Newspaper Articles
Newspaper Articles
Smartphones have undoubtedly taken over our lives. Spend time in any crowd or shopping mall and notice how many people are doing something on their phones at that instant. Whether it be reading e-mail, downloading, playing a game, taking a picture…and yes even talking… so loud that we all must know that their dog is safely at the groomer getting a blowdry…or how insufferable it is to wait a few extra minutes on the tarmac. (pardon me; I digressed for a moment..but I’m sure that you too, are familiar with this phenomenon).
Plastic surgery is no different in being swept up in the smartphone craze. There are now numerous iPhone and Droid apps that are designed to give your body a total makeover. People contemplating some type of surgical metamorphosis can now get to know what their post-procedure look may be thanks to these apps.
One of my favorites is called the iSurgeon Game. It combines a game mode that enables users to try their hand at surgery (sounds pretty accurate, doesn’t it?). People can modify images ranging from lip enhancements, breast augmentations and many other improvements. Users can quickly simulate plastic surgery by easily modifying face and body features on their phone including such operations as rhinoplasty, breast augmentation, brazilian buttlifts and tummy tucks.With clever and unusual names like BodyPlastika, Modiface and FaceTouchUp, morphing a body part is becoming as easy as nuking a frozen dinner. With some of the apps, you can even turn your phone around, take your own photo and email them to the doctor with your questions.
There is a lot to be said for seeing the potential outcomes of cosmetic procedures. This is common practice in plastic surgery during a consultation and is of the greatest value in understanding what changes will occur in one’s own face. The public’s interest in this kind of personal ‘modification’ is great even if one is never going to embark on a surgical journey. While some plastic surgeons may criticize the concept of allowing patients to make changes to their own body parts- which may be wildly unrealistic and usually are- it is certainly a fun ‘test drive’. Having patients simulate what they want creates an informative dialogue in the vein of a picture is worth a thousand words.
While the smartphone and electronic manipulation can make plastic surgery like a fun game, it is largely just that. If only surgery was as simple and predictive as morphing a few thousand pixels around. What one can do on the computer and what can actually be done in the operating room is often quite different and certainly far less precise. Let us never confuse Photoshop plastic surgery with real plastic surgery. While most people would quickly acknowledge that, a few do forget during the recovery process.
In the spirit of continual smartphone distraction, I must run now to answer an inquiry that just came in on my own iphone app, Ask My Cosmetic Surgeon.
Dr. Barry Eppley
Indianapolis, Indiana
The discovery that fat is one of the most generous sources of stem cells in the body has generated excitement in plastic surgery as much as it has within mainstream medicine. With the theoretical potential to someday provide more effective treatments to diverse medical problems such as neurologic diseases, cardiovascular problems, and even tissue regeneration in reconstructive surgery, the research activity on this ‘wonder’ cell’ is nothing short of feverish.
Who would have thought that the very thing so many of us struggle to get rid of may someday be the key to new medical treatments? That’s like finding an outfit in the back of the closet that not only still fits but is back in style. (OK, that is beyond the common definition of a miracle.) Since fat can be easily extracted through liposuction, and it contains a high concentration of stem cells, whole new cosmetic uses are being derived for what is known as stem cell-derived fat grafting (SCFG). Fat is being injected all over the body by plastic surgeons, mainly because it is easy to do and perfectly safe. Injected fat has many body uses from body contouring to facial rejuvenation. For the body, buttock augmentation and breast reconstruction (lumpectomy defects) are being widely done. Fat-transplant breast augmentations are being approached more cautiously, but even this use is gaining momentum. Another excellent use for our own ‘fat’ is for hand rejuvenation- using the injected fat to fill hollows between the extensor tendons and to camouflage prominent veins.The face, however, is the most common target for fat and its stem cells. As we age, we lose fat in our faces, and it produces a deflated look. This facial deflation is one of the reasons that we begin to look older and our skin appears to slide from our faces and into our necks. This has led to younger people getting fat injections at an early age and fat injections being used as part of a facelift procedure for more advanced degrees of facial aging.
But, with every bit of hope comes a little or a lot of hype. In the most contemporary spin on fat grafting to the face, right out of Beverly Hills, comes the Stem Cell Face Lift. The theory is that stem cell-rich fat grafts combined with skin tightening makes for a better facelift result. Proponents espouse the theory that the stem cells provide a regenerative effect on the skin, also resulting in smaller pore size and less wrinkling and pigmentation.
Is this actual science or science fiction? Stem cell researchers would most certainly tell us that how such cells behave isn’t so simple. While moving them from one place to another in the body seems as though it should work…that doesn’t necessarily make it so. Conversely, a Stem Cell Facelift is a perfectly natural procedure that has no harmful effects, an almost organic procedure if you will. It uses the patient’s own tissues and may exemplify the appealing concept of ‘heal thyself’. It may even be considered a green procedure, a bit of body recycling if you will.
The use of stem cells in a cosmetic procedure may one day be the key to the proverbial fountain of youth. But for now, it more likely represents a common occurrence that has been used by overzealous cosmetic providers for years. Extrapolating a bit of science into a marketing phenomenon for patient recruitment. It may in fact generate some ‘green’ – but it’s not magic.
Dr. Barry Eppley
Indianapolis Indiana
This upcoming Thanksgiving will be the unofficial kickoff to holiday indulgence and overeating. Each holiday season, through the New Year, many of us excuse the mountains of calories consumed as just part of the festivities. Admittedly it is difficult to resist so many of our favorite foods when they are strewn around and we have a lot of time off from work. And eating is an activity that definitely helps fill that void of time.
Most people gain weight during the holidays and this accounts for many hopeful New Year’s resolutions to eliminate those extra pounds. But most weight loss resolutions don’t last…and many never really get even started.
One body contouring and weight loss approach that has been having a lot success is Zerona. Not to be confused with liposuction, Zerona is a non-surgical treatment. A painless procedure that is done in the office, Zerona exerts its effects through a ‘cold’ laser that passes through the skin and goes after the fat cells. It makes them leaky which releases the fat which is then absorbed and eliminated naturally.
Zerona is not just a machine, it is a process. Multiple treatment sessions are needed and studies have been shown that it can take off three to five inches in the hips, waist and thigh in three weeks. To help the fat loss, one must increase their water intake and take a twice-daily niacin supplement during the treatment periiod. The program require a commitment and must be done every two to three days to really be effective. Each treatment session takes about an hour and is painless. You literally get up and go afterwards. Daily exercise can increase the final results by aiding in lymphatic clearance and an increased metabolism.
How well does Zerona fat reduction work? There has been a lot of claims of inches lost in the media and internet. Our experience from our first twenty patients treated showed that the average inches lost (from three body area measurements) was 7 inches Over 70% of the patients were extremely satisfied patient and would readily do it again.
Right after the holidays could be a perfect time to get that jumpstart on weight loss and body toning. Many of you will probably implement some sort of a program. Zerona could be that perfect fit into such a program. A total treatment takes just three weeks and provides a safe and no risk method to lose some fat and slim some body areas.. At the least it is a commitment and a jump start to a healthier lifestyle for 2011.
Dr. Barry Eppley
Indianapolis, Indiana
The internet continues to redefine our existence on a daily basis. From how we shop for everything from clothes to cars, to how we shop for information, it now influences and controls our culture. Even our English language is being affected.
This is best reflected in the Urban Dictionary. This is a web-based dictionary of slang words and phrases. The definitions on the website are meant to be those of slang or subculture words, phrasing phenomena not found in standard dictionaries. Most words have multiple definitions, often quite different than you think. It contains over five million definitions and is expanding rapidly with an average of over 2,000 new submissions per day. While it has tremendous web traffic, most of its users are younger than 25. For this reason you may not have heard about it…but eventually you probably will.
When it comes to ‘urban’ terminology, plastic surgery has many such terms. Used everyday with patients or in the operating room, these thinly veiled innuendos instantly describe the cosmetic problem. Let me share with you a few of the most common ones- some which you will know, and others which you may find enlightening.
Elevens– Not a number but a type of facial wrinkle. Popularized by the manufacturer of Botox in their advertisements, these vertical lines appear between the eyebrows when a person is scowling or frowning. Because they most commonly appear as paired lines, they are appropriately described as this number. The elevens are exactly what Botox injections were initially FDA-approved to treat.
Crow’s Feet – Long recognized as the wrinkles that radiate out from the corners of the eyes as we smile, a crow would probably be delighted to have its feet so described. Since wrinkles on our face always form perpendicular to the direction that the underlying muscles move, these naturally occur from eye squinting. Botox works well to reducing these also.
