Archive for the ‘Newspaper Articles’ Category
Monday, May 17th, 2010
Celebrities who undergo plastic surgery without question have a compelling influence on the general population, particularly those under the age of 40. One has to look no further than the checkout aisle in the grocery store to see how celebrity visibility is thrust upon us. From these consumer magazines to numerous television shows, anyone with a Hollywood connection is tracked and speculated upon about their cosmetic surgery, even if they have never had it. The media’s desire to push these cosmetic surgery tales of the stars fuels the public’s obsession with discovering the secrets to what keeps the beautiful and famous looking so.
While the star’s experiences may fascinate, they do little to actually educate. It is easy to confuse entertainment with reality because it is simply more interesting. Take the recent case of 23 year-old Heidi Mondag who had numerous cosmetic procedures done to satisfy her narcissistic and career agendas. While she may have had a lot of procedures, they were all quite small in scope. Most of her procedures were really ‘nip and tucks’ and not major overalls. After all, how many physical problems could a young person really have particularly given her appearance beforehand? But this is not how the media interpreted her surgery. Rather it was made to sound like it was a great undertaking and required supernormal surgical skills to complete.
These ‘tweakments’ are largely what is fueling the increasing visibility of plastic surgery. Botox, injectable fillers, lasers and minor skin lifts of the face have created a whole new set of treatment options that did not exist just a decade ago. While a 23 year-old partaking of this cosmetic menu does border on the overly self-indulgent, those in their late 30s and 40s have a more significant purpose. Fending back the early signs of aging is proving to be a more effective strategy than awaiting the day when major plastic surgery is needed. While my mother may have waited until retirement to wage the battle against the effects of time, today’s middle agers understandably what to look better and more rested now.
What is unique about these minimal procedures is that most of them are fueled and promoted by the cosmetic device and pharmaceutical industry. Plastic surgeons have taken a back seat to the promotions and marketing that billion-dollar-in-sales companies can do. The once retail approach to cosmetic and beauty products has expanded to include drugs and surgery. Targeting consumers through popular magazine and internet strategies, rebate coupons for Botox and eyelash stimulants are widely available as well as even franchise surgery for facelifts. Breast implant sizer kits are mailed to prospective patient’s homes with incentives for other procedures packed inside. Plastic surgeons collectively spend an insignificant fraction on marketing compared to that of the corporate world. This wave of industry’s promotion for profit and media attention for sales is why most people today know something about cosmetic enhancement and why it is now mainstream.
But like all entrepreneurial endeavors, making a profit and driving sales does produce some good byproducts that have wide benefit. Like the old commercial slogan from decades ago, there is ‘better living through modern chemistry’.
Dr. Barry Eppley
Tags: botox, cosmetic surgery, dr barry eppley, indianapolis, injectable fillers, plastic surgery
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Friday, May 7th, 2010
As people age, two of the most noteworthy and bothersome facial changes is what occurs along the jaw line and neck. These two changes are usually progressive, first comes the jowls then goes the neck. Like wax melting off of a candle, cheek skin and fat begins to slide off of the face creating those fleshy droopy folds at the jaw line known as the jowls. Recent research also indicates that it is more than just gravity that causes jowls, it is the shrinking of facial fat as well.
The appearance of jowls will eventually occur in everyone with enough time. Jowling creates an undesireable change in facial shape, making it wider and more rectangular in the lower face which is characteristic of an older person. It also causes a distinct disruption of a smooth jaw line from the chin on back, which is characteristic of a more youthful appearance.
Jowl correction is generally part of a facelift procedure. This is done during a facelift by either trimming the jowl fat, suturing the jowl fat back up to a higher level, or some combination of both of these manuevers. Facelifting is a relatively common procedure as evidenced by the 95,000 performed in the U.S. in 2009 according to the American Society of Plastic Surgery.
