Dr. Kenneth Benjamin Hughes performs a great number of plastic surgical procedures in his surgical center in Los Angeles.  Tobacco combustion and cigarette smoke increases the risk of complications following any type of surgery. Most surgeons typically recommend that smoking patients cease smoking for at least one month prior to elective surgery.

 

       There are manifold reasons for this recommendation. Smoking contains several chemicals that are harmful to healing. Nicotine is a potent vasoconstrictor, which will decrease the blood supply to the healing tissue and result in greater complications including poor wound healing and poor scarring.   In some cases, the vasoconstriction can lead to the death of tissue or death of a flap of tissue, known as tissue necrosis or flap necrosis.  This dead tissue develops due to lack of blood supply to the tissue that is surgically manipulated.  Smoking can have disastrous consequences that cannot be overstated in the surgical setting.

  

       Additionally, cigarette smoke contains carbon monoxide, which decreases the ability of the blood to transport oxygen to the healing tissues. This chemical also results in poor wound healing.  Finally, cigarette smoking contains hydrogen cyanide, which is essentially a cellular poison that increases complications through multiple processes. In addition to these chemicals, there are many other chemicals that are the combustion products of the tobacco that result in additional problems including the well-known correlation between smoking and various types of cancer.

 

        Some of the chemical compounds in the tobacco smoke can be removed from the body in a few hours.   Thus, smoking cessation just a few hours or days before surgery can result in significant reduction of complications.  However, for the patient to return to more normal respiratory and immune system function, smoking cessation should occur at least a month prior to surgery.  The cigarette smoke definitely reduces the ability of the immune cells to recognize and remove bacteria and other microbes that can lead to infection. The inability of the cells to perform the normal surveillance functions can obviously have grave repercussions.  Cigarette smoke is also known to significantly reduce lung function, increasing the risk for lung-related complications including asthmatic attacks. We also know that smoking increases the rate of platelet aggregation and clot formation leading to the increased risk of heart attack and stroke.

 

          In addition, there are some very specific complications related to plastic surgery. In addition to the wound healing complications that have already been delineated, these compounds can lead to poor scarring and higher scar revision rates. In addition, smokers have a 50% higher rate of fluid collections (seromas), which can distort and totally destroy a very nice cosmetic result after liposuction or similar body contouring procedures.  Patients who have breast reconstruction and who are smokers have a much higher rate of breast implant complications, requiring removal of those implants.  The most serious complication of cigarette smoke to the plastic surgery itself is the death of tissues, known as tissue necrosis or flap necrosis.  A piece of skin dissected can literally die, yielding an open wound that can create a very long healing period and a horrible and possibly disfiguring result.

 

        Although this has been a cursory review of smoking’s negative impact upon healing following surgery and specifically plastic surgery, it is very important to follow guidelines recommended by your surgeon.  Most surgeons will recommend at least 2 to 3 days of cessation of smoking to reduce the short term negative repercussions of the cigarette smoke reflected by the nicotine and the carbon monoxide. For patients who have a higher smoking burden, it is probably much more appropriate to recommend at least a month prior to any elective surgery including cosmetic surgery. It is also important to recognize that you should not just quit before surgery but you should not be smoking throughout the postoperative period, which may be at least six weeks if not longer.

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Question:

 

I'm 39 yrs old and have been a regular smoker since the age of 18. Is quitting 1 month prior to surgery safe? Do I need any tests? 

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Answer:

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         Definitely stop smoking! Smoking reduces circulation to the skin and impedes healing and can cause the death of tissue called tissue or flap necrosis.  In fat transfer procedures such as BBL or Brazilian buttlift, the chemicals in cigarettes can cause a higher likelihood of fat death or fat necrosis.  This means that the fat not only dies, but it can create very hard and unattractive lumps as it calcifies.

 

        It is best to avoid smoking, including second hand smoke, and cigarette replacements, such as nicotine patches or gum, in the perioperative period.  Stopping 1 month prior to surgery is usually recommended by most plastic surgeons prior to undergoing elective cosmetic or aesthetic surgery.