Dog Ears- Having nothing to do with a dog’s ear or anyone’s ear for that matter, this is the bunching of skin at the tail end of a scar. They commonly appear when skin areas are ellipitically removed, like the shape of a football, and the closure results in a straight-line scar. From procedures such as tummy tucks and breast reductions, dog ears may develop at the ends of the scars. They are a frequent source of minor scar revision.
Turkeyneck – Who doesn’t recognized this one, particularly if you are middle-aged or older. It needs no description and it often drives the desire for a necklift procedure.
Saddlebags – An older, urban plastic surgery term that many women recognize. That fat collection at the side of the thighs that resists every form of diet and exercise, but which liposuction can treat so well. If only they were as simple to get rid off as pulling their historic corollary off a horse.
Parentheses – Not an English quotation mark but those classic lines that develop from the sides of the nose down past the sides of the mouth. They are one of the major places for the use of the very popular injectable fillers (such as Juvederm) to make them look less deep and obvious.
Muffin Tops – While a tasty and crunchy part of a muffin, eating enough of those will put them on your waistline. These are the classic fat rolls that stick out from the side and back of your pants…and which are nearly impossible to get rid of. Liposuction machines love this part of the muffin, too.
Puff Daddy – Men won’t recognize this problem, but most women will. It is the fullness or puffiness of the pubic area just below the waistline. It can become evident after a tummy tuck when the waistline becomes narrower than what lies below. It can be an embarrassing bulge in pants that no slimwear can flatten.
If you recognize more than five of these terms, you can consider yourself to be both hip and plastic surgery savvy.
Dr. Barry Eppley
Indianapolis, Indiana
Advertising and marketing permeates our existence at every turn. It is so omnipresent that it takes outlandish claims and often near unbelieveable stories to even catch most people’s attention anymore. Nowhere is this more true than in anything connected to the pursuit of beauty and youth. From magical skin care creams that purport to make one look 10 years younger in just a fraction of that time to amazing non-prescription supplements that claim to grow body parts, it is hard to separate reality from just another pitch into your pocketbook.
The world of cosmetic surgery, even though it is done by medical doctors which should be more credible, frequently falls into these same marketing shenanigans. This has become rampant in the unregulated sphere of cyberspace where the only monitor is whomever is doing the posting. But when it comes to board-certified plastic surgeons, it is a completely different story. The American Society of Plastic Surgery provides it members with a clear set of ethical regulations and rules which clearly provides what can and cannot be marketed and claimed. Violation of these rules can result in Society expulsion. Here are a few of these highlights.
Plastic surgeons are not allowed to claim to be the ‘best’ without indicating where that claim comes from. No claim of superiority of skills or results of those skills can be stated compared to physicians of similar training unless it can be factually verified by the public. There are no rating methods provided by any legitimate plastic surgery society. Patients may have different experiences with various surgeons, and the internet provides countless means by which to report them (unregulated and one-sided), but plastic surgeons and their results are not something that can be quantitatively evaluated like a product by Consumer Reports.
The use of before and after photographs must be of the same patient and unaltered. Photographs that have been digitally altered, are of different people, or show results that are not typical for the average patient is forbidden. Before and after surgery pictures that use different lighting, angles and poses that misrepresent results from any plastic surgery procedure is prohibited.
American Society of Plastic Surgery members cannot participate in a raffle, fund raising event, contest or promotion in which the prize is free surgery. No method of inducement to encourage patients to undergo surgery for a financial reason can be done. When you see such a contest or someone who has won a free makeover, you can be assured it is not a board-certified plastic surgeon that is involved.
Claims can not be made of guaranteed surgical results. Predictions of any outcomes of surgery, including satisfaction or any degree of improvement, is likewise prohibited.
Procedure description or outcomes that are placed next to a picture (usually a model) whom has never had the procedure is another ethical violation. This would suggest that the accompanying picture is representative of results that the plastic surgeon can produce. While models in advertisements may be used, they must clearly state next to them that the person in the picture has not received the advertised procedures.
The need for such rules in advertising and marketing in plastic surgery runs counter to what is happening in the ever expanding world of the internet and social media. On the one hand, such rules seem both fair and obvious. But in the pursuit of the cash paying patient for elective surgery, it should be no surprise that the temptation for anything goes can be a powerful one. Plastic surgery is taking the high road in ‘truth in advertising’ and is holding its member’s feet to the fire.
Dr. Barry Eppley
Indianapolis, Indiana
The drug, Botox, has become a household name in less than decade. It is used in every form of grammar from a noun to a verb to an adjective (check out Urban Dictionary) to convey the treatment of facial wrinkles to looking like one has a frozen face. Who would have conceived that the use of an injectable drug for the treatment of something as seemingly trivial as a few wrinkles would strike such a cultural phenomenon? With nearly two billion in sales annually and climbing, the thirst for a less-scowling countenance and a smoother forehead is only as limited as the population that is aging.
But Botox and the concept of ‘selective muscular weakening’ have a much longer history than its current use as a wrinkle treatment and a future that exceeds that as well. It was originally conceived as a treatment for unstoppable eye twitching (blepharospasm) and for painful and contracting muscle spasms for those with neuromuscular diseases. It’s even used in the same context for veterinary medical indications- such as the treatment of stringhalt in horses. These uses predated any cosmetic application, and its use for muscular-based problems is still undergoing medical development with great promise.
Last week, Botox was officially approved by the FDA for use in certain types of chronic migraines. For people who struggle with migraines, this could be viewed as a near-miracle cure, offering almost instant relief that is both prolonged and presents no significant side effects. For migraine sufferers that have tried and failed to get relief with every other available treatment, and who have a very specific trigger located at the base of the neck, temple, or along the brow bones above the eye, Botox injections could be immensely helpful. With the theory that it is the muscles pinching down around nerves which come out of the bone in these areas of the skull that causes the migraine pain, weakening or paralyzing these muscles relieves pressure on the nerves. Botox can be injected directly into the muscles around these nerves to produce this muscle weakening. With the pressure on the nerve relieved, the trigger for the migraine is either eliminated or significantly reduced.
Plastic surgeons have long known of the potential beneficial effects of Botox for migraine sufferers. The number one location for Botox injections is for wrinkles between the eyebrows known as the glabellar furrows, popularized in Botox Cosmetic advertisements as the ‘11’s. This facial wrinkle area is what the FDA used to approve Botox for cosmetic use in 2002. This brow area, ironically, is exactly where the supraorbital and supratrochlear nerves emerge from the brow bones. They are well known triggers for migraines that come out of the eye area. Every plastic surgeon has seen from time to time patients that comment on how their headaches have been reduced after their ‘11s’ have been ‘Botoxed’. Such observations have led plastic surgeons to try with good success the use of Botox injections at the back of the neck (occipital area) where the muscles attach to the bottom edge of the skull. This is where the greater occipital nerves come out through the muscle and can be another trigger point due to muscle compression on the nerves. Occipital-based migraines are actually more common than those of the brow or eye area.
While plastic surgery has played a contributing role in discovering this new injectable treatment option for chronic migraines, it is also leading the way to a potentially longer-lasting treatment that for some migraine sufferers may be a ‘cure’. If Botox provides a dramatic migraine reduction through these trigger point injections, then surgically removing the muscle from these nerves should produce a more permanent effect. Known as surgical decompression, it can be done through very small incisions in the scalp. Cleaning the muscle off of the nerves is really a form of ‘surgical Botox.’ Thus, the use of Botox for migraines is both a treatment (lasts about four months) and a test to prove if surgical decompression would be helpful. My experience with this type of migraine surgery over the past year has been extremely encouraging. All patients that I have decompressed have had immediate and significant reduction in their migraines. I’ll be more even more enthused if these results persist for one year or longer.
Dr. Barry Eppley
Indianapolis, Indiana
Has anyone ever said to you that you look tired…have puffy eyes…or commented on the bags under your eyes or your dark circles? If you are over 35 or 40 years of age, you have undoubtably been told that at least once. Many have been told that more than just a few times. While I could espouse on the merits of pointing out the good in people rather than the bad, that would be a pertinent subject for a different column that has little to do with plastic surgery.
Without being told, most people that develop tired-looking eyes know it from looking in their own mirror. Women are particularly sensitive to how their eyes look as they engage in the daily ritual of make-up application. The vast majority of men, however, are unaware until their tired eye problem almost interferes with their vision. While there are some useful simple home ‘remedies’ that can help, such as astringents and endless numbers of creams, they do not remotely produce an improvement that is comparable to what blepharoplasty surgery can do.
