David C. Branch's Blog

High BMI Linked to Longer Healing Time After Breast Reduction Surgery

For patients undergoing breast reduction surgery (reduction mammaplasty), higher body mass index (BMI) is a risk factor for delayed wound healing, reports a study in the April issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

“While reduction mammaplasty is a safe procedure, our study suggests that patients in higher BMI categories may take longer to heal, with increased risk of wound healing times longer than two months,” says lead author Jesse Payton, MD, a plastic surgeon at Baylor Scott & White Medical Center, Temple, Texas. Older age is also identified as a risk factor for minor complications.

Age and Weight Impact Breast Reduction Complication Risk

Reduction mammaplasty is the standard of care for reducing physical symptoms (such as back and neck pain) and improving psychological well-being (such as poor body image and low self-esteem) in women with overlarge breasts (macromastia). Some previous studies have suggested that patients with higher BMI—a standard measure of body weight per height – are at higher risk of complications after breast reduction surgery. That’s an important consideration, as many patients with high BMI have macromastia-related symptoms.

To assess BMI and other possible risk factors for complications, Payton and colleagues reviewed their department’s experience with 277 patients undergoing reduction mammaplasty between 2014 and 2018. Average age was 36 years and average BMI 30 kilograms per square meter (kg/m²). Although most were at or above this high-BMI cutoff point, the patients were generally healthy, with low rates of other health problems.

Nearly half of patients experienced minor complications: a rate of 49.1%. The most common category of minor complications was superficial wound-healing problems, occurring in 42.1% of patients. Major complications were uncommon, occurring in 4.31% of patients. On initial analysis, BMI was unrelated to the risk of minor or major complications.

However, patients in higher BMI categories were more likely to have delayed wound healing, with healing times longer than two months. Higher-BMI patients also had longer surgical times and greater amounts of tissue removed at surgery (resection weights). Older age was also associated with an increased rate of minor complications.

Delayed Wound Healing Increases at Highest BMI Levels

After adjustment for age and resection rate, high BMI remained a significant risk factor for wounds requiring longer than two months to heal. For every 5 kg/m² increase in BMI, the estimated odds of delayed wound healing increased by 77%. High BMI was not related to the overall risk of minor or major complications, although there was a “positive trend“ in that direction.

Older age was an independent risk factor for minor complications in the adjusted analysis. For each decade of age, the estimated odds of minor complications increased by 22%.

The study adds to previous evidence that BMI is a risk factor for complications after reduction mammaplasty and is first to focus on wound healing times of longer than two months. The authors suggest that patients should be counseled about the BMI- and age-related increase in risks. For those in the highest BMI categories, steps to optimize patients’ health before surgery might help to reduce complication risks.

“Women with higher BMI are more likely to require larger resections, longer operative times and are at higher risk for wound healing requiring greater than two months,” Payton and coauthors conclude. They add: “While BMI is an important consideration for determining operative candidacy, the benefits of reduction may outweigh these risks in carefully selected patients.”

from Plastic Surgery Practice https://plasticsurgerypractice.com/client-objectives/aesthetics/breast-augmentation/reductions/high-bmi-linked-to-longer-healing-time-after-breast-reduction-surgery/

The Transformative Role of Retail Skincare in Plastic Surgery Practices

A New Approach to Patient Care

As plastic surgeons strive to deliver comprehensive care to their patients, incorporating retail skincare into their practices is emerging as a vital component. In recent years, the skincare industry has experienced tremendous growth, with many patients seeking professional guidance on products to enhance and maintain their surgical results. By integrating retail skincare, plastic surgeons can not only improve patient satisfaction, but also elevate their practice’s profitability and reputation.

The Rise of Retail Skincare in Plastic Surgery Practices

A growing number of plastic surgeons are recognizing the benefits of offering in-house skincare solutions tailored to their patients’ needs. These products, carefully selected by the surgeon, can help patients achieve their aesthetic goals and prolong the effects of surgical procedures. By providing access to medical-grade skincare products, plastic surgeons can ensure their patients receive the best possible care, both pre- and post-surgery.

The Retail Skincare Advantage: Quality and Trust

Retail skincare in plastic surgery practices goes beyond simply offering patients off-the-shelf products. By curating a selection of high-quality, scientifically-backed skincare products, surgeons can foster trust and patient loyalty. Patients are more likely to trust and purchase products recommended by their surgeon, as they feel confident in the expertise and knowledge of their medical professional.