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Question:

 

I had a tummy tuck first. Am I a good candidate for a BBL? Can I take fat from my back, arms and thighs?  

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Answer:

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If the waist was smaller at one time, the waist can likely be reduced through liposuction to those same measurements or smaller provided the muscular and fascial integrity has remained the same.  Fat can be taken from many different areas of the body including abdomen, sides, back, bra rolls, thighs, arms, underarms, etc. The harvested fat can be transferred to the hips to make your waist look even smaller.

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Question:

 

I’m currently 218.4 lbs and 5’4” tall. Do I qualify to get liposuction and a BBL?

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Answer:

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Your goal weight of 190 should be stable for at least 6 months prior to liposuction 360 and Brazilian buttlift or BBL.  Reaching a BMI (body mass index) in the lower 30s would enhance results and decrease the risk of complications during and after surgery.  Fat can be taken from many different areas of the body including abdomen, sides, bra rolls, thighs, arms, underarms, flanks, lower back, upper back, calves, ankles, buttocks, hips, and knees.  You have to consider not only which areas will have perhaps the best fat, but also you have to consider which donor sites will have the fewest problems afterward with the liposuction.  In general, the abdomen and thighs are preferred, but, if those sites are not available, other areas can be used. You may find that the laxity of the skin on your abdomen requires a tummy tuck at a later date.

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Question:

 

Would I be a good candidate for a Brazilian buttlift or BBL? If so, what would be the price for my body shape? (I'm 5"4, and 170 pounds) 

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Answer:

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You appear to be a good candidate for liposuction and a BBL.  Sometimes, individuals will have problem areas that are relatively exercise and diet resistant. These are the focus areas for your plastic surgeon to liposuction.  You have to consider not only which areas will have perhaps the best fat, but also you have to consider which donor sites will have the fewest problems afterward with the liposuction.  In general, the abdomen and thighs are preferred, but, if those sites are not available, other areas (bra rolls, back, and flanks) can be used. While liposuction will greatly improve those areas, it will not improve the skin on the abdomen, which will likely require a tummy tuck if you have finished having children.  Consult with a board certified plastic surgeon who is an expert in liposuction and BBL. Price will depend upon your ultimate goal, number of areas liposuctioned, demand for the plastic surgeon, geographic location, etc.

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Question:

 

Can the BBL process be used strictly to shape an already big buttocks? 

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Answer:

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Without photos or an exam, it is impossible to provide specific feedback to your question. You may need an inferior buttock lift, posterior lower body lift, liposuction, fat transfer or a combination of listed techniques.  Consult with a board certified plastic surgeon who is an expert in all of these body contouring procedures to allow for the best possible buttock result. 

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Question:

 

How many cc or ml could be transferred to get my desired outcome? 

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Answer:

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Your plastic surgeon should be able to tell you if 800cc will be enough for you to reach your goals.  Dr. Kenneth Hughes usually gets a minimum of 500 cc per buttock (1 liter of fat) in a small individual and 1000 cc or more per buttock (2 liters of fat) in larger patients. About 50 to 70% of the fat survives long term following a BBL.   Dr. Hughes has seen patients after a year or two and the pictures reveal that the gain is permanent.  Perhaps this is due to injection technique, harvest technique, and the amount of fat transferred.  Dr. Kenneth Hughes does not tend to encounter fat necrosis, which is the death of fat and subsequent calcification.  However, Dr. Hughes does perform a great number of fat necrosis or death removal reconstructive procedures.  First the dead fat is removed by cutting it out.  The dead fat cannot be liposuctioned as the density of the dead fat prevents vacuum suction removal.  The defect from the removal can be reconstructed later if necessary.

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Question:

 

Is a Brazilian Butt Lift or BBL a possibility for someone who is 5' 2" weighing 98 lbs?