Blepharoplasty, or ‘cosmetic eyelid’ surgery, is one of the most successful of all facial plastic surgery procedures. By removing loose and extra skin and fat from the eyelids, one can look refreshed again helping restore an eye appearance that one used to have. But many people are unduly hesitant about undergoing it because of misconceptions about recovery and pain after the surgery.
The thinness of the eyelid tissues and their superb blood supply make swelling and bruising an inevitable, but temporary, sequelae of the surgery. Despite how it looks, it is not painful and most patients only comment that their eyelids initially feel a little tight. There may be some slight stinging discomfort around the eyes the first night after surgery, but that passes quickly by the next day. Bruising and swelling are what persists and that will take up to two weeks after surgery until one is fully in the ‘benefits’ period. For some, this is a time for social reclusion. For others, they embrace it and do not let it be a hindrance for returning to work or getting out and about.
One of the great things about blepharoplasty surgery is that it is not a ‘one size fits all‘ procedure. There are different types of eyelid tucks based on how slight or severe the tired eye problem appears. If one has a lot of droopy or hanging skin then the traditional blepharoplasty would apply. But for those that have just a little extra skin or lower eyelid wrinkling, then the new ‘pinch and peel’ blepharoplasty can be done where just a pinch of skin is removed and the wrinkles reduced by a chemical or laser peel at the same time. If one is just bothered by their undereye bags, that protruding fact can be removed from inside the eyelid, having no external incision at all.
While the eyes may be the window to the soul, the eyelids are the window shades. They create, fairly or unfairly, an impression of our alertness and liveliness. A crisper and refreshed eye appearance is readily possible through blepharoplasty surgery and is easier to go through than most people think. Whether one’s tired eyes are just beginning or are quite advanced, blepharoplasty surgery can be customized to just the right amount needed to put that twinkle back and still fit into one’s lifestyle.
Dr. Barry Eppley
Indianapolis, Indiana
The desire for fat reduction is a near universal one that crosses all age, gender and ethnic lines. From the countless number of diet and exercise approaches to the opposite choice of liposuction surgery, loss of body fat can be successfully done with varying degrees of individual effort. But between these two ends of the fat loss spectrum lies the developing field of non-invasive body contouring. The concept of losing fat without surgery through an external device is both appealing and promising.
External ‘machine-driven’ methods for fat reduction are not new. Whether it was the belt-driven shaking machines from the first half of the last century to sitting in a sauna box and sweating it off, letting something else do the work and hopefully losing weight will always catch the public’s attention. Taking a pill, of course, is the simplest and requires the least amount of effort. But you probably didn’t get overweight or develop those few fat areas by taking pills, so it seems unrealistic that you can lose this fat by pills alone. While science and technology has come a long way, does today’s non-invasive body contouring devices really work…or are they just a modern-day version of the old ‘shaking machine’?
The newest technology for non-surgical body contouring is Zerona. This is an external cold laser that helps make fat cells leaky and loss some of their lipid contents. While people think of a laser as being a focused beam of light that hits a target and causes it to vaporize or melt, cold laser technology is different. It can pass through the skin without injuring it and penetrate up to 5 cms (2 inches) in depth. This can reach localized fat and exert its photochemical effect. The concept of photochemical-induced leakiness of fat cells is a bit hard to grasp but its physics are a little similar to the way cell phones actually work. I have a hard time wrapping my mind around cell phone technology to understand how all these messages and images are flying around and get to their intended recipients….even when I am on an elevator or a plane. But despite my ignorance I have plenty of evidence every day that it does work. So I won’t hold it against photochemical-induced fat loss simply because I don’t completely understand the science behind it.
The effects of Zerona on fat is very short-lived so multiple treatments are needed, spaced but a few days apart. Over a course of several weeks and multiple treatments, many patients have been shown to lose several inches around the waist, hips and thighs. But along with the treatments it is advised to drink water and take a niacin supplement to support the lymphatic clearance of the released fat. Herein lies the important difference from today’s technology and yesterday’s devices of hope…the use of some modest lifestyle changes and good patient selection.
Non-invasive body contouring is not a substitute for what liposuction can achieve or for the large amounts of weight loss that occur from bariatric surgery. Rather it is intended to benefit those who have some stubborn areas of fat that are just not responsive to what you can do at home with your best efforts. And for those who do not feel they have enough of a fat problem to justify surgery or want to do anything to try and avoid that solution. By using these criteria, most patients that use Zerona have more modest fat collections. This size of the problem and the modest lifestyle changes that are part of the program account for the generalized success and satisfaction that occurs from this non-invasive body contouring device.
Dr. Barry Eppley
http://eppleyplasticsurgery.com/
Indianapolis, Indiana
For those who don’t know, the “wattle” is that fleshy fold of skin hanging down from the neck or throat. While not seen as an endearing piece of anatomy as one gets older, it is quite common in birds be it the pelican, common rooster or a Thanksgiving turkey. While it may be cute in a bird and makes it identifiable as a species, I have found no human yet that finds it flattering. Common amongst men and women alike as they get older, this sagging piece of skin and fat is often what bothers them the most about their aging face.
The wonderful world of digital cameras and cell phones have helped some people discover their neck wattles by seeing themselves in side view in a picture. Men make the discovery when wearing certain shirts and often feel it ‘flopping’ around when they move their heads. (swinging a golf club seems to bring on this sensation)
The good news is that neck wattles can be successfully eliminated and usually much easier than one thinks. The trick is matching the proper solution for the size of the neck wattle. Some wattles are small, others are quite large. Different wattles need different approaches.
The two things that we know about neck contouring is what doesn’t work. There has yet to be a cream that has a real ‘neck rejuvenation’ effect. The winner in that transaction is always the manufacturer and seller of the magical potion. If there was a cream that could really change your neck, we would all know about it and it would cost hundred to thousands of dollars per jar. (wrinkles are one thing, wattles are quite different) The other hopeful but unsuccessful effort is that of neck exercises. If the loose neck was primarily due to muscle looseness, this approach might have some benefit. But for the skin and fat that has become loose and is sliding off the face into your neck, the ‘neck gym’ remains more theoretical than useful. Neck exercising will have about the same benefit as it would for lifting the sagging breast or those eyebrows that just keep getting lower.
While many people would consider having a necklift, they wouldn’t dare undergo a facelift.This comes from a misunderstanding of the two procedures, not realizing that they are largely one and the same. I have found only a handful of patients who have ever actually known what a facelift really was. A facelift is really a necklift. But facelifting comes in two varieties which differ based on how much improvement in the neck is needed. A limited facelift (popularly known as a Lifestyle Lift or jowl lift) is great for jowling but not so much for the neck wattle. For small neck wattles, a Liftstyle Lift combined with liposuction in the neck may just do the trick. For a neck that hangs more, a full facelift is what is needed. It has a powerful change effect on making that neck more shapely and tucked up again.The difference between the two is the location and extent of the incisions around the ears. To really change the neck in more significant wattles and sagging, the facelift must have an incision that goes up behind the ear and back into the scalp. It is the pull from behind the ear that draws up and tightens the loose skin in the middle of the neck.
The other neck wattle surgery that few people have ever heard of is the direct necklift. It is the real wattle reducer and is the simplest of procedures to go through with but a few days of recovery. By cutting out the wattle directly, it is gone forever and creates a neck shape that hasn’t been seen for decades. The price for this most effective and simplest of wattle solutions is a fine line scar down the center of the neck. For the beard skin of men, this scar heals beautifully and may be the procedure of choice in the older male. For women, the location of this scar must be thought about carefully to determine if this is a good trade-off.
Dr. Barry Eppley
Indianapolis, Indiana
As the recession has continued now for over two years, most businesses have noticed. The number of cosmetic procedures performed has been no different. After continuous and unprecedented growth for over a decade, the number of elective plastic surgery procedures has taken a downturn these past couple of years. With this downturn has come the ‘shrunken pond’ effect that inevitably occurs when the same number of fish occupy a smaller body of water… competition for food increases dramatically. In the world of sales this translates to an increase in discounting for some to keep a steady flow of customers.
While discounting is a great idea for retail products like cars, jewelry and clothes, it has definite drawbacks in plastic surgery. Price reductions and the ever famous :Buy One, Get One Free” advertisements have appeared like never before. While the use of clever marketing is ethical and business-savvy, bargain-basement operations could exact their own price. The recent rash of major problems and deaths from plastic surgery procedures in the news is an example. Most of these tragic events are related to choices of doctor training, location where the procedures were formed, and the use of unethical or illegal substances and procedures.
