Being an Expert Witness in Plastic Surgery
Garry Brody is a professor emeritus of plastic and reconstructive surgery at the University of Southern California. He speaks to us about the basics of plastic surgery, when insurance is applicable and how his industry is developing.
Can you give a quick insight into plastic surgery?
The discipline of plastic surgery has two arms –
- Cosmetic – enhancing patient’s aesthetics such as face lifts, breast implants, “tummy tucks” liposuction, correcting “baggy eyelids”, improving an unpleasant looking nose, Botox, etc.
- Reconstruction – repairing injuries such as in burn care, with skin grafts; simple or complex lacerations; hand surgery; repairing cut tendons and nerves setting fractures and even taking a toe to replace a missing finger using microsurgery to reconnect the blood vessels, nerves tendons and fractures.
Microsurgery is a technique by which very small blood vessels tendon and nerves using magnifiers, small instruments needles and sutures. It permits the transplantation of amputated limbs and even damaged faces harvested from patients who have signed organ donation documents.
Many birth deformities require repair such as cleft lip, deformed skull, absent or deformed ears, webbed fingers. It includes excision of skin, breast and oral cancer and repairing the defect. Anecdotally our domain is the “skin and its contents”.
Can you share common occurrences in your profession?
Medical malpractice is rare from board certified plastic surgeons. Most cases come from rogue and pseudo doctors who practice cosmetic surgery with little or no competence except collecting the cash.
As an expert witness, catering to the jury is rewarding. Humour in an appropriate situation can be effective. As an example, I was instructed on a case regarding workman’s compensation, with the complaint being a loss of strength. I had tested him and found him normal for a blue-collar worker. When his lawyer asked how strong he was I responded, “well he is stronger than me”, even the worker laughed.
Insurance: when does it cover surgery costs and when does it not? Does this in any way affect legal cases and the medical industry in general?
Straight cosmetic surgery is not covered by the major carriers. However, in the last few years a company called “cosmedisure” has provided insurance for these patients. The major insurance companies cover reconstruction, but some disorders place pressure on the company. The most common ones being the reduction of large and heavy breasts which are uncomfortable and contribute towards backache. As well as large weight loss in men and women whose excess skin becomes a hygiene problem and requires removal. Indigent patients are cared for in county hospitals and are treated by residents and salaried professors. The indigent patients with legitimate cause would still have access to legal assistance.
How has reconstructive surgery progressed over your years of practice?
The changes in reconstructive surgery over the years have advanced with research, especially the growing understanding of cancer, and methods to replace the defects left from the surgical removal and the availability of materials which are tolerated by tour bodies – mostly silicone, in many forms. Breast implants, finger joint replacement and ear reconstruction, are examples. Titanium is used as internal splints for fracture stabilization, as well as the development of special instruments, fine needles and suture materials required for microsurgery.
Dr Garry Brody
Dr. Garry Brody is a plastic surgeon in Los Angeles, California. He received his medical degree from University of Alberta Faculty of Medicine and has been in practice for more than 20 years.