Botox and Burpees
Botox and Burpees
S05E112 The Price of Beauty: Tragic Lessons from Ana Bárbara Buhr Buldrini's Case with Guest Dr. Lawrence Tong
In this episode of Botox and Burpees, host Sam Rhee invites Dr. Lawrence Tong, a renowned plastic surgeon from Toronto, to discuss the tragic passing of 31-year-old Brazilian influencer Ana Bárbara Buhr Buldrini @anabmusi following cosmetic surgeries traveling from Mozambique to Istanbul, Turkey.
They explore how the transactional nature of trading surgical procedures for social media exposure potentially compromised standard safety protocols from allegedly partying with the surgeon before surgery to operating late at night and possibly ignoring basic safety measures like NPO status.
The conversation delves deep into what makes cosmetic surgery safe – proper patient preparation, medication disclosure, facility standards, and the risks of multiple procedures. Both surgeons emphasize that while excellent doctors exist worldwide, patients must conduct thorough due diligence when seeking treatment abroad.
Whether you're considering cosmetic surgery at home or abroad, this episode provides vital information to help you make informed decisions that prioritize safety over cost. Remember - if a surgical deal seems too good to be true, corners are likely being cut somewhere, and the price may ultimately be your safety.
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Hello and welcome to another episode of Botox and Burpees. I'm your host, sam Rhee, and I have with me special guest Dr Lawrence Tong from Toronto Canada. What's your Instagram handle again, larry?
Speaker 2:At Yorkville Plastic Surgery at Yorkville Plastic Surgery.
Speaker 1:One of the most talented plastic surgeons I know trained with him at University of Michigan. He's killing it for all facets of plastic surgery and, as I mentioned in our previous episode, our esteemed podcast Three Plastic Surgeons and a Fourth is currently on hiatus, so I thought I'd bring Larry on Botox and Burpee so we could talk about a very tragic story that just recently happened. There was a 31-year-old influencer, anna Barbara Bohr-Boldrini, who died after a series of cosmetic procedures in Turkey, and her circumstances in terms of her passing is pretty tragic, and I think that there's a lot that we can learn, both as surgeons and patients, in terms of unpacking this to make sure that our patients are safe and that plastic surgeons are following best practices in terms of what they do. So, before we get into it, larry, if you could give us our disclaimer?
Speaker 2:My pleasure. So this show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation and medical judgment. After appropriate discussion, Always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care. Never disregard professional medical advice or delay seeking advice because of something on this show. So tell us about the circumstances with Anna Barbara. All right medical advice or delay seeking advice because of something on this show.
Speaker 2:So tell us about the circumstances with Anna Barbara, all right so Barbara Baldrini is a was a 31 year old female influencer from Brazil, and she and her husband had traveled to Istanbul, Turkey, to have a series of cosmetic procedures with the understanding that she would be promoting the hospital where she was having the surgery. It's reported that the surgeries that she underwent were breast augmentation, rhinoplasty and liposuction, although they did not elucidate how much liposuction was done, which might be important. The surgery occurred on June 15th and it's reported that this occurred hours after her and her husband had quote-unquote partied with the surgeon who was performing the procedure. The husband states that the procedure ended at 11 pm, which is, in my opinion, sort of late to end surgery, and the assistants told him that she was recovering from anesthesia and showed him a photo of her recovering, but then, sadly, one hour later, the surgeon came out and told him that her heart was beating slowly, while another surgeon told him that she had died. It's reported that she had died of cardiac arrest and obviously the husband is very upset about this and he's saying that she was not prepared adequately for the surgery. One of the things that he noted was that she was not NPO, which means she had still been ingesting food prior to surgery and that her surgery had been moved up, actually two days earlier than was scheduled because of quote unquote scheduling issues.
Speaker 2:So there are pertinent topics that we should discuss, but it is important to note that we do not know the entire story and all the facts about what happened, so some things are unclear.
Speaker 2:But this discussion is around important topics surrounding this tragedy how things should ideally take place, and you know what are the particular issues regarding having surgery in a foreign country, having social media mixed in with the aspect of having surgery, and safety in surgery. So I'll start off with talking about the fact that she had a cardiac arrest. That's how it's been reported in the news. There has not been further information about that, but there are, you know, tragically, times when this can occur, and so, as a patient, you might be wondering well, you know, what can I do to minimize that risk? Because you know, with all surgery, there's going to be the potential for complications. There's no way to get around it. But there are things that can be done to, you know, minimize the risk, and there are things that the surgeon is responsible for, but there are also things that the patient has some responsibility in as well. Absolutely.