One method of cost-cutting in plastic surgery that I have noticed to be prevalent is the use of local or sedation anesthesia as opposed to a general anesthetic which requires an anesthesiologist. While usually touted as being safer and offering a quicker recovery, it is understandable while some people would be attracted to it. But that doesn’t mean it is the most comfortable or allows the surgeon to perform the best job. A recent story covered one physician nationally touting breast augmentation without general anesthesia. In the story the doctor claimed that he would sit the half-awake sedated patient up during the operation so they could agree to the size of their breasts before he stitched them back up. Had a board-certified plastic surgeon developed this method I might have listened but these arguments from a gynecologist are less persuasive.
Much of this discount approach to surgery is being led by doctors who have studied an unrelated area of medicine and have entered cosmetic surgery through a low-fee approach. Not having to bill and process insurance makes the allure of patients who pay up front very appealing. Doctors not trained as plastic surgeons usually have to perform their procedures in their office. While they can legally do so, they also have to because they don’t have the privileges for these procedures in hospitals and surgery centers. Unfortunately, some privately-owned surgery centers are so crimped for cash that they may allow the stringest requirements of training that hospital requires to be bypassed to get any doctor in there to do procedures.
Breast augmentation and liposuction are the most common cosmetic surgeries where discounting and dubious training seem to parallel each other. This is particularly prevalent in bikini-clad sections of the country like Miami, Southern California and Las Vegas. We see less of it here in more clothed Indiana but it still is not rare. But body contouring is not alone in this trend, the facelift franchise known as the Lifestyle Lift offers a ‘mini-facelift’ at a discount rate under local anesthesia. While volume surgery may be predicated on rapid turnover…your face may be more interested in a long-lasting result that is suited to your aging needs…even if it costs more.
While bad plastic surgery is not always cheap plastic surgery, it can be a warning sign. Plastic surgeons with great skills and experience usually don’t have to resort to discounting to sustain their business. If you want to save money, do it when buying a vacation, clothes, or a gym membership. Think twice before being price swayed when considering plastic surgery. Skill, experience and a track record of satisfied patients is more important than a low price.
Dr. Barry Eppley
Indianapolis, Indiana
This advertising phrase has been used countless times in the world of cosmetic surgery. I usually just gloss over it and write it off as exuberant advertising. After all, very few things in life of any value can really be obtained in just five minutes…even a good cup of coffee takes almost that long to get. But seeing this phrase as the main topic on the cover of a major magazine of good reputation made writing about it irresistible.
The concept of the ‘5 Minute Facelift’, beyond the slathering on of alleged beauty crèmes that ‘really work’, relates to the contemporary use of injectable fillers. Not to be confused with Botox (which paralyzes small areas of facial muscles) which is also injected, fillers add volume to the face underneath the skin. Most commonly used for the lips and the facial parentheses (a.k.a. lip-cheek grooves), it has become more widely used for many other areas of the face. Since one’s face is known to lose fat as we age, plumping up the face with fillers can have some rejuvenative effect. Inflating the face pushes out the skin and accounts for the claims of ‘making wrinkles disappear instantly’.
The allure of the 5 Minute Facelift, however, must be looked at more closely to see if it is real. The five minute part for any injectable treatment is not exactly accurate. Since placing the material requires multiple needle sticks, most people would prefer to take a little longer…if they could be numbed up for it. Getting good local anesthesia before having your face injected is appealing to just about everyone. As I always say…nobody ever says they are too numb. (or conversely, can I have just a little more pain?) While the actual injections may only take five or ten minutes to do, the preparation for it is much longer.
Time is not important, however, if the procedure does what it promises. I’ll bet most people would be willing to spend several hours if it would take away five or ten years in such a short period of time. Does plumping up the skin really achieve a facelift? Not by what most people would consider a facelift to be. While inflating a hot air balloon will lift it, such a phenomenon does not really occur in the aging face. While some areas of the facial skin can be made smoother and little volume added to the cheeks and lips, those falling eyebrows, heavy eyelids, or jowls and sagging neck will not be improved. A few wrinkles may be better but calling that a facelift is more than just a bit grandiose.
But for the sake of argument, let’s assume that the 5 Minute Facelift was really possible. Would it be a good idea? If you were going to an event or wanted any improved look for a few months, then it is clearly better than any surgical alternative. When viewed from the perspective of value, however, it is not a good investment. The volume of injectable fillers needed and their cost could easily be several thousand dollars. For a treatment that lasts six months or less (there are no permanent injectable fillers) that money would be better saved and eventually invested in a surgical facelift which is proven to last many years.
The 5 Minute Facelift, also called the Liquid Facelift, sounds too good to be true because it is. It undoubtably appears on magazine covers because it makes you instantly grab it off the rack and turn to the article. Injectable fillers have been a revolutionary facial treatment for adding small areas of temporary plumping. But to say they can lift a sagging face is like that hot air balloon…over plumped and soon to be lost in the horizon of hope.
Dr. Barry Eppley
Indianapolis, Indiana
The concept of non-surgical fat reduction has been around for over a century. From belt machine devices in the Sears and Roebuck catalog in the early 1900s to the infomercial weight loss supplements of today, hope is eternal when it comes to getting rid of unwanted fat. No one knows the number of fat reduction methods that have been proposed over this time but it is fair to say it must number in the thousands. So many approaches tell you that not only is there no one single method that is best, but how one loses fat varies for different people.
One concept that is important to understand is the difference between non-surgical vs surgical fat removal. Without question, the definitive way to lose spot areas of fat is liposuction. Liposuction is a proven surgical method to reduce spot areas of fat and trim down specific body areas, but it is an operation and involves expense and recovery. Non-surgical fat removal, no matter what the method, will never be as effective for spot reduction. One pursues that approach in the hope that enough fat may be lost to not need or desire the surgical solution. In short, non-surgical vs surgical fat reduction are not comparable methods. They have different outcomes.
Now enters one of the newest non-surgical fat treatments known as Zerona. Touted as a painless body slimming method that is proven to remove fat and inches without surgery with zero pain and downtime. Could such a thing be really true? Is this hype or hope?
Zerona works by using a low frequency ‘cold’ laser that passes through the skin without injury and targets the fat cells. The laser energy targets the fat cells through a photochemical process. Not to be confused with a photothermal (heat) or photoacoustic (vibration) method, this non-heat generating process makes the fat cells ‘leaky’. The fat cells shed their liquid fat content, now known as free-fatty acids, which is then absorbed through your lymphatic system. The lymphatic system transports it to the liver where it is processed and broken down, and most importantly, not re-circulated and stored again as fat.
Zerona is more than just a machine, it is a process. Treatment sessions number six to nine and have been shown to be able to take off three to five inches in the hips, waist and thigh in two to three weeks. But to aid the lymphatic clearing process, one must significantly increase their water intake and take a twice-daily niacin supplement during the treatment process. The treatment sessions require a commitment and must be done every two to three days to really be effective. Once the fat cells get leaky, you can’t let them heal themselves by missing treatments or having them too far apart. Each treatment session takes just under an hour and is painless. You literally get up and go afterwards. Daily exercise (such as brisk walking, light running, or other cardio training) can increase the final results by aiding in lymphatic clearance and an increased metabolism.
Is Zerona fat reduction too good to be true? It is if you think it is a replacement for liposuction or a significant weight loss method. But if you are looking for a safe and no risk method to lose some fat areas, Zerona may be a good option. For some, it is an alternative approach to try before submitting to liposuction and may eliminate the need for that experience and expense altogether. For others it is a commitment and a jump start to a healthier lifestyle…and along the way you may find a few things in your wardrobe that fit again.
Dr. Barry Eppley
Indianapolis, Indiana
This is one of those headlines that attract a lot of attention as the concepts of Free and Plastic Surgery go as much together as Peyton Manning and quarterback sacks. One of the not infrequent requests that I get as a plastic surgeon, however, is about this very concept. On my practice website and numerous blog sites, requests come in every week for some form of plastic surgery ‘donation’. Many of the requests go into great detail about why they want a certain procedure and they are often quite moving. While the idea of performing surgery for free seems fairly simple, it actually is not.
This can best be explained by my response to a recent request for a free breast augmentation with a heart-felt plea for an improved perception of herself.
‘I have great empathy for the concerns you have about your breasts, and wish that providing you with a free procedure were an easy choice. Given the number of women who come into my office with similar concerns about their bodies, I can understand how connected self-esteem and a positive self-image are. Providing surgery for free may seem like a simple and straightforward thing to do, but there are many factors involved that make the concept of ‘donated’ surgery not exactly free. While any plastic surgeon can give away his time to perform the operation, a surgeon’s fee represents just a fraction of the total costs of surgery. The cost of the breast implants, use of the operating room, and the fee for the anesthesiologist expertise are other cost factors that must be accounted for and paid. The surgery center or hospital, implant company and anesthesiologist are under no obligation, and usually are unwilling, to provide services and materials at their expense for an elective procedure. Often times, these costs make up more than that of the plastic surgeon’s normal fee.’
