Category Archives: Plastic Surgery

Day 1 Vegas Cosmetic Surgery 2013

First official day of the Vegas Cosmetic Surgery and Aesthetic Dermatology Conference 2013

I particularly got a lot great ideas and info regarding Botox and Fillers (Juvederm). I was very interested in the way they treated complications.

I also attended sessions that talked about social media, habits of very successful cosmetic practices, blogging, reviews, thank you notes, patient surveys, and the usage of YouTube videos. I hope to act on much of this. It was almost info overload. And this was only day 1.

Plastic Surgery Related Booths we visited

Operative headlamp company – about $800 for a head lamp. 3 hour-4 hour battery life. LED bulb!
Zein Obagi. Looked at the differences between Zein Obagi and Obagi
Touch MD – incredible stuff indeed. Touch MD is a technological way to visually share the plastic surgical consultation with the patient. There’s a program component which resides on the computer and then there’s a “cloud” component where the data resides. The data can be accessed from many other devices and webpages via secure methods. This is a great addition to EMR. And perhaps would be a great addition to our plastic surgical practice in Modesto, CA. They said that currently they don’t have any doctors in Modesto, CA who have Touch MD. It also has a back end for picture management.

We were originally going to see a show, but instead we talked with the guys at Touch MD.

TiZO3 and Lip Balm

We found an an amazing Sun Screen for the lips. It is made by the Fallene company in their Solar Protection Formula line. TIZO is among one of their products. Dr. Tammy Wu said that she has been looking for a lip balm that is a physical / mineral based for awhile. We just found the LipTect product at the Vegas Cosmetic Surgery conference. Along with this, we also found the TiZO3 sunscreen for the face. It has Titanium, Iron, and Zinc. It is Paraben, Oil, PABA and fragrance free. It is also tinted and is a very water resistant formula. We will have the LipTect (Lip balm) and TiZO3 sunscreen available for purchase at Surgical Artistry, Modesto, CA. Dr. Calvin Lee (me) takes credit for introducing Dr. Tammy Wu to the booth, and Dr. Wu made the decision to make an opening order! One more reason for this – it would be an great product to protect a lip augmentation investment.

Vegas Cosmetic Surgery and Aesthetic Dermatology 2013 Day 0

Day 0 of the Vegas Cosmetic Surgery and Aesthetic Dermatology Conference 2013

Date: June 25, 2013

Located at the Bellagio Resort Hotel, Las Vegas. This is the 9th annual conference. The 10th annual conference has already been set for June 18th-22nd, 2014.

Vegas Cosmetic Surgery at the Bellagio Hotel Picture by Dr. Calvin Lee.

My adventures on the day before the Vegas Cosmetic Surgery conference begins

Dr. Tammy Wu and I saw a very full day of office patients and ended at 5:15pm in our office, we were think that we would catch the 8:10pm flight out of a neighboring city: Stockton, and take the Allegiant Air flight to Las Vegas. But it was delayed. But because it was delayed. I got some administrative paperwork done at the office. I read some of the mail and paid some bills. Dr. Tammy Wu got to inventory some of the Obagi that came to the office. It was a massive order – I think it was about $16,000 worth of Obagi products that came in and we had to unpack these large Obagi Skin Care products and put them on our shelves. Some of these were ordered specifically for patients.

Allegiant Air

Delayed 4 hours
Got my $2 water at the airport.
It was a packed waiting room at the Stockton, CA Airport.
The Allegiant Air plane didn’t take off till around 12:30pm.
Seating was quite uncomfortable for me – my neck just didn’t seem to fit the seats.
We arrived around 2:00am in Las Vegas
But good things: Dr. Tammy Wu and I got to sit next to each other and Dr. Tammy Wu slept through most of that flight. I was just too uncomfortable to sleep through the entire flight. But it was a relatively short flight.

Strange Taxi Guy

Took us to an entrance of the Bellagio which was pretty far from the reception desk. There was an entrance that was right by the reception desk, but I guess it would have taken the taxi driver longer to get out of that round about, etc. We had to walk pretty far with our luggage. At 2am, it just seems a little bit more confusing, and the Bellagio in Las Vegas is a pretty big hotel.
The trip from the Las Vegas Airport to the Bellagio hotel took about 10 minutes.
And the trip with tip was about $26.00 for us. In retrospect, I wasn’t so sure the Taxi driver deserved any tip for dumping us off at a far entrance.