Speaker 1:And you mentioned, there are always risks associated, potentially, with surgery, and choosing the right people that you feel comfortable with to perform your anesthesia, to perform your surgery, plays a large part of it, and that's something that we might talk about in terms of how she traveled, how she chose this particular group or surgeon. But you're right, there are things that patients can do also to make sure that they stay safe during the procedure as well as after. So what are some of the things that people should know about in terms of trying to stay safe?
Speaker 2:So one of the things that you know every patient is told before they have surgery and if our viewers have ever had surgery they probably told you nothing to eat or drink after midnight.
Speaker 2:Then that's often referred to as NPO after midnight, and there's a reason for that and that the reason for that is because when you are put under general anesthesia is because when you are put under general anesthesia you should have an empty stomach. If you've eaten just before you have anesthesia and you have food in your stomach, the risk is that you might aspirate. Aspiration means the food from the stomach comes up through your esophagus and then goes back down into your lungs, which can cause pneumonia and you can die from that. So that is a very basic thing that every surgeon will instruct you to do, and so it's important. If a surgeon instructs you to not eat or drink after a certain time period, you should really follow that advice, because that is very, very important and in general, unless it's an emergency, if we know about a patient who's eaten, who's ate or drank before surgery, we will, you know, we will cancel their case for that day because the safety aspect is that important.
Speaker 1:Absolutely. I have known people who have not been truthful about that and they put themselves at enormous risk because those stomach contents, if they go into your trachea, into your lungs, it's very acidic. This stuff is all filled with your stomach acid and you're going to have huge problems, as you mentioned, with pneumonia, with lung damage, potentially death. And if you wonder, well, how about trauma surgery or some situation where people are not without empty stomachs, well then the anesthesiologists perform a slightly riskier type of procedure called rapid sequence intubation, where they are trying to minimize that risk of people aspirating stomach contents into their lungs. So that's something that I haven't. I mean, I can't remember the last time I saw a rapid sequence intubation I think it was probably residency on the general surgery service on trauma, like that's sort of what, and that's not a great situation to be in.
Speaker 2:How do you and that is not something that you should be doing in a cosmetic practice that?
Speaker 2:is exactly right, you should never be in that situation. So any kind of you know intubation should have the proper protocol in place and having the steps in place before doing the surgery. So I think that if it's true that that patient did not follow NPO before the surgery, I would not have done that surgery. What else so related to that is actually, you know, some of the drugs that you take that a patient might take. So one of them is Ozempic.
Speaker 2:So Ozempic is very popular, especially amongst the cosmetic surgery population, and one of the things that Ozempic does is it slows down gastric emptying. That means the rate at which food leaves your GI system is slowed down a lot. And if you are taking Ozempic, even if you have stopped eating the night before, that is generally not enough time to minimize your risk of aspiration. So some people are on Ozempic and because it's to the point where it's so commonplace, they might not even mention that they're taking it, or they're maybe taking an Ozempic sort of copycat and they don't think it's really like taking a drug. So if you are on Ozempic, you definitely need to tell your surgeon that you are on it, because we usually stop that medication about two or even three weeks before a patient goes under general anesthesia.
Speaker 1:Yeah, and there's so many variations. Now there's Zepbound, monjaro, you name it. There are so many different GLP-1 type agonists that, like you said, and a lot of them are just intermittent injections, they're not daily pills or anything. So people might even forget that this is quote, a drug that might affect their procedure. And you're right, I probably see. Now I don't know what would you say. I would say maybe for my body contouring. I would say at least a third of those patients are on some sort of, or have tried a GLP-1 agonist.
Speaker 2:Yeah, I don't know if the number is that high in my practice, but it is somewhere maybe in my practice around 10 or 15 percent, something like that. So it's not unusual at all. Diuretics so diuretics is a medication that you take to get rid of fluid in your body and it is primarily used for patients with high blood pressure or heart disease. But patients also take it to make themselves look thinner so that they don't look so quote-unquote bloated. And using that medication messes with your fluid balance and can mess with your electrolyte imbalance. So it's also very important to inform your physician if you're taking that kind of medication. And there are other kinds of drugs that are not pharmaceuticals but recreational drugs that are important for you to tell your doctor, such as you know if you use cocaine. That is a very high risk thing to take if you're having surgery in the near future.