One of the hidden costs of any donated surgery in this country is the potential medical-legal responsibility. Unfortunately, donating surgery does not waive any responsibility on the plastic surgeon for the outcome. Should any untoward events happen, such as a rare but possible complication, the surgeon is still liable and responsible. The possibility also exists for the need for revisional surgery after the initial procedure should the result not be ‘perfect’ and the question then arises is the surgeon again expected to waive his or her fees? While many patients say they will sign anything to get the procedure for free, the legal reality is that there are no forms or waivers that a patient can sign that will legally hold harmless the physician for the services that he or she has provided.
One may wonder then how do they do these free makeover surgery contests, either done locally or even on TV? The answer is whoever is doing it most likely is not a board-certified plastic surgeon. The American Society of Plastic Surgery strictly forbids providing any free surgery as a result of a contest, promotion, or any other method of inducement which encourages a patient to undergo surgery based on an economic incentive. Doing so is an ethical violation of its membership and could be grounds for dismissal from the Society. Those non-plastic surgeons who do offer such free surgery are not bound by these ethical guidelines and merely see the risk as a marketing expense.
While a plastic surgeon may choose to donate his or her skill and experience for free, the rest of the costs of surgery remain, and are usually out of the surgeon’s control. The legal and ethical issues, that are completing unaware to most patients, makes donating an invasive operative procedure not quite the same as giving away a more traditional retail product.
Dr. Barry Eppley
Indianapolis, Indiana
The desire to eliminate excess fat is both universal and historic. The sheer number of diet books, meal programs, and fat burning medications and supplements are a testament to what the majority of the American population would like to do. If one of these approaches was universally effective, there would not need to be so many treatment choices.
Liposuction is a proven surgical method to reduce spot areas of fat and trim down specific body areas, but it is surgery and involves expense and recovery. Lipodissolve injections are a non-surgical method of spot fat reduction but it is a slow and somewhat uncomfortable process that really works for the smallest areas of fat.
Along now comes ZERONA. Imagine a painless body slimming method that is medically proven to remove fat and inches without surgery with zero pain and downtime. Seem too good to be true? As a weight loss method…yes. As an effective body slimming method that can shrink your tummy, hips and thighs without surgery…no.
ZERONA is uniquely different from liposuction and other body slimming methods. How does it work? Using a low frequency ‘cold’ laser that uses the 635nm wavelength, the energy passes through the skin without injury and penetrates up to 5 centimeters. The laser energy causes the fat to emulsify through a photochemical process. Not to be confused with a photothermal (heat) or photoacoustic (vibration) method, this non-heat generating process makes the fat cells ‘leaky’. The fat cells shed their liquid fat content, now known as free-fatty acids, which is subsequently absorbed through your lymphatic system. The lymphatic system transports it to the liver where it is processed and broken down, and most importantly, not re-circulated and stored again as fat.
ZERONA is more than just a machine, it is a process. Through a typical series of 9 treatments, up to 5 inches off of the hips, waist and thigh in two to three weeks can be achieved. But, to aid the lymphatic process, the patient must significantly increase their water intake, and take a twice-daily niacin supplement during the treatment process. The treatment sessions require a commitment and must be done every two to three days to really be effective. Once the fat cells get leaky, you can’t let them heal themselves by missing treatments or having them too far apart. Each treatment session takes just under an hour, and is painless. Some have described them as almost ‘zen-like’ which I interpret as relaxing and non-stressful. Equally important, the patient can get up, go and return to all regular activities without any restrictions. There is no pain, bruising, or need for restrictions, but daily exercise (such as brisk walking, light running, or other cardio training) can increase the final results by aiding in lymph mobility.
If you are looking for a quick, safe, and affordable way to lose some fat areas, ZERONA may be a good option. For some people, it will be an effective alternative to liposuction and may eliminate the need for liposuction procedures altogether. For others it may not be a magic pill, but does offer a jump start to a healthier lifestyle…and along the way you may be able get back into that favorite pair of jeans.
Dr. Barry Eppley
Indianapolis, Indiana
Divorce is an unsettling experience for everyone involved, and represents a time of unwanted and maybe even unexpected change. Divorce is often cited as the second major stressor in life, second only to the death of a loved one. Divorce can be a crushing experience, and can easily produce feelings of failure.
As a way to feel better about themselves again, or searching for a fresh start in a newly single world, opting for plastic surgery after divorce occurs more and more frequently. The benefits of plastic surgery after divorce are far greater than what occurs on the outside. It can have a profound emotional and psychological uplifting effect. From my perspective as a plastic surgeon, I believe this is its most significant benefit. Patients can feel almost reborn after surgery, generating a fresh start to another chapter in their personal life.
Many patients, particularly women, have spent a significant part of their adult lives looking after others. Whether it’s for their children, husband or their own parents, their needs are often subrogated to everyone else around them. As a result, their own self-value and worth may have become diminished. Combined that with the effects of time on the face, and the stress of childbirth on the body, it’s not hard to understand why the self-esteem suffers. It can reach rock bottom when presented with the prospect of divorce.
The impact of childbirth on the female body is well recognized. When those changes occur in the company of the man who helped create these kiddos, sagging breasts and loose belly skin are just part of the child-rearing experience. But when it comes to having a new set of eyes view those changes, it is perfectly normal to be apprehensive that forgiveness and understanding may not be part of the equation. This makes some of the most popular and effective procedures women undergo is from the collection of Mommy Makeover options. These include breast implants and lifts, tummy tucks and thigh liposuction or some combinations thereof to get back to that once smaller and more firm body that existed before childbirth. For some women, their bodies actually end up looking better and more shapely than they ever were.
While the body can be disguised by clothing, the face can not be so obscure. Lines, wrinkles, and sagging jowl and neck lines are the hard-earned result of life’s experiences, but a refreshed countenance can go far toward turning back the proverbial clock. Some women test the plastic surgery waters with in-office Botox, injectable fillers and skin resurfacing procedures. Others go for more significant rejuvenation through eyelid tucks and lifestyle versions of face and necklifts which produce change without a lot of recovery.
While plastic surgery can drastically boost self-image and confidence, it is not a fix for most of life’s problems. When done for the wrong reasons of expectation for some secondary gain, short-term euphoria can soon be met with disappointment. It can’t make someone else like you better or get you a better job or promotion. It is really about making you feel better…about you.
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One of the benefits of a more firm face and body is that it can be combined with the wisdom of life’s experiences and lessons. That combination can only bode well for moving on to new opportunities and challenges.
Dr. Barry Eppley
Indianapolis, Indiana
The recent hullabaloo over the controversial Health Care Reform Act brought to the surface many pertinent issues of our entrepreneurial medical industry. While no piece of legislation will solve most of the really important problems, lost in the fray were economic and legal issues that impact more than just who pays for what and why.
A recent news story from Georgia brings to the surface one of these issues. CBS has reported that a woman almost bled to death during a surgical procedure performed by an ophthalmologist. According to their accounts, the woman awoke during the procedure and heard the doctor calling 911 for help as she was bleeding extensively.
Just this much of the story should raise two pertinent questions. The first being how do you bleed to death from eye surgery? Even the anatomically uninformed would assume there are no major blood vessels around the eye. Contrary to what one would think, he wasn’t performing eye surgery at all. He was performing breast augmentation! And the second question is how was it that she awoke to find herself in this dilemma? She was having it done in the doctor’s office. Luckily, a plastic surgeon was on staff at a nearby ER and helped save her life.
Such a story, while not common, is by no means rare. Today, every medical specialty is suffering from plummeting insurance reimbursements and skyrocketing malpractice premiums. (The Health Care Reform Act has addressed neither of these issues). This sets the stage for economically struggling doctors, and borderline unethical ones as well, to turn to more profitable fee-for-service cosmetic procedures to enhance their income. The public would assume, incorrectly, that there are laws in place to keep doctors practicing outside of their scope of training…but there are not. In most states, Indiana included, there is no law against physicians performing whatever procedure they choose, whether they have qualified training or not. All you need is a valid medical license. Because hospitals protect their own liability and will not allow doctors to perform procedures outside of their training, this can be easily bypassed by performing these procedures in their own office where the only governing body is the providing physician. There is no law against me, a board-certified plastic surgeon, performing Lasik vision correction or cataract removal in my office, even though I have no formal training to do it.
