Issue 9.10

“Does your CHIN hang low…does it wobble to and fro…can you tie it in a knot…can you tie it in a bow?”  This version of an old-time favorite song often reminds me of my patients’ chief complaint.  Unfortunately, as we age, everything begins to “hang low, wobble and jiggle” in all the wrong places.

Female patients are most bothered by those pesky sags and bags - especially the neck and chin.  My patients often say, “I decided to come see you the day I looked in the mirror and thought my MOTHER was looking back at me.”  Some refer to this neck sagging as the “Gobbler deformity” because they think they look like a turkey. 

Bulk or fullness because of fat deposits, commonly called a “double-chin,” is also often the patient’s concern.  Double chins are often a family trait, not just a sign of being a little overweight.  That being said, let’s talk “TURKEY.”  What can be done to make this saggy/baggy neck disappear? 

A double chin due to fat deposits can be improved by reducing the fat with liposuction.  You’ll see ads for lipo-contouring, tumescent lipo, quick-lipo, cool-lipo, lipo-sculpture etc.  Essentially, all are just liposuction.  The training and education of the person doing the liposuction should be your most important concern.  Although the chin is a small area, it should not be cared for by any “Joe” who owns a liposuction machine.

Loose chin and neck skin can be tightened by several methods.  Let’s examine the least invasive to the most significant and effective:

·  Chemical peels come in different strengths and depths of penetration. 

·  Laser skin resurfacing can tighten loose skin more deeply than chemical peels.

·  CO₂ and Fraxel lasers cause skin to contract and reduce lines and wrinkles. 

·  String lifts have been shown to make a nice improvement, but the results are very short-lived and very costly.

·  Surgical neck lifts will permanently remove skin and give the longest results.  These should only be performed by plastic surgeons. 

Remember to be evaluated by a plastic surgeon who is board certified in the specialty of Plastic Surgery.  Less trained “cosmetic-surgeons” do not recognize that some skin looseness is caused by underlying muscle bands.  Many disappointed patients do not know there is a significant difference in training, experience and expertise.     

Dr. Marcus L. Peterson graduated from BYU and attended Medical School at USUHS in Bethesda, Md.   He is board certified in both General Surgery and Plastic & Reconstructive Surgery.  His practice is at the Center for Advanced Plastic Surgery in St. George, Utah.  To ask Dr. Peterson any questions regarding plastic surgery, e-mail him at mpeterson@infowest.com or call him at 435-628-2895.

Issue 41.09

Surgical procedures, however routine, can be a stressful experience.  Some recent events with family, friends, and patients highlight the need for effective communication to prevent unneeded anxiety. 

The first event involved a neighbor who moved in following a surgical procedure.  In the process, he lost his prescription medication.  He phoned the surgeon after hours, only to hear a recording which said, “Leave a message for the next business day or if needed, go to the emergency room.”  It was Friday night — too long to wait for Monday, but too expensive and inappropriate to visit an emergency room. 

The second was a close family member.  He required a routine surgical procedure.  At the physician’s office, he was seen only by the physician’s assistant who diagnosed the problem and set up the surgery.  The day of surgery, he was seen by a nurse, signed the consent forms, and went in for the procedure, never meeting the surgeon.  According to his wife, the surgeon spoke to him as he was coming out of sedation.  He left the procedure, never even knowing what his doctor looked like.

The third event was a patient who had a surgical procedure performed at a local medical practice.  The surgery was performed by an out-of-town physician who came once a month at the invitation of the host physician.  All follow-up care was to be done by the host physician.  I was contacted when a surgical complication arose.  The surgeon would not return for three weeks and the host physician was not qualified to handle the problem.  In each case, patients were left asking: “Where did my doctor go?”

Unfortunately, the experiences of these patients are not unique.  Prior to any procedure, patients should meet their actual surgeon, discuss the medical plan, ask who will be handling the post-operative care, and identify how a person in the office can be contacted day or night.  Post-surgical care, even for small, routine procedures, is an imperative part of the recovery process.  Surgery is not an exact science.  Problems must be anticipated with a plan in place, if an unfortunate problem occurs.  

Occasionally, specialists travel to smaller communities to perform specific procedures not available by full-time local surgeons.  However, this is the exception, not the rule.  Remember to choose a qualified, board certified surgeon.  Good medical care includes a physician you see before, during and after the procedure.  Don’t be left in the dark asking: “Where did my doctor go?” 

Issue 28.09

When you visit your doctor or look for a doctor to treat you, you will often see the designation “Board Certified.”  What does this mean and should you care?

In the United States there are designated specialties that have a rigorous and prescribed training program to earn certification in that specialty.  The American Board of Medical Specialties (ABMS) assists 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physicians.  If you want to see if your physician’s board certification is a bona-fide specialty you can look on the ABMS web site to see if it is listed and if your physician is board certified.  Any other board certification does not have the same standards of training and competency as the boards within the ABMS.

Board certification is obtained in the same specialty as the residency training program that is completed by your physician.  In residency training the young physician is proctored and mentored in the skills and knowledge of that specialty by more experienced physicians.  After the requirements of the residency are met the physician can take the board certification examination.  The examination is frequently composed of a written and oral examination.

In addition to completing years of schooling, fulfilling residency requirements and passing the exams required to practice medicine in the state, your board certified specialist participates in an ongoing process of continuing education to keep current with the latest advances in medical science and technology in his or her specialty as well as best practices in patient safety, quality healthcare and creating a responsive patient-focused environment.

If your doctor is certified by an ABMS Member Board, it means he or she is dedicated to providing exceptional patient care through a rigorous, voluntary commitment to lifelong learning through board certification and ABMS Maintenance of Certification (MOC).

If you medical condition is important, make sure you see a board certified specialist in that field.

Dr. Marcus Peterson is board certified in general and plastic surgery.  He has practiced at Center for Advanced Plastic Surgery, 676 S. Bluff Street, Suite 207, St. George,  since 2004.  He can be reached at 628-2895.