The Non-Refundable Deposit Is When You Walk Away

Dr. Chang (00:00):
I mean, it's not like you're a trauma surgeon and you had two patients that had horrible accidents and you couldn't save them.

Jackie (00:06):
Correct.

Dr. Chang (00:06):
This is an elective patient. These are people who are healthy and well. You are listening to Secret Services where we discuss the procedures nobody admits to, but everyone's curious about. I'm your host, Dr. Christopher Chang.

Jackie (00:23):
Your in-laws are in Miami.

Dr. Chang (00:25):
Yes, they are Miami through and through. My wife's from Miami. So I travel to Miami for family all the time. I feel like I've been going there for over 20 years. And there was a time when people were like, "Oh, you're going to be a plastic surgeon. You got to open up in Miami. You got to come down to Miami." So thought about it.

Jackie (00:42):
I was going to say, yeah, what did you think?

Dr. Chang (00:44):
Thought about it, but Miami is a special place. I mean, Miami has a lot of culture, but it's all Miami culture. It's diverse and unicultural all at the same time. It's all sort of South Florida Latin American culture that dominates and it's a very unique spot in the US. And from a plastic surgery standpoint, there's a whole spectrum of different things that come into play. There are people that are pushing the boundaries on things that are a little bit risky. There's people that are trying experimental stuff that's maybe a little fringe. There are people that are very price competitive because a lot of the population in Florida traveled internationally very often to Central and South America. So you're competing with the economy of other nearby countries. And of course there's the demands of being in a beautiful area with lots of beaches and people wearing revealing clothing and having pool culture all year round.

(01:50):
So there's a lot of interest in cosmetics as well and want to be young and have fun and wealth. So there's all those factors about Miami.

Jackie (02:01):
I went to Miami in February and yeah, it's like if you're not wearing a thong on the beach, you're the weirdo.

Dr. Chang (02:09):
Oh, I remember one of the very first times I went, I had lunch with my wife. We were on in South Beach and we're just sitting there, maybe Johnny Rocket or some sidewalk outdoor ceiling and the men and women walking by with thongs. It was hard not to look, but you felt weird looking.

Jackie (02:28):
Right. So there's so many plastic surgery clinics, but like you said, I feel like a lot of the women have a very similar look. Everyone's wearing the same things, a lot of revealing clothing.

Dr. Chang (02:39):
Big hoop earrings, gold earrings.

Jackie (02:40):
Yeah. A lot of thong bikinis, a lot of athleisure showing off your body. So yeah, it's kind of -

Dr. Chang (02:48):
Bright colors. They're never subdued colors. They're always bright.

Jackie (02:52):
Very bright. Yeah.

Dr. Chang (02:54):
Yeah. Miami is a special place. Miami is a place where, I think I've told you this before, but last statistic I heard was over 45% of all fat grafting of the buttock or BBLs, Brazilian buttless, are done in the country in Miami, Florida. And it is sort of the capital for that in the world, just like hair transplants are popular in Turkey and that kind of thing.

Jackie (03:20):
So this anonymous question, I found a surgeon in another state who's a third of the price of everyone near me and the reviews look great. The deposit is non-refundable and they want me to fly in two days before surgery. Something feels off, but the savings are huge. What would make you walk away from a deal like this?

Dr. Chang (03:40):
I mean, everything would make me walk away from a deal like this.

Jackie (03:44):
I agree.

Dr. Chang (03:45):
The first comment I think so the writer says something feels off, but the savings are huge. First of all, when you go for surgery, it's a real treatment. If something feels off, don't do it.

Jackie (03:58):
100%.

Dr. Chang (04:00):
Come on. You don't want to be like, oh, something feels off. If you're not vibing, stop. Don't be like, oh, well, it's good for -

Jackie (04:08):
Trust your gut.

Dr. Chang (04:08):
Good for the money. You can make more money. You can save more money. Your intuition exists for a reason and there's no reason money to save that.

Jackie (04:22):
Well, and you know how people always say you should splurge on a mattress because you sleep on it every night and it's going to last for years.

Dr. Chang (04:30):
I think Oprah Winfrey just said that in some recent graduation.

Jackie (04:34):
Well, it should be the same way with your cosmetic surgery.You are in your body every day and this is not the time to be looking for Groupon discounts or the cheapest thing out there.

