Another American Dies During Plastic Surgery in Mexico

Another awful tale of a Southern Californian who died as a result of a botch job from a disreputable Mexican plastic surgeon.  From 10news.com...

Lourdes Trinidad Died After Liposuction Procedure Performed By Dr. Louis May Villanueva

CHULA VISTA, Calif. -- A local doctor who may have overstated his credentials is being held responsible for the death of a Chula Vista woman he operated on recently.

 

According to family members, 48-year-old Lourdes Trinidad underwent a liposuction procedure performed by Dr. Louis May Villanueva of Bonita.

 

Family members said Trinidad was a healthy and active pharmacy technician who opted for liposuction and went to May's Millennium Cosmetic and Laser Institute in Tijuana for the procedure.

 

"The doctor assured her it was real simple, it was a real simple procedure," said Trinidad's brother, Sergio Salazar.

 

It ended up becoming a deadly procedure, although Trinidad's family has yet to receive a good explanation as to why it turned out that way.

 

"We're just shocked and we're amazed that a doctor like that could just leave, could leave her there by herself," said Trinidad's brother, Bernard.

 

Trinidad's mother is warning others, not just because of her daughter's death, but what happened after. The family said May disappeared.

 

"He was nowhere to be found ... The doctor was gone," said Salazar.

 

The family said after Trinidad's accounts were frozen when she died Saturday, May still wanted his $2,000.

 

"On Monday, we get a call from the bank that said he tried to cash it. He had the nerve to try to cash the check that killed her," said Bernard Trinidad.

 

10News visited May's Bonita home for his version of events, but he was not there.

 

May said he is a member of the American Academy of Cosmetic Surgery, but 10News learned from academy officials that he is not a member.

 

Additionally, May also claims membership in the American College of Phlebology, but any member of the public who wants to learn about leg veins is allowed to join.

 

"We don't want any money from him. We want to stop him from doing this again to someone else," said Bernard Trinidad.

 

Trinidad's family will bury her Thursday, and they continue to question whether it was a complication or incompetence that led to her death.

 

10News contacted May's clinic and they said they did not have any information right now.

 

10news also contacted the Ministry of Health in Tijuana to determine if May is fully licensed, but there has been no response.

Please beware of plastic surgery in Mexico.  While there are many excellent physicians south of the border, it can be very difficult for an American to vet the qualifications of her Mexican doctor.  Even when tragedy doesn't strike, standard "botch jobs" end up costing the patient much more than she would have saved had she seen a Board Certified Plastic Surgeon in the USA.  Make wise choices.

A Full Tummy Tuck (With or Without Circumferential Extension) Will Best Correct the Upper Belly and Bellybutton

I've lost 100 lbs. after having a Lap Band put in nearly 4 years ago.  My stomach issues are very unique looking, which is why I'm having the difficulty in determining what procedure I need.  My unwanted fat and loose skin are mainly only above the bellybutton, like they're sitting on a shelf.  I am unsure of which procedure would benefit me the most among simple liposuction, a modified Tummy Tuck, a full Tummy Tuck, or extended.  I'm open to any other suggestions as well.  I believe my skin has shrunk back as much as it can already.  Thoughts?

First and foremost, congratulations on your weight loss!  What a wonderful transformation. In addition to your improved health, your figure already looks terrific.

Second, even though you might think that your tummy has "unique" issues, nothing could be further from reality. I see at least one patient per week whose tummy looks like yours.

Third, go for a full tummy tuck.

• After 4 years, your skin is not going to shrink on its own any farther--no matter how much exercise you do.
• Liposuction will not be helpful to treat the upper tummy (called the epigastrium) and bellybutton. Since liposuction is a fat removal technique (without any significant skin tightening), liposuction is the wrong answer.  You are already skinny!  The problem is too much skin without good tone, not excess fat.
• Mini tummy tucks are nonsense operations. I have never found the right patient for a mini tummy tuck--even after 8 years of practice!  A mini tummy tuck is for that very rare patient whose problem area is limited to her lower middle abdomen, just above her pubis.  Obviously, this is not where you are concerned.
• A standard tummy tuck will work.  To minimize "dog ear" formation on the bilateral hips, weight-loss patients generally get their best results when the tummy tuck is extended all the way around circumferentially.  Whether you choose to keep the surgery just in the front or all the way around will be your decision.  Both are good choices, but the circumferential technique generally produces better contours.
• Do not do a fleur-di-lis abdominoplasty.  The vertical portion of the scar is ugly, and the operation is now recognized as obsolete.  If any doctor offers you this surgery, run away!  He is out of date!!

