New regulations out of Alabama

Earlier this summer, Alabama’s State Board of Medical Examiners (BME) pumped the brakes on the widely unregulated service of elective IV therapy according business and health care law firm Byrd Adatto. Under Alabama law, IV therapy constitutes the practice of medicine, meaning only a licensed physician, physician assistant (PA), nurse practitioner (NP), or midwife may diagnose, assess, and prescribe IV hydration therapy.

This means registered nurses, who can legally administer IV therapy, are not qualified to prescribe IV therapy and the use of “standing orders” (pre-written prescriptions that RNs can follow without consulting the provider) does not meet the legal requirements. The regulations for IV therapy vary by location, but as more states begin to follow Alabama’s lead, tighter regulations may be soon to follow.

Currently in California, the law states that IV therapy must be rendered through a medical corporation, and at least 51% of the practice must be physician-owned. Despite physician ownership, don’t be surprised if, similar to Alabama, the doctor, NP or PA must eventually prescribe treatment in California. In many places, IV therapy businesses are entirely staffed or even owned by RNs. With new state and federal regulations forthcoming, many of these businesses will potentially be out of compliance due to lack of oversight by a licensed provider.

Why is this important?

Ultimately it comes down to patient safety. IV fluids and added supplements have the potential to interact with other meds or even worsen existing medical conditions. For example, a patient with congestive heart failure (CHF) – a condition where a weak heart is already overloaded with too much fluid – should not have a seemingly harmless bag of IV fluids!

When we first discussed the idea of offering IV hydration in our office, this was one of my top concerns as a nurse practitioner. Can I order medications that can potentially be dangerous without seeing (virtually or in-person) the patient myself? I want to know their medical history, what surgeries they’ve had, what medications, supplements, and over the counter meds they take – all the details I need as a provider to determine if IV hydration is appropriate.

Because of this, I review each patient’s intake forms, verify their medical information, and conduct a brief assessment prior to treatment. For IV therapy, our patients come into the office and everything is done in person; for injections that can be self-administered, the entire visit can be conducted virtually, with live step-by-step instruction and visual confirmation of safe technique.

One size fits all?

There is no “one size fits all” for anything in medicine, even for something that may seem simple as a bag of IV fluid. Our safety-focused approach to IV hydration not only keeps us fully compliant with regulations, it allows us to provide customized care to each patient based on their individual needs. As with all medical treatment, we advise patients to do their research when seeking IV hydration therapy to ensure there is appropriate medical oversight of the business. Your health and safety, and those around you depend on it… even if the laws and regulations in your area haven’t kept up.

More Information

Check out our website to learn more about IV hydration therapy or click here to schedule a live or virtual evaluation today!

By Jennifer Cooper, MS, APRN, AGACNP-BC

Click here for the original blog post written by Jennifer Cooper for BuildMyHealth.

The post New Regulations for IV Hydration Therapy Coming Your Way! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Dr. Bae:
Hey Greg. Thanks for having me.

Greg:
How have you been?

Dr. Bae:
I’ve been good. I’m good. I’m better now that they’ve stopped making us wear masks outdoors, and maybe even indoors in certain situations. But of course they stay consistent with whatever your local guidelines and rules are, but it’s still, it’s showing signs of progress. That’s all, that’s the main focus.

Is Botox a gateway drug?!

Greg:
Yeah. We’re getting back to normal and feeling good. Hey, and I’ve got a question for you. Botox, it seems kind of the entry level thing that people do when they-

Dr. Bae:
Gateway drug. Yeah.

Greg:
Yeah, absolutely. And in the beginning it was to treat wrinkles mostly on the forehead, around the eyes, stuff like that. But there are so many more uses for Botox, even helping with migraine headaches these days.

Dr. Bae:
Right.

How young is too young?

Greg:
But how young is too young and how do you help determine with a patient whether they really need it and if the time is right for Botox?

Dr. Bae:
I think it would be simple enough to say, oh, if you’re 18 years old or older, the age of consent, that’s when you can start doing Botox. But even people would think, oh, that’s too young. And it’s easy to get real judgemental of people. Like a 25-year-old shouldn’t be using Botox. Wrinkles on our forehead are normal. But people should step back and realize that whatever may be appropriate for you may not be necessarily appropriate for other people. And it’s, so one of the things I would tell people is caution, caution them to not get too critical because different situations apply to different people. Specifically, I think of a girl that was, I think she was 14-years-old that called the office, scheduled a consult, said she was coming in with her mom and she wanted Botox. She actually said she wanted fillers to her lips. And so I’m thinking, okay, this is someone that’s been watching Kylie Jenner.

