How to Shop For a Good Plastic Surgeon

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Laura

How to Shop For a Good Plastic Surgeon

Post by Laura » Sat Aug 27, 2011 3:56 pm

Here's another gem post at LipomaSupport group that may help some of us shopping for a good surgeon. Very helpful info.
It also discusses getting 5 lipomas removed at a time vs hundred:
How to Shop For a Good Plastic Surgeon

I thought it might be helpful for me to advise you on how to find a
plastic surgeon in your area that uses the latest lipoma excision
techniques. This advice would apply to anyone with Familial Multiple
Lipomatosis, and may or may not be relevant to anyone else. I
recognize that some people reading this may not have insurance that
will allow them to shop for a doctor, but perhaps this will be of
value to someone.

I have had 40 lipomas removed by at least four different doctors over
the last 25 years. I've seen the good, the bad and the ugly
techniques. One doctor removed just one small lipoma, and I had an
uncomfortable recovery and a big scar. Yet, my current doctor
removes five at a time in an easy, fifteen-minute office visit. The
small scars that he leaves fade, and most are already much less
noticeable than the older scars from the other doctors. The reason
is that my current doctor uses a much more sophisticated technique.

My suggestion (for those lucky enough to be able to afford it) is
that you schedule consultations with a few plastic surgeons in your
area and ask them about their technique. Here is the technique my
doctor uses:

1. First the surface is treated with an antiseptic—not just
alcohol, and not iodine. Prevention of infection has a huge impact
on both the scar and the ease of recovery.

2. Next, the lipoma is injected with a mixture of an anesthetic
and a vaso-constrictor. The vaso-constrictor is key—it causes the
lipoma to bulge up and also keeps it from bleeding during the
surgery.

3. A thin incision is then made over the lipoma. This should be
longitudal to the muscle. This direction leaves less of a scar than
if the incision is made in the other direction.

4. The lipoma is then squeezed out by applying pressure—rather
than with a lot of fishing around with a scalpel.

5. The wound is then closed with internal stitches. This is
critical. These stitches do not lie on top of the skin, so the scar
has no stitch marks. (If a lipoma is located on your trunk or is very
large, it may not be possible to use internal stitches.) Next a glue
is applied over the incision, and this is then covered by tape that
is called "steri-strips".

6. Recovery consists of keeping the wound dry for a couple of
days and not putting any stress on it (no weight lifting) for a
couple weeks. After my last surgery (removing five lipomas) I did
not need to take a single Tylenol. You leave the tape on until it
falls off. The internal stitches dissolve. When going out in the
sun, use sunscreen on the scar for the first couple of years to keep
it from darkening.

Your first step would be to phone plastic surgeons and ask the person
who answers the phone how often the doctor performs excisions of
lipomas. When you find one that frequently performs excisions,
schedule a consultation appointment to ask him about his technique.
You may not be able to find a doctor that uses the exact technique
given above, but at a minimum you can ask him if he uses internal
stitches covered with steri-strips.

I did have to persuade this doctor to remove five at a time in his
office. His preference was to go into an operating room and remove
50 at a time. He also said that for more difficult lipomas he would
not agree to remove five at a time in an office visit. I may have a
type of lipoma that comes out easily, and I also tend to ask him to
remove only the ones closest to the surface of the skin (which are
more visible and perhaps easier to remove).

With the old technique, I was having only my largest lipomas
removed. However, since this new technique has an easier recovery
and less scarring, I have decided to have more removed. I am lucky
that my insurance happens to cover the full cost of this, and I have
no idea how widely this technique is available across the country.

A few days ago I noticed one of my excision scars from over 20 years
ago. That scar is more obvious than some that are only two years
old. I remember those old excision procedures as being uncomfortable
and the recovery being painful and bloody. But that was with a bad
old technique. My newer scars would be difficult to find if I would
do a better job keeping the sun away from them.