When only jowls are present and the neck has minimal loose skin, a different variation of a facelift can be done. Scaling back the ‘size’ of the facelift procedure can very effectively eliminate those troublesome jowls. Known by a wide variety of different names, the limited or downsized facelift tucks up the hanging loose jowls with very minimal recovery. Unlike a traditional facelift where incisions are made in front of and on the back of the ears, the jowl facelift only uses a fine incision in the front. The lack of any significant recovery is noted by the different names that are used to describe it, such as Lifestyle Lift, Quicklift, Swiftlift and EZ Lift. Expect one week for the significant recovery period of some mild swelling and bruising.
One of the great advantages of a jowl lift or ‘short scar facelift’ is that it also addresses a common facelift fear, that of looking unnatural. Few patients that I have ever met want to look like they have had a facelift. These procedures have no risk of that ever happening as they deliver a more subtle and less dramatic result. One will never look have that windwept or overdone look as, by definition, the procedure is more limited.
Tags: dr barry eppley, facelift, facial aging, indianapolis, jowls, lifestyle lift, limited facelift, plastic surgery, short scar facelift
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Friday, May 7th, 2010
There are many reasons why people undergo plastic surgery. The desire for self-improvement is the most compelling but the underlying motivation for such an emotional decision is never quite that simple. In a recent study in a prestigious plastic surgery journal, it was reported that nearly 80 percent of patients surveyed said that part of their decision to have plastic surgery was triggered by television and other media exposures. One television influence prominently noted was that of reality programming. The influence in the last decade of the reality TV concept is undeniable and has focused on everything from cake baking to child rearing..
The early success of ‘Doctor 90210’ and the now defunct ‘Extreme Makeover’ has fueled many copycats and there does not appear to be an end to the public’s desire for this form of reality plastic surgery. Whether the appeal is similar to the transformations seen on ‘Yard Crashers’ and ‘Rock Solid’ or the fascination of watching others subject themselves to an extensive makeover is undoubtedly part of it. I am all for increasing the public’s awareness of the benefits of plastic surgery but the ‘reality’ shown in the little bit of these programs that I have seen doesn’t really reflect the real life experience of the plastic surgery process.
Just like the entertaining but tragically distorted plastic surgery show, ‘Nip/Tuck’, television is all about entertainment and getting you to watch and rarely about truth. Only the highlighted moments of excitement and results is portrayed, leaving out all of what the producers consider dull filler material. This unshown filler, however, is really what plastic surgery is about. Boring accurate information, such as risks and complications and realistic outcomes, are never portrayed. What may happen when the plastic surgery doesn’t turn out so well is rarely if ever shown. In fact, some of these shows focus almost exclusively on the eccentricities of the plastic surgeons or their patients. While Dr. Ray may be entertaining, it is never revealed that he has never taken the effort to be board-certified.
Not all plastic surgery programs on TV, however, are badly done. There are some that are especially informative and insightful. This is the case with the Discovery Channel’s “Plastic Surgery: Before and After.” It is clear in this type of programming that their intent was educational, not a festive diversion to keep your eyes glued. Rather its intent is to teach, educate, and give us a greater explanation of what cosmetic surgery is all about. That is meaningful time spent about a serious TV subject.
In reality, most patients are not primarily driven to get plastic surgery because of these reality TV programs. They do it because they have physical imperfections that are bothersome to them. These TV programs are an extension of the often distorted Hollywood world where the pursuit of physical perfection and the fighting of father time is taken to sometimes ridiculous levels. They promote unhealthy desires such as teenage girls possessed about enlarging their breasts or changing their nose in the hope that this make them famous or get them noticed. Most people may be able to see through the façade of these shows and see them for the trivial entertainment that they are. But impressionable teenagers and insecure adults may not be so discerning. Just like the recently passed Health Care Reform bill, the devil is in the details. The real reality of plastic surgery is in that boring stuff that is hardly worth watching…but is really worth knowing.
Dr. Barry Eppley
Tags: dr barry eppley, indianapolis, plastic surgery, reality tv, TV plastic surgery
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Friday, April 23rd, 2010
For most Americans, the war in Iraq is far away and none of us can really comprehend what it must be like to live there. Living and working in an environment where uncertainty, the military presence from any side, and the potential to not be here tomorrow is an everyday reality that can not be fathomed from afar. More germaine to us is the trivial problems of do I have time to make it to Starbucks today, should I get an iPad or not, and searching for the best travel deal on the internet.
