelling. Liposuction is an effective option for male patients who suffer from fat in their belt line, chest, and neck. The patient’s abdomen is challenging, because so much of the fat is distributed under the muscle. Also, one must take precautions when performing pseudo­gynecomastia liposuction, because, in many cases, some breast tissue will need to be excised. Keeping incision points concealed and to a minimum will also ensure successful outcomes and gratified male patients. Mordcai Blau, MD, PC, is a board-certified plastic surgeon in private practice in White Plains, NY. He can be reached at (914) 428-4700 or via his Web site, www.gynecomastia-md.com Gabriel Sheffer is a contributing writer for Plastic Surgery Products.

BRING BACK FACIAL FULLNESS

MUse midface implants to restore youth and avoid the “skeleton” look엑소좀 효과 Over the past few decades, there has been a paradigm shift in the approach to treating facial aging. This philosophical recalibration has consisted of a departure from older “subtractive” facial-surgery techniques to newer “restorative” procedures that evoke more appealing and natural-looking results. Older facial-rejuvenation methods consisted primarily of removing—subtracting—skin and fat and pulling tissues tight. In many instances, this often led to a skeletonized and more aged, “operated-on” appearance. We now recognize that it is not only the skin that needs to be addressed to correct the signs of facial aging, but also facial soft tissues—subcutaneous tissue and fat—and facial bones that lose vital volume and projection as an individual ages. The major architectural promontories of the facial skeleton, including the malar–midface region, nose, and chin, provide the structural foundation for facial beauty. The overall harmony 엑소좀 비용 of the face is largely determined by the balance, size, shape, and position of these fundamental structures. An aesthetic surgeon may be able to add implants to the facial skeleton to accentuate the areas of the cheekbone and achieve midfacial restoration. These skeletal augmentations redrape and tighten facial skin and reorchestrate the elements of facial balance and proportion for an improved aesthetic result. Depending on the individual’s specific aesthetic requirements, implant procedures can be performed alone or in combination with other facial plastic surgery procedures to provide a more healthy and youthful appearance. Implant-placement surgeries are performed with hidden or invisible incisions so that no scars are evident and the results are immediately apparent. Implant Selection Proper selection of implants requires a working knowledge of the general size, thickness, and material composition of the implant types available. Alloplastic facial implants offer the surgeon many advantages over autogenous tissue, including ready availability of material and simplicity of the surgical procedure. The surgeon must be careful to select the proper implant characteristics for the desired aesthetic result, because each synthetic material has unique properties. With all implant types and materials, careful surgical technique is essential to minimize the risk of complications.슈링크 In the past, a wide range of substances were used for soft-tissue and bone augmentation, including autogenous materials such as iliac and rib-bone grafts and nasal cartilage. Various alloplastic materials, including ivory, acrylics, and precious metals, were also used, but they 슈링크 비용 are now solely of historical interest. Advance­ments in biomaterial science have promoted the use of novel, alloplastic implant materials for facial-skeletal augmentation. Several general features contribute to an implant’s biocompatibility. The ideal im­plant consists of materials that do not elicit a chronic inflammatory response or foreign-body reaction, and are nonimmunogenic, noncarcinogenic, and inert toward body fluids. Implant materials must not bio­degrade, and they must be malleable enough to sustain their shape and position over time. Many materials are used for alloplastic implants, including solid silicone elastomers, expanded polytetrafluoroethylene (ePTFE), high-density porous polyethylenes, poly­(methyl methacrylate), nylon mesh, bioglass, alumina ceramics, and hydroxy­apatite (calcium phosphate) materials. Currently, the most commonly used materials are solid silicone and ePTFE. Both have performed well in terms of low infection incidence and low tendency toward bony resorption when they are positioned in the correct dissection plane.슈링크 효과시기 Improved understanding of the biology of tissue–implant interfaces has spurred the development of bioactive im­plants, which permit the biological bonding of tissue to implant. This bonding permits natural tissue regeneration, as opposed to chronic foreign-body or in­flammatory reactions. Evolving material technologies have led to the creation of better implants. However, the ideal alloplastic material has yet to be formulated. Plastic surgeons are still being challenged to develop safe and effective materials for facial contouring and restoration. But the most significant burden remains accurate facial analysis, assessment, and planning to achieve a good surgical outcome. Assessing the Midface Surgical technique affects both the short-term and long-lasting outcomes of facial skeletal augmentation. General surgical principles related to implantation technique, such as avoiding contaminated fields, using perioperative antibiotics, and meticulous intraoperative handling of the implant materials, are vital to the success and safety of the operation. Careful preoperative assessment of the recipient site should determine whether adequate vascularity and soft-tissue coverage are present. Prominent malar eminences are a can­on of beauty in many cultures, conveying the youthful appearance of facial fullness. A flat, hy­po­plastic malar area can make the face appear tired and contributes to a prematurely aged countenance. This tired, sunken look can be secondary to midface hypoplasia or atrophy and ptosis of the soft tissues. But it can also be accentuated by an overresected facelift procedure. The goal of midface augmentation is to restore the appearance of youth and beauty by enhancing structure and facial contour. Most patients are unaware of the contribution the midface provides to overall facial harmony. They focus instead on the nose, eyes, or lax facial skin. The plastic surgeon can educate patients by illustrating how malar augmentation can restore a youthful and balanced facial contour. In patients who lack bony substructure, rhytidectomy alone may not provide sufficient rejuvenation. Volume restoration by means of midface augmentation in conjunction with a facelift can provide the scaffolding for the optimal redraping of facial tissues to achieve a more successful rejuvenation. Malar implantation can enhance rhytidectomy or rhinoplasty results by further improving facial balance and harmony. The majority of malar augmentations are performed on an elective basis. General indications for malar augmentation include post–tumor-resection and posttraumatic de­formities, congenital deformities, an aged face with atrophy and ptosis of soft tissues, an unbalanced