Plastic Surgeons: The latest target by Drug Seekers

Drug Seekers have always been one the biggest challenges to physicians of all specialties. Plastic Surgeons have never been immune to this demographic of patient, but the current environment of electronic prescribing and monitoring has placed new challenges for narcotic abusers and dealers. The State of Alabama Medical Board of Examiners has implemented tools to help physicians verify and monitor patient prescriptions via an on-line portal. Along with this helpful system, the medical board appears to be on a mission of intimidation to those physicians who might be classified has high prescribers. The last few newsletters published by the Alabama medical board contain educational articles regarding this practice and how to prevent being a target by these “patients.” However, the tools suggested are not enough to protect the physician from new tactics by desperate drug seekers.

Since the first of this year, Plastic Surgeons have noticed an increase of new patients that fit this persona. Since their usual “sources” aka primary care physicians, orthopedics, internal medicine and pain management clinics are under the gun by the medical board to help reduce narcotic abuse, addicts and dealers are choosing new targets. Plastic Surgeons long have a history of highly individualized care for these elective procedures that include more personal access to the surgeon and/or staff. Allow me to first outline a some examples experienced by our office and other physicians:

(1) New Patient presents for cosmetic surgery consultation. The patient schedules surgery and a pre-operative appointment at which time the patient will sign necessary paperwork, receive pre-operative instructions including prescriptions required for day of procedure. The patient pays by check. The check is returned for insufficient funds. The procedure is cancelled. Patient is contacted and claims to have changed their mind regarding the procedure. The prescription is not returned as requested.
(2) Patient has liposuction procedure. Two days following procedure, patient’s caretaker calls to request a refill of pain pills. The refill is denied pending patient’s appointment the following day. Caretaker attempts to bribe the nurse into calling in the refill.
(3) A new patient appears for consultation. After being placed in exam room, office staff can over-hear the cabinet doors opening and closing in said exam room. When they open the door, the patient is sitting in the chair. Only then do they realize why the patient is carrying an oversized handbag that appears to be empty. Apparently bottles of alcohol, peroxide, and ointment were not on their wish list. Patient never signs up for any procedure.
(4) A new patient arrives early for their consultation. Appearing frustrated, the new patient informs receptionist their cell phone is not operational and they request to borrow an office phone. The receptionist offers her mobile phone charger instead. Patient refuses the assistance of the charger and still insists on needing to use a “land-line” phone.
(5) A tummy tuck patient, who had requested multiple narcotic refills following surgery shows for a scheduled post-operative appointment. Having already been cut-off of narcotic refills and Tylenol recommended, the patient shows with her husband. While in the exam room, the husband becomes aggressive with the surgeon demanding a full script pad of signed blanks. The altercation became violent when surgeon refused. Office staff dialed 911. Suspects fled the scene before police arrived but not after threatening bodily harm to the doctor and his staff.
(6) A primary care physician is threatened by a drug seeking patient during a routine office visit. Patient threatens a multitude of threats including bodily harm, law suit, sexual harassment claim, and filing formal complaints with governing hospital and state medical board. He refuses. Patient follows thru with complaints with the hospital and medical board. The physician was forced to defend himself in a “she said he said” situation.
(7) A primary care physician is contacted by a local pharmacist requesting prescription verification. The pharmacist had been presented with narcotic script with a very high pill count. The prescription was a fraud and the pharmacist destroyed the script. Upon further investigation, the physician discovered numerous prescriptions had been written using a counterfeit prescription pad, forging his signature and even using his correct medical license number and DEA number.
(8) Several years ago, Plastic Surgeon’s wife (me) went to fill a prescription of Valium written for her by her husband just prior to having to put-down their beloved 16 year old dog. At the pharmacy, the pharmacist questioned the prescription and stated he had just filled a prescription earlier that day in the same name by the same doctor for narcotics. I demanded to see the prescription and even requested he contact my husband. I gave him my driver’s license to verify I was who I claimed to be and he gave me a description of the person who came earlier with the narcotic prescription. The description closely resembled an employee and the pharmacist refused to give me a copy of the prescription presented. He also refused to speak with my husband whose signature had been forged. In my investigation, I discovered a flaw in our practice software that allowed users to print prescriptions then delete the records. The software was fixed and the employee eventually fired after obtaining further proof of misconduct.

