September 5th, 2010 Dr. Mele
Every now and then, a State Bill comes along that just makes sense. AB 583 is such a bill. It has no hidden agenda, it is easy for health care practitioners to comply with and it provides meaningful objective information for patients.
AB 583 (Hayashi) requires health care practitioners to disclose their name, license type (RN, MD, DO, etc), highest level of academic degree received and for physicians, their board certification. This information must be placed on the health care practitioner’s website, and is also required to be given to the patient in writing at the initial patient encounter or must be prominently displayed in their office.
As simple as this sounds, it has taken over three years of work by many members of the California Medical Association and the California Society of Plastic Surgeons to get this bill on Governor Arnold Schwarzenegger‘s desk.
AB 583 is not yet a law. There is some debate, mostly from practitioners who are not Board Certified, to withhold any type of disclosure requirement. As a Board Certified Plastic Surgeon, I fully support this disclosure. As a Walnut Creek Plastic Surgeon, I have many well educated patients. I have had to care for patients who have seen less qualified practitioners, and who have received questionable treatment and results. Often they are surprised and embarrassed to find out the “Plastic Surgeon” they had entrusted with their health, was not a Board Certified Plastic Surgeon, and in some cases, was not even a doctor.
Critics will say that even the best Board Certified Plastic Surgeons can have poor results. While this is true, when the correct approach is instituted from the start, the chances of a poor result are significantly decreased, and the chances of recovery from a poor result are significantly enhanced.
The more you know as a patient, the safer you can be. In California, anyone with a Physicians and Surgeons License can perform plastic surgery. Non-MD oral surgeons are allowed to do facial plastic surgery. AB 583 helps patients by requiring your health care provider to inform you about the type and duration of training they have received. This will not protect you from the truly unscrupulous, but it will help you to know the type of training any ethical health care practitioner has received.
I encourage you to support passage of AB 583. Letters can be sent to the Governor here:
The Honorable Arnold Schwarzenegger
Governor of California
State Capitol Building
Sacramento, CA 95814
or you may fax your letter to 916 558-3160.
Your opinion is important. Please act before September 17th (the earlier the better) to let your viewpoint be heard.
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August 20th, 2010 Dr. Mele
Dr. Joseph Mele, guest author for ABoardCertifiedPlasticSurgeonResource.com
I was recently asked to contribute to A Board Certified Plastic Surgeon Resource, an online resource helping patients find Board Certified Plastic Surgeons. My article stresses the importance of Board Certification, and explains how to recognize a true Medical Board.
Most Medical Boards are self regulating. The long standing, traditional medical boards are also under the regulation of the American Board of Medical Specialties (ABMS). Under the ABMS the only Board specifically dedicated to Plastic Surgery is the American Board of Plastic Surgery. Other sound-alike boards, for example The American Board of Facial Plastic Surgery and the American Board of Cosmetic Surgery, have not been accepted as ABMS Boards, and thus fall outside the regulation of the ABMS.
Information about the American Board of Plastic Surgery can be found right here on the San Francisco Plastic Surgery Blog: Board Certified by the American Board of Plastic Surgery.
For the full version of the article, click the picture below.
Dr. Mele's article on Board Certification
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August 16th, 2010 Dr. Mele
The International Society for Aesthetic Plastic Surgery (ISAPS) started its 40th anniversary meeting this weekend in San Francisco. While the majority of the meeting will be spent discussing the finer points of plastic surgery technique, Saturday was spent discussing patient safety on a global scale.
The ISAPS is leading the way in global guidelines for plastic surgery patient safety. Topics included:
- Uniform global plastic surgeon certification requirements
- Uniform global facility accreditation requirements
- Medical Procedures Abroad ™ i.e. Medical tourism
- Guidlines for patient safety
- Medical device guidelines and usage
Sunday was spent discussing Blepharoplasty (eyelid surgery) and Rhytidectomy (face lift surgery). Today was dedicated to Rhinoplasty (nasal surgery) and Mammoplasty (breast surgery: breast augmentation, breast implants, breast enhancement, breast reduction, beast reconstruction, congenital breast deformities and breast lift surgery).
Tomorrow Maria Siemionow, MD, the team leader of the first U.S. face transplantation surgery, will be making a special presentation. Tuesday will focus on aesthetic reconstructive surgery, as well as Abdominoplasty (tummy tuck) and Body Contouring (liposuction and body lifts).
The final day of the conference, Wednesday, will be spent on Cosmetic Medicine and finally Patient Safety and Complications. It’s been great so far. If you would like more information on any of these procedures, please click on any of the Categories to the left, or visit my main website: DrMele.com.
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August 11th, 2010 Dr. Mele
Body Art
Body art traditionally refers to tattoos and piercings, but some would say cosmetic plastic surgery is a form of body art. It is not scalpelling, but a scalpel is used. As body art becomes more main stream, questions regarding breast augmentation before and after nipple piercing come up more often than you might think.
