Plastic Surgery News Commentary

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

2007-03-02T11:14:00.000-05:00

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

Allergan Set To Make Juvederm A Name

2007-02-09T12:40:00.000-05:00

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.

The Cry of Danger... Is it ENOUGH?

2006-09-17T20:06:00.000-04:00

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.”

Cosmetic Surgery Getting Out of Hand

2006-08-31T07:58:00.000-04:00

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.)

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

2006-07-06T13:16:00.000-04:00

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"

2006-07-06T12:38:00.000-04:00

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

Skin Deep; Do My Knees Look Fat to You?

2006-06-23T10:05:00.000-04:00

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."

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

2006-06-19T19:45:00.000-04:00

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."

Oprah boosts treatments, but . . .

2006-05-19T11:35:00.000-04:00

Here we go again with another case example of the dangers of our "Pop Culture Icons" legitimizing treatments to their audiences that are not as they appear. Look... Oprah is loved by so many viewers and I think the world of her but it is just innapropriate for her to send this message to her audience... What makes for entertaining television does not always equate to "good medicine".

Oprah boosts treatments, but . . .

HERALD STAFF AND WIRE REPORT

Few Americans had heard of a beauty treatment called Thermage until Oprah Winfrey began championing it on her talk show. Billed as a procedure to tighten skin, Thermage uses a radio-wave emitting machine to heat and expand collagen beneath the skin's surface.
In episodes with names like "How to Stop the Clock on Aging," "Look Younger! Live Longer!" and "Look 10 Years Younger in 10 Days," Winfrey introduced Thermage as one of the "latest cutting-edge treatments" and as a "lunchtime face-lift" that requires no recovery time.
About Face, a medical aesthetic clinic on Manatee Avenue in Bradenton, has a Thermage machine as well as a DVD of an "Oprah" episode touting the procedure. Patients can watch the video and peruse similar educational materials when deciding whether to go ahead with the treatment, said Diane D'Anca, a paramedical medical aesthetician there.
"Absolutely. Yes, I do" think Winfrey can influence her viewers to try new things, D'Anca said. "She can choose to do anything, obviously . . . and she looks awesome."
Thermage pricing at About Face starts at $2,600 and depends on the number of pulses stimulating the collagen in the skin. D'Anca suggests her patients receive enough stimulation to get the results they want.
The machine had a packed schedule late last week. D'Anca has had the machine for a year and a half and said only 25 percent of patients need the procedure done more than once.
Popular with women and men, the procedure takes about two-and-a-half hours. It stimulates new collagen growth with no surgery, injections or downtime, D'Anca said. "It's pretty much reshaping the future of skin care."
When Thermage was first showcased on "The Oprah Winfrey Show" in 2003, "the show drove so much interest that our sales reps were selling machines over the phone," said Stephen J. Fanning, president and chief executive of Thermage Inc., which sells machines to doctors for about $30,000.
And every time "Oprah" reruns one of its Thermage episodes, most recently last summer, traffic on the Thermage Web site (thermage.com) spikes to 30,000 hits for the day, Fanning said. Ten to 14 percent of the people who visit the site after seeing an "Oprah" episode end up visiting a doctor's office to have a facial procedure, at an average cost of $3,500, he added.
Winfrey's ability to create best-selling books with an endorsement on Oprah's Book Club is well known. Much less recognized is her Midas touch in the beauty industry. With an average of about 9 million viewers daily, the "Oprah" show drives enormous traffic to cosmetics counters, spas and doctors' offices when she endorses a product or a treatment, according to beauty industry executives.
"Getting on 'Oprah' is like winning the lottery," said Marianne Diorio, senior vice president of global communications for Estee Lauder. "Because her audience really trusts her, if Oprah or her producers sincerely fall in love with some product or person, the results can be spectacular," Diorio said.
The skin-care brand Philosophy was sold only in a handful of stores when Winfrey included its Hope in a Jar moisturizer in a 1996 episode. "She took this obscure little company and gave us national name recognition," said Cristina Carlino, founder of Philosophy. The brand now sells in Nordstrom, Macy's and Sephora stores and on QVC. Last December, when Philosophy Amazing Grace Shower Gel appeared on "Oprah," the product's monthly sales increased to 18,000 bottles from 3,000 the previous December, said Carlino, who calls her manufacturing plant "the house that Oprah built."