As you can see, physicians are at risk and drug-seeking patients have very little fear. Stories such as these are never ending. Physicians are now forced to protect their credentials from all angles. Documentation in medical records is at a whole new level when dealing with drug seekers, that’s if you have a medical record.

First of all, let’s examine the ways these drug seekers obtain your correct medical license numbers and DEA number: internet. The first guilty party is Angie’s List. Physicians do not create their own profiles on their service, but are allowed to monitor their profiles and can request to correct the information. The physician must email the web site administrators to request removal of their sensitive license numbers. Physicians of all specialties should hire an in-house web site administrator to not only handle your sensitive web site material, but now to help monitor the web for abuses of your protected license numbers and reputation. Out sourcing this position is not advised.

Second, remove any and all office land-lines from unprotected areas of your office. The “my cell phone died” trick is a ruse to use your phone to call a pharmacy. Pharmacies often use caller-ID as their prescription verification methods. Otherwise, anyone from any phone number could call in a prescription claiming to be your nurse, especially if they already have your license numbers from the internet or from a previously written prescription. Even if you only use electronic prescriptions, not all pharmacists will know this is your office policy.

Third, create a new document for your office employee manual. If a chapter regarding prescription fraud is not already present, it’s time to revise. Medical staffs are often targeted by drug-seekers, often buddying-up to them offering bribes or playing a pity story. It’s time for all physicians to have a camp-fire meeting about this sensitive subject making very clear they are all at risk should only one cross this line. Make sure your employees understand it’s your medical license at stake, which is your career and all of their jobs. When hiring new employees, verifying employment history is imperative. Also, if an employment history of “doctor-hopping” is present, skip and move on to the next candidate.

Assign only one staff member responsible for handling prescriptions: calling in refills, access to the old-school paper prescriptions pads, and password protected access in the computer system for electronic prescriptions and printing. Otherwise, this duty will be all yours. Request this person to also create a daily prescription log by the end of every day to be placed on your desk.

For the threatening situations mentioned among the examples, there are few suggestions to help avoid or to defend yourself. The internal medicine physician now carries a small recorder in his pocket at every patient encounter. In most states, this practice is legal as long as one of the parties involved is aware of the recording. Many commercial phone systems also have a “record” button. If your practice software will allow for audio or visual recording files, then consider this protection as part of your patient’s medical record. Otherwise, create an excel spreadsheet by date to save the recorded files. Transfer those files to a memory chip to store in a secure HIPAA compliant place. Otherwise, consult with an attorney regarding the laws of your state and any further advice they may be able to offer. Further steps to protect your practice would be to install a “bank teller” like security system, and hire an expert to educate staff how to handle these situations.

Advanced prescriptions have been a courtesy in the plastic surgery industry for decades especially when meds are required prior to the surgical procedure. With the new trend of in-office procedures becoming more popular, plastic surgeons will need to develop new steps to avoid becoming victim to the drug seeker in these scenarios. Since drug seekers have no problem signing bad checks, a new financial policy requiring a cashier’s check or money order could prove beneficial. Many practices have also fallen victim to the “charge-back” scenario for cosmetic procedures. To get around this, practices have created “convenience fees” up to 4% for credit card charges of surgical services. One practice went from paying out thousands every month in merchant fees down to less than $200 a month after placing this policy without losing one single patient. If this policy is not feasible for your practice, then consider not providing prescriptions in advanced. If some prescriptions are necessary prior to surgery, requiring a non-refundable cash deposit to hold the surgery date would be advised.

As you can see, physicians need to yet again add another area of protection to their practices making the practice of medicine more challenging. These drug seekers are under pressure with state medical boards placing more accountability on the physicians. As physicians crack down on the amount of narcotics they prescribe and/or become more aware of those drug seekers in their patient files, they will also become softer targets by said drug seekers due to their credential and reputation vulnerability. Be aware of any and all situations where you could be cornered by a drug seeker. Arming yourself and staff with protecting tactics such as audio recorders could prove vital should you fall prey to the desperate drug seeker.