 Preexisting Body and Nipple Piercing - Before Breast Augmentation |
 After Breast Augmentation - Body and Nipple Piercings Survived. |
Pre-Existing Nipple Piercing
If you have pierced nipples, and are considering breast implants, breast augmentation can be safely performed in the presence of pierced nipples. A few precautions need to be taken to maximize the safety and predictability of you surgery:
- The piercings need to be clean and without irritation. Irritated piercings are a set up for infection, and this could lead to an infection around the breast implants.
- The jewelry should be removed from the piercing immediately before surgery. Electrocautery is used routinely during surgery to prevent bleeding. An electric shock to your piercings would cause a burn.
- The jewelry should be replaced immediately after surgery. At the end of the breast augmentation I normally replace the jewelry to prevent the piercing from closing.
- If the piercing should become irritated or infected after surgery, it should be addressed immediately. Sometimes this means removing the jewelry from the piercing.
Nipple Piercing After Breast Augmentation
If you already have breast implants, and are considering getting your nipples pierced, I don’t recommend it. If you are still determined to get a nipple piercing, you need to be especially vigilant. Choose a reputable establishment, which uses sterile technique. Infections can occur with any piercing, and every infection has the potential to spread.
Nipple piercings can be especially problematic as the breast gland itself can become infected. This can put the both the breast tissue and the breast implants at risk, especially if your breast implants are in front of the pectoralis muscle. If there is any redness, swelling, discharge or increasing pain at the piercing site, call you plastic surgeon, and seek immediate treatment. The jewelry may need to be removed, but it is better to lose a piercing than to lose a breast implant.
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July 8th, 2010 Dr. Mele
Dr. Mele is an Active Member of the California Medical Association (CMA)
The California Medical Association (CMA) was formed as the State Medical Society of California on March 12, 1856. The initial membership totaled 75 physicians who held their first meeting over 154 years ago at Pioneer Hall on J Street in what is now Old Town Sacramento. In 1923, the association was renamed the California Medical Association. At its 150th anniversary the membership totaled 35,000.
The CMA continues to support the people of California. It has studied the effects of lack of access to care for the poor since the 1930s, and tried to get legislation passed in the state and nation that would establish compulsory health insurance. They continue to advocate for health insurance for all, via voluntary participation, through legislation, policy and the courts.
I was privileged to see how the society works first-hand as the California Society of Plastic Surgeons Young Physician Representative to the CMA, dealing with issues such as access to care and the distribution of vaccines. The CMA continues to work closely with County Medical Societies to assist with local problems, with State Legislators for statewide medical issues, and with the American Medical Association for national health issues.
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July 6th, 2010 Dr. Mele
Dr. Mele is a Lifetime Member of the American Medical Association (AMA)
The American Medical Association (AMA) was founded in 1847 at the Academy of Natural Sciences by Nathan Davis. With it, the first minimum standards for medical education were established. The original goals of the AMA where to:
- advance the science of medicine
- improve the standards for medical education
- develop a program of medical ethics
- improve the health of the public
The often quoted Journal of the American Medical Association (JAMA) was established in 1883. This was not the first journal created by the AMA. Indeed, the Archives of Ophthalmology, Archives of Otology and the Journal of Cutaneous Diseases (now Archives of Dermatology), all preceded the JAMA.
Through the 1900′s the AMA had a tremendous amount of influence over medicine in North America. In public health, it helped to craft national legislation for the control of tuberculosis (TB) and smallpox. In medical education, it inspected and accredited medical schools and curriculums, set standards for internship and specialty training, and encouraged the recognition of specialty boards. It formed many other more influential bodies, including:
There are over 814,000 doctors licensed in the United States of America. State medical societies used to require that their members were also AMA members. After several states dropped this requirement in 1971, the AMA lost over 11,000 members. Today approximately 15-20% of practicing physicians are members.
As the number of physician member decreases, so does funding that comes from dues. Increasingly, the association’s income comes from advertising, CPT and ICD-9 code licensing, and information technology. This has caused controversial decision making in the recent past. The Sunbeam scandal is one glaring example. Despite the controversies, the AMA remains a potent political force, with the ability to influence regulations locally and nationally.
Posted in Home, Patient Safety, Plastic Surgery Societies | 1 Comment »
July 4th, 2010 Dr. Mele
Dr. Mele is a Fellow of the American College of Surgeons (FACS)
Just the FACS Ma’am
Ever wonder why some doctors have FACS after their name? It means they are members of the American College of Surgeons (ACS). FACS stands for: Fellow of the American College of Surgeons. To be a member, a surgeon’s education, training, professional qualifications, surgical competence and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College.
