Dr. Andrew Mark Klapper helps cut through the marketing hyperbole, smoke and mirrors and B.S. of today's top headlines in Plastic Surgery. His honest commentary helps focus on what is useful and what is not.

Friday, March 02, 2007

Old versus New Silicone Implants - Let's Cut to the Reality

Since the reintroduction of silicone implants by the FDA it is clear that my patient population prefers silicone with 90% of my surgical candidates opting for silicone.

I wanted to share a little of what happens in my consultation that helps explain the difference between the "old silicone implants" and the "new".(see before and after photos of silicone implants)

Here is a photo of my exam room counter with a silicone implant that is around 20 years old. Observe:
-the thickness of the shell(it is thin and flimsy).
-the shape and fluidity of the material(it ripples over and over on itself and the cohesiveness of the silicone is low and the material appears to flow not allowing it to hold its shape well)


Now have a look at the counter after we remove the implant...


THE OLD SILICONE IMPLANT WEEPS












Reintroduced "New" Silicone implants
Observe:
-Thickness of the shell
-Ability to hold its form(this means they are more cohesive - companies try to use terms like "memory gels" or refer to "gummy bears")

and...
Observe there is no ring of silicone left on the counter when the implant is lifted.

Bottom line is that these are two DIFFERENT ANIMALS.









THEY SLIGHTLY RESEMBLE EACH OTHER IN A SIDE TO SIDE COMPARISON...















SUMMARY
The old silicone implants that were removed from the market weeped - essentially leaking silicone into the body.
The modern approved silicone implant has a shell that is thicker/stronger and the silicone gel itself if more cohesive(meaning if the shell ruptures-its contents are less likely to migrate)
see more before and after photos of silcone and saline breast augmentations

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Friday, February 09, 2007

Allergan Set To Make Juvederm A Name

HYPE or HOPE
Every 6 months the filler gods bestow upon us the latest and greatest soft tissue filler. We have watched this with Restylane, Hylaform, Captique and now Juvederm. I like to tell patients that when a company tells you the filler will last "x" amount of time it is a best case scenario and in you it will last 1/2 that long. So here we have Juvederm which promises to last 6 months. I think the educated patient should be prepared for it to last 3 months and if they can live with that they will be happy. It is also my experience that in dynamic structures like the lip no filler will last more than 2 months. I anxiously await my 2 month followups with Juvederm so I can be proved wrong.

Allergan Set To Make Juvederm A Name
by Christine Bittar, Thursday, Jan 25, 2007 5:00 AM ET

ALLERGAN, WHICH HAS TURNED BOTOX into a household name, is poised to launch new advertising to market its other injectable wrinkle reducer, Juvederm.


The print portion of the new campaign breaks next month and is coming from Grey Worldwide, which handles Botox advertising. Allergan did not comment on the timing of the broadcast portion of the campaign, except to say that 30-second TV spots will start later this year and run on network and cable TV.

A Web site for consumers and physicians launched last week for Juvederm Ultra and Ultra Plus. The site helps consumers find dermatologists who are approved in their area to administer the product, and features plenty of before-and-after photos.

At the moment, consumers are being made aware of the Web site through a giant billboard in Times Square, which went up on Dec. 1 and will appear until Jan. 31. Professional communications--including patient information brochures--are part of the mix, along with what Allergan describes as "robust" public relations programs.

Known predominantly as an eye care company, Allergan has become a giant in prescription dermatology products/cosmetics during the past few years, and last year took over competitor Inamed, which manufactures Juvederm.

Unlike Botox, which works to reduce the look of lines by easing tension in facial muscles, Juvederm is in a class of products known as wrinkle fillers. Juvederm essentially smoothes wrinkles by plumping the skin. Its biggest competitor in the category is Restylane, made by Medics Pharmaceuticals.