Greg:
I was about to say, Kylie Jenner. This Kylie Jenner.

Dr. Bae:
Exactly. It’s Kylie Jenner’s fault. And I’m thinking, all right, I’m going to have to talk this girl down. It’s like, I can’t give you fillers. You’re 14 years old.

Greg:
Yeah.

Understand what the patient wants

Dr. Bae:
And even I was being not, I wouldn’t say judgemental, but I was already coming up with reasons to not do this treatment for her. And when she got here, she came in with her mom. They obviously had a good relationship and like yeah, my daughter thinks she wants fillers. And I’ll say, “Well, so what’s your concern?” She’s like, “Well, whenever I smile, my lip gets really thin and it shows my gums and that makes me uncomfortable.” And I was like, “Well, actually, now that I better understand your situation, you don’t really need fillers.” Because fillers obviously can plump up your lips. But the thing is, if you plump up your lips so that when you smile, because it’s natural for your lip to thin out when you smile, that happens to everybody.

Dr. Bae:
So if you plump up your lips to make them fuller when you smile, that means that when you’re not smiling, your lips are going to look even more full. Like might even look a little bit weird. You’ll have this big, full upper lip when you’re not smiling.

Greg:
Yeah.

Dr. Bae:
And when you smile, it might thin out.

Greg:
Rubber ducky lips.

Dr. Bae:
Exactly, exactly. So I was like the most appropriate thing for you to treat that thinning upper lip, the gummy smile, if it’s really bothering you, if it makes you feel uncomfortable at school, which it’s kind of hard to tell somebody, don’t … Buck up. Don’t feel weird at school.

Greg:
Yeah.

Upper lip botox for this patient

Dr. Bae:
Don’t give into peer pressure. It’s just ridiculous. So one of the things that’s most appropriate for her is something we’ve talked about before is Botox to the upper lip so that when you smile, it relaxes the muscles in the upper lip. So when you smile, your upper lip doesn’t go up as high. So it doesn’t show up as much of your gums. And also because it doesn’t lift up as much, it stays fuller, doesn’t then out as much. So it ‘kills’ a couple birds with one stone that Botox, not fillers, was really the most appropriate thing for her. And because she was there with her mom, and even though she was 14, I did Botox to her upper lip and she was really happy.

Dr. Bae:
And her mom and she had reached out to me since then and thanked me for it. And it’s like how much more comfortable she is. And maybe we should get to the point where she is still so comfortable in her own skin that she won’t feel like she needs to keep coming in for it, and her face will change. But it was a really nice experience for me, a learning experience for me to just don’t be judgy, listen to what the person’s concerns are and see if there’s maybe a really less invasive way to treat them, to make them more comfortable in their own skin.

Greg:
The two important things there, if you are younger, younger than 19, obviously you need to consult your parent, bring your parent with you.

Dr. Bae:
Right.

Greg:
But also really important to just make sure you’re finding a Board Certified plastic surgeon who can give you a good consultation and is really going to do or not do what is in your best interest.

Dr. Bae:
Yeah. It’s true. And it doesn’t necessarily have to be a Board Certified plastic surgeon to do your Botox. You could go see a Board Certified dermatologist. They’re trained in all that. But it is really-

Greg:
But you want somebody who’s got your best interest at heart.

Dr. Bae:
You want somebody that’s as smart and as experienced as me. That’s what you’re really trying to say.

Greg:
There you go. And me.

Dr. Bae:
That’s why I’m here.

Greg:
And me too. All right.

Dr. Bae:
Of course.

Greg:
See more of Dr. Bae’s work, check out pricing, all that stuff. Reach out to him on his social media. He loves to interact.

Dr. Bae:
That’s right. @realdrbae, r-e-a-l-d-r-b-a-e. Not b-a-y, and realdrbae.com.

Greg:
All right. Thanks everybody.

Dr. Bae:
Thank you.

The post How young is too young for cosmetic procedures? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Early on in this pandemic, the recommendations from the CDC and state authorities were pretty clear when it came to mass gatherings: don’t have them. In fact, the CDC reiterates this guidance in an update from July 7th, 2020. The highest risk of spread of the coronavirus comes from “large in-person gatherings where it is difficult for individuals to remain spaced at least 6 feet apart and attendees travel from outside the local area.”

What constitutes a mass gathering?

In other words, congregating in large groups can lead to a surge in infection, like the surge we currently find ourselves in. So what qualifies as a mass gathering? If you sample articles like here, here and here, you would think mass gatherings only apply to debaucherous events such as partying during Memorial Day or July 4th weekends. In the articles above, the banner image is often that of folks partying on inner tubes, bars or beaches.

