SurgeonHouseCall - Plastic Surgery

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Online Consultations the Future of Plastic Surgery? Some Doctors Say Yes, Others Worry?

If you've been secretly contemplating a cosmetic fix-me-up like a nose job or facial injections, the idea of actually scheduling an appointment and taking a few hours out of a workday to see a doc about it could seem daunting, not to mention unrealistic.

But now the cosmetic consult is coming to the privacy of your own home – via the internet.

SurgeonHouseCall.com, which was recently profiled in The New York Times, allows prospective patients to get professional opinions on beautifying treatments. How it works: You fill out a free registration detailing your medical history and lifestyle habits (smokers may want to finally kick the addiction before trying this – if you light up, a doc may turn you down because of potentially dangerous healing complications), upload some pics of your "trouble" area, and wait as one of the 83 board-certified surgeons gets back to you with a suggested plan of action – complete with cost estimate.

It's Joan Rivers' dream come true.

"Many people wonder for years what it would be like to have plastic surgery, but are nervous to take the step to set up an in-person consultation to learn about their options," says Dr. Jason Mussman, founder of SurgeonHouseCall.com told StyleList.

"Virtual consultations allow you to quickly receive 1st, 2nd and 3rd opinions – and that's the real value to the patient. Once patients feel truly educated on the process and are committed to the procedure, they can meet face-to-face with the doctor of their choice to have a much more focused conversation detailing specific outcomes and scheduling," adds Dr. Mussman.

Another benefit to patients is that they can size up a list of nearby doctors and decide which one has the best qualifications and advice.

"I believe that plastic surgeons should be a 'medical partner' by making decisions with their patients, not for them. The site gives patients the ability to become informed about surgeons by specialty, experience and location so they can concentrate on finding a surgeon who can lead them in their decision-making process," says Dr. Michelle Copeland, a Harvard-educated New York Plastic Surgeon who is active on SurgeonHouseCall.com.

Some patients even save both time and money by finding out that they're not a candidate for a wanted procedure, instead of having wasted an afternoon in-person at a doctor's office – and having possibly shelled out a $50 - $200 consultation fee.

And many docs take it even a step further than just email exchanges; Indianapolis Plastic Surgeon Dr. Barry Eppley offers free Skype sessions – which are done over webcam.

"Don't confuse what I'm doing on Skype with a consultation though. It's more of a conversation. When I'm at parties or even at the mall, people ask my opinion all the time about getting something done because they know I'm a plastic surgeon. Usually the questions are very basic, and I give them what I call a 'curbside consultation' – general info that helps them decide if it's worth investing time to find out more about the surgery," says Dr. Eppley.

Message boards are another anonymous and convenient way to glean professional advice from a doctor; on JustBreastImplants.com, a collection of board-certified surgeons answer posted questions about breast augmentation.

"The greatest advantage to message boards for patients and physicians is in one word: access," says Dr. Joseph A. Mele, a San Francisco area plastic surgeon who dispels advice on the forum.

"But there is still something missing. Because there is no way to do a physical examination, the answers remain general information, and cannot be definitive. The inability to touch is a real problem for cosmetic surgery – I can't feel the fat in an area being considered for lipo via a bulletin board. And I have to consider that there might be some missing detail – that may seem trivial – but which if I knew, could change everything," Dr. Mele adds.

Some critics are also concerned with the safety implications of these virtual chats.

"Keep in mind that online interactions should never replace a traditional consultation – they should only be an additional component to your research," says Dr. Loren S. Schechter, Chairman of the Patient Safety Committee for the American Society of Plastic Surgeons.

And in order to protect yourself as a user, there's also a big red flag that you should look out for when perusing online consult sites.

"You would never schedule straight to surgery after only talking to someone online. No good and certified doctor would do that," says Dr. Loren.

There are even murky legal issues in cyber space that haven't been sorted out yet because the communication is so new; in fact, dermatologic and cosmetic surgery associations are rushing to catch up with the innovations to determine if what's going on is legit.