Bridging the Gap: Educating Patients and Staff

To effectively integrate retail skincare into a plastic surgery practice, education is key. Surgeons should take the time to educate themselves and their staff about the products they offer, ensuring that everyone involved in the patient’s care is knowledgeable about the benefits and usage of each product. By providing patients with comprehensive information, surgeons can create a seamless and supportive patient experience.

The Impact on Practice Reputation and Revenue

Incorporating retail skincare into a plastic surgery practice can significantly enhance its reputation and profitability. By offering a range of targeted, high-quality products, surgeons can position themselves as leaders in the field, attracting new patients seeking comprehensive care. Additionally, the sales of skincare products can contribute to a practice’s bottom line, providing a new revenue stream that can be reinvested into further growth and development.

Embracing the Future: A Win-Win for Patients and Practices

As the role of retail skincare in plastic surgery practices continues to grow, both patients and practitioners stand to benefit. Patients receive expert guidance and access to quality products tailored to their needs, while practices can enjoy increased revenue and an enhanced reputation. By staying informed and adapting to the evolving landscape, plastic surgeons can ensure they remain at the forefront of the industry, providing unparalleled care to their patients.

A Pathway to Comprehensive Care

In a world where patients increasingly seek holistic solutions, incorporating retail skincare into plastic surgery practices is a natural evolution. By embracing this opportunity, surgeons can elevate the level of care they provide, ensuring that their patients achieve and maintain the best possible results. Through education and dedication to quality, plastic surgeons can pave the way for a brighter, more comprehensive future in patient care.

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Factors Linked to Cognitive Impact of Delayed Craniosynostosis Surgery

For infants with the skull deformity craniosynostosis, head reshaping surgery after age 12 months has long been linked to impaired cognitive and language development. Now, a new study suggests that the difference in developmental outcomes may reflect a range of other patient characteristics and clinical factors affecting age at surgery, reports the April issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

“Multiple factors may affect cognitive outcomes in infants undergoing craniosynostosis surgery, regardless of patient age at the time of surgery,” says ASPS Member Surgeon Steven R. Buchman, MD, of the University of Michigan in Ann Arbor. “Our study suggests that children who undergo surgery later have characteristics that independently predispose them to both delayed surgery and impaired neurocognitive development.”

How Surgery Timing Affects Cognitive Development in Craniosynostosis

Craniosynostosis is a common skull deformity occurring when the joints (sutures) between the bones of the skull close prematurely. Craniosynostosis surgery is performed to correct the abnormal head shape and allow the growing brain room to expand normally.

In 1988, a research article suggested that children undergoing craniosynostosis surgery after 12 months of age were at risk of delayed neurocognitive development. Subsequent studies seemed to support this conclusion. However, few studies have evaluated other factors that might affect the risk of developmental delay after craniosynostosis surgery.

What’s the real effect of surgical timing on cognitive outcomes? Buchman and colleagues evaluated their center’s experience in 227 infants undergoing craniosynostosis surgery between 2009 and 2020. All patients had craniosynostosis involving a single skull suture, unrelated to any genetic syndrome.

Head reshaping surgery (cranial vault remodeling) was performed before age 12 months in 157 infants and after 12 months in 70 infants. Average age was 8 months in the early-surgery group versus 18 months in the late-surgery group.

Head Reshaping Delays Linked to Socioeconomic and Clinical Factors

Several patient characteristics differed between groups. Nineteen percent of children with delayed surgery were of non-white race/ethnicity, compared to nine percent of the early-surgery group. Children in the delayed-surgery group were more likely to qualify for need-based financial assistance such as Medicaid: 41% versus 21%.

There were also differences in key clinical factors. Children with delayed surgery were more likely to have preterm birth, 25% versus 10%; and had higher rates of other health problems (comorbidity), 40% versus less than 10%. On standard assessments of child development performed before surgery, 15% of children in the delayed-surgery group had cognitive delays, compared to three percent in the early-surgery group.

“These results demonstrate an association between patients who undergo surgery after 12 months of age and patients who identify with a minority race and/or experience socioeconomic disadvantage,” the researchers write. These and other differences in patient characteristics raise questions about how the timing of craniosynostosis surgery affects early-childhood cognitive development.

