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.

Sanabria, breast implant

Medellin Plastic Surgeons: Aristizobal Aramburo thru Gomez Botero


Medellensa (or women from Medellin) are considered some of the most beautiful women in the world.  However, they often have had some help.  Plastic surgery is wildly popular in Medellin, Colombia and much of Latin America, and standards of beauty are based on a voluptuous physique with large breasts, small waist and an (often) exaggerated caboose.  Actress Sofia Vergara, of Barranquilla is a classic example of Colombian beauty ideals, which have spread into popularity to the United States.  Many North Americans and Europeans seeking this look come to Medellin for the city’s famed plastic surgeons.

Of the 650 members of the Colombian Society of Plastic, Aesthetic and Reconstructive Surgery, 98 members are located in the Medellin area. Using this directory, I attempted to contact surgeons for interviews.  When e-mail addresses were not available, I contacted surgeons thru the Colombian Society website, when that option was available*.  If the surgeons listed a website, contact was also attempted via website.

Alphabetical listing – compilation is ongoing as I continue efforts to contact and interview plastic surgeons in the city.

Luis Fernando Aristizobal Aramburo

Calle 7 #39-290  Office # 1216 Cl Medellin

Medellin

Tele: 266 9823

Email: aristi01@epm.net.co

Emailed 7/4/2013, no reply.

Joaquin Aristizabal

No email or internet contact information available

Edgar Alonso Becerra Torres

Calle 6 Sur #43 – 200

Office # 1001

Sector Poblado

Medellin

Tele: 268 – 1132

Email: consultorio1001@une.net.co

Website: esteticaedgarbecerra.com

Emailed 7/4, and used contact form at site, no reply.

Carlos Alberto Betancourt Madrid

No contact information provided

Juan David Betancourt Perra

Calle 7 #39- 197 Torre Intermedica

Piso 13, Office # 1816

Medellin

Tele: 352 – 0264

Email: plasticjdb1@une.net.co

Website: www.plasticjdb.com

Emailed 7/4, no reply.  Met in person at the Clinica Interquirofanos 7/13/2013.

Specializes in post-bariatric surgery procedures.  Interviewed August 2013.  To read the interview, click here.

Rafael Ivan Botero Botero

Clinica Las Vegas Fase II

Office # 370

Medellin

Tele: 311 9167

No email provided.

Contacted via Society website on 7/4

Lists fluency in English and Spanish.

Luis Fernando Botero Guiterrez

Cra. 25A # 1-31  Parque emp. El Tesoro

Office # 907

Medellin

Tele: 448 – 6030

Email: luchobot@gmail.com

Emailed 7/4, responded immediately.

Lists English and French in addition to Spanish.  Following correspondence, I interviewed Dr. Botero at his office.  The interview with Dr. Botero can be seen here.  You can read about my visit to the operating room here.

Juan Botero Londono

No contact information provided

Jenny Carvajal Pareja

Calle 2 Sur #46 – 55

Office 266  Fase II

Medellin

Tele: 444 – 1312

No email provided

Contacted via society site 7/4*

J. Mario Castillon Montoya

Clinica Medellin Fundadores

Office #1003

Medellin

Tele: 511-6634

No email provided

Contacted via society site 7/4*

Diego Alberto Castillon Munoz

Calle 54 # 46 – 27 (Clinica Medellin)

Office # 1003

Medellin

Tele: 511 -6634

Email: dacastillon@une.net.co

Emailed 7/4, no reply

Reports on the society website that he speaks English and French in addition to native Spanish.  Shares office with Mario Castillon.

Oscar de Jesus Chica Gutierrez

Calle 2 Sur #46 – 55

Office 235

Medellin

Tele: 311 – 6344

Email:  oscarchica1@hotmail.com

Emailed 7/4, no reply.

Camilo Correo Herrera

No contact information provided.

John Emiro Cortes Barbosa

Calle 33 # 74E – 80 Cl. Medellin

Tele: 250 – 3941

Cell: 315 – 343 – 6898

Email: jamanta@hotmail.com

Emailed 7/4

Speaks English.

Jose Ivan Cortes Hernandez

Calle 38A # 80 – 72 Apto. 216

Cuidadela Laureles

Medellin

Tele: 412 5803

No email ontact provided.

David Ricardo Delgado Anaya

No contact information available

Ruy Rodrigo Diaz

Calle 32 # 72 – 28 Clinica Las Americas

Medellin

Tele: 345 – 9159

Email: rdiaz@epm.net.co

Emailed 7/4.   Interviewed July 18, 2013.  To read more about the interview, click here.

Jenny Maricela Diaz Cortes

Cra. 48B # 15 Sur 35

Aguacatala 2

Medellin

Tele: 321 0539

Cell: 317 639 7501

No email.  Contacted on 7/4 using society form*.

Gonzalo Diaz Palmett

Calle 2 Sur # 46 – 55

Office # 450

Medellin

Tele: 268 – 0158

Email: sdiaz@une.net.co

Emailed 7/4,no reply.

Andres Diaz Romero

Diag 75B # 2A – 80

Office # 421

Torre Medica Clinica Las Americas

Medellin

Tele: 345-9159

Email: cplastica@hotmail.com

Emailed 7/4 no reply received.

Clemencia Duque Vera

Diag 75B # 2A – 80

Office # 419

Torre Medica Clinica Las Americas

Medellin

Tele: 345-9159

Email: duqueclemencia@hotmail.com

Emailed 7/4, no reply received.

Alberto Echeverry Arango

Diag 75B # 2A – 80

Office # 422

Torre Medica Clinica Las Americas

Medellin

Tele: 345 – 9160

Email: albertoecheverry@yahoo.com

Emailed 7/4, no reply.