In January I was in my doctor's office and he had me cut open and was
squeezing out a lipoma. He said, "I call this the zit squeezing
technique…do you know what I mean by that?" I laughed and
said, "yes, I know what you mean, but I've never heard it called that
before". He then said "O.K. how about `expulsion of the lipoma by
application of manual lateroinferior pressure'". I smiled and
said "whatever you call it, it sure beats the days when they would
fish around with the scalpel." Part of the reason why he and I could
joke around while he is pulling out five lipomas from me in fifteen
minutes is that I am not bleeding. The vasoconstrictor--which was not
used in the old days--makes this a nearly bloodless surgery.

Yet the vasoconstrictor and use of pressure rather than dissection
are the least of the innovations—the incision closure technique is
more important. There is no "scab", no itching, no need to tape a
big cotton gauze over the incision after surgery, no "dot" marks from
suture holes, and none of the discomfort that I previously
experienced from nylon sutures. Normally even with the new procedure
I still feel some pain on the night after surgery, but this last time
I had virtually no pain and never took a single Tylenol. I recognize
that some people reading this might not have the easy-to-remove type
of lipoma (subcutaneous, well differentiated, non-infiltrating) that
I do. However, far more people suffer from my easy-to-remove type of
lipoma than the other types, so the surgical procedure above should
apply to most readers. Of course, incisions on the trunk are harder
to keep together than are incisions on the arms.

Anyway, there is NOT a lot of good news for lipomatosis patients on
the cure/treatment front, so I hope that as many people as possible
are at least benefiting from the huge advances in surgical excision
techniques.

http://health.groups.yahoo.com/group/Li ... ssage/1541
also see
http://groups.yahoo.com/group/LipomaSup ... ssage/1554
Laura

Re: How to Shop For a Good Plastic Surgeon - Sequel & Ins Ad

Post by Laura » Sat Aug 27, 2011 3:59 pm

The follow up post
How To Shop for a Surgeon--the Sequel--and Advice on Insurance

This posts gives further information on how to shop for a good
plastic surgeon, as a follow-up to my post:

http://groups.yahoo.com/group/LipomaSup ... ssage/1541

This advice, like most of my posts, would apply to most FML cases and
the more common forms of lipomatosis, but may not apply to Dercums or
MSL. My perspective is from that of my own condition, which I
described in post # 1552.

Finding a Surgeon: In response to my post, someone wrote that her
surgeon uses exactly the same procedure as I described. She
absolutely agreed with me about the benefits of the procedure, and
that everyone should shop around as I had suggested. So we know that
the technique is not unique to my doctor (confirming what my doctor
had told me.) Here is how to find a similar doctor in your own
area. First, phone plastic surgeons (not general surgeons, not
dermatologists, but plastic surgeons.) Ask the person who answers
the phone "does your office do a lot of excisions of lipomas?" Some
may not even know what "excision of lipoma" means. You are looking
for those that reply "oh, yes, the doctor does those all the time".
Then ask: "what hospital is he associated with?" Does he do lipoma
excisions both in the office and in an operating room?" After you
find a person that says "yes", say "I would like to schedule an
appointment for a consultation".

When you meet the doctor open with: "I would like to ask you a
couple of questions about your technique." "What types of sutures
would you use on these lipomas on my arms?" "Would you close the
incisions with internal stitches and steri-strips?" "I would like to
have these five (moderately-sized subcutaneous) lipomas removed in
your office with only local anesthesia. Can you do that?" "Do you
use a vasoconstrictor?" "What is the highest number of lipomas that
you have ever removed from someone in an operating room?"

I know that some of my friends would not be comfortable with this
approach. For whatever reason, they just don't interact with doctors
this way. For people such as them, I would suggest an easier
approach. Simply take my post # 1541 in to your consultation, show
it to the doctor, and ask him "how does your procedure differ from
this one?" The "wrong" answers would include "I get equally good
results using staples (or nylon, silk, or catgut sutures) as other
surgeons obtain with internal stitches. I have been doing this for
years and the procedure outlined in that note is not any better or
worse than my approach." You want to exclude surgeons who make such
comments in an attempt to justify why their current approach is just
as good as the one that I have described. Don't debate these types,
just be polite and listen. Then never visit them again. When you
find one that uses the # 1541 approach, then you've found your man
(or woman) and its time to set up the surgery appointment!