“The overarching purpose of this paper is to demonstrate that certain factors may predispose patients to delayed cranial vault remodeling and introduce selection bias toward slowed neurocognitive development,” Buchman and colleagues conclude.

They call for further studies in larger groups of children with craniosynostosis to determine which factors have the greatest impact on age at surgery and cognitive development.

from Plastic Surgery Practice https://plasticsurgerypractice.com/uncategorized/factors-linked-to-cognitive-impact-of-delayed-craniosynostosis-surgery/

Cedars-Sinai Guerin Children’s Introduces Cleft and Craniofacial Program

Los Angeles-based Cedars-Sinai Guerin Children’s is opening a new plastic surgery program for children with facial deformities. The Cleft and Craniofacial Program, led by Victor Chien, MD, addresses the needs of any pediatric patient with a congenital craniofacial difference, including cleft lip and cleft palate, ear and jaw deformities, skull bones that fuse prematurely, as well as birthmarks.

“In the cleft lip and cleft palate cases, these can be picked up in a prenatal screening, as early as 18 to 22 weeks,” says Chien. “We meet with the families in a prenatal visit and come up with a detailed plan for surgical intervention, so the parents know what to expect after birth.”

Chien says both cleft lip and cleft palate negatively affect the ability of a baby to feed as well as speak normally. Fortunately, babies as young as 3 months can undergo cleft lip surgery because the lip is important for breast and bottle feeding. Cleft palate, which is a separation of the roof of the mouth, can affect a child’s ability to speak, so physicians aim to surgically treat the defect when the child is a little older and learning to speak.

The premature fusing of the skull bones, known as craniosynostosis, can restrict the growth of the brain, impact brain function and cause abnormally shaped heads. This, too, requires a surgical plan to free up abnormal fusion and growth restriction as well as change the child’s appearance.

“Nobody plans on having a child with a craniofacial difference,” says Chien, “but when a parent gets that diagnosis, it can be very stressful. Our goal at Guerin Children’s for the Cleft and Craniofacial Program is to be your lifelong partner. Many of these diagnoses require multiple operations and follow-up, and we are going to be with children and their parents every step of the way.”

from Plastic Surgery Practice https://plasticsurgerypractice.com/client-objectives/aesthetics/reconstructive-surgery/cedars-sinai-guerin-childrens-introduces-cleft-and-craniofacial-program/

Bimini Health Tech Acquires Rights to Acellular Dermal Matrix Portfolio

Acquisition expands Bimini’s global soft-tissue franchise, which already includes the PureGraft and Dermapose fat transfer systems

Medical device and regenerative therapy company Bimini Health Tech has acquired the exclusive rights to an acellular dermal matrix (ADM) technology for the plastic and reconstructive surgery field.

“The addition of an ADM to Bimini’s existing product portfolio is the next foundational step in our strategy to become a global leader in the plastic and reconstruction market and advance the standard of care for patients requiring reconstructive surgery,” says Bradford Conlan, CEO of Bimini Health Tech.

“Bimini expects total revenue from the ADM products to exceed $400 million over the next 10 years,” Conlan adds. “The ADM technology is a welcome addition to the 20-plus products in our portfolio that are currently approved and cleared around the world.”

The ADM is pre-hydrated, perforated, and ready to use, and comes with a medical-device grade sterility assurance level of 10^-6, eliminating the need for additional washing or preparation steps, thereby increasing efficiency and reducing operating times. Bimini’s offering will be provided in multiple shapes and sizes to meet its customer’s needs, according to Conlan.

Specifically, the ADM technology utilizes a proprietary manufacturing process that removes donor DNA without compromising the desired biomechanical structure or biochemical properties. This leaves key factors of the native dermis intact for integration and neovascularization to meet its intended use.

By acquiring the exclusive license for this technology, Bimini Health Tech will be able to leverage its existing infrastructure and expertise to bring this technology to a wider patient population, with an estimated U.S. market size of over $700 million per year, company officials say. “This acquisition represents a strategic investment in the company’s future and is in line with its mission to improve patient outcomes through the development of innovative medical technologies,” they add.

from Plastic Surgery Practice https://plasticsurgerypractice.com/news/company-news/bimini-health-tech-acquires-exclusive-rights-to-acellular-dermal-matrix-portfolio/

Study Shows Promising Option to Avoid Mastectomy

Patients who have multiple tumors in one breast may be able to avoid a mastectomy if the tumors can be removed while leaving enough breast tissue, according to research led by the Alliance in Clinical Trials in Oncology and Mayo Clinic Comprehensive Cancer Center. Patients would receive breast-conserving therapy: a lumpectomy followed by whole-breast radiation therapy, rather than mastectomy.

