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The "Do Over" or in marketing parlance, "Enhancement"
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| gospa68@aol.com 2005-08-07, 6:04 pm |
| When it comes to surgery, a second procedure is a repair of a failed
initial procedure. However, as this article highlights, repair
procedures in cosmetic surgery (and refractive procedures) have been
given a new name - "enhancement(s." The term makes a repair sound like
something good when, in fact, it is a cover-up for something bad.
For those investigating refractive procedures and refractive surgeons,
make sure you ask the surgeon/practice what their repair (enhancement)
rate is. Do not settle for a top of mind response. Ask to see the
practice data.
Repair rates can run as high as 20% in some practices.
WK
New York Times....August 4, 2005
After Cosmetic Surgery, the 'Do Over'
By SUSAN SAULNY
DENISE KUMPEL knew something was wrong as soon as the swelling went
down. Her right nostril just didn't have enough substance to stay up.
Within six weeks it had collapsed, and she was back in surgery again to
fix what turned out to be a botched nose job.
A few weeks after the second rhinoplasty, she realized that her latest
nose was abnormally flat, as if it were sinking into her face. She
looked for a new surgeon.
Not one, not two, but three more operations followed over the next
three years at a cost of more than $30,000. Finally, nine months ago,
using cartilage from her ears, Ms. Kumpel said, she got the results she
had originally sought.
"I thought I was going in for something fairly simple: I had a bump on
my bridge and didn't like my profile," Ms. Kumpel said. "But it became
a never-ending cycle. I was like, 'Is this ever going to be over?' "
While Ms. Kumpel's case might sound extreme, her experience is not that
rare. As the number of people electing to have plastic surgery
continues to rise across the country, the number of corrective revision
surgeries, or redos as they are often called, also appears to be
increasing at a rate that is high enough to cause concern among some
prominent surgeons.
"I'm seeing more than I think we should, given the number of primary
procedures being reported," said Dr. Steven J. Pearlman, a facial
plastic surgeon in New York and president of the American Academy of
Facial Plastic and Reconstructive Surgery.
To be sure, some patients have multiple surgeries on a single body part
simply because they want to. For another group, however, revision
surgery is seen as necessary after complications from sloppy work or
from problems that could not have been anticipated.
While anecdotal evidence seems to suggest an increase in the number of
revision cosmetic procedures, it is nearly impossible to quantify how
many are being done - or to say if they are necessary - because the
major medical associations do not keep statistics on redos, and doctors
are not required to disclose information about revisions of their work.
These cases usually fall short of malpractice, but they still leave
patients unsatisfied and determined to risk surgery again, if they can
afford it, patients and experts said.
"Revisions and complications are underreported, and there's no easy way
to access that information," said Dr. Robert Goldberg, the chief of the
ophthalmic plastic surgery division at the Jules Stein Eye Institute at
the university of California, Los Angeles, which sees patients seeking
revisions from all over the country. "It's not something people talk
about."
If faulty cosmetic procedures are on the rise, it would be hard for the
average patient to know. Cosmetic surgeons, advertising for largely
cash business, have no incentive to disclose information about
revisions of their work or to track the long-term satisfaction of their
patients. And strong patient interest groups that might push for such
information are hard to find. Because so many procedures are elective,
some cosmetic surgery patients feel guilty about voicing even the most
minor complaints.
Ms. Kumpel, for instance, didn't want to talk much about her ordeal
until it was over. And she said she never even thought about suing the
doctors who made her nose worse. "When you go into plastic surgery, you
sign away that things can go wrong," said Ms. Kumpel, a 30-year-old
speech and language pathologist from Tuckerton, N.J. "You're not
guaranteed a good outcome."
Another cosmetic patient, Amy Longtemps, is awaiting an appointment for
a third abdominal procedure, after two operations - a tummy tuck, then
liposuction - failed to deliver the flat stomach she had expected. The
surgeries, instead of helping her postpregnancy belly look better, made
her midsection lumpy and disproportional, she said.
"It's been a learning experience," said Ms. Longtemps, 45. "I'm not
going to give up until I get what I want."
But once she gets that, Ms. Longtemps said, "I'll probably not have any
kind of cosmetic surgery again."
Unsatisfactory results may be one of the last aspects of plastic
surgery still seen as an unseemly topic of conversation for doctors and
patients. They undercut the field's image - portrayed glamorously in
countless television shows and advertisements - and bring harsh reality
home to people who would prefer to believe that dreams of ageless
physical beauty can come true.