aesthetic facial triangle, a very round full face or a very long narrow face, and midface hypoplasia. Patients may present with changes associated with aging, such as hollowing of the cheeks and ptosis of the midfacial soft tissue. Malar implants can augment cheek hollows and grooves associated with inferior displacement of the malar fat pad and soft tissues secondary to volume depletion of aging. Patients with midface hypoplasia gain aesthetic benefit from enhanced facial volume. Patients with mild hemifacial microsomia may also show improvement. Patients not in any of these categories may request facial augmentation to produce a dramatic high and sharp cheek contour. Flat, thin, and round faces all benefit from malar augmentation, because it balances the face to create a more aesthetically appealing appearance. Facial evaluation that incorporates photographic documentation is a critical component of patient selection for malar augmentation. Several techniques for facial-measurement analysis of the malar region are available. However, the exact location for augmenting the malar eminence is not universally agreed upon, because the type of malar deficiency varies from patient to patient. Surgical Technique After the measurements have been made and the implant size has been determined, the patient is ready to undergo the procedure. The most common technique used is the intraoral approach, in which no external incisions are made on the face. The patient is marked to determine where the implants will be placed. The specific anesthetic solution used is not critical, but it must contain epinephrine. After the anesthetic is infiltrated on both sides, a 1.5-cm sublabial incision is made in the vertical direction through all layers down to the bone. Horizontal incisions for the approach are not advisable. Once this incision has been made, a periosteal elevator is used to dissect the periosteum off the bone. Many authors favor the use of fixation to help secure the implant, but I prefer to use precise sub­periosteal pockets for implant placement. Therefore, wide undermining is not required, but careful, deliberate creation of pockets allows for precise localization of the implant. The infraorbital nerve is not compromised during the dissection. Depending on the type of implant used, the lateral dissection may be extended to the zygomatic arch. Submalar implants or combined implants necessitate a more inferior dissection from the arch over the masseter muscle. The correct plane of dissection is over the glistening white fibers of the muscle. Prior to implant placement, an antibiotic solution is used to irrigate the cavity. A 4-0 chromic suture is passed through the lateral edge of the implant. With the use of an Aufricht retractor, the lateral extent of the pocket is identified and the same suture is passed though to the skin surface. With a gentle amount of tension, the implant is inserted into the pocket. The assistant gently pulls on the suture while the surgeon guides from medial to lateral direction. The suture is then gently tied over a bolster. The incisions are meticulously closed in two layers. Attention to detail during the closure cannot be overemphasized: Any saliva that penetrates the wound cavity can lead to infection. Over the next 24 to 48 hours, the pocket will “shrink-wrap” around the implant, thereby holding it in its correct position. By the time the sutured bolsters are removed at 5 days postprocedure, the correctly placed implant should be firmly healing into place. I have described the intraoral route, but other approaches may be preferred by other surgeons. The subciliary approach, through a lower-blepharoplasty incision, may be used to place smaller implants, especially those used to augment the nasojugal fold. During facelift surgery, penetration can also be made via the subcutaneous musculoaponeurotic system (SMAS) and then carried down to the bone. A subperiosteal pocket can be formed from lateral to medial. This technique limits the access for implant positioning. Complications The complications of using implants for facial augmentation include infection, extrusion, malposition, bleeding, persistent edema, abnormal prominence, seroma, displacement, and nerve damage. Most of these complications are the result of technical error; they are not caused by the implant material used. Implant extrusion should not occur if the implants were not forced into the pockets. There should be no folding or spring in the implant after placement. Impaired nerve function, which is usually temporary, is caused by trauma to the tissues overlying the dissection. Bone erosion beneath the implant can occur, and it is more commonly seen in mandibular implants than malar implants. However, there have been no reports of clinical significance when the implant has been placed in the correct position. Disfigurement is a risk following a failed implant. This can occur as capsule formation, contracture, or scarring. The failed implant must be removed along with any capsule that has developed. The wound must be debrided in case of infection. Implant replacement following a failed implant is not recommended. Summing Up The role of skeletal changes in facial aging has brought to light the importance of volume restoration in modern facial rejuvenation. Many patients seek surgery to improve the appearance and balance of facial features to restore a youthful visage. Performing a detailed, complete facial analysis and setting appropriate expectations are vital for all patients who undergo aesthetic surgery. Alloplastic facial im­plants offer the aesthetic or reconstructive surgeon many advantages over autogenous tissue, including availability of allograft materials and simplification of the surgical procedure. With all implant types and materials, careful surgical technique is crucial for minimizing the risks of complications, including extrusion and infection. Cheek implants can serve to effectively and aesthetically replace lost midface volume with relative simplicity and low morbidity. In properly selected patients, alloplastic mid-facial implantation can yield highly satisfying results and may complement other facial plastic surgical procedures. PSP Benjamin A. Bassichis, MD, FACS, is a double board-certified facial plastic and reconstructive surgeon and director of the Advanced Facial Plastic Surgery Center in Dallas. He is also a clinical assistant professor at the University of Texas-South­western Medical Center in Dallas. He can be reached at (972) 774-1777 or via his Web site, www.advancedfacialplastic.com. Recommended Reading Eppley BL. Alloplastic implantation. Plast Reconstr Surg. 1999;104: 1761–1783. Friedman CD. Future directions in alloplastic materials for facial skeletal augmentation. Facial Plast Surg Clin North Am. 2002;10: 175–180. Friedman CD, Constantino PD. Alloplastic materials for facial skeletal augmentation. Facial Plast Surg Clin North Am. 2002;10:325–333. Article Tools » E-Mail This Article » Reprint This Article » Write the Editor » Print This Article Terino EO. Facial contouring with alloplastic implants: Aesthetic surgery that creates three dimensions. Facial Plast Surg Clin North Am. 1999;7: 55–83.

