In order to get accredited by the AAAASF, surgical facilities must pass an inspection and the Medical Director and physicians practicing out of the center must have appropriate credentials. After the outpatient surgical center receives accreditation, routine follow-ups and inspections will be conducted.

Physicians in various specialties run the AAAASF accreditation program. They ensure that each facility follows the proper standards of care in a number of areas, including anesthesia, recovery room policies and procedures, operating room policies and procedures, medical records, and personnel.

Dr. Paul Pin performs all of his plastic surgery procedures in a safe, accredited facility. Contact our plastic surgery office today to schedule your consultation with Dr. Paul Pin.

Victoria Beckham

Former Spice Girl and current fashion icon Beckham is rumored to have undergone breast implant revision last spring to reduce the size of her implants.

Amy Winehouse

According to Winehouse’s father, the British songstress underwent breast augmentation last fall to fill out her small frame.

Kelli Pickler

After Pickler showed up to an awards show last spring looking like she had recently undergone facial plastic surgery, gossip magazines and bloggers speculated that the American Idol alum underwent procedures ranging from rhinoplasty, cheek implants, BOTOX injections, eyelid surgery, brow lift, and lip augmentation.

Carrie Prejean

Pageant directors at Miss California Organization admitted that they had paid for Prejean to have breast implants placed after she won the Miss California title.

Lindsay Lohan

Though she has yet to admit it, it appears that the actress and notorious party girl had lip filler injections throughout the past year.

Rupert Everett

Last spring, Everett’s notably different appearance led many to believe that the actor undergone facial plastic surgery procedures such as facelift and eyelid surgery.

Gordon Ramsay

It appears that TV chef Ramsay had BOTOX injections to reduce forehead wrinkling.

Bruce Jenner

On the reality show Keeping Up with the Kardashians, the former athlete underwent a second facelift to correct a previous plastic surgery, as well as a neck lift.

2. Patients should rest in bed for the first few days following surgery.

3. Do not shower for at least 48 hours after surgery.

4. Keep incisions clean and replace bandages as necessary.

5. Drainage tubes will be removed about five to 10 days after surgery.

6. Stitches will be removed after about a week.

7. A support or compression garment should be worn for about a week after surgery.

8. Have a family member or friend available to help care for you in the days following surgery.

9. Do not smoke or consume alcohol in the weeks following surgery.

10. Take at least one to two weeks off of work.

11. Take pain medications as recommended by your doctor.

12. Do not drive when taking pain medications.

13. Do not engage in strenuous activity for about six weeks.

What I do tell them is to worry more about who is doing the procedure rather than focusing on the technique.  Companies that manufacture medical devices are concerned about selling those devices to doctors.  Whether those doctors have formal training in plastic surgery does not always seem to matter.  I recently looked at the website of a leading laser liposuction manufacturer and found eight doctors in Texas.  One was Board Certified in Plastic Surgery, and one in Dermatology. Of the other six, two were certified by OB-Gyn, one in  Anesthesia, one in General Surgery, one in Family Medicine, and one had no Specialty Certification at all.

I am amazed that patients will have liposuction done by an ob-gyn or an internist. If they went to a plastic surgeon to have their baby delivered, would they expect the same quality they would receive from a Board Certified Ob-Gyn?  Of course not!  So why do patients think their liposuction done by a non-plastic surgeon will be as good?

Laser Liposuction is frequently “sold” as a procedure that is done under local anesthesia, leading patients to believe that it  will cost less. However, if they would comparison shop, patients would find this is not at all true.  Likewise, there is an implication that Laser Liposuction is somehow safer, but I have seen two patients who have been irreparably damaged by laser liposuction.  Less pain is also a purported benefit of the Laser technique, but there was a recent patient who thought the procedure was so horrible, that she complained to the Texas State Board of Medical Examiners.

I advise patients to ignore the hype and to be wary of heavily advertised procedures like  laser liposuction, as they are frequently oversold.  I continue to do tumescent liposuction under general anesthesia in an operating room as I believe the technique is proven to give the most consistent results at a reasonable cost and  with the fewest complications.      In selected cases such as revision liposuction or liposuction for gynecomastia, I will also use ultrasonic-assisted liposuction.  When scientific evidence is presented that laser liposuction is safe and offers an advantages to the patient, I will consider performing the procedure.