But as some form of normalcy tries to return to war-torn Iraq, there is a phenomenon they we as Americans can recognize. According to a CNN report, beauty salons are beginning to reappear and some people are even looking to cosmetic surgery for personal improvement. Even in Baghdad where buildings are pockmarked and scarred, billboards have appeared advertising for beautification procedures.
As one young Iraqi female was interviewed about her upcoming nosejob (rhinoplasty), she stated she never cared much for her nose and wanted her face to be prettier. When asked about the vanity of cosmetic surgery given her circumstances, she stated that it was nothing out of the ordinary even for an Iraqi. Because of the internet, satellite channels and television, they see people having these types of cosmetic surgeries done and they look better after. Seeing such things encourages them and gives them an incentive to get cosmetic surgery. Iraqi women have always prided themselves in the Arab world for their looks and style and taking care of themselves is a matter of national pride. As a result, the women are happy to spend their hard earned money to make themselves look as good as they can.
An increasing number of Iraqis appear to be electing to undergo cosmetic surgery for the simple reason that most Americans do…because they can. Changing the face of Iraq for some appears to have a different meaning.
But the emergence of cosmetic surgery out of war is not a new phenomenon. Most people don’t know that most of the common cosmetic procedures performed today had very humbling and catastrophic origins. Plastic surgery today has been highly influenced by the world wars of the last century. Working on the war wounded leads to the development of surgical techniques that have more universal applications. The trench warfare of World War I, for example, has led to many modern-day facial procedures. (it was generally not a good idea to stick your head up out of the trench too frequently) Rhinoplasty surgery was highly influenced in World War II by ethnic masking of the Jews through alteration of the nose. Dental implants were first used to bridge jawbone war defects. The list continues for dozens of plastic surgery procedures that we assume came out of pure imagination.
Will anything new in plastic surgery come out of the Iraq/Afghanistan conflicts…one never knows. But the desire for people to look and feel better is universal. Even in a country like Iraq that has been ravaged by decades of war, beauty and cosmetic procedures bring hope and a feeling of self-improvement. When you have so little to say in what goes on around you, making changes in your own little world can provide some personal empowerment.
Dr. Barry Eppley
Tags: bagdad, dr barry eppley, indianapolis, iraqi war, plastic surgery
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Friday, April 9th, 2010
Identity theft is a growing problem that now threatens just about everyone, even if you don’t spend a lot of time online. It is a huge problem with risks that are estimated to place most Americans as having a 1 in 4 chance of being victimized in the next five years. With credit card and social security numbers flying around in cyberspace by the billions, it is a wonder that those risks are not even higher.
Plastic surgery faces its own identity theft problem but of a different nature. In the most noteworthy case of plastic surgery identity theft to date, an American in the Middle East was recently arrested posing as a renowned U.S. plastic surgeon. Shockingly, he had operated on scores of patients in his Dubai villa. There he allegedly performed numerous cosmetic surgery procedures with primitive surgical equipment and lack of any sterile conditions. To no surprise, several of his patients (victims) have suffered serious complications requiring additional surgery and medical care.
This former Oregon physician was impersonating and using the good reputation of a plastic surgeon in Washington, D.C. who performs several surgeries per year at the American Academy of Cosmetic Surgery Hospital in Dubai. Aside from facing legal charges in Dubai, this fake plastic surgeon is wanted in the U.S. by the FBI and Interpol on charges of drug trafficking and numerous other crimes from when he held a medical license in Oregon.
While this identity theft story seems remote and far from the American medical scene, plastic surgery identity theft occurs more regularly here…but it is of a more subtle and insidious nature. With the ongoing erosion of medical fee reimbursements and increasing practice revenues and regulation demands (which is only going to continue to worsen, particularly with the passage of the new Health Care Reform Act), some physicians search for methods of cash only services. No seemingly ‘riper fruit’ currently exists than that of cosmetic services. (although weight loss is a close second) Between public interest and the all-to-willing drug and device manufacturers to sell to anyone with a medical license and a credit card, there is a dearth of cosmetic surgery providers with quite dissimilar education and training backgrounds.