THE GO-TO MAN

Mordcai Blau, MD, PC, offers hope for males with gynecomastia 리쥬란 Mordcai Blau, MD, PC, did not set out to become a preeminent performer of gynecomastia surgery for men in the United States, but it certainly has turned out that way. Last year alone, Blau performed about 175 such procedures, far more than almost all other surgeons. “Gynecomastia—a condition in which the male develops enlarged, feminine-appearing breasts—is a surprisingly common condition,” says Blau, who practices in White Plains, NY. He estimates that it is a problem for three out of every 10 American men. “Ideally, a man’s chest should be flat, not round. Women generally view the flat-chested man as more masculine, attractive, and sexy.” It has been Blau’s 리쥬란 효과 experience that many men who suffer from oversized or flabby breasts typically try to conceal them by wrapping layers of tape tautly around their upper torso. He says that others, in desperation, will wear a bra—the most humiliating solution for any male who takes pride in his machismo. “As a result of their gynecomastia, some males feel so embarrassed that they withdraw from social contact and lapse into deep bouts of self-pity,” Blau reports. “Only when the psychological pressure becomes too much to bear do many of these men seek the help of a plastic surgeon.” In 2005, some 18,000 men across the United States decided to throw away their bras and opt for a surgical remedy. Avoiding Deformity Many plastic surgeons prefer to treat gynecomastia with liposuction. Blau, however, uses liposuction as an adjunctive, not a primary, intervention. “In two thirds of the gynecomastia cases, liposuction alone 리쥬란 비용 cannot correct this problem,” he says. “Only comprehensive excision of the gynecomastia tissue can bring about the desired effects.” PRACTICE PROFILE Name: Mordcai Blau, MD, PC Location: White Plains, NY Specialty: Plastic surgery Years in practice: 26 Number of patients per day: 20 Number of new patients per year: 500 Days worked per week: 5 Days surgery performed per week: 5 Number of employees in practice: 10 Office square footage: 2,200 Blau says the best candidates—those who can expect to see the most stellar results from surgery—are those with the least amount of excess skin and adipose tissue above their pectoral muscles. “The less adipose and excess skin tissue the person has, the more gynecomastia tissue can be removed without leaving a depression or deformity,” Blau says. “In those patients, after surgery, the skin will drape directly on a developed pectoral muscle, 리쥬란잘하는곳 and the chest will look more masculine and attractive.” If too little tissue is excised, there is a 10% or greater chance that gynecomastia will recur. However, Blau says the chance of recurrence can be decreased to less than 5% if at least 90% of real breast tissue is removed. “Knowing exactly how much excision to make without causing a depression and deformity isn’t easy, but it’s key to the success of the whole procedure,” Blau explains. Typically, Blau likes to begin a gynecomastia surgery with a periareolar incision, because this particular site will leave an essentially undetectable postoperative scar. To further ensure an unnoticeable scar, he limits the incision length to between 1 and 1½ inches. Blau tells patients to halt their use of all dietary supplements for 2 weeks prior to surgery and to stay off them for 2 weeks following surgery. “If not stopped prior to surgery, dietary supplements can cause complications,” he explains. “Some supplements increase the risk of excessive bleeding during surgery. 리쥬란힐러 If that occurs, it will make it more likely that I can’t completely excise all of the gynecomastia tissue. Then, after the surgery, supplements—because of the way they thin the blood—may also cause hematomas or seromas.” Bodybuilders Are Hardest Hit Gynecomastia turns out to be more of a problem for bodybuilders than for couch potatoes. Accordingly, a sizable share of Blau’s patients are professional and serious amateur weight lifters. “When bodybuilders—as opposed to sedentary, overweight persons—develop gynecomastia, it’s because they have real gland tissue involved,” he says. Some bodybuilders try to turbocharge their ability to build muscle by taking anabolic steroids. Steroids often deliver on their promise of quick and relatively easy muscle development, but they usually do so at a terrible price. Among the side effects is estrogen production, which can stimulate the growth of female-looking breasts. Says Blau, “How much estrogen is produced depends on the particular type of ste­roid substance used and how often it’s being taken. And then there are some types of ste­roids that simply convert to estrogen. Either way, you’ve got these very 리쥬란힐러 효과 muscular men with abnormally high concentrations of fe­male hormone in their bodies. Studies have shown that high-dose, high-frequency steroid usage is directly proportional to the probable development of gynecomastia.” Fortunately for bodybuilders (steroid takers or not), they are usually the ones best helped by gynecomastia surgery because they have such well-developed pectoral muscles. Not so fortunate are non-bodybuilders, unless they commit to a regimen of physical training to develop their pectorals. But Blau contends that even sedentary men will look better after gynecomastia surgery. “Nonathletic types will have a chest that is a lot more natural, the way an average man should appear.” Blau himself is not a bodybuilder, but that hasn’t deterred world-class champions in that sport—whose ranks include women—from seeking his help. “Several of the women bodybuilders I’ve worked on have gone on to claim important titles, including one woman who won the 2005 US and world championships in her division,” Blau says, clarifying that supermuscular females don’t come to him for gynecomastia surgeries, but for other procedures—mainly breast augmentation and mid- to lower-body liposuction. “Another class 리쥬란힐러 비용 of women I treat are extreme fitness enthusiasts. They are not as buffed and cut as the female bodybuilders; nonetheless, they have exquisitely firm and toned bodies. Like the bodybuilders, they also come primarily for breast enhancement and liposuction. No matter how hard they work at it, these athletes still have layers of fat that they can’t get rid of in their thighs and along the belt line without a surgical assist.” The Word Gets Around Blau’s involvement with gynecomastia dates back to the early days of his practice. At the time, around 1980, he was teaching at nearby Westchester Medical Center. One day, Blau was approached by a medical student who wanted the shape of his breasts cosmetically modified. “This student was a bodybuilder, and he needed a gynecomastia procedure to tighten up his pectoral area to give him more of that muscular but flattened, ‘cut’ look that bodybuilders strive for. I wasn’t all that enthusiastic about it, but I said ‘sure’ and agreed to do it. The results were very good, and the student was very pleased.” He was so pleased that soon he began sending his bodybuilder friends to Blau for the same procedure. However, these friends were not casual exercisers, men 수면리쥬란 who hung around at the corner health club and pumped iron for the heck of it. These were serious bodybuilders—competition champions. “A couple of them were winners of US events; one was a winner from Canada.” Before Blau could say Incredible-Hulk-versus-Conan-the-Barbarian, his waiting room began to look like the lobby of Gold’s Gym in Venice, Calif. “It was mostly professional bodybuilders who were coming to my office, and they were from all over the continent,” he recounts. Gradually, however, word spread from the bodybuilders to their scrawnier male relatives and friends, who also suffered from enlarged male breasts. In time, the average Joes seeking Blau’s help surpassed the number of bodybuilders. “Ordinary