Episode 23 - Thinking of Taking a Medical Vacation for Plastic Surgery..Listen First! with Dr. John Grossman

Transcript

Teri Hausman: I am Teri Hausman, host of Beauty Now. We have a weekly show on everything beauty, anti aging, laser, lipo, lips and more. Today we are going to be talking with Dr. John Grossman, a board certified plastic surgeon who talk to us about having surgery abroad, a term known as Medical Tourism

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Dr. John Grossman: What value do you place on your life? Internally, I have the patience and hear from my own patience. Our friends are there, who have done this sort of thing and have had spectacular results. The problem is, it’s not the spectacular results, it’s the disasters that we are concerned about. Other than that, the areas are questionable hmm… so we want to know the education and training, and certification of the physicians, both anesthesia and the surgeon. We want to know the level of the facilities. These sorts of things can and do occur even in the United States with the best of plastic surgeons, and the best of hospital and outpatient facilities. Complications are part of the risk that one takes in any surgical procedures no matter how minor.

When somebody says to you…well… I am a dentist but I am also a board certified or a board of a cosmetic surgeon you really need to probably get out of the office fast or ask to see what the qualifications are.

[Music]

Teri: Welcome Dr. Grossman and thank you for talking with us today.

Dr. John: Thank you Teri

Teri: So...explain to our beauty analyst nurse about what medical tourism is?

Dr. John: Well, actually I speak about the two aspects of medical tourism. The medical tourism that we want your listeners to be aware of and consider very seriously, is the price shopping that many Americans consider an interesting means of having cosmetic surgery traveling to Russia ,or the far east, or Mexico, and elsewhere, for cosmetic surgery at what appears to be a far better price. It often includes hotel, not necessarily airfare but hotel and touring the general area. The problem is that we believe that cosmetic surgery is real surgery and it carries with it all of the attended risks of any operating procedure. And certainly you can’t possibly be aware of the level of training, the nature of the facilities, the anesthesia, anaesthegiolist and another country where the educational process, rules and regulations are far more relaxed than the United States. So you know, you really are putting your lives in the hands of a stranger who you know virtually nothing about.

Teri: And you hear more and more today women…. I even saw something on the TV the other day about Africa, that you can go there and have all these different procedures done and they are saying oh…..you get a vacation and it’s a better price. But…but it’s scary.

Dr. John: I guess the question is “What value do you place on your life?” And certainly, I see patience and hear from my own patience. Our friend’s are there who have done this sort of thing and have had spectacular results. The problem is, it’s not the spectacular results, it’s the disasters that we are concerned about. Many years ago, I used to know an ear, nose and throat doctor who operated and did breast surgery and had virtually no complications for this. And I met patients who said G.E. operated on me and everything went fine. The problem was I was also seeing for every one good result, I was seeing five or ten disasters. And the same thing is true here. You know, it makes little sense to venture outside your normal environment to an area where the surgery is of questionable quality and that includes the hospitalization, the cleanliness and all the rest of it. I guess if the answer is having to say for another six months or another year, that’s I think is a far better solution to the potential nightmare that you may face.

Teri: Right

Dr. John: The other kind of medical tourism and I alluded to two types, is just the reverse. You know, as the balance of trade and the value of American dollar has fallen, such that the Euro and the Japanese yen are far more valuable. We even, in fact, encourage people from Europe and parts of Asia to come to the United States for their cosmetic surgery where they can, in fact, count on predictable results, and well trained plastic surgeons at an economic rate that is far more affordable for them too. So we would encourage this kind of reverse medical tourism rather than to encourage people to go elsewhere not just for their cosmetic surgery, but for kidney transplants, and hip replacements.

Teri: So what you are really saying is that we really need to do our research on who the doctor is going to be, and then also if you are traveling so far away and if there is a complication, who is going to help you.

Dr. John: That’s right. And of course, you know….there certainly are insurance policies that one can purchase that provide for medical airlifting or if there is a problem. But you really want to anticipate virtually everything. It is very difficult to find out accurately in many [] countries who the surgeon is going to be and the level of training. But beyond that, is there is anybody or if there is an organization that certifies the hospital and operating room facilities, who are the nurses in these operating rooms, Certainly who is going to provide anesthesia, the part that can be potentially, like truly life threatening, immediately fatal event. All of these are pieces of the puzzle that if you seriously want to venture to another part of the country or another part of the world for surgery that you need to know in great depth.

Teri: Certainly there are just so many risks. Why don’t you tell us some of the risks that these patients face when they are going out of the country to get some surgery?