While many of these cosmetic surgery ‘adopters’ are largely involved in office-based injection and laser treatments, some perform invasive surgery which is within their legal right as a licensed physician. As long as you hold a valid medical license, you can do almost anything in your office which is largely unregulated unlike a hospital or surgery center. A great illustration of this phenomenon can be read in the April 7th issue of The New York Times where a California physician (non-plastic surgeon) was interviewed touting his breast augmentation surgery technique under local anesthesia. Claiming that patients can now have a say in the breast implant selection process, he teaches weekend courses to physicians of any background (the articles states mainly family practice and Ob-Gyn docs) who are willing to pay.
The argument that women want to be awake and watch their surgery being performed is fundamentally flawed. I know of no female patients who want to sign up for that experience. But the underlying premise for such surgery under local anesthesia was not revealed in the article. Without proper training and credentials, an uunregulated office environment is the only place he could ever perform such procedures. And without an anesthesiologist, the only option is local anesthesia. Hardly good reasons for choosing a surgical method or even offering the procedure.
Dr. Barry Eppley
Tags: breast augmentation, dr barry eppley, identity theft, indianapolis, plastic surgery, plastic surgery identity theft
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Sunday, April 4th, 2010
The eyes may be the window to the soul, but they also create a strong impression of how we look. So many people comment to and about others based on how their eyes look. We all have had the experience of someone asking us if we are tired or have been up late. You can be certain their question is not probably based on how we were dressed or what we were eating.
But it is not the eyes per se that give these impressions, it is what is around them. The drapes of the eyes, the lids or window shades, are largely responsible for their appearance. Too much skin, deepening wrinkles, and bulging fat creates a tired and aging appearance. When combined with falling eyebrows, the amount of eye we see gets smaller and one really does look older. All this excess lid tissue is also prone to collect and retain fluid, hence those swollen eyes in the morning.
Because of the impact of how our eye area looks, eyelid surgery (blepharoplasty) is the best value in all of facial rejuvenation surgery. This is certainly true based on the size of the treated surface area. But more importantly, changing the look of the eyes does exactly what one is after…to look more refreshed. Few want to look different, but all want to look like themselves, only better.
While there are some non-surgical treatments that can make some areas around the eyes look better, none of them can improve the way the eyelids look. Botox can decrease wrinkling between the eyebrows and around the sides of the eyes, and that can be a great benefit for sure, but that affects expression only. If you look in the mirror without your face smiling or moving and your eyes still look tired, eyelid surgery is the only option.
By the way, forget about some magical cream making your eyelids look better. Amongst the many hundreds that exist, a few can make some minor reduction in fine wrinkles and puffiness. But really visible differences require removal of what makes them look that way, too much skin and fat.
While blepharoplasty surgery works on the lid skin, there are differences between what is done on the upper versus the lowers. The upper eyelids are largely about skin removal and re-creating an upper eyelid crease. Having a well defined eyelid crease is more important than trying to remove all excess skin. In the lower eyelid, more focus is on fat removal and skin tightening and making it as smooth as possible. There is no lower eyelid crease that needs to be made.
Many potential patients fear that blepharoplasty surgery will make them look unnatural. While this is possible if too much skin is removed from the eyelids, most overdone results come from browlifting not blepharoplasty. While browlifting can be a valuable addition to eyelid tucks, it is a procedure that is easily overdone. High eyebrows can easily change the appearance of the eye area and not favorably. Consider browlifting very carefully. It is not a cavalier addition to eyelid surgery.
If you are tired of looking tired, blepharoplasty may be a good choice to get a more youthful look back.
Dr. Barry Eppley
Tags: blepharoplasty, browlift, dr barry eppley, eyelid surgery, eyelid tucks, indianapolis, plastic surgery
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Saturday, April 3rd, 2010
Breast implants are a very common plastic surgery procedure that has not waned in popularity despite the recession. While they are unparalleled in making an instant body change, they have also make news for other interesting and unfortunate reasons. In the past year, these are the noteworthy breast implant stories you may not have read.