men heard about this—men who had just lost significant weight and men who were genetically predisposed toward the condition—and they started coming too,” he says. Coming to America Blau first learned about gynecomastia while attending Tel Aviv Medical School in his native Israel. Blau entered that academy in 1969, and 4 years later he completed his training in a program that included a year of plastic surgery instruction. Immediately afterward, Blau was conscripted into the Israeli army. He was the only physician for a fairly sizable contingent of soldiers—about 700 in all. In peacetime, that would have been a burdensome enough responsibility. But, alas, Blau’s Sinai Peninsula-based unit was in the thick of the fighting that broke out when Egypt and Syria attacked Israel during the 지방이식Jewish high holy day of Yom Kippur in 1973. The war lasted a relatively short time. How­ever, for weeks after the hostilities ceased, Blau performed minor to moderately complicated surgeries on soldiers in his unit and several others who had been wounded in battle. It was dispiriting work on the one hand, but beneficial for Blau on the other. The volume of cases he handled allowed him to become very proficient at reconstructive procedures. Blau completed his obligations to the military in 1974, and shortly thereafter he immigrated to the United States. “I wanted to be trained in cosmetic plastic surgery, but, at the time, that was a speciality almost unheard of in Israel. The place for that was the United States,” he says. “My idea was to come to America for training, return to Israel, and start a cosmetic practice there. But it just didn’t work out that way. I fell in love with the United States and decided to stay here.” Once on American soil, he was welcomed to Albert Einstein Medical Center in New York City, where he spent the next 6 years undergoing training in general and plastic surgery. During his time there, Blau became chief resident of the plastic surgery 지방이식 효과 department and worked as an anatomy lab instructor. Accredited Facility In 1980, having wrapped up his training at Albert Einstein, Blau moved to White Plains, in Westchester County just north of New York City, where he opened a private practice. “My wife’s sister lived near White Plains, so we would often drive out for visits,” he remembers. “We really liked it—it was a nice area, very upscale, and it was close to New York City. I thought it would be a perfect place to have an office.” Still a relative newcomer to the Empire State, Blau knew he was taking a huge risk by striking off as a solo practitioner—especially in a market already saturated with plastic surgeons. Indeed, there were times during the first months that Blau worried that his practice might go under. That it did not was a testament to Blau’s determination to succeed. “I developed a rotation of about five hospitals in this area where I worked the emergency rooms, performed lots of hand reconstructions, and treated trauma and burn cases,” he says. “The patients I worked on liked what I did, and so they began referring family and friends to my office. After about 6 months, people started asking me about cosmetic procedures. Then, every year afterward, the cosmetic cases 지방이식 비용 grew, until now they are the vast majority of my work.” Two years after launching his practice, Blau moved into the facility he occupies today. “It’s located a block away from White Plains Hospital in a freestanding medical office building,” he says. The office has four treatment rooms (two of them are equipped with lasers for ablative and chemical-peeling work); two consultation rooms; a large secretarial room; a similarly large reception area; and an in-office, Joint Commission on Accreditation of Healthcare Organizations-accredited surgery suite. “I do most of my procedures right here,” he says. “I’ve got a couple of anesthesiologists who come in, and I’ve got an operating-room nursing team in place. Only on rare occasions do I use the hospital’s surgery center.” At one point, Blau contemplated adding a medical spa, but he ultimately decided against it. “It just didn’t seem like a good fit for my particular practice. Besides, I’m busy enough as it is,” he explains. Blau estimates he performs about 500 surgical procedures of all types during the span of a typical year. The vast majority of them involve body work and sculpting. About 20% are facial procedures. The Artist in Him Blau was motivated to seek a career in plastic surgery in part because of his love of art—not just as one who appreciates well-crafted paintings but as one who creates them. “I started oil painting when I was young,” he says. “My mother was an artist, and she got me interested in it. In medical school, I learned anatomy in part by painting it.” In addition to oil paints, Blau also dabbles in watercolors and charcoal as well as stone and clay. His favorite subject matter is the human body. Blau characterizes his style as eclectic, but it is plainly influenced by early Picasso and Gauguin. “I like the impressionists most of all,” he says. “They took everyday subjects and revealed the hidden beauty within them. Very gutsy in the time in which they lived and worked.” Blau not long ago was honored with an award in artistic excellence from the Ruben Dario Cultural Institute, and his artworks have been exhibited at galleries in New York City, in San Francisco, even in Germany. Many of those pieces now hang throughout his office and his home—the best of them, that is; everything else is stored in the basement, which is brimming with his art. “I never get rid of any of my older works. I keep everything,” he says. And yet, it is plastic surgery for which Blau—a diplomate of the American Society of Plastic and Reconstructive Surgeons—is most widely celebrated. For example, the Westchester County Medical Society feted him for dedicated service to patients and to the medical profession, while the Consumer’s Re­search Council of Amer­ica tapped Blau for a spot on its America’s Top Surgeons list a few years ago. On top of this, Yeshiva Uni­versity heralded him as a respected community leader, esteemed congregant, and outstanding community figure for his devoted and noteworthy service to the public and to Jewish people everywhere. The loudest applause for Blau comes, of course, from his satisfied gynecomastia patients, who, if they had an organization of their own, would in all likelihood also give Blau an award of some sort. Certainly, the parents of one 16-year-old athlete would love to see Blau thus lionized, so greatly did the amiable and soft-spoken physician’s work on him bring about dramatic, positive change in the youngster’s life. “This teenager was a gifted football player—tall, handsome, and in great physical condition—but he was extremely embarrassed by the shape of his enlarged breasts,” Blau says. “He would go to the beach and never take off his shirt. Never. He was really going through a lot of psychological suffering. Eventually, his parents became so concerned about him that they brought him in to be seen by me. “At first, I felt he was a little too young to be thinking about a surgical solution. But his parents pleaded with me to take the case. I finally agreed because of the severe psychological trauma the youth was experiencing. We went to surgery, and it was a complete success. The teenager felt a tremendous load had been lifted from his shoulders.” As Blau can attest, concern with breast size is no longer limited to women. The good news he offers to men with feminine-looking chests is that they can be helped. And, thanks to Blau’s long years of experience in treating gynecomastia, the help that awaits is among the finest to be found. PSP Article Tools지방흡입 » E-Mail This Article » Reprint This Article » Write the Editor » Print This Article Rich Smith is a contributing writer for Plastic Surgery Products.