"Online discussions can give the patient an idea of the costs involved, and what the surgery entails – much like a brochure would do. But attempting to evaluate an individual for surgery is inappropriate, and in many cases illegal – since it is considered the practice of medicine and establishes a doctor patient relationship without a history and physical examination of the patient," says Dr. Michael F. McGuire, President of the American Society of Plastic Surgeons.

"If this is done across state lines, the doctor is then practicing medicine without a license in the remote state. Such a practice could result in medico-legal consequences if any guarantees are made regarding outcomes before the patient is seen in a face-to-face consultation," adds Dr. McGuire.

Despite the cloudy legal and ethical issues, most surgeons see the internet as an inevitable force that will only become more present in their everyday interactions with patients. Emerging technology like three dimensional imaging could pave the way for more advanced and accurate online consults between doctors and patients online.

According to Dr. Mele, it all comes down to empowering the patient with better info on available procedures, and what could work most effectively to transform their beauty.

"Cosmetic surgery used to be a best kept secret. Unless your best friend was willing to share research, it was difficult to find all the options available. Now the information is everywhere."

Should Surgeons Meet Patients Online?

By CATHERINE SAINT LOUIS

IMAGINE the ease. It’s 2 a.m. and you can’t stop thinking about your saggy midsection. You log on to SurgeonHouseCall.com and create a free patient profile declaring your wish to get a tummy tuck. You fill out a brief medical history and include photographs of the problem area.

In no time, three plastic surgeons offer detailed opinions on the best course of action — with price quotes. It’s as if SurgeonHouseCall.com co-opted the LendingTree slogan, “When banks compete, you win.”

In less than a year, SurgeonHouseCall.com has recruited 55 plastic surgeons nationwide to offer opinions. Meanwhile, dozens of plastic surgeons also offer virtual consultations on their own Web sites. But does a patient who gets a plastic surgeon’s recommendation before a face-to-face visit really “win?” Conservative plastic surgeons say it’s fine to send an e-mail message with general information about a range of procedures to a patient, but the practice of offering a diagnosis without ever having met a patient can be problematic.

What’s more, offering a surgical recommendation to a distant patient may violate state laws, if the plastic surgeon isn’t licensed in the home state of the patient, according to the Federation of State Medical Boards, a nonprofit group representing 70 boards in the United States and its territories.

Critics also say that patients’ poor-quality pictures don’t provide doctors with adequate information. And patients seldom realize that no virtual recommendation is solid without an office consultation and medical clearance.

Advocates of virtual consultations suggest that they are convenient and that receiving multiple opinions online benefits a prospective patient. “It changes the first in-person consultation, empowering the patient with knowledge of the procedure, decreased anxiety level and financial readiness,” said Dr. Jason L. Mussman, the founder of SurgeonHouseCall.com. (Dr. Mussman, a resident at Loma Linda University in California, isn’t one of the board-certified plastic surgeons offering his services on the site because he hasn’t been certified by the American Board of Plastic Surgery.)

Out-of-town patients are the primary users of virtual consultations, in which a doctor may offer an opinion in a video chat, an e-mail exchange or a phone conversation. Convenience is the main draw, but a few surgeons also cited the anonymity of the situation, which is attractive to shy patients.

“They want a semi-anonymous type of evaluation,” said Dr. Dean P. Kane, a plastic surgeon in Baltimore who offers online consultations. “They want to know cost, and what you get for that cost before they make a commitment, before they walk through that door.”

Most plastic surgeons don’t offer virtual consultations. However, in an age when many Web-savvy plastic surgeons answer questions at cosmetic enhancement sites like RealSelf.com, plenty feel comfortable dispensing opinions to patients they’ve never met.

Some promise to evaluate pictures quickly and to call back with their expert opinion. Others charge $100 to screen patients to see if they are appropriate candidates.

The Web site of Dr. Barry Eppley, a plastic surgeon in the Indianapolis area, promotes “Webcam consultations with Skype.” But in a phone interview, Dr. Eppley called them “online conversations” because, he said, “Technically it’s not a consultation. You’re not going to jump from an online consultation to surgery. You’re using the online thing as a connection.”