One potential area of confusion for consumers might be in discerning the differences between Botox and Juvederm--a topic which could presumably be addressed in ads. Conceivably, spots could also promote the use of both products simultaneously--laymen's terms for tightening the muscle/line with Botox, then softening or filling the area in with Juvederm. In fact, that combination therapy is something that many dermatologists have long been doing with Botox and Juvederm competitor Restylane.

Grey and Allergan executives declined to describe forthcoming Juvederm creative other than to say ads would be "descriptive and informative of its uses and benefits," and clearly set up the indicated usage for the product "in the lower face," with other communications clearly differentiating the two products.

Although doctors often inject Botox in other areas, it is only approved by the Food and Drug Administration for use in the vertical frown lines between the eyebrows. Juvederm, on the other hand, is recommended to "restore skin volume" and smooth facial wrinkles and folds, in areas including the smile lines and the lines that go from the nose to the mouth.

In place of plastic surgery procedures such as facelifts and eye lifts, consumers have been moving toward less invasive injections in the name of youth and beauty. In 2005, the global market for dermal fillers was $442 million (up 200% since 2000), with the U.S. dermal filler market projected to grow 25% a year through 2011, according to research supplied by Allergan.

Last year, 3.2 million Botox injections were administered--up 99% since Botox was approved for cosmetic application in 2002, the company says. The company also says growth of non-surgical aesthetic procedures is outpacing surgical procedures by three to one--dermal fillers being third, behind Botox and electronic hair removal.

Sunday, September 17, 2006

The Cry of Danger... Is it ENOUGH?

I find it ironic that the dermatologists are now speaking out about untrained physicians placing fillers... they feel it is unsafe for patients... This is exactly how I feel about dermatologists putting in Breast Implants(Dr.Sal Calabro for example of Howard Stern noteriaty). I applaud them for their comments on untrained physicians placing fillers and using lasers but if all it takes is a weekend course to put in breast implants or do liposuction where is their outrage there? Why is that okay?

Warning on plastic surgery risks
Reuters
Sunday, September 17, 2006 23:10 IST
NEW YORK: Undergoing cosmetic surgery performed by someone who’s improperly trained can result in scarring, burning and, in some cases, even death, a group of dermatologic surgeons warns.
The American Society of Dermatologic Surgery (ASDS) has launched a public safety campaign in response to what it calls the “alarming national trend”of non-physicians performing procedures such as Botox injections, laser hair removal, microdermabrasion and chemical peels.
“What we’re seeing is an overwhelming preponderance at this point of these untrained people getting their hands on these devices and using them,” Dr Renata Hirsch, a dermatologic surgeon in practice in Boston and ASDS spokesperson, said. “Top offenders are these pseudo medi-spas.”
According to the ASDS, 41 percent of its members say they have seen an increase in patients seeking second treatments to repair damage from botched procedures performed by improperly trained individuals.
Hirsch said she has seen people suffer loss of pigmentation, particularly people of colour who receive treatments from individuals who don’t know how to set the laser level properly. There have also been cases of practitioners using “gray market,” untested, versions of materials injected into the skin to fill wrinkles. Also, Hirsch adds, a procedure may simply not work.
According to the ASDS, a physician should always perform a cosmetic surgical procedure -- and the physician should be a dermatologist, rather than a family practitioner or gynaecologist, Hirsch notes. If a physician is only supervising the procedure, he or she should be on-site and available to respond to emergencies. Hirsch also advises buyers to beware of procedures offered at cut-rate prices. “This is just one of those times when you just don’t want to get a bargain.”

Thursday, August 31, 2006

Cosmetic Surgery Getting Out of Hand

Is this too much or is this the right amount of control? Personally I applaud local government for taking a more active role in medicine but think this is a bit much. It should be left to the surgeon and the parents to counsel a teenager on plastic surgery. In my practice I will not operate on anyone (teenager or adult) unless I am convinced through discussion that they understand the risks of the operation and the impact a complication might have on their day to day lives. For example: Is a teenage girl who most likely is having breast augmentation to improve her self image equipped to deal with the devastating complication of an infection? How will her sense of self be when she has an open wound with pus draining out of it? Now thankfully this has never happend to any of my breast augmentations, but as the responsibile surgeon I always inform the patient of what keeps me up at night...