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What you need to know before you go for your Breast Augmentation Consultation

Choose your surgeon wisely

Choosing a surgeon who is Board Certified by the American Board of Plastic Surgery should be your first requirement.  A recent survey conducted by found that patient satisfaction is 30% higher when patients chose a Real Board Certified Plastic Surgeon.  If you need more information about how to find a Real Board Certified Plastic Surgeon, read my article, or go to  Most surgeons will recommend you see at least three different surgeons before making a final decision. Some factors to think about when choosing the Plastic Surgeon:

How long have they been in practice?

Do they have before and after photos for you to view?

Is the office staff friendly?

Where is the procedure performed?

Does the surgeon spend adequate time with you?

Will the surgeon be seeing you for your post-operative care?

Know your correct current bra size

Most women are not currently How to measure chest for bra sizewearing their correct bra size.  In fact, most women currently wear the wrong bra size because they have not properly measured themselves.  Most women begin with the usual “34” sized bra then choose the cup size from there.  When measuring for a bra, place the measuring tape UNDERNEATH the breast, measuring only around the chest, not on top of the breast.  This is the biggest mistake that manages to get so many women in the wrong bra size.  The purpose of the bra is to provide support of the breast.  Most women fit themselves focusing on mere coverage of their breast under clothing.  The bra cannot provide support if it is loose around the back, causing the back of the bra to rise up, thus the breast sag in the front.

Once you have the correct chest measurement, then you choose your cup size.  This is where so many Americans get frustrated.  Women tend to think that a size “C” cup is the same for a chest measurement of 32, 34, 36, and so on.  Nope.  Nothing could be further from the truth.  In fact, a 34C is the same cup size as a 36B or a 32D.  Also, a DD size is also size E, and triple D (DDD) is also size F.  Europeans use common sense cup sizes of A, B, C, D, E, F, G, and so on.  Americans like to be complicated and use A, B, C, D, DD, DDD, and so on.

So when you go into your Plastic Surgeon’s office and tell them you desire to be a “C” cup, think again.  Most “C” cups are actually not as big as you think.  Below is a chart to give you a better idea:  a 32C has the same cup size as 34B, a 32E (DD) has the same cup size as 34D and so on.

Bra Cup Sizing Differences

Saline or Silicone?

Choice in implant substance is a very personal decision and must be chosen wisely.  Saline is salt-water.  Silicone is, well, silicone.  The lifetime of saline implants is on average 10 years, meaning the implants are likely to require replacement approximately after 10 years.  Saline implants also are known to “reduce” in size and lose volume over the years which can lead to implant deflation which is why the life expectancy is around 10 years.  Silicone is back on the market and is gaining momentum as the implant of choice for a few factors.  Some believe the silicone gel is more natural feeling than the saline, and the life expectancy of the silicone implants is greater than saline.  Silicone is more expensive and the FDA recommends patients monitor the implants by way of an MRI every few years which is not covered by insurance.  Both implants run the risk of deflation, or outer shell failure, but the saline is absorbed by the body.  On the other hand, silicone is not absorbed by the body but less likely to deflate due to the silicone gel not losing volume over time.  Loss of saline volume over time causes the shell of the implants to shrink, thus creating folds, or rippling, in the shell.  These folds break down the shell due to friction leading to deflations.

There are three FDA approved Implant Companies in the USA:

Allergan (Natrelle™ Breast Implants) – manufactures saline and silicone implants

Mentor- manufactures saline and silicone implants

Sientra- only manufactures silicone implants, AND only sells their implants to Real Board Certified Plastic Surgeons.

Breast implant warranties chart

Implant Incision Site

The incision site for breast augmentation will be dependent on many factors depending on your choice of surgeon and choice of implant type.  Saline implants are most commonly placed using the sub-mammary incision (under the breast), and this incision site is required for silicone breast implant placement as well.  Other incision options include in the arm-pit (trans-axillary), through the umbilicus (TUBA), and around the nipple (peri-areolar).  Not all surgeons are skilled at these other incision sites and those that are not often have clever excuses such as “it is dangerous.”  What they really mean to say is, ‘it is dangerous for me to do it that way because I am not skilled at doing it that way.’