Speaker 1:Yeah, it's funny, we have several menstrual cramping medications in our household, mainly because not for me, but for other members of my household, like my daughter and I looked at the ingredients and a lot of them contain diuretics. So not only do they contain some sort of pain medication for menstrual cramping, but they also have these pretty powerful water treatments to address water retention, and so people might not even think a Midol or a Pamprin or something like that is a real medication. But yes, definitely you got to let your surgeon know, because if you're dehydrated and you go into a procedure, that could definitely adversely affect your system.
Speaker 2:Yes. And then the last thing is your general medical history. It's actually pretty common that patients don't tell me what cosmetic procedures they've had when they come in, and then when I look at them, I can you know. When I examine them, I can tell them and, if that's okay, did you have this done? You know they have a scar or something like that which makes it obvious.
Speaker 2:So having prior surgery affects how your surgeon may approach any future surgery, especially if it's in the same area. So I think that's important because in general it's not going to be as easy the second or third time as it was the first time, and you should you know for your own safety and interest. You should tell your surgeon if you've had surgery before in those particular areas and, in addition to that, if you have any other medical conditions, especially related to your lungs or your heart, or you know strokes or history of anesthetic complications or blood clots. All those things are very important. So I guess it's very, it's very, very important that you be truthful with your surgeon, because it's only going to help you in the long run.
Speaker 1:It can be embarrassing to disclose everything to somebody, but in these cases I think people have to take their. You know, be courageous, tell everything, and sometimes people forget. I cannot like. Last week I had someone who came in for a tummy tuck forgot everything, and sometimes people forget. I cannot like. Last week I had someone who came in for a tummy tuck forgot that she had liposuction. We screened her twice, we talked to her on the phone, then my medical assistant talked to her before I saw her and it was only after about 15 minutes of talking. She's like oh yeah, by the way, I also have liposuction, in addition to, you know, whatever hysterectomy or gallbladder surgery or whatever else she told us about. So, yeah, like, take, take a second and sort of think about your medical history. I know you feel like you know all this stuff is not something that is that important, but it is very, very, very, very important for you to get the best results for your outcome.
Speaker 2:Yeah, I think you tell us what you've had or what your history is, and we'll decide if it's important or not.
Speaker 1:Right. So what else do you want to talk about with Boldrini right now?
Speaker 2:All right. So I want to talk about people who go to other countries to have surgery, often known as medical tourism. So in general, there are issues related to that, and that's not to say that every foreign country is bad compared to North America. And you shouldn't go to international surgeons, because there are many, many excellent, well-trained, world-renowned, you know, respected surgeons. But patients have to do their due diligence because it's not the same as in North America. I think that, in my opinion, north America has the highest standards for physician training and for regulation and licensing of facilities and licensing of facilities. And so you know, if a patient is thinking about medical tourism, they have to be extra careful in choosing who they're going to and what country they're going to. And you just have to look at all of those things From a training standpoint.
Speaker 2:In the United States and Canada, plastic surgeon trains from anywhere from five to seven years and then goes to have board certification, which is a rigorous type of examination to make sure that the surgeon is sort of up to snuff to do the surgery. Surgeons in the United States and Canada have to operate in an accredited facility. That means a place where they do the surgery which has standards, that is, you know, recognized by certain regulatory groups. And in North America, you know, each jurisdiction has a strong medical board, which means that they conduct surgeon licensing and patient complaints and investigations. So patients have, you know, strong legal system and protections with surgery, and so in other countries not all of these safeguards are in place.
Speaker 1:I think there are two things I think about when I think about these types of issues associated with medical tourism. The first is is you're absolutely right, there are great surgeons everywhere, but the biggest thing that I have seen for patients who go somewhere outside of their own country for surgery is cost. It is generally expensive in North America to have aesthetic surgery procedures, and so they're looking for a cheaper way of doing it, and that is very popular for a lot of types of procedures, especially hair transplantation. In Turkey, what Ms Baldrini went through, there was something like 2 million visitors that went to Turkey last year in 2024.