Fourth, make sure that your lap band port is exchanged from a high-profile to a low-profile.  Now that you are thin, the low-profile port will be less visible.  You don't need that extra prominence to find the port anyway; you've got no subcutaneous fat.  (Congratulations again!)

Fifth, make sure that your surgeon is certified by the American Board of Plastic Surgery.  And, better yet, research whether he specializes in weight-loss patients.  I do a lot of post-bariatric contouring, and let me tell you that weight-loss patients are very different from "regular" plastic surgery patients.  Your surgeon needs the expertise only garnered from years of experience with your peer group.

Good luck!

ATX-101: FDA Approval for Dissolving Fat (?!)

Maybe, I shouldn't have been so quick to disparage injection lipolysis.  Kythera Pharmaceutical's ATX-101 just might prove me wrong.

Back in November 2009, I called attention to the farce of injection lipolysis and mesotherapy, also known as...

• LipoZap
• Lipostabil
• Flabjab
• Lipomelt
• Lipodissolve
• Fat-Away

http://www.pickartplasticsurgeryblog.com/2009/11/whatever-happened-to-lipozap.html

Mesotherapy, injection lipolysis, LipoZap, etc., involved injecting bile acids beneath the skin to melt fat--or at least that was the hope.  Compelling advertising enabled LipoZap centers to spring up throughout the United States and Europe.  As is so often the case, clever marketing preceded any clever science.  Without appropriate testing for safety and efficacy, many patients were swindled, and some were seriously harmed.

Enter Kythera Pharmaceuticals.  Led by executives and researchers from the established biotechnology industry (such as Amgen and Allergan), Kythera seems grounded in science and safety.  ATX-101 is Kythera's fat buster.  Preliminary trials have been completed for dissolving lipomas--benign fatty tumors, affecting 2% of the population, which can be painful and cosmetically displeasing.

The traditional treatment for lipomas has always been surgical excision.  However, surgery always entails risks, such as scarring, infection, damage to critical structures like nerves, etc.  The hope is that ATX-101 will significantly reduce the size or eliminate lipomas without the need for surgery.

If ATX-101 were to work on lipomas, then I don't see why it shouldn't work on those stubborn fat deposits that we have inherited from our parents.  Analogous to current lipoma treatments, stubborn fat is now removed with surgery--liposuction.  Wouldn't it be nice to sign up for a few injections rather than a surgical procedure (albeit a minor one)?

Why Am I Gaining Weight After Liposuction?

I had liposuction of my tummy about a year ago.  My doctor removed 2000 cc.  I didn't lose weight, but I looked good.  But, now, my love handles are growing.  I have a muffin top, and I am up 5 pounds.  What gives?  I thought that I wasn't supposed to gain weight after lipo.  Isn't there some kind of guarantee?

- Heather C., from Oxnard, California

Heather, let's reeducate you about liposuction...

Myth #1:  Liposuction is great for weight loss.

Liposuction is not a good weight loss technique.  Most patients usually lose just 1-2 pounds after liposuction.

Liposuction removes stubborn fat deposits and thereby improves a patient's contours.  Ideal liposuction patients are already at their ideal weights; they just can't lose those darn saddle bags, or tummy pooch, or chin fat, or whatever.

Heather, I am therefore not surprised that you didn't lose much (if any) weight after liposuction.  This is typical.  However, you did get what a good liposuction procedure should provide:  a better appearance and more confidence.

Myth #2:  After liposuction, I won't ever gain weight again.

Liposuction cannot change the future!  If a liposuction patient ingests more calories than she burns, then she will gain weight.  If she wants to lose weight, she should either eat less or exercise more (or better yet, both).

Liposuction removes fat cells.  They are gone and will never come back.  However, if a patient ingests more calories than she burns, then her body will deposit fat somewhere.  It's just less likely to be stored in the liposuctioned area than somewhere else.