The American College of Surgeons
Established in Chicago, in 1913, the society has 73,000 American Surgeons and more than 4,000 surgeons from other countries. The college’s main activities include the:
- Annual Clinical Congress and other sponsored continuing medical activities
- Commission on Cancer to improve the care of cancer patients
- Committee on Trauma to improve the management and prevention of injuries
- Division of Advocacy and Health Policy monitors legislative and regulatory issues affecting the field of surgery
- Sponsoring of the Residency Review Committee for Surgery and the Surgical Specialties including Plastic Surgery
- Office of Public Information provides general information about surgeons and surgical care
- Surgical Education and Self-Assessment Program (SESAP) a resource for surgeons lifelong learning, and to prepare for Board Certification
- Publications:
So if you are a patient, the letters FACS after a surgeons name mean the American College of Surgeons has independently evaluated and accepted their qualifications.
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June 22nd, 2010 Dr. Mele
Dr. Mele is a Active Member of the International Confederation for Plastic Reconstructiive and Aesthetic Surgery (IPRAS)
The International Confederation for Plastic, Reconstructive and Aesthetic Surgery (ICPRAS) is the largest plastic surgery society on Earth. Since 1955, meetings have been held around the world to foster the advancement of Plastic Surgery. Previous sites include:
- Stockholm (1955)
- London (1959)
- Washington (1963)
- Rome (1967)
- Melbourne (1971)
- Paris (1975)
- Rio de Janiero (1979)
- Montreal (1983)
- New Delhi (1987)
- Madrid (1992)
- Yokohama (1995)
- San Francisco (1999)
- Sydney (2003)
- Berlin (2007)
- Vancouver (2011)
I was fortunate to have attended the last Quadrennial congress held in San Francisco (1999). While it was 11 years ago, almost 90 National Societies were represented, more than twice the founding 39 National Societies.
The IPRAS has four Chapters, each with its own International Society.
- Reconstructive Microsurgery
- Hand Surgery
- Aesthetic Plastic Surgery
- Craniofacial Surgery
These cover the main areas of subspecialization in Plastic Surgery. Aesthetic Plastic Surgery is represented by the International Society for Aesthetic Plastic Surgery (ISAPS) which will be having its meeting here, in San Francisco, this August.
Practicing Plastic Surgery in the San Francisco Bay Area has advantages. San Francisco is a nice place to visit, so we attract many state, national and international plastic surgery meetings. This certainly makes it convenient to attend the best Plastic Surgery Conferences in the World.
As plastic surgery advances and expands, international societies like the IPRAS and the ISAPS will continue to provide a wide range of experience and perspective.
Posted in About Dr. Mele, Home, Patient Safety, Plastic Surgery Societies | 1 Comment »
June 20th, 2010 Dr. Mele
Dr. Mele is an Active Member of the California Society of Plastic Surgeons (CSPS).
The California Society of Plastic Surgeons (CSPS) is celebrating its 60th Anniversary this year. The CSPS is the largest State Plastic Surgery Society in the US with 450 members. It is the third largest American plastic surgery society after the two National Societies: The American Society of Plastic Surgeons (ASPS) and The American Society for Aesthetic Plastic Surgery (ASAPS). Every member is Board Certified by the American Board of Plastic Surgery.
The mission of the California Society of Plastic Surgeons is to:
- Advance the profession of plastic surgery through continuing educational activities
- Advise the public through direct patient education
- Act as patient advocates, protecting the welfare of the people of California with respect to cosmetic and reconstructive plastic surgery
As part of its mission, the California Society of Plastic Surgeons monitors legislation that effects the practice of medicine, especially as pertains to plastic surgery. To extend its expertise, the CSPS maintains delegates to the California Medical Association (CMA). In 2000, I was the CSPS delegate to the Young Physicians Section, at the California Medical Association’s Annual Meeting held in Reno, Nevada.
The society includes plastic surgeons specializing in both cosmetic plastic surgery and reconstructive plastic surgery. Most members of our state society are also members of the ASPS. Members who specialize in aesthetic (cosmetic) plastic surgery, are often also members of the ASAPS. I am proud to belong to all three groups, each of which promotes the practice of plastic surgery with the highest ethical standards and the foremost professional training and qualifications.
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June 18th, 2010 Dr. Mele
Dr. Mele is a member of the American Society of Bariatric Plastic Surgeons
The American Society of Bariatric Plastic Surgeons (ASBPS), was established by Board Certified Plastic Surgeons with a special interest the facial and body contouring procedures used after massive weight loss. Its mission is the care of patients who have lost significant amounts or weight through diet, exercise, bariatric surgery or any combination of the three. The ASBPS facilitates the exchange of ideas and techniques of post-bariatric plastic surgery among experienced board certified plastic surgeons and provides information for patients seeking relief from the burden of the excess skin that can remain after weight loss.
What are the Most Common Post-Bariatric Plastic Surgery Procedures?
The post bariatric plastic surgery procedures performed are similar to the traditional techniques. Some require modifications to allow more skin to be removed. The more common procedures are:
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