But it is worth talking about, many doctors and patients say, because
risks increase, and the likelihood of pleasing cosmetic results
decrease, with every surgery, mainly because of accumulation of scar
tissue and the loss of cartilage. Revision surgeries are also more
expensive than first-time surgeries and usually take longer.
For instance Dr. Pearlman, who performed Ms. Kumpel's final surgery,
said a first-time rhinoplasty usually takes one to three hours. A
revision surgery could last up to six, he said.
Many plastic surgery practices have come to focus primarily on the
revision of other surgeons' work, while such practices were rare a
decade ago, experts said. Some patients said they sought revision
specialists only after doctors unskilled in working with altered tissue
made their cosmetic problems worse.
Dr. Goldberg said he sees about four new patients a day who are unhappy
with the cosmetic results from surgeries around the eyes, like eyelid
lifts. Those cases account for more than half his practice.
"The average patient I see has had three to five surgeries before they
see me," Dr. Goldberg said. "Once you have a problem with a revision,
then you're having a revision-revision surgery, then a revision of a
revision-revision surgery. It's a cycle and the problem only gets
worse."
Another facial plastic surgeon, Dr. Jonathan Hoenig, who practices in
Beverly Hills and Los Angeles, said it is not unusual to treat patients
who've had as many as a dozen revisions on one body part, all for
legitimate reasons. "We see people who've been to 10 doctors before and
had 15 surgeries," he said.
The frequency of revision ought to be the same as in the past, or
decrease because of the advances in plastic surgery. But those gains
might be offset by two things, experts said: more doctors vying to get
into the lucrative plastic surgery business while their training and
backgrounds are in other fields, and the dramatic rise in expectations
among patients for perfect results.
Regulations governing the practice of medicine vary from state to
state, but one thing is true across the country: Any medical doctor who
chooses to perform surgery may do so by virtue of having a license.
Dr. Michael Bermant, a plastic surgeon in Chester, Va., specializes in
revision gynecomastia, or male chest contouring, among other things.
Citing one extreme case, he said a man recently came to him for a
correction after having his chest sculptured by a gynecologist. Dr.
Bermant and others say only board-certified plastic surgeons who have
met strict training standards should be allowed to do plastic surgery.
"Having good primary surgery is a much better option than needing a
revision," he said. "Choose your primary surgeon carefully."
But when it comes to choosing a plastic surgeon, "success rate
information is hard to find," said Dr. Arthur Caplan, a medical
ethicist at the university of Pennsylvania School of Medicine. He said
patients, as consumers, are "shopping in a complicated world."
Some medical societies have also become concerned about an increase in
procedures being done outside hospitals in private settings like
offices and clinics, a practice that is not limited to cosmetic
surgery.
Two years ago the American college of Surgeons and the American Medical
Association urged states to develop guidelines for office-based surgery
according to the level of anesthesia used, among a host of other
things. Only a few states have responded to the suggestion, said Jon
Sutton, the manager of state affairs for the American college of
Surgeons.
And there is yet another obvious component to cosmetic work that makes
the world of plastic surgery so complex: the subjective evaluation of
beauty.
"For certain things in medicine you either kill the infection or you
don't," Dr. Caplan said. "In cosmetic, there's a negotiated outcome of
satisfaction between the patient and the doctor. It's far more
subjective than in most of medicine."
It is not unusual for doctors and patients to have different points of
view on what it means to look good, although that is usually the goal,
however vague.
"I saw a patient today who had a brow-lift and a facelift and who was
really unhappy," Dr. Hoenig said. "I thought she looked great."
Dr. Hoenig and other surgeons say they have encountered patients who
see problems with their looks that might be overblown or nonexistent.
Those patients, some of whom may suffer from an illness known as body
dysmorphic disorder, usually raise red flags during consultations,
doctors said.
Most of the surgeons interviewed said they had refused revision
services to potential patients who had unrealistic expectations or
problems beyond which plastic surgery could help. Dr. Bermant said he
refuses far more patients than he treats.
Some patients are initially pleased, but the problems develop later.
Diane Hennig, a painter and model from Dobbs Ferry, N.Y., thought she
looked great immediately after her first rhinoplasty in March 2003. But
during the healing process, her profile changed. She has since had two
more nose jobs.
Her reconfigured nose became so weak at one point two years ago that
the bridge collapsed. She said she's worried by the thought of another
surgery, so she's taking precautions.