Noticeably absent in the national conversation about this surge are the largest mass gatherings over the last 6 weeks: protests. If your only source of the world around you was traditional media, you would think protests are exempt from the definition of mass gatherings.

Why is that? Why do political protests against police brutality (an obviously worthy cause), get a “pass” when it comes to assigning responsibility for a surge? It’s as if we’re afraid to recognize the role of the recent protests in the current surge. Are linking protesting and surges somehow politically incorrect? Is there really no scientific basis to state this simple fact: mass gatherings of any kind, including protests and parades (as in the case of a war bonds parade in Philadelphia during the 1918 influenza pandemic), increase the spread of the disease.

Here’s a quote from an article about Pittsburgh, Pennsylvania’s recent surge that epitomizes this ongoing journalistic dishonesty and total lack of recognition about the role protests play in spreading the coronavirus:

“The main source of the current outbreak is largely undisputed. People who had been cooped up for months flocked to the city’s bars and clubs, crowding shoulder-to-shoulder like old times on East Carson Street.”

No mention of the protests occurring in Pittsburg throughout the month of June. No mention of thousands of protesters with and without masks, yelling, chanting and spreading droplets of virus amongst other protesters.

Evidence that the current surge is due in part to the protests

If you question the validity that protests are potential super spreader events, this map of the more than 2000 protests that took place across the US should make you reconsider.

Based on research from the Pew Research Center, the majority of protesters were ages 18-49. This corresponds with the same age group that is contracting the virus during this surge.

The same Pew research also points out that Black and Hispanic communities were overly represented at the protests. While Blacks only account for 11% of the US population, 17% of the protesters were Black. Hispanics account for 15% of the US population but were 22% of the protesters. Sadly, these same communities are also disproportionately affected by the coronavirus.

While the media is hesitant to blame the thousands of protests that took place across the country in June, they’re quick to blame a single pro-Trump rally for a recent surge in Tulsa, Oklahoma. Keep in mind that the media initially reported a “disappointing” low turnout for the Trump rally but then weeks later determined there indeed were enough people attending the rally that it was responsible for the subsequent surge in Tulsa.

It’s interesting to see how the media has twisted the words of the local public health official in Tulsa. The official referred to an increase in cases after “several large events” including protests and the Trump rally. Notice that the public health official recognized it was all mass gatherings that led to the surge, but the media assigned the blame to the Trump rally only.

Why it is important to admit the role protests have in the current surge

All of this is to point out two realities: 1) surges are not political phenomena and 2) not recognizing the role of protests in the current surge diminishes the credibility of our news media and public health officials.

Surges are epidemiological realities of mass gatherings. It’s immaterial as to whether you’re a Democrat or Republican, or whether you agree with the social justice issue at hand. Protesters need to recognize that while they are fighting for a worthy cause, they’re endangering the same minority communities they’re trying to help. And how worthy a cause may be, is irrelevant to the transmission of viral genetic material.

Understandably, stopping a protest because of concerns about the spread of the coronavirus is impractical. Nothing is stopping the rage and anger leading to these protests. But when there is a surge, the media should recognize it for the epidemiological inevitability that it is, rather than avoiding the reality because it may be politically incorrect. Admitting to and recognizing problems and how best to deal with them doesn’t just apply to social justice. It also applies to pandemics.

Protesters need to recognize that while they are fighting for a worthy cause, they’re endangering the same minority communities they’re trying to help.

Despite the overwhelmingly skewed coverage of the surge, this article attempts an honest look at protests as an example of mass gatherings that are leading to the surge across America. The article interviews and highlights the hypocrisy of public health officials that essentially say mass gatherings in a pandemic are ok if you agree with the context of the protest. And these opinions are being promoted by people supposedly motivated by science and not politics.

The ignorance of these public health officials further reaffirms the erroneous belief held by members of society that this “pandemic” is a hoax. That segment of society is hearing that it’s not ok to socially distance in a church, but it is ok to be in a protest where protesters are shoulder to shoulder, potentially coughing and wheezing from tear gas. Is it any wonder that Americans are disillusioned with our elected and appointed leaders who issue directives and edicts about social distancing?

Bottom line: if you must protest, first, recognize that you are contributing to the spread of a virus that is not a hoax, and affects the young and the old alike. Second, consider the safest form of protesting: a caravan protest.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

Dr. Jonathan Kaplan is a board-certified plastic surgeon based in San Francisco, CA and founder/CEO of BuildMyBod Health, a price transparency-lead generation platform. 