This is one great example of why you do not want the government dictating health care policy.  Even though the committee is composed of physicians, they were all appointed by government funded agency. When the government dictates policy, there will always be a tendency to place a value on a life, as was done in this report.  The committee even acknowledged that if the purpose of the health care system was to save lives, their recommendations would be unnecessary.  They are only trying to make the system “efficient,” which is a modern term for rationing.

These recommendations are particularly offensive because they are partially based on “models” that try to predict the consequences of their proposed changes.  This is in contrast to a scientific study where changes are made to a small group and those patients are followed to determine the impact of the changes.  Health care models are as fallible as economic models, as they are based on numerous assumptions.  Just as bad economic predictions have had adverse effects on our economy, so could bad health care models adversely impact thousands of women.

While using models may be bad, the task force made use of some questionable studies to form their opinions. One of the studies used to support stopping breast self exams involved a poorly-controlled trial of Russian women whose overall survival was much worse than is seen in the US. What that means is that the study is probably not applicable to American women. A conservative approach would be to duplicate the study in the US before changing recommendations about something so serious.

There is no question that trying to find breast cancer early is difficult and expensive.  However, the process becomes ridiculously expensive because of medical liability concerns.  As the committee pointed out, the majority of tests done following an abnormal mammogram fail to demonstrate breast cancer.  These test are an example of defensive medicine, practiced by many doctors doing mammography. Since a delay in diagnosis is a leading cause of medical liability claims,  doctors are forced to order extensive testing to prove that any abnormality on a mammogram does not represent cancer.  Being right 99% of the time is not good enough, as the one missed cancer can result in a multi-million dollar law suit. Being perfect in mammography is very expensive.

Unfortunately, instead of addressing the problem of tort reform as it impacts breast cancer detection, the government’s committee has chosen to advise everyone to just bury their heads in the sand and hope nothing happens.  A reasonable compromise would be to free physicians from the fears of ruinous lawsuits  and continue with the present mammography recommendations. With proper tort reform, physicians could still detect breast cancer early without wasting billions of dollars ordering unnecessary tests. Thousands of women would be saved along with billions of dollars.

My current advice to patients is to ignore these new recommendations until there is more scientific data to support them. The Mayo Clinic and the Baylor College of Medicine have taken a similar stance. Women should continue to get yearly mammograms beginning at age 40; some women with certain risk factors should begin sooner. All women over the age of 20 should do monthly breast self examinations and should report abnormal findings to their doctor.

Breast cancer remains a common and potentially lethal form of cancer that affects about 1 in 8 women. Since survival is clearly improved by early detection, I feel women should continue to do everything to try and detect breast cancer as early as possible.

All plastic surgeons are aware that smoking can lead to horrible complications, such as delayed healing or even dead skin. This is true particularly in procedures that involve lifting up the patient’s skin. Certain chemicals in cigarettes reduce skin blood flow, and are the cause of these problems. In fact, standard consent forms from the American Society of Plastic Surgeons clearly delineate these risks. Moreover, it is also well known that if a patient completely quits smoking for a few weeks, they can tremendously reduce their risk. So if your doctor is willing to do such a procedure on you while you are still smoking, it means he is not terribly concerned with your well-being and you are probably better off with a different plastic surgeon.

Smoking is generally contrary to cosmetic surgery. Patients seek plastic surgery to feel more youthful, and to be healthier and to be more attractive. Smoking is unattractive, publicly discouraged, and causes cancer and emphysema. As much as possible, a truly reputable plastic surgeon will use your desire to have plastic surgery to help you quit smoking. Choosing to have plastic surgery should also mean choosing a healthier lifestyle that involves proper diet, reasonable exercise and no smoking.

Many plastic surgeons have adopted a very mechanical approach to breast implant selection.  This process involves making a few measurements of the patient, and then telling her which size best fits her body.  While this process is well motivated, and may result in few surgical revisions, it may leave the patient with a result that is different from the one she really wanted.

One of the central problems with this process is that it involves trying to make measurements and decide what implant fits best.  To anyone who has tried and failed to buy clothes on the Internet, this approach seems hopeless.  Most measurements that can be made are two-dimensional, but the final fit depends on generating a three-dimensional result.