But a number of doctors say such an impact is more problematic when the beauty treatment being featured is medical, with possible complications, rather than simply a cosmetic or spa procedure. In its desire to be the first show to introduce the latest anti-wrinkle options, "Oprah" sometimes features treatments before doctors have determined how effective they are, who they are best suited for and how safe they are, according to some leading dermatologists and plastic surgeons.
"Cosmetic procedures are presented in a casual, cavalier fashion that gives people a false sense of security about safety," said Dr. Amy E. Newburger, a dermatologist in Scarsdale, N.Y., who is a consultant on the Food and Drug Administration's General and Plastic Surgery Devices Panel, a committee that issues recommendations on whether new devices should be approved.
Emphasizing that she offered her own opinion, not that of the agency, Newburger added: "Do you remember how angry Oprah was when she found out that fellow lied to her about his memoir?" She was referring to James Frey, the author of "A Million Little Pieces." "When is she going to get irate because these cosmetic treatments are not the risk-free procedures she was told they were?"
Lisa Halliday, communications director of Winfrey's production company, said in a statement: "Harpo Productions Inc., as the producer of 'The Oprah Winfrey Show,' presents to its viewers content that reflects research-supported emerging products and procedures."
A critic, Dr. Roy G. Geronemus, a clinical professor of dermatology at New York University Medical Center, said that medical procedures were presented on the show as "a gross oversimplification."
"People see a physician on 'Oprah' touting a new procedure," he added, "and they think that if it's coming from Oprah, it must be gospel."
He said segments that presented more than one doctor's view of a new technology would better serve viewers. Most important, the show should explain that some cosmetic procedures are so specialized that they are best performed by doctors with extensive formal training in facial anatomy and not by general practitioners or nurses.
In 2004 "The Oprah Winfrey Show" gave the first major television exposure to the facial thread lift, in which threads made of surgical suture material are embedded in the face and used to hoist lax tissue. Winfrey called it "a cutting-edge procedure with no cutting edges" on the show.
Dr. Karyn Grossman, a dermatologist in Santa Monica, Calif., and New York City, said she had just learned the thread-lift technique when she demonstrated it on "Oprah." Winfrey's producers "are interested in getting something out the door first before it has been shown elsewhere," said Grossman, who has had positive results performing the lift on her own patients.
Since that show was broadcast, doctors have reported complications from thread lifts including scarring, indentations, bunching, dimpling, broken or lapsed threads, and asymmetry, said Dr. V. Leroy Young, a plastic surgeon in St. Louis who is the outgoing chairman of the emerging trends task force of the American Society for Aesthetic Plastic Surgery.
Thirty of 51 plastic surgeons Young polled at the society's annual meeting in April said they thought thread lifts created more problems than benefits, he said. The "Oprah" show reran the original thread lift episode last August.
"Oprah is well-intentioned, and she doesn't give bad advice," Young said. "But if she told viewers that arsenic would make them beautiful, we'd be getting hundreds of calls from people asking us for arsenic."
In the case of Thermage, the skin-tightening procedure, the dermatologist Dr. Patricia Wexler first presented it on the "Oprah" show in 2003. Wexler, who is based in New York City, told viewers that after a patient had a Thermage treatment, "the jaw line gets tighter and tighter, just like a neck-lift." But earlier this month she said it is impossible for doctors to predict how well the treatment will work on an individual patient.
"I tell patients it's never a strikeout or a home run, but everyone will get on base, we just don't know which base ahead of time," she said.
Since the FDA approved the treatment for use on eye wrinkles and folds in 2002, Americans have had about 125,000 Thermage procedures and about 1,000 of the machines have been sold, according to Thermage Inc. of Hayward, Calif.
The agency has collected 172 reports from doctors and patients of problems caused by Thermage, including facial burns and indentations.
Fanning, the chief executive of Thermage Inc., said in a statement that no medical procedure is risk-free and "99.8 percent of the treatments have had no adverse reports."
But Dr. Gary Motykie, a plastic surgeon in Los Angeles who has become a specialist in treating burns caused by Thermage treatments, said the "Oprah" show should make viewers aware of problems associated with new beauty devices. One of his patients who had the treatment after seeing it on "Oprah" came to him with indented craters and ripples in her face and neck where the procedure melted the underlying fat, he said.
"The patient wanted to know how this technology could get on TV," said Motykie, whose practice does not offer Thermage.
Wexler suggested a possible answer. "I always say these shows are too dreamy," she said. "They never talk about the bad because the bad doesn't sell."
Natasha Singer of the New York Times News Service wrote this report, with local inserts by Herald reporter Tiffany St. Martin.
Local Thermage availability

