In the News

The numbers are in from the American Society of Plastic Surgery and it looks like we are making our way out of the recession, one surgery at a time. If your neighbor’s face is looking a bit more symmetrical than it used to; he or she could have been one of the 243,000 people that had a rhinoplasty (nose reshaping) in 2011. Breast augmentations are still leading the way with over 300 thousand procedures performed in 2011.

What do these numbers really mean? If you compare the statistics of 2011 with those from 2000, trends in health, beauty and finances become very apparent.

Weight gain and extreme weight loss has increased:  Weight Loss procedures are up – 3,000% up in fact.  Procedures to remove excess skin after a significant weight loss (100 pounds or more) include lower body lifts (up 3,579%); upper arm lifts (up 4,337%) and buttock lifts (up 235%).

Patients are looking for a less expensive, quicker treatment: Aside from the increase in surgical procedures, the minimally-invasive non-surgical treatments are showing even more growth. Total minimally-invasive procedures are up 123% with Botulinum Toxins (Botox and Dysport) being the top seller with over 5.6 million patients treating their wrinkles.

We’re taking our skincare more seriously: Laser skin resurfacing procedures to treat hyperpigmentation from sun exposure, rosacea, acne scars and fine lines have increased from 2000 to 2011 over 170%.

What will the numbers have to tell us in 2020?

Breast reconstruction has been in the news lately due to the announcement of E! News star Giuliana Rancic’s breast cancer and double mastectomy.  Giuliana opted for an immediate breast reconstruction procedure following her mastectomy. Fans of the E! star are praising her choice to share her experience with the world and bring awareness to breast reconstruction.  Chances are many of us aren’t familiar with the procedure.

Most women undergoing a mastectomy are given the option of breast reconstruction to rebuild the size and shape of the removed breast(s).  Many women (like Giuliana) chose to reconstruct the breast immediately following the mastectomy (during the same surgery).  There is also an option to hold off on reconstruction and perform it at a later time.

Whether the procedure is performed immediately or down the road, there are two basic options for breast reconstruction:  the use of implants or your own body’s tissues:

Breast Reconstruction with Implants

After a mastectomy, the breast skin is not thick or strong enough to hold a reconstructive implant.  The plastic surgeon therefore inserts a special temporary implant called a tissue expander behind the major muscle on the chest wall. This expander is needed to stretch the chest wall muscle to make a pocket for the breast implant.

Over a period of several months, saline is injected into the expander, slowly expanding the chest wall pocket. When the pocket is fully expanded, the device is removed and a breast implant is placed in the new pocket.  Other secondary operations may be performed at the same time or later, such as nipple reconstruction.

Immediate Reconstruction with Your Own Body’s Tissue

The body’s own tissues can also be used to reconstruct the breast.  Your surgeon will remove tissue from certain areas of the body and use those to reconstruct the breast.  Tissues (skin, fat, and muscles) can be taken from the abdomen (DIEP Flap/Free Flap); the back (Latissimus Flap) or buttock (Gluteal Flap).  In some cases there isn’t quite enough tissue and a small implant is added to give enough volume.

As Giuliana Rancic stressed during several interviews, her decision to have a double mastectomy and breast reconstruction was all hers. Patients referred to plastic surgeon Dr. Franckle learn all of their options at the time of consultation.  Every effort is made to give you a choice between simple and more complex procedure, depending on medical needs and your wishes for the final result.

Plastic surgeons are jumping on the bandwagon of “Daily Deal” websites like Groupon and Living Social, offering deep discounts on lasers, Botox and filler treatments. Doctors want to get new patients in the door and consumers are getting a great deal on a treatment. Sounds like a win-win, right?

Daily Deal websites are a great promotion tool for many products and services, but for plastic surgery they are just too risky.

The number one concern with these websites is the lack of proper screening for the patient.  You have limited time to purchase these deals and that leaves little time to research and no time to visit the doctor to see if you are a candidate.  With any plastic surgery treatment screening the patient is an extremely important part of the job. A doctor needs to see you face to face, discuss what are looking to treat and if your expectations are realistic. Everyday patients can be turned away from our office simply because they are not candidates for the treatment they are seeking. Or even more commonly patients come into our office thinking they need a Botox treatment and it turns out they really need a series of laser treatments. You never really know until you see the doctor.

Secondly, when a patient purchases a deal they may feel pressured to undergo the treatment no matter what because they already paid for it. (And returning the “deal” is not a quick or easy process). At the same time, one worries that a doctor may feel obliged to perform the treatment (whether or not the patient is a candidate) because they already purchased the services.

We get it – you want to save some money. Understandable. Here is a better way to save money. Become a fan on Facebook, follow us on Twitter, subscribe to our newsletter – we’ll keep you informed of the new developments in plastic surgery. You will also see promotions on non-surgical treatments offered from time to time as a special thanks to you, our patient. The essential difference is – you will not be required to pre-purchase a treatment for which you may not be a candidate for or not even need.  This way, you can rely on us to keep your best interests as our only consideration.