Decide what size you think you would like to be then do your research

Trying to choose your desired breast size can be easier than you think.  Most women have a friend who has 350cc saline filled implants, they look great, and they claim to be a “C.”  Take note than 350cc implants do not equal “C” cup for everyone.  Some women get locked-in an idea of what breast size they want to be according to “CC’s.”  Get over it.   Not all women are created equal and certainly not our breasts.  Decide what cup size you are now, and what cup size you desire to be.  The best way to assist in your decision process is by purchasing a few bras at your local discount store, stuff them and play around with sizing until you get a better idea.

Trying to pre-determine your implant size according to what size implant your friend got, who is taller or shorter than you, or may have started out with more or less breast tissue, is just not smart.  Let your surgeon measure you and chose the implant size according to what cup size you request.

The East Coast or West Coast Look?

I know this sounds funny, but it is a real thing.  Women on the East Coast have a different idea of how the implanted breast should look than the women on the West Coast.  I’m an East Coast woman and like the full look that achieves an augmented appearance on the upper polar portion of the chest.  West Coast women like the fuller look in the lower cup portion of the breast.   The difference in the two looks is created by implant size, shape, and placement.   Breast implants come in three different projections:  low profile, moderate profile, and high profile.  High profile is often used to achieve the upper polar fullness, moderate profile is the most commonly used implant, and low profile is the least commonly used implant.

There is another “anatomical” implant shape on the market referred to as the “tear drop” shaped implant.  Not that popular since most breast implants are placed under the muscle for the most natural appearance.  This implant is a consideration when sub-muscular placement is not an option for some patients such as body builders.  Otherwise, any special shape is lost under the muscle.


Breast Augmentation is the most “shopped around” procedure.  Price is usually the very first factor in choosing a Plastic Surgeon for this procedure.  Unfortunately, choosing your surgeon according to price can land you in a bad facility.  Most surgeons who charge very low fees for surgical procedures are business minded people focused on turning their operating room at rapid rates, which means you will be one of maybe a dozen patients that day.  Make sure you choose this type of surgeon wisely if price is that important of a factor.

Post-Operative Care

The patient’s after care plan is something that should be well organized in advance of any surgical procedure and breast augmentation is no exception.  Many young women perceive this procedure as a “weekend recovery” and often make plans to return to work or go enter that bikini contest.  Breast Augmentation involves the placement of a foreign object (implant) inside the body.  This procedure can involve a painful recovery easily resolved with pain medication.  The incision site must be protected until the doctor instructs otherwise, and physical activity will be limited if not prohibited by your surgeon for a period of time.  Most patients describe the pain discomfort as “an elephant sitting on my chest.”  Most Plastic Surgeons recommend taking a week off of work or other physical activities.  You should also make arrangements to have someone stay with you for the first day or two, and even drive you to and from your post-operative appointments the first week.

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2018: Your Doctor is a Plastic Surgeon

For over 12 years I have worked for my husband in his Plastic Surgery Practice in Birmingham, Alabama.  I began by managing his Cleft Lip/Palate Clinic  which included fighting with insurance companies to cover the medically necessary services for these special children born with facial deformities.  For ten years I fought tooth and nail to get insurance companies to “approve” surgery for children born with facial deformities.  Did you hear me?  I had to fight to get these surgeries “approved.” Often times, the insurance companies would “authorize” the surgery only to have the claim denied after the surgery had been performed.  We would then have to follow the insurance company’s protocol of filing a “letter of appeal” only to get that brushed under their mat hoping the surgeon’s office staff would forget thus allowing for the time to run out for the claim.  After numerous phones calls, faxes of medical records, sitting on hold listening to how wonderful they are, the claim would eventually be mailed as “paid” only no check would be enclosed and the “Patient Responsibility” would list the full amount of the claim minus the insurance company’s “contractual not-allowed.”  The patient’s family would call and the insurance company would tell them the doctor’s office didn’t submit a “clean claim,” and when we called the insurance company they gave us the run around.  It was a classic pit-the-patient-against-the-doctor scam.  It worked.  The last time this happened to my husband, he never got paid.   The patient’s family was convinced by the insurance company that his office “didn’t file a clean claim.”  The insurance company claimed the “elective surgical procedure” had been approved under a clause of the patient’s insurance policy where they were financially responsible.

This is how it has been and will be for doctors and insurance companies.  Somehow the people of the USA think Obamacare will guarantee them healthcare.  Not so fast.  Allow me to shed light on where this is going and why I say:  2018- Your Doctor is a Plastic Surgeon.