SYDNEY, Australia (AP) - August 28, 2006 - The leader of Australia's most populous state has said new laws are needed to make it harder for young people to go under the knife for cosmetic surgery.
Morris Iemma, the leader of New South Wales state, says he's shocked by an apparent rise in the number of teens seeking breast implants, Botox injections and nose jobs.
He told the Sunday Telegraph newspaper that the number of people under 18 seeking cosmetic enhancements has gotten out of hand.
The report says Iemma plans to introduce new laws requiring teenagers to get a referral from their doctor and get counseling before having plastic surgery.
Parental consent will also be required, and surgeons will be forced to offer a minimum one-month cooling-off period before conducting any procedure.
(Copyright 2006 by The Associated Press. All Rights Reserved.)

Thursday, July 06, 2006

SCARY BUT TRUE: More Doctors are Providing Both Medical and Cosmetic Serives

Let me first say that the educated patient will always choose the qualified practitioner over the imposter. The sad part is that those that have less education and understanding about the differences between qualified and not... are preyed upon...here is such an example.


I have to jump the gun a little and comment about this Obstetrician/Gynecologist Marco Pelosi II in New Jersey that thinks it he is the best person suited out there to offer plastic surgery (oh yes...he can't call it that legally because he is not one...so he calls it "cosmetic services") to women

ARE YOU KIDDING ME?
IS ANYONE BUYING THIS?

I have a question.. Who Takes Care of Your Complications? You may be an excellent technician and get results that are satisfactoyry to your patients but where did you get your training to deal with the intraoperative complications and postoperative complications of liposuction and the procedures you offer. PLASTIC SURGERY TRAINING IS NOT ONLY ABOUT QUALITY OF RESULTS... BUT SAFETY AND HOW TO DEAL WITH COMPLICATIONS. THIS CANNOT BE TAUGHT IN A WEEKEND COURSE




More doctors are providing both medical and cosmetic services
By Czerne M. Reid
McClatchy Newspapers
(MCT)

Now, there are more reasons to visit the family doctor.

Or dentist.
Or gynecologist.
Or ophthalmologist.

Patients can pop in for a checkup or to have some wrinkles removed or even liposuction.
Doctors' offices across the nation increasingly are becoming one-stop shops for both medical and cosmetic services, offering procedures generally done by plastic surgery specialists.
Doctors say they offer cosmetic services so they can better meet the needs of their patients. But plastic surgeons find the trend disturbing. They understand the motivation, though: As doctors face reduced reimbursement rates from insurance companies, they look for ways to bring in extra money.

Whatever the doctors' reasons, patients say they like the familiarity, convenience and discreetness of going to their own doctors for cosmetic services. And more and more people are asking for them.

In 2005, close to 11.5 million surgical and nonsurgical aesthetic procedures were done in the United States, according to the American Society of Aesthetic Plastic Surgery.
But that figure is conservative; it is based on a survey of only plastic surgeons, dermatologists and ear, nose and throat specialists. Those specialties represent just a fraction of physicians who now offer cosmetic services. More than 80 percent of cosmetic procedures in 2005 were nonsurgical, and almost half were done in an office facility.
Dr. Stephen Izard, who runs First Care family practice in Columbia, S.C., said he started offering cosmetic procedures after several patients approached him.

"I saw that there was a need, and so I decided to give it a try," he said.
So did gynecologist Lilly Filler, who thought about cosmetic services after treating a young woman who had excessive hair growth on her face and body.
"I began to see that the care of the skin and the care of women overlapped a lot with what we were doing in our office," said Filler.
Miriam Harrison, a patient of Izard's for 21 years, turned to her doctor for treatment for wrinkles, enlarged pores and things "sagging a bit here and there."
"I came here because this is where I've always come," she said. "I trust these people. They won't do (something) to me if it's not right."

