Dr. Tapper to present at Veith Symposium November 2018

The Veith Symposium is the biggest most prestigious vascular conference in the world. Dr. Tapper has been invited to present 2 important talks to an international audience. Thousands of vascular physicians from all corners of the world will be in attendance.

In his first talk of the symposium, Dr. Tapper will explain the “Principal - Agent Dilemma” which describes relationships that can be exploited by unscrupulous professionals. Google “the principal agent dilemma” and you will see that it is easy for malicious unethical figures of “authority” to advise their clients/patients/customers to agree to something that is not really in their best interest. This conflict of interest leads bad doctors to recommend that patients have unnecessary procedures on their arteries or veins. Patients beware..please get a second opinion before you get an vein ablation or an atherectomy / stent.

In his second talk, Dr. Tapper will teach the audience about lipedema and the benefits of lymph-sparing liposuction. Lipedema is most often confused with obesity or lymphedema therefore physician education is so important. US physicians are largely blind to the diagnosis of lipedema…..Dr. Tapper wants to rectify that problem.

Information Asymmetry

Ever feel like someone in a professional relationship was taking advantage of you? There is something called the "Principal-Agent Dilemma" that describes such a feeling. Whenever a lay person (a Principal) hires an attorney or a stock-broker or visits a doctor (all of whom are Agents), the principal has to trust that the agent is going to act in his/her best interest. But we all know that doesn't always happen. Sometimes the agent acts unethically in his/her own best interest (maybe by over billing or over treating), which is clearly not in the best interest of the principal. Sometimes we sense this, sometimes we can't tell that it is happening.

Abuse like this can happen because the agent (doctor) knows so much more than the principal (patient) that there is "information asymmetry". A bad actor can exploit the information asymmetry and manipulate a patient into "choosing" treatments that are expensive but not helpful. 

Medical abuse is rampant in Florida, particularly in the treatment of varicose veins and PAD.

BE CAREFUL. Don't be intimidated by Information Asymmetry. Ask questions. Get a second opinion. If you sense something is wrong call a time out, have a family member double check for you. Make sure you ask the 5 questions I posted on a previous blog. Make sure your doctor is a "peach" acting in your best interest, not an unethical "lemon".


WAL liposuction comes to Symmetry Vascular Center

I am now two years into exploring the benefits of lymph sparing liposuction for women suffering from lipedema. As a busy Fellowship trained Board-Certified Vascular Surgeon, I did not undertake this venture lightly. I have great respect for the German and American surgeons who have pioneered this field. Two years ago, I went to Germany and spent time with Dr. Stutz who practices the water assisted liposuction or WAL technique and Dr Rapprich who uses power assisted liposuction or PAL. I was lucky to have had a Johns Hopkins trained Plastic surgeon colleague who has offered advice and assistance with the first 25 surgical cases of PAL. I am now using WAL and see advantages of each.  

Intra-vascular ultrasound-IVUS. The Hubble telescope for vascular disease.

For the past several years, I have been using a miraculous tool called intravascular ultrasound or IVUS. This is a small catheter with an ultrasound probe on the tip, which allows me to see inside and artery or vein, as well as all around the vessel. The images that IVUS gives of arteries and veins are as revealing as those from the Hubble telescope. Vascular surgeons can see things with IVUS that we never knew existed. IVUS allows us to see abnormalities from inside an artery or vein with more accuracy than with just a simple arteriogram or venogram. IVUS is critical for planning a stent placement and assessing the success of an intervention. I have IVUS available to use for all my patients whether your procedure is done at the hospital or in the office. Ask your doctor about IVUS and how it can be used to help guide and assess your treatment.



International Society for Endovascular Surgery--ISET 2018

I was fortunate to be invited to participate as a faculty member for ISET 2018. This meeting of radiologists, surgeons, and cardiologists is one of the 3 largest and most prestigious gatherings of endovascular physicians in the world. I presented a talk on the enigma of the swollen leg that highlighted the unique aspects of venous edema, lymphedema, and lipedema. The talk generated many follow-up comments with regard to lipedema. It remains such a fascinating yet poorly understood and under-diagnosed disease.