Heather, your 5 pounds are being stored preferentially in areas that were not liposuctioned.  Since your tummy was treated, the weight is going elsewhere--to your flanks and hips.  Hence, you have developed love handles and a "muffin top."

If you lose those 5 pounds, I bet that you'll get back your old post-op "look."

Myth #3:  Plastic surgeons can and should guarantee their work.

Plastic surgeons can't, in good faith, ever guarantee their work.  There are too many variables.  Biological systems (i.e., human bodies) are far too complex for any person to perfectly control in all instances.  Abnormal healing, infections, and other acts of God can mar the results of the best surgeons.  Patients themselves overindulge in sweets, forget to exercise, forget to follow post-operative instructions, etc.  And, yes, even superstar surgeons have bad days; Michael Jordan didn't dominate every basketball game.

Rather than a guarantee, Heather, your surgeon should have offered you a frank discussion about liposuction, including all the risks.  In my pre-operative conversations, I always inform patients that weight gain after liposuction can detract from the final result.

I hope that this helps, Heather.  Try to lose those 5 pounds; skip desserts and increase your exercise regimen.  Then, recheck your figure.  You'll probably look great again...without the muffin top!

Patient Dies in Florida After Liposuction...Performed by an Occupational Medicine Specialist

Awful stories of bad plastic surgery outcomes abound on the internet.  Unfortunately, there is a common theme:  The plastic surgery is often NOT performed by plastic surgeons.

Rohie Kah-Orukotan, who was herself a nurse, died after liposuction surgery on September 25, 2009, in Broward County, Florida.  The operation had been performed in a medical spa by Dr. Omar J. Brito Marin, an occupational medicine specialist, who had taken a three-day course on cosmetic surgery procedures.

This case nearly brings me to tears.  Not only is she an attractive young lady with a bright future, but the circumstances surrounding her death are unsafe and bizarre.

• Her physician is an occupational medicine specialist.
• • What the heck is that?!  I have been a physician for 13 years, and I don't even know what an occupational medicine specialist is.
  • Everyone should know what a real plastic surgeon is--a physician who has been certified by the American Board of Plastic Surgery. 
  • How could a nurse not know the difference? 
• He took a three-day course on cosmetic surgery.
• • I spent close to seven years in surgical training after four years of medical school. 
  • How could a nurse not know that a three-day course over a long weekend is not adequate?
  • Couldn't she have found a Board Certified Plastic Surgeon with years of training?
• The surgery was performed in a medical spa.
• • Liposuction is real surgery.  It should be performed in a real operating room!
  • Safety equipment and appropriate monitoring is essential to ensure good outcomes.
  • Board Certified Plastic Surgeon are required to use accredited facilities.  No occupational medicine specialist would even be let in the door to a certified facility.
  • How could a nurse not know that it is unsafe to have surgery in a spa where people usually just get massages?
• Apparently, the liposuction was performed with carboxytherapy, which supposedly reduces stretch marks and cellulite.
• • I have never even heard of carboxytherapy.
  • There is certainly NO scientific evidence that carboxytherapy reduces stretch marks and cellulite.
  • Carboxytherapy is NOT a standardized liposuction technique.
  • (For discussions of other liposuction gimmicks, check out http://www.pickartplasticsurgeryblog.com/2009/10/waterjet-assisted-liposuction-breakthrough-or-gimmick.html or http://www.pickartplasticsurgeryblog.com/2009/01/smartlipo-and-brazilian-butt-lifting-can-a-patient-use-the-smartlipo-fat-for-buttock-augmentation.html) 
  • How could a nurse fail to know that she was being duped with a gimmicky procedure?

This case teaches me that even professionals can be tricked.  If a nurse can be convinced to undergo gimmicky liposuction in the back room of a spa by a non-surgeon after he trained over a long-weekend, then the lay public is in deep trouble.

Water-Jet Assisted Liposuction: Breakthrough or Gimmick?

More than in any other surgical technique, liposuction technology is marketed directly to consumers with little (to no) scientific evidence.  Some background...