The post So we’re to believe some mass gatherings are ok during a pandemic? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

The evolution of the tech neck to the ZOOM neck

As patients started taking selfies or using FaceTime several years ago, they saw their neck as never before. For better or worse, they were unhappy with the appearance of their neck. Enter, the tech neck. With the onset of the pandemic, an entirely new group of consumers using ZOOM are starting to notice they have ZOOM neck!

We recently performed a SIMI neck lift on a patient that said in her consultation, “I didn’t realize I had these neck bands until I was using ZOOM more!” She didn’t have an excess amount of skin. If she did, a full neck lift would be appropriate. A full neck lift includes an incision behind the chin to perform liposuction and tighten up neck muscles. A full neck lift also includes incisions behind the ears to remove excess skin.

The SIMI neck lift, in contrast, avoids these long, painful incisions behind the ears because there is no skin removal in the process. The SIMI neck lift, in the appropriate candidate, allows for the repositioning of “misplaced” skin from the midline of the neck. Essentially the excess slack is taken up and spread across the neck. Since no skin is removed, just repositioned, there’s no need for the incisions behind the ears.

So if you’re “suffering” from ZOOM neck, there’s a minimally invasive, long lasting treatment – the SIMI neck lift! Check pricing here. But there are other options to treat ZOOM neck, depending on what you’re noticing about your neck.

Other options for treating ZOOM neck

If you’re noticing your skin to be a bit crepe-y (loose crinkly texture) or more dark spots than you’d like, a facial from our aesthetician, Aesthetica by Rocio may be the right option.

If there’s fullness, as in some fat, CoolSculpting of the neck or even Kybella performed by our dermatologist Dr. Zanelli may be the right option.

Interested in scheduling one of these procedures with Aesthetica by Rocio Guzman, Dr. Zanelli or Dr. Kaplan? Call or text us at 415-923-3005 or BOOK ONLINE here!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Do you have ZOOM neck?! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

When we consider black swan events, which I’ve discussed here before, they’re often looked at in a negative connotation. And rightly so. But in an effort to find a silver lining to this pandemic, we should consider the pandemic as a black swan event, a once-in-a-lifetime opportunity to make a dramatic improvement in society. There are many changes that will occur post acute phase pandemic. As we enter this new chronic pandemic phase, things will change. Ironically, many changes will result in better customer service in the healthcare setting. One example? No more waiting in doctor’s offices!

No more waiting in doctor’s offices

If you’ve received an email from your doctor as they start to see patients in person again, you’ll notice a common thread. They all detail the changes you should expect when coming into the office. This is part of phase 2 in many states. Our office is no different.

Based on the San Francisco Mayor’s recent announcements and clearance by the Department of Public Health, hospitalizations due to the coronavirus are flat which means we can resume non-essential services as part of Phase 2 on Monday, May 18th.

Just as so many other physician office’s prepare for this next phase, we are implementing several safeguards as well. Our office building already requires that everyone entering the building wear a mask. But standalone offices are requiring the same of anyone entering their office.

Many offices will begin spacing appointments further apart so patients can be brought directly to the exam room after entering the office and having your temperature checked. That means no more waiting in our waiting room! This is a huge paradigm shift for patient care and customer service. Something that has been a long time coming.

Doctors and staff will also wear masks during consultations and treatments. To ensure patients don’t come into the office sick, staff will confirm they are not experiencing any symptoms associated with COVID-19 such as fever, cough, loss of taste (ageusia) or loss of smell (anosmia) before they leave home.

Elective surgery

For facilities that offer surgery, this will also be a new experience. Elective procedures that were originally postponed will be allowed to reschedule. That means rescheduling hip and knee replacements. Or cataract surgery. But for hospitals and surgery centers that have lost a great deal of revenue during the pandemic because they had to cancel elective procedures, they will probably not allow cosmetic procedures for the time being.

Why the difference? For patients undergoing cosmetic procedures, they must pay out of pocket. For the surgeon’s fee and also for the facility and anesthesia fee. When comparing cosmetic vs medically necessary, insurance-based procedures, hospitals get paid a small facility fee from cosmetic patients. So if the name of the game is prioritization of procedures as facilities ramp back up, they will preferentially go with better paying procedures, of which cosmetics is not.