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Answer:

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You should consult with an expert in butt implants to determine an appropriate size for your body dimensions.   All of the patients for whom I perform butt implants are skinny or muscular with very low body fat.  I place implants within the muscle to minimize being able to feel or see the implants. This creates a much more natural result. The intramuscular placement also reduces the risk for capsular contracture and sciatic nerve damage.  This placement tends to reduce long term tissue death or tissue thinning.  Dr. Kenneth Hughes is not only an expert butt implant surgeon, but also Dr. Kenneth Hughes is an expert at thin patient or skinny patient Brazilian buttlift or BBL.

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Doctors Retiring Early Due to Coronavirus Pandemic

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There have been many news articles covering the influence of coronavirus on doctors and trends in medicine.  Some plastic surgeons have reported an increase in business during this time as patients apparently have more free time and can recover in private.  However, other doctors are seeing much less business and are downsizing or retiring or just going out of business.  Some of these doctors may have health-related issues and the risk of catching the coronavirus at the hospital is imply not worth the extra income that they could make during this time.  Obviously, this consideration varies with the specialty, the location,  and the patient population.  An emergency medicine physician or an anesthesiologist, who may have to intubate those infected with COVID, may have the highest risk for contracting the disease. 

 

Other doctors are simply encountering a reduced volume of patients.  This reduced volume can simply not sustain a practice or the employees.  Some practices cannot be maintained with virtual consults due to the nature of the specialty or the patient interest in setting up those appointments.  So, despite the fact that many doctors are asked to cover the front lines with COVID and endure greater risks, many others find themselves in the same boat as many others in the US without a job and without prospects for the outlook to improve any time soon. 

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The Demise of the Small Business and Jobs Amid the Pandemic and The Need For Doctors

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Former President Trump and President Biden have repeatedly said that he was going to protect small business owners and those employees associated with the small businesses.  However, little has been done for the small business.  The repeated shutdowns have forced huge unemployment numbers.  The small stimulus checks to individuals are doing nothing to replenish the huge untold losses to the small business community and the economy as a whole. As a small business owner, a plastic surgeon certainly understands this.  Many plastic surgeons have laid off their entire surgical workforce and even their executive workforce in the previous months.  Some have returned to work, but some have retired or temporarily closed.

 

This is just a microcosm of what’s going on with doctors and small businesses across the country. In a time when doctors are needed for than ever, doctors take increased risk, less pay, and more stress.  The simple truth is is that no one possesses the intellectual or technical knowledge of doctors to save us from ourselves. It is important to remember that the doctor is the only one preventing the patient from making the journey to the grave.

 

        Many doctors are being asked to go even farther. Despite huge economic losses to the businesses they are being asked to give whatever supplies they can possibly get. In addition, they are being asked to donate equipment as well.  So, in addition to losing businesses, they are being fleeced for everything else. Certainly no one else in society is being called upon in such a fashion as our doctors during these dire times. Perhaps society will learn a critical lesson to not disparage or be critical of doctors when and and if the world recovers from the coronavirus. It will be a costly lesson to learn as doctors are being required to help in an epidemic that is largely being kept alive by irresponsible people not practicing appropriate measures. 

 

People have continued to the beaches, the house parties, traveling the world over, gathering for holidays and birthdays, not to mention the rioting and looting.  The truth of the matter is that this global issue would run its course over the period of a few weeks if people stayed unto themselves.  The virus cannot survive for long at all outside the host. The incubation time is short as well.  It is unfortunate that people keeping the coronavirus alive are the same people who have been critical of doctors despite not having the knowledge or wherewithal to be in a position to critique. 

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Unfortunately, in the aftermath of the several hundred thousand deaths from the coronavirus, medical providers, doctors and surgeons, will be sued at record rates.  Many medical malpractice carriers are publishing new programs to help protect doctors from the unfair lawsuits to follow.  The truth is that there is no treatment for Covid-19 related illnesses and care is largely supportive.  Some patients will recover from the virus no matter how poorly they are managed and some patients will die no matter how well they are managed. 