"I'm paranoid to even touch the nose now," she said. "I deal with it
like crystal."
| |
| serebel 2005-08-07, 10:58 pm |
| Actually a second surgery could be planned. It doesn't always mean a
failed first go round. For high myopes and hyperopes more than one
surgery is necessary.
But,,,,,, checking out the surgeon is a basic part of ones research.
SErebel
| |
| Glenn - USAEyes.org 2005-08-08, 11:53 am |
| When marketing and medicine collide, euphemisms abound. "Enhancement"
is one of them, but it is the term used throughout the industry and
recognized by doctor and patient alike. I try to use "enhancement
surgery" just to point out that the additional procedure are surgery
and like all surgery, there is risk as well as potential benefit.
Enhancement surgery may be planned and a multiple step process may be
the best course for a patient, but every surgery is surgery whether it
be first, second, or last.
| |
|
| Yes, check with the surgeon so that he can omit important details such as
the fact that corneal tissue does NOT regenerate and you have a limited
amount.
The thinner your cornea the higher your risk of ectasia. Surgeons disagree
about
the 'safe' limit for residual stromal thickness. It used to be 250 microns,
now the
consensus is 300 microns. Patients still get ectasia with 300 microns of
residual
stromal thickness.
Your surgeon will also likely admit the important detail that you will
sustain substantial
nerve loss in your cornea - the Mayo Clinic demonstrated a loss greater than
40% at
the 3 year point. These corneal nerves are important for keeping your eyes
moist
and comfortable. As you age, your eyes naturally become drier. Do you really
want to
kill off 40% of your corneal nerve reserve while you are young? Think about
what
that may mean later.
Your surgeon likely will not admit that LASIK surgery introduces distortions
in your cornea
called higher aberrations. They routinely double with standard LASIK, and
increase about 20%
on average with 'custom wavefront' LASIK that's supposed to give you
'supervision'. Nonsense.
It gives you aberrations that cannot be fixed by glasses.
If that isn't enough, the speculum is damaging to the nerves in your eyelid,
and the suction ring
used to get enough suction to cut the flap is bad for your retina.
I can't believe people plan a FIRST surgery. It's only because they haven't
been fully informed.
LASIK - the more you know, the worse it looks.
"serebel" <serebel@aol.com> wrote in message
news:1123468883.280568.125610@g43g2000cwa.googlegroups.com...
> Actually a second surgery could be planned. It doesn't always mean a
> failed first go round. For high myopes and hyperopes more than one
> surgery is necessary.
> But,,,,,, checking out the surgeon is a basic part of ones research.
>
> SErebel
>
| |
|
| LASIK was a rather unfortunate collision of greed, technology and well... I
hate
to call LASIK 'medicine', but it is performed by people who went to medical
school
and took an oath to 'first do no harm'. They somehow lost their way and
ended
up butchering people for cash.
LASIK is not medicine. It is not performed by healers. Physicians should not
consider
LASIK surgeons colleagues.
"Glenn - USAEyes.org" <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message
news:f3qdf11ds82dj5ncg9hjfo72nkrddu8a2f@4ax.com...
> When marketing and medicine collide, euphemisms abound. "Enhancement"
> is one of them, but it is the term used throughout the industry and
> recognized by doctor and patient alike. I try to use "enhancement
> surgery" just to point out that the additional procedure are surgery
> and like all surgery, there is risk as well as potential benefit.
>
> Enhancement surgery may be planned and a multiple step process may be
> the best course for a patient, but every surgery is surgery whether it
> be first, second, or last.
| |
| pjpeck 2005-08-08, 10:58 pm |
| I had my initial LASIK treatment about 3.5 years ago. My vision was -9 in
both eyes, and I needed bifocals for reading. My Doctor told me that he
would purposely undercorrect me the first time. He said it was easier and
safer to do an enhancement if needed, rather than risk overcorrection. I did
require one enhancement in each eye eventually. Now I am 20/15 for distance,
and slightly better than 20/20 for reading. Yes, I had monovision done.
Is the monovision a compromise? Yes, but one that I prefer to needing
glasses for reading. My night vision still has some halos around bright
lights, but not much different than "dirty" glasses. As I said in an earlier
posting, my LASIK experiance was not a 20 minute miracle, but a year long
process with excellent results! It's great to live life without glasses, and
I would do it over again.
By the way, I had a great Doctor, who explained everything, including the
risks, and every prediction he made about my proceedure came true. I would
recommend Dr. Borisuth at the Virdie Clinic, in Rock Island, IL, to anyone.
pjpeck
"serebel" <serebel@aol.com> wrote in message
news:1123468883.280568.125610@g43g2000cwa.googlegroups.com...