“I am excited about these findings because it will empower patients and the multidisciplinary care teams caring for patients to be thinking about this option for women who may want to preserve their breast,” says Judy Boughey, MD, lead author and breast surgical oncologist, and the W.H. Odell Professor of Individualized Medicine. “Some patients may still prefer or require a mastectomy, and that is a perfectly fine approach. But being able to provide more patients diagnosed with breast cancer with a choice is a great step forward.”

The prospective, single-arm trial, a study where all women enrolled in the trial are treated the same way, looked at data from 204 eligible women over 40 that had two or three separate areas of breast cancer in the same breast and were interested in breast conservation.

All patients had a preoperative mammogram and/or ultrasound, and all but 15 had a breast MRI. They had lumpectomies to remove tumors, followed by whole-breast radiation with radiation boost to each lumpectomy site. The women were observed for five years for subsequent breast cancer events.

The data after five years showed that at a median follow-up of 66.4 months, six patients had a local recurrence. The rate of cancer local recurrence was 3.1%. This is an excellent outcome and is like the local recurrence rate for patients with a single tumor in a breast who had breast-conserving therapy, Boughey says.

Historically, women with multiple tumors in one breast have been advised to have a mastectomy. Now, patients can be offered a less-invasive option with faster recovery, resulting in better patient satisfaction and cosmetic outcomes, according to Boughey

An additional finding is that the local recurrence rate was lower in patients who had a preoperative MRI than in those who did not have an MRI before surgery. For patients who have two or three tumors in a breast and are considering breast conservation, an MRI before surgery should be considered to ensure there is not more extensive disease, Boughey says.

Several other factors, such as breast size, will influence whether a patient would be able to be offered breast-conserving therapy, she adds.

from Plastic Surgery Practice https://plasticsurgerypractice.com/client-objectives/aesthetics/reconstructive-surgery/breast-cancer/study-shows-promising-option-to-avoid-mastectomy/

The Hidden Dangers of Medical Tourism

Medical tourism has been on the rise in recent years as people seek cheaper cosmetic surgery options in foreign countries. However, this trend has been associated with a range of risks and complications, as discussed by Alexander Zuriarrain, MD, FACS, a board-certified plastic surgeon and owner of Miami-based Zuri Plastic Surgery, in this podcast with PSP co-chief editor Keri Stephens.

According to Zuriarrain, patients seeking affordable cosmetic surgeries often consider traveling to the Dominican Republic, Venezuela, Colombia, or Mexico, where the costs are significantly lower than in the United States. However, there are a number of concerns associated with medical tourism, including the potential for patient exploitation, the risk of complications arising from long flights, and the difficulty of diagnosing and treating complications without in-person consultations.

One of the major worries associated with medical tourism is the potential for patient exploitation. Patients who seek cosmetic surgery in foreign countries may be unaware of the quality of care they will receive or may not have access to adequate post-operative care. This can lead to a range of complications, including infections, necrosis, and blood clots, which can be difficult to diagnose and treat remotely.

Another risk of medical tourism is the financial cost associated with undergoing cosmetic surgery abroad. Patients may believe that they are getting a better deal by traveling to a foreign country for surgery, but they may not consider the additional costs associated with follow-up care and complications. These costs can quickly add up, making the overall cost of surgery much higher than expected.

Overall, Zuriarrain advises patients to mull the risks and benefits of medical tourism before deciding to undergo cosmetic surgery abroad. Patients should be aware of the potential for patient exploitation, the risks associated with long flights, and the difficulty of diagnosing and treating complications remotely. Instead, patients should consider seeking surgery from U.S.-based board-certified plastic surgeons, who can provide them with high-quality care and adequate follow-up care at a reasonable cost.

Podcast Transcript

Keri Stephens:

Hello and welcome to the Plastic Surgery Practice Podcast on the MEDQOR Podcast Network. I am Keri Stevens and I’m the co-chief Editor of Plastic Surgery Practice.

