pignataro was also an entrepreneur. he invented and wore the snap-on toupee held in place by four bolts drilled into the skull. >> he's always been different and he just came up with this idea, i could say off the top of his head, but -- >> i remember laughing about it. it was the subject of many, many, many jokes around the family and even when he was around, but he was dead serious about it. >> his medical practice consisted primarily of cosmetic surgery, which he performed in his office. one of his patients was 26-year-old sarah smith, a young mother of two scheduled to have breast augmentation. dr. pignataro had no anesthesiologist or registered nurse present. his only assistants were his wife and a licensed practical nurse. >> sarah smith was feeling pain, so dr. pignataro ordered a little more sodium phenethanol to dull the pain. when he did that, her system started shutting down and she was losing oxygen. >> at that point, he broke scrub, and i remember him tapping her on the chest and calling out her name, but t