[Music] cosmetic surgery can improve a person's appearance self-esteem and self-con confidence but what all goes into procedures like this in this episode of being well I'll pick the brain of hshs St Anthony's Memorial Hospital plastic surgeon Dr Dean page when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the Ever Changing needs of our community has remained the same Horizon Health 50 years strong Carl is redefining healthc care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with Health Alliance is always at the Forefront to help you thrive [Music] thank you for joining us for this episode of being well I'm your host Lacy Spence and today we are going to be talking about all things cosmetic surgery we've got a new guest on the show today we are welcoming in Dr Dean Paige welcome to being well thank you for being here today well thank you for having me of course so just so we can let Folks at home get to know who you are can you give us a little bit of background how did you end up doing what you're doing uh well it all started um After High School I went to college at alagan College in medeville Pennsylvania I then went to medical school at the University of Pittsburgh and then I had a Navy scholarship for the first part of my training so I ended up doing my surgery residency general surgery residency at Bethesda naval hospital and then after that I did some work with the Navy and about three years later I did my plastic surgery residency at the University of Cincinnati and from there I went on and did a fellowship in Houston Texas on reconstructive uh breast surgery and then went back to Bethesda naval hospital and uh practiced there for two years to finish out my time in the Navy for a total of 12 years then I went into private practice for a while and I currently work at hshs Medical Group in Effingham Illinois at uh St Anthony's Hospital well first off thank you for your service uh my goodness so you've been everywhere kind of like a Johnny Cash song sort of kind of yeah uh so as we're we're kind of delving into this topic today um you were telling me that there is a kind of a rich history an evolving history around this type of surgery so can you kind of fill us in on what that looks like sure well plastic surgery years ago uh was it started out really with hand and reconstructive surgery the hand and then it progressed on they formed an organization and a board for plastic surgery and branched out into doing reconstruction for all parts of the body uh it wasn't really until later that cosmetic surgery became a a big part of plastic surgery currently when people hear the word plastic surgery they think of cosmetic surgery but truly uh it started out with a lot of reconstructive work and now it's just a lay interpretation of that specialty but um we're we are the board that is or the American Board of plastic surgery is the board for cosmetic surgeons there's no other board and I I always tell people that when you're shopping for a surgeon or to have a procedure done you should look for somebody who's board certified by the American Board of plastic surgery no this is nothing to play with no but yeah you don't want to go to Kmart when you're shopping for plastic surgery so and so as you are trying to locate a surgeon um that certification how can I sort of what am I looking for is it you know letters behind someone's name or you can actually go on the internet and look up the American Board of plastic surgery and it'll tell every body who's actually board certified and whether their credentials are uh current or not um the other place to look is the American Society of plastic surgeons um it's plasticsurgery.org and most of the plastic surgeons who are board certified are also on that uh group or that's a more of a a professional group not the actual board certification group so true board certification you can look for everybody on um the American Board of plastic surgery but every everybody who's in the American Society of plastic surgeons are also board certified as well so okay and then as as far as cosmetic surgery the um American Society for cosmetic surgery is also another place where board certified plastic surgeons are registered and basically show examples and have their websites connected to that because before we got recording you were kind of giving me an example that uh at this point you could walk into yeah so if you have MD after your name you can hang your shingle up for any specialty you want but to be board certified sets your physician or doctor ahead of everyone else because you've completed examinations um in plastic surgery it's written and oral examinations as well as every year now we have to do uh continuing certification skills uh it used to be once every 5 years and that it's been changed now so that we do a little bit every year so it's not all one big retest but we're constantly learning and maintaining our skills and maintaining our board certification which is so important because I think when a lot of people hear cosmetic surgery they might think of the show like botched where plastic surgery goes really really wrong or they think of maybe a tabloid they've seen and a star was you know trying to get a nip and a tuck and they came out looking kind of like a balloon so yeah there's been some horror stories about people you know setting up operating rooms in their homes or garages and then they um do surgery out of those and uh without being board certified so not having the proper anesthesia and so forth and uh there was a big crisis in Florida years ago where you know they had to like limit what they people could set up as an outpatient surgery center because those people who are not board certified can't get hospital privileges and it's harder for them to get credential to be an outpatient surgery center as well every year when I sign up for the American societ Society of plastic surgeons and pay my dues I have to verify that I only operate in certified facilities Okay so we've laid the groundwork yes you are so legitimate you you are you are trusted professional in this area so let's dive into this topic so um types of cosmetic surgeries and procedures that you all offer so uh well myself I focus on I'm kind of a general guy right now I mean we do some facial um my favorite things to do are um breast and body contouring and uh but people