Robert Austin, a businessman and seven-year patient of Izard's, also felt comfortable having brown spots removed from his face at his doctor's office.
"It made it very convenient. They were right there where I go for my medical needs," Austin said. "And it was discreet. No one knows what you're there for."
Filler's gynecology practice offers laser treatments for removal of unwanted hair, spider veins, scarring and discoloration.
"As a woman, I know what I want in a doctor's office," Filler said. "We try to provide that for our women."
New Jersey gynecologist Marco Pelosi II, founder of the International Society of Cosmetogynecology, said, "The gynecologist is probably in the most ideal position to provide cosmetic service."

Gynecologists treat women through their various life stages and have surgical skills transferable to procedures such as those aimed at making scars inconspicuous, said Pelosi, who seven years ago started offering liposuction in his office. He also offers mesotherapy for "body-sculpting," as well as cosmetic fillers such as Restylane, and Botox injections for smoothing the skin.
Cosmetic services bring new patients and more money into doctors' offices. Americans spent $12.4 billion on cosmetic procedures last year, says the American Society for Plastic Surgery.
Insurance companies don't cover cosmetic services, so clients pay the full cost. Prices can range from $100 to more than $4,000, depending on the service. The cash flow helps keep doctors' bottom lines in good shape.

"I think as long as physicians have to work as long and as hard as they do," said plastic surgeon John D. Newkirk II, "the tendency is to do those things that give maximum revenue with minimal work."

The procedures being offered in doctors' offices are relatively quick and easy. In fact, many offices advertise them as "lunchtime" services since people are well enough to go right back to work afterward.

But for a good outcome, the person administering the treatment has to have good training and practice frequently.

"It's when something goes wrong, or something has to be modified, when the training comes into play," said Pelosi, who offers training courses for doctors, one of which Filler attended.
But plastic surgeons worry the short courses and field visits that other doctors take don't qualify them to practice cosmetic medicine.

"I'm not sure the public is well served by going to anybody whose residency does not include training in those areas," Newkirk said. "A weekend course in liposuction is inadequate training and experience to allow any physician to carry out that procedure in his or her office."
Some doctors say opposition to non-specialists doing cosmetic procedures is a turf battle.
"It's all politics, and it's all about money. It has nothing to do with the practice of medicine," Pelosi said. "The American Medical Association ... states that education, training and experience are the qualifications needed to be able to practice any procedure, whether it's brain surgery or taking a hangnail out."

You May See a Funny Cartoon but all I See is the "FEATHER LIFT"


This cartoon is funny in its absurdity but the underlying message is real. People today are always looking for cheap shortcuts. We live in a fast food society where in less than a minute you can order a fully cooked meal and go on about your business. To many their approach to beauty brings them down a similar path. "let me do as little as possible to get a result."

Now in theory there is nothing wrong with that. Procedures today are becoming less and less invasive and the future will bring revolutionary advances that may eliminate the need for surgery to rejuvenate one's appearance.

But...

When I look at this cartoon all I can think about is how unscrupulous physicians and companies prey on people's innate desire to "get more with less". I can't get the image of the FEATHER LIFT out of my head.

The Feather Lift is a nonsense procedure where threads are placed in the face to provide lift. There is no undermining, redraping or excision of tissues. It is sad but true that the majority of sites that push these "THREAD LIFTS" all show the same before and after photos. People... you are all reasonable consumers... this can't make sense to you. Why would everyone be showing the same photos.

I had the pleasure of spending time at the Maryland State Anatomy Lab where I ordered some "APTHOS THREADS" from the company and placed them into the faces of Fresh Cadavers with my Colleague Dr. Jennifer Walden. We are both highly trained surgeons and together with standard placement could not get any noticable lift from the technique.