> Actually a second surgery could be planned. It doesn't always mean a
> failed first go round. For high myopes and hyperopes more than one
> surgery is necessary.
> But,,,,,, checking out the surgeon is a basic part of ones research.
>
> SErebel
>
| |
| Glenn - USAEyes.org 2005-08-08, 10:58 pm |
| Based upon the majority physicians who discuss this matter and present
papers at medical conventions, multiple studies throughout the world
over decades, and the official FDA requirements, it is determined that
a healthy cornea will remain stable if 250 microns of tissue remains
untouched, however more is always better and some doctors use
different requirements.
The Mayo Clinic study that reports nerve loss after LASIK at 3 years
also reports that subnasal nerves regenerate to their preoperative
levels at 5 years postop. It seems this fact was convenient edited out
of the previous post.
Of course, nerve sensitivity (the real issue) usually returns within
the normal six month healing period. Corneal nerve sensitivity is
important because it contributes to good eye tear production.
On the whole, all refractive surgery elevates higher order aberrations
(HOA), however not always. Wavefront-guided laser ablations induce
less HOA than conventional ablation. Sometimes the HOA are reduced and
sometimes specific key HOA are lower after refractive surgery than
before, however this is not terribly predictable.
The intraocular pressure rise with the application of suction to
attach the microkeratome used to create the LASIK flap does not damage
a healthy retina. Any person with a history of retina problems should
be evaluated by a retina specialist before having LASIK, IntraLASIK,
or Epi-LASIK. If a concern exists, the surface ablation techniques PRK
and its cousin LASEK may be more appropriate because they do not
require a microkeratome.
All of these issues, and more, are why it is so important for a
patient to be evaluated by a competent refractive surgeon.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| Glenn - USAEyes.org 2005-08-08, 10:58 pm |
| It is great to hear of a good outcome and your personal experience of
the need for enhancement surgery.
People with more than about 6.00 diopters of myopia (nearsighted,
shortsighted) vision are very likely to have some of the effects of
LASIK regress in the first few months after surgery. Exactly how much
regression will occur is not precisely predictable.
While every doctor and patient would prefer the safety, efficacy, and
ease of only one surgery, it is sometimes better to plan a two-step
process. The doctor could have deliberately overcorrected the patient
into hyperopia (farsighted, longsighted) vision and expect regression
to bring the patient back to plano (no refractive error), but this is
a process that risks the patient not regressing enough and ending up
hyperopic. Hyperopic correction is significantly more difficult to
correct and with less predictability. Myopic correction is much more
predictable.
Some doctors take a more conservative approach and will only correct a
high myope to plano, allow the cornea to regress, and then provide
enhancement surgery to resolve any regression. While this adds the
risk of a second surgery, it reduces the risk of the patient being
left hyperopic.
This kind of technique may make the doctor's enhancement rates seem
high, but the doctor is actually providing better care (or at least,
more conservative care) for the patient.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| serebel 2005-08-08, 10:58 pm |
|
Tony wrote:
> Yes, check with the surgeon so that he can omit important details such as
> the fact that corneal tissue does NOT regenerate and you have a limited
> amount.
> The thinner your cornea the higher your risk of ectasia. Surgeons disagree
> about
> the 'safe' limit for residual stromal thickness. It used to be 250 microns,
> now the
> consensus is 300 microns. Patients still get ectasia with 300 microns of
> residual
> stromal thickness.
>
> Your surgeon will also likely admit the important detail that you will
> sustain substantial
> nerve loss in your cornea - the Mayo Clinic demonstrated a loss greater than
> 40% at
> the 3 year point. These corneal nerves are important for keeping your eyes
> moist
> and comfortable. As you age, your eyes naturally become drier. Do you really
> want to
> kill off 40% of your corneal nerve reserve while you are young? Think about
> what
> that may mean later.
>
> Your surgeon likely will not admit that LASIK surgery introduces distortions
> in your cornea
> called higher aberrations. They routinely double with standard LASIK, and
> increase about 20%
> on average with 'custom wavefront' LASIK that's supposed to give you
> 'supervision'. Nonsense.
> It gives you aberrations that cannot be fixed by glasses.
>
> If that isn't enough, the speculum is damaging to the nerves in your eyelid,
> and the suction ring
> used to get enough suction to cut the flap is bad for your retina.