William Echeverry Duran

Calle 1A Sur # 43A – 49

Office # 206, Edificio Colmena

Medellin

Tele: 311 – 0555

No email.  Attempted contact via society site on 7/4*.

Francisco Fabian Eraso Lopez

Cra. 45 # 1 – 191

Torre 1 Apto 1607

Torres Patio Bonito

Medellin

No telephone, no email provided

Attempted contact via society site on 7/4*

Julio Cesar Eusse Llanos

Calle 7 # 39 – 197

Office # 908

Medellin

Tele: 444-5464

No email.  Attempted contact via society form 7/4*

Sabrina Gallego Gonima

Calle 2 Sur #46 – 55  Fase I

Office # 528

Medellin

Tele: 311 – 6780

Email: sgallegog@gmail.com

Emailed 7/4, no reply.

Lists English and French in addition to Spanish.

Monica Maria Garcia Gutierrez

Calle 33 # 42B – 06

Office 1220

Torre Sur San Diego

Medellin

Tele: 262 – 3915

Email: monicamg@une.net.co

Emailed 7/8.

Rodrigo Gaviria Obregon

Carrera 25B $ 16A Sur – 211

Biofarma

Medellin

Tele: 317 1626

Email: Rodrigo.gaviria@biofarma.com.co

Email bounced.

Julio Alberto Giraldo Mesa

Carrera 25A # 1 -31

Office 716

Parque emp. El Tesoro

Medellin

Tele: 317 4478

Cell: 311 333 4061

No email listed, emailed through society website on 7/8*.

Profile states he speaks English and Portuguese in addition to Spanish.

Lists plastic surgery education at Hospital Barata Riverio – Rio de Janiero, Brazil.

Martha Elena Gomez Botero

Calle 2 Sur # 46 -55

Clinica Las Vegas

Medellin

Tele: 268-3818

Email: megomezbotero@hotmail.com

Emailed 7/8.

Dr. Gomez specializes in maxiofacial surgery and hand surgery.

** the website  email form for the Colombian society of plastic surgeons does not appear to be working. I have contacted the society regarding this issue.

Dr. Luis Botero Gutierrez, plastic surgeon


All plastic surgeons listed (for Colombia) are members of the Colombian Society of Plastic, Aesthetic and Reconstructive Surgery.

Dr. Luis Botero during a tour of the new El Tesero ambulatory surgery clinic

Dr. Luis Botero during a tour of the new El Tesero ambulatory surgery clinic

Dr. Luis Fernando Botero Gutierrez

Carrera 25A #1 -31

Edificio Parque emp. El Tesoro

Office # 907

Medellin, Colombia

Tele: 448 – 6030

Email: luchobot@gmail.com

Website: currently under revision

It is fitting that one of Medellin’s most prominent plastic surgeons shares the same last name as one of Colombia’s most (but not related) famous artists – since plastic surgery requires considerable artistic vision from its practitioners.  While Fernando Botero’s classic works depict a more fleshy, voluptuous and sumptuous view of the world, Dr. Luis Botero spends much of his time doing the opposite: slimming and smoothing his clients with the judicious application of the latest liposuction techniques.

Quirofanos El Tesoro

His office is located next to the El Tesoro mall, in one of the most affluent parts of the city, but that will soon change with the August opening of a large ambulatory surgery clinic within the upscale shopping center.  Dr. Botero is a large part of the vision behind the 15-million dollar surgery center, which will also house the  150 physician offices from multiple specialties (including 21 plastic surgeons).

Trilingual surgeon

Dr. Botero speaks English and French fluently in addition to his native Spanish.  Much of this is due to his training.  After attending medical school at the Universidad de Antioquia here in Medellin and practicing as a general medicine physician for four years – he headed to Europe for specialty training in plastic surgery.

He attended the Free University of Brussels (Universite Libre de Bruxelles) in Belgium for his plastic surgery residency before moving to the University Henri Poincare (now University of Lorraine) in Nancy, France  for four years to complete  fellowships in maxiofacial surgery, plastic surgery of the face and separate training in hand and microsurgery and upper limb surgery.  He spent an additional year working as a plastic surgeon in France. He also spent time in Singapore (National University Hospital)  with Dr. Robert Pho and Taipei, Taiwan (Chang Gung Memorial Hospital) as a visiting fellow.

He returned to Colombia 12 years ago, and has been working as a plastic surgeon in Medellin ever since.

He is currently the president of the Antioquia chapter of the Colombian Society of Plastic, Aesthetic and Reconstructive surgery as well as holding memberships in Belgian Society of Plastic Surgery and the Group for the Advancement of Microsurgery (GAM).  He is also a member of the International Society of Aesthetic Plastic Surgery (ISAPS) and the Latin American Federation of Plastic Surgery (FILACP).

He is the official physician for the French Embassy office in Medellin.

Current practice in Medellin

Despite his extensive training, his current practice is almost exclusively aesthetic surgery (rather than reconstructive, micro or hand surgery).  He performs a combination of facial and body procedures including facial endoscopy, and reports that like almost all plastic surgeons, around fifty percent of his practice is liposuction.

While the majority of his practice are women, he estimates that around 15% are male clients.  The most popular procedure for his male patients are blepharoplasty (eye-lid lift), mandibular liposuction (chin) and corporal liposuction (body).

He is patient, pleasant and very likeable.  We talk about current trends in plastic surgery, cultural attitudes regarding plastic surgery and the anticipated opening of the new clinic.  During our walk through the mall after a tour of the new clinic – we are greeted by two of his former patients who are pleased to see him.  One young lady ruefully shrugs with a shy smile  while showing off her advanced pregnancy, as if acknowledging that she will be back soon.

Hopefully, we will follow Dr. Botero to the operating soon.