PRACTICING IN PARADISE

our Hawaii-based 지방흡입 효과 plastic surgeons discuss the ins and outs of setting up shop on the island oasis Gentle trade winds caress towering high-rises along the pristine azure-blue ocean along the shores of Waikiki. Multitudes of tourists from all corners of the world frolic in the sun to have their dreams of the perfect vacation in paradise come true. Can this be the ideal setting for plastic surgeons to set up shop and cater to the eternal need for beauty and youth? Or is it just another outpost, an illusion of the perfect environment?지방흡입 비용 I set out to shed light on the reality of practicing in paradise by interviewing a few Hawaii-based plastic surgeons. Three allowed me to use their names; one requested anonymity. “I always had a low profile,” explains the Hawaii-born surgeon of Asian ancestry who requested anonymity. “I think some people would like to be well-known and publicized. It’s just me; it has nothing to do with the profession.” Perhaps there is a different attitude among local people that shuns a high profile, in keeping with the Japanese proverb, “The nail that sticks out gets hammered in.” On the other hand, there also may be a more relaxed attitude toward outward appearance and status. “Things in Hawaii tend to be more relaxed, informal,” the anonymous surgeon 리프팅 continues. “We don’t wear ties here, and on the weekends we frequently wear shorts when we make our rounds. Patients don’t seem to mind at all.” Establishing Their Roots Not too long ago, a different type of hospital occupied the space where a modern multistory tower now provides all types of medical services. “It was like a plantation,” our anonymous surgeon chuckles. “The hallway was outdoors, the rooms had windows that opened to the outside air, and electrified coils kept the mosquitoes down—but the infection rate was low. The operating 리팅성형외과 room, a wooden building, reminded me of [the television series] M*A*S*H. It was adequate, but it was not what you would call a hospital.” All this has changed, and so have the patients. Maxwell Cooper, MD, FACS, who was initially exposed to Hawaii through military service 35 years ago and has practiced here ever since, thinks the patients have become smarter “primarily because of the Internet and the television shows that portray live plastic surgery.” He often hears remarks such as, “Doc, you don’t need to tell me that, because I have seen the surgery already on The Science Channel.” Thinking back at how difficult it was for him to start out in private practice, Cooper says, “Somebody told me it would take 3 years for me to start paying myself a salary, and that’s how long it took. The pay scale is lower for everybody, so there’s less money available. “A lot of people have to have two jobs, with grandparents taking care of kids, so that they can pay the mortgage,” he continues. “There’s less money left for plastic surgery, or they are going to defer any elective surgery.” Allen Strasberger, MD, who describes his practice as 50% reconstructive and 50% aesthetic, remembers his initial problems to get established. “Getting on the staff in various hospitals was somewhat difficult, because there was a sort of catch-22. “You have to have a certain number of cases reviewed before they let you take calls in the emergency 리프팅 효과 room,” he says. “If you were new in town, you didn’t have much in the way of patients unless you did some emergency-room visits.” James Penoff, MD, the chief of plastic surgery in a large multispecialty group, didn’t have to struggle quite as hard. “I walked straight in and had a practice set up for me. Now, we have a pretty good net of people we hook together through our clinic. And just because I have been around for a while, I have a pretty good net of people that send me cases.” Common Themes These surgeons may practice in a unique setting, but they face the same issues as those in other geographical areas. Strasberger, who does a fair amount of hand surgery, observes, “In the case of rheumatoid arthritis, physicians don’t want to refer pa­tients outside their practices because that would be almost like an admission of failure on their 리프팅 비용 part.” He wishes other physicians would refer these patients to him earlier so that he could improve their quality of life. On the other hand, the local plastic surgeon who prefers to remain anonymous thinks that, “If you provide good care and the referring physician likes you, you get more referrals.” He describes his practice as exclusively reconstructive in nature. “I think the average physician in the state is still reluctant to refer cosmetic-surgery cases,” Cooper says. “I think I get essentially zero cosmetic-surgery referrals from my colleagues, unless they refer their wives. There’s still a lot of prejudice against cosmetic surgery.” He doesn’t think he could survive on a reconstructive-referral basis in Hawaii. “I would move elsewhere, where there are few plastic surgeons and farther in between.” Another common theme is concern with inadequate reimbursements. “My impression is that the insurance companies pay slower here, and less,” Strasberger observes. “His­torically, the reimbursements have been less than on the민트실리프팅 US mainland, and they are still getting lower. The costs of doing practice have been escalating steadily, at least 20% over my reimbursements.” “Our reimbursement is low, and our cost of living is higher than elsewhere,” Penoff agrees. “It’s a real catch-22. Most of our insurance is done by a single provider, so there’s little competition involved, and the reimbursement is choked way down.” He thinks that Hawaii’s cosmetic surgery fees “are probably middle of the road. Certainly, surgeons in New York, San Francisco, and Los Angeles demand huge fees for their cosmetic procedures. I think our prices are pretty good and probably should be higher, since we have the issue with reimbursements and cost of living.” “I think our prices are equivalent to the West Coast,” Cooper says. “I think you could get better deals in the Midwest and certainly overseas in Asia.” Another common concern seems to be the encroachment by other specialists on the traditional field of plastic and reconstructive surgery. “It’s rare to see a very distinct line of separation,” according to the anonymous plastic surgeon. “We do see a lot of crossover. Some of them do a pretty decent job, in my mind. What bothers us is whether they are adequately trained to take care of 입술필러medical problems.” “We always have a group of people who come from Asia to do surgery,” Penoff says. “They come to town unannounced, they do the surgery either in the patient’s home or in a hotel room, and then they slip out of the country again. “We used to see terrible complications from facelifts, rhinoplasties, and breast augmentations,” he continues. “They were absolutely horrendous.” According to Cooper, encroachment by other surgeons is only “a moderate problem here. Some of the so-called cosmetic surgeons are into big-time advertising and draw a large amount of patients. We see some dissatisfied patients with complications, some patients with the wrong operation to start with.” Patient Parameters So what’s unique about plastic surgeons who practice in Hawaii? How do their cases differ from those on the US mainland? Strasberger sees many more Asians in Hawaii compared to the rest of the United States. “In Ohio, where I did my training, we saw perhaps two or three Japanese patients in a year. But if I don’t see two or three Japanese patients per day here, it’s a slow day.” He has to be much입술필러 효과 more aware of keloids and pigmentation problems among his patients in Hawaii. “There are certain operations you don’t want to do on them. Facelifts would be almost contra­indicated if patients are known to form hypertrophic scars. You don’t want to do elective procedures on those patients.” “Being aware that they can scar, I tend to use silicone early on as a prevention,” says the anonymous plastic surgeon. “I use steroids generally as a second line of defense. I am more prone to use it in darker-skinned people and Southeast Asians, particularly young immigrant women from that part of the world. They seem to be bothered a lot by vaccination scars that wouldn’t concern me.” “There’s the issue of dealing with non-Caucasians, and their healing, whether it’s a scar from accidents, or whether it’s cosmetic procedures,” Penoff adds. “Obvi­ously, the big issue with pigmented skin is controlling hyperpigmentation and hypertrophic scarring. Sometimes you may have to do a test area before you do the whole operation you planned.” “Treating Asians and Polynesians is much more difficult than treating Caucasians,” Cooper observes. “You can’t do—and I don’t do—laser surgery or 입술필러 비용 deeper chemical peels on those individuals. “For instance, not long ago, I saw a beautiful Polynesian dancer who had gone to the [midwestern United States] for an augmentation mammoplasty.” Cooper continues, “The surgeon had no experience with Asian or Polynesian skin, so he made an inframammary incision that turned out hypertrophic. It looked like an extra nipple under her blouse. “There was nothing that could be done about it. You can’t fix those. The best treatment would have been to give her a periareolar or axillary incision.” Hawaii’s perennial sun seems to take a toll—particularly on pale Caucasian skin, according to Penoff. “We see lots of things that are sun-related, whether they’re cosmetic or skin cancers. “Since 1997, I have kept a database of more than 700 melanomas, and certainly I would never have seen that number on the US mainland,” Penoff continues. “Basal and squamous cell carcinomas—I don’t even know what the number is, it’s so great.” When it comes to cosmetic surgery, he finds that, “The Asian facelift is comparable to the Caucasian facelift, but there are marked differences in the nose and eyes that we have to be aware of. Asians need to have a fold that blends well with their appearance, not just 어린공주 a fold that looks Caucasian. With the use of silicone on the Asian nose, it’s just a matter of time before it erodes through at the sharp angle at the tip of the nose.” Strasberger talks about “pediatric” im­plants for breast surgery: “A mainland plastic surgeon was surprised that we use pediatric implants here on our patients, but our patients tend to be somewhat smaller” “The average size of breast implants has absolutely increased over the past 30 years, from 250 to 375 mL,” Cooper chuckles. He tells small Asian girls whose tissues are not stretched out from childbirth, “I can’t do that, at least not all at once.” Marketing Ideas어린공주성형외과 As to the idea of opening a spa and attracting a clientele from the US mainland, Strasberger remarks, “I don’t think actually anybody has done that. I think the problem is where you advertise. I don’t think patients want to cut down on vacation time they have here.” Penoff sees a few patients from overseas, mostly people who are stationed at military bases across the Pacific. He says that spas are just beginning to surface in Hawaii, but as for rejuvenation and aesthetic-surgery spas, “it would take a good entrepreneurial person to get into it.” Cooper tried to attract patients from Japan, but he sees a fair amount of US patients from Asia instead—military and civilian. “I get some referrals from my Web site. They shop online.” He once also tried advertising in a high-circulation magazine. “I could have paid patients to come to see me rather than paying the media to run the ad. I got three or four consultations from that, and none scheduled surgery.” Memorable Patients Cooper says some of his most memorable cases center on the Kodak Hula Show and the Polynesian dancers. “They frequently want liposuction or breast implants. Yeah, that typifies Hawaii.” To the unidentified plastic surgeon, eel bites are quite memorable. “They cut in many places like a shredder. The resulting tendon injuries are very difficult to repair. It’s not unusual to see tendons cut in two places.” Penoff remembers a spectacular case of a stick fish, which flies through the air. “It struck a young boy right through the eye and gave him a carotid sinus fistula. The boy eventually died.” Here to Stay Asked if they would set up a practice in Hawaii all over again, they all agreed wholeheartedly in the affirmative. “I would probably still choose Hawaii,” Strasberger says. “For me, it has been pretty rewarding.” “It’s been a great ride; the answer is yes,” agrees our anonymous Hawaii-born plastic surgeon. So does Penoff: “I have an increasing desire to stay here.” For young plastic surgeons who would like to start out in Hawaii, Cooper has the following advice: “Hawaii is like a crowded elevator. There’s always room for one more.” And he adds with a laugh, “Buy my practice so I can retire.” PSP Article Tools » E-Mail This Article » Reprint This Article » Write the Editor » Print This Article Gunther Hintz, MD, a retired Honolulu plastic surgeon, is a contributing writer for Plastic Surgery Products.