>
> I can't believe people plan a FIRST surgery. It's only because they haven't
> been fully informed.
>
> LASIK - the more you know, the worse it looks.
Okay Tony, let's breathe a little. We've all heard the sky is falling
routine you people present. You just refuse to live in the real world.
SErebel
| |
| Ragnar 2005-08-12, 5:56 pm |
| Your statments defy all logic. Second procedures are not a repair of
a failed procedure. When it comes to LASIK, the second procedure is
virtually always a refinement. However, good surgeons tend to have
lower rates of 2nd procedures whereas bad surgeons have higher rates.
This is not because of failure, that is because the good surgeon took
the time to plan the procedure to predict the final outcome after
regression. With severe myopia, the surgeon is usually a bit
conservative in how much they flatten the cornea. If they flatten it
too much, they have just gone from nearsightedness to farsightedness.
You and Jone would be doing everyone a service if you just kept your
rambling negativity to yourselves.
On 7 Aug 2005 13:17:47 -0700, gospa68@aol.com wrote:
>When it comes to surgery, a second procedure is a repair of a failed
>initial procedure. However, as this article highlights, repair
>procedures in cosmetic surgery (and refractive procedures) have been
>given a new name - "enhancement(s." The term makes a repair sound like
>something good when, in fact, it is a cover-up for something bad.
>
>For those investigating refractive procedures and refractive surgeons,
>make sure you ask the surgeon/practice what their repair (enhancement)
>rate is. Do not settle for a top of mind response. Ask to see the
>practice data.
>
>Repair rates can run as high as 20% in some practices.
>
>WK
>
>
>New York Times....August 4, 2005
>
>After Cosmetic Surgery, the 'Do Over'
>By SUSAN SAULNY
>DENISE KUMPEL knew something was wrong as soon as the swelling went
>down. Her right nostril just didn't have enough substance to stay up.
>Within six weeks it had collapsed, and she was back in surgery again to
>fix what turned out to be a botched nose job.
>
>A few weeks after the second rhinoplasty, she realized that her latest
>nose was abnormally flat, as if it were sinking into her face. She
>looked for a new surgeon.
>
>Not one, not two, but three more operations followed over the next
>three years at a cost of more than $30,000. Finally, nine months ago,
>using cartilage from her ears, Ms. Kumpel said, she got the results she
>had originally sought.
>
>"I thought I was going in for something fairly simple: I had a bump on
>my bridge and didn't like my profile," Ms. Kumpel said. "But it became
>a never-ending cycle. I was like, 'Is this ever going to be over?' "
>
>While Ms. Kumpel's case might sound extreme, her experience is not that
>rare. As the number of people electing to have plastic surgery
>continues to rise across the country, the number of corrective revision
>surgeries, or redos as they are often called, also appears to be
>increasing at a rate that is high enough to cause concern among some
>prominent surgeons.
>
>"I'm seeing more than I think we should, given the number of primary
>procedures being reported," said Dr. Steven J. Pearlman, a facial
>plastic surgeon in New York and president of the American Academy of
>Facial Plastic and Reconstructive Surgery.
>
>To be sure, some patients have multiple surgeries on a single body part
>simply because they want to. For another group, however, revision
>surgery is seen as necessary after complications from sloppy work or
>from problems that could not have been anticipated.
>
>While anecdotal evidence seems to suggest an increase in the number of
>revision cosmetic procedures, it is nearly impossible to quantify how
>many are being done - or to say if they are necessary - because the
>major medical associations do not keep statistics on redos, and doctors
>are not required to disclose information about revisions of their work.
>
>
>These cases usually fall short of malpractice, but they still leave
>patients unsatisfied and determined to risk surgery again, if they can
>afford it, patients and experts said.
>
>"Revisions and complications are underreported, and there's no easy way
>to access that information," said Dr. Robert Goldberg, the chief of the
>ophthalmic plastic surgery division at the Jules Stein Eye Institute at
>the university of California, Los Angeles, which sees patients seeking
>revisions from all over the country. "It's not something people talk
>about."
>
>If faulty cosmetic procedures are on the rise, it would be hard for the
>average patient to know. Cosmetic surgeons, advertising for largely
>cash business, have no incentive to disclose information about
>revisions of their work or to track the long-term satisfaction of their
>patients. And strong patient interest groups that might push for such
>information are hard to find. Because so many procedures are elective,
>some cosmetic surgery patients feel guilty about voicing even the most
>minor complaints.