Speaker 2:That's like $12 billion and the reason is is that the cost so two million people who went for surgery, you mean.
Speaker 1:Yes, two million people went for surgery and it was like a $12 billion industry in Turkey right now for medical tourism, and so the cost is such a powerful draw factor for so many people. But that doesn't mean that you are absolved of your responsibility of finding the right person. In fact, it's probably even more so, and the issue is is that a lot of it is based on, uh, social media or other issues, like I understand that people don't want to delve into the regulatory or certification sort of aspects of stuff very boring, not exciting, doesn't make any difference like and and I agree it doesn't necessarily.
Speaker 1:if people will argue that doesn't mean that that person is a great surgeon, that is true. Just because you have your driver's license does not mean you're a great driver. However, you probably are going to be a safer driver than someone who does not have their driver's license in general. So there are some minimum standards there. That's what you can think of it as, and then you have to find someone that you think is going to do a great job, but social media from someone 5,000 miles away is probably not going to give you necessarily an accurate picture. I don't know how Ms Baldrini picked this particular surgeon. Some negative publicity or incidents was literally trading procedures for social media exposure. And how do you feel about that as a plastic surgeon?
Speaker 2:Well, it's sort of a slippery slope because once you have that aspect involved, it's not the norm, that aspect involved it's not the norm, and sometimes you don't treat the patient as your typical patient, which is something you should absolutely not do. You should be treating patients all you know, equally, with the same degree of safety, with the same protocols. Safety with the same protocols. Because if you deviate from that, that's when you run the risk of you know complications happening, such as you know having you know drinks or partying with the patient prior. The surgeon might have felt that you know this is something to gain favor, or you know something that that surgeon probably would not have done if it was just a sort of a regular patient that he was going to do on a Tuesday. And so it's an issue because the incentive is very strong. When you have somebody who is an influencer and this patient had, I think, 800,000 subscribers then that draw can be something that clouds your judgment.
Speaker 1:Absolutely I. Always it makes me wonder, like you said, they are providing their services for free. Did that alter how they manage this particular patient, why they push this patient two days sooner, why they, you know, didn't weren't allegedly concerned about the NPO status of this patient, like all of those things are are brought into question when you look at the transactional nature of this surgeon patient relationship which, as you said, is that's. That's very concerning. I don't, I've never, ever done something like that and I I don't think I would ever want to do something like that. But even if you did, let's suppose were a surgeon who did something like this. Like you said, that patient has to be treated just like every other patient, whether they're paying zero or a million dollars, whatever it is like that treatment has to be top-notch regardless.
Speaker 2:Yes, and another issue with medical tourism is from a logistic point of view.
Speaker 2:What if you have a complication after you've flown back to the United States? What if you're not happy with how the procedure has turned out? With how the procedure has turned out, those things are difficult to treat, even in my patients who maybe come from cities further away or even from different provinces. It is exponentially more difficult when it's in a different continent and you know, unless you're Turkish, you don't even understand the language. There's a big language barrier as well with that. So if a patient is going to consider having surgery, as you said, price is a big driver, but you have to think about the whole picture. If you end up having a complication and you need surgery, then you're either stuck with accepting the appearance that you don't like, or you have to take a plane back to Turkey, if they're even willing to do more surgery on you, or you have to find a surgeon where you live and then at that point your savings from the original surgery are probably erased and you're probably paying more than would have if you just had the surgery done in North America.
Speaker 1:You're 100 percent right. I have seen multiple versions of medical tourism patients either to Florida or to the Dominican Republic, latin America, dominican Republic, latin America. And, it's funny, most of them won't go back again, so they've done it once and then after that they will find someone who is closer to them. So there are very few patients I've seen who go multiple, multiple times back. Most of the experiences are adverse to some degree either results, the way they were treated, the difficulty with it. You know all of those, you know the logistics, like all of those things are.
Speaker 1:It sounds great on paper and then when they actually go through it, most patients have related yeah, you know, and they will. It's so funny cause I'll say, oh, how was the experience? And they'll say, oh, it was great, and I said, okay, well, so then why don't you go back for your next procedure with them? And they're like oh, and then like some variation of some excuse comes up and I can tell it's hard for them to own that. Maybe that wasn't the best idea for them to have done that, own that. Maybe that wasn't the best idea for them to have done that, and I'm not pressing them on it, but it is interesting to hear or see so many patients who've tried it once but then won't try it again. So there's something to that for sure.