This week a California woman was sentenced to six months in jail and required to pay monetary reimbursement for ‘stealing’ breast implants as well as other cosmetic surgery back in 2008. Under an assumed name, the 30 year-old woman used a credit line in someone else’s name to obtain $12,000 in plastic surgery which included breast implants and liposuction at a plastic surgery center in Huntingdon Beach California. She pleaded guilty to burglary, grand theft and identity theft for using another woman’s personal information to obtain the surgery. How did she get caught you may ask? Police tracked her down using the serial numbers from her old implants, which she had removed when the new ones were put in.
In a similar scenario, but much more tragic, you may remember the murder of model Jasmine Fiore last August in California. The Playboy model mysteriously disappeared and was later found mutilated. With missing teeth and fingertips, she was initially unable to be identified as was the intent of the murderer. She was later identified by something her assailant had overlooked…literally…the serial numbers on her breast implants.
Proving that many criminals are dumb, most implantable medical devices today have serial numbers for tracking purposes as an FDA requirement. Usually the benefit of them on breast implants is for replacement and warranty reasons, but they also serve nicely as a human identification method that is more precise than fingerprints or dental records.
On a happier note, it was reported that a silicone breast implant saved the life of a California woman who was shot in the chest. A woman working in a Beverly Hills dental office last July was struck by a bullet after one of the employee’s estranged husband entered the office and killed her with a handgun. On exiting, the gunman ran into another employee and shot her in the chest. Unlike her co-worker, she miraculously survived. According to the Los Angeles Times, one of her breast implants stopped the bullet and prevented any fragments from getting as far as her heart. A physician who took care of her at the hospital stated that the bullet fragments were just millimeters from her heart.
A forearms expert was later quoted as saying that the breast implant probably slowed down the bullet enough that it caused it to stop short of the heart. While its an appealing story, that is not likely. A silicone gel or saline breast implant would not slow any bullet fired at close range. Breast implants have the stopping power similar to that of Jell-O. More likely her sternum or ribs was the reason that the bullet was deterred from going any deeper. The intervening breast implant, however, is happy no doubt to take the credit.
Breast augmentation and the implants needed to do them have weaved their way into the mainstream of American society, sometimes in ways not exactly as intended.
Dr. Barry Eppley
Tags: breast augmentation, breast implants, dr barry eppley, indianapolis, plastic surgery
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Thursday, April 1st, 2010
Too much fat is a near ubiquitous problem. The sheer number of weight loss diets, medications, and exercise programs that we are inundated with each day is a testament to their ‘popularity’. Accompanying these fat concerns, to no surprise, is the desire for liposuction as a surgical fat removal method. Liposuction is by both number and surface area the most common cosmetic plastic surgery procedure in the United States.
Contrary to the perception of some is that most liposuction patients are not trying to use it as a weight loss method. Almost every liposuction patient that I have ever seen in my Indianapolis plastic surgery practice has come in with a history of diet and exercise efforts. Whether it is the 35 year-old mother who can’t get that stomach pouch off after her second child or the very trim 42 year-old male who just can’t get rid of those stubborn love handles, liposuction is usually sought out for the right reason…as a spot method of body contouring.
As potential patients seek out liposuction today, they are surrounded by an array of technology that did not exist just ten years ago. And such information is freely available for their assessment on the internet. Between marketing ads and alleged patient testimonials, every manufacturer and many doctor’s practices tout one liposuction method over another. Whether it is tumescent, ultrasonic, laser, water jet or cold liposuction, they all seem to be the ‘best’. At the least, many are relatively new and after all newer is better…isn’t it?
To understand this maze of liposuction technology, it is important to appreciate how the liposuction process actually works. Essentially, it is a two-part process. Simplistically, the first part of liposuction requires that the fat be loosened by some method. The second part is that the loosened fat is then suctioned out. All the different liposuction techniologies need to use the second phase, suctioning. The difference between all of them is in the first part, the method they use to loosen up the fat.
In traditional ‘old-style’ liposuction, good old elbow grease is how the fat is gotten free. Most everyone has a good vision of how that is done by the in and out motion of a cannula that looks like a good beating up, to quote quite a few patients. In ultrasonic liposuction, it is the high intensity sound waves that do it. With laser, it is the heat and melting of the fat. With water jet, it is the high pressure of water. With cold, it is the reverse thermal effect of heat that does it.