>
>Ms. Kumpel, for instance, didn't want to talk much about her ordeal
>until it was over. And she said she never even thought about suing the
>doctors who made her nose worse. "When you go into plastic surgery, you
>sign away that things can go wrong," said Ms. Kumpel, a 30-year-old
>speech and language pathologist from Tuckerton, N.J. "You're not
>guaranteed a good outcome."
>
>Another cosmetic patient, Amy Longtemps, is awaiting an appointment for
>a third abdominal procedure, after two operations - a tummy tuck, then
>liposuction - failed to deliver the flat stomach she had expected. The
>surgeries, instead of helping her postpregnancy belly look better, made
>her midsection lumpy and disproportional, she said.
>
>"It's been a learning experience," said Ms. Longtemps, 45. "I'm not
>going to give up until I get what I want."
>
>But once she gets that, Ms. Longtemps said, "I'll probably not have any
>kind of cosmetic surgery again."
>
>Unsatisfactory results may be one of the last aspects of plastic
>surgery still seen as an unseemly topic of conversation for doctors and
>patients. They undercut the field's image - portrayed glamorously in
>countless television shows and advertisements - and bring harsh reality
>home to people who would prefer to believe that dreams of ageless
>physical beauty can come true.
>
>But it is worth talking about, many doctors and patients say, because
>risks increase, and the likelihood of pleasing cosmetic results
>decrease, with every surgery, mainly because of accumulation of scar
>tissue and the loss of cartilage. Revision surgeries are also more
>expensive than first-time surgeries and usually take longer.
>
>For instance Dr. Pearlman, who performed Ms. Kumpel's final surgery,
>said a first-time rhinoplasty usually takes one to three hours. A
>revision surgery could last up to six, he said.
>
>Many plastic surgery practices have come to focus primarily on the
>revision of other surgeons' work, while such practices were rare a
>decade ago, experts said. Some patients said they sought revision
>specialists only after doctors unskilled in working with altered tissue
>made their cosmetic problems worse.
>
>Dr. Goldberg said he sees about four new patients a day who are unhappy
>with the cosmetic results from surgeries around the eyes, like eyelid
>lifts. Those cases account for more than half his practice.
>
>"The average patient I see has had three to five surgeries before they
>see me," Dr. Goldberg said. "Once you have a problem with a revision,
>then you're having a revision-revision surgery, then a revision of a
>revision-revision surgery. It's a cycle and the problem only gets
>worse."
>
>Another facial plastic surgeon, Dr. Jonathan Hoenig, who practices in
>Beverly Hills and Los Angeles, said it is not unusual to treat patients
>who've had as many as a dozen revisions on one body part, all for
>legitimate reasons. "We see people who've been to 10 doctors before and
>had 15 surgeries," he said.
>
>The frequency of revision ought to be the same as in the past, or
>decrease because of the advances in plastic surgery. But those gains
>might be offset by two things, experts said: more doctors vying to get
>into the lucrative plastic surgery business while their training and
>backgrounds are in other fields, and the dramatic rise in expectations
>among patients for perfect results.
>
>Regulations governing the practice of medicine vary from state to
>state, but one thing is true across the country: Any medical doctor who
>chooses to perform surgery may do so by virtue of having a license.
>
>Dr. Michael Bermant, a plastic surgeon in Chester, Va., specializes in
>revision gynecomastia, or male chest contouring, among other things.
>Citing one extreme case, he said a man recently came to him for a
>correction after having his chest sculptured by a gynecologist. Dr.
>Bermant and others say only board-certified plastic surgeons who have
>met strict training standards should be allowed to do plastic surgery.
>
>"Having good primary surgery is a much better option than needing a
>revision," he said. "Choose your primary surgeon carefully."
>
>But when it comes to choosing a plastic surgeon, "success rate
>information is hard to find," said Dr. Arthur Caplan, a medical
>ethicist at the university of Pennsylvania School of Medicine. He said
>patients, as consumers, are "shopping in a complicated world."
>
>Some medical societies have also become concerned about an increase in
>procedures being done outside hospitals in private settings like
>offices and clinics, a practice that is not limited to cosmetic
>surgery.
>
>Two years ago the American college of Surgeons and the American Medical
>Association urged states to develop guidelines for office-based surgery
>according to the level of anesthesia used, among a host of other
>things. Only a few states have responded to the suggestion, said Jon
>Sutton, the manager of state affairs for the American college of
>Surgeons.
>
>And there is yet another obvious component to cosmetic work that makes
>the world of plastic surgery so complex: the subjective evaluation of
>beauty.
