Newspaper Articles

Due to the marketing and appeal of a facial rejuvenation procedure called the Lifestyle Lift, many people have at least heard of it. A scaled-down version of a facelift, the Lifestyle Lift is not unique or new but is actually a common procedure performed by many plastic surgeons. Todays trend toward less invasive plastic surgery and beginning facial rejuvenation earlier has led to the marketing of an otherwise routinue facial procedure.

Unknown to most, the Lifestyle Lift is a branded name and is a blended marketing and service approach to delivering minimally invasive facelift surgery. In essence, it is a franchise approach to selling surgery with office locations in 22 states. (the closest office to Indy is in Cincinnati)

While there is nothing wrong with that concept, the Lifestyle Lift company was recently fined $500,000 in New York where its corporate headquarters is located.. The attorney general there has settled complaints against the company as it has admitted that it used its employees to pose as satisfied customers in online ads. Apparently the company ordered employees to write positive reviews of the Lifestyle Lift on message boards and other internet forums to appear as unsolicited testimonials and endorsements, thus violating consumer protection laws. (proving once again that www. really means the wild wild west…believe at your own risk!)

While the company and the way it operates may have some deceptive marketing practices, the actual operation however is still a sound one. The limited facelift or short scar facelift (a.k.a Lifestyle Lift) is very popular and highly successful. It is a scaled down version of a more extended facelift into which many other smaller facial procedures can be added as well.

Younger patients today want to treat jowl and neck sagging early rather than wait until it looks worse. Therefore, their facial concerns are less severe and they do not need a full facelift operation. The limited facelift is often combined with other smaller procedures (e.g., Botox, injectable fillers, laser resurfacing, neck liposuction, eyelid tucks) to create an even better overall result without extending one’s recovery.  Older patients (who really do need a bigger operation but do not want it) can still get a simpler and less invasive operation that will provide some real improvement. (although less than that from a full facelift) This usually fits their financial situation and allows them to have surgery that they can afford with a recovery that fits into their work or leisure schedule.

Dr. Barry Eppley

In researching a plastic surgery topic this week, I came across an entertainment article in which the writer presented an opinion on the top ten plastic surgery disasters in men. Using photographs, they compared the ‘before’ and ‘after’s of several well known male celebrities- of which there is no doubt that these men have had facial work done. And I am not referring to in-office procedures such as Botox and injectable fillers. All had obvious surgical manipulation of aging facial features.

Those listed are well chronicled and include often cited celebrities such as Kenny Rogers, Gary Shandling, Carrot Top, Sylvester Stallone, Bruce Jenner, Burt Reynolds and Gary Busey to name a few. While I am certain that they don’t feel unusual looking, most women would disagree. This begs the question of what is it that makes them look unnatural? Is there a common problem that they now all share?

In reviewing these pictures it appears the problem lies for many of them in the work around the eyes and cheeks. On the whole, the appearance of these men has changed to more of a feminine look. This is the result of a variety of changes that include over-elevation of the brows, a ‘pulled too tight’ appearance around the eyes, and unnatural cheek bone augmentation giving an ‘apple-cheeked’ effect.  The neck and jowl lines, while no longer sagging, have changed them. In an effort to rejuvenate the aging and sagging face, they have been overlifted and plumped up too much.

This may make the skin much smoother and eliminate a lot of skin wrinkles and folds, but the end result is anything but ‘natural’ in appearance, and is a red flag that screams ‘facelift!’ to even the least discerning eye. Certainly, men care about their appearance as they age, and want to look as young as they feel.  With regard to celebrities, it’s a usually a foregone conclusion that plastic surgery is a necessity in order to keep pace with the up and coming younger entertainers.  However, great work – and natural looking results are never a guarantee in Hollywood surgical circles, and paying top dollar to a well-known or famous surgeon really has nothing to do with the final outcome.

To get a natural looking result in men, facial rejuvenation really has to be ‘underdone’ in comparison to that of a woman. Women can aesthetically tolerate more significant facial changes.. The goal of very smooth skin and sleek facial features simply looks better on women. Even when women have gone too far, they rarely look as bad as what can happen in men. Nips and tucks are very helpful to slow the aging process down in men, but dramatic sweeping changes simply trade-off one problem for another. Facial rejuvenation in men illustrates the age-old concept that less is often more.

Dr. Barry Eppley

Breast cancer remains a threat to every women and the emphasis on early detection can not be overemphasized. As October and Breast Cancer Awareness Month has now passed, the upcoming holiday season may temporarily displace some of these concerns. Plastic surgery throughout the year, however, plays an inadvertent but beneficial role in the detection and management of this disease.