And because those virtual connections bring in new patients, they are, in effect, marketing tools that some plastic surgeons consider crucial in this difficult economic climate.

Dr. Eppley said he often persuaded out-of-state patients after just 20 minutes of a Skype chat. “They do move ahead,” he wrote in an e-mail message. “Regardless of where they are geographically,” he said, “people will come to you because they connected with you.”

Experts like Dr. Loren S. Schechter, the chairman of the patient safety committee for the American Society of Plastic Surgeons, worry about patients getting a hard sell. Consultations “shouldn’t be about selling the surgery,” he said.

Providing a diagnosis to patients across state lines also raises legal issues. Dr. Humayun J. Chaudhry, the president of the Federation of State Medical Boards, said that according to its guidelines a patient-doctor relationship is “clearly established and begun when a physician agrees to undertake diagnosis and treatment of the patient, and the patient agrees.” Such a distinction matters, because usually doctors should only be able to care for patients in states where they are licensed.

All the plastic surgeons interviewed for this article insisted an in-office consultation took place prior to surgery. However, when doctors first examine out-of-towners — who often arrive 24 to 72 hours before the scheduled procedure — the doctor’s recommendation might change, or the cost might increase, said Carol M. Martin, an independent plastic surgery consultant who works on behalf of patients. On Skype, Ms. Martin said, the doctor might have stated, “It was going to be X, Y, Z and cost $10,000 but now that I see you in person, it’s going to be $13,000.”

Not being prepared for last-minute changes “seems like the biggest pitfall to me,” said Ms. Martin, who tells clients to meet with three to five surgeons before committing.

Angela Segal, a patient consultant, reviews quotes for women seeking plastic surgery and negotiates a price. (She also helps plastic surgeons with “online social networking marketing.”) But if a patient didn’t have an in-office consultation, she won’t even look at a price quote. “Nothing is more true and correct than actually seeing a doctor in person,” said Ms. Segal, who worked 12 years as administrator in two plastic surgery practices.

She doesn’t trust the pictures patients send in e-mail messages to plastic surgeons for evaluation any more than the ones the lovelorn post at online dating sites. “You expect the doctor to trust the pictures, which is ridiculous.”

Since some family practitioners have begun using electronic visits, the American Academy of Family Physicians has established guidelines, including the stipulation that a physician should evaluate only established patients virtually, and only over “safe, secure, online communication systems.”

The American Society of Plastic Surgeons has no policy. Some plastic surgeons make it clear to their patients that communications through their Web site “are not necessarily secure” and that “you assume the risk of unauthorized use” of say, the topless pictures you send for evaluation.

Paramount in this brave new world is ensuring that patients receive the same standard of care online and in person, said Dr. Chaudhry of the medical board association. “It should be the same exact standard as if the patient was in your examining room. You can’t cut corners.”

Plastic surgeons are not the only doctors who do consultations on the Web. Radiologists and dermatologists do some that entail communicating with a far-flung physician; primary-care physicians also keep tabs on established patients virtually.

Dr. John W. Bachman, whose family practice department at the Mayo Clinic in Rochester, Minn., did a two-year pilot study of more than 2,500 online consultations, said the aim should be to improve the standard of online care. One issue that plagues any doctor is that they sometimes forget to ask a crucial question. A computer asked patients in the pilot study questions tailored to find potential oversights.

A more structured virtual consultation might have helped Dr. Kane. The day before surgery, he saw an out-of-state woman with whom he had exchanged e-mail messages about rhinoplasty. It was only then that she mentioned her occasional cocaine use. “The problem here is it adds significant risk to the surgery,” said Dr. Kane, who canceled the operation. “Your expectations get knocked down and your patient’s expectations are knocked down.”

So why then does Dr. Kane even bother with virtual consultations? “If I don’t do it, somebody else will do it,” he said, citing the difficulty of having a solo practice in a competitive world. “The technology is there.”