First thing we did in Las Vegas was check out the Bellagio Gym

We really came here for the conference. Just a few months ago we were in Vegas already, so we weren’t all that motivated to check out all the sights of Vegas again. But working out and and taking care of ourselves and preparing for our next half marathon (perhaps Santa Rosa Half Marathon?). Dr. Tammy Wu hasn’t run in a long time, so she gave it a try today again at the treadmill. I ran about 1 mile on the treadmill, and she ran about 2 miles. One great thing about the gym was a cable weight machine where I was able to adjust the rotation and angle of the arm, and thus I was really able to stretch out my right shoulder which has been bothering me from some chronic over use with injecting, operating, inserting acupuncture needles, and worst of all, using a computer mouse to write blogs (ie. this one) / do social media, etc.

We ate at Noodles Restaurant in the Bellagio

We had to tell them about our Vegan and Gluten Free preferences. They were very happy to accommodate. I’m not Gluten sensitive, but Dr. Tammy Wu is. So the dishes we got were: Agadashi, Endamamme, steamed vegetables, soy flavored rice noodles stir fried with vegetables, and rice. This was quite a good meal and we escaped with a $71 price tag.

Considered getting tickets to a Cirque du Soleil show.

O is showing at the Bellagio. However we couldn’t decide quite yet. The tickets ranged from $120 to $220 – I think. Instead we looked at the sculpture gallery associated with the Cirque Du Soleil. The sculptures were so artistic – they looked so anatomical – sort of like cosmetic surgery to us. The artist was Richard Macdonald, and the sculptures were for sale. They price tags for little sculptures were about $10,000 and the larger ones were around $150,000. There were two sales associates which gave us info on the sculptures, but the price tag were a bit too expensive for me anyway. One of them asked me about any other art pieces which I own. I said that the closest thing I have to these things are my teddy bear “collection.” They didn’t seem to understand. Regarding the possibility of seeing a show, we wanted to see the schedule of the Vegas Cosmetic Surgery and Aesthetic Dermatology conference, but the registration desk for that event hasn’t been open yet.

Walked around the Vegas Strip and then went to Walgreens

It was a pretty hot day already today. But I read in the weather forecast that it will be even hotter in the next few days, perhaps as high as 117 degrees F? We shall see. Good thing the air conditioners work well in the hotels. At Walgreens, I got a quart of orange juice and a gallon of water to lug back to the Bellagio. I considered taking the tram that connects the Aria hotel with the Bellagio, but we just walked around till the heat got too much.

Back to the Gym to stretch my shoulder.

By this time it was around 7:30pm. The gym at the Bellagio is open from 6am to 8pm. So it’s about to close. I went back to the gym to use the Cybex Cable weight machine. It wasn’t to lift weights, but I discovered that this was one of the best ways to stretch my shoulder joint. So I was able to spend another 15 minutes with this type of stretching to help rehab my shoulder which is already getting much better with my own stretching.

Went to Jasmine Restaurant in Bellagio

The most fun thing about going on vacation for me is eating out. So we tried the Jasmine Restaurant which was within the hotel grounds. We’ve been sticking to restaurants which have an Asian flare because it seems easier for us to find gluten free vegan choices. And they were happy to provide solutions for us. We had two dishes the eggplant dish and the monkey mushroom dish – both were made gluten free and vegan. We had two extra bowls of rice. The price tag with tip came out to about $75. Which we charged to our Bellagio room.

Early Registration at the Vegas Cosmetic Surgery and Aesthetic Dermatology conference

We finally got to pick up our materials and name tag. We met Karen Miller who said she’d help us with our Vegan/Gluten free preferences – how nice! The conference is 5 days long, and super packed with great cosmetic surgery information. I am most interested in the cosmetic injectable portion of the course and there’s plenty of that information including demonstrations on the Botox and filler injections.

We spent the next hour picking out how we would spend our time at the Vegas Cosmetic Surgery and Aesthetic Dermatology Conference

It is somewhat complex with about 3 different activities going on at the same time. There are also evening program going until 9:30pm. I made sure to pack in as much Botox and Cosmetic Injectable info as I could get. There is a whole bunch of stuff regarding social media, but I’m not sure I can get all that in.