Introducing My Weekly Celebrity Dissection -- This Week: Burt Reynolds

2006-05-09T20:14:00.000-04:00

BEFORE:
AFTER:
What he had done...

-Facelift
-Upper and lower eyelid blepharoplasty
-Brow lift
-Rhinoplasty

Too Much Work? Yes

Commentary:
Burt has too much tightness/pull in his face and too much lateral brow height, which gives him unnatural look at any age (especially since he is now almost 70 years old).- In men the brow should sit over the bony ridge at the top of the eye socket. In his case the brow sits at a height that is well above the ridge and is more appropriate for that of a woman.Great Plastic Surgery leaves you looking "NATURAL" (http://www.outer-beauty.com)

American Board of Medical Specialties®

2006-04-30T16:15:00.000-04:00

(The American Board of Medical Specialties was created for the safety and protection of patients and monitors the quality of a surgeon’s medical education. It’s resolved to initiate the qualifying requirements for applicants requesting certification, regulate comprehensive examinations, and present certification to those who meet the established requirements)

Find Out If Your Doctor Is Board Certified

http://www.abms.org/login.asp

American Board of Medical Specialties Member Boards

Allergy & Immunology510 Walnut StreetSuite 1701Philadelphia, PA 19106-3699(215) 592-9466
Anesthesiology4101 Lake Boone TrailSuite 510Raleigh, NC 27607-7506(919) 881-2570
Colon & Rectal Surgery20600 Eureka Road Suite 600Taylor, MI 48180(734) 282-9400
DermatologyHenry Ford Health System1 Ford PlaceDetroit, MI 48202-3450(313) 874-1088
Emergency Medicine3000 Coolidge RoadEast Lansing, MI 48823-6319(517) 332-4800
Family Medicine2228 Young DriveLexington, KY 40505-4294(859) 269-5626
Internal Medicine510 Walnut Street, Suite 1700Philadelphia, PA 19106-3699(215) 446-3500
Medical Genetics9650 Rockville PikeBethesda, MD 20814-3998(301) 634-7316
Neurological SurgerySuite 21396550 Fannin StreetHouston, TX 77030-2701(713) 441-6015
Nuclear Medicine4555 Forest Park Blvd., Suite 119St. Louis, MO 63108(310) 825-6787
Obstetrics & Gynecology2915 Vine Street, Suite 300Dallas, TX 75204(214) 871-1619
Ophthalmology111 Presidential Blvd, Suite 241Bala Cynwyd, PA 19004-1075(610) 664-1175
Orthopaedic Surgery400 Silver Cedar CourtChapel Hill, NC 27514(919) 929-7103
Otolaryngology5615 Kirby Drive, #600Houston, TX 77005(713) 850-0399
PathologyP.O. Box 25915Tampa, FL 33622-5915(813) 286-2444
Pediatrics111 Silver Cedar CourtChapel Hill, NC 27514-1651(919) 929-0461
Physical Medicine & Rehabilitation3015 Allegro Park Lane SWRochester, MN 55902-4139(507) 282-1776
Plastic SurgerySeven Penn Center, Suite 4001635 Market StreetPhiladelphia, PA 19103-2204(215) 587-9322
Preventive Medicine330 South Wells Street, Suite 1018Chicago, IL 60606-7106(312) 939-2276
Psychiatry & Neurology500 Lake Cook Road, Suite 335Deerfield, IL 60015-5249(847) 945-7900
Radiology5441 East Williams Blvd., Suite 200Tucson, AZ 85711(520) 790-2900
Surgery1617 John F. Kennedy Blvd., Suite 860Philadelphia, PA 19103-1847(215) 568-4000
Thoracic Surgery633 N. St. Clair St., Suite 2320Chicago, IL 60611(312) 202-5900
Urology2216 Ivy Road, Suite 210Charlottesville, VA 22903(434) 979-0059