ALL ABOUT INSURANCE

A refresher course on the types of insurance you should have for your practice코재수술 If you’re like most plastic surgeons, you’ve never filed a claim with your insurance company. In most practices, insurance is reviewed—or should be reviewed—once 코재수술 효과 per year when the invoice arrives and is paid as a cost of doing business. Insurance has its own language, and insurance people seem to be the only ones who understand it. We all do what it takes in our practices to limit our risks and exposures, and insurance is a primary risk-management tool. In our increasingly litigious society, having the proper insurance is more important than ever. Therefore, you need to understand the kind of insurance you have, and you need to have an insurance agent or broker who speaks your language. Your carrier also needs to have a high rating so that you can be sure that it will be there in the future if a patient files a claim or suit. I cannot make any blanket statements about insurance in this article, because insurance is governed in each state by the state’s insurance department. Insurance companies must be registered with the state where they are located and receive approval to sell in that state. Some states even have an insurance commissioner, who is a watchdog over the solvency of insurance companies that operate within that state. You can clarify insurance issues through your state’s insurance department. Insurance companies are rated based on their assets and performance by the AM Best Co. The highest rating is “A.” Be­cause insurance claims are paid in the future, you must be sure that your carrier will be there in the event a 코재수술 비용payment is required. Always ask about your carrier’s rating at each renewal. In the event of a claim or a lawsuit, your insurance company will often represent you in court. Here again, you need to be sure that your carrier will have the appropriate resources to defend the claim effectively. Practice Insurance It’s very important that you have “tight” insurance with no “gaps.” Usually, you will need different types of insurance for your specific practice, as well as malpractice insurance for your actual work. Be sure that you have coverage for every type of surgical procedure you might perform. If your practice is limited to facial plastic surgery and you perform a surgery on a patient’s leg, you might not be covered. If you have an office and a staff, you need additional insurance. Most states require workers’ compensation insurance for all employees, which pays the medical costs and lost work time in the event an employee is injured on the job. Most states have minimum requirements for workers’ compensation insurance, but as a plastic surgeon, you would probably want to look at higher limits. The premium for a much higher limit is a bit higher, but this represents better risk management. You may also wish to offer health, life, and disability insurance for your 눈재수술 employees and their families. Some surgeons purchase insurance for their employees, whereas others pay a portion of it and the employees pay the remainder. Usually, there is a benefit for you, as the practice owner, to offer such employee benefits through a section 125 plan. This allows payroll deductions for qualified employee benefits to be made before taxes, which reduces your employee’s taxable income and your practice’s matching FICA taxes. Offering such benefits is a great employee-retention tool. Surveys have shown that employees feel better about their employer when a comprehensive package of employee benefits is available—even if the employees pay for some or all of it. You will also need liability insurance for your office, which protects you in the event that a patient or a visitor is injured there. Liability is often part of a general-business package policy that will also cover such risks as property damage, fire, theft, and vandalism. The best option is to purchase an “all-risk” policy. Business interruption may also be included in such a package. This type of insurance protects you in the event that your practice must 눈재수술 효과 be closed for a period of time, causing you to lose income. For example, a burst pipe might cause your office to be flooded, requiring you to close your practice for a week or two while repairs are made. Business-interruption insurance will pay you a portion of your lost revenues. You should have disability insurance for yourself. As you know, if you were to become disabled in a way that you were no longer able to perform surgery, your income potential would be severely reduced. Here again, good risk management dictates that you purchase a disability policy that is specific to your work so that you would be paid if you were unable to perform your usual and customary work (as opposed to “any” work). Medical-Spa Insurance Many plastic surgeons are opening medical spas. In some cases, a plastic surgeon may be the medical director for a medical spa outside his or her practice, while in other cases, a plastic surgeon will open a medical spa inside his or her practice. Be sure to talk with your insurance agent if any of these situations applies to you. If you are the medical director of someone else’s medical spa, your current malpractice insurance may not cover you. If you intend to perform procedures at this spa, be sure to communicate with your insurance agent or carrier so that you are covered for those procedures. Be specific about what you are doing. If you are covered for injectables, mesotherapy may not be included under the general-business package policy by all carriers. If the medical spa’s owner with whom you will be working says that you are covered under his or her policy, be sure to request an insurance certificate showing you as a named insured. Insurance is in effect as long as the premiums are paid, so I recommend that you request these certificates on a quarterly basis. The field can be so confusing that the International Medical Spa Association (IMSA) has created a partnership with an insurance-brokerage company to offer insurance packages for medical-spa operators. I recently spoke to Gina Meyer of the law firm Scanlon, Guerra, Jacobsen, and Burke, located in Woodland Hills, Calif. She told me, “The field is changing all the time. Some companies cover 눈재수술 비용 procedures that others don’t. Doctors who make assumptions about their coverage can find themselves open to risks they didn’t expect. It’s so important to review your coverage with a good agent monthly or quarterly.” For a new practice or a new operation such as a medical spa, one of the mistakes often made is seeking quotes from several agents at the same time. Because the medical-spa insurance market is not very big, the same information may end up on the desk of an underwriter from several different agents. This reduces the chance of obtaining the best insurance rate. The best strategy when starting a new practice or a new operation, or when seeking competitive quotes at renewal time, is to use one broker who has good relationships in the entire market so that you can obtain the best rates. Premiums are high, but financing is available. Some carriers offer payment plans, and many brokers offer access to credit providers for insurance payments. Patient Insurance and Financing The last area I will discuss is patient insurance. You may perform some procedures that are paid by patients’ insurance plans and others that are not. We are all painfully aware of the way health-insurance companies limit payments for covered surgeries; hence, the trend toward aesthetic surgery, which is paid by the patient. When there are medical complications as a result of aesthetic surgery, patients’ regular health insurance will normally not cover their treatment. You should be prepared for this eventuality by purchasing a type of insurance that covers specified complications for a defined set of elective procedures. The covered complications include infection, hemorrhage, and pulmonary embolism, pulmonary dysfunction, arrhythmia, and others. To be covered, the complication must occur within a specified period after the procedure. We have found that patients who are willing to pay for procedures may not have the full amount available to them at the time the payment is due. Offering a patient payment plan will help you make the sale and allow the patient to move forward with his or her procedure. In turn, your practice receives payment within 2business days. Some patient-financing plans offer 0% interest financing for up to 18 months, so patients feel they are receiving a great deal—especially when general finance companies may charge them upward of 18%APR.성형외과 진료시간 You may have to pay a small fee for this service, but the increased business for you and the convenience for your patients will make this a smart investment. A patient-financing service enables you to attract a larger number of patients that you might not otherwise reach. PSP Article Tools » E-Mail This Article » Reprint This Article » Write the Editor가슴보형물 종류 » Print This Article Cheryl Whitman, a beauty-industry consultant for more than 20 years, is the founding board member of the Medical Spa Society and an active member of the Day Spa Association. She can be reached at (201) 541-5405 or via her Web site,

PATH TO SUCCESS

Benjamin A. Bassichis, MD, FACS, and his staff 코성형 보형물 종류 team up for excellent patient service

Solo Dallas plastic surgeon Benjamin A. Bassichis, MD, FACS, is supported in his practice by eight employees, but none is a receptionist—because all of them are. And that has been part of the secret behind the rapid ascent of his Advanced Facial Plastic Surgery Center, started just 3 years ago.

“Each of our clinical and administrative employees is trained to perform the receptionist function,” Bassichis says. “So, when prospective patients call to ask questions about our services, it’s guaranteed that the very first person they’re going to be talking with is a college-educated, articulate, knowledgeable individual who can help the caller become eager for an appointment to come in and be seen by us.”

More importantly, 코 보형물 종류 those callers will be speaking with someone who holds a stake in the success of the practice.

“I’ve empowered the staff to take ownership over their own areas of responsibility,” Bassichis continues, adding that they each receive bonus pay for every month in which the practice surpasses its financial-performance goals—and they can directly affect the performance by how they do their jobs. “As a result, the staff is motivated to continually strive to improve the running of the practice.”

They also are constantly looking to make patients happier—the most fundamental way to help any practice grow.

As an example, Bassichis describes how the staff will step up to the plate when he falls behind schedule. “Just today, the situation came up where we had a facelift consult in the waiting room. Rather than let her sit there for a half hour until I could get caught up, one of my aestheticians took it upon herself to escort the woman back to the treatment area, where she proceeded to give the patient a complimentary hydrating facial to help her pass the time. The patient was delighted.”

Beyond empowerment, Bassichis motivates his staff simply by treating them well. Twice per week, on busy patient-consultation days,
he has a chef who specializes in organic meals prepare lunch for the staff, gratis. And periodically Bassi­chis treats his entire staff to an all-expenses-paid visit to a high-end day spa for a Saturday afternoon of serious pampering.

PRACTICE PROFILE
Name: Benjamin A. Bassichis, MD, FACS
Location: Dallas
Specialty: Facial plastic surgery
Years in practice: 3.5
Number of patients per day: 60–70
Number of new patients per year: 1,200
Days worked per week: 5–6
Days surgery performed per week: 4
Number of employees in practice: 8
Office square footage: 3,000
He shows no favoritism, either. “If a drug-company representative comes by and wants to take me out to dinner, I insist that the invitation be extended to the entire staff, or it’s no go,” Bassichis says. “My staff is incredible. They have an ideal blend of talent, energy, and personality.”

A Holistic Approach

Bassichis’s practice—which specializes in facial aesthetic surgery—isa market standout for numerous reasons that go beyond the quality of his staff. One of those is that he has decided to take an holistic approach to facial health.

“There are certain fundamental building blocks that lead to optimized results, and we try to help patients put those in place,” he says. “For example, if people are not taking care of their skin, they’re not on a good diet, or they’re not exercising or taking care of themselves, the results that I can deliver in surgery are not going to be as long-lasting as they could be if the opposite were true.”

To support the holistic approach, Bassichis has established subsidiary units within his practice. One is focused on skin care, the other on health and wellness.

“It’s all about what we can do to help patients fight the aging process,” he maintains. “Every new-patient consult not only meets with me but also meets with our skin-care and wellness teams, whose task it is to assess the patient’s lifestyle and make appropriate recommendations for im­proved healthful living.”