Speaker 2:Yes, Now I'll also take the flip side of that. We are seeing the patients who have problems. There may be many, many, many patients who've gone through the experience and haven't had any issues, so we never see them True.
Speaker 1:Very true. I'm biased, for sure, in terms of what I see.
Speaker 2:One thing that I want to touch on is having multiple procedures in one setting. So this patient had rhinoplasty, breast augmentation and liposuction. I think one of the things that's important to find out and learn about this is how much liposuction did this patient have? Because out of those procedures, I think liposuction is actually the one that has the most potential to cause physiologic problems in the perioperative period. How do you feel about that?
Speaker 1:I agree. I think there can be a lot of fluid shifts, volume changes, with large volume liposuction that might potentially need to be managed. I think if you're doing position changes in the operating room with liposuction and the patient is under general anesthesia, that's always a challenge. I don't think people necessarily think of liposuction as an arduous or complicated procedure but, like you said, it really depends on the situation.
Speaker 2:That's right, because what patients see is this little couple tiny incisions. It's not like some long scar, like a tummy tuck. So they will equate that to a sort of easier or smaller procedure. But there are a lot of fluid shifts and for the viewers who don't know, there's actually a guideline or a limit that the American Society of Plastic Surgeons puts out as to how much liposuction you can do in one setting, and that number is five liters. So you know, five liters is a pretty large amount and once you hit five liters the recommendation is that you have to hospitalize the patient.
Speaker 2:And that's because it's been shown that the complication rate goes significantly higher beyond five liters. So in my practice I never go beyond five liters. I try to stay away from that number as much as possible. And if a patient comes in and they want to do multiple areas of liposuction and I think it's going to hit more than five liters, then I will have a discussion with them beforehand. They can either choose to break it up into two procedures or we'll get as far as we can and then before we you know well, before we get to, or once we're getting close to that five liter mark, we will stop. And then you know, do the rest of it at a later date.
Speaker 1:In Florida, I think it's even more restrictive in terms of doing an abdominoplasty plus liposuction. I think they restrict the liposuction lipoaspirate to like one liter with a tummy tuck or something like that, just because they've had so many complications in Florida with large volume liposuction and then probably other procedures. So you're right In this case, what they called a Bob lift, breast augmentation, liposuction, rhinoplasty none of those procedures themselves are particularly of issue in and of themselves, and I have I mean, I will say I've never done a bod lift, I've done breast augmentation, liposuction in one sitting. What are your criteria in terms of combo procedures and when patients want multiple things done at one time, like how do you, what are your guidelines or how do you advise patients on that?
Speaker 2:So I would say that there's no one specific way you evaluate it, but in general, one of the more important things is how long the surgery is going to take. More important things is how long the surgery is going to take. So if a person wants you know five procedures done and you sort of look at it and it's going to be like 10 hours, then I'm not going to do all those things in one sitting. And that's because the longer the surgery is, the more physiologic changes start to occur. The patient starts to get the body temperature starts to drop, there's more blood loss associated with it, there's more fluid shifts associated with that. So timing is one thing. Also, you don't want your surgeon to be like exhausted when they're starting your you know fourth procedure. You want your surgeon to be fresh and you know I don't want to your surgeon to be fresh and you know I don't want to operate when I'm exhausted either. So time is one of them.
Speaker 2:Also, combination surgeries, where you're going to be really impeding on their ability to heal postoperatively, I think is an issue. For example, if you're doing brachyplasty, which is arm lift, and then bilateral vertical thigh lift, which is basically long incisions on the legs and long incisions on the arms that can maybe really impede on them being able to move around or do self-care and hygiene after surgery. So sometimes I will have a discussion with them. Sometimes there are practical reasons, like if I'm doing a tummy tuck which involves an incision, big incision on the front, and they also want a Brazilian butt lift, which is fat ejection in the butt. That's not a practical combination because after the surgery the patient has to basically lie on their back and be sort of the V position so they don't put too much stress on the endoplasmic incision. But then you don't want them to be sitting on the fat because that's going to impede on how much of the fat will survive with the BBL.