Today I’m excited to have Dr. Alex Zuriarrain back with us to discuss the growing and potentially dangerous trend of medical tourism. It’s a topic he recently covered in an article for PSP. Dr. Zuriarrain is the founder of Zuri Plastic Surgery in Miami, where he specializes in aesthetic procedures of the face and body, including facelift, eyelid surgery, rhinoplasty, breast augmentation, and reduction, abdominalplasty, liposuction, and the Brazilian butt lift. Dr. Zuriarrian, thank you for joining us today.

Dr. Zuriarrain:

Thank you so much for having me on. It’s always a pleasure.

Keri Stephens:

It’s always ours, too. We love having you on. And I think this topic right now, honestly couldn’t be more timely because the news lately of people that were killed and abducted in Mexico with a friend getting plastic surgery.

Can you just kind of discuss your reaction to that story from a plastic surgeon perspective, and potentially how do you address the concerns about the potential exploitation of patients who are seeking cheaper cosmetic surgery options in foreign countries like Mexico?

Dr. Zuriarrain:

Yeah, I think that practicing here in Miami, I see a lot of this happening in terms of patients seeking to go outside of the United States to have plastic surgery. I’m pretty much like the last stop before they decide to exit the country, because here in Miami the pricing is so competitive and the demand is very high. So if you’re in the United States and you want to have reasonably priced surgery, most of the time you’re going to be heading down to Miami in general.

But for those seeking even lower prices and that type of environment, they end up going a lot to the Caribbean. So the Dominican Republic is a very hot location, and then Venezuela used to be before the government changed. Columbia’s still pretty high up there, Mexico, et cetera.

Yeah. So this recent event, it just is very timely. It illustrates how dangerous it could be to travel to some of these destinations, including Mexico, which is right now very violent in some locations. There are warnings from our government, from the State Department that literally tell you, do not go to certain places in Mexico, okay? You are not supposed to be there. You’re not supposed to travel there for any reason whatsoever.

And one of the locations where this individual went with some family members, I believe they were traveling from South Carolina via vehicle, and they crossed the border and they were intercepted by the drug cartel. And the rest of the story can be found online, but it’s a pretty sad story about what happened.

Keri Stephens:

So when people are going abroad for cosmetic surgeries, what are the most common complications associated with them? And also what are some of the most common surgeries that people tend to look abroad for?

Dr. Zuriarrain:

Yeah, I think nowadays they’re going abroad for almost anything. I mean, from rhinoplasty in Turkey, to mommy makeovers in Dominican Republic, liposuction in Mexico, breast augmentations. I mean, the sky’s the limit. And let me be clear, this is not just a plastic surgery phenomenon. This is a phenomenon that’s occurring with gastric bypass patients who want to lose weight and they’re getting it done in other countries. These are people that have major dental work, veneers, teeth implants that are going to Columbia to get it done for half the price with a Colombian dentist. This spans way, way broader than plastic surgery.

The issue with plastic surgery is that, in my opinion, is way more dangerous than getting a root canal or a tooth implant. These are major surgeries. They can have major implications, complications that I see a lot are infections, a lot of infections. I see a lot of necrosis, like wounds that open up. They separate. Blood clots, we see a lot of blood clots from the traveling. They’re traveling too soon after surgery, long flights. So we see it all, and they end up in the emergency room, typically here in Miami because Miami’s the hub to get to the rest of the US. So a lot of them land in Miami International Airport, and then they go straight into one of our local hospitals. And it’s a burden to our system, quite honestly.

Keri Stephens:

And also, your article I think mentioned this really well, but you talk about how the financial costs where people think, going abroad, getting cheaper surgery, but then they end up with all these hidden fees. Can you talk about that, the financial risk associated with undergoing cosmetic surgery abroad?

Dr. Zuriarrain:

Yeah. I think people fail to recognize how important it is to be able to follow up with your surgeon in person, actually see them and have them evaluate you physically. I can tell you that as a practicing plastic surgeon, it’s very hard to diagnose certain conditions or complications from a video call or over the phone or through pictures and email. I mean, it’s very challenging.

So the price that you end up paying, even if you have a very minor complication, let’s say the wound just kind of separates a little bit, you’re going to be so nervous. You’re going to be so concerned. You’ve never had this happen to you before. You’re going to end up having to fly back, typically to see this surgeon wherever you had surgery. And these flights and these hotels and all of these things, they add up very quickly as opposed to traveling within the United States. Domestic flights are much cheaper than international flights for the most part.