Dr. Chang (04:48):
Well, the funny part about that point is that people wi say, "Well, this is my face." But people will price shop or they'll kind of be a little bit less serious when it's their breasts and body.

Jackie (05:05):
Because you can cover it with clothing, I guess.

Dr. Chang (05:07):
I don't know why. I don't know why, but there are people who will say, "Well, I'm not going to just anybody to do my facelift. This is my face."

Jackie (05:16):
Yeah, that is true. And I've had people I know say same thing. They'll be like, "Well, or I could just go to Florida and get my boobs done for 5K." I think because to them they're like, "Oh, it's a super quick and popular procedure. Everyone does them. Everyone does breast dogs, so why not get a deal there?" But it's still a surgery.

Dr. Chang (05:38):
Yeah. I mean, there's still risks and for sure that's -

Jackie (05:43):
At this point, I feel like, could I do a breast aug probably. Is it going to look like Dr. Chang did it? No.

Dr. Chang (05:50):
We'll find from volunteers. Some of us nurse, if you're interested, drop a note in the comments, be like, "I'm Jackie's patient number one here."

Jackie (05:58):
Patient zero.

Dr. Chang (06:00):
Patient Zero. Uh-oh. But I remember actually when I was in training, the chairman at the University of Miami came to Yale to talk to us about different things that they were expert in. But one of the things we do as residents, we kind of take the visiting professor up to lunch or dinner and we kind of socialize. And we were talking about the cosmetic experience of the residents at the University of Miami. And I said, and this was years and years ago, not the current chairman who's a good friend of mine also from Yale Plastic Surgery. So he's a great guy.

Jackie (06:36):
Never heard of it.

Dr. Chang (06:39):
The other faculty was sort of saying our residents can't get cosmetic patients at the University of Miami, so they don't get good training because the market is so competitive.

Jackie (06:51):
Oh, that makes sense.

Dr. Chang (06:52):
That even at the university with all these discounts and things that they would do just basically because it's academic, they have to teach the residents. We have such a hard time to be able to market and compete with the local economy because everybody in Miami is cost-cutting.

Jackie (07:07):
They can just go down the street and get it even cheaper.

Dr. Chang (07:10):
Yeah. But you have to think about it, cost cutting, what are they cost-cutting? Everything costs money. The breast implants costs money. The medications costs money. The OR staff and regulations and credentialing and how to set things up. That costs money. The licenses cost money. The supplies are all coming from the same national suppliers. That all costs money. So where is the margin getting squeezed? Is it maybe they're not really using a real nurse to be your recovery? Maybe it's just -

Jackie (07:37):
100%.

Dr. Chang (07:37):
Maybe it's a medical assistant. Maybe it's their wife who's involved in the practice or somebody -

Jackie (07:42):
Yeah, you hear these stories of these South Florida clinics and something goes horribly wrong and they're like, "Well, it was just the doctor and the front desk girl." And it's like, okay, well in an emergency, the front desk girl has zero medical background. So there's your cost cutting.

Dr. Chang (08:03):
Yeah. So that's another thing that Miami is famous for is there are very large practices or clinics. When you have a good surgeon who gets good results and they have good volume, you got to think, well, how are they doing that? If they're doing more surgery than another surgeon can do, there's only so many hours in the day. So they have to be economizing and maximizing their efficiency. So that could be from having assistants do a lot of the surgery or they even call them ghost surgeons, people who are not necessarily... They're maybe supervising, but they may not even be in the room. There are a lot of things that are a little questionable sometimes done in some of those places. And we've known historically that some of the clinics in Miami have really gotten into trouble with patient safety.

Jackie (08:55):
Right. And our surgery center is credentialed by Quad A. They just came out with this whole new... They revamp their rules every few years. And as I was going through the new guidelines, there are no exaggeration, probably a hundred new guidelines that are all in red, Florida only. So Florida essentially has no rules. And so Quad A finally realized, all right, we need to step up and put some guidelines in for Florida since the state isn't doing it. And so they were getting away with all this stuff. And so they did just come out with this. And again, you still have to do your research and see if the facility you're going to is credentialed by Quad A, but it is good to know that at least they're realizing that this is becoming a pattern in South Florida and they're working on fixing it.