Speaker 2:But I think the main thing is you know timing. I also look at blood loss, although traditionally cosmetic surgery does not have a lot of blood loss unless you're dealing with somebody who's blood really really large and can somebody want to contouring procedures. So blood loss is another factor to look into. And then of course, overall health status.
Speaker 1:I'm discussing this assuming a healthy patient but if a patient is older or frail or has systemic medical issues such as diabetes and things like that, it's probably is a challenge in terms of recovery, in terms of positioning. They end up getting like body pillows and sort of like on their side like kind of curled up, and it's not optimal. You really have to work with a patient to try to get that to work, but it is always a challenge. But I agree with you, for me it's operative time. I mean I was just thinking about it when you mentioned it in this case, I can't remember the last time I was operating at 11 pm, like maybe, like I mean that wasn't in the ER, like or some kind of like trauma case, like when was the last time you did an elective case at 11 pm? Honestly, never, Never Right.
Speaker 2:There's a reason we should not be operating on elective people at 11 pm, and if you are, either you are the busiest plastic surgeon out there and you have inexhaustible energy, or or maybe you start your day at four o'clock in the afternoon, or something like that.
Speaker 1:Yeah, Maybe you're Dracula and you're keeping odd hours, but on the other I mean, listen, every hospital I've been to, surgical start time is usually seven 30. Like we're early morning type people. Uh, the other thing is is have you ever partied with a patient ever prior to any procedure? Maybe not even the day before, but like ever.
Speaker 2:I have not.
Speaker 1:I have ever partied with a patient ever prior to any procedure, maybe not even the day before, but like ever, like I mean, listen, when I was a resident and all that, like that's a totally different situation. I was 20, in my 20s, I had limited, more limited responsibilities, but as but as an attending, like it's not awesome, especially for these types of procedures to be out late at night. It's so. It's always funny because I always have a patient or two who will like look at me very carefully before a surgery and be like how are you doing? Are you good? You have a good night's sleep, do you feel? Do you feel good? And I'm always like dude, it was like I'm a little bit hung over.
Speaker 1:Right, Like that's what I should say, right as a joke, but no, I mean, I'm always like dude it's more important for me to feel good about this than you even know. Like I can't stand not being optimized for my procedures, and so that just makes no sense to me really.
Speaker 2:All right. So in closing, you know some patients might wonder OK, well, if I am going to, if I'm dead set on going out of the country because I can't afford it any other way, what are some of the criteria we should try to look at if we're choosing a surgeon outside? So I have a few that I've listed here and maybe you can give some comments on that. So number one find a reputable plastic surgeon.
Speaker 1:Reputable meaning what? That they have a million followers on Instagram.
Speaker 2:No, I would say, you know, ideally, american Board of Plastic Surgery is certified, but it's sort of that, something equivalent to that in their home country, maybe internationally known, well-published, with multiple years of experience. You know, the pitfalls is that there may be difficulty to actually know what these credentials are because of language barriers and, you know, lack of some degree of transparencies. Number two facility standards. Any comments on?
Speaker 1:that yes. So I don't know how much due diligence you can do for a facility thousands of miles away. But yeah, I would assume that Turkey does have some sort of regulatory body. That't be hard for them to find out that a center down there is not QA certified or has whatever appropriate certification.
Speaker 2:Probably you could do something similar for the country that you're in Right, or maybe like a larger center, like a well-known hospital that they're at. That's right, so something like that. Just do some diligence on the facility and then you know who's doing your anesthesia Ideally an anesthesiologist and then you know if not an anesthesiologist, some sort of equivalent to a nurse anesthetist, some sort of equivalent to a nurse anesthetist Barring that if it's maybe a small procedure, like at least a nurse administering some seduction. You don't want to be in a situation where the surgeon is also the person giving your anesthesia. You want your surgeon to be focused and concentrating on the surgery and the surgery alone, not also giving something to knock you out while they're doing it at the same time.
Speaker 1:If you're doing something big, for sure, if you're doing IV sedation or general anesthesia, something more than, say, light sedation it's very important to have someone who's trained appropriately, and that's really hard to find out. I'm sure that if you ask these people who does your anesthesia for you, they may give you any kind of answer, and so you know that that's a tough one.