Dr. John: Well, the first risk of course, is the cleanliness of the facility. You know, we hear a lot about staff and strap bacteria that are very difficult to cure. So there are all sorts of hosts of bacteria that may not be completely sterilized or eradicated in their sterilizing equipment for their operating room instruments. What kind of anesthesia devices and machines do they have? So that is the equipment piece of this, the kind of facility, any sort of certification of those facilities.

Number two: the training of all of the staff. If these people are western trained, or they are trained in Europe, or in Australia, areas of the world where the training is excellent and equivalent to the United States. So if somebody who is venturing out of the country and is going to have their cosmetic surgery done in Great Britain, or in France or in Germany and a major of [] hospital facility or in Australia, New Zealand, I would say that they are venturing to an area of the world where the training and the quality of facilities is equivalent to ours. The same is true of many of the South American, in particular, Brazilian and Argentinean facilities. Other than that the areas are questionable. So we want to know the education and training, the certification of the physicians, both anesthesia and the surgeon, we want to know the level of the facilities. Beyond that, what exactly is the procedure and technique of the surgeon? Is it a standard facelift as performed in the United States or its some invention of this particular surgeon and the same applies to other procedures? When implants are going to be used, where are these implants made? Are they for example, American made, or they are provided by a very large company called Silamade in South America in Brazil. Those implants would be just fine. On the other hand, if their implants are from some local company, I would question the use of those sorts of things. What’s going to happen post operatively or inter operatively supposing somebody would have a problem with bleeding or clotting or heart issues and so on? Are there, in fact, physicians who are qualified to deal with these sorts of things? And finally who is going to be responsible for the cost of that additional care? Is there going to be some form of a surcharge or you to have a complication that required extra time in hospitalization and then lastly were you to have a problem that required that you be airlifted back to United States, how is that going to happen? Is it possible? Is there a company that can do that? Who’s going to pay for that cost? And where would you be hospitalized…can’t just sort of be lying in a bed in some far away land and say take me to the main clinic. It just doesn’t happen that way.

Teri: No, this sounds so scary. I mean, people really need to investigate. And the only reason I can think of that somebody would want to try to do their surgery abroad was would be to save money. So…

Dr. John: In the end are you really saving anything?

Teri: No, you are not saving anything. It’s all very very scary. So what would you tell our listeners that would need financing or they would have to save up for their surgery. Because I think it is so important for women to be able to get the surgery that they want but then a lot of women can’t afford it and so they get desperate and go out to Mexico or Singapore or wherever they are going to go.

Dr. John: I guess there are several pieces to it. Firstly, most plastic surgeons are acquainted with the variety of financing measures that are provided by several of our societies, American society of plastic surgeons and the American Society for aesthetic plastic surgery. Both have organizations and companies that they recommend who do financing. You certainly can consider financing your cosmetic surgery on your existing credit card or through your bank.  But let’s assume that still the amount of money is too great and saving over a period of several years just doesn’t seem possible, there is always something to spend it on, you know, if it is in your bank account. And so you decide to venture abroad. But then you really need, as you said earlier Teri, to do your homework. You need to essentially write everything down, all the things that we have addressed today. You need to write down in terms of the physicians that are involved, their credentials, the hospitals and facilities and so on. And you need to do your homework. And get all the information, find out about all of the costs, try to get some references, try to find out, if possible the names of Americans who have done the same thing and interview them and find out all the pros and cons before you leap and make this momentous decision. You know, it’s the old story, if it seems too good to be true I’ts probably not. And..

Teri: I was just telling my sister that same thing about a man…[Laughter] It’s so true…

Dr. John: Well I don’t know about a man but tell me about this. It’s not necessarily so totally taboo, if in fact you do your homework and you come to the conclusion that yes you have found somebody fully qualified, you feel safe and comfortable, you have spoken. You know, telecommunications is such and computer is such that one can be in touch with this proposed physician and speak at length, so he also gets some level of comfort speaking directly with the person whose hands you are going to trust to take good care of you. And if you finally come to the conclusion that it is the right thing, the right person, and you have done your homework then…Best of luck!

Teri: This is all where you spoke [] information and we are going be having to take a break, real quick and we are going to be right back with Dr. John Grossman telling us about what to do and what not to do if you are looking in to surgery abroad.

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Teri: I am Teri Hausman, host of Beauty Now and we have been talking with Dr. John Grossman on having surgery abroad. Welcome back Dr. Grossman and thanks for talking with us.

Dr. John: Thank you Teri

Teri: So…we were just talking about researching the different doctors if you are going to consider this type of surgery abroad and all the different risks involved. And it seems like it’s a lot of risk.