Benefits of an office-based operating room

To be clear, this is not because cosmetic procedures are not allowed. On the contrary, new health orders are allowing any type of elective procedure, including, and without limitation, cosmetic and dental procedures. But there is a caveat. Facilities that resume elective procedures must have a protocol in place that ensures the safety of the surgical patients. And since it appears most hospitals and surgery centers will not prioritize cosmetic procedures, patients may find it’s easiest to schedule their cosmetic procedure in an office-based operating room like ours.

Here are several surgery specific protocols that facilities, including ours, will put in place to avoid the possibility of operating on a COVID+ patient. We are requiring all surgery patients to obtain a COVID test at one of the free testing centers in the Bay Area prior to their surgery date. As a follow up, we will also perform a rapid COVID-19 antibody blood test the morning of surgery. This is to rule in (or rule out) exposure. But also, this test will confirm they possess antibodies that confer immunity to the virus.

Flattening the curve

Based on recommendations by the country’s foremost experts, a complete return to normalcy via a vaccine or herd immunity, may take at least 18 months. Sadly, waiting to reopen society once there is absolutely no risk of contracting the coronavirus is not realistic or plausible. That is why we as a society must restart, with safeguards in place. Throughout this entire crisis, the overarching goal was to flatten the curve (and thus far, at least as San Franciscans, we have done that), not eliminate the curve.

In other words, the goal is to minimize the number of people that get COVID-19 at any one time so as not to overwhelm the healthcare system. To that end, the shelter-in-place and quarantine are relaxing in a way to allow life to move forward. And at the same time continue with various forms of surveillance and social distancing to minimize the risk of spread.

The irony is these changes will actually provide much better customer service than many expect from the healthcare system. From more convenient virtual consults to no more waiting in doctor’s offices. We can use this opportunity as a black swan event of improvement, not failure.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post No more waiting in doctor’s offices! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

But one could also read it as, if ice cream shops are considered essential forms of takeout restaurants that should remain open when a shelter-in-place is in effect (which they are), then plastic surgeons should be able to perform cosmetic surgery if elective surgery is deemed appropriate during a shelter-in-place designation (which they’re not). They highlight an interesting conundrum that our elected leaders and public health officials currently find themselves in (even if they aren’t aware of it).

Is cosmetic surgery a legitimate form of elective surgery?

Across America, hospitals are starting to perform elective procedures again. They stopped elective procedures at the beginning of the COVID crisis because hospitals wanted to ensure beds were available for COVID patients. And with each elective operation, that was potentially one less bed for a COVID sufferer. Elective procedures range from a colonoscopy to breast cancer to heart valve dysfunction. If a patient was in imminent danger, they could have their procedure. If not, their operation was postponed.

Now as elective cases are added back to the elective operative schedule, hospitals are prioritizing which procedures should go first. In a recent email that I received from the Sutter Health system based in Sacramento, one parameter to determine whether an elective procedure could proceed was if the patient was likely to need less than 48 hours in the hospital postoperatively. Again, very reasonable considering that a quickly discharged patient would “free up” a bed for a potential COVID patient.

Ban cosmetic surgery?

Despite these recommendations, Governor Newsom went out of his way to ban cosmetic surgery. His thinking is that these are unnecessary procedures. But when is cosmetic surgery ever necessary? It’s not! So if these procedures are always unnecessary, what’s the distinction that makes them “more unnecessary” now, if other elective procedures are allowed? Additionally, most cosmetic procedures take place in outpatient surgery centers or in accredited office-based operating rooms (like ours). As such, they’re not taking hospital beds from COVID patients. These procedures aren’t even taking place in the hospital. And don’t forget, cosmetic surgery patients are inherently the healthiest patients as a rule.

Could there be a complication in an outpatient setting that would require transfer of a cosmetic patient to a hospital, thus taking a bed from a COVID patient? Certainly, but the data shows that’s not likely. Complications of any kind, including those requiring transfer to a hospital occur less than 0.5% of the time.

And how are our elected and non-elected leaders making these decisions? Based on a personal communication with another plastic surgeon, some hospitals in San Francisco are allowing transgender surgery to proceed, considering them to be essential elective procedures. So someone born as a man, undergoing gender affirmation surgery to become a woman can undergo a breast augmentation, or “top surgery,” but someone born as a woman can’t get breast implants for confidence affirmation surgery?

What are the current CMS recommendations for resuming elective procedures?

Where does the Centers for Medicare and Medicaid Services stand on this topic? They recommend elective procedures when the number of admissions to local hospitals are trending down, especially admissions to the ICU. They also want to ensure that staff has access to personal protective equipment (PPE) and that testing is available. Keep in mind the recommendations are in conjunction with the local climate of admissions and infections.