Dr. Chang (09:50):
Yeah. And I know how much work you put into it. I mean, how difficult is it to get certified as a center and get everybody up to speed and credentialing?

Jackie (10:02):
Yeah.

Dr. Chang (10:04):
Describe it kind of.

Jackie (10:05):
Yeah. I mean, there's a lot of staff education, having all the proper things on hand in case of emergency.

Dr. Chang (10:16):
Medications.

Jackie (10:17):
Medications, equipment. We have to have all of our equipment in the surgery center, not just the emergency stuff. Everything inspected by a biomedical company sometimes twice a year depending on the piece of equipment. So there's so many regulations. Everyone in the center has to have advanced cardiac life support. So you're making sure that everyone in the facility has the appropriate credentials. You have all working equipment. It's a clean, safe environment. You have all the emergency medications. You're doing everything best practice. You're having peer review on all of your cases and complications. And so yeah, now they kind of crack down a little more on Florida so that they're more up to speed with what most other states in the United States have as governance.

Dr. Chang (11:11):
Yeah. I mean, all that stuff costs money, frankly. I mean, we have emergency medicines that are extremely expensive.

Jackie (11:18):
And they expire very quickly.

Dr. Chang (11:20):
And you're not using them. We never use them because it's rare. God willing. Yeah. But it's like having a fire extinguisher that expires. You don't want to leave it there. You got to make sure when you do have the fire that you can put it out. So hopefully we'll never have to use those things, but we have to have them there. And I think that's where if it's not regulated, yeah, you could leave it there and cut corners and okay, it's a month, two months, a year past this deadline. And if nobody's checking, of course it's going to slip.

Jackie (11:50):
And so now I do wonder how many facilities in South Florida are going to continue to be Quad A certified because they probably weren't doing a lot of these things. If they had to add so many rules for them, it'll just be interesting. So I think that's an important thing to ask as a patient. If you're considering traveling for surgery and you're looking at Florida, especially in the next upcoming year as things are expiring and they're going for their re-certifications, it would be really important to ask, are you credentialed? Credentialed by who? When does that expire? I think also if you're traveling so you can't physically be there, you could ask, could you do a little quick video tour of what the facility looks like? Just to get a better feel for what you're getting yourself into. And if they have nothing to hide, they should be eager to do that.

Dr. Chang (12:43):
Traveling for surgery is a little risky, but a video tour or some sort of explanation about the credentials is super important. And I hope that patients think about that when they're going away because once you leave, you really don't have the support.

Jackie (13:03):
Right. If you have any complication, then you can keep doing Zooms with your doctor, but they're not going to be able to do hands-on examinations. So you do kind of lose that benefit when you're traveling for surgery.

Dr. Chang (13:17):
Yeah. Well, I mean, the reason why these things are relevant is because two patients reportedly died recently days apart after procedures at the same South Florida clinic.

Jackie (13:27):
Days apart.

Dr. Chang (13:28):
Yeah. And I don't know if it was the same doctor, but I think it was. But including one woman undergoing a combination mommy makeover. A single attorney is now representing both families and local authorities have opened an investigation. Such deaths have repeatedly involved out - of-state patients traveling to the region for discounted cosmetic surgery. So what's your reaction to that?

Jackie (13:54):
It seems to me like if there is something happening back to back, there's got to be something going wrong with these patients and you don't have the skilled staff available to recognize it and stop it before it comes to them passing away.

Dr. Chang (14:11):
Yeah. I think also if you had a patient die or even get hospitalized, you would think that you would say, "Wait a minute, we got to take a pause here." And it's emotional for -

Jackie (14:24):
Yeah. And the next procedures we're doing, we are going to be on our Ps and Qs as we're following every protocol to a T, we're being very safe. And so it seems like this surgeon did not learn from his mistake.

Dr. Chang (14:42):
I mean, it's not like you're a trauma surgeon and you had two patients that had horrible accidents and you couldn't save them.

Jackie (14:48):
Correct.

Dr. Chang (14:49):
This is an elective patient. These are people who are healthy and well. There's got to be something in the pipeline, whether it's how they screen the patients or how they prep the patients or whatever happened intraoperatively. There's got to be something -

Jackie (15:03):
Screening I think is another good point. These facilities, are they getting proper backgrounds on these patients or are they just looking for someone calls them up, "Hey, I'm going to travel down there." And they're like, "All right, we'll put you on the books." Maybe they didn't know anything about their medical history. Are they operating on people with comorbidities that they don't know about? That could be another thing.