I also gave a talk about the Principal-Agent Dilemma which describes the information asymmetry inherent in the doctor-patient relationship. Unfortunately, there are unscrupulous physicians who mislead patients into unnecessary and sometimes dangerous procedures. This talk was picked up by the press, https://www.tctmd.com/news/clinician-patient-mismatch-how-get-past-imbalance-knowledge-and-power. It is critical that patients ask questions and do as much research as possible before submitting to either venous or arterial procedures. If something doesn't seem right, it probably isn't so please be careful, get a second opinion. Your legs are worth the effort. Go only to Board Certified endovascular physicians. Check education, check training, and check credentials. There are many pretenders and self-proclaimed experts who are in fact "lemons". To help find yourself a "peach" of a doctor, see my earlier post on "5 Questions to ask your doctor".


Clinician-Patient Mismatch: How to Get Past the Imbalance in Knowledge (and Power)

Clinician-Patient Mismatch: How to Get Past the Imbalance in Knowledge (and Power)

“By exploiting information asymmetry, unethical providers put patients through unnecessary interventions to boost profits,” S. Scott Tapper says.

HOLLYWOOD, FL—Physicians armed with years of training and much expertise often find themselves in the sticky position of treating patients with less knowledge about their condition and options. But according to one speaker at the recent International Symposium on Endovascular Therapy (ISET) 2018, there are ways to surmount this power imbalance that’s skewing healthcare decision-making.

“What is a conflict of interest? Very simply, it can be defined as any situation in which a person is in a position to derive personal benefit from actions or decisions made in one’s official capacity,” S. Scott Tapper, MD (Symmetry Laser Vein Center, Stuart, FL), said in a session devoted to the future of aortic therapies.

5 Questions For Your Vein Doctor

Unfortunately, venous disease has become the playground for unscrupulous physicians. Florida has become a haven for manipulative doctors who prey on our natural fear of blood clots. All kinds of doctors many of whom have no vascular training market themselves as experts. Slick TV commercials and direct mail ads may fool you into seeking their advice. If you are contemplating treatment of your veins, then you must ask a few important questions. An ethical well trained doctor will welcome your questions and readily answer YES to #1, #2, and #3 BUT NO to #4 and #5.

1) Are you Board Certified in Vascular Surgery, Interventional Radiology, or Interventional Cardiology ?

The answer should be yes!

2) Do you have hospital privileges in one of the 3 specialties listed in question #1 ?

The answer should be yes!

3) Is your Vascular Lab (the place where the Doppler ultrasound of your legs is performed) certified by the IAC (Intersocietal Accreditation Commission)?

The answer should be yes!

4) Do you recommend that I have 4, 5, or 6 separate LASER vein ablations for my varicose veins?

The answer should be NO!

5) Do you recommend that I have an ablation procedure for my spider veins?

The answer should be NO, NEVER!

If your doctor cannot answer these simple questions without "hemming and hawing" you need a second opinion!

Vein Surgeons in Florida: Find a "peach" and avoid the "lemon".

The Florida Vascular Society meets in Amelia Island this week and Dr Tapper is presenting important work on the ethics and economics of venous surgery. Dr. Tapper and other vascular surgeons in Florida are concerned about inappropriate vein treatments being done by unqualified physicians. Neither the State nor the insurance companies do enough to protect patients from bad vein doctors. Much like the used the car market before Carfax, it is hard for patients to tell if their doctor is a "peach" or a "lemon". Dr. Tapper wants you to have a way to know for sure that your doctor has your best interest at heart. Because so much money is involved in vein surgery, large companies whose motive is profit and physicians trapped in the cycle of declining reimbursement conspire to convince patients to submit to unnecessary but highly profitable LASER procedures. Right now there is no regulation to protect patients. So if you are considering vein surgery, make sure you get an opinion from a Vascular Surgeon certified by The American Board of Surgery.


Top 4 reasons for leg swelling

Leg swelling or edema is a common problem that can become debilitating if left untreated. Many causes can be cured pain free, the key is to make the correct diagnosis. Here we review the top 4 reasons for leg swelling.

1) Medications: Edema is a side effect of many common prescription and OTC drugs. Your legs might be swollen as a side effect of the medications listed below.

  • Blood pressure pills: Amlodipine (Norvasc), Nifedipine (Procardia)
  • NSAIDs: Ibuprofen (Advil, Motrin), Naproxen (Aleve) and Celebrex
  • Nerve pills: Gabapentin (Neuontin) and Pregabilin (Lyrica)
  • GERD (acid reflux) medications: Pantoprozole (Protonix), Esomeprozole (Nexium), Omeprazole (Prilosec)
  • Hormones and steroids: Birth control pills, testosterone, prednisone, Medrol 
  • Diabetes medications: Pioglitizone (Actos)... especially if taken with Insulin
  • Pramipexole (Mirapex) used for Parkinson's disease and restless leg syndrome

Do not stop or change your medication schedule without consulting your doctor!