It is also very interesting who pushes Thread Lift Surgeries... It is pushed by doctors who are not surgeons and do not perform surgery. "When you are limited by the scope of your training to perform only non-invasive procedures you will push only non-invasive procedure plain and simple." My problem is when these doctors will tell you this is better than the invasive procedure.

This is why we see many non-Board Certified Plastic Surgeons such as those that call themselves "cosmetic doctors or cosmetic surgeons" offering such procedures. They mostly have nothing else to offer. Before you spend your hard earned money on a procedure that will not deliver. Find a Board Certified Plastic Surgeon to discuss your rejuvenation concerns with... Please

Friday, June 23, 2006

Skin Deep; Do My Knees Look Fat to You?

by Natasha Singer (NYTimes)

The following article which appeared in the NY Times June 16, 2006, is poignant and timely. Ms.Singer's recent articles bring much needed awareness to the public regarding the considerations one should take before undergoing plastic surgery and the necessary qualifications, or lack thereof, that one should look for in the individuals providing plastic surgery.

As a board certified plastic surgeon, my reaction to this amusing article is that there is real danger in non-surgeons performing liposuction. You would never go to a plastic surgeon to have your baby delivered so why would you think it is okay to visit an Ob-Gyn to have liposuction? Moreover, mere weekend courses that an Ob-Gyn may take to learn the procedure simple cannot compare or replace a 5-10 year surgical residency. Surgeons are taught not only surgical technique, but more importantly, what to do in case of an emergency or complication.

Anecdotal story time again... I would like to share a well known story from my time at NYU Medical Center and Bellevue Hospital that drives home that Liposuction can meet with disaster. These two facilities maeke up the foremost plastic surgery teaching center in the world--which drives the point home even more... because if it could happen there it could happen anywhere!

During a resident case at Bellevue a Chief Resident was taking a Junior Resident through a liposuction case. During the surgery the tumescent cannula (This cannula is used to put fluid in to reduce bruising and bleeding) was placed through the abdominal wall and perforated the stomach!!

Luckily enough an Anesthesiologist Resident was also training his subordinate and teaching the proper placement of a nasogastric tube(used to suction the contents of the stomach). Upon insertion they got back a large amount of clear fluid... very unusual for a patient that had been fasting for surgery. This fluid was sent to the lab and came back with lidocaine the key component of the tumescent solution!!

Needless to say, it was realized here what error had occurred and surgery was performed immediately to close the hole in the stomach.

What is the moral?

Very simple... how would a Gynecologist who took a weekend class on liposuction even know how to recognize or handle this life threatening situatioin? ... and let's be honest--how would a Dermatologist be able to deal with this?

It is my opinion that only people that come from general surgery backgrounds be allowed to perform liposuction in areas where the complications of such operations require immediate surgical diagnosis and intervention. This is a patient safety issue and not a quality of results issue. I am sure that there are plenty of non-surgeons that perform adequate liposuction and their patients are satisfied. But it is just not safe.

My Golden Standard for patients:

Make sure your doctor has operative privileges at a hospital to perform the procedure they are offering you in their office operating room. If they do not then DO NOT HAVE SURGERY WITH HIM OR HER. FIND SOMEONE ELSE!


Do My Knees Look Fat to You?

LOVE handles, saddlebags, turkey wattle. Self-conscious women have been trying to reduce those body areas for years. But now, with more efficient diets and fitness routines, women are turning to more obscure anatomical zones. The newest worries? "Bra fat" and "back fat."