ABMS Associate Members
Accreditation Council for Graduate Medical Education 515 North State Street, Suite 2000Chicago, IL 60610-4322(312) 755-5000
Accreditation Council for Continuing Medical Education515 N. State StreetSuite 7340Chicago, IL 60610(312) 755-7401
American Hospital AssociationOne North FranklinChicago, IL 60606-3421(312) 422-3000
American Medical Association515 N. State St.Chicago, IL 60610(312) 464-5000
Association of American Medical Colleges2450 N Street, N.W.Washington, D.C. 20037-1126(202) 828- 0400
Council of Medical Specialty Societies51 Sherwood Terrace, Suite MLake Bluff, IL 60044-2232(847) 295-3456
Educational Commission for Foreign Medical Graduates3624 market StreetPhiladelphia, PA 19104-2685(215) 386-5900
Federation of State Medical Boards400 Fuller Wiser Road, Suite 300Euless, TX 76039-3855(817) 868-4000
National Board of Medical Examiners3750 Market StreetPhiladelphia, PA 19104-3190(215) 590-9500

American Board of Cosmetic Surgery Application For Board Equivalency Is Denied By Medical Board Of California

2006-04-30T15:29:00.000-04:00

(Excellent Example of Local Government Setting a Standard
That Should Be Instituted Nationally)

American Board of Cosmetic Surgery Application For Board Equivalency Is Denied By Medical Board Of California
EL SOBRANTE, Calif., Dec. 02 /PRNewswire/ --
EL SOBRANTE, Calif., Dec. 2 /PRNewswire/ -- In order to avoid patient confusion in selecting a qualified doctor, it is illegal in the State of California for a physician to advertise as being board certified unless that board is recognized by the American Board of Medical Specialties (ABMS) http://www.medbd.ca.gov/Specialty.htm or is deemed to be equivalent to an ABMS board by the Medical Board of California. However, a board that does not have this status can be recognized in California, if they demonstrate that their training program is equivalent in scope, content, and duration to an ABMS board. The American Board of Cosmetic Surgery (ABCS), currently not recognized as equivalent to an ABMS board, submitted an application to the Division of Licensing of the Medical Board of California (MBC) to be deemed equivalent.
Following strong opposition by the California Society of Plastic Surgeons (CSPS), the Division of Licensing of the Medical Board of California (MBC) voted unanimously, 7-0, to deny the application of the ABCS to be deemed equivalent to an ABMS Board. The vote occurred Friday afternoon, November 4, 2005, in San Diego.
news230();