I have left out the tumescent method as it is not really a liposuction method per se. Every liposuction technique first infuses a fluid to make the suctioning part easier, to make the treated site numb, and to lessen bleeding. It is called tumescence because it inflates or tumesces the planned treated area. It is necessary to do this first for all liposuction methods. While this may have been a liposuction advance by the late 1980s and early 90s, it is standard today and not a novel liposuction approach.
While great and appealing arguments can be made for each of these liposuction technologies, the reality is that none of these methods have been proven or shown to be better than another. They are accepted techniques that can make for an acceptable liposuction outcome. The most important technology or technique, however, remains that of the hands and the experience of the plastic surgeon wielding the device. The greatest tool ever made is only as good as the person using it. Conversely, skill and experience can make an average tool do a great job. More focus should be placed on that assessment by potential patients, if possible, than the allure of the next great liposuction wand.
Dr. Barry Eppley
Tags: dr barry eppley, indianapolis, laser liposuction, liposuction, plastic surgery, tumescent liposuction, ultrasonic liposuction
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Tuesday, March 30th, 2010
Almost everyone has now heard of the facial wrinkle treatment, Botox. While some may not know exactly what it is really good for, its recognition and popularity is because it simply works. When it comes to softening facial expressions, it does something that even surgery can’t do.
Many misconceptions exist, however, about Botox (and now Dysport) and it is time to reveal some of its secrets. Here are some facts about its use that are not commonly known.
Botox is a poison and can be quite lethal if the dose is high enough. It is administered in units which originally stood for mouse units. A unit was the dose of Botox that could kill a mouse. Fortunately, there is a big difference in size between a mouse and a human. To poison a human, it is estimated that it would take about 25,000 or more units to do so. The average dose for wrinkles is around 20 to 30 units, so it is well within the margin of safety. (mathematically, cosmetic dose units are a mere 0.001% of the doses that could be fatal). Cosmetic injections are precisely placed 2 to 4 unit doses in select facial area.
While Botox is touted for a lot of facial uses, it is largely a ‘northern’ face procedure. The areas of the forehead and around the eyes accounts for much of its use. Weakening of the muscles between the eyebrows, in the forehead, and at the sides of the eyes produces the desired effect of less frowning, a more relaxed forehead, and less lines around the eyes. While some do use it down south around the mouth, it is not effective as a primary wrinkle reducer in that area. A little too much Botox there can affect the way you smile.
Botox injections do not produce immediate results. It usually takes one week or more to see its effects. This is because it blocks the release of chemicals from the nerve endings that cross over to stimulate the muscle fibers to which it is attached. Because there is a supply of chemicals in the nerve endings to start, they must first be depleted. As a result, the muscle will work normally for a few days before it begins to weaken as its ‘gas supply’ diminishes.
The effectiveness of Botox can vary from one doctor to another or from one treatment center to another. This seems initially unusual because one of the benefits of a prescription drug is that it has been tested and approved for the uniformity of its effects. But Botox differs from a pill and many other prescription medications. It comes as a dry powder and must be formulated or reconstituted prior to treatment. How well it works, therefore, is affected by how it is mixed and how long ago it was prepared. It is designed to be mixed according to the manufacturers recommendation in a very specific way. (2.5ml of saline per vial) and it should be used either immediately or within a few days after preparation. But treatment centers vary on how they mix it and how quickly they can use it. You have no way of knowing if you are getting diluted or old Botox. If it doesn’t seem to be working well or lasting very long, this could be the reason.
Like all drugs, there is an effective dose to Botox or a ‘sweet spot’ at which it works well. What you want as a patient is to find the Minimum Effective Dose as well as the right injection spots. You may regularly be getting 40 units in the forehead are, for example, when 32 may work just as well. More Botox than necessary does not make it work better or any longer. Don’t be afraid to ask your injector to adjust the does or injection locations to see if the results improve…or become less.
