What is a medico esthetico?

What is the difference between a medico estetico and a cirujano plastico?  The answer is more than just an issue of translation and semantics. We discussed this and several other issues during a visit to Clinica Plastic & Estetica Nova with Julio Casadiego, who works in the medical tourism sector here in Medellin at Colombia Travel Operator.  Mr. Casadiego works with many of the healthcare professionals here in Colombia to assist overseas traveler in making arrangements for medical travel and has done so since 2009.

The Clinica Plastica & Estetica NOVA

Carrera 48 #32B sur 30

Envigado, Antioquia

Tele: (4) 339 2300 EXT 125

Email: gerencia@clinicanova.com.co

Nova is an ambulatory surgery center and a center for aesthetics.  (Aesthetics is an umbrella term that encompasses other treatments outside of plastic surgery.)  This five-story facility houses several doctors offices, aesthetic treatment facilities (laser treatment area) other nonsurgical treatment areas (cellulite treatment, botox/ injectables etc.), a cosmetic dentist (Dr. Jorge Ivan Echavarria) specializing in crowns, dental implants, maxiofacial surgery, and orthodontics along with other cosmetic services such as teeth-whitening.

There is a small pharmacy as well as a full lab (for development of gel matrix in addition to performing blood analysis), and sterilization facilities along with an operating theatre and recovery unit.

There are three operating rooms; all of which are spacious and well-lit.  Each operating room has a full complement of fully functional and modern equipment and hemodynamic monitoring devices.  There are also several well placed ‘crash carts’ for potential emergencies.  The recovery room contains hemodynamic monitoring equipment with additional emergency equipment (just in case.)  Dr.  Diego Correa was my guide for a tour of the operating facilities and was happy to answer all of my questions.

He also reported that in the last year there have been just three cases of minor skin infections (the causative agent was normal skin flora).  He reports no serious infections or complications after surgery, and states that have been no instances of resistant bacteria or MRSA.

What is a Medico Estetico?

The literal translation of medico esthetico is aesthetics doctor, but a more accurate description would be a doctor who serves as an Aesthetics Consultant, or a doctor who performs nonsurgical aesthetics treatments. For a better understanding of this specialty, I spoke with Dr. John Jairo Monsalve Bedoya,  a medico estetico and general director at the Nova clinca.

A cirujano plastico is a ‘plastic surgeon’.  This is the surgeon who is trained to perform surgical procedures such as abdominoplasties, breast augmentation and similar types of procedures.

As he explained, the Aesthetics Doctor is a physician who specializes in the study of Aesthetic procedures.  Patients consult with this physicians as part of the initial consultation to help patients determine what procedures the patient needs or wants to achieve a desired result.  This is important in many cases when the patient knows what type of result they want (“I want to look younger”, for example) but may not know exactly what procedure is best to accomplish the results they want.

During the consultation, the doctor listens to the patient describe what they are looking for, collections medical history and other medical information as well as preferences.  Then the doctor discusses a range of procedures from injectables (botox, restalyne, gel matrix), and other non-surgical treatments (laser/ light therapies, mini-lift procedures) to larger, more invasive surgical procedures such as facial endoscopy, traditional face-lifts, eye lifts and other related procedures.

Finally, based on the information provided and the discussion with the patient and their family – the doctor recommends the procedures to accomplish the results the patients are seeking.

Once the patient has decided on their options, Dr. Monsalve, and his associate Dr. Correa begin the pre and post-operative treatment plan.  This plan is more than discussing payment, arranging a date for surgery, and a follow-up visit.  As Dr. Monsalve explains – it’s a process that encompasses the entire pre-operative period, surgery and recovery.

Patients undergo a compete physical examination, with blood work and cardiac testing as appropriate (usually EKG).  Patients are evaluated and treated by internal medicine physicians for any co-morbid conditions before meeting with the anesthesiologist for further evaluation.  (This is done to reduce risk of peri-operative and post-operative complications).   The degree of pre-surgical evaluation is related to the type of treatment – with more comprehensive evaluations for patients who elect to have surgical procedures with general anesthesia.

Intra-operative care is provided by the attending anesthesiologist with the initial post-operative recovery under monitored care in the recovery room.  But after the immediate recovery, patients aren’t simply discharged home.

The discharge planning / recovery phase is also governed by Dr. Monsalve and his team.  This includes a 24 hour call line, and home visits, as needed.  In fact, Dr. Monsalve encourages patients to call, saying, If a patient is having pain – they should call.. If they have questions or concerns, they should call.  It doesn’t matter what time it is.

Dr. Monsalve also encourages patients to consider aesthetics “a process- not just a surgery”.  He states that this treatment is a part of a patient’s life, and that using a philosophy of a process-based approach (rather than an episodic experience of pay – surgery – follow-up visit) results in a better patient experience, better outcomes and greater satisfaction/ happiness with the outcomes.  He believes that successful aesthetic procedures aren’t about  making people prettier, it’s about making people happier with themselves.

Medellin surgeons serving their community

During our discussion, we also talked about the many ways that local surgeons give back to their communities.  While this includes the more widely known programs such as Operacion Sonrisa, it also includes programs such as Gorditis de Corazon for post-bariatric procedures, Angeles por Colombia , a more generalized organization that recruits volunteers from all professions and areas of society (which operates under a philosophy of each one recipient then helps three others) as well as several other programs aimed at providing reconstructive surgery procedures to low-income Colombians.

Gel Matrix for skin rejuvenation

During our visit we also talked to Dr. Maria del Pilar Sanin, another medica estetica, who performs many of the non-surgical procedures offered at Nova.  She talked about Recombinant Plasma (approximate translation) which uses a gel matrix made for the patient’s own blood to improve the appearance and condition of the skin.

The origins of gel matrix: cardiac surgery

Having worked in cardiac surgery, this concept is not new – our perfusionist in Virginia often used the patient’s shed blood in orthopedic surgery to make a similar gel matrix that enhanced healing and reduced inflammation – particularly in patients with a history of poor wound healing.

Here at the clinica Nova, no major surgery is required.  Blood is taken, (by syringe) and placed into a centrifuge.  Now if you can remember back to high school biology – this causes the blood to separate into its components, buffy coat, platelets and red cell matter.  Then the doctor uses the platelet rich portion (which also contains fibroblasts, collagen, and other nutrients important to skin elasticity and wound healing).  This formula is then injected in small increments into the patient’s face to promote skin health and rejuvenation.  Since the material is made for the patient’s own body, (and unadulterated with preservatives or other chemicals) there is no possibility for allergic reactions or sensitivities to the ingredients.

Dr. Maria del Pilar Sanin reports that the healing time for this procedure is approximately four days, and that redness and inflammation at the sites of injections are common immediately after this procedure.  She states that the duration of the effects depend on the patient’s underlying skin condition, general health and age.  On average it lasts 1.5 to 2.0 years in most patients, but may not last as long in patients with extensive sun damage or deteriorated skin condition.

She recommends this procedure as a complimentary treatment to other non-surgical treatments for better overall skin condition/ health and a reduction in the appearance of wrinkles and fine lines.  She reports it is frequently used to treat the deepening of the naso-labial fold (the line that stretches from the nose to the corners of the mouth.)

Clinica Nova offers a wide-range of patient-centered aesthetic procedures and plastic surgery – all under one roof.

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