And then that’s just for a minor complication. If you get anything more significant than that, then you’re going to be paying out of pocket here in the United States to have a plastic surgeon who doesn’t know anything about your surgery, has no clue what they did to you, doesn’t have the operative notes from the other surgeon that are probably in another language. And then you got to decipher all of that and figure out how to help somebody.

Keri Stephens:

So let’s get into the postoperative care that you’ve talked about, with people come back to you after they’ve had these botched surgeries. But can you discuss the importance of post-operative care and follow-up appointments, especially for patients who’ve undergone cosmetic surgery abroad?

Dr. Zuriarrain:

Yeah, so the post-operative care is a big deal. When you’re in the US you have access to your surgeon that can intervene physically if need be, even if it’s just a short flight away. The post-op care is going to be involving wound care, drain care, all types of exams to make sure you’re not developing a seroma, hematoma, a wound infection. When is the right time to pull the drain? How many drains do you have? How extensive was the surgery? I mean, these require a lot of handholding by the surgeon. But a lot of these surgeons that are abroad, they’re busy doing such high volume surgery because their prices are so low that it all ends up based on their staff, the staff at these facilities trying to help patients that are coming to them from the United States.

And again, there’s a huge language barrier when it comes to these situations. And sometimes it’s hard to get even people to pick up the phone in another country, in another time zone. Forget about trying to deal with a real serious problem. So again, what ends up happening is that the US system, healthcare system gets burdened. People end up in the emergency room all the time trying to figure out what to do. And it could be very frustrating for the ER doctors and the US plastic surgeons.

Keri Stephens:

Do you feel like the medical tourism, especially for plastic surgery, is becoming a worse problem? And I hate to say worse, but because it can have so many complications, I think that might be the proper term.

Dr. Zuriarrain:

Yeah, yeah, and I think now that we’re having this change in the economy, that we’re seeing a lot with inflation, rising interest rates, this is the time that most people end up even considering leaving and seeking surgery elsewhere, abroad. And I would caution them, be very careful. There are good surgeons out there, but you know, have to be very, very careful.

And we offer insurance programs here in the United States. There are two major companies that offer you cosmetic surgery insurance, and those are Aesthetisure and CosmetAssure. I particularly use Aesthetisure in my practice, and I offer it to all of my patients. It’s a very small fee. We’re talking about a one-time fee of about $300, and it covers you the first 45 days of any type of complication related to your surgery, going back to the operating room, going to the ER, getting in an ambulance for whatever reason. It’s a huge safety net that you don’t have to pay out of pocket for.

Keri Stephens:

Do you think that Covid changed the medical tourism industry in plastic surgery? I mean, especially with the restrictions?

Dr. Zuriarrain:

Yeah, I think there are parts of this country that got very, very, they got hit very hard. Places like New York, Manhattan, places in California like San Francisco that were total shutdowns, total closing of all elective surgeries. I know I have a lot of colleagues that suffered tremendously financially, almost at the brink of bankruptcy and collapse as cosmetic surgeons.

And so yeah, that really changed the landscape. Places like Florida, Texas that were opened much faster and allowed surgeons to get back to work on elective surgery quickly allowed surgeons like myself to stay afloat and stay in practice. And so I think a lot of patients came to places like Florida and Texas to have surgery. But yeah, a huge percentage went abroad. They left the US because of that.

Keri Stephens:

I want to get to the regulations now. So how do the regulations and standards of care for cosmetic surgery vary between different countries, and how can patients ensure they’re receiving high quality care when traveling abroad?

Dr. Zuriarrain:

Yeah, so the most rigorous board examination in the world, I would argue is the American Board of Plastic Surgery. And the most rigorous medical training in terms of even just based on years of training is the United States. I mean, we are for the most part, held as the gold standard for medical education across the world. I mean, many countries that don’t even speak our language use our textbooks to teach their students and teach their residents.

So when you’re dealing with a board certified plastic surgeon in the United States, I really can’t, I really don’t have a handle on how we’re able to compare that type of surgeon to a surgeon in another country. I don’t know their rules and regulations honestly, regarding their medical education. I know that many countries in Latin America have a system whereby, you know, you go straight to medical school out of high school. You don’t go through four years of college or university, and then an additional four years of medical school and then an additional five or six years of residency. They shorten and they condense all of that time significantly. And so in that regard, again, I don’t think that the level of expertise is the same or even the level of experience. You can’t say you have the same level of experience.