Dr. John: Well it is. But I think that it is not out of the realm of possibility that once you have done all of your homework and you have written everything down that you come with conclusion that perhaps surgery abroad does suit you and it suits your pocket. But you really need to make sure that you have done it completely and you have not done it through rose colored classes because you have not tried to pad it or assume the best. And I think in all of these things you have to assume the worst and what would you do under the worst circumstances? What would be your direction in terms of if you get a serious complication of any sort not, just a surgical complication but God forbid, a pulmonary emulous a pop that travel to your lung or heart problem, or any of these sorts of these which are dreadful infection. You need to be prepared to deal with those sorts of things because you know these sorts of things can and do occur even in the United States with the best of plastic surgeons and best of hospital and outpatient facilities. Complications are part of the risk that one takes in any surgical procedure no matter how minor. The problem of course that we have over the years as we have become more and more educated about the cosmetic surgery we have relied on or been willing to trust a lot of fluff and advertising that suggest that cosmetic surgery is a little more than going to the beauty salon. And that unfortunately is very far from the truth. Cosmetic surgery is serious, its real surgery. People die or have dreadful complications from cosmetic surgery done well. And so if cosmetic surgeries done well, in predictable facilities, those done in places that you have very little control over and very little knowledge about is even a greater risk. So all of the serious homework. You certainly…you probably wouldn’t hire an electrician or a plumber without checking their references and making sure that they could do the work well. Why would trust your healthcare to somebody who either doesn’t or barely speaks your own   language and who you know nothing about.

Teri: Right and I have also read [] even tend to approve dentists doing breasts augmentations. And I know that dentists are really smart guys but I actually really want my dentist to do my teeth, not my breast augmentation.

Dr. John: That’s exactly. And you know isn’t it bizarre that here again nobody would consider asking electrician to do your plumbing but you are willing to ask a dentist or gynecologist to do your cosmetic surgery just because they say that they recently took a two day course in bokorotone on how to do this. This is the most ridiculous….

Teri: Please expand on that. Please expand Dr. Grossman on that. Because I really think it is important and I try to stress this in the lot of the shows that even if you are going to do your surgery here…I mean….please…even if it is a doctor you need to find out what kind of a doctor.

Dr. John: You know the problem of course is that the medical licensing is still rooted in the 19th century. It is to say that the license that we as physicians get is from the state in which we reside or the state in which we want to practice and it’s a generic license which says license to practice medicine and surgery. And that because in the true old days the old doc actually did everything that is he delivered babies and he repaired [??], he took care of your pneumonia and so forth. But now a day’s medicine is far more complex than it was in the 19th century. And it’s much too much information for any single physician to know everything and certainly be qualified and able to do everything. And so we in fact over the course of several hundreds of years… we developed boards, that is, organizations in each area and each specialty of medicine and surgery that overseas the training, education and general qualification of people in particulars areas and so whether it is an internal medicine which is its own specialty or emergency medicine, or dermatology, or pathology, radiology, cardiology, obstetrics and gynecology. Similarly, there is, in fact, training and a board in plastic surgery. So when somebody says to you well I am dentist but I am also a board certified or a board of cosmetic surgeon, you really need to probably get out of the office fast or ask to see what the qualifications are because in reality there is only one board “The American board of plastic surgery’ that is certified to say that a physician is, in fact, trained in plastic surgery. There is no board of cosmetic surgery.

And so the fact that your dermatologist who previously took care of your acne now wants to do liposuction is totally inappropriate. Its legal, but its inappropriate. And the fact that it’s legal is a travesty unfortunately of the licensing process. In reality in 2007, the licensing of physician ship probably on a national basis done in Washington, for all states and should be based on your training, not on the course you just took in some lovely resort for two days.
                                                                                            
Teri: Right. Not the thing that I stress, you can get a course for two days and get a certificate for cosmetic surgery and a certain procedure because I don’t think women will ever understand that. Because they are like...no he is a cosmetic surgeon. I had one friend who wanted to get a bra lift and she told me that the one doctor didn’t believe and distorted procedure and I said would you even research to see if he is even able to do it. And it turned out that he was like an intern or something that had gone to cosmetic surgery and was going to fly for four heads open. And I said please don’t go to him, I don’t care who you go to but make sure that they are board certified in plastic and reconstructive surgery.