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Medical doctors during this time of national scourge were the  heroes to everyone, literally sacrificing heir lives and the lives of their families due to the exposure faced each and every day all day.  And the coronavirus is not done with us yet.  The Good Samaritan laws should protect doctors in such cases as society would have been destroyed without the efforts made by these courageous doctors.

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Yet patients and patients' rights groups will no doubt speak to the untold medical errors that could have saved thousands of lives in addition to the ones that were saved.  And the lawsuits for medical negligence will roll in by the thousands in an attempt to try to extract as much money as possible from a profession and a calling at its breaking point. 

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The truth is that pretty much all doctors were the smartest, most capable individuals in their high schools, colleges, and grad schools and could have done anything in life at much less personal risk and exposure and without the degree of academic rigor required.  They could have made more money doing something else as well.  It is laughable and absurd to think that everyone else could meet those demands in their absence.

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What if the doctors in the United States were to just step away from the battlefield and retire?  What then?  The plague that would follow would be epic and civilization as we know it would be no more. 

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This is already happening.  Doctors are committing suicide at 4 times the national average and several have made front page news during the coronavirus pandemic.  Doctors are retiring early or quitting and moving to a different career.  The desperation seen by politicians and regulatory officials attempting to license medical students, foreign medical individuals, retirees, etc. should give the general public some insight into the apocalypse to come.

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   Physician Sense and Physician Burnout Amid Pandemic

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Unfortunately, many are taking the contributions of physicians and other healthcare workers for granted. Our healthcare system is far from perfect, and the pandemic certainly revealed room for improvement, but it did not break down. Doctors, nurses, and other frontline healthcare workers held and continue to hold the line. But at what cost?

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The ongoing struggle with COVID-19 will likely keep us from knowing the full impact on physician mental health for years to come. However, we do know that physician burnout was a serious issue prior to the pandemic, and that early research has raised some alarms. Coronavirus may prove to be an accelerant.

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The novel virus created massive amounts of fear and uncertainty among physicians, tasked with keeping others, and themselves, alive. A recent WHO report found that of all viral cases globally, healthcare providers represent 1 in 7. The figure hits 1 in 3 in some countries. Not only do doctors worry about falling ill, many must also grapple with the fear of infecting the people they love when they go home.

 

A UC San Francisco study of emergency medicine physicians during the early days of the pandemic. Among the surveyed physicians from 7 cities, male doctors reported stress levels at 5 on a scale of 1-7. Women put their stress levels at 6. Both said burnout increased from a pre-pandemic level of 3 to 4 out of 7 after the onset of the pandemic.

Researchers documented similar results in China among healthcare workers. A JAMA Network Open study found that among more than 1,200 healthcare workers in 34 hospitals, 50.4% reported symptoms of depression, 44.6% reported anxiety symptoms, 34% said they had insomnia, and 71.5% said they felt distressed.

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The existential risk of being a physician during a pandemic is one thing. But exposing one’s loved ones is another. COVID-19 has added a new layer of complexity to the burnout crisis. Not only do physicians worry about harming their families, but they also don’t have access to their usual social outlets.

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Unfortunately, asking for help isn’t a part of physician training and conditioning, and many often worry about the career implications of mental illness.  Doctors must have access to choose the approach that works best. That might include telemedicine, video chats, online forums, or in-person visits with psychologists and psychiatrists. 

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How Bad Is It to Be a Plastic Surgeon in Los Angeles?

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Worse than you could ever imagine.  Every day patients call for consultations, and some will hang up or get extremely rude when they are told there is a $300 consultation fee.   Lawyers charge $300 to over $1000 an hour and have only 3 years education after college.  The minimum time to achieve the level of plastic surgeon is 10 years after college with much more intensive and rigorous training against much more competitive and intelligent colleagues.    

 

Dr. Kenneth Hughes probably receives 300 to 400 inquiries about plastic surgery each month. The office staff then follows up with all of those individuals to determine interest. Most of the patients when called or emailed never respond yet, just hours before, they expressed great interest in the procedure. What happened in the intervening period that they now are no longer reachable by any means?