My guess is that the initial phone screen will weed out a lot of the
surgeons who would use staples or nylon sutures, so you shouldn't
need five consultations to find a surgeon that uses the # 1541
approach. But I cannot say for sure how widespread the # 1541
procedure is.

Insurance: I am not sure how all of the different insurance plans
might handle lipomas, but I am sure that a person's chances of
getting coverage would be greater if the excision was for some
purpose other than cosmetics. Most insurance companies are going to
be reluctant to deny coverage for removal of any lumps that are of
uncertain composition or that cause pain. Lipomas can cause pain
either in and of themselves, or due to their position. It is
difficult for a physician to tell whether any given lipoma is painful
or whether its position causes it to bump into a nerve. However, any
garden-variety lipoma is unlikely to be extremely painful, so avoid
telling any tall tales. Lipomas can become sore when they are
bumped, such as "at work my forearm is on my desk and it makes these
two lipomas sore". Regarding the unknown composition: Avoid
comments such as "I have had lipomas for 20 years and these three
that I want to have removed are just like all of the others".
Perhaps you might have selected those three for some reason other
than cosmetics, such as "I don't mind the others, but these three are
different and they bother me".

Trish: You should find it easier to find someone to remove 50 in an
operating room than to convince someone to remove 5 in his office. I
had to push my doctor to agree to remove 5 at a time in his office.
(Your idea of a big incision down your arm to remove them all would
not work.) In any case, my goal is not to have all of my lipomas
removed—just the ones that are obvious to others when I wear a short-
sleeve shirt, and some larger ones on my sides.

I also have a lot more information on other lipoma-related topics
such as: liposuction (exactly why it's ill-advised), translocation
mutations (how lipomas are caused and how they can be passed-on or
not passed-on to children), "homeopathic" treatments (exactly why
they don't work), different types of lipomas, etc. Unfortunately,
none of that information is as useful as this information about this
excision technique given in my post # 1541. So the best advice that
I can give (to people with similar conditions to mine) is to shop for
a good plastic surgeon because that can really make a big difference.
Good luck!

http://health.groups.yahoo.com/group/Li ... threaded=1
Charlupa
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Re: How to Shop For a Good Plastic Surgeon

Post by Charlupa » Sun Aug 28, 2011 5:18 am

Great post. Thanks.
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matt
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Re: How to Shop For a Good Plastic Surgeon

Post by matt » Sat Oct 01, 2011 1:41 am

If only they taught this technique in the medical school... I've actually explained this technique to my plastic surgeon but he just answered: not possible. In his opinion the lipoma needed to be forked out so that nothing would be left behind. He's one of the country's top surgeons BTW. It's 2011, come on! The technique most surgeons use is from the Medieval Age!?
Hi I'm Matt - the creator and owner of this site. I have dozens of small nasty lipomas all over. I've tried many treatments including surgery and Lipostabil injections. See my lipoma prevention supplement recommendations and please consider donating a small amount via PayPal (click the Donate button) to keep this site up and running. Thx!
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Re: How to Shop For a Good Plastic Surgeon

Post by Mitchelle » Thu Nov 24, 2011 9:39 am

One of the best ways to find a quality cosmetic surgery center to seek treatment from is by speaking to your primary care physician. If you are unable to do so, consider calling or stopping by your local hospital. In the medical field, most doctors have an open network of communication. This means that your primary care physician or hospital workers should be able to give you the contact information of local cosmetic surgery centers or surgeons with their own private practices. This approach is nice, as you won’t get sent to just anyone.
Last edited by Mitchelle on Mon Nov 28, 2011 5:57 pm, edited 1 time in total.
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Re: How to Shop For a Good Plastic Surgeon

Post by Guest » Fri Nov 25, 2011 3:17 am

Great Post. Does anyone know of any good cosmetic or general surgeons in Sydney for Lipoma surgery? I thought it was a good idea to ask felow members who may be from Sydney and have had good experiance with doctors here. Contact details or their name would be very helpful. Thanks.
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Re: How to Shop For a Good Plastic Surgeon