The ICU admission rate is going down in San Francisco. And the number of deaths is very low, especially when compared to other large metropolitan areas. The local climate is heading in the right direction. We have enough PPE in our office to protect patients and staff. We have access to rapid antibody testing in our office and will soon have access to rapid PCR testing. Lastly, since our patients are healthy and not having surgery in a hospital, they’re not taking COVID patient beds. Therefore, they seem to be the safest elective procedures to be performing at this time.

But I’m not here to argue that cosmetic surgery is essential. Or to allow it. Nor am I arguing whether ice cream shops should rise to the same level of essentiality of a takeout restaurant. What I am arguing is that if the government is setting parameters for elective procedures, just as they are for what is and is not an essential business, then there’s no logical reason to ban cosmetic surgery. These patients are not taking beds. They’re healthy. And in our office, they have access to all of the testing and PPE that CMS, and most organizations recommend. So Governor Newsom and Mayor Breed, set parameters and be consistent… and let my people go!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Ice cream shop : takeout food :: cosmetic surgery : elective surgery first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Why San Francisco is ready to reopen for business

As I discussed here previously, San Francisco has had fewer COVID-19 deaths than most large cities in the country. The city benefited from the early institution of shelter-in-place orders. Additionally, the large number of tech workers in the area began working remotely even earlier in the month of March. These early social distancing recommendations are having far reaching benefits in San Francisco.

There were only 12 COVID-19+ inpatients at all three Sutter Health CPMC San Francisco  hospitals as of Friday, April 10th. Clearly, not every city has these same low rates of inpatient admissions for patients with the coronavirus. And that’s why the decision to reopen for business or relax the shelter-in-place orders are not a national-level decision. These decisions are necessary on a local and regional basis, when appropriate, in coordination with state decision makers.

Because there are so few COVID-19+ inpatients in San Francisco, that means the hospital has the capacity to accept more of these patients if necessary. But it also means hospitals can start performing elective procedures again. With beds available, we can reassure every patient they will have a bed if needed.

Concerning news for San Francisco

While San Francisco is controlling the outbreak with social distancing, there is a potential problem on the horizon. On April 10th, public health officials announced that 70 people at San Francisco’s largest homeless shelter were found to be COVID-19 positive.

At this time, it remains to be seen if this will lead to the surge that has yet to materialize.

Benchmarks before reopening businesses

Based on the roadmap to reopening issued by former FDA commissioner Scott Gottlieb, there are four benchmarks before we can move to the next phase (Phase II) of this crisis. In his words, the current quarantine and shelter at home is Phase I. Now that we have 1) a reduction of patients needing inpatient medical care over the course of 14 days (one incubation period) and 2) hospitals in the area can safely treat all patients requiring hospitalization, San Francsico satisfies two of his four milestones at this moment.

The third and fourth benchmarks include widespread testing along with active monitoring and tracing of all confirmed cases. This is possible to implement over the remaining days in April.

On a case by case basis, doctor’s offices can join the city and other lab testing facilities in providing rapid testing capabilities to our citizens. My office is receiving delivery this week of antibody testing kits. These rapid blood testing kits can determine if one of my patients has 1) not been exposed to the virus, 2) was recently exposed and does not have full immunity yet or 3) they’ve been exposed and now has full immunity. If any patients test positive, but not yet immune, in our office, they will be sent home or to the hospital depending on symptomatology and they will be reported to the CDC.

The last requirement to move on to Phase II, contact tracing, will be available by the end of April. This includes the notification of an individual via smartphone if they’ve been near someone else that has since tested positive for the virus. By tracking this information, affected individuals can be monitored, sent home, isolated or seek out treatment. The technology to accomplish this is being provided by both Apple and Google. The software or API (application programming interface) they’re building for health department apps will have interoperability between both iPhone and Android.

Guidelines when reopening businesses

According to Gottlieb, in Phase II, the majority of schools, universities, and businesses can reopen. The truth is, many governors are leaning towards leaving schools closed for the rest of the school year. But working from home, when feasible, should continue. And he suggests gatherings be no more than 50 people at a time.

While grocery stores and convenience stores can limit the number of people that come in at once, this is a more complicated decision for restaurants and bars. Many restaurants can continue delivery through DoorDash, Caviar, Postmates and UberEats. And I suppose dine-in restaurants can operate at 50% capacity where some social distancing is possible.

However, most restaurants operate on a thin margin. Being in a situation wherein their expenses/payroll are at pre-pandemic levels, but the restaurant is generating half the revenue may be untenable and impractical. It will also be interesting to review the numbers, when available, if restaurants whose business model is not meant for delivery and take out only, are generating enough revenue.