Patients always gripe about their “co-pay” and “patient responsibility” with their doctors.  First thing everyone needs to understand is that physicians have a contract with these insurance companies they are providers for that requires them to collect co-pays and patient responsibilities from the patients at the time of service.  Patients are required to pay these fees as outlined in their contracts they have with their insurance providers.  These co-pays are part of the payment, if not all, the physicians agree to accept from the insurance companies. Since the passing of Obamacare, insurance rates have skyrocketed, including the out-of-pocket expenses for patients, and additional taxes are burdening basic medical supplies at the expense of the physician and/or medical facility.  What this means for physicians is that their private practice costs have also skyrocketed, reimbursement remains a challenge and un-fixed, and their patients are no longer able to afford their co-pays.  Given the insurance payment challenges physicians have been up against for decades,  physicians have been “crossing the specialty line” for many years changing their specialties from general surgery, family practice, dermatology, OB-GYN, to “cosmetic surgery.”  This is where I stepped in 2010 with exposing these rogues with fly-by-night liposuction training in Vegas then showing up Monday morning with a hang-over and a sign that reads “Now offering lipo.”  These rogues are ever increasing as the true insurance regulations are ignored by Obamacare resulting in fewer primary care physicians and more “cosmetic surgeons.”

It’s common knowledge in the Plastic Surgery Industry that a majority of the plastic-surgery-gone-wrong stories plastered in our media are due to the procedure being performed by one of the rogues who are not board certified by the American Board of Plastic Surgery.  As outlined on, these rogues have created their own board certifications as a pathetic attempt to justify their lack of formal education for the specialty they practice.  This deception has been recognized by states such as Florida with a “Truth in Medical Marketing Act.”  Even my OB-GYN offers Botox and artificial fillers as a “French Fry” business to supplement his income.  This is what my husband refers to as a “perfect storm” in the Plastic Surgery Industry meaning both a storm surge of Plastic Surgeons, and also a lack of other medical health providers offering real medical services other than cash paying cosmetic services to squeeze out pathetic insurance reimbursements.  Imagine going to your cardiologist for bypass surgery and the doctor asking you “would you like lipo with that?”

Bottom line is that physicians are being squeezed more and more by insurance companies as they place more of the financial burden on the patients.  The cost of physicians to file insurance claims and fight for these payments is merely an additional practice expense to the already squeezed private practice physician.  Even the Society for Hospital Medicine recommends physicians could “provide Botox services at cosmetic parties in the evenings” as a way to supplement their income.  The storm surge of cosmetic surgeons had already been on the rise prior to Obamacare, and now post-Obamacare sans real insurance reform gives Americans “the perfect storm.”  The American Academy of Cosmetic Surgeons (home of these physicians whom are not board certified by the American Board of Plastic Surgery) states on their website they had the “highest attendance in the Academy’s history with more than 900 medical professionals” for their 2013 annual meeting.  The internet is littered with articles discussing the decrease in physicians for the years to come.  Physicians from coast to coast are faced with early retirement or seeking alternative ways to generate income outside the exam room.  Many predict the only place to find medical care will be the major universities thus foreseeing overcrowded waiting rooms and longer waiting times with less time to speak to the physician.  And, you think it is lean now.  Just wait, or go see your Real Board Certified Plastic Surgeon for that head cold.

From time to time, state medical boards are faced with the task of regulating these rogue physicians in response to the plentiful complaints of damaging cosmetic surgery results performed by these rogues.  Recently, the Medical Board of the State of Alabama made such an attempt to regulate in-office liposuction procedures in the name of “patient safety.”  While it’s all a great idea, it doesn’t address the root of the problem.  These medical boards can legislate how the procedure is performed as far as anesthesia safety is concerned, but they cannot address the permanent contour deformities and tissue loss these patients are given as a result of their cosmetic physician not really knowing how to do the procedure.  These are things real plastic surgeons learn in their plastic surgery residencies.