Post by matt » Fri Nov 25, 2011 8:07 am

Amazon.com WidgetsHi there! I'm not sure from which part of Australia Klaus is located but he lives there down under. He has had many of his lipomas cut out. Maybe you should contact him? If you login you can send him an email or a private message. Cheers!
Hi I'm Matt - the creator and owner of this site. I have dozens of small nasty lipomas all over. I've tried many treatments including surgery and Lipostabil injections. See my lipoma prevention supplement recommendations and please consider donating a small amount via PayPal (click the Donate button) to keep this site up and running. Thx!
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Re: How to Shop For a Good Plastic Surgeon

Post by Guest » Tue Jan 17, 2012 3:20 am

Thanks, but I am pretty sure that he is from Perth. Thanks again, Cheers.
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sjohn
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Re: How to Shop For a Good Plastic Surgeon

Post by sjohn » Thu Jan 19, 2012 10:59 pm

Some nice inputs from members of LipomaSupport@yahoogroups.com. Clears some things up. Especially the second one.
There are many techniques you could consider to remove your lipomas. One of them is the excision technique which has been described often in this forum. However its suitability depends on the color of your skin and ethnicity. Assuming you are not a keloid-former, the whiter you are, the less likely you are to have scarring. I am someone of Indian origin in Montreal who had 20 excisions in one session, and the result was a horrific pigmented mess of scars which has ruined my social and sexual life. I went to a plastic surgeon to get one of the scars removed and it created a hyperpigmented scar twice as big.

From your last name, I'm going to assume you are Caucasian. Because of the sheer quantity of your lipomas, I would not suggest excision for you. It will be ridiculously expensive to do so many, and also leave you with multiple minor scars.

I suggest you try two things: 1) Vaser or Vaser combined with SmartLipo. It makes a 3-4mm incision and uses a long micro-cannula to inject a local anaesthetic, and then another micro-cannula that uses ultrasound to destroy fat cells. After that, the doctor can use a SmartLipo cannula at a certain frequency to increase collagen formation and tighten the skin. Your whole forearm can be treated with only two tiny incisions.

Theoretically, it is been said that because liposuction does not remove the entire capsule, it may leave/scatter lipoma tumour cells to grow back. I've never actually found or read any reports of this happening.

If you are prone to lipomas, it may come back, at which time you can do the Vaser/SmartLipo combo again. Frankly I think it is a much better solution than removing hundreds of lipomas individually.

Another treatment that could be helpful in reducing lipoma size dramatically is Zeltiq. Research has shown that subcutaneous fat cells freeze at a higher temperature than other cells. Zeltiq freezes entire slabs of your abdomen, thighs, back, etc. The fat cells will degrade and breakdown over the next three months. You need at least two treatments to have dramatic results. Obviously, this treatment is better for people with MFL, as their lipomas tend to be subcutaneous and superficial.
Surgeons willing to use liposuction on FML lipomas were always a minority, but now fewer and fewer surgeons are willing to use liposuction on FML lipomas. It is not because they don't know how to perform liposuction procedures. It is not because they are lazy, incompetent, or don't care about their patients. It is not because they cannot make money on liposuction.

The real reason why so few surgeons will use liposuction on FML tumors is that liposuction doesn't work well on FML tumors and can even cause faster growing daughter tumors to grow. FML tumors are encapsulated (surrounded by a fiberous shell). Normal liposuction would only suck up the surrounding healthy fat tissue, because it is softer. So lipoma tumors first need to be be pulverized with ultrasound to get drawn into the liposuction wand. Pulverizing the lipoma means that instead of one whole mass to remove, you have dozens of small fragments, each which can grow into their own lipoma now that they have been let out of their shell.

I have read with great sadness the posts of people who (mostly fifteen years ago) had their lipomatosis worsened by liposuction. They reported that after a couple years the lipomas not only came back, but came back much worse. Fortunately, we don't hear as many such sad stories today because today very few surgeons would agree to the procedure (in most cases).

As to the Zeltiq freezing method--this has actually been banned by the FDA for use on lipomas. The FDA has approved Zeltig only for very specific uses, which do not include lipoma removal. Even the maker of Zeltig, which has a huge financial interest, would not advise trying it on lipomas.