Time flies when you’re having fun. It’s about 12:10am now.

We’ll see how it goes! Can’t wait to bring all this great information and education back to our plastic surgery practice in Modesto, California.

Smart Lipo Question for Dr. Tammy Wu

Dr. Tammy Wu, Board Certified Plastic Surgeon in Modesto, CA, got asked about considering professional liability coverage for a few general surgeons and OB/GYNs in California who are applying for coverage of SmartLipo. Dr. Wu explains her take on the situation

What is Smart Lipo?

SmartLipo by itself is not a dangerous procedure, it is laser-assisted liposuction, which has been shown to have a greater rate of seroma formation (as does ultrasound-assisted liposuction) and greater surrounding fatty tissue damage, possibly resulting in a greater potential for contour irregularities or deformities compared to traditional liposuction (old-fashioned way). Both laser and ultrasound are modalities used to “melt the fat” so that it makes it easier for the surgeon to do the liposuction. Traditional liposuction of sucking out the fat is still necessary, after the fat has been “melted”, so it is really not that different from traditional liposuction. It does not benefit the patient much, more for the surgeon. Of course, the marketing would have you believe that this is the greatest thing ever invented by mankind – NOT TRUE. We have seen complications of the procedure which includes scar formation with the adipose tissue which has complicated some tummy tuck surgeries. But we have also seen some wonderful work done with the device.

Dr. Tammy Wu prefers Traditional Liposuction over Smart Lipo

Personally, because of the higher rate of seroma and surrounding tissue injury, I believe that traditional liposuction is superior; it is more work on the surgeon’s part, but I think of it as liposuction art created by hand rather than by machine.

Non-Core Physicians doing Liposuction out of their own offices.

SmartLipo is a procedure marketed by the SmartLipo company catering to those who operate out of their offices (either b/c they prefer to do so, or they can’t get privileges at the hospitals to do it b/c they are not core physicians, ie, plastic surgeons). I think the risk may be low for those non-core physicians doing these procedures, b/c I think they would be more conservative and less aggressive (hopefully). As an in- office-procedure, the amount of liposuction should be limited to a safe limit.

What does the ASPS say about Safe Liposuction Limits?

The ASPS (American Society of Plastic Surgeons) recommends no more than 5L of total suction aspirate when liposuction is done in an office surgery suite, or surgery center by board certified plastic surgeons. Of course, all members of the ASPS (plastic surgeons) need to operate out of accredited surgery suites /centers. The non-core physicians may or may not have these restrictions.

Changes in Health Care is driving more non-core physicians to Liposuction.

Unfortunately, the way medicine and insurance is going, we are going to see more and more non-core physicians performing cosmetic procedures. We have to decide as a company what we want to do.

Dr. Wu says if they can prove good training, and are good physicians, then they have a chance at being good at Smart Lipo.

My personal opinion is that if they are well-trained in their specialty, and they have shown a responsible attitude (through office visits and claims history, as well as peer review opinions, etc.), it’s ok to approve them to do the procedure. However, I believe the following should be done before approval:

1. a site-visit is a must to evaluate the OR setting to make sure that they are equipped to react when the worse case scenario happens and to make sure that the suite/ center is accredited. Also the operating site should be in close proximity to a major hospital with ER in case of emergencies.

2. the physician should provide proof of training, and submit the number of cases performed, hopefully under supervision (for non-core physicians, not plastic surgeons – we get this stuff in residency and /or fellowship) to demonstrate competency in the procedure.

3. Preferably these are physicians who have no claims in the past in their own specialty. The reason for this is b/c plastic /cosmetic patients are very demanding and require a lot of TLC and patience. IF they have done well in their own specialty with good patient rapport, they most likely will continue to do so. I would not approve anyone who has had multiple claims for whatever reason, to do this procedure.

4. Limit their total liposuction aspirate to maybe 3L for each patient (for every surgery they do). This will minimize risks associated with large-volume liposuction (fat embolism, DVT, contour irregularities due to surgeon fatigue, etc.). We can consider having a clause saying that we would not cover the procedure if they do more than 3L at one setting.

5. We can also consider setting up a Risk Management Seminar specifically geared toward non-core physicians wishing to perform cosmetic procedures such as this. The seminar would probably be more medical, ie, the risks associated with liposuction, what to look for, what to avoid, etc. and require these non-core physicians to attend before approval.