• Standard suction assisted lipectomy employs a strong vacuum to remove stubborn fat deposits.
• Most surgeons add tumescent fluid to numb the surgical area and to constrict blood vessels (and thereby minimize bleeding).
• Power assisted liposuction involves a vibrating handle to minimize surgeon effort when removing the fat.
• Ultrasonic assisted liposuction uses ultrasonic energy to melt the fat before it is sucked out.
• Laser assisted liposuction uses a laser for melting fat before it is vacuumed out.
• Water-jet assisted liposuction supposedly limits intra-operative tissue distortion caused by the tumescent anesthetic fluid.

If all you knew about plastic surgery was learned from daytime television, then you would think that plastic surgeons perform liposuction...

• in their offices
• under local anesthesia--with tumescent fluid alone
• employing lasers to melt the fat
• water jets to minimize distortion

The truth is much less sexy.  The vast majority of Board Certified Plastic Surgeons prefer...

• an accredited surgical facility rather than the back room of their office
• heavy sedation--either "twilight sleep" or general anesthesia provided by an appropriately trained anesthetist
• some quantity of tumescent fluid for additional comfort and to decrease bleeding
• performing the actual liposuction with... standard techniques, power assisted devices, or ultrasonic machines

While I do like ultrasonic assisted liposuction (and I use the VASER system), as a Board Certified Plastic Surgeon, I have to admit that there are no good scientific studies documenting the superiority of ultrasound or laser-assisted liposuction relative to standard or power-assisted tumescent liposuction.

The water-jet is so new on the scene that there are exactly ZERO articles about it in the most prestigious plastic surgery publication Plastic & Reconstructive Surgery.  So, is water jet liposuction a breakthrough or gimmick?  I have absolutely no idea.

The best study on laser-assisted liposuction (from Chile, and published in Plastic & Reconstructive Surgery in 2006) demonstrated no major clinical differences between standard liposuction and laser assisted liposuction.  However, there were higher concentrations of free fat molecules floating in the blood of the laser patients, which alerts me to the possibility of potential damage to the liver, kidneys, or lungs.

So, truthfully, when patients ask me about laser and water-jet liposuction, I don't even know what to tell them.  In the past, I have mentioned the potential dangers of minimally tested technologies, and patients have actually become angry at me for my skepticism!  It's amazing to me that my caution turns people off.  Typically, patients express disbelief that lasers or water could be anything but positive.

The effects of marketing can obviously be pernicious.  It's incredible that the makers of these product have been able to convince the public of their products' efficacies before they have even convinced the surgical community!  Crazy!!

Protruding abdomen? Consider a Tummy Tuck

My belly looks like a "prune."  I've had two kids.  I watch my weight.  I exercise daily.  What else can I do?

-Nicole

  

Nicole, you could consider an abdominoplasty.

An abdominoplasty is commonly known as a tummy tuck.  It is a major surgical procedure to improve the appearance of the tummy by...

• removing excess skin (and most of the pregnancy-related stretch marks!) from the lower and middle abdomen
• removing excess fat from the tummy
• tightening the abdominal muscles (whose laxity produces a protrusion of the central belly)
• rejuvenating the bellybutton

The best candidates for a tummy tuck usually...

• are in good shape
• have an abdominal "roll" that won't respond to dieting
• have loose skin that won't tighten with exercise
• have stretched abdominal muscles, due to multiple pregnancies
• have lost significant amounts of weight

An abdominoplasty is NOT...

• a weight loss technique
• for a patient who intends to lose more weight
• for a women who plans more pregnancies (The vertical muscles which are tightened during surgery can separate again after a pregnancy.)
• for patients who scar very poorly

Overall, an abdominoplasty can dramatically improve the appearance of a post-partum abdomen.  However, patients should bear in mind that...

• there will be a permanent scar that extends from hip to hip (about 3 times the length of a C-section)
• the recovery can be prolonged (2-4 weeks is typical.)
• smoking must be stopped for 4 months--2 months before and 2 months after surgery (Tobacco may lead to poor healing.)
• poor healing may necessitate a secondary operation

Our questioner Nicole did great:

 

Breast Augmentation Through the Belly Button? Don't Be Fooled

Many women would like breast implants, but they are turned off by the thought of visible scars...

• around the areola, or
• in the fold beneath the breast, or
• in the arm pit

So, some surgeons offer breast implants through the bellybutton.  Termed the TUBA (Trans-Umbilical Breast Augmentation), I have seen more disasters with this technique than any other....

