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There are so many factors that seem to be shaping health care today, trying to cut costs and improve care.  So this is what we have all been told, but I’m not so sure.  The takeover of medical decision making by the insurance industry, accountants and politicians has been devastating to the quality of care and its accessibility to you the consumer.  Unfortunately without a medical background you can be led down any path presented with little resistance, not having a clue there may be a cheaper more efficient and more skilled approach to resolving your problem.

A classic example is the treatment of skin cancers.  Originally the treatment and reconstruction of resulting defects from these common skin problems rested in the hands of Plastic and Reconstructive surgeons.  We fielded skin cancer problems sent to us from dermatologists, family practitioners, Internists and other surgeons. Logic prevailed that the experts in reconstructing damaged or missing anatomy anywhere on the body would be Plastic & Reconstructive surgeons.  Which makes us the only choice for excising these common cancers and reconstructing the defects so well, that you had trouble seeing where the cancer was.

For a variety of reasons the times have changed.  What used to be for the most part, a one-stop-shop process with diagnosis, removal and reconstruction being done in a single procedure has now evolved into the current state of care.  You are sent to a dermatologist who does a punch biopsy.  A positive biopsy sends you to another dermatologist, a Moh’s surgeon.  (I take issue with the term surgeon since the Department of Internal Medicine trains all Dermatologists).  This physician then does several excisions, along with a pathology fee for each specimen until all margins are clear. 

After the Moh’s technique is completed you frequently have to come back another day for reconstruction of the defect.  Unfortunately, the Moh’s surgeons are dermatologists without the seven to ten years of surgical training required to become a Plastic & Reconstructive surgeon.  The choices of reconstructive options available are entry level compared to the options of a trained Plastic & Reconstructive surgeon.  Frequently you end up with patch work skin graft on the end of your nose and you are told how lucky you are that they got all the cancer.  Unfortunately this scenario has been sold to the health insurance industry and to the public.

Even with a complex problem excision, the procedure fees and facility costs can be less than most people’s insurance deductibles.  This means that you can have the one-stop-shop process done by doctors that invented the techniques of reconstruction for often times, less than the cost of the current conventional route.

What can you the consumer do?  Ask to see a Plastic & Reconstructive surgeon for the initial diagnostic excision.  You have choices!

For more information please contact the office to schedule an appointment

_ Smarter Lipo?

Is the latest always the greatest? Is liposuction really smarter now or are consumers paying the price of ignorance?  I love making analogies, simple stories to clarify complex decisions, in my practice and find invaluable. Liposuction, a very common cosmetic procedure, is very heavily marketed.  What is true and what will make you blue?  Tough to find reality in a sea of marketing schemes pulling the unknowing consumer in fifty directions.

Let’s say I give you a simple task to go to the grocery store for groceries.  I also give you transportation options;

·         Option #1:  Standard SUV currently in your garage.

·         Option #2:  Latest Mars explorer rocket ship (most current technology in the world).

What is the smart choice?  The latest and greatest or the old standby?  Let’s weigh the Pro’s and Con’s:

SUV Requirements                                             Spaceship Requirements

  1.       Drivers License (at age 16)                   1.  License for spaceship (years to learn)

  2.       Gas from local station                            2.  Liquid Nitrogen fuel = $$$

  3.       Parking spot at grocery store               3.  No parking available and tough to stop!

  4.       Room for groceries                                 4.  No extra space for groceries

  5.       Cost for car is affordable                        5.  Cost for spaceship is astronomical

Seems to me the best choice for a run to the grocery store isn’t the latest and greatest technology.  As a matter of fact for that common task what we usually drive is safe, easy to learn to drive, cost effective, and predictable 99.9% of the time.  Sure bad things can happen, but rarely and certainly not as often as trying to get skilled enough to land a spaceship in the grocery store parking lot!

Standard, worldwide, tried and true liposuction techniques are much like the family car and in well-trained hands give predictable, safe, and excellent results.  Is lipo really smarter with a new laser, ultrasound, fat-vaporizing, tissue cooking, bells and whistles marketed spaceship?  I don’t think so.  Complications are frequent with the latest and greatest because more heat and power make it more difficult to control, even in the hands of the properly trained spaceship pilots.  Tough to park in the parking lot without burning a large hole.

Careful what you ask for and what you are marketed to ask for!

So did anyone do anything fun in February?

February seems to have commandeered a focal point in my annual calendar for the past twenty-seven years.  1985 I was chief resident in my plastic surgery training, six years after finishing medical school.  I was ready to start on a new chapter in my training having been accepted to study craniofacial surgery in Paris in August.  Life was good but I had no idea I was about to experience a landmark event that continues to give meaning, purpose and motivation to my life.

My program director had agreed to send the two chief residents and two of his clinical professors to the Dominican Republic for ten days to operate on the poor people with congenital deformities of the face and hands, as well as burn victims with horrible scar contractures.  We joined forces with the Peace Corp to help our every move in that strange environment.  We set up the equivalence of a MASH unit on a chicken ranch in the mountains near the Haitian border.  We had no electricity or running water and shared our cots with tarantula’s and Kane spiders.  The four of us performed 110 surgeries in four days that first year.