President of the Licensing Division, Richard Fantozzi, MD, ruled that each side would be given 20 minutes for its presentation. Dr. Fantozzi gave ABCS the opportunity to go first. ABCS used the first portion of its 20 minutes for testimony from an out of state surgeon certified by the American Board of Cosmetic Surgery stating in his opinion that ABCS' training was equal or superior to ABPS training. The second portion of their testimony concentrated on attempting to refute the conclusion of MBC's expert reviewer, Ronald Tompkins, MD, that ABCS was not equivalent.
Dr. Tompkins' report had concluded that granting board certification to three different categories of physicians - general cosmetic surgery, facial cosmetic surgery, and dermatologic cosmetic surgery - was inconsistent with any ABMS board, and that the dermatologic cosmetic surgery requirements were deficient in surgical training.
ABCS's rebuttal to the Tompkins report endeavored to demonstrate that dermatologic training included substantial training in surgery, and they presented several experts to present arguments to that effect.
CSPS' opposition followed. Testimony was provided by Malcolm Paul, M.D, President of CSPS; Robert Singer, M.D.; Steve Teitelbaum, M.D.; Jim Randlett, Legislative Advocate for CSPS; and Bob Aicher, Attorney for American Society for Aesthetic Plastic Surgery (ASAPS). Below is a brief outline of the testimony follows:
1. CSPS provided legislative history, stressing the requirement in regulation that the Division "ensure" that ABCS is equivalent, and repeating the finding of MBC's expert reviewer, Dr. Tompkins, that ABCS was not equivalent. 2. CSPS presented a letter from ABMS stating that ABCS was not equivalent, and repeating CSPS' core arguments in opposition. 3. CSPS presented information demonstrating that many ABCS members were advertising "board certification" in violation of the law, and that a significant number of ABCS members had disciplinary actions taken against them by MBC. 4. CSPS presented information that rebutted the ABCS argument that dermatologists have adequate surgical training, showing that all but two ABCS members would be qualified as "board certified" by virtue of the number of unsupervised procedures performed (as opposed to completing a "fellowship" program). 5. CSPS presented information demonstrating that from CSPS' standpoint, the majority of ABCS members and training directors are performing surgeries outside of their area of certification, in violation of ABCS' own rules.
Once CSPS completed its testimony the Division recessed to go into a meeting with the full Board, and re-convened 20 minutes later. When they re- convened, the Division gave ABCS a few minutes to rebut CSPS' arguments, followed by a similar opportunity for CSPS.
Dr. Fantozzi then asked for comments by the members of the Division. After little discussion Dr. Fantozzi moved that the application be denied. The vote was unanimous to deny the application. The Division of Licensing felt that the ABCS was not equivalent to an ABMS Board.
California Society of Plastic Surgeons
CONTACT: Tim Madden of California Society of Plastic Surgeons,+1-916-447-6555, ext. 3
Web site: http://www.surgery.org/

WHY?

2006-04-30T14:43:00.000-04:00

(a statement to the press)
I felt it was important to bring to the public’s attention the difference between a cosmetic surgeon and a plastic surgeon. These differences are tremendous, and are often misunderstood by the public. Plastic Surgery is one of 24 recognized subspecialties of the American Board of Medical Specialties whereas cosmetic surgery is not. The American Board of Medical Specialties was created for the safety and protection of patients and monitors the quality of a surgeon’s medical education. It’s resolved to initiate the qualifying requirements for applicants requesting certification, regulate comprehensive examinations, and present certification to those who meet the established requirements. Unfortunately, in most states, including New York, a licensed physician may perform cosmetic procedures without being board-certified or eligible in plastic surgery. It is my opinion that this should not be the case, and certainly no public figure should ever endorse any physician as an expert that does not meet these basic requirements.

http://www.abms.org/
http://www.abms.org/Downloads/Monthly_Articles/Board_Certified.pdf

The Market of Plastic Surgery: Cosmetic Surgery for Sale-At What Price?

2006-04-30T14:34:00.000-04:00

(Here is a great article that explains why every Board Certified Plastic Surgeon will not give away Breast Implants on the Radio)

Plastic and Reconstructive Surgery: Volume 107(7) June 2001 pp 1845-1847

The Market of Plastic Surgery: Cosmetic Surgery for Sale-At What Price?
Rohrich, Rod J. M.D.
Dallas, Texas
Rod J. Rohrich, M.D.
Co-editor, Plastic and Reconstructive Surgery
Department of Plastic and Reconstructive Surgery
UT Southwestern Medical Center
5323 Harry Hines Boulevard, Suite E7.210
Dallas, Texas 75390-9132
rod.rohrich@utsouthwestern.edu