Plastic surgeons can use a process that is less mechanical and a little more like trying clothes on before you buy them. First, prospective patients should show their surgeon a picture of what looks good to them.  The Internet is full of before and after pictures that patients can look through to find examples they like.  Next, the surgeon should advise the patient about how the result in the picture would relate to her surgery.  Would it create a huge difference or a very subtle one?  Would breasts that large make someone look overweight? Would implants that small leave too much of a gap between a woman’s breasts?

Once a patient and her surgeon reach agreement on size, the breast augmentation surgery can be performed.  After a space or pocket for the implant is created, the surgeon can actually “try on” various sizes to see which implant volume and dimensions are most likely to make the woman look the way she has indicated with the pictures she chose.  The surgeon can then select and place that implant.

This system works well, and though it is imperfect, it gives the patient considerably more choice in the selection of their final breast appearance.

In the past, plastic surgeons would decide in the operating room what they thought was the best implant size for the patient.  This was extremely problematic, especially when the plastic surgeon thought everyone should be proportioned like Barbie. Even in the best cases, the surgeon’s tastes might not match those of the patient. This resulted in somewhat of a backlash, where patients began telling their surgeons what size breast implants they should have. These outcomes were also frequently unsatisfactory, as the patient did not have the knowledge, training, or experience to make such a decision.

To reduce the amount of revisional surgeries being performed, plastic surgeons have sought to develop a full-proof system for identifying the proper implant size for a patient pre-operatively.  Several measurements of the patient are made, and then the patient is told what implant size is appropriate for her.  As part of the consent process, the patient agrees to accept a specific size implant.  The end result is that revisions are less common, first because the patient participated in the process, and second, because she agreed to the implant size.  Realistically, it is hard for a patient to demand a revision of a breast implant she helped select and agreed to having placed.

This advance in implant selection has been tremendously beneficial in reducing revision surgery.  However, it has its drawbacks.  First of all, many patients want a certain look after their surgery.  Since implant size is determined by a formula, patients may or may not achieve their desired look. They may be unhappy, but are stuck with the implant they chose.  Second, while participation in implant selection is important, many patients really do not understand what they are agreeing to when they sign a consent for a “300 cc implant.”  How many patients know that 30 cc roughly equals one liquid ounce?

Plastic surgery, like any science, moves forward slowly.  One imperfect process is replaced by a better, but still imperfect process. For a patient, the point is to not be so preoccupied with the process of selecting an implant that the ultimate goal of looking the way you want is compromised.  Formulas and systems can improve the implant selection process, but they may generate recommendations that are nothing like the patient wants. While patients need to trust their plastic surgeon’s judgement, if they want to be happy with their results, patients need to make sure their desires are heard so their goals can be met.

Whenever possible, patients should make sure their prospective surgeons can complete their procedures in a reasonable amount of time. This can be done easily by comparing their times to times available on the internet. For instance, a tummy tuck should be easily completed in less than three hours. If your prospective surgeon is not planning on that, you should find out why or find a new doctor. While slow surgeons occasionally are just very meticulous, most of the time they are slow because they are indecisive, inexperienced, and generally less capable than their peers. Conversely, faster surgeons don’t move quickly but are able to complete surgery more rapidly because they are experienced, capable, and decisive. While not all fast surgeons are good, slow surgeons are generally suspect. Speed in surgery is just one factor to consider when choosing a plastic surgeon, but it is an important one. It is one more way to judge the ability of your of your doctor.

To begin with, plastic surgeons have realized that tighter is not only not better, but can actually make things worse. Research, particularly in breast reconstruction, has shown that beyond a certain degree of tightness, muscles and skin simply stretch. The goal of a tummy tuck is to achieve the ideal amount of tightness that gives a great result, while avoiding the excessive tightness that is associate with prolonged pain and recovery.

For instance, muscle repair is precisely performed to restore abdominal shape and function while at the same time allowing the patient to comfortably stand up straight on the first day after surgery. Similarly, excess skin is removed, but only to a reasonable tension. This avoids the patient feeling excessively tight, and contributes to a better scar. By controlling tension and thus limiting post operative discomfort, patients can recover more quickly and most can return to work in an office within a week or two.

All tummy tucks involve some type of incision. The incision is closed with dissolvable sutures under the skin. This means there are no cross hatches across the incision and there is no need to remove sutures. Additionally, the wound is covered with surgical adhesive, which means there is no need for bandages and patients can bathe normally on the first day after surgery.