When it comes to bars, is there any scenario where they can reopen during Phase II? Bars seem to be less conducive to social distancing and more likely for patrons to be in close proximity to one another. Can a bar operate at 50% capacity? This may be a decision for a later phase.

Having realistic expectations

It’s critically important the public understands it’s not realistic to expect no one to get sick during the process of relaxing social distancing protocols. We just have to minimize the number of people that get sick at any one time. That’s what flattening the curve is all about.

We should not frame the question as, if we stop social distancing too soon, will people die? Unfortunately, it’s inevitable that as home quarantines are lifted, more people will die. More people will contract COVID-19, some will require admission to the hospital, and a few of those people will then go to the ICU and succumb to the virus. That’s unavoidable to some extent.

The right question is, how to do we relax social distancing, lockdowns and quarantines in such a way as to reduce the possibility of a spike in new infections that overwhelms the healthcare system? Just as flattening the curve was the goal at the beginning and in the midst of this crisis, flattening the curve is still the goal as we start to return to a more normal (but definitely not normal) way of life.

A phased return to “business as usual” is necessary. But only in areas that are ready based on the four benchmarks above. With contact tracing and rapid immunity testing, businesses can reopen. And as time goes on and new data becomes available, more test-proven immune employees will be able to return to work. We can eventually gather in successive waves of 50, 100, or a 1000 people. And then one day, we’ll be able to attend an NFL game. One day.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post America has to reopen for business… but not at the same time first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

The evolution of the butt

This isn’t the first time we’ve put a fuller figure on a pedestal. Peter Paul Rubens, (28 June 1577 – 30 May 1640), a Flemish painter, is well known for his voluptuous women. An overweight, full-bodied woman was all the rage in early modern history. And that’s the way it has been for centuries. “But” things change.

It was until the 90’s, the 1990’s that the idea of a petite, thin supermodel was considered “hot.” So fairly recently. And just as fast as that trend came, it went!

Whether it was the influence of hip hop and Latina culture on American pop culture, or the simple fact that it was easier to be curvy than super thin, voluptuous was back. This was specifically clear in regards to the butt. The arrival of J Lo on the scene in the early 2000’s brought fuller buttocks back into vogue.

The big butt really caught on with the Kardashians in the 2010’s. However, it wasn’t just a big butt. Interested women now wanted a narrow waist and full hips. Specifically, elimination of the hip dips (the natural sunken area between the pelvic bone above and the hip bone below) was the next step in this journey.

Now we’re seeing big round butts with round hips. Sound familiar? These trends, like so many, have come full circle. While it doesn’t include the obesity of the Rubenesque paintings in the 1500 and 1600’s, the ideal aesthetic women are requesting from their plastic surgeon is a return to this more voluptuous silhouette!

The evolution of the butt video

To check pricing on a Brazilian Butt Lift from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post The evolution of the butt [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Why BMI isn’t enough

Sure BMI is better than looking at weight alone. Because even if a person weighs a lot, they may be very tall. And in that case, they would not be considered overweight.

However, BMI doesn’t take all nuances of body shape into account. For example, in the video below, the patient had a BMI of greater than 30. She would be considered obese. But there were several reasons she was a great candidate for a tummy tuck. First, she was healthy. No high blood pressure or diabetes. Second, her weight was concentrated in her thighs, not her abdomen.

So while her BMI was high, it didn’t accurately reflect the operation she wanted – skin removal from her abdomen. If most of her weight was in her abdomen, then it would be more appropriate for her to lose weight first since skin removal would not address the excess fat around her intestines (visceral fat). In her case, she her torso and abdomen were amenable to a tummy tuck and she had a great result.

If a patient is considered obese, they can still be offered a procedure. As long as no more than 5 liters of fat is removed in an operation, the patient can go home. With that limitation, they may have to come back in stages for surgery. But when patients undergo a cosmetic procedure that’s not medically necessary, there’s no reason to take unnecessary risks.

Video on Body Mass Index

Click here to check pricing on a procedure from Dr. Kaplan.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post There’s more to it than BMI! [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Join the Bae Club (aka Club Kaplan)!

For those of you not aware by now, Dr. Kaplan goes by Dr. Bae on social media! As silly as it sounds, this online persona has taken on a life of its own. He’s still the same person regardless, but being Dr. Bae in the Bay Area just made sense on Snapchat and Instagram. Spelling it B-a-e rather than B-a-y is simply a play on words.