• How can the surgeon expect to do finesse work from a foot away?  The belly button is too far away from the breasts.
• Hence, the implants are never placed 100% correctly.
• And the breasts are frequently asymmetric.
• How do you control operative bleeding from a distance?
• Hence, there are more bleeding complications with the TUBA.
• The long-term complication of bleeding around an implant is capsular contracture (hardening and disfigurement of the prosthesis).
• Surgeons cannot use silicone implants for TUBAs.  They are limited to saline, which are suboptimal for most patients.

I try to dissuade patients from undergoing TUBAs.  Los Angeles and Beverly Hills are filled with TUBA practitioners who have no intention of correcting their own mistakes.  So, in my practice in Ventura, California, I have to revise the breast implants on at least 5-10 TUBA patients each year.

On the other hand, non-surgical, "scarless" breast augmentations may be available soon....

• Commercially available fillers, similar to Restylane and Juvederm, have been trialled in Europe.  These products are injected into the breasts to produce small augmentations (maybe 1/2 of a cup).  While the fillers might last only 6-12 months, their placement involves no general anesthesia, no cutting, and no down-time--just a few needle pokes.
• Fat grafting may have efficacy.  Imagine liposuctioning fat from your tummy or hips, and then injecting it into your breasts.  It's a two-fer!  The big problem is the issue of cancer.  Will the fat cause breast cancer?  Will scarring from the fat transplant obscure tumors on mammograms?
• Vacuum?  Could you apply a vacuum to your existing breasts to stimulate their growth?  Sustained tension on your teeth allows your orthodontist to correct your smile.  Little people have been stretched to increase their height.  Why not suck the breasts bigger?!  This is an awfully compelling area of research which I hope pans out.

"My Blood is Thin. Can I Still Have a Tummy Tuck?"

I have von Willebrand disease.  So, my platelets don't function properly, and my blood is thin.  Can I still have a cosmetic tummy tuck?

-Nicole

Yes!

There are variety of situations that cause the blood to be thin....

• von Willebrand disease
• hemophilia
• the prescription use of warfarin (also known as Coumadin)
• the over-the-counter use of aspirin, ibuprofen, naproxen, etc., for headaches or other pains

In most circumstances, the blood can be safely thickened so that it will clot normally even during major operations.  Tummy tucks typically produce very little bleeding, so Nicole's surgery went perfectly....

 

Package Deals in Plastic Surgery: Why They Make Sense

I have increasingly seen advertisements for plastic surgery "packages":

• New mommy makeovers:
  • Breast enhancement
  • Tummy tuck
  • Liposuction

• Surgical facial rejuvenation:
  • Browlift
  • Eyelids
  • Facelift
  • Necklift

• Non-surgical anti-aging:
  • Fotofacial/intense pulsed light lasers
  • Botox or Dysport
  • Fillers (like Juvederm, Restylane, Radiesse, or Sculptra)

My wife has been skeptical.  "Aren't those packages just gimmicks to sell additional services?"

Yes, but that's a good thing.  These bundled procedures do work well together.  Combining services can lead to results that are greater than the sum of their individual parts.

Consider the "new mommy makeover."  All women know that pregnancies and breast feeding cause both the breasts and the abdomen to swell.  In many women, the skin never snaps back to its pre-pregnancy elasticity.  Lifting or augmenting the breasts makes the chest look great.  However, the whole torso is not balanced until the tummy is also flattened and tightened.  So, combining breast enhancement with a tummy tuck does produce the best proportions.

Non-surgical solutions can also be performed concurrently to optimize results.  For example, the "11's" between the eyebrows will usually respond to Botox or Dysport; a 60-80% improvement is typical.  However, for some patients, 60-80% is not good enough; they want 90% erasure of the wrinkle.  So, adding a little bit of filler beneath the relaxed wrinkles (such as with Restylane or Juvederm) can nearly eradicate the 11's.

Fillers can even be used to enhance a surgery.  Everybody knows that a face/neck lift can improve the cheeks, jowls, jaw line, and neckline.  However, the area around the mouth is usually not rejuvenated.  So, I will often recommend Restylane or Juvederm to minimize the "smoker's lines" radiating from the lips.  Combining these fillers with the face/neck lift can produce the most harmonious result.