Mothers undergo breast augmentation, breast lift and tummy tuck procedures to regain their pre-baby figure

CHICAGO, IL– August 6, 2009 – Having a child brings tremendous joy to a mother, however it also takes an extremely difficult toll on a woman’s body including sagging breasts, a prominent stomach area with loose skin and weight gain. Many women are taking back their lives by choosing to undergo a “mommy makeover” that includes breast augmentation, breast lift and a tummy tuck. As an added convenience for the on-the-go mother, SurgeonHouseCall.com provides patients access to board certified surgeons and the opportunity to place an online pre-consultation with a board certified plastic surgeon from the convenience of their home.

Hollywood mothers have set a high bar to get their bodies back quickly after childbirth, therefore it’s not surprising that the American Society of Plastic Surgeons has noted that popularity for the mommy makeover is sharply increasing. In fact, statistics show that mommy makeover procedures increased at a rate more than five times higher than plastic surgery procedures in general.

As the innovator of the plastic surgery online pre-consultation, SurgeonHouseCall.com is designed to bridge the gap between surgeons and those considering cosmetic or reconstructive plastic surgery to enhance their lives. The purpose is to empower the patient with knowledge and resources in an online community to allow patients to approach the first in-person surgeon consultation with in-depth understanding and financial readiness.

“Although mothers are of course thrilled to welcome their child into the world, it can be frustrating to try and regain their before-baby figure when diet and exercise just isn’t enough,” said Dr. Jason Mussman MD, founder and CEO of SurgeonHouseCall.com. “Mothers are some of our favorite patients. They have given so much of themselves to their children. It is nice to be a part of the one afternoon that is all about them.”

The online pre-consultation on SurgeonHouseCall.com includes a patient’s brief medical history, optional pictures of the area the patient is considering enhancing and a summary of their expectations for the surgery. The surgeon of their choice then receives a notification that they have a patient waiting in their “virtual waiting room” for them to respond to with information such as estimated cost of the procedure, recuperation time, potential for success, etc. The patient benefits from the online pre-consultation due to its flexibility, comfortable environment and financial knowledge.

3D informational library of plastic surgery procedures and online forum empower those considering plastic surgery with knowledge

CHICAGO, IL– August 7, 2009 – Before undergoing plastic surgery, it’s important to learn about the procedure including pre and post-operation preparation and recovery. SurgeonHouseCall.com, the innovator of the online pre-consultation, provides prospective patients access to a 3D informational library, powered by Understand.com, that walks the patient through various procedures including a breast augmentation, tummy tuck, face and hair, as well as minimally invasive skin treatments such as Botox.

As an additional added resource, patients can also visit the online forum to speak to other patients who are considering or have undergone the procedure. Plastic surgeons also frequent the forum in the “ask an expert section.” It’s a unique social network that not only provides patient’s access to their peers, but also the opportunity to ask questions to plastic surgeons themselves to get a well-rounded perspective.

“We’re designed to provide a one-stop-shop for patient’s considering plastic surgery from learning about a procedure, locating a surgeon that specializes in the desired procedure such as breast augmentation or tummy tuck, placing an online pre-consultation with a board certified surgeon and obtaining financing if needed,” said Dr. Jason Mussman, founder and CEO of SurgeonHouseCall.com. “We want to bridge the gap between surgeons and those considering cosmetic or reconstructive plastic surgery, by empowering the patient with knowledge, resources and an online community so plastic surgery is a reality for those who would benefit from it.

To ensure the highest level of quality for the patients, surgeons must be Board Certified by the American Board of Plastic Surgery® and/or The Royal College of Physicians and Surgeons of Canada®.

SurgeonHouseCall.com is a Web-based service created to provide a convenient and non-threatening medium for a greater population of patients to enhance their lives through plastic surgery. It’s an all-encompassing destination for plastic surgery patients offering education tools, a social community and skin/beauty products. It’s based on the principles of quality, convenience, empowerment, and commitment. For more information, please visit www.SurgeonHouseCall.com.