Surveys conducted by Athena Health and Sermo show “79 percent of physicians are less optimistic about the future of medicine, 66 percent indicated that they would consider dropping out of government health programs, and 53 percent would consider opting out of insurance altogether” (Daniel Palestrant, M.D., “Why Physicians Oppose the Health Care Reform Bill,” Sermo, April 8, 2010).  It’s that last number of 53% which strikes my attention.  What would these doctors do?  Will they only accept cash for medically necessary services or are they considering crossing over to the rogue cosmetic surgery side?  Considering the high insurance premiums, co-pays, and deductibles, is it financially feasible for a patient to pay cash to see their doctor for sinusitis?  Doctors already know the answer to that question is ‘no.’ No, Mr. Obama, patients are not likely to keep their doctor.  Instead their doctor will be glad to see them for a facelift or liposuction.

Recent reports of restaurant chains and movie theatres decreasing employee hours so as to avoid health benefit programs should be more than alarming to patients and physicians alike.  Physicians need patients and patients need physicians.  These employees will be at the mercy of a government based health plan, with fewer doctors willing to accept them as a patient. “If 66% of physicians are considering dropping out of government health plans, if only half actually do we would have an incredible shortage of doctors to see Medicare and Medicaid patients. The last resort is your local university training program, but don’t expect to see an attending physician,” states my husband, Dr. Paul Howard who spent years on the faculty at the University of Alabama Birmingham as an attending physician.  A recent report by The Texas Medical Association shows two alarming grafts of the decline of physicians accepting Medicaid and Medicare.  Texas physicians are dropping out of these government insurance plans steadily since 2000.  This is only the beginning.  The real Medicare deal hasn’t even hit yet.

Obamacare only addresses the Medicare system for physician payment.  Private insurance companies already have a long history of cat-and-mouse with their providers as mentioned at the beginning of this article.  With no real health insurance reform protecting physicians, they will continue to drop out of accepting not only government insurance plans, but private ones as well and the “cosmetic surgeon” trend will continue with the likes of me on their coat tails calling them out for the rogues they are.   This will leave us with the Real Board Certified Plastic Surgeons who most have already adapted to the poor insurance reimbursements and are actually qualified to practice according to their board certification.  Let it also be known that most Real Plastic Surgeons completed a general surgery residency before going on plastic surgery residencies, making them quite qualified to help out with those head colds.  By 2018, Obamacare will be at its finest and the number of physicians opting-out of accepting insurance plans can only predict to be devastating, and they will all be labeling themselves as either a Plastic or Cosmetic Surgeon.  Secure your Real Board Certified Plastic Surgeon today.

©Pamela Howard



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ASPS – ASAPS Unification by Pamela Howard

A recent proposal is on the table calling for the “unification” of the American Society of Plastic Surgeon and the American Society for Aesthetic Plastic Surgery.  Those in favor cite “economic” reasons as well as the “creation” of a more “aesthetic” unification.  Must I be the one to point out it was the ASPS who decided to remove the “R” over 10 years ago?  It seems we have an organization with an ongoing identity crisis.

I vividly recall hearing about the name change from the American Society of Plastic & Reconstructive Surgeons to the American Society of Plastic Surgeons when I was first employed into this industry. Having been employed into a Reconstructive sector of my husband’s practice, I remember my reaction to the news as a negative one.  “Simplification” was the answer, even my husband understood both sides of that argument.  This blonde-brain didn’t.  I recognized instantly the narrow road it would create for an industry built on both the reconstructive and the cosmetic.  So the “Ann Coulter” of the Plastic Surgery Industry here (that would be me) is happy to say “I told you so” as I explain why this was such a bad idea and why the unification proposal doesn’t help our position in the real world of Plastic Surgery.

First of all, removing the “R” was a big slap to this industry.  It clearly opened the door for the “rogues” to step in and claim the “cosmetic specialty” for themselves as they refer to plastic surgeons, such has my husband, as “general plastic surgeons” and they plaster all over their websites phrases such as “plastic surgeons are only trained in wound care and reconstructive surgery.”   Your “simplification” ideas of the past have not worked out for the reputation of your very members.  To simplify this paragraph for those of you who are merely scanning; Plastic surgeons are now considered “general plastic surgeons” which is the old “reconstructive surgeon.”  Anything “cosmetic” got reassigned to those physicians (I do not refer to them as “surgeons” for the obvious reasons) who have gone rogue.  Also, marketing and branding is more complicated by the capitulation in the “core” physician agreement.