Buff Enough? Not yet? Micro liposuction can take a few ounces off the knees.
"I had a little roll of fat hanging over the back of my jeans, like a spare bicycle tire in the back," said Dana Conte, a bartender in Manhattan. It was so obvious that her mother constantly came up behind her and pulled her shirt down over it, Ms. Conte said. "When your mother is doing that, it means there's a problem."
Ms. Conte, 34, says she has an hourglass figure that attracts whistles as she walks along the street. To get rid of the back fat, she tried working out — "like a lunatic," she said — five days a week. Then, she enrolled in Weight Watchers. When neither worked, she turned to plastic surgery.
Last August, she had liposuction on her lower back around her waistline, and in January, she had liposuction again, this time on her mid- and upper-back to eliminate "bra fat," bulges that can occur when "your bra pushes lumps of fat down your back and up over the bra fastening and to the sides right near your arms," Ms. Conte said.
The total fee for both procedures, $10,000, was well worth it, she said.
Last year, Americans had about 455,000 liposuction operations, making fat removal the most popular cosmetic surgery procedure, according to the American Society for Aesthetic Plastic Surgery. But in the last two to three years, liposuction, once used predominantly to reduce the flabby abdomens, hips and thighs of average Americans, has become a tool to enhance the near-perfect body parts of the already fit.
For this designer-body approach, an increasing number of doctors are using a technique known variously as precision, selective or micro liposuction. The goal is to remove an ounce or three of fat from ankles, knees, chins, necks, backs and upper arms, according to some prominent plastic surgeons and dermatologists.
"This is mostly for people who do not need much work done," said Dr. Luiz S. Toledo, a plastic surgeon in São Paulo, Brazil, who has taught the technique to American surgeons at their annual medical meetings. "It's liposuction for skinny people."
But some sociologists and medical ethicists say that using liposuction — which can cause complications ranging from infection to death — for such tweaks raises profound questions about the increasing risks cosmetic doctors and patients are willing to take in the name of perfection. They say these microprocedures may signal a shift in beauty standards in which people come to regard the body the way they do their cars or kitchens: as an object able to withstand never-ending renewal and modification.
And they worry that the idea of precision liposuction carries an inherent suggestion that everyone should have surgery, even those who are already beautiful.
"The goal posts are changing so rapidly that what was once considered cosmetically unnecessary is now considered helpful," said Victoria Pitts, an associate professor of sociology at the City University of New York, who teaches a course called Sociology of the Body. "As calves, ankles, knees and even genitalia become zones of perfectibility, we will feel more and more pressure to get involved in projects that improve them."
Dozens of experienced American doctors have been performing precision liposuction for more than a decade. But in the last two to three years, hundreds of other doctors have been adding it to their surgical repertory because it seems easier to perform than it used to be and because more patients are asking for it, said Dr. Peter B. Fodor, a plastic surgeon in Los Angeles.
"Because our equipment has gotten better, surgeons who a few years ago would not have touched areas like kneecaps, inner thighs, back rolls, calves and ankles have extended their practices," Dr. Fodor said.
New types of ultrasound machines, which can be used to break up fat before it is extracted, and daintier cannulae, the blunt-tipped hollow tubes used to dislodge and suck out fat, have made it easier for doctors to fine-tune liposuction, Dr. Fodor said.
During liposuction operations, doctors anesthetize patients, inject a numbing solution and suction fat cells out of the body with a tube inserted into incisions in the skin. Patients may be sore and bruised for several days to weeks afterward, but doctors say results are permanent on the treated areas as long as patients maintain stable weight.
Because removing too much fat can be risky, medical societies do not recommend liposuction for the morbidly obese. But it has been widely used to reduce bulges on the merely chubby.
And now, as it has grown more precise, liposuction is attracting a new clientele of body-conscious people who want to improve physiques already honed by diet and regular exercise.