Disclaimer: These are just her thoughts at the moment

These are my thoughts. It is a difficult market place out there. I would have normally said “no” to approving these physicians, but they are going to be a significant portion of those who attempt to resist joining large groups and try to stay on their own. We are a company that has historically catered to the small group and solo physicians, as an attempt to continue to support them, I think we may have to shift our thinking. As I said before, cosmetic and plastic surgery and some variations thereof (concierge medicine) will be the only ones standing alone amongst all of the recent and near future health care / insurance changes.

Dr. Wu is available to answer further questions to help professional liability companies consider coverage of Smart Lipo.

I hope this helps somewhat in answering your question. Let me know if you have any other questions.

FaceBook rejects Plastic Surgery Advertisement

Conflict with Plastic surgery and FaceBook Ads

See update below.

It’s understandable that FaceBook has a diverse audience. I just wanted to post this to help others who are considering advertisements with FaceBook.

I am very thankful that FaceBook has given us tools to promote our practice, but when it has come to advertisements, it has been a bit difficult when it comes to promoting Breast Augmentation.

I think perhaps wording could be adjusted in a way that it doesn’t offend FaceBook. I’m in the process of adjusting the ads. I’ve tried about 4 different ads on FaceBook, and they have been rejected. All of them have had the word “breast” in it. I tried to remove the word “augmentation” however that didn’t help.

What we wanted to advertise was a free informational session with those who are interested in breast augmentation. Perhaps this is a strange concept. We’re not entirely sure because we’ve not done this yet.

FaceBook took a long time to approve the plastic surgery ads which had the word “breast” in it.

In the past when I advertised things like Latisse, the ads were approved within perhaps a few hours. But I thought something was strange when the breast augmentation advertisements for Plastic Surgeon, Dr. Tammy Wu in Modesto, CA was taking over 48 hours. On about the third day we were notified that the ads had not been approved.

Here’s a picture of what it looks like when your plastic surgery advertisement is rejected by FaceBook:

Disapproved: “Your ad wasn’t approved because it violates Facebook’s Ad Guidelines by advertising adult products or services, including toys, videos, or sexual enhancement products.”

In the past I’ve had rejection of ads before for plastic surgery, but when I’ve written an email to the contact us section in the help files, they would review the ads and then release them, but sometimes that would take a few more days later. I don’t have that luxury this time. But I also think that this wasn’t a mistake on FaceBook’s part, this may be part of a ban against “Breast Augmentation” advertisements.

“Your ad wasn’t approved because it violates Facebook’s Ad Guidelines by advertising adult products or services, including toys, videos, or sexual enhancement products.”

It’s unfortunate in my opinion, as we see Breast Augmentation as a medical and surgical procedure, not something that is as they had quoted as the reasons for the rejection of my plastic surgery / breast augmentation info session advertisements.

I’m writing this to let other plastic surgeons and advertisers who work for the plastic surgeons know that this is a potential roadblock from FaceBook, but perhaps choosing different words may help.

Meanwhile, I’ll also contact FaceBook, to see if I can learn more about the situation and explain to them our situation and see if they feel any differently. I’d like to be hopeful that FaceBook doesn’t purposely block plastic surgeons and their plastic surgery advertisements. I’ll also find out if this is something new or in response to some sort of religious/public requests that FaceBook is trying to appease. I totally understand that it isn’t easy to please everybody in this world.

Stay tuned as I write them back for an explanation – although it will most likely be too late for our Breast Augmentation Info Sessions with Dr. Tammy Wu. There is much for us to learn about the massive world called FaceBook.

Update: I got one of the ads approved a day after

A day after I wrote the above blog. I finally got one of the ads approved, but I took the words Breast and Augmentation off of the copy of the advertisement, but I didn’t change the landing page which was a facebook event advertising our Breast Augmentation Open House event.

At this point, I’m still waiting for FaceBook to respond to my emails regarding my previous ad. Perhaps plastic surgeons need to avoid the words “Breast Augmentation” on their ads from this point on?