Botox and Dysport have a very consistent duration of effect of around 4 months. Repeat treatments, unfortunately, do not make it last longer. But some patients feel that it does. This is likely an effect of muscle re-education, a chemical training if you will. It may take your body awhile to begin using those muscles again if they have been weakened repeatedly. Conversely, most people will not build up tolerance or immunity to Botox. But a few patients say that they have and resistance to any drug is always possible. One can than switch to Dysport which has a slightly different molecular structure.
Dr. Barry Eppley
Tags: botox, dr barry eppley, dysport, facial wrinkle reduction, indianapolis, plastic surgery
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Sunday, March 28th, 2010
Of the very large number of cosmetic surgery procedures that are performed each year in the United States, a certain number will undergo subsequent revision. While this is a concept explained to patients by their plastic surgeon beforehand, it is understandable that it falls on deaf ears for the most part. The euphoria of the upcoming outcome blocks any realistic consideration that anything but the best will happen. The decision to undergo cosmetic surgery is both emotional and optimistic.
Why does surgery not always turn out to be exactly as desired? While there can be numerous reasons, including the wrong operation for the problem or that the operation was not done well, but the most common reasons for these undesired outcomes are less obvious. How the body responds to the trauma of surgery and the not always predictable events of wound healing account for much of the need for revisional surgery. The occurrence of complications in cosmetic plastic surgery is uniquely different from that of most other types of surgeries. Unlike common surgical problems, such as infection or bleeding, the healing of a cosmetic surgery site may be perfect but the aesthetics of the healed site may still not be what was desired. Cosmetic surgery results are judged by a higher standard, they must both heal and look good as well. Even the avoidance of common wound healing problems is not enough in cosmetic surgery.
While the real number of the incidence or need for revision in cosmetic surgery will never be known, estimates are thrown around of around 15% on a national average. This estimated number will be quite different depending upon the type of procedure being performed. For example, any form of breast surgery carries a higher revisional risk than that of a facelift. Any operation that relies on an implantable device to achieve the outcome will always have more potential problems than those operations that don’t. While revisional surgery in most cases is minor and nothing in comparison to the original operation, potential patients need to appreciate that the need for secondary surgery in cosmetic procedures is not rare.
When postoperative complications occur and revisional surgery is needed, there is unhappiness on the part of both patient and plastic surgeon. The cosmetic patient is understandablely unhappy as they never really believe it would happen to them no matter how it was disclosed or what forms they signed. Such surgical problems happen to other people, no one thinks or hopes that it will happen to them. Other people make up statistics but not themselves. Patient naivety in this regard has been promoted, inadvertently, by cosmetic surgeon’s themselves through countless promotional efforts. Advertising ‘lunchtime facelifts’, ‘weekend recovery’, and other seemingly too good to be true procedures has only added to dumbing down that fact that it is real surgery with associated risks.
Like the patient, plastic surgeons are equally not pleased about the need for revisional surgery. There are many reasons for such a response by the surgeon from facing a patient’s disappointment, a perceived failure of their own skills and expertise, and how this result reflects on their own reputation and image. Sometimes, a difference in opinion may develop between the patient and surgeon as to the need and advisability of revisional surgery. In these circumstances, patients often seek out other surgeons to undergo their revisional surgery, getting a fresh perspective on their adverse outcome. When needed, however, surgical revisions should be done in the proper setting and under the appropriate circumstances. Certain minor revisions can be reasonably performed under local anesthesia in the office. This approach is simple and avoids the use of the operating room. Many times, however, this office approach to revisional surgery is overused in an effort to save the patient further expense. As a result, the desired outcome may still be suboptimal. In many cases of revisional surgery, the patient and surgeon needs to be willing to accept the additional arrangement and expense of an operating room to put themselves in a position where the procedure can be carried out properly.
The potential need for revisional surgery after a cosmetic procedure is a statistical reality. Revisional cosmetic surgery has associated physical, emotional, and economic consequences. It will often test the depth of the relationship and preoperative dialogue between plastic surgeon and patient.
Dr. Barry Eppley
Tags: cosmetic surgery, dr barry eppley, indianapolis, plastic surgery, plastic surgery revisions, revisions in cosmetic surgery
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