Recently, I was struck by how creative the marketing of cosmetic plastic surgery has become. It is no wonder that despite living in a sophisticated environment like Dallas, patients remain confused by what it means to be board certified in plastic surgery. In this instance, an individual who claimed that he was a cosmetic surgeon (but was actually an obstetrician-gynecologist) was offering free breast-augmentation surgery in a contest hosted by a local radio station. The marketing strategy was to entice young women to expose their breasts on the radio station's Web site so that they could be judged as the person most in need of a breast augmentation. The winner of the contest was awarded the prize of a complimentary breast augmentation by a cosmetic surgeon in an office-based surgical facility.
Once this prize is awarded, this winner now becomes the patient of a physician whom she does not know. Can this be classified as a true patient-physician relationship? What if she is not a good candidate for this procedure or is not psychologically prepared? What happens if the patient finds out that the procedure is being performed in someone's office that may or may not be an accredited office-based operating facility? How will she respond when she learns that her cosmetic surgeon is not a board-certified plastic surgeon?
For members of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS), such activity is a direct violation of these societies' ethical codes. The bylaws specifically state that any member who participates in a charity raffle, fundraiser, event, contest, or other promotion for which the prize is any procedure is in direct violation of the code of ethics and will be subject to due-process hearings. Of course, this has little meaning if one is not a board-certified plastic surgeon! More important issues, however, are patient safety and the potential for misleading a patient regarding the physician's qualifications to perform a given cosmetic procedure.
Why is this now occurring in the United States? During the year 2000, more than 2.2 million cosmetic and reconstructive plastic surgery procedures were performed by board-certified plastic surgeons. This was an increase of 175 percent from 1992 for cosmetic procedures alone. As fee-for-service medicine has been transformed to its lowest common denominator-managed health care-it has left patients struggling for proper patient care and physicians struggling for survival. Many physicians are now turning to cosmetic surgery as a way to supplement their income. Is this good for the quality of care that we deliver to a cosmetic surgery patient? I think not!
How does a board-certified plastic surgeon market ethically and stay competitive in cosmetic surgery? Every day we see billboards on our major expressways, signs on the back of transit buses, and promotional spreads in local magazines marketing our trade. For many, marketing our practices has become necessary. The question then is, how do we ensure ethical marketing? ASPS recently highlighted ethical marketing through its Plastic Surgery Education Campaign's broad-based and far-reaching programs. This public service campaign was coordinated on a national basis by ASPS, whose members all are board-certified plastic surgeons.
How will this national campaign help the individual plastic surgeon get more patients into his or her office? The era of merely having a Yellow Pages advertisement or a Web site, no matter how large, is no longer enough. It seems timely and appropriate to educate the public. As we talk to our patients, we have a perfect opportunity to educate them about plastic surgery. 1 The following points are plain and simple yet very important and cogent. They should be included in your marketing materials and reiterated to patients, especially during the initial office consultation.
* As more and more Americans have plastic surgery, the most important part is choosing the proper board-certified plastic surgeon. It has been shown 2 that most patients spend more time picking out a pair of shoes than they do selecting a plastic surgeon for cosmetic surgery.
* Practitioners must have a medical license. Today, individuals with dental degrees are performing cosmetic surgery of the face and body. I find it interesting that they rarely inform their patients of their nonphysician status or explain that their primary board certification is in dentistry.
* Having completed an approved and accredited plastic surgery residency training and becoming board certified in plastic surgery are good indications that physicians are properly credentialed. If they are board certified by the American Board of Plastic Surgery (ABPS), the patient can be assured that the physician has done the following:
* Graduated from an accredited medical school.
* Completed at least 5 years of surgical residency training, usually 3 years of general surgery and 2 years of plastic surgery.
* Practiced plastic surgery for 2 years.
* Passed comprehensive written and oral examinations covering both the cosmetic and the reconstructive areas of the specialty of plastic surgery.
* Patients should know and look for the symbol of membership in the ASPS or the ASAPS. Both ASPS and ASAPS members are certified by the ABPS, one of 24 member boards of the American Board of Medical Specialties. 3,4 The training and experience of these members uniquely qualifies them to perform cosmetic and reconstructive plastic surgery of the face and all areas of the body.
* Safety is a major issue for all patients in plastic surgery. Both of our major societies (ASPS and ASAPS) have modified their bylaws to require members to perform surgery requiring anesthesia (other than minor local anesthesia) in a facility that meets one of the following criteria:
* Accredited by a national or state-recognized accrediting agency/organization such as the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or the Joint Commission on Accreditation of Healthcare Organizations.
* Certified to participate in the Medicare program under Title XVIII.
* Licensed by the state in which the facility is located.
* If a patient is to have surgery in an office-based facility, then it behooves him or her to ask whether the surgeon has hospital privileges to perform the same procedure in an accredited hospital. This assures the patient that the surgeon is credentialed and subject to peer review.
* What defines experience? Surgeons who market themselves as having performed thousands of procedures could be including simple mole removals. There is no magical number of procedures performed or length of time in practice that defines experience. People must feel comfortable that the surgeon is well trained and up-to-date on the procedure being performed.
* Patients should interview their plastic surgeon in the same way that their surgeon interviews them. Is the surgeon being forthright in presenting options, potential risks, and possible complications to the patient? Are these issues discussed at length until the patient is satisfied that he or she has all of the information needed to make an informed decision?
What can you do as a plastic surgeon? My residents and colleagues often ask me how they can compete with other specialties in the arena of cosmetic surgery and with other plastic surgeons who have aggressive marketing campaigns. The answer is that the evolution of plastic surgery in your practice is much like your life. It is not a sprint, but a marathon! We must learn to pace our personal and professional growth. We all must look at ourselves in the mirror in the morning as we prepare to work in our chosen profession that we love. We must be honest and ethical in representing ourselves, not only to our patients but also to our profession. We have already committed a large portion of our lives in becoming board-certified plastic surgeons, and our continued learning and critical self-analysis are necessary to maintain the highest level of competency and proficiency. In the long run, how we skillfully and ethically practice the art of plastic surgery will always speak louder than any words. The key element is to work out a long-term strategy of marketing our practice internally and externally. The following are suggestions to assist in this process 5 :
* Create a focused mission statement for your practice.
* Become a patient in your own office. Make your practice user-friendly.
* Empower your office staff as your representatives. There should be no weak link in your chain of excellent patient care.
* Do not underestimate the word-of-mouth power of your patients.
* Let patients know all about your services through newsletters, brochures, and your Web site.
* Become involved locally and speak to community, hospital, and auxiliary service organizations.
* Take care of your practice champions (patients who refer patients repeatedly). Make them a part of your internal marketing strategies.
* Exceed patients' expectations and experiences with their initial consult and preoperative and postoperative care.
* High tech still means high touch. Establish a useful and helpful personal Web site with links to your local, state, regional, and national societies' (ASPS and ASAPS) Internet addresses.
* Greet your patients with a handshake, and sit down during your patient consultation.
* Survey your patients periodically about your practice.
* Develop effective communication skills to improve your ability to listen to your patients.
* Provide your patients with visual and educational materials before their initial visit.
* Manage your schedule so that you are on time. Avoid delays, and entertain patients while they wait. If you are late, notify your patients so that they can make an informed decision to wait or to reschedule.
* Use your own or your societies' brochures or newsletters to communicate your areas of expertise.
* Become a cost-effective practice in a managed-care environment.
* Pick one objective that allows you to measure and track your results.
* Work cooperatively with a motivated and talented staff. Reward them for their merit and loyalty to you, your patients, and your practice.
* Develop and maintain a positive image of your practice regionally and nationally.
* Enjoy yourself, and instill humor in your practice. Like your life, your practice is not a dress rehearsal.
So, the next time you are asked to provide a free procedure as a prize for a contest or a charity or are asked to market yourself on the Internet or a radio station to an uninformed, anonymous patient, think again! Look in that mirror and ask, Is this how I want to present myself to my patients, my colleagues, and my profession?
references
1. American Society of Plastic Surgeons. Talking Points on Credentials. Washington, D.C.: ASPS, 2001.
[Context Link]
2. Rohrich, R. J. The increasing popularity of cosmetic surgery procedures: A look at statistics in plastic surgery. Plast. Reconstr. Surg. 106: 1363, 2000.
[Fulltext Link] [CrossRef] [Context Link]
3. Rohrich, R. J. The Web and your cosmetic surgery practice. Plast. Reconstr. Surg. 107: 1253, 2001.
[Fulltext Link] [CrossRef] [Context Link]
4. Rohrich, R. J. So you are board-certified in plastic surgery: What it means in the new millennium. Plast. Reconstr. Surg. 105: 1473, 2000.
[Fulltext Link] [CrossRef] [Context Link]
5. Rohrich, R. J. The 20 commandments of marketing. In W. Erhardt, G. Borah, B. Shack, and J. Wells (Eds.), Marketing Your Cosmetic Practice Resource Guide. Arlington Heights, Ill.: ASPS, 1997.
[Context Link]