Regards.........
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Re: How to Shop For a Good Plastic Surgeon

Post by matt » Fri Sep 14, 2012 11:27 am

Good info, thanks sjohn. Now, I'd only hope these techniques were widely available for us... :cry:

The post sums up nicely why liposuction isn't such a good method on its own. And also taking out dozens of lipomas one by one is madness.

BTW there's some more info about Vaser in the Wikipedia (VASER = Vibration Amplification of Sound Energy at Resonance). Vaser is apparently approved by the FDA. And I think Vaser goes also by the name Liposelection.

Unfortunally I'm pretty sure most docs haven't even heard about this prosedure :(

Still, I'm wondering how effective will this be on fibrous and encapsulated lipomas? This video explains how the ultrasonic waves break up the fat cells but leave other tissue like blood veins alone. Would it still be able to eliminate the fibrous tissue often around the lipomas?

Hi I'm Matt - the creator and owner of this site. I have dozens of small nasty lipomas all over. I've tried many treatments including surgery and Lipostabil injections. See my lipoma prevention supplement recommendations and please consider donating a small amount via PayPal (click the Donate button) to keep this site up and running. Thx!
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Re: How to Shop For a Good Plastic Surgeon

Post by Joana » Thu Jan 10, 2013 6:42 am

Could anyone recommend a good surgeon specialized in removing lipomas for patients in Perth, Western Australia?

Thank you

Joana
Jess

Re: How to Shop For a Good Plastic Surgeon

Post by Jess » Sat Feb 09, 2013 8:47 am

Hi does anyone know a great plastic surgrpn in Brisbane or Adelaide to remove my forehead lipoma? I have had one removed and it grew back. Is there any Dow isl diet I should try? Thanks!
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Re: How to Shop For a Good Plastic Surgeon

Post by matt » Sun Sep 15, 2013 12:28 am

I came across of an article of how to handle your doctor and I thought these might help you when confronting your doctor next time.

1. Tell your whole story. Studies have shown that more than 80% of diagnoses can be made based on history alone. Unfortunately, doctors sometimes seem to want to steer you toward a cookbook "chief complaint" or a series of "yes/no" answers. Learn to tell a succinct, effective story. Prepare and rehearse it.

2. Assert yourself in the doctor's thought process. Find out what your doctor is thinking as you recount your history, and let your doctor know what's on your mind. If you're not starting out on the same wavelength, it's hard to develop that crucial partnership.

3. Participate in your physical exam. If you're being examined, make sure you know what the doctor is looking for. Don't be afraid to ask about the implications of any findings.

4. Make a differential diagnosis together. A "differential diagnosis" is just the list of all the possible diagnoses that could explain your symptoms. Make sure you and your doctor come up with a thorough list, with some estimate of the likelihood of each possible diagnosis. Keep asking what else could be going on.

5. Partner in the decision-making process. Devise a strategy with your doctor for narrowing down the list of possible diagnoses. By partnering with your doctor, you can often arrive at a working diagnosis without a lot of tests.

6. Apply tests rationally. If you do need to undergo further testing, you should understand how a particular test will help narrow down your differential and what the risks and alternatives are. Look out for "cookbook medicine," and make sure your doctor is tailoring an approach that works for you.

7. Use common sense. You shouldn't leave the doctor without a working diagnosis that makes sense to you. Don't just assume the doctor must be right. If the picture doesn't add up, go back to the drawing board.

8. Integrate diagnosis into the healing process. Talk through your diagnosis with your doctor and make sure you understand its predicted course. What treatment options do you have, and what risks and benefits do they carry? If your working diagnosis turns out to be wrong, what warning signs should you be on the lookout for?


Last bumped by Anonymous on Sun Sep 15, 2013 12:28 am.
Hi I'm Matt - the creator and owner of this site. I have dozens of small nasty lipomas all over. I've tried many treatments including surgery and Lipostabil injections. See my lipoma prevention supplement recommendations and please consider donating a small amount via PayPal (click the Donate button) to keep this site up and running. Thx!
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