sometimes Focus only on facial plastic surgery um I I think you know it's a lot of ground to cover and so um you want to find somebody who does a lot of whatever they're doing is what I would say um we do a lot of eyelids and things like that um ENT doctors as well as plastic surgeons do cosmetic nasal surgery and facial surgery and then uh we're we're truly the ones who are doing all the breast and like abdominal surgery mhm so um backing up into talking about breast augmentation those sorts of things yeah um even the tire Sporting oh uh you know you were talking about doing reconstructive surgery for breast cancer patients I mean that is huge for uh mental health self-confidence please talk about that and the kind of work that you do with that sure so um as I mentioned I did an extra Fellowship in breast reconstruction so um there's a a number of different techniques that we use for reconstructing breasts after um mastectomy surgery and now even more emphasis on lump lumpectomy surgery because as the techniques advance for treating breast cancer we're taking less and less of the breast itself and then using other adant treatments to make sure that the cancer doesn't come back so sometimes we're not taking the whole breast we're using only part of it and then it's my job to kind of take what's left and put it back together again and maybe add an implant or tissue from another part of the body to help put things back together so it's usually a process that takes several months because there's different stages for uh the different kinds of procedures that we do probably the most common thing we do now is what we call tissue expanders and then that goes in right after the mastectomy and that's inflated so we reach an appropriate size or get a good pocket and then we let that sit for about three months and then we go back and replace that tissue expander or a balloon basically with a permanent implant and then move on from there as needed uh recently we've also been doing fat grafting and so forth to help recreate breasts and and smooth out Contours after M ectomies too so maybe I dove in a little to head first with that yeah um to back up if I'm somebody who is considering this type of uh procedure what makes someone a good candidate for it so uh you're talking about cosmetic really yeah okay where do I start sure so um I think you know we all have things we'd like to change that's what I say so so um I think that's that's an important part of it deciding what's right for you um some people get influenced by friends or husbands or whatever about what's right or what they need I think it's important that people decide for their themselves what they really want to do and then once you've decided what things bother you or what you'd like to have changed then that's that's when it's time to see a plastic surgeon and have a consultation and move forward with whatever area concerns you and in terms of breast and preparing for that I think um you want to be uh fully mature so we like to operate on young adults not um girls basically it's not 16 and go get your breast implants type thing sure it's better to be uh fully mature before you do that um my personal recommendation is that if you're planning on getting pregnant and you know it then you should probably hold off on cosmetic surgery of the breast until after you're done with all your children because uh lactation and just being pregnant your breasts engorge and that causes the shape to change and it makes it it takes a step back if you've already had some work done basically so I say when you're ready uh come and do it I think the other important thing is to be at what I call your happy weight where you're not starving yourself and exercising you know five hours a day to maintain a certain weight you want to be a place where you can be not necessarily what all the charts say but something that you're happy with because then when we manipulate or change tissue or add implants whatever we're going to do for our surgery then we're adjusting it to who you are and what you want to be basically right because you don't want the body changing a lot correct um one of the questions I have down is how long do breast implants last so that's a good question you know that we used to say all the time 15 to 20 years um and I think a big misconception is that well when I hit 20 years I got to go get new breast implants and that's truly not the case um breast implants are good until they fail or you have a problem with them and so uh there's no set date and time if you're if you have breast implants I've had people go for 25 and 30 years without any trouble and then you know they at some point have a failure or have what we call capsular contracture where this there scar tissue that forms around the outside of the implant and that has to be either loosened or removed and then at that later surgery we decide whether the implants need to be changed out or not um like getting another 50,000 miles out you know new set of tires right so sure um and you know it it also depends on the implants themselves like the newer gel implants that we have um because they're cohesive where the gel is no longer liquid back in the 60s and um or or late late 60s early 70s the gel used to be more liquid so if you had a rupture you would figure it out that's where there was a bit of controversy about whether they were harm whether they were harmful or not okay and uh from that emerged after a about 10 or 11 year moratorium more cohesive gel implants were if you cut into them the gel didn't even leak out basically so now we've even moved a step further to that which to what we call stable form implants where you can cut a wedge out of it nothing comes out you can squeeze it it bulges but you let go and it actually goes back in so those implants are probably unless we um are doing investigations like MRIs or high resolution ultr sounds we might not even know when those implants leak at all unless there's a problem like that scar tissue or capser contracture that I mentioned before so I would say that everybody's different that the average I would say is somewhere between 15 and 20 years and you don't have to have them replaced unless there's a problem and so what is kind of the time frame from when I consult with you scheduling the surgery how long to recoup what does that kind