Beyond holistic health, Bassichis believes that optimal results require cutting-edge technologies and techniques—the reason he strives to be as innovative as possible in his approaches not only to surgery but also to preoperative and postoperative care.

“I’m always interested in integrating new techniques that will lead to shorter recoveries with less pain and bruising so that patients can return to their normal routines faster,” he says.

However, Bassichis tempers his ahead-of-the-curve posture with a healthy dose of caution. “I like to see the evidence in the literature that a new treatment or technology is safe and efficacious before I incorporate it within my practice,” he says. “For example, take injectables and nonsurgical treatments. Every year, new ones make their way onto the market. My first rule of thumb is, if a product or treatment is not FDA-approved, I won’t even bother considering it.”

His second rule of thumb is: If a product or treatment is not around a year after a splashy, ballyhooed debut, it was nothing more than hype. “Twelve months korean plastic surgery is not a long time to wait for the sure signs that a new treatment or technology is valid before getting on board with it. By the same token, it’s a short-enough time that you’re still going to be cutting-edge when you do adopt that innovation,” he says.

From Lifts to Mohs Closures

Bassichis’s practice provides mainly aesthetic services, but he also accepts reconstructive cases. His procedures include: midface lifts, rhytidectomies, revision facelifts, endoscopic browlifts, blepharoplasties, primary and revision rhinoplasties, otoplasties, mentoplasties, submental lipectomies, neck lifts, facial reconstruction, hair restoration, link plastic surgery skin-lesion treatments, cheek and chin implants, scar revisions, and skin resurfacing.

Many of the reconstructive cases he sees involve closing the hole left by cancer surgeons after a Mohs procedure—an intricate intervention designed to completely remove the cancer while maximizing the amount of normal tissue left intact.

“I do about 250 Mohs closures a year,” he says. “What’s interesting about these is that my surgical plan is never completed until the patient has had the Mohs procedure and I get to look under the bandage to see what’s韓国の美容整形ツアー actually there. So to be successful with these requires a lot of on-the-spot creativity.”

In a typical case, Bassichis begins the planning process days or weeks in advance when he first meets with the patient, who at that point will not yet have undergone the Mohs procedure. “I look at the affected area and come up with a couple of anticipatory scenarios for the reconstructive work I’ll do after the cancer is excised.

“For example, let’s say the patient has a cancer on his lip. I have a book of Mohs closures that show the options available for a lip reconstruction depending on the size of the リンク美容外科 cancer. Letting the patient review those photos is a worthwhile exercise, be­cause it helps mentally prepare him or her. Some patients come in thinking the post-Mohs surgery defect is going to be little when in fact it will be large.”

Bassichis normally performs the reconstruction the same day as the Mohs surgery. Afterward, he follows the patient at 2- to 3-week intervals. At or about the sixth week, he may, as appropriate, perform dermabrasion to help camouflage the scars.

“In some cases, we postoperatively use a laser that targets blood vessels,” he says. “That can be necessary because the body often responds to Mohs surgery and the subsequent wound closure by enlarging the blood vessels to supply nutrients to the area that was operated on. Frequently, those blood vessels remain enlarged, so we use the laser to shrink them back to a more normal size.”

As proficient as Bassichis is with Mohs closures, he confesses it isn’t easy blending these cases with his regular aesthetic practice. “My surgical schedule stretches 6 to 8 weeks out. If someone shows up with cancer on his face, I have to be able to accommodate that patient right away. I can’t let him languish eight weeks before he gets on the surgery 韓国美容外科 schedule.”

Consequently, Bassichis—who performs his regular aesthetic operations 4 days per week—must work longer hours to accommodate those Mohs patients. “Instead of going home in the late afternoon, on most days I head over to the surgery center to perform Mohs closures until 7 o’clock or later in the evening. But I don’t mind the extended hours; I’m willing to endure those because I know it’s going to make an enormous difference in the quality of the result for the Mohs patient.”

Bassichis’s willingness to go the extra mile for Mohs patients, combined with his ability to obtain ウォンジン整形外科 good results, has made him a first choice among referring physicians. That explains why his Mohs practice has been growing exponentially.

Meanwhile, his satisfied Mohs patients often cross over to become elective aesthetic surgery patients, returning for facelifts and other services at a later date. But approximately 10% of them cannot wait that long and ask to have the additional aesthetic work done at the same time the Mohs hole is closed, Bassichis says.

Putting Patients at Ease

The Advanced Facial Plastic Surgery Center occupies a 3,000-square-foot office. In the spa-like environment, many of the clinical attributes are downplayed to help patients feel more at ease. “We wanted the office to have an elegant, modern look, so it’s very uncluttered, very streamlined—yet it’s also very serene, very relaxing,” says Bassichis’s wife and office manager, Michelle Mantel Bassichis, MD, who designed the office interior.

“The idea was to make ナナ美容外科 patients as comforted as possible so that they would be less reticent to discuss their interests, goals, and desires during consults,” she says. “We believe that the better able we are to communicate with patients, the better the result we can deliver for them.”

Toward the back of the office is a medical spa where laser procedures, microdermabrasion, spa facials, chemical peels, and other nonsurgical treatments are provided, primarily by two full-time aestheticians. Near the medical spa is a room for minor surgical procedures.

Bassichis enjoys relationships with several state-of-the-art surgical facilities ringing Dallas so that he can deliver services nearer to where patients live. “If I’ve got a patient in north Dallas, she doesn’t have to drive to central Dallas to have the work done,” he says. “She can instead go to my facility closest to her home, and I’ll meet her there.

“To me, the question is: How can I make things more convenient for the patient without sacrificing quality?” he continues. “The use of facilities in ID美容外科 each part of the city is one way of accomplishing that.”

In making things more convenient for patients, Bassichis also is paving the way for more growth. Thanks to cutting-edge technologies and techniques—coupled with one of the best staffs in town—his still-nascent practice seems well positioned to gain in size and stature in the years ahead. PSP

Rich Smith is a contributing writer for Plastic Surgery Products.

A Helping Hand

The practice of Benjamin A. Bassichis, MD, FACS, is blessed with many assets, but none so valuable as the helping hand of his wife: women’s-health specialist Michelle Mantel Bassichis, MD.

At present, Job One for Michelle is raising their two young children. She helps out in the practice only as time permits, about 10 to 12 hours per week total. “When I’m in the office, I play a lot of different roles,” she says. “Sometimes I use my own medical skills in providing wellness services to the patients, or as an aesthetician stand-in. I’m trained to provide microdermabrasion and laser hair removal, among other things.

“Sometimes I use my artistic skills to keep the office and our Web site looking great, and coming up with fresh ideas for our advertising,” 韩国整形 she continues. “I’m sort of a jack of all trades around here, doing whatever is needed to make sure the office operates smoothly and our patients are well satisfied.”

Michelle hails from Detroit, but became a Texan after marrying Ben, a Lone Star State native. Their wedding took place in May 2003, following a whirlwind courtship. “Ben and I were introduced by mutual friends who thought we might hit it off,” says Michelle, who at the time was employed at an HMO in Boston operated by Harvard University, her alma mater. “Ben was in fellowship training in Chicago and went to the trouble of catching a flight to Boston 韩国整容just to take me out for drinks. That was our first meeting. Four months later, we were married.”

Actually, they didn’t begin that initial encounter as total strangers. They knew quite a bit about each other from things they had been told by those mutual friends, and they had chatted at length by phone several times before they ever laid eyes on each other.

Even so, Michelle says it was love at first sight. “He showed up at my door, and I was struck by Cupid’s arrow. I thought he was the most amazing man I’d ever met. We hit it off immediately.”