Dr. John: Yeah, I mean it’s really a situation of buy or beware. Again what I would tell you as a lesson is there are a number of ways of determining whether your prospective plastic surgeon is in fact a board certified plastic surgeon. And that is to contact either the “American society of plastic surgeons” or if one goes on the internet one would find that it is under the plasticsurgery.org or the American society for aesthetics plastic surgery and that url is surgery.org or if one were to go to your local hospitals medical library there is a seven or eight volume compendium entitled the American board of medical specialties and if you look in these volumes there will be a listing section for plastic and reconstructive surgery and listed alphabetically is every single board certified plastic surgeon. If your surgeon or prospective surgeons name is not listed there, again you need to leave.

Teri: Right exactly. That’s really good advice. What’s your favorite procedure to deal?

Dr. John: I have a number of favorites. I enjoy very much doing breast enlargements and breast lifts, I enjoy very much doing face lifts and perhaps among the most interesting and challenging is rhinoplasty but you know I also love tummy tucks. So…I am glad that as a… when I refer to as a real plastic surgeon… I do all of the procedures.

Teri: Right

Dr. John: I do not do any of the reconstructive surgery any longer because again I believe that if you do aesthetic surgery it needs to be what you do only, if you really got to be profession to at that. So I enjoy operating around the face as well as around the body.

Teri: You know and you made a really good point earlier on a show which was Mat. You don’t know the technique of the surgeon if you are going to have a facelift. I can just tell you if anybody is going to work on my face, I would want to make sure that your face is going to look normal after a procedure like that especially when you are spending money and you are going to look like that for the rest of your life. That’s where I say save up your money, get it done right

Dr. John: I agree

Teri: Really, I mean that was really really good point. I mean there is no way that you want to save money when you are dealing with your face. If you want to do something for cosmetic vanity really…then…make sure it’s done right…you want to look your best.

Dr. John: That’s right. There certainly are often shortcuts, but shortcuts that are efficient ..that is not trying to skid around the basics and primary requirements of a surgical procedure like a facelift for example. You need to understand the normal anatomy of the face; you need to understand the process of aging. The process of aging in the face involves not only relaxation of skin and underlying structures but also the face deflates like so many other areas of the body. We begin to loose the natural fatty contours and so if in fact, you plan to undertake a reversal of aging process, you need to understand what the aging has done in a particular individuals face. Its worthwhile seeing photographs of that patient of previous years when they had a more youthful appearance because as you were saying…you want them to….unless there is a reason to change their appearance, You want to them to look like themselves, you want to try to restore them to where they were in earlier days as opposed to make them look like an entirely different individual. And you know that’s often the misconception of patients who will say to me that doctor when you do this  I am going to look like myself or not? And, of course, the assurance is that’s the plan unless there is a reason to change your appearance like altering your nose or filling in the areas of cheeks that have never had full contours or enlarging the chin and so forth, we want you look very much like the person that you were 10,20 or 30 years ago, not like somebody different so that when you walk in the door your family dog bites you since he doesn’t recognize you.

Teri: Right…and specially the nose. I think that you brought up a good point too again is that Rhinoplasty is very difficult even for plastic surgeon to do. You really need to see before and after of the nose.

Dr. John: Absolutely. And you know, just often things do you want …just going to have my nose redone …that’s not going to change my appearance. That, in fact, is totally incorrect. Rhinoplasty can in many dramatic ways change the appearance of the face…usually for the better. It really is the cornerstone…the center of the face and creates balance and symmetry. And it’s not unusual to see either a young man or a young woman who has a very ordinary or not totally attractive face with a newly reshaped nose is absolutely delightful looking.

Teri: And it can be a disaster…

Dr. John: Absolutely.

Teri: And conversely it be an disaster because of the wrong person…know this…really attractive person who does that six or seven nose jobs and its still horrible…its so sad… because they didn’t go to a qualified surgeon.

Dr. John: well and that’s right. In Rhinoplasty in particular, we often say to patients that the ideal time to get the result is the first operation and every operation after that you are less and less likely to end up with the nose that you desired. So here again, if it is not right the first time, and you are going to embark on a second, or even a third operation on the nose, you need to be very clear with the surgeon exactly what his expectations and yours are, and what’s reasonable? Because it’s just not going to be possible to go for the third operation on that nose and end up with the ideal nose which you originally planned on. I think you need to temporize your expectations.

Teri: Such a great point….we will have to have you back but we are running out of time. And I would love to talk more about Rhinoplasty.

Dr. John: That will be our next subject.

Teri: That will be our next subject when we have you back. Thank you so much for talking with us today.

Dr. John: You are so welcome

Teri: Dr. John Grossman and you can go to personallifemedia.com and we will link Dr. Grossman’s website to our website and you will be able to get a consultation with him. He has offices in Denver and Beverly Hills. Thank you again and I hope to talk to you soon.

Dr. John: Bye

Teri: bye