"Some of them are perfect 10's who want to be 10½'s," said Dr. Howard D. Sobel, a dermatologist in Manhattan whose liposuction patients have included models and personal trainers. "These patients' 'before' pictures are what patients in the past wished their 'after' pictures looked like."
One of Dr. Sobel's patients is Judy Goss, a former Ford model who works as a model agent. "By normal standards, I'm pretty skinny," said Ms. Goss, 38. She is 5-foot-10 and weighs 126 pounds, she said. "But my arms were getting a little flappy. I could feel it wiggle every time I shook hands."
Two years ago Dr. Sobel performed liposuction on her upper arms.
Dr. Lawrence S. Reed, the plastic surgeon who operated on Ms. Conte, the bartender, said some patients who choose micro liposuction want to reduce such negligible deposits that doctors can have trouble seeing the problem when the patients are undressed.
To pinpoint the little lumps of fat, Dr. Reed, who is based in Manhattan, asks patients to wear their favorite jeans or bra right before surgery so he can mark the areas with a pen.
Patients have developed their own nicknames for these obscure fat deposits. To help doctors understand the exact locations their patients are describing, the journal Dermatologic Surgery recently published an article titled "Lexicon of Areas Amenable to Liposuction." According to the article, patients are now asking for liposuction of the "buffalo hump" (upper back), the "wings" (bulges around the bra area), the "doughnut" (around the belly button), the "banana fold" (below the buttocks), the "piano legs" (calves) and the "chubb."
"Chubb is a Southern term for the kneecap area," said one of the article's authors, Dr. William P. Coleman III, a clinical professor of dermatology at Tulane University School of Medicine in New Orleans. He has not yet heard a colloquialism for ankle fat.
Even though these miniprocedures sound superficial, sometimes marketed as "lunchtime liposuction" or "liposculpture," they can cause medical and aesthetic problems. Possible complications include infection, scarring and perforated intestines.
Liposuction can also result in death from an overdose of anesthesia or from a pulmonary embolism in which clots block blood vessels in the lungs, Dr. Toledo said. He put the death rate from liposuction at one in 5,000 procedures in an article this year that appeared in the journal Clinics in Plastic Surgery. (Not all doctors agree on the risks: a survey by the American Society for Aesthetic Plastic Surgery estimated the death rate to be one in about 47,000 procedures.)
Dr. Fodor said operations for "lesser corrections" are technically and aesthetically more challenging because the areas that are not so fatty require more experience and wider anatomical knowledge. Ankles have superficial nerves and arteries that can be damaged, he said. Fat on the back or kneecap is very fibrous and can be difficult to remove evenly. And kneecaps have sac-like cavities that can be easily traumatized, Dr. Fodor said.
Doctors are grappling over where to draw the line. Last week Dr. Toledo saw a patient who wanted to have liposuction of her pubic area.
"In Brazil, bikinis are very small, and she complained that a little bit of fat stuck out over her bikini," he said. Dr. Toledo refused to do the surgery. He said removing the fat might make sex painful for her. "Sometimes a change is so small that it is not worth the time, money and risk."
Some medical ethicists are concerned that medical societies have not established standards or guidelines for doctors on what kinds of micro liposuction are too minor to be worth the risk. "Today the cutoff point is the pubic area, and what about tomorrow?" said Sheila M. Rothman, a professor of sociomedical sciences at the Mailman School of Public Health of Columbia University.
But Rosamond Rhodes, the director of bioethics at Mount Sinai School of Medicine, does not see an ethical concern. "Humans have always been willing to invest time, energy and risk in looking attractive, so I don't see smaller liposuction procedures as a sign of doom, gloom and the downfall of our culture," she said. "It's just medicine being used to address problems that it could not address before."
Still, Dr. Rothman worries that these tiny procedures may create a demand for serial liposuction in which patients come to view surgery as a maintenance technique, like fitness.
"We already have a model for this with Botox and Restylane, where people go to their doctors every few months to get another shot whenever they feel like it," Dr. Rothman said. "Maybe liposuction will become like a gym membership where you pay a doctor $10,000 for the year and you can have as much surgery as you want."

Monday, June 19, 2006

Medical Tourism - Leaving the American Medical System is Like Gambling In Vegas With Your Life on The Pass Line

It is interesting that International Societies have started to crack down on unscupulous surgeons performing surgery for discount prices. Below you will find such an article. Let me first tell you a great anecdotal story of a flight attendant that met a plastic surgeon in Costa Rica who convinced her to have surgery. This woman had a pulmonary embolism ( a complication that can happen here as well ) but she was in a country that was not a world leader in healthcare and needed to be medivac'd by ambulance jet back to United States where she nearly died in an Intensive Care Unit at one of the finest hospitals in the country.