>
>"For certain things in medicine you either kill the infection or you
>don't," Dr. Caplan said. "In cosmetic, there's a negotiated outcome of
>satisfaction between the patient and the doctor. It's far more
>subjective than in most of medicine."
>
>It is not unusual for doctors and patients to have different points of
>view on what it means to look good, although that is usually the goal,
>however vague.
>
>"I saw a patient today who had a brow-lift and a facelift and who was
>really unhappy," Dr. Hoenig said. "I thought she looked great."
>
>Dr. Hoenig and other surgeons say they have encountered patients who
>see problems with their looks that might be overblown or nonexistent.
>Those patients, some of whom may suffer from an illness known as body
>dysmorphic disorder, usually raise red flags during consultations,
>doctors said.
>
>Most of the surgeons interviewed said they had refused revision
>services to potential patients who had unrealistic expectations or
>problems beyond which plastic surgery could help. Dr. Bermant said he
>refuses far more patients than he treats.
>
>Some patients are initially pleased, but the problems develop later.
>Diane Hennig, a painter and model from Dobbs Ferry, N.Y., thought she
>looked great immediately after her first rhinoplasty in March 2003. But
>during the healing process, her profile changed. She has since had two
>more nose jobs.
>
>Her reconfigured nose became so weak at one point two years ago that
>the bridge collapsed. She said she's worried by the thought of another
>surgery, so she's taking precautions.
>
>"I'm paranoid to even touch the nose now," she said. "I deal with it
>like crystal."
| |
|
| Glenn, there is no 5 year study. Please cite this imaginary study. The study
stopped in 2004 at 3 years. If there
werera current study it would be a 4 year study. Why do you continually lie
to patients? Oh yeah,
to pad your wallet because you're a LASIK profiteer and you don't care what
happens to patients.
Corneal nerve density is related to corneal sensitivity. Please show a study
where sensitivity is normal.
Especially at the 5 year mark. There is such profound nerve damage after
LASIK patients can't possibly
be normal. What will happen when dry eye increases naturally with aging, and
LASIK patients already have
substantial nerve loss?
I'm sitting here with both upper and lower plugs. Dry eye was not in my
consent forms. My eyes hurt like hell
every day. Maybe that's sensitivity... but it doesn't help much with tear
secretion. The lack of adequate tear film
makes my vision blurry. I have been diagnosed with conjuctivitis sicca. Not
present before LASIK. As a matter
of a fact, it's a contraindication.
The FDA still says tobacco is OK and won't take a stand to regulate it as a
drug. Is it a surprise that they
won't set firm limits on minimal residual stromal thickness? Patients are
getting ectasia at 300 microns
under the flap. Are you calling anything less than 300 microns SAFE? If you
are, there are patients out there who
have ectasia with 300 microns that would like to hold you responsible for
spreading misinformation.
LASIK, even custom LASIK almost ALWAYS increases higher order aberrations,
except in very unusual circumstances
which usually represent a retreatment where a surgeon really botched a
patients eyes in the first surgery.
The suction from a microkeratome can cause floaters in young people that are
distracting enough to be a persistent problem
FOR LIFE. I know a young military officer in his 20's whose floaters are so
bad he wakes up miserable every morning to a floater-speckled ceiling. A
young woman in my Ophthalmologist's office has terrible floaters after her
LASIK, and dry eyes as well. She can't take cold medicine without being
absolutely miserable with dry eyes. What will happen to HER as she ages? Her
boss put a button on her that read "Ask me about my LASIK surgery". Gee, I'm
glad I did and that I can share her experiences hopefully with a few people
who haven't had this destructive surgery and may be disuaded.
Competent refractive surgeon? Now there's an oxymoron. A competent surgeon
would refuse to perform this procedure. Many Opthalmologists are joining the
ranks of those who will not perform LASIK.
"Glenn - USAEyes.org" <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message
news:sboff19ed7dben7op46hdk66mmqma2k6d9@4ax.com...
> Based upon the majority physicians who discuss this matter and present
> papers at medical conventions, multiple studies throughout the world
> over decades, and the official FDA requirements, it is determined that
> a healthy cornea will remain stable if 250 microns of tissue remains
> untouched, however more is always better and some doctors use
> different requirements.
>
> The Mayo Clinic study that reports nerve loss after LASIK at 3 years
> also reports that subnasal nerves regenerate to their preoperative
> levels at 5 years postop. It seems this fact was convenient edited out
> of the previous post.