And then the other aspect of it is the regulations regarding facility management, cleanliness of the operating rooms. I mean, we have some very, very strict accreditation agencies in the United States regarding OSHA, regarding all types of workplace environment stipulations. So I mean, I personally, and I’ve been in operating rooms in many different parts of the world, and I’ve never felt that they were at the level or above of those that I’ve operated on in the United States.

Keri Stephens:

And that kind of gets into my next question. Can you just discuss the importance of having a qualified plastic surgeon, a board certified plastic surgeon, why that’s so necessary for patients? Because I don’t think they always know that.

Dr. Zuriarrain:

No, I think it’s a struggle. I think that even though we try to educate every day about it, I think that just the word board certification, it’s like they just check that box and they move on. But I don’t think people really understand how rigorous it is, the examination process. I mean, we’re put through a very, very difficult three day grueling oral examination process, where all of the cases that we did during the last year are scrutinized by a group of some of the most qualified academic plastic surgeons in the country, and they put you through the ringer. I mean, they put you through the grind, and they will fail you either for lack of ethics, for improper billing, the way you bill your patients, how you document your surgical technique, your complications, how you managed your complications.

That’s actually one of the biggest parts of the exam is everybody has complications, but what did you do? How did you fix the problem? How did you follow up with the patient? How responsive were you? How did you document everything? That really sets us apart from, for I think even a lot of other specialties, I’ll argue, in terms of how rigorous the training is and how rigorous the examination is.

Keri Stephens:

Yeah, definitely. I mean, that’s a very important message for this industry, I think. So for our last question, how can plastic surgeons work to raise awareness about the risks of unregulated cosmetic surgery practices in foreign countries? What can you all do to change the narrative?

Dr. Zuriarrain:

Yeah, it’s funny because on social media it’s kind of a double-edged sword. And I’ve had this experience personally where I’ll say, “Hey, be careful going to X, Y, or Z country. We’ve been seeing infections of this type of bacteria coming back into US.” And then some people kind of comment on the threads and say, “Oh, but why do you have to knock going to other places?”

I’m not knocking anything. I’m not trying to say that those places may not have good surgeons or that, you know, you may not have a good outcome. It’s just that there’s a serious concern that if you do go abroad, that what happens if something serious were to happen over there, number one, and if you get back and you have a serious problem, then what are you going to do and how much are you going to have to come out of pocket for?

So I still think that as surgeons, we have to do a better job, I think of educating our patients and our citizens in the US about the dangers of going abroad. But we also don’t want to come across as being elitist or that we’re the best in the world and everybody else’s subpar and all that, because then we get into this tit-for-tat with a lot of patients that may have had a good experience abroad. So it’s a dicey, it’s a touchy subject to be honest with you.

Keri Stephens:

No, thank you. Well, this was very informative. And just to our listeners, be sure to check out Dr. Zuriarrain’s article on the Plastic Surgery Practice website. Until next time, be sure to subscribe to the MEDQOR podcast network. To be alerted to future episodes and to keep up with the latest plastic surgery news, visit plasticsurgerypractice.com. Until next time, take care.

from Plastic Surgery Practice https://ift.tt/1jLEC6g

What’s the Difference Between Traditional vs. Roth IRA?

Traditional IRAs and Roth IRAs are two of the most advantageous types of accounts for saving money for retirement. While very similar, there are some key differences between these two types of retirement accounts. Everyone needs to know about traditional IRAs and Roth IRAs to decide which one is right.

Traditional IRA

In a traditional IRA, account holders can deduct contributions from their annual taxable income for both federal and state returns. This means that they are not taxed on money contributed to a traditional IRA in the year it is earned. When it’s time to take distributions from the IRA, however, the contributor will have to pay the appropriate tax based on their income level. Essentially, this makes contributions to a traditional IRA tax-deferred since taxes must eventually be paid on money received from the account.

Roth IRA

A Roth IRA works in the opposite way to a traditional IRA. In a Roth, contributions are made on a post-tax basis. Contributors are still taxed on the money they pay in, negating the immediate tax advantage of a traditional account. The power of a Roth IRA, however, is in the long run. With a Roth, capital gains are not subject to tax. This means that when the contributor retires, they are not taxed on withdrawals from the account.