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We would venture to bet that anyone who suffers from migraines is willing to explore just about any treatment to obtain relief from the pain.  The symptoms of migraine (pain, photosensitivity, and nausea) are keeping 30 million Americans miserable for up to a day or even more.  Medication is still considered the only effective solution to conquer these debilitating symptoms, but a plastic surgery procedure has recently been publicized as a revolutionary way to treat migraines.  How?   Supporters are claiming that the glabellar muscles (muscles between the eyebrows) and related nerves which are surgically removed during a browlift are removing a trigger point which can cause migraines.

It has followed that the non-surgical procedures using the botulinum toxins such as Botox Cosmetic, Dysport, and Xeomin, have also made similar claims in being effective in the treatment of migraines.  These popular treatments work to block those same nerves resulting in paralysis of the glabellar muscles.  It was only a matter of time before some doctors starting connecting the two.

All of these claims came about by circumstance; patients receiving a browlift or botulinum toxin treatment that had previously suffered from migraines were claiming that their migraines were cured.  These patients turned to their doctors for answers as to why this happened.  Thus, the connection was made. So far, however, these claims have not stood the test of extensive medical analysis.

So where is allthis buzz coming from? NewBeauty.com performed their own study with 49 migraine sufferers.  The patients underwent a Botox Cosmetic treatment followed by a brow lift procedure and found that 57% had their headache symptoms completely eliminated.

That study may have encouraging numbers but this is not in-depth research!  It would be wonderful if botulinum toxin treatment is eventually proven to be an effective treatment for migraine sufferers.   It is a simple, safe, non-surgical treatment and would likely be well-tolerated by migraine patients.  Until then, it is considered experimental and will not likely be covered by insurance.   My opinion is to watch and wait.  This is currently under investigation by many reputable scientific groups.  Until then, we may just have to call the patients in NewBeauty’s study lucky.

NewBeauty.com Article: http://www.newbeauty.com/dailybeauty/entry.aspx?id=2468

Articles released this week from USA Today have brought attention to the number of physicians performing cosmetic procedures without formal training.  One article highlights a self-taught non board-certified surgeon who regularly teaches a weekend course in breast augmentation.  Interestingly, this surgeon never completed any plastic surgery training nor did he qualify for board certification in any recognized specialty.  For $7,000, this “surgeon” taught as many as 6 untrained doctors every weekend in how to perform his augmentation operation, sometimes with disastrous consequences. This doctor came to light in lawsuits alleging malpractice by some of his “graduates.”   Unfortunately for patients, this is likely the only way non plastic surgeons can learn cosmetic techniques.

Another feature is low-cost, high volume cosmetic surgery centers; following Elsie Soto (among others) through her unhappy experience with this type of center. These medi-spas contain countless doctors, large medical staffs and are lacking in the doctor-patient relationship. The articles are not meant to frighten patients or discourage them from plastic surgery, but instead to remind them that faster and cheaper may not mean better.

“…making cosmetic surgery affordable for the masses.”

Soto visited several plastic surgeons before choosing Strax Rejuvenation and Aesthetics Institution. She chose Strax because the cost they quoted her was less than 50% of what other doctors had told her.  At these large clinics, to keep prices down, doctors are overfilling their schedules instead of giving themselves adequate time with each patient to be sure the procedure is down correctly.

Soto felt she was “just another patient … in what seemed like an assembly line of patients.”

Large cosmetic surgery centers are juggling high volumes of patients every day.  In many cases, the doctor you meet with for a consultation isn’t the doctor who performs your surgery.  Soto compared these large practices to a Denny’s restaurant, with patients funneling in and out all day.

“…claims about the low risk, dramatic results and short recuperations time are misstated.”

A highly publicized quick-fix procedure, The Lifestyle Lift, is under investigation by the Florida attorney general for this very reason.  There is no such thing as a “quick fix surgery.”  These procedures have risks, demand recovery time. They can have dramatic results, but that won’t happen overnight.

“Doing procedures in office surgery centers saves money, something that many consumers…found attractive…”

Don’t be fooled by “in office” procedures. Surgeons certified by the American Board of Plastic Surgery must perform in accredited ambulatory surgery centers to maintain certification. Many in-office operating rooms are not accredited and do not have to abide by any regulations or meet certain standards to keep patients safe.

These high volume centers are frequently where you can find untrained physicians. They are using a loop-hole in state laws to get around basic training requirements for their doctors.  Since the procedures are performed under local anesthesia, they do not raise a red flag in the regulatory system which prevents untrained doctors from performing medical procedures outside of their scope of training.  Comparing the training of residency in plastic surgery (80 hour work weeks for a minimum of 6 straight years following medical school) to a weekend “course” taught by another untrained doctor is no comparison at all. Be smart when choosing your plastic surgeon and don’t be afraid to ask questions.