Now more than ever this Industry is faced with a “so easy a cave man can do it” mentality created by the cosmetic rogues.  Real Board Certified Plastic Surgeons are faced with the daunting challenge of marketing themselves against these rogues stressing the importance of “board certification.”  This is where I stepped in with my a few years back.  We all know that anyone can claim to be “board certified,” but the general public doesn’t understand that statement can be deceptive.  We do, the ASPS does, the ASAPS does, but where are all of the financial efforts focused?  Medicare?  We also know that the bread-and-butter of this industry is in cosmetic cases and that Congress could care less about the reimbursement of a cleft lip repair or BCC removal.  With ideas such as the removal of the “R” and now a unification proposal on the table, I cannot help but think the ASPS is in some sort of bubble and has no clue about this industry.  Maybe some of you cats would like to work with me for a day in Birmingham, Alabama.   I dare you.

Don’t get me wrong, Medicare and Medicaid reimbursement is very important to any physician. I have direct experience in filing these claims.  I also know, the reputation of my husband’s industry is extremely important to putting food on my table.  Our news is bombarded with “plastic surgery gone wrong” stories that often fail to mention, or merely stress, the importance of finding a “real” board certified plastic surgeon, and I wonder where is the ASPS?  Ok, so they issue a press release, or they may manage to get some news time, but why does it appear they are focusing their efforts more on Washington than the integrity of this industry with the general public?  You want more respect with Washington?  Here’s a novel idea:  start with the respect of this industry with the general public.  Better yet, restore the “R” and leave the ASAPS alone.  The “American Society of Plastic & Aesthetic Surgery” would only be more confusing to the public we market to.

I have more respect for the ASAPS because they were the first to respond to my efforts.  I knew I got their attention.  This plastic-surgeon’s-wife-from-Alabama made waves with Plastic Surgeons world-wide.  The ASAPS took notice and recognized the void I attempted to fill.  They were the first to step-up to the plate with social media and help tackle this growing problem with “the rogues.”

So, who put this proposal on the table?  The ASPS?  Why would it benefit the ASAPS to unite with another organization with a history of identity confusion?  I have heard a few arguments for both sides.  The ones citing economic reasons I must disagree with first.  The ASPS divided plastic surgeons in a pathetic attempt to unify the specialty during a time when division was already rampid.  They folded, caved in, and changed their name, and obviously opened a door for the cosmetic rogues to step in and create “white coat confusion.”  The reason being we never trademarked our “Plastic Surgery” moniker.  Has anyone seen a marketing effort by a Real Plastic Surgeon that touts their “core” physician status?  Then, we have the core curriculum ambiguity which created even more marketing confusion.  So I ask you “economic reason” supporters, why seek to save a little money when the reputation of the industry in which you thrive is at stake?  If either group is having problems maintaining membership or meeting attendance, they should look within rather than trade on false assumptions.


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Originally posted on drpaulhoward:

There are literally hundreds of companies developing, manufacturing, and selling laser systems to treat a wide variety of ailments. Some of these laser platforms actually work, but for the most part they never live-up to the expectations created by their marketing campaigns. There are many companies that sell the exact same technology as others but offer new “bells and whistles” as well as more attractive packaging. Doctors have a bewildering number of choices with conflicting claims of “remarkable” results. Complicating the marketplace even further is that the companies market their laser and other “do-dads” directly to the patient hoping that patient inquiries to their doctors will drive the marketplace rather than scientific studies which determine the efficacy of a specific laser treatment.

Concomitant with the latest marketing schemes a lexicon has evolved to describe the wondrous things these lasers can do. Certain words reappear frequently such as: powerful, pain-free, immediate…

View original 284 more words

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Breast Implant Revision Surgery on the Rise

Breast augmentation has been one of the most popular cosmetic procedures for almost 50 years.  This plastic surgery procedure has had some low moments with the controversy surrounding the silicone implants.  Saline breast implants stepped up for the spotlight, but have presented their own cosmetic complications such as deflation and rippling.  Despite the pros and cons of both types of implants, women haven’t been deterred from having the surgery to improve their figures and overall self-esteem.