But this disturbing story does not stop there. Months after this event has occurred, the state medical licensing board refuses to suspend his medical license or has yet to even have a formal investigation. This lack of regulatory intervention is not rare. Licensing boards are shockingly slow and often very reluctant to pull any license even when the issue that is being reviewed is one of blatant disregard for the rules and does place patients at risk. The take home message is do not count or give too much credit for any governmental agency looking out for you. The legal roadblocks and delay tactics will often let a rogue doctor continue in practice for years.
The obvious message of the story from Georgia is that the burden is completely up to the patient to determine whether their physician is qualified to perform the cosmetic or plastic surgery procedures they seek. Slick-looking websites and discounted or low-fee incentives can make it easy to overlook the big picture…your safety.
Do your research and bear in mind that most, if not all, physicians in good standing will welcome your questions. An informed patient is a great patient.
Dr. Barry Eppley
Indianapolis, Indiana
Cosmetic plastic surgery has long been unintentionally gender-biased. Since the field began, the vast majority of patients who seek cosmetic enhancements, albeit it surgery or office-based treatments, have been women. Men have always made up less than 10% of most plastic surgery practices. Hollywood would lead you to believe otherwise but it just isn’t so. The only rare exception to that has been the more recent popular treatment of laser hair reduction. When it comes to hair removal, men make up about half of the patients seen with the hairy back and shoulders being the prime targets.
But more men are finding their way into the plastic surgeon’s office in the past few years. Besides a steady increase in male numbers, what is noteworthy is the change in what what men are requesting. While there remains some traditional procedures that have always been of interest, technology, societal trends, and younger men have opened up new areas of the face and body for change and improvement. Here are four of the most popular younger male (teenage to early 40s) procedures today.
Liposuction still remains the most requested male procedure. The culprits are always the same, the stomach and love handle areas. But most men that want liposuction are not fat and many are not even overweight. To the contrary, they are lean but have fat collections at the side of the waist and flanks. Even in men that work out regularly, those love handles can be impossible to work off. Today’s liposuction techniques can even give that ‘six-pack’ look for those leaner men that are not opposed to a little surgical cheating.
Chest recontouring is the one male plastic surgery procedure that is really on the rise. Male breast enlargement, known as gynecomastia, has always been an issue. But with increasing teenage weights and the present young male aesthetic for a completely flat and smooth chest, improvement in the male chest is sought out like never before. Even small nipple protrusions can be bothersome for the teenage male. Obvious man boobs are not desireable at any age.
Nose reshaping (rhinoplasty) has always been a popular male operation and that has not changed. It is the one procedure of the face that young men are not afraid to change. Noses that are big with prominent humps and wide nasal tips are bothersome and distracting to an otherwise balanced face. Sports and recreational activities make the young male nose a good target for injury causing twisted and deviated noses that often pose problems for breathing as well.
One set of procedures that is really new and undoubtably influenced by movies and models is structural facial reshaping. Creating that chiseled and angular face is what some young men aspire to achieve. A good jawline in particular is associated with enhanced masculinity. While one perceived just as making a strong chin with an implant, modern plastic surgery implants can be extended all the way to the back of the jaw. With the development of jaw angle implants, the jaw line can become more defined than just with a chin implant alone.
A new generation is redefining male plastic surgery. Have a lean body, flat chest, and a nose and jaw line that creates a well defined face has probably never been out of style. But modern surgical developments make them more attainable than ever before.
Dr. Barry Eppley
Indianapolis, Indiana
Cosmetic plastic surgery has long been gender-biased with the vast majority of patients being women. While one could argue that this speaks significantly towards our societal standards and to women in general, men are increasingly having plastic surgery as well. While men still make up less than 20% of surgery and office-based cosmetic procedures, those numbers continue to increase each year.
What separates men from women in plastic surgery is two-fold. First and perhaps surprising to many, most men require extreme discretion and privacy. Men are much more sensitive to how they might be perceived by others for having plastic surgery. Secondly and not surprisingly, the type of procedures that men undergo in plastic surgery are different from women. The top male cosmetic procedures in my Indianapolis plastic surgery practice are nose reshaping (rhinoplasty), eyelid tucks (blepharoplasty), facelifts, gynecomastia reduction and liposuction.
Liposuction still remains the most requested procedure for men. Unlike women, however, male liposuction is done in the abdomen, love handle, and neck areas. Even in relatively lean individuals, fat collections at the side of the waist and flanks are common as one ages. Even in men that work out regularly, those love handles can be impossible to work off. Today’s liposuction techniques have been refined to produce better results with less risk of skin irregularities and etching procedures are now available for the leaner male who want an easy way to the ’six-pack’ abdominal look.
In younger males and teenagers, nose reshaping (rhinoplasty) remains a popular operation. Putting the nose into better balance with the rest of the face can make a significant aesthetic change. It is not commonly done in men over forty who have come to accept the shape of their nose. Changing the nose in mid-life may make one feel ‘not like themselves’. Rhinoplasty may frequently be performed with chin augmentation for an overall better facial profile. Computer imaging is used before surgery to determine what changes to make on the nose and whether chin augmentation would be beneficial.
Gynecomastia reduction is the one male plastic surgery procedure that is really on the rise. Whether it be a small protrusion of the nipple in a teenager, to a more traditional larger gynecomastia in adolescents, to the sagging and deflated appearance in the middle-aged and older male, improvement in the male chest is sought out like never before. Liposuction, nipple lifting and reduction, and pectoral implants are potential methods for male chest enhancement. Refined liposuction techniques, known as etching, provides better definition to the pectoral muscle outlines which can be combined with any of the other chest contouring procedures.
Eyelid surgery (blepharoplasty) in the male is the best way to get rid of that tired and saggy eye look. Unlike women, most men wait until they have a lot more loose eyelid skin and wrinkles before considering surgery. Browlifting is rarely done in men lest they end up having the ‘Kenny Rogers’ result. Removal of eyelid skin and fat should be conservative in men to appear less tired and more rested, not create a new look. In the more senior male, the upper eyelids can become heavy with skin hanging down onto the eyelashes resulting in obstruction of one’s vision. Upper eyelid surgery in this situation can help one see better than they have for years.
Facelifts are the most misunderstood cosmetic procedure for men. As a tuck-up for the neck and jowls, a facelift only improves the jaw line and neck angle. Like eyelid tucks, men often wait until they have a very noticeable neck wattle that may interfere with shirt closure and may move unflatteringly when the head turns. Facelifting in men is best done in moderation, producing a neck change that is improved but not too dramatic. In very large neck wattles, a direct neck lift is a simpler and easier solution with the trade-off of a thin neck scar.
Dr. Barry Eppley
Indianapolis, Indiana
Catchy and clever names are an integral part of branding in the essential game of marketing for most products. A great working product without a memorable name may never catch any attention with the public, while a mediocre product could grab a market share with just the right name. While this use of ‘naming’ is part of everyday marketing in retail sales, it is fairly uncommon in health care.
Hospitals certainly do advertise, as evidenced by the many billboards around the city but they rarely play the name game. While promoting new facilities, equipment and services, five star ratings and open houses are common marketing approaches in health care, ear grabbing phrases and slick-sounding names are not needed. When you are providing a service with proven benefit – such as a new hospital wing or MRI center, it is more about creating awareness, trustworthiness, and availability. In plastic surgery, however, marketing often veers from the path of traditional medicine. In the world of cosmetic surgery, thanks to the reach of the internet, we are seeing the emergence and widespread use of clever names (and sometimes deliberately confusing ones) to entice patients to have procedures and surgery.
The most well-known example is that of the ‘Lifestyle Lift’. Through their national magazine and television ads, this is a franchise approach to getting a facelift…or some version of it. Promising to turn the clock back at least ten years and look recovered in just a few days, its snazzy name seeks to assure patients that it will fit into their ‘lifestyle’. Interestingly, nowhere in their advertising does the company suggest it is actual surgery. I have seen numerous patients who have visited their facilities and were surprised to learn that it was actually an operation. These same people are certainly surprised to learn that the ‘Lifestyle Lift’ is an operation that is over twenty years old and is practiced by most plastic surgeons. This ‘mini-facelift’ operation has now cloned many spinoffs including Swiftlift and Weekend Lift to name just a few. Often touted as being innovative and original by the advertising surgeon, the names suggest that getting a fresh, younger look is really easy.