This disappearing act would probably frustrate anyone and it frustrates Dr. Kenneth Hughes and his office staff to no end. Should you actually get a person by phone or email they will usually start with several questions before even considering paying the small consultation fee. They want to extract as much information as possible without any respect for anyone else’s time. On top of the endless questions, the office staff usually encounters quite a few unreasonable people who yell at them about why there is a consultation fee.   Some will argue about why they know what must be done despite never having received a consultation with Dr. Kenneth Hughes. 

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Remember that no one at Hughes Plastic Surgery is actively recruiting anyone and we never send emails or call patients to ask about those procedures.   These patients are  sending inquiries through the website or calling the office directly.  So it is sometimes hard to fathom why a patient could somehow get upset that we are responding to them or asking them if they’re interested in moving forward with a procedure or something of that nature. However, this happens all the time.

 

If a patient is not interested in a procedure, he or she can just simply tell us that.  This certainly saves Dr. Hughes‘s office staff a lot of time with all of the misspent time on emails and phone calls that fall on deaf ears. Certainly, the goal is not to deal with people who do not want to have a procedure. There are plenty of people who do want to have a procedure.   The doctor wants to focus on those patients.  And, actually, all of these other patients who are asking unending questions who will never have the surgery only serve to disenfranchise the office staff and take away from the office staff's ability to help those patients who truly need the attention.

 

Nonetheless, there will be patients who will claim to call in and schedule a procedure only to find out later that they have not scheduled.  They will say that they will schedule in the future only so that you can read their MRIs or write to their insurance companies or give doctors' excuses for work, or give doctor's excuses for travel, or get help with visas to enter the United States.  These are just examples and do not even scratch the surface.  The number of disingenuous people is truly astonishing.

 

 

Dr. Hughes could probably list several thousand different ways patients try to manipulate doctor and staff in the plastic surgery realm. Once the patient schedules for surgery then all of the labs have to be done as well as medical clearance. This is where you get further stratification of patients. Some of the patients, after scheduling the surgery, will want to back out of the surgery, because they have buyers remorse or want to spend the money for something else. So, at this point, they become impossible to reach by phone or email, despite calling the office dozens of times in the previous few weeks and asking Dr. Hughes hundreds of questions.  In this manner, they can they think that they can avoid paying the fees for surgery for which they are obligated as these types of cancellations within the month of surgery lead to huge losses to any business.

 

Another method that is frequently employed is to find some type of illness. This has become particularly prevalent during the time of Covid as everyone just says they have Covid even though they supply no documentation of any positive test.  Some have used the excuse that it is not safe to get surgery during COVID, as though they possess the knowledge necessary to make that determination.

 

Another very common excuse that people will cite is some type of family emergency. The number of family emergencies goes up exponentially anytime a surgery is scheduled for a patient who does not want to fulfill his or her financial obligations.  An additional maneuver employed occurs when a patient says that he or she could not get the labs or  that he or she does not have the lab results. The same thing is done for medical clearance. You can see how just getting a patient to surgery can be a very frustrating and time-consuming exercise for a lot of patients.

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Assuming that a patient finally gets to have the surgical procedure, Dr. Kenneth Hughes routinely performs surgery at levels approaching perfection. Even in a perfectly executed surgery, at least 5% of the patients will have some kind of complaint following surgery. Despite 100% of the patients looking markedly better, this type of scrutiny will continue for months or years afterwards. There will be patients who will try to extort money by threatening to write reviews that are totally ludicrous and dishonest. There are patients who threaten to get a lawyer.  There are patients who demand a copy of their records.  Dr. Hughes has won lawsuits, legal fees, and compensation due to defamation or malicious prosecution or legal misconduct.   These amounts can be substantial amounts far exceeding what the patient or lawyer originally tried to extort. This approach serves to teach these really horrific individuals the dangers of trying to extort people as they have done throughout their lives.

 

If you are a reasonable person who is honest and has a kind heart, Dr. Kenneth Hughes will go above and beyond to try to help you. Dr. Hughes can help where someone else would not or could not help.

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