Breast reduction remains as a very popular and commonly performed plastic surgery procedure. It provides a dual reconstructive and cosmetic benefit by making the large breast better shaped and more uplifted and improving back, shoulder and neck pain by size reduction. As part of the reduction procedure, breast tissue removed is almost always sent to the Pathologist for examination. While I have yet to have positive cancer findings from submitted breast reduction tissues, reports exist that it is occasionally found.

The finding of breast cancer during a reduction procedure can occur in two circumstances. The first is during the course of the operation some suspicious tissue is found and sent to pathology for an immediate evaluation, known as a frozen section. The second is when the submitted tissues are examined by the pathologist and cancerous tissue is found. A recent study report has shown that the finding of breast cancer or precancerous tissue in pathology specimens existed in 12% of the patients studied in one treatment center.

This is a rather surprising finding given that prior published reports have not shown such high caner rates of cancer detection in breast reduction patients. However, given the relatively high incidence of breast cancer in women, it does seem logical that a significant number of yet symptomatic women have the disease.

This raises an interesting and  obvious question. Does breast reduction surgery decrease the incidence of breast cancer? Will it decrease the risk of some women from eventually getting this disease? The answer to that is an emphatic yes….for some but not all women.

This question has been looked at and reported on in 2004. A study published in the pretigous journal of Plastic and Reconstructive Surgery reported a difference in risk of breast cancer after breast reduction surgery. This appears to be especially true in women who are over 40 years old at the time of surgery. Risk of cancer reduction in this age group was 28 to 50 percent. No reduction was seen in women having the surgery before the age of 40. Although the complete removal of a woman’s breasts (prophylactic mastectomy) can virtually eliminate the risk of breast cancer, most women find it extremely difficult to elect to remove all of their breast tissue. Women now have an additional preventative option to have their breasts partially reduced rather than removed. This represents a real alternative for someone who is a candidate for breast reduction, even though the amount of tissue removed may be small.

Given the occult incidence of breast cancer found in the pathology of asymptomatic women during routinue breast reduction surgery, this can be viewed as an additional benefit of the operation. However, I would emphasize that breast reduction is a risk reducer, not a preventative guarantee.

Dr. Barry Eppley

Since its commercial availability since 2002, Botox has revolutionized wrinkle treatment of the face with emphasis on improvement in the forehead and eye areas. There are few people who would not recognize the name, even if they may not understand what it exactly does.

Botox is so effective (although only temporary) and simple to do, it has given rise to an entire industry of treatments, cosmetic practitioners, and business models based out of strip malls to doctors offices. Billions of dollars of annual revenues have been created out of what is essentially a chemical poison. But the doses used are so small to treat wrinkles that it is harmless to humans. But calculated out per pound, Botox would roughly cost a trillion dollars… making it the most expensive material on the planet.

With such a proven and desireable commodity, it is no surprise that other manufacturers have been feverishly working on coming up with a competitive product. The recently available Dysport can now stake its claim as second in line. Whether it will make a significant dent in Botox’s business remains to be seen.

Dysport is not new and has been used around the world for years. In those countries where Dysport and Botox co-exist, the market shares of each are not that different. But Botox in the United States has tremendous brand awareness and a huge headstart. As a result,  it will likely be the ‘Coke’ for a long time in facial wrinkle treatment and Dysport can best hope to become ‘Pepsi’ in time.

Like any new product, Dysport must seek a marketing edge. Claims have been made that it lasts longer and costs less…the holy grail doctrines of the cosmetic industry. But a close look at the scientific studies and available evidence on Dysport does not support those marketing theories. The company does not actually claim them as the FDA would not allow such unsupported statements based on the studies that were submitted. Such claims appear to be the propagation of rumors and hope… and zealous physician marketing. In my experience, Dysport appears to be a good but equivalent treatment to Botox. In time, it may show a few select advantages (or disadvantages) but they are not obvious yet.

While competition usually drives down price, that does not appear to be the case in this battle of wrinkle reducers. Because they are given in different doses, it is not even possible to compare Botox and Dysport prices on  a unit basis…which is how they are given by injection. Because Dysport is new to the public, it is natural to assume that it may be better. Its value at this point, however, appears to be as a treatment alternative for those few patients who are either resistant to or becoming less responsive to their current Botox injections.