of look like sure so um we have initial uh consultation and I think again because this is cosmetic we don't want to um put anybody at more risk than they have to be so we want you to be as healthy as you can be before you approach surgery so one of those one of the basic concepts is you know are you healthy enough to go undergo elective cosmetic surgery and once we've decided that's okay then my next step generally with people is making sure their breast tissue is good so if you're over the age of 35 I like everybody to have a screening mammogram before they have any surgery done to their breast because you don't want to come next year for your regular mammogram and find out that there's an abnormality there and now we've done something to fix you up and we're going to disrupt that by doing investigative work to figure out if there's a cancer or heaven forbid that we find a Cancer and we need to do something to fix it up so um so good mamogram good health and then um then we talk about the different options so um in some people it's an issue of volume they want to be bigger some people it's an issue of um I'm not as perky as I used to be and then we tighten tissues up that's called a mastopexy or a breast lift and um so once we have that consultation we decide what we're going to do then um we talk about appropriate timing and you know depending on the o schedule and someone's urgency of you know what they have coming up I think uh the most important thing to understand is that after the surgery there's um uh two weeks where at least the way I run my um practice is two weeks where I don't want you do much activity at all and then we kind of set you loose but no swimming for another two weeks and then you can kind of Hit the road but nothing that hurts or uh pulls for a total of six weeks and then after six weeks all holds or No Holds Barred you can do whatever you want and um but I do think that it's somewhere between three and six months that the implants actually settle out and really look as good as they're going to look sometimes we're waiting for your breast tissue to what we call EAS or stretch out behind or in front of the implant so it takes some time for that to happen um it's kind of like a pregnancy as the implant settles into place the skin Thins and stretches and um until that happens they can look a little high or a little tight or too big um but once they settle in somewhere between that three and six month range that's when I'd say that you're 100% so if you're thinking about surgery for Fourth of July it's too late basically so are you uh in that process of the 3 six months am I coming back to you to like check on progress make sure things are looking okay right so our general uh followup regimen is we see you at 48 hours so after surgery put a elastic wrap on you we leave that on for 48 hours and then you come back at that time we take it off make sure everything's going okay uh depending on how the implants are sitting we sometimes add a a breast band to help push them down a little bit or say maybe wear nothing at all let them settle on their own and then we see again two weeks and then at one month and then at three months and then six months and then that's kind of the place where we say okay how are things doing what do you think and do we need to do any other alterations or changes is this a painful process um the answer is it depends some people are more tolerant to pain others are not um I rarely prescribe more than like viin pills for uh breast augmentation and I I think with proper counseling and understanding the how the procedure works and what to expect afterwards knowing that you're going to have a couple days of what I call the regret phase of plastic surgery um but after you get past 48 hours you can take Motrin and and Tylenol and um and usually we stop any narcotic pain medication after 48 Hours gotcha it's important for people to know well you don't want to just think you snap your fingers and all of a sudden you're a new you sure and I think the other concept you know worldwide now or what at least in the United States is were you know we used to do pain scores on people to figure out you know whether we should give them more medicine or not well to get people to a 10 or a zero or one you'd have to give them so much narcotic that it would make them sleepy so putting everybody to sleep is not a goal what we're our current Target is manageable pain and I think that can be achieved with um good um preoperative counseling and then proper medication selection afterwards so some other topics uh that hshs had kind of suggested that we talk about uh a tummy tuck and a mommy makeover they different sure well uh yes and no so um the concept of a mommy makeover is just kind of you know the two things that go bad after pregnancy are your breast shape and and uh texture as well as the extra skin you might be left with in your abdomen afterwards okay so kind of my definition of a mommy makeover is taking care of those two areas I mean other people find they gain weight so they might want liposuction or things like that but traditionally or most for most surgeons that's the areas that we focus on after pregnancy is the breast and the abdomen um sometimes we can do all those procedures at once sometimes a tummy tuck gets more involved and then we shouldn't be doing you know long extended procedures you know on both the breast and the abdomen at the same time so kind of what's right for the patient is what we try and Target we want to stay under six hours for elective surgery because that's where the risk for complication goes up afterwards and so sometimes we do it in stages sometimes we can do it all at once but it's taking care of the skin and shape of the abdomen and taking care of the skin and shape of the breast after surgery is what I would Define as a mommy makeover um you were asking about tummy tucks too okay so tummy tuck is the main part of that procedure is removing the excess skin that accumulates at the lower part of the abdomen usually below the umbilicus and what we do is make an incision and take out a large ellipse of skin that tapers out to your hip bone and then we loosen that up and bring it all the way down and then once we bring the skin down we make a hole and bring the belly button back out we actually cut around the belly button while we're