BATTLE OF THE BOOB SURGEONS

2006-04-30T14:28:00.000-04:00

April 30, 2006 -- WAR has broken out between Howard Stern's favorite cosmetic surgeon, Philadelphia-based Dr. Sal Calabro, and Upper East Side plastic surgeon Dr. Andrew Klapper(http://www.outer-beauty.com), who claims that Calabro doesn't deserve the glory of being Stern's prized mammary maestro.
Klapper kicked off the silicone smackdown when he fired off e-mails questioning Calabro's credibility to former Stern show regular Chaunce Hayden, who was nice enough to forward the missives to Page Six. When we contacted Calabro - best known for performing breast augmentation on women who win contests on Stern's show - and told him about Klapper's trash-talking, Calabro promptly issued a challenge:
"If he wants to take me on, I will meet him in Howard Stern's studios and tell him to bring his surgery records for the past five years," a steamed Calabro told us. "I'm sure I do much better work than he does. Tell him to bring his last 500 facelift pictures and I will bring mine and we'll compare them. He'll [bleep] his pants."
But Klapper shot back, "I'm not interested. I'll be judged by my peers. I'm a serious plastic surgeon. I just don't think that someone who's an ophthalmologist is being recognized on the radio as a breast expert. That's just my opinion." (Calabro counters that he did his residency in dermatology and dermatologic surgery, and that he's been a cosmetic surgeon for many years.)
Calabro - whose racy Web site features him frolicking with bikini-clad women and a quote from Playboy describing him as "the most recognized cosmetic surgeon in the country" - said Klapper is jealous of his success. "All I do is cosmetic surgery," Calabro crowed. "I get paid in advance. He has to bill people. If he treats someone's bed sore, he has to bill the insurance company and wait six months to get paid."
Klapper - who admits he was once in talks with Hayden to appear on Stern's show for a contest called "Bobbing For Boobs," in which women would bob for implants in a tank of water - says he isn't interested in a "p--ing match" with Calabro.
"I do a lot of cosmetic surgery," he said. "I don't want to talk about his work. The only thing I was commenting on was that he's not a plastic surgeon, which he does not deny."
We'll give the final word to Calabro, who called Klapper "a pimple on the ass of cosmetic surgery."

The Rise of the In Office Procedure... to Look Good in the Office...

2006-04-26T14:24:00.000-04:00

News:
The American Academy of Facial Plastic and Reconstructive Surgery reports that from 2000 to 2004, the number of facial plastic surgery procedures and injections increased 34%.
In 2004, the academy found that 22% of men and 15% of women who had plastic surgery did so for business purposes

In 2004, the academy found that 22% of men and 15% of women who had plastic surgery did so for business purposes.

Previous studies in the US have indicated that attractive and younger-looking people are more successful and earn more.

Commentary:
It has become quite clear that more and more patients have been coming in for procedures to be more competitive in the job market. With this comes the danger of idealizing that all of one's personal and career problems can be solved through surgery. I have always taken the attitude that plastic surgery does the best in patients that do base their success in life or in business around their results. What happens when you look more youthful but you still don't get the job?
(http://www.outer-beauty.com)

I have found that minor in office procedures that can be done with little or no downtime are favored by the busy professional. Botox to wrinkles and soft tissue fillers such as Restylane, Radiesse and Captique to soften smile lines or blunt deep nasolabial folds can take years off the face.(http://www.wrinklescure.com for some before and after photo examples)