M.A.C.L.A., Medical Aid for Children of Latin America, was born.  My good friend Dr. Tom Geraghty in Kansas City, MO built from that auspicious beginning a surgical charity that has treated over 10,000 patients.  Tom and I have been going every year since, with the exception of my time in Paris studying craniofacial surgery followed by a fellowship in microvascular surgery.  We now work out of Padre Belini Hospital in Santo Domingo, the capital.  And we perform an average of 220 cases a year with back-to-back one week trips with separate teams.

Every year, in spite of the hundreds of surgeries I have performed there, one or two patients touch even the most seasoned of us.  This year Tom and I shed a few tears over a beautiful 3 year old girl who pulled a scalding caldron of water onto her shoulder and chest.  The other heart breaker was a 22 year old handsome boy riding his motorbike.  The group that stole his bike threw a mixture of molasses and battery acid on the right side of his face.  He lost vision in his right eye and is permanently disfigured with his mouth frozen open and his chin contracted down to his collar bone. My youngest son Vince is the same age as that young man. 

Tom and I worked for hours through our tears on those two patients, releasing the little girls’ right arm that was frozen to her side and releasing the young mans frozen jaw from his collar bone, his frozen mouth so he could close it, and his frozen open eyelids so he could close them.

Neither one will ever be normal again, but at least we can give them some sort of functional improvement.

Twenty-seven years and counting.  I can’t wait for February.

It's a matter of honor. We live in an interesting time. The old rules of communication certainly seem to be different than past generations. Believe it or not, people, yes real humans actually used to regularly engage in verbal face-to-face communication. Yes, complete with facial expressions and emotional responses. The general population needed skills in face-to-face encounters to be successful in the business world and equally important, in our personal lives.

Times have changed and I'm not sure our social ethics have kept stride with the new cyberspace age dialogue. When was the last time you or your friends actually read an honest profile from any of the new "meet a mate" dot-com cyber fake social environment dot-net, dot-org...?

No face-to-face communication opens the door for anyone to fabricate, hallucinate, embellish or otherwise alter reality.

It's a matter of honor!

We all have to pay attention in this new regime where hallucinations are presented as fact. These changes are not only evident in social interactions, but perhaps even more so in the business profiles we encounter on the net.

What is real? I'm not sure people care anymore. We read a great website and make decisions based on what can be pure disillusion. No human contact is required or even more importantly, desired.

My life passion, Plastic and Reconstructive surgery, has been besieged by an army of pretenders. The poor reimbursements currently the norm doled out by the insurance industry have driven many insurance dependent physicians to the brink of bankruptcy. Attempting to stay afloat, many of these Board Certified physicians have reinvented themselves on cyperspace. They creatively design their websites to present themselves as something they are not. Smoke and mirrors!

Plastic and Reconstructive surgery is a very specific specialty. Usually the training period after medical school is seven to eight years followed by three years of extensive Board examinations before you can call yourself a Board Certified Plastic and Reconstructive Surgeon. There is no other way to become a Plastic Surgeon. No short cuts are available. It's a matter of honor.

Many cyberspace buzz words are rampant throughout the smorgasbord of websites for "Cosmetic Surgeons; Board Certified; Facial Plastic Surgeon; Lipoplasty Surgeon; Breast Specialist; Tummy Specialist; Liposculpting Specialist" to name a few that are commonly displayed verbal credential presented to the public.

These partial truth statements can make a variety of training backgrounds that may not have anything to do with surgery. For example, Board Certified can be in Obstetrics and Gynecology; Ear, Nose and Throat; Dermatology; Family Practice; General Surgery or even Psychiatry. All of these "specialists" can legally do anything to a patient who is naive enough to sign a permit if the surgery is performed at their own facility. These specialists cannot get privileges to perform any service, outside of their actual training background, in a hospital operating room. So an Ear, Nose and Throat or Facial Plastic Surgeon cannot do tummy tucks or breast enlargements or any other surgery below the neck at a hospital because they are not formally trained below the neck.

This loop hole in the law allows non-trained physicians to perform cosmetic surgery legally as long as it is performed in their office in-spite of no formal training.

Those of us that have finished the fifteen years of training after college to actually become Board Certified Plastic Surgeons have met every rigid requirement of the American Board of Medical Specialties, the governing body that determines the training requirements for all physicians.

We are required to be able to reconstruct any damaged or deformed part of the entire body regardless of cause; for example: congenital, disease process, trauma, or aging. Cosmetic surgery simply has evolved from the methods derived from these reconstructive efforts through the years. Most of us are well into our thirties by the time we finish training in Plastic and Reconstructive Surgery. Our lives have truly been dedicated to being the best we can be to serve you, the patient.

I'm of Sicilian American heritage with all four grandparents from the same village in Sicily. My father became a physician, as well as his younger brother. There are now seventeen Longo M.D.'s in the family. My father died at 87 years old still practicing medicine. His patients were all extended family. I have been a Plastic Surgeon for twenty-six years and certainly give myself entirely to my patients as is my family tradition. It's a matter of honor.

Charles T. Longo, M.D.