Speaker 1:Yeah, hopefully they'll say an anesthesia off chest and then one one one would hope, but you're right Um the way that the, the surgeon, helps to uh make sure your anesthesia is safe. Is is critical.
Speaker 2:Yeah, uh, make sure that you know when, when they go through your consultation, that they ask you about your full medical history, want some blood work, maybe EKG, and, as necessary, get clearance from your other doctors, like if you have some sort of you know heart condition arrhythmia or you're on some blood thinners. You know all those types of things are important, are important. You know they should be setting realistic expectations and really not trying to sell you the surgery. They should be telling you how it is, what the complications are, what the expected outcomes are, based on your particular anatomy and you know and your health status. And you know you should be maybe a little bit concerned if they think, oh, everything's going to be great, it's going to be fine, and they don't talk about any of the potential downsides to surgery.
Speaker 1:Yeah, I think the biggest thing is and I've heard this time and time again with patients who've had not awesome experiences is that they felt like there was no due diligence on the surgeon's part. They blew through the prior medical history, they blew through any health issues or medications and they had some other person pressuring them to put a deposit down right away for their procedure. Like if, if that person isn't actually taking any time to to know you as a potential patient, that's a red flag, like you better not just walk, but you better run away from that place, because every surgeon out there that is worth their weight and, as a surgeon, is going to try to avoid complications, make sure it goes smoothly, and the number one way that we can do that as surgeons is to know our patients. Make sure we know all of their medical history, know everything that they've talked about. We just talked about that like being truthful, like that's critical, and if a surgeon doesn't even bother to take the time to do that before taking your money, that's that's a huge problem.
Speaker 2:All right. And then the last thing is make sure you you portion enough time to recover before you leave. Make sure you at least see the patient and have your stitches removed before you leave. I mean, we see patients, we get called all the time. Oh, I had surgery here, Can you take my stitches out? I was wondering why they didn't just stay a few extra days and get their stitches out. That's not just to get the stitches out. You want the surgeon to see to make sure you're not having an infection, your wounds are healing properly, you're not having some sort of complication that you might not be aware of.
Speaker 1:That is universal. I can't my office staff have a standing policy. Now, if someone wants some sort of follow-up after a procedure that they've had somewhere like in Florida or another country like that's a hard, no, like that's a hard, no, like that's a hard pass. And the funny thing is is a lot of these surgeons that are from a distance will instruct their patients get on the plane, fly back. You can find someone to do this. It's very simple. They just have to, like take out some sutures or do something like that's part of their standing post-op instructions. And I'm like sutures or do something like that's part of their standing post-op instructions. And I'm like, wow, like who has the balls to do something like that? Like that's crazy, um, to not actually know or care, uh, about the outcome of your patient in any way.
Speaker 2:Yeah, and, and I just thought of something you know getting on a plane after you've had a major surgery, that increases your risk of having DVT, especially if you're doing some sort of transcontinental flight. So you know, if you're going to do it, at least stay there to recover to a pretty good extent before you decide to come back home. Agreed, 100%, all right. So in summary, red flags if you're going out of the country to do surgery. Red flags are, you know, inadequate board certification or trainings or equivalent to something like American Board of Plastic Surgery If the procedure is done in an unlicensed facility or maybe sometimes in a hotel.
Speaker 2:Having multiple procedures done in one setting for example, getting a BBL, a tummy tuck, lipo 360 and breast augmentation lift in one setting that is probably not a smart strategy to go with Very short post-op stays. So make you know, make sure that your surgeon is going to see you afterwards to make sure you're okay before you leave. No anesthesiologist, especially in any of these standard procedures that require you to go into general anesthesia or even deep sedation. Smaller procedures maybe it's acceptable If the clinic refuses to answer detailed questions beforehand. Or maybe you know you want to know more about it and they sort of gloss over all the potential risks and complications. And then, lastly, if the price is too cheap, if the price seems too good to be true, you know they have to be cutting corners in some aspect.
Speaker 1:Larry, that's such a great summary. Agree with a thousand percent with everything you just said. I think everyone who's considering something similar to what Miss Boldrini did should take that to heart. Yeah, 100% agree and make sure that they avoid such a tragic potential risk. 100% agree, yeah, thank you so much, larry. Until next time, man.