In 2006, the FDA re-approved the use of silicone get breast implants.  Patients and their surgeons now have an array of breast implants to choose from to achieve the desired result.  The internet has a vast amount of information to help women make an informed decision regarding their choice of breast implants, but many patients fail to choose their surgeons for credentials and expertise.  Many consumers are lured by fancy marketing and cheap prices, not to mention deception of the physicians’ true board certification.  As a result, many women fall prey and become victims of bad plastic surgery.  Thus, a big boom of breast implant revision surgery is occurring among the real board certified plastic surgeons.  Top Beverly Hills Plastic Surgeon, Dr. John Anastasatos devotes a large portion of his practice to these unfortunate patients.  “I see hundreds of women every year who have very bad breast augmentation results by physicians who are not board certified plastic surgeons, but advertise themselves as cosmetic or plastic surgeons,”  says Dr. Anastasatos.   This growing problem of phony plastic surgeons prompted Dr. Anastasatos to create a specialty web site focused on the different scenarios of breast revision surgery.  “Most women with bad breast implant surgical results become very depressed, feeling hopeless, and embarrassed to admit they didn’t verify the physician’s credentials,” he continues.  Dr. Anastasatos proudly displays numerous before and after surgical photos proving to these patients surgical correction is not hopeless, but very possible.

Although the financial investment increases significantly when a patient requires a surgical revision, the rewards are priceless.  Obviously, consumers should not only take the time to choose the type of implant best for them, but place more emphasis on the plastic surgeon performing the procedure.   Dr. Anastasatos notes “breast augmentation surgery can be the most rewarding cosmetic surgery procedure when performed by a qualified surgeon.”  Consumers are encouraged to do their own research and seek a Plastic Surgeon who is board certified by the American Board of Plastic Surgery.

Pamela Howard is a Plastic Surgery Consultant and Cosmetic Surgery industry spokes model.  To learn more, please visit her web site:

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No Difference Between Cosmetic Surgery and Plastic Surgery by Pamela Howard


There is no difference between Cosmetic Surgery & Plastic Surgery.  The difference is between Cosmetic/Plastic AND Reconstructive Surgery.  A REAL Plastic Surgeon is trained in  both: Cosmetic and Reconstructive Plastic Surgery. Reconstructive Plastic Surgery is the foundation for Cosmetic Surgery.  A Plastic Surgeon cannot truly master Cosmetic Surgery without first understanding and learning Reconstructive Plastic Surgery.

A Real Plastic Surgeon, one who is Board Certified by the American Board of Plastic Surgery, has extensive General Surgery Training prior to entering a formal Plastic Surgery Residency training  program.  This is critical for them to learn Reconstructive & Cosmetic Surgery of the face and body.  A Plastic Surgeon’s foundation of Reconstructive Plastic Surgery is key for Cosmetic Surgery to reconstruct the signs of aging.  It is this intense training background that makes their board Certification the creme-de-la-creme and the only one recognized by the American Board of Medical Specialties.

When considering Cosmetic or Reconstructive Surgery,  one can usually parse out the real Plastic Surgeons from the phony ones by how they title themselves.  If they title themselves as “cosmetic surgeons,” this is usually a red flag and indicator they do not have the proper credentials for this specialty.  This group of rogue plastic surgeons attempts to deceive the cosmetic consumer with word-play.  They even go as far as to claim “plastic surgeons are not trained in cosmetic surgery” (insert laugh here!).  When in fact, they are exposing themselves as not legitimate for they do not have formal plastic surgery training at all.  This group of rogue plastic surgeons are physicians of other medical backgrounds such as OBG-YN, Family Practice, ENT, Urology, Dermatology, and General Surgery.  They usually claim to be “board certified,” but hardly ever state the name of their board certification for obviously reasons: deception.  If they claim to be “board certified” in an area of plastic or cosmetic surgery, it is because they have obtained an un-recognized board certification such as the American Board of Cosmetic Surgery, which obviously does not require formal plastic surgery training as a qualification, or even require the physician have a surgical background at all.  This group of rogue plastic/cosmetic surgeons treats Plastic Surgery with an “anyone can do it” mentality.  This is why there are so many “plastic surgery gone wrong” stories plastered in our media.  Almost all of them are due to the physician not being board certified by the American Board of Plastic Surgery (such as Donda West’s fatal experience in Hollywood and the tragic outcome of Dr. Rey’s brother, performed Dr. Rey).


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