>
> Of course, nerve sensitivity (the real issue) usually returns within
> the normal six month healing period. Corneal nerve sensitivity is
> important because it contributes to good eye tear production.
>
> On the whole, all refractive surgery elevates higher order aberrations
> (HOA), however not always. Wavefront-guided laser ablations induce
> less HOA than conventional ablation. Sometimes the HOA are reduced and
> sometimes specific key HOA are lower after refractive surgery than
> before, however this is not terribly predictable.
>
> The intraocular pressure rise with the application of suction to
> attach the microkeratome used to create the LASIK flap does not damage
> a healthy retina. Any person with a history of retina problems should
> be evaluated by a retina specialist before having LASIK, IntraLASIK,
> or Epi-LASIK. If a concern exists, the surface ablation techniques PRK
> and its cousin LASEK may be more appropriate because they do not
> require a microkeratome.
>
> All of these issues, and more, are why it is so important for a
> patient to be evaluated by a competent refractive surgeon.
>
> Glenn Hagele
> Executive Director
> USAEyes.org
>
> "Consider and Choose With Confidence"
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.
| |
| Glenn - USAEyes.org 2005-08-13, 11:54 am |
| You are truly unbelievable. And I mean that literally.
>Glenn, there is no 5 year study. Please cite this imaginary study.
There is a five year study. In fact, if you would have bothered to do
a quick search on this very newsgroup the information is right there.
http://makeashorterlink.com/?B26C22B9B
>Corneal nerve density is related to corneal sensitivity.
Corneal nerve density is NOT directly related to corneal nerve
sensitivity. Sensitivity returns long before the density returns to
preoperative levels.
>I'm sitting here with both upper and lower plugs.
Do you really think people should pity you because you have punctal
plugs? Give us a break.
>My eyes hurt like hell every day.
It appears that your corneal nerve sensitivity has returned.
>Dry eye was not in my consent forms.
Then sue. If you think your doctor is guilty of malpractice because
you claim dry eye was not in your consent form, then stop going on and
on and on here and do something about it.
>I have been diagnosed with conjuctivitis sicca. Not
>present before LASIK.
Conjunctivitis is a very common nontraumatic and naturally occurring
eye complaint. Tens of thousands who have NOT had refractive surgery
get it all the time. The term describes any inflammatory process that
involves the conjunctiva; however, to most patients, conjunctivitis
(often called pink eye) is a diagnosis in its own right.
You had LASIK how long ago and you are now blaming pink eye on it?
>The FDA still says tobacco is OK and won't take a stand to regulate it as a
>drug.
Maybe in your world, but in the real world where most of us reside the
FDA not only does not say that tobacco is okay, but has no
jurisdiction to say anything about it either way.
>Is it a surprise that they
>won't set firm limits on minimal residual stromal thickness?
You are a never ending repository of inaccurate information. Take a
look at the transcripts of the FDA advisory panel, clinical trial
protocol, and the professional labeling of the excimer lasers. The FDA
has determined that 250 microns of tissue needs to remain untouched
after refractive surgery. This is consistent with decades of studies
and practical application. Of course, more is always better.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
| |
| serebel 2005-08-13, 10:54 pm |
| He may be on to something with the conjunctivitis thing, shortly after
my lasik, I cut my left thumb, it never happened before lasik.
SErebel
| |
|
| Just in response to the conjunctivitus issue. Prior to Lasik I had
Giant Papillary Conjunctivitus. This nasty condition occurs only in
contact lens wearers. I had a choice in the end - wear glasses only or
have Lasik. I chose Lasik and have not looked back. The GPC cleared up
within a few weeks of having Lasik after having the condition for about
3 years! I had Lasik nearly 3 years ago and like the vast majority,
have no residual problems. Dry eye was an issue for about 3 months and
it took about 12 months for my eyes to completely stabilise. Being
severely myopic is comparable to me to being disabled. I had an
opportunity to correct my disability and I chose to go ahead. Comparing
the Lasik industry to the Tobacco industry sounds dramatic, but there
are no comparisons to draw.
How can you say that dry eye was not mentioned on your consent forms?
This is the most basic issue raised by the surgeon and/or his staff. I
simply refuse to believe that this was not mentioned !
Linda
| |
| serebel 2005-08-14, 10:55 pm |
| Linda,
Of course dry eye is one of the first thing they look into. It's the
zealots who are in denial about this.
I also took the opportunity to correct my visual disability. No one
here or anywhere else can take that away.
SErebel
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