For those patients clamoring for a cheaper and better Botox, Dysport will not be the new fountain of youth.

Dr. Barry Eppley

An important concept in cosmetic plastic surgery is that of value. In short, what are you getting for your money?  The importance of a good return on one’s investment is one factor of how you will interpret the result and the experience.

While talking frankly about a patient’s expectations before surgery remains the cornerstone of good ‘doctor-patient’ communication and goes a long way toward a patient’s satisfaction afterwards, the ‘value’ concept in plastic surgery is often overlooked. What is the inherent value or lifespan of the operation or procedure? In other words, how long will the results last? Interestingly, this will vary greatly amongst the many surgical options available.

Certain plastic surgery procedures have tremendous value because they will essentially last a lifetime, almost regardless of the patient’s lifestyle postoperatively. In this category would be procedures such as rhinoplasty (nose job), otoplasty (ear pinning), and facial implants (e.g., chin implant) for example. Once these changes are made, barring complications, they are permanent and will never change no matter what the patient’s lifestyle. The same can almost be said for breast augmentation and abdominoplasty (tummy tucks), although how permanent these results are is influenced by the patients’ age at the time of surgery.  If a woman is done having children, these two operations can have a long lifespan with little change. If you amortize these more ‘permanent’ procedures over one’s remaining lifetime, they can become well less than a dollar a day. It is hard to find anything you could buy that would last so long at such a low lifetime cost.

More moderate lifetime value plastic surgery procedures are those which can be influenced by one’s lifestyle…the potential for weight gain and a lack of care for one’s self. Liposuction is the leader in this category. While immediate postoperative changes can be quite gratifying, the short and long-term benefits of the procedure are only going to be as good as long as the patient continues to support their original investment ( proper nutrition and exercise).  Any anti-aging facial procedure, such as a facelift, browlift, or blepharoplasty (eyelid tucks), falls into this category because it treats the symptoms of the problem and not the actual problem itself – aging.  Therefore, time will always outlast the surgical benefits (and I would argue you want to outlive how long these operations will last!).  The value of these procedures must be judged more in the intermediate term (5 to10 years) and the cost must be averaged over this time period, which makes it a few dollars per day.

Ironically, those procedures that have the shortest value period (Botox, injectable fillers) have become tremendously popular during this decade. While Botox lasts just four months, its cosmetic uses account for nearly a billion dollars in sales nationally. These very short value procedures overcome the economics due to how easy they are to administer, immediate results, and lack of any recovery from them. In other words, an instantaneous fix at a relatively low cost (compared to actual surgery) increases their relative value.

While elective cosmetic plastic surgery decisions are really emotionally driven, it is interesting to look at their economic value in terms of the lifespan of their results. Such considerations are not a major determining factor in the decision for surgery but may help in deciding if a certain procedure is ‘worth it’. 

Dr. Barry Eppley

There is sure to be much discussion about a provision in the U.S. Senate’s version of Health Care Reform which would impose a tax on elective cosmetic procedures. With a tax rate of 5%, the measure presumably will raise close to $6 billion of the projected $850 billion price tag of the healthcare bill (most analysts agree that this projected cost is fancifully low).

Given the name of “Botax” by many, the intent of it is to clearly tax those who can ‘afford’ to pay it…some call it a tax on the wealthy. But those who do so clearly have no idea who really makes up the cosmetic population. The Botax name is a clever variation of Botox® facial injections which have become the beacon procedure for non-surgical office procedures used for wrinkle reduction. In theory, the Botax could impact about 12 million cosmetic procedures and surgeries performed each year in the U.S..

As one would expect, all sides of the cosmetic surgery industry from physicians to patients are voicing opposition. Their argument is that such a tax unfairly targets the middle class and working women in particular. Statistics from the American Society of Plastic Surgeons (ASPS) show that only a minority of people who undergo any form of cosmetic surgery has a household income greater than $90,000 per year and the vast majority (greater than 80%) are women between the working ages of 18 to 65. Clearly this is not a tax on the wealthy and is a discriminatory tax that falls largely on women.

While the idea that it is a tax on the wealthy is fallacious, it is a tax on the healthy. Contrary to what many would guess, the vast majority of cosmetic procedures are done are health-conscious individuals. Most are already reasonable fit and are ‘appearance focused’.  The obese, smokers, diabetics and other ‘unhealthy’ patients make up just a fraction of those people ever undergoing cosmetic procedures or surgery. This proposed discriminatory tax is targeting those who do take care of themselves to help some who have made poor health choices along the way. It would make more sense to tax unhealthy food items, for example, that have incredibly high fat content…and it would bring a hundred fold increases in revenue to support health care reform.