Dr. Chang (15:26):
Absolutely. I mean, you do a lot of the preoperative calls, right? So I mean, what are the things that come up often?

Jackie (15:34):
Yeah. So if a patient's older, has a cardiac history, we're looking at EKGs, we're looking at everyone's labs, past medical procedures, past medical history. And when I see something that is alarming, I bring it to you. I bring it to our anesthesia providers and we decide, is this a candidate that's safe to be done in an outpatient procedure? However, if you look at the guidelines for credentialing, technically the surgeon can say, "I examined this patient." It doesn't have to be a full workup. The surgeon can take the responsibility and be like, "I examined this patient and they're a candidate." So if they're not doing their due diligence, I'm sure a lot of people that are sick that should not be done in an outpatient facility can slip through the cracks and end up in a bad situation.

Dr. Chang (16:28):
Right.

Jackie (16:28):
And also, I think they're doing these combo procedures, lipo, breast, tummy. So that means they're longer procedures. People that have comorbidities, obese patients, we have a BMI cutoff. A lot of places I'm sure also in South Florida don't have a BMI cutoff. So these are people that are more at risk going under anesthesia in general.

Dr. Chang (16:53):
Yeah, absolutely. I think sometimes you have to keep patients out of trouble. It's like, oh, well, I've already taken off time work and I've saved up for this and somebody's watching my kids. I can't reschedule this. But if you're not a good candidate or there's something that's not lined up, sometimes you got to be the bad guy. And if you suggest that we have to reschedule or somebody on the team is not on board, this is not the right thing to do, you got to respect that. And that's why you do this in a group of professionals. You don't do it in a silo of one person in their office and they're just the ultimate decider. You have to respect your colleagues to say, is this going to be good, safe? Because nobody wants a bad outcome. So I think that we want to make sure we're there for the patients for safety, for success, and have a great, happy, beautiful cosmetic outcome, but also happy that nothing went wrong.

Jackie (17:52):
Yeah, absolutely. And we've heard a lot of these clinics, if they have something bad happen, they'll just change the name.

Dr. Chang (17:59):
Right. They paint a blue sign or a green sign.

Jackie (18:02):
A totally new alias.

Dr. Chang (18:03):
And then they just change the LLC.

Jackie (18:05):
Yeah. But same address. So I think you also -

Dr. Chang (18:09):
It's not even well done. It's not sneaky at all.

Jackie (18:12):
Right. So as the patient, you got to be like, "Well, I thought that this was a different facility a year ago. Are you a totally new group of doctors or did you just change your name?" Ask those questions.

Dr. Chang (18:24):
It's incredible. I don't know how they get away with that. And they just probably declare bankruptcy and then the owners just shift over into a new LLC and just dodge the responsibilities. I mean, it's horrible if you think about that.

Jackie (18:40):
Yeah. So as a patient, that's another red flag. If they're not strong in their brand, there's probably a reason why.

Dr. Chang (18:47):
Absolutely. Well, we're strong in our brand, so come see us if you want.

Jackie (18:52):
Yeah.

Dr. Chang (18:52):
The top, in terms of certification and credentials, we're very concerned about making sure that we provide the best possible care. So if you're interested in learning more about credentialed providers in our area or your area, please leave us a comment below. We'd be happy to sort of respond.

Jackie (19:10):
If you want to travel here, we can answer all your questions, show you all around all the good stuff before you make that choice.

Dr. Chang (19:16):
An open book. So we got to go. Patients are here.

Jackie (19:20):
All right. We'll see you next time then.

Dr. Chang (19:22):
We'll see you guys next time.

Jackie (19:23):
Bye.

Dr. Chang (19:25):
Thanks for listening to Secret Services, the podcast where we see everything and say nothing except right here. I'm Dr. Christopher Chang, double board certified plastic surgeon located in Tysons, Virginia. Follow us on TikTok @congressionalpsurgery or on Instagram @congressionalplasticsurgery. To send us a classified message or to hear more episodes, go to secretservicespodcast.com. Links to everything we talked about on today's show are available in the show notes. Oops, patient's here. We got to go.