2) Venous Disease: 40% of women and 15% of men are affected by venous disease. Do any of these signs or symptoms sound familiar? 

  • Achy leg pain, throbbing, tingling, itching, restless legs, heavy legs, burning, and of course swelling can all be symptoms of venous disease.
  • Physical signs may include, bulging varicose veins, skin changes like brown staining (hemosiderin deposition), hardening, thickening, stasis dermatitis (dry chapped looking skin above the ankle), or venous stasis ulcer. 

If you have a history of varicose veins, DVT, phlebitis, venous insufficiency, or venous ulceration a vascular surgeon can help you.


4) Lymphedema: Although annoying, this cause of leg swelling is usually painless. Milky lymph fluid is made of fats and proteins that are too large to be taken up by the small venules and is returned via delicate lymphatic channels to larger veins closer to your heart. When lymph channels are obstructed their contents back up and congest the skin. The skin can get tight and develop prominent pores kind of like the texture of an orange, in fact we call this sign "peau d'orange", which is French for skin of an orange.

  • If you think you might have lymphedema, try to pinch the skin on top of your second toe. If you can't pinch the skin on top of your 2nd toe, we call this a “positive Stemmer's sign” which is diagnostic for lymphedema.
  • Lymphedema can be treated with compression hose, lymphatic massage (MLD), and other manipulatory techniques to push the lymph fluid towards areas with functional lymph channels.
  • If compression is too painful, try walking in a pool at chest-high depth for 30 minutes three times per day. The water pressure provides a greater force than any stockings you can comfortably fit into.


4) Lipedema: This is a common disease that is new to the medical scene and frequently missed by doctors. Lipedema is a fat storage disorder. Inflamed, painful fat is trapped in the legs yielding a “bottom heavy” appearance. Lipedema is estrogen mediated so it only occurs in women. It usually begins or fluctuates around times of hormonal stress such as puberty, pregnancy, or menopause. It is frequently mistaken for obesity or lymphedema and to further complicate things, these diseases may occur concomitantly with lipedema. However, remember that toe pinching test you did earlier? Lipedema does not extend to the toes. Ergo you WILL be able pinch the top of your toe (a NEGATIVE Stemmer sign). What to do about lipedema?

  • Anti-inflammatory diets and supplements have been recommended to control symptoms. Unfortunately, lipedema fat seems to be resistant to diet, exercise, and even bariatric surgery.
  • Liposuction is the only effective treatment for removing painful lipedema fat. This surgery is different from the traditional cosmetic liposuction in that its goal is to remove the inflammatory, painful fat from the legs and butt while keeping the lymphatic vessels intact. Originally developed in Germany, lymph-sparing liposuction for lipedema requires specific training and is now available in the US.


WARNING about vein surgery: Surgery for varicose veins is NOT always necessary! Although safe and effective when you have big bulging veins, some patients are being harmed by unnecessary procedures. Make sure your physician has vascular credentials from the American Board of Surgery. Docs without specific vascular training may be wasting your time, money, and comfort with a procedure that may not resolve your problem.


Kirsten Nathan MS4

S. Scott Tapper MD FACS RPVI


Fat Disorder Research Society (FDRS) Meeting

The FDRS meeting in Salt Lake City is right around the corner. Dr Tapper will be there as a lecturer and as a sponsor. He will be giving a talk entitled "The enigma of the swollen leg". He has given a longer version of the talk to multi-specialty physician audiences for 1 hour of CME credit. Leg swelling is a common problem that can be frustrating to both patient and physician.  Dr. Tapper breaks down the myriad causes and offers solutions for patients and referring doctors. 

Dr. Tapper does his 1st lipedema liposuction!

Our program is off and running! After 10 months of careful planning and training, I performed my 1st lipedema liposuction today. I want to thank everyone who has supported me along this journey. In particular, let me thank Dr. Stutz and Dr. Rapprich who welcomed me to their clinics in Germany in the true spirit of Hippocrates. Many other people have influenced me along the way including, FDRS participants, bloggers/organizers (you know who you are :)), and Dr Correa in Orlando. But the biggest push forward has come from patients who I have seen suffering with lipedema. Your support and encouragement to pursue this path has been vital. I have seen your legs for years and now I know how to help. To my brave 1st patient, thank you. You are a hero, thank you for trusting me.