The fear of what transpires during a ‘Tummy Tuck’ keeps many women from actually having one. While there are different versions of tummy tucks, they all involve some degree of invasion of your mid-section, and some period of recovery. The ‘Smooth Tuck’ procedure puts a different twist on it. Promising less than a week of recovery and six-pack abs, who would not want to have one? After all it is smooooth. The reality is the closest most tummy tuck patients can get to a six-pack is at their local convenience store. Flat, fairly taught tummies can be realistically achieved, and that is more than enough for most patients. But getting back to work in less than a week looks better in an advertisement than it will feel in real life.
My current favorite is the Vampire Lift. Yes, that is an actual name that I hate to admit even exists in the industry. Using modern platelet and stem cell biology, the concept of extracting and purifying your blood for its healing components is used in many surgical specialities. While it can be a useful adjunct to certain surgeries, the fact that it is natural does not give it ‘pixie dust’ properties. The Vampire Lift takes that concept and uses it as a substitute for injectable fillers to plump up your face. Promising to grow your own tissues to make lips bigger, and injecting blood to make facial parentheses less noticeable certainly seems better than any synthetic product off-of-shelf. While this is an organic way to dispose of your money, it is a far fantasy from actual medical science.
What’s in a name? In cosmetic surgery, clever names often disguise an established procedure and might be just another way to catch the attention of a prospective patient.
Dr. Barry Eppley
Indianapolis, Indiana
The first of the month of July marks the first visible sign of the recently passed Health Care Reform Act. You might not notice it unless you are paying to get a tan. The 10% tax on tanning salons has gone into effect and it will cost you that much more to get one now. Tanning salons were easy targets for Washington legislators. With analogies to tobacco and alcohol, its association with increased skin cancer risks made it easy pickings with no significant protest. The initial cosmetic target was a Botox tax but that ran aground due to being a gender-biased tax. The elephant sitting in the room with the tanning salon tax is that it is a racially-biased tax…but I digress.
The debate over the Health Care Reform Act is all but a faint rumble now but it was really a largely economic and taxing exercise over an issue that has long been decided. With Medicare and Medicaid now making up well over half of whom most doctors and hospitals service, and with the percent growing, we have insidiously grown into a nationalized health service that existed before this recent discussion. Throw in the large Veteran’s Administration and military service health facilities and the government is by far the biggest payor for our nation’s health. The recent legislation was merely the tipping point that made the path to greater government control over heath care just go faster and even more evident.
While many clamored that the health system in the U.S. was broken, the reality is that it functions pretty well but is overwhelmed with demand that exceeds the economics to pay for it. The idea of insurance coverage and a societal safety net established in the 1960s never could have envisioned the population demand and the magnitude of health care advancements that have occurred in the past forty years. The very feature that makes our health care system the best in the world…a system driven by entrepeneurship…is exactly what is making it suffocatingly affordable to many individuals and businesses now.
The one certainty that will result from this legislation is that you will be paying more…and eventually getting less. No matter how it was painted and sold in Washington, this is an absolute certainty. As a result, we have been seeing for the past few years the development of the field of concierge medicine. As a fee for service concept, you pay a flat fee per year for an individual or family and get access to medical care 24-7. Various tests that may be needed are still billed to your insurance company. This allows you to use your health insurance as a catastrophic plan (and even a one day stay in the hospital can be an economic catastrophe) and pay lower premiums. This may only lower your out-of-pocket a little but it changes the level of service and cuts down on the amount of paperwork needed for doctor visits, etc.
While concierge medicine may not be the right choice for everyone, it is taken out of the playbook that plastic surgeons have used for decades. Elective cosmetic surgery, such as breast augmentation, facelifts and tummy tucks, is the original form of the concierge medicine fee-for-service concept. The idea of paying a fixed price for a certain medical service is re-emerging and will become increasingly popular. As more doctors withdraw from Medicare and Medicaid, due to the abysmal reimbursements and the labryinth of befuddlling paperwork and coding schemes, cash providers and practices will again become more commonplace.
Dr. Barry Eppley
Indianapolis, Indiana
While my parents, and their parents, have lived much of their lives with fairly similar methods of doing business, the present world has seen a near total transformation in just the past decade. The merging of two initially unrelated technologies, electronic communication (now wireless) and social networking, have created a paradigm shift in societal thinking and strategies. While most who will read this have felt the impact on their business and personal lives, health care is one area where an equal transformation is rapidly occurring.
Plastic surgery has been one of the early adopters of both social networking and digital communication in the medical world. Part of this is because so much of plastic surgery is visual. Almost all of what we do can be seen and easily imaged. This is a double edged-sword as assessment is easy but with that can come an equal opportunity for criticism. Plastic surgeons rely on imaging only less than that of radiologists, whose entire practice is essentially the analysis of complex three-dimensional arrays of pixels. While a plastic surgery patient can provide great verbal detail and descriptions of their concerns, a good picture or two can leapfrog hundreds (or is it thousands?) of words.
Because of the need to market fee-for-service elective surgery, social networking sites have become a popular medium for plastic surgeons and numerous other practitioners of cosmetic services. In the old days (2000?), one would rent a hotel conference room and put on an evening program for the public. Advertising by word of mouth or newpaper ads might get an audience of 50 to 75 people. Post a blog or a promo on Facebook or Twitter and the potential exposure is to thousands.
I could pontificate on the medical impacts of these technologies, and there are too many to mention here, but one recent story makes the point. Driving home one evening after a day of surgery, I received a call from an emergency room halfway across the city. They had a five year-old boy that had a laceration on his forehead after his older brother yelled, fore!, and swung. These type of calls are common in plastic surgery and despite that I would have liked to fix this child’s problem, being up since 4AM and driving 35 miles was not beyond what I could muster. I asked the emergency room doctor to pass along my regrets and asked them to call another plastic surgeon. As I was settling down for the evening and just put my feet up, I received an unrecognized e-mail on my iphone with a one sentence message and a picture attachment. The message said, ‘My son is in need of your skills.’ signed by a mother’s name I had never heard of. The picture showed a close-up of a child’s face with a laceration down the center of the forehead between the eyebrows and the scalp…right down to the bone.
I don’t need to tell you what happened later that evening. With estimates that at least two-thirds of American physicians have smart-phones, doctors are prime targets for access from multiple wireless methods. With nimble technologies, from smart phones to health-monitoring devices, patients as well as doctors are becoming more empowered. Will this make health care better and reduce costs? Who knows but interactive health and wellness programs already surround us. Apple alone has thousands of health-related applications. Cell phone services using the Droid are not far behind.
Medical care is becoming more wireless at a brisk pace. While receiving the actual care still requires an in-person visit, the day may not be too far away when all you need to do is hold your cell phone next to what hurts.
Indianapolis, Indiana
Although eyelid surgery (blepharoplasty) treats only a small area of the face, it has a dramatic impact on facial appearance. Dollar for dollar, blepharoplasty surgery has the best value of any plastic surgery procedure of the face because it is seen by all in everyday conversations. The eyes show age more than any other body part due to smiling, squinting, frowning, sun damage , and heredity. A lot of what you perceive in other people has to do with how their eyes appear. Most of us know this because when we go into work, more often than not, what does someone seem to frequently say…you look tired!
Upper eyelid surgery gets rids of hooding and excess skin that may be hanging down on your eyelashes. Upper blepharoplasty helps restore a natural, youthful appearance by removing skin through an incision in the eyelid crease. In some cases, fat may also be removed or redistributed. Since the incision is carefully placed, it is undetectable once healed. The only way that fine little scar can be seen in the upper eyelid is if they look while you are sleeping!
The lower eyelids are one of the first areas of the face to show age-related changes. Most of us know this because the appearance of bags and wrinkled skin. Loose skin and muscle create a droopy appearance and a protrusion of fat, which normally is under the eyeball, creates that classic but dreaded appearance of lower eye bags. These bags are really prone to absorbing fluids which is why they are more swollen in the morning or if you have eaten really salty foods the day before. The lower eyelids can be improved by an incision which is hidden either inside the eyelid (if fat only needs to be removed) or just below the lashline. (when all tissues need to be treated) The muscle, support tendon, and skin are reshaped and tightened back up against the eye. That protrusion of fat is either removed, tucked back in, or repositioned over the edge of the eye socket bone, dependent upon what will look best. In some patients, chemical peels or laser resurfacing can be done at the same time (only when the incision is on the inside of the eyelid) to improve wrinkles and loose skin on the lower eyelid and crow’s feet area.
One of the most interesting things about these procedures is that most patients say… the most surprising thing about eyelid surgery is the lack of pain during recovery. While eyelid surgery may look bad, it actually produces very little pain. Your recovery is largely social and about how you look.