UPDATE with EMAIL FROM FACEBOOK

I got a response back in 1 day from FaceBook. They didn’t exactly talk about the ads which I did specify over age 21. But I suspect it has something to do with a filter that screened out the word “Breast”. But there are some good points in this email about changing the status of a FaceBook Page (ie. our Surgical Artistry Page on FaceBook). I’m making these changes and I think this will work:

Hi Calvin,

Thanks for writing in. Your ad was rejected because it violates the targeting policies of the Ad Guidelines. Ads for acceptable adult products (ex: cosmetic surgery and family planning) must be targeted to people 18 years or older.

While you can’t edit the targeting for an existing Promoted Post, please create a new targeting-compliant post, and share it on your Page to reach your fans and their friends. To target your posts appropriately, I suggest you gate your post first, and then run the promoted posts. To limit or target your posts, make sure your Page has post privacy gating turned on:
– At the top of your Page, click Edit Page
– Select Manage Permissions
– Check the box next to Post privacy gating
– Click Save Changes

After this, you will be able to see the option of targeting in your box to try messages. To add targeting:

– Before you publish your post, click the target in the sharing tool.
– Click Add Targeting and choose one or more of these filters: Gender, Relationship Status, Education, Interested In, Age, Location, and Language.
– Click the options on the right side to choose who you want to target your post to. For example, when targeting by gender, Male is automatically selected. Click ‘Male’ and select ‘Female’ to target your post to women’s news feeds instead.
– When you’re done adding filters, click Post.

Thanks,

Alan
Risk Operations
Facebook

Further Update 7/28/13 – more difficulties for Botox advertising

I tried to follow the directions and advertise a BOTOX event. However, that Boosted post got rejected again. I’m sending another email to FaceBook to see if they can help me. My overall conclusion is that it isn’t really easy to advertise on FaceBook with Plastic Surgery Ads, even with some expert help from Alan (see above). But perhaps there are other problems. I have noticed that there are other methods of getting to the targeting features on these ads.

Join our Surgical Artistry Page on FaceBook.

Cooperative of American Physicians at the 63rd California Society of Plastic Surgeons Annual Meeting

63rd California Society of Plastic Surgeons Annual Meeting

The Cooperative of American Physicians (CAP) will be there to provide Professional Liability Insurance Information May 24, 2013 to May 27, 2013

The 63rd California Society of Plastic Surgeons Annual Meeting will take place at The Westin St. Francis on Union Square in San Francisco, CA May 24-27, 2013. Visit CAP at Booth H.

The Westin St. Francis San Francisco on Union Square

335 Powell Street

San Francisco California 94102

United States

California Society of Plastic Surgeons

Cooperative of American Physicians

Lots of Breast Augmentation Expertise at the meeting, we will have our own event in Modesto, CA for discussing the latest advaces in Breast Augmentation

We will have our own Breast Augmentation Open House to discuss the latest techniques and breast implants available at our office. June 1, 2013 (Saturday) 9a-12p at our office in Modesto, CA: 2336 Sylvan Ave. Suite C, Modesto, CA 95355. (209) 551-1888 for more info.

CAP (Cooperative of American Physicians) is represented in San Francsico at the CSPS meeting!

The last picture above is an actual picture taken at the California Society of Plastic Surgeon’s Event.

Dr. Tammy Wu, Modesto Plastic Surgeon, is a member of the California Society of Plastic Surgeons and she is on the board of directors for the Cooperative of American Physicians.

Some general info about California Malpractice Coverage which I wrote some time ago.

Professional Liability Insurance vs. “Malpractice Insurance”

PLI = Professional Liability Insurance
Also called professional indemnity insurance (PII)
Also called Errors and Omissions (E&O) insurance
Professional liability insurance takes on different names depending on the profession. In reference to health care, it is sometimes called medical malpractice insurance. For the most part it’s just a choice of terminology.
CAP provides California Professional Liability Coverage for doctors.

Other Insurance related Terminology

For a Glossary of some of these professional liability terms, please visit: http://www.capphysicians.com/footer/glossary
Tail and Nose coverage terms are not in the glossary above so I’ll try to explain that to the best of my ability.
Tail Coverage = coverage of events that occur while the policy is in force but are reported after the policy terminates.
Nose Coverage = “prior acts” coverage, transfers the retro-active date for an old policy to a new insurance carrier. Nose coverage eliminates the need to purchase tail coverage from the last carrier.

Continuing Medical Education for Calvin Lee, MD, Modesto Surgeon

Lifelong student of Surgery, Medicine, and Health. Surgical Artistry (209) 551-1888