Dr. Tapper invited to present at prestigious 2017 ISET meeting

ISET, the International Symposium on Endovascular Therapy (www.ISET.org) is the largest, most prestigious meeting of its kind. It attracts physicians in multiple specialities from around the world. Earlier this year, Dr. Tapper gave a talk at ISET 2016 about when doctors should NOT do endovenous ablation of the saphenous vein. There are too many patients who needlessly get saphenous ablation, either because they are deceived by an unethical practitioner, or the practitioner does not understand the anatomy of their venous disease. For example, patients with isolated spider veins do NOT need saphenous ablation. Dr. Tapper's talk focused on the complex anatomy of venous disease and how our understanding of it has changed over the past 15 years. He also emphasized the importance of ethical behavior by physicians in this area that is so prone to abuse.

For ISET 2017, Dr. Tapper will be speaking on evolving strategies and techniques used to reconstruct the inferior vena cava (IVC) once it has become occluded by an IVC filter. There are a subset of patients with debilitating painful swollen legs as result of IVC filter occlusion. Dr. Tapper has developed techniques to remove the filter and restore flow through the IVC.  Once the IVC is re-opened, the pain and swelling dissipate resulting in renewed mobility. There are many IVC filter attorneys but very few doctors who are dedicated to removing problematic filters and restoring IVC function.

If you have problems with your IVC filter, call Dr. Tapper, he can help you!


Take a moment to remember our heroes today.

Germany thru the lens of lipedema

Well I have completed a whirlwind tour of Germany thru the lens of lipedema. German physicians are doing fantastic work to treat this ubiquitous disease. Multiple branches of medicine including vascular surgery, dermatology, and lymphology are involved. I greatly appreciate the generosity of Drs. Stutz and Rapprich for sharing their expertise with me. And the patients that I met were also kind enough to share their experiences.

My take home messages are: 

  • Lymph sparing liposuction techniques used in Germany for lipedema can be used in America.
  • Liposuction provides amazing functional results.
  • Awareness of lipedema is the bottleneck that must be overcome.

I am working to establish a liposuction program for lipedema patients in Stuart, Florida. 

Stay tuned!


Hello from Germany

Thank you Dr. Stutz, Jutta, their staff, and their patients for a tremendous learning experience. What a privilege to be allowed to spend a few days with them. Dr. Stutz is a wonderful physician, surgeon and teacher. I have learned a great deal in a short period of time. I am continuing my liposuction for lipedema education in Germany with Dr Stefan Rapprich over the next few days and will report back soon.

Dr. Tapper goes to Germany to learn new surgical techniques!

Dr. Tapper will be visiting two surgeons in Germany from May 7 to May 14, 2016. He will be learning 2 different lymph sparing liposuction techniques to help patients with LIPEDEMA. Dr. Stutz, a vascular surgeon in Bavaria, has pioneered the WAL technique or water assisted liposuction for lipedema. Dr. Rapprich in Frankfurt is an expert at the PAL technique or power assisted liposuction for lipedema. Both techniques have a place in helping people who suffer from lipedema. The German surgeons are 10 years ahead of us in their understanding and treatment of lipedema. Dr. Tapper is going to be part of a small cadre of American physicians determined to catch up, then lead the way to better understanding of this troubling disorder. Check back for an update from Germany!

Symmetry Vascular Center

Welcome to our new website!

I am proud to announce the renaming of my practice, from Symmetry Laser Vein Center to Symmetry Vascular Center. The name change recognizes that for years my team and I have taken of patients with every possible arterial, venous, or lymphatic disease. We do much more than laser varicose veins. Nothing that you love about Symmetry will change. We will still answer the phone with a real person, make all your appointments for you, and help you navigate the insurance maze. When you come to Symmetry Vascular Center you will still be greeted by the friendliest most knowledgeable staff and you will be evaluated by the most experienced Board Certified vascular surgeon on the Treasure Coast. We welcome patients from Stuart, Port St. Lucie, Okeechobee, Hobe Sound, Jupiter, Palm Beach, Vero Beach and Ft. Pierce.  Call today!  772-286-5501

Welcome to Symmetry Vascular Center!
S.Scott Tapper MD FACS RPVI