In addition to this key difference, some minor differences separate traditional and Roth IRAs. To begin with, there are income caps on Roth IRAs. Individuals making $144,000 or more cannot contribute to a Roth IRA. Contribution limits are also lowered for individuals making more than $130,500.

Roth IRAs also do not come with required minimum distributions. In a traditional IRA, contributors must take distributions beginning at age 72. This requirement isn’t placed on Roth IRAs.

A final key difference between the two types of accounts is that Roth IRAs can be left to beneficiaries tax-free. As with the contributor, a person who inherits a Roth IRA does not have to pay taxes on withdrawals. This makes Roth IRAs suitable as vehicles for transferring wealth to children or grandchildren.

Keeping Your Money Safe in the Digital Age

In today’s world, technology continues to evolve to provide more services and capabilities than ever before. As a result of the evolution, various industries have been disrupted in how they function. One of the industries that continues to see a big shift is the financial industry, as more capabilities become available online. Those who are customers within finance understand the need to be aware of how to keep their information and money safe in the digital age is more important than ever. Customers with online financial information should be aware of the following tips to keep their money safe.

Maintain Strong Passwords

One of the first and most important things to do to keep one’s money safe in the digital age is to maintain strong passwords to any online account. Accounts with financial information should have strong passwords that are difficult to break and do not have any relation to one’s personal information. For example, many individuals find that using things like a pet’s name or a parent’s birthday as a password to be helpful, as they are easy for the person to remember. While this seems like a good idea, these types of passwords can be easy for hackers to figure out. Instead, use a password generator from a place like LastPass to create an automatic password with a variety of letters, numbers, and symbols. These will not only be difficult to break but can reduce the risk of an account being hacked. Use these types of passwords for every account, and ensure that each account has its own unique password.

Don’t Click On Unknown Links Or Emails

With emails becoming a more common way for hackers to obtain sensitive information, it is crucial for individuals to be aware of these risks. To prevent this from happening, never open any emails from unknown sends or if the email looks suspicious for any reason. In addition to this, it is also incredibly important not to click on any links within unknown emails. In many cases, these links can open up one’s private information to hackers. If an email looks suspicious or includes an unknown link, it is best to avoid clicking on it and ensure that the email address is blocked from sending anything in the future.

Keep Track Of Online Information

An underutilized tip to protect one’s online financial information is to keep track of everything. Periodically checking one’s bank account for any unknown or suspicious charges will be one of the best ways to know if someone has access to online banking information. If this does happen, it is important to contact the bank right away and change the password for the banking account. Additionally, it can be helpful to turn on two-factor authentication, which requires two forms of proof when logging into the account. This can help reduce the risk of someone gaining unauthorized access to the account.

Why is fintech important to understand within the financial industry?

Fintech, which is shortened for financial technology, is the incorporation of technology into financial services. The delivery of traditional financial services, from lending to banking, is streamlined and increased in speed. However, fintech is an emerging industry that makes use of smartphones, computers, mobile banking, cryptocurrency, and other forms of technology.

Increased customer service

Fintech improves the levels of customer service that are provided by financial institutions. Customers find it easier to speak to customer service representatives and discuss any financial topic over the Internet or on their phones.

However, human experts are hard if ever replaced by robotic software. The use of real, qualified financial advisors is still being used, even from remote distances.

Reduced costs of technology

Most business owners have misconceptions that the costs of technology are exceptionally high. The use of cutting-edge technology is intimidating to people who are skeptical about its future success. Usually, the initial cost of investing in technology is expensive, but after long-term use, technology helps to reduce the expenses of running a business.

Greater convenience

Fintech provides greater levels of convenience for busy individuals. Technology allows industry professionals and their clients to set appointments around their own schedules. Technology allows more professionals to work from home and select the hours when they will be most productive. For business owners, saving money in the financial sector of the industry includes saving time for professionals and the clients who receive their services.

Increased speed

Speed is important in an industry where everyone wants fast approvals and transaction processing times. Fintech increases the speed of every financial task, from advising to loan approvals. With traditional financial methods, applicants have to wait several weeks or months for the bank’s response. Technology-based financial institutions give clients more access to finance professionals with additional specialties.

Why fintech is important

Technology is becoming unavoidable in every industry, especially finance. Few people can perform business on the move without their smartphones. Startup business owners are able to research additional options for financial services online. Overall, financial services are becoming more easily accessible, affordable and convenient with the help of modern technology.