Now...

What is the moral of this story?

It is pretty obvious...

Back in the days when I was the chief at the famous Bellevue Hospital we had poor souls arrive half dead at JFK airport with a note that read "take me to Bellevue" and their charts in a neat folder...

The moral...

Their is no such thing as a bargain when it comes to your health... People die in surgery and plastic surgery is not exclusive. When you choose a plastic surgeon this is where you have control over this variable... people be careful...

You wouldn't gamble your life in Vegas... why would you do it in South America?

Guidelines for Plastic Surgery Tourists, Techniques and risks
New York:


The International Society of Aesthetic Plastic Surgery (ISAPS), representing nearly1,500 of the world's leading board certified aesthetic plastic surgeons in 73 countries has launched its new website with the publication of the first ever comprehensive international guidelines for consumers traveling for plastic surgery procedures - commonly referred to as Plastic Surgery Tourism. http://www.isaps.org/www.isaps.org
The ISAPS guidelines, in development for nearly one year, reflect a growing consumer trend and were created to address the thousands of inquiries ISAPS has received from consumers, medical professionals, media and governmental organizations.
Dr. Joao Carlos Sampaio Goes of Sao Paulo, Brazil, the current President of ISAPS, championed these breakthrough guidelines as well as the new ISAPS website. "Consumers around the world have looked to ISAPS for over 30 years for the most accurate and reliable information about qualified plastic surgeons and advice about up-to-the-minute procedures. Now, for the first time, there is a worldwide standard for consumers to reference when traveling for aesthetic plastic surgery."
The Guidelines were developed under the direction of American plastic surgeon, Dr. Malcolm Paul, Clinical Professor of Surgery, Aesthetic and Plastic Surgery Institute, University of California, Irvine. "These easy-to-understand recommendations are the absolute first stop before anyone should consider traveling from home for plastic surgery," noted Dr. Paul

The key guidelines for plastic surgery travelers, Techniques and risks
What is the surgeon's training?

A gynecologist performing a breast augmentation or a dermatologist doing a face lift are not an appropriate choices.
Is the plastic surgeon certified?
The ISAPS website lists the names and addresses of nearly 1,500 certified plastic surgeons in 73 countries.
Is the surgery center or clinic certified?
Ask for certification information and who the certifying body is.
Does your personal health insurance cover you outside your country?
Most health insurance providers do not cover individuals for surgery performed outside their own country. Consider obtaining extra coverage.
What about aftercare?
Patients should stay in the area where the surgery was performed for at least one week, depending on the procedure. Find out in advance where you will stay and if this facility is prepared to care for your post operative needs.
What about complications?
What doctor will care for you at home if you have complications and who will pay for secondary or revision procedures?
Do the key personnel at the surgeon's office speak your language fluently?
If you cannot be understood fully, be prepared for complications.
With whom are you communicating?
You should be talking directly with the doctor's staff and the doctor. A travel agent should only make travel and accommodations arrangements.
Is the surgeon a member of recognized national and international societies?
ISAPS membership is by invitation only and is granted only after extensive screening.
Have you checked for references?
Ask for names and contact information of patients who have recently had a similar procedure and contact them about their experience with the surgeon, their staff, aftercare facilities and post-operative follow up.
Commenting on the new ISAPS website, ISAPS president-elect Dr. Bryan C. Mendelson of Melbourne Australia, remarked, "Information that was once only available to a few is now readily accessible to consumers in virtually every country. The ISAPS guidelines for plastic surgery travelers provide consumers with vital and perhaps even life-saving yardsticks to gage if the doctor they choose for their plastic surgery is appropriately trained and certified for the procedure they are considering."