And now Pacific Heights Plastic Surgery and Dr. Kaplan are launching the Bae Club! The Bae Club is an additional way to provide our patients with a high end, VIP experience.

When you join the Bae Club, you’ll enter a world of special offers just for you and the ability to treat yourself year round. Check out either the Membership or Package below and see which fits your needs best:

The Bae Club Injectables and SkinCare Membership:

• Up to 20% off Botox/Xeomin, fillers, Latisse and Obagi skin care products.
• Get treated, or purchase, as much and as often as you like and always get up to 20% off.
• All you do is pay a low monthly membership fee (automatically charged to a card on file).
• Purchase must be made online by clicking the button below. Can not purchase in office.

Purchase your Membership HERE!

The Bae Club Wrinkle Reducer Package: 

• Come in the office every three months, get 20 units of Botox/Xeomin and walk right out of the office!
• Instead of paying a lump fee for treatments at each appointment, you pay a little each month with an automated charge to your card on file.
• You’re getting the treatments anyway but instead of paying the full amount every three months, you pay a monthly fee that covers your cost for the year – but at a 15% discount!
• Purchase must be made online by clicking the button below. Can not purchase in office.

Purchase this Package HERE!

We know something new like this can be confusing so please don’t hesitate to call with any questions. Dr. Kaplan (aka Dr. Bae) and his team are always available! Call or TEXT us at 415-923-3005.

The post Introducing the Bae Club! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

The effect of a price transparency executive order

Despite President Obama’s efforts with the “Unaffordable Care Act,” this Executive Order will actually have an effect on the cost of care. Obama simply extended Medicaid to more consumers, feeding the healthcare machine, but not altering the cost curve in the process.

By requiring healthcare providers to disclose their negotiated rates, consumers will be able to shop for quality, lower cost care. And by exposing healthcare to typical market forces, providers will have to compete on customer service and quality. But that’s not how rates are currently set because providers and insurers set their rates in secret.

This will directly affect providers of medically necessary services typically covered by insurance. But the Executive Order will also indirectly affect providers that may be outside of the purview of the new law. Why?

Even if the law only refers to the interactions of insurance companies, doctors, hospitals and their negotiated rates, this will change the mindset of the consumer. The consumer will now expect price transparency from all providers. They won’t make the distinction between medically necessary services  or cosmetic services. They won’t care if the doctor is out of network and has no negotiated rate with the insurance company. And they won’t care if the service was performed at an outpatient facility and not a hospital that may be affected by the Executive Order.

No, the consumer won’t consider any of that. They’ll simply assume all doctors, by law, should disclose their prices. So to appear credible in the eyes of the consumer, all doctors will need to be price transparent. Just like a doctor appears more credible if they have a Facebook or Yelp account, price transparency will convey legitimacy as well.

What should a provider do?

So, for providers that want to comply with this Executive Order and generate leads in the process, you can sign up for the BuildMyBod Health platform here. And for consumers interested in finding pricing from Dr. Kaplan, click here!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post President Trump officially signs price transparency executive order first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

According to the Wall Street Journal, President Trump will issue an Executive Order this week regarding price transparency. The price transparency executive order will require hospitals, insurers and doctors to disclose their negotiated rates. This will have direct and indirect consequences.

The effect of a price transparency executive order

Despite President Obama’s efforts with the “Unaffordable Care Act,” this Executive Order will actually have an effect on the cost of care. Obama simply extended Medicaid to more consumers, feeding the healthcare machine, but not altering the cost curve in the process.

By requiring healthcare providers to disclose their negotiated rates, consumers will be able to shop for quality lower cost care. And by exposing healthcare to typical market forces, providers will have to compete on customer service and quality. That’s not how rates are currently set because providers and insurers set their rates in secret.

This will directly affect typical providers of medically necessary services, lowering the cost curve for out-of-pocket expenses, particularly for outpatient services. However, this will also indirectly affect providers of cosmetic or typically cash-pay services. Why would this affect those providers if this Executive Order doesn’t directly affect doctors in that space?

Because consumers will now expect price transparency from all providers. They won’t make the distinction between medically necessary or cosmetic services. They’ll assume all doctors, by law, should disclose their prices. And so to appear credible in the eyes of the consumer, all doctors will need to be price transparent. Just like a doctor appears more credible if they have a Facebook or Yelp account, price transparency will convey legitimacy as well.

For providers that want to comply with this Executive Order and generate leads in the process, you can sign up for the BuildMyBod Health platform here. And for consumers interested in finding pricing from a doctor near you, click here!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Trump’s Price Transparency Executive Order first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.