taking out that big piece of skin and moving it down you kind of wake up in a beach chair position and um and then the recovery involves wearing a compression garment most of us uh don't use drains anymore for that procedure there's um some suturing techniques that we use that help uh keep fluid from accumulating but from time to time people will have fluid fluid that accumulates under that area of uh skin that we moved and we just remove that an outpatient visit so I know we've been uh we've been hitting on the ladies a lot okay but do men ever come see you for a variety of things um sure uh I think it's you know I would still say it's it's more than 9010 women but um yeah men do come for surgery we done a fair amount of gynocomastia or male breast surgery to reduce the size there's different procedures that we do for that including sometimes liposuction sometimes actually taking out a small amount of tissue and sometimes literally doing like a breast reduction similar to what we would do for a woman who has large breasts and um with bariatric surgery we've had men come for post bariatric surgery for taking off loose skin as well but again I think women far out number the men in in those statistics fair enough so insurance a lot of this is the so I would say the definition of cosmetic surgery is it's not covered by Insurance okay so if you're doing something uh 100% for appearance it's um it's generally not covered by Insurance um I've had some weird things in my career where um some policeman's insurance from New York had some great benefit where this gentleman's wife came and she got her Botox and jections and so forth paid for by his insurance Cur so that's one case out of thousands where Insurance paid for it but it would have to be a special Rider on your policy about what was covered but in most often no it's it's it's for purely cosmetic reasons it's not covered by Insurance okie dokie and then uh is there any sort of a consult fee when someone comes to see you sure um we have a basic consult fee of $100 and um that's to kind of cover our time in the clinic and because we we treat every even cosmetic patients as a medical patient so we uh do a health survey we look at your medications we do a a tho physical exam so that kind of covers our basis for that but if you decide to have a cosmetic procedure in our office then um that $100 is refunded back to you when at your time of payment when you um come to do the surgery itself and then if I'm somebody who is looking to get connected with your services specifically how does someone get a hold of you sure um so we have a general clinic phone number and I don't know if you flash that on the screen or whatever but we can do that yeah 21754 2350 and um that that gets you into the the um the front desk people who will schedule you for a consult and tell you the details of it and get you set up at at your convenience uh before we wrap up I do want to ask um you've talked about a couple of cases where um maybe things can happen to go wrong it just it it does happen sure um what are some signs or symptoms that somebody should look out for well I think just like with any surgery there's risks of bleeding and infection anytime you cut the skin so those are always things that we look for um you know you can have bleeding around your implant or in your abdominal plasty so we have ways of taking care of those either in the office with um needle drainage or if they're bad or there there's a fair amount of bleeding then sometimes we do have to go back to the hospital to um drain that area and then you know sew things back up again those are extremes though I would say for the most part because we're careful about patient selection and making sure people aren't on blood thinners and they've managed their medications appropriately we we have a low complication rate um but yeah stuff happens and that's why it's a big deal and that's why I say stick with somebody who's board certified and knows how to not only do the surgery but can handle the complications and has appropriate affiliation with a hospital so if you need to go and have some emergency work done afterwards that that person's qualified to do that now in our last minute or so here can you talk about any sort of uh success story you've had that maybe meant a lot to you meant a lot to the patient um uh yeah I had a bariatric patient who came and had um four different rounds of surgery with me and um at the end of it uh after she had finished her last procedure and she was well recovered she sent me this um globe that was um it was solar powered or whever and it spun around and sat on my desk and she put a metal plate on it she said thank you Dr Paige you changed my world a and that's of all the Cosmetic things that I would tell you that I remember that's really one of them because I I really did I mean she had pounds and pounds of skin removed when it was all done and and I did make it make her feel a lot better it was it was very rewarding to me too so I mean I enjoy helping people all the time that's why I got into the business in the first place but um if you ask me about a certain one that I truly remember that's really it but we work hard every day to make everybody feel better so selfconfidence quality of life both are so important and you are helping patients walk through that Y and like we s talked about earlier to the cancer side of it as well I mean it's you know cancer is a devastating event and to be able to help somebody get back as close to normal as they can be for me that's that's a rush too that's really um that's why I did that extra work at the beginning of my career in um breast reconstruction well Dr Dean paage thank you so much for coming on being well I sure appreciate your time well thanks for having me I appreciate it of course and we thank our viewers for joining us for this episode of being well and we hope to see you next time Carl is redefining Healthcare around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with Health Alliance is always at the Forefront to help you thrive for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the Ever Changing needs of our community has remained the same Horizon Health 50 years strong when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's healthc care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care [Music]