The other comment that patients often say is…why did I wait so long? I spent a lot of money on creams and other potions and none of them worked…and they promised they would! (hope still remain the #1 selling point) Eye creams are beneficial but they are largely about prevention and not about reversing the age changes that are already there. They simply can not tighten or lift skin to any visible degree.
Dr. Barry Eppley
Indianapolis, Indiana
The mixing of religion and plastic surgery are an unlikely pair that on the surface go together like oil and water. The current Gulf oil leak brings vivid images of how such things don’t go well even though they are closely aligned by proximity. Those considering plastic surgery with deep personal convictions undoubtedly feel like those contrasting mixtures. While no Christian religions of which I am aware specifically forbid having cosmetic surgery, it is with a certain amount of guilt that one of such beliefs ponders such a seemingly self-aggrandizing act.
I recently saw a mother on whose son I had operated many years ago to repair a birth defect. To leave a child’s face deformed is, of course, unimaginable in our society. But there are many third-world countries where, due to lack of medical care, such facial birth defects are not routinely repaired. Even those persons with the deepest and strongest of personal convictions against ‘plastic’ surgery would not quibble about a parent’s decision to seek reconstruction of a birth defect. The same could be said for a church secretary that I saw who had breast cancer and wanted immediate breast reconstruction. But what about my former pediatric patient’s mother who now wanted a tummy tuck? Or what about the individual who has body issues so serious after a 100 lb. weight loss that their mobility is affected?
For some, plastic surgery seems like a selfish and indulgent pursuit. While this response is often a knee jerk reaction on the part of some who see it that way, those with religious convictions are forced to look even deeper and confront their beliefs and sometimes even question their spiritual integrity. But in a modern consumer-driven society, the awareness of such personal improvements is all around and are as readily available as the office across the street or in the next biggest town.
Over the years, I have performed cosmetic surgery on many more than a handful of patients with deeply held personal convictions who have undergo everything from breast augmentations to facelifts. I know of their personal convictions because they told me so. While most patients offer an explanation (although not needed) as to why they want cosmetic surgery, those of religious persuasions are upfront about their struggle with this decision. There are few others that they can turn to for this discussion for fear of judgment in their community as well as to avoid the criticisms they would feel even if such words were unspoken. Most of us are quite quick to judge the motives of others without any real knowledge of their story.
A baby with the cleft lip and a mother who wants a tummy tuck seem worlds apart. But are they really? My observation is that both situations are wholly about the need to look and feel ‘normal’. No parent corrects a birth defect with aspirations their child will one day become a supermodel, and a mother of four kids whose body has borne the brunt of repeated pregnancies are very similar. These surgeries are about normalcy; and about feeling confident. Few cosmetic patients that I have ever met really want to be special, most only want to feel better about themselves- they want confidence. Whether that desire conflicts with the integrity of one’s religious beliefs, or are mutually exclusive, is not for me to say.
What I tell any patient, of strong religious convictions or not, is that plastic surgery is a tool. It is a method for personal improvement. The decision to have surgery or not is only part of the personal enrichment process.
Dr. Barry Eppley
Indianapolis, Indiana
Watching the crowd today at the Indy 500 in 90 degree heat with open skies, many no doubt wished that they had a better sunscreen. Perhaps some wished they had some sunscreen, any sunscreen for that matter. But for those who had the forethought to pull some sunscreen out of the closet or buy some on the way to the race, they probably couldn’t tell the difference between the numerous brands. The usual public mindset is that they are pretty much all the same and slathering on something is better than nothing at all.
What most people don’t know is that most sunscreens only protect against ultraviolet B rays. Most sunscreens don’t provide sufficient protection against skin damage that is caused by a much larger percent of the ultraviolet spectrum, ultraviolet A rays. (UVA) It is these UVA rays that contribute to wrinkling, freckling, brown spots and skin cancer since they are the same strength all year, all day long. They penetrate glass and is why your left face and left arm frequently develop greater skin damage from the sun exposure gotten during decades of driving.
While some sunscreen manufacturers now carry combined UVA and UVB protection ingredients, the lack of FDA regulation makes their claims confusing and often misleading. One would think that the same federal agency that regulates medical drugs would have long ago set standards for sunscreen performance and ingredients. But that is not the case. This is particularly peculiar given that every other industrialized nation uses UVA protection with specific guidelines. The FDA has stated that they will be releasing sunscreen recommendations in the fall. But until then another summer will pass with most people not knowing what they are actually putting on their skin.
If you are a teenager or in your 20s, the thought of skin cancer is as remote as the need for Botox or developing an unflattering neck wattle. But recent statistics show that more than 2 million people in the United States are diagnosed with skin cancer per year. This is an almost shocking two to three times increase from just twenty years ago. And most of these are directly related to sun exposure. The seeds of these skin cancers are sewn at the very age when one thinks the least about it.
The myths of sunscreen claims are numerous. Besides not knowing whether they really are as effective at blocking the sun rays as they state, many other label claims are more than just misleading. Such proclamations as ‘all day protection’, ‘waterproof’ and ‘sweatproof’ have no scientific basis and are simply not true.
The only reliable sunscreen claim is SPF (sun protection factor) which blocks UVB rays. But manufacturers use this well recognized sunblock factor to sell more sunscreen. With common SPF numbers of 15, 30, 45 and greater, one would logically think that the sunburn protection would be substantially better as the number gets higher. But the truth is that SPF 15 blocks 94% UVB and SPF 30 blocks 97% UVB. Beyond that there is no real improvement in sun ray blocking effect.
Until the FDA regulates sunscreen, the best approach is to use a dual protection UVB/UVA combination that is SPF 30 rated. UVA blockers avobenzene and meroxyl are becoming more widely used now in these broader spectrum sunscreens and they may last up to five hours. Reapplication should be done if the one sweats heavily or goes swimming. They are certainly pricier than what most are used to paying for it but is worth it for not getting skin cancer.
Dr. Barry Eppley
Indianapolis, Indiana
Reality TV is often far from ‘reality’ but sometimes there is a kernel of significance in a portion of a show. In a recent episode of the ‘Real Housewives of New York City’, one of the women accompanies her friend to a plastic surgery consultation. During the show, she recommends and helps her friend to ask the plastic surgeon some important qualifying questions about liposuction in which she has interest. During the consultation, the women asked the plastic surgeon if he was board-certified and when, did he have operating privileges at a hospital for the procedure in question, and if he was a member of American Society of Plastic Surgery.
While these questions would no doubt bring acclaim for our national organization, these queries today can be answered long before you ever enter a plastic surgeon’s office. If you have to get these basic qualifying answers from a personal visit, you mustn’t have a computer in your house or have never ‘Googled’ or ‘Binged.’
Historically, patient’s were advised to ask a basic list of questions to their plastic surgeon to be certain they were qualified to perform the surgery. These included board certification and in what specialty, society membership and hospital privileges. While these are still good questions, they are so simple to find and don’t have the significance that they once did. If the plastic surgeon doesn’t have a contemporary website that easily provides this information, I would quickly move on to one that does. An informative website for a plastic surgeon, or any business for that matter, is an essential as any individual having a cell phone. If one isn’t investing in an internet forum for patient education, I doubt if they are investing much in advanced medical education either.
With today’s ease of information gathering, photo acquisition, and methods of presentation, contemporary plastic surgery qualifiers are much different and more defining. I believe these are the more relevant questions to search for in finding a qualified plastic surgeon. They include photographic demonstration, recent patient experiences, and educational information.
Photographic publication surrounds us at every corner today. Whether it is on Facebook or other social media, even the most basic cell phone can take a pretty good picture. Plastic surgeons are the most advanced and proficient of all medical specialities in photography on average. Therefore, one should come to expect a good demonstration of a plastic surgeon’s most valued asset, before and after patient photographs. While it is true that any business is going to put out its best results, at the least you need to see a handful of actual patient before and after photographs. The more, the better.
A past customer’s experience is a good barometer of service and results for any business. But a patient who had surgery a long time ago is not as useful as one who has had a surgical experience in the past weeks to months. Fresh experiences are what you need and preferably from more than just one patient. Having a recent patient also suggests that the procedure is performed more than just a few times a year.
Brochures and flyers are standard educational pieces in any plastic surgery practice. But there are so many boiler-plate pieces that are available to purchase for any plastic surgery procedure that they are not only unimaginative but provide generic (and often useless) information as well. What you want to see is customized practice information that provides detailed and meaningful procedure information that reflect’s what that plastic surgeon specifically does. You want to know what this plastic surgeon does, not what the ‘average’ plastic surgery approach is.
Dr. Barry Eppley
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
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, 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.
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
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
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