Strolling a Common Path

Of course, marriage was far from Ben Bassichis’s mind while growing up in College Station, Tex. As a teenager, many of his thoughts centered around a career in medicine, which technically began during high school when he landed a part-time job drawing blood samples and running tests on them in the office of a local family physician.

In medical school at the University of Texas in Houston, Bassichis settled on otolaryngology as his chosen specialty. He performed his residency in otolaryngology–head and neck surgery at the University of Texas’s Southwestern Affiliated 林克整形外科Hospitals in Dallas, eventually becoming the service’s chief resident. The Chicago-based fellowship program he later entered provided advanced training in facial plastic and reconstructive surgery, and placed him under the tutelage of University of Illinois plastic surgeons J. Regan Thomas, MD, Dean M. Toriumi, MD, and Steve Dayan, MD.

Today, Bassichis is double board-certified: first, by the American Board of Otolaryngology–Head and Neck Surgery, and, more recently, by the American Board of Facial Plastic and Reconstructive Surgery. The author of more than 50 scientific chapters and papers, he also serves as a clinical assistant professor in the Department of Otolaryngology–Head and Neck Surgery at nearby University of Texas Southwestern Medical Center and holds a clinical faculty position in the surgery department’s Division of Otolaryngology–Head and Neck Surgery at the Veterans’ Administration Hospital, also in Dallas.

Like her husband, Michelle Bassichis is the child of a physicist—and that’s how she became interested in medicine as a career. “When you’re 10 years old, and your father keeps talking about all this cool technology he works with in the lab, you tend to pick up a strong interest in science,” she says. “So, instead of wanting to become a ballerina, like other little girls at that age, I was making plans to become a genetic engineer.”

Those plans changed direction while Michelle was in medical school, where she developed an interest in women’s health care. “My residency and fellowship training at Harvard University were in pathology, but I specialized in diagnostics—all of it centered on medicine for women,” she says.

Michelle says she finds it a delight that her and Ben’s professional and personal interests have so neatly meshed. “We make a great team,” she says. “The best part of this is we get to spend so much time together. The downside is it’s sometimes hard to leave the office behind when we come home at night, although I’m not sure how much of a downside that actually is.

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“We’ll be out at dinner with the kids, noodles flying everywhere, and Ben will get a glimmer in his eye and a big smile on his face and announce he’s suddenly got a great idea for a new ad campaign or something,” she relates. “It’s just a lot of fun having our work and family life integrated in this way. We’re business partners and life partners, headed along a common path. It’s a โรงพยาบาลศัลยกรรมลิงค์real privilege to be able to work alongside the man I love. It’s incredibly fulfilling.”โรงพยาบาลศัลยกรรมเกาหลี

HELP FOR THE HEALER

Training physicians in poor countries offers the best hope for them and their แพทย์ผู้เชี่ยวชาญ patients Among movingly naïve paintings in vivid colors of Buddhist mythologies sits a small girl in a neatly pressedบินตรงจากเกาหลี man’s shirt with sleeves far too long for her tiny frame. “They call me ‘cripple,’” she, named Sythan, answers hesitatingly when asked for her nickname, and for just a fleeting moment, tears start to well up in her soulful almond eyes. Then she stares out into the humid and gloomy heat of the Cambodian monsoon season. “That’s what your family calls you?” She nods once and stares down at the dusty soil around her right foot. That’s the only one that can touch the ground. The other one hides permanently folded up against her thigh, toes glued to her shin, heel to her buttocks, in an unholy union. It has been this way for 13 of her 14 years. “Driving along the lone country road, I saw this little person hopping along. ‘Perhaps another ศัลยกรรมเกาหลีต้องทำที่เกาหลีเท่านั้น landmine victim,’ I thought, but then I found out the real reason,” explains Bill Simonsen, who took her into his home for disabled children. “Her homemade crutches hurt her so much that she learned to hop along on one foot for miles. When she was 2 months old, she got burned in a fire. That’s how it healed by itself.” In this nation of 14 million people, health care is but a dream for most of them. The herbal healer rules supreme. The average Cambodians earns $300 per year. Therefore, the cost of traveling to the hospital, let alone receiving medical services, is prohibitive. And in most hospitals, primary physicians are the only choice. Simonsen nearly พบกับงานปรึกษาศัลยกรรมเกาหลี died a while ago from a tropical infection, so his home is now closed. So Sythan returned to hopping along that same dusty road that once held promise for a better life. What can we do for the myriad of burn scars and other reconstructive challenges? Shall we send in a team of plastic surgeons and free those limbs from their chains of gnarly scars? Shall we fly Sythan and others like her to rich countries and perform restoration miracles? Shall we pay for am­putations in the big city or poor country? New Solution Needed Perhaps education and training can provide a solution different from creating dependence. Unless the local surgeon learns how to release scars and graft skin, problems like Sythan’s will fester on. Unless patients in poor countries gain confidence in their physicians, they see hospitals as places to die. As long as professional isolation robs physicians of the chance to increase their skills to a level appropriate for the pathology presented, their self-confidence will languish as well. Medical missions เอเจนซี่ศัลยกรรมเกาหลี often impair the economic survival of local physicians, hospitals, and pharmacies, because patients will wait for the next handout. “Despite im­proved skills, we see less and less cleft lips in our practice,” says Mok Theavy, MD, a surgeon trained by Operation Smile. “Foreign teams take over. We are reduced to footing the bill for the hospital costs.” In the end, these physicians will look for any way to get out of their country, even at the cost of retraining as nurses, as happens in the Philippines. The health gap widens. Yet, there may be an alternative, sensible approach, as proposed by Medicorps, a ศัลยกรรมเกาหลี Hawaii-based nongovernmental organization: Increase capacity by the unobtrusive transfer of specialty skills and technology. Here is how it works: A plastic surgeon receives an e-mail in his office with some images attached. The message reads: “I am Dr X, a general surgeon from Cambodia. Could you kindly have a look at the attached case and give me your opinion?” The physician in the United States sees pathology he likely will never see in his practice at home. Folded-up legs from burns, 40-year-old cleft lips, advanced tumors displacing entire faces, and giant scars of any shape and size—great material for grand rounds, and challenges for the best physicians. During a quiet moment in his office or at home, he hammers out an answer. “With a click of the mouse, I can be in the middle of a distant country, like Cambodia, and help people who have no hope,” muses Honolulu plastic surgeon Fereydoun D. Parsa, MD. “It’s a miracle come true. I feel privileged to participate in this noble cause. That’s why I became a physician.” He attaches the screened pages of textbook illustrations hoping that the faraway colleague can follow the instructions. One day, he thinks, he will donate a week or two of his หมอletmein time for hands-on training with Medicorps. A Familiar Face Gregory Borah, MD, has done just that. He sees a familiar face on the operating-room table in Siem Reap. “It’s a case that I had discussed earlier with a local surgeon over the Internet,” he says as he deftly places an incision he had planned back home. “It really helps greatly to know what one encounters before one sets out on a teaching visit. “I wish I would have asked for pictures of the instruments and sutures in the hospital next door. I could have brought my own,” he continues as he watches the local surgeon complete his first plastic surgery repair. Strategic planning, careful scheduling, and minimal intrusion are the trademarks of Medicorps’ approach. All emphasis is on teaching and training, and universities are starting to encourage their residents to spend elective time with programs like Medicorps. The ultimate goal is to create autonomous chapters of Medicorps in poor countries with a continuous connection to the industrialized world. “One day, I would like to become an English teacher,” Sythan whispers among those Buddhist paintings, “but I cannot walk to school.” That goal is now farther off than ever for her and many other kids like her unless we support her physicians with our skills. PSP

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