This type of tax proposal is also troubling because it treads on choppy waters that health insurance companies have trouble deciphering.  What is the official or tax definition of a cosmetic procedure? IRS rules for tax deductions state that any procedure necessary to treat a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease is a medical procedure. Anything else is a cosmetic procedure. Some delineation is quite clear- Botox® used for wrinkles or for migraines for example. But what about a tummy tuck to treat the effects of pregnancy?   Are the effects of childbirth on a woman’s abdomen a cosmetic or reconstructive procedure? 

With so many differences between the House and Senate Health Reform bills, it is difficult to say what will eventually shake out. But this hidden tax will largely penalize health conscious women. It is a troubling signal of how far reaching your legislators will go to get more of your hard earned money. And once again the beneficiaries of your ‘generosity’ will likely be those that have sacrificed less.

 Dr. Barry Eppley

Some may have read the recent story of a 38 year-old ex-Miss Argentina who died from complications after undergoing plastic surgery on her buttocks. Solange Magnano, who won the crown in 1994, died of a pulmonary embolism three days after having buttock augmentation in Buenos Aires.

For many, this tragic story points to the inherent dangers of cosmetic surgery and that someone risked everything she had in life for a more firmer behind. On the one hand, there is some truth to that perception.  Surgery of any kind always involves some risk. The potential for deep vein thrombosis and pulmonary embolus has become a big prevention emphasis in any kind of surgery these days.

But the ex-Miss Argentina did not die from a vein-clot related pulmonary embolism.

Closer inspection of this story shows that she died from a lung embolus that resulted directly from what was injected into her. When I first read this story I thought this woman died from a fat embolus from having had buttock enlargement by  fat injections. It is rare but fat emboli have been reported to occur from liposuction and fat injections. But when pictures showed how thin she was, it became obvious that she had not enough fat to use. What was not printed was that a liquid filling material that contained tiny beads was used. Such a material is used here in the United States for facial injection purposes, but never anywhere else in the body. With many thousands of beads and clumps of beads injected, it would be very easy for some of them to get into the larger veins in the buttock…and be transported right upward through the heart into the lungs. Such a risk does not exist in the face where such materials were developed and intended for use.

What does this story tells us about the risks of cosmetic surgery? Does it indicate that cosmetic surgery is inherently dangerous? The answer is no…when done under the proper circumstances with good medical judgment. Almost everyone of these tragic stories that I have seen in my years of practice ends up showing some breach of the known standards of care. Whether it be how the surgery was performed, by whom, or in what type of setting and circumstance, violating established methods and standards of care can have catastrophic results.

Cosmetic surgery is real surgery…and there are no shortcuts. Sacrificing safety for what appears to be easy and quick has not usually proven to be a good trade-off.   

Was the death of the ex-Miss Argentina preventable? By not doing the surgery… for sure. But if the surgery had been done with proper methods and materials (or not done at all if there was not enough fat to be used), the risk of such an outcome would have been no higher than a similar fate occurring from an accident while driving to work everyday. Outside of the United States, there are few rules governing what ‘cosmetic doctors’ do.  In the United States the plethora of regulations and training requirements for plastic surgeons, while certainly contributing to costs, go a long way towards a much safer experience.

Dr. Barry Eppley

Liposuction continues to be one of the most popular plastic surgery procedures. Without question, significant changes in one’s body contours can be achieved. The marketing and promotion of liposuction across all types of media strongly suggest that it is a precise surgical procedure. Inferences are not subtle that surgical fat removal is equivalent to sculpting or the chiseling out of body parts.

While some body areas can be sculpted, most liposuction results are not like art work. The body is not a bar of soap nor a block of marble. And most patients will not end up like the model that appears in an advertisement. The outcome of a liposuction procedure is certainly influenced by the surgeon performing it and the tools that are used. But there are numerous logistical factors that will always limit the exactness of the results that can be achieved.

The topography of the treated area is one important factor. Most of the body is not flat but rather a curved surface that has different thicknesses of fat as it curves around from area to another.  This certainly makes it difficult to always ensure evenness of fat removal, particularly when the removal is done with a straight cannula.

Liposuction surgery is almost always done with the patient in the horizontal position.  While this does not affect some body areas such as the stomach, such positioning allows most fat collections to shift backward and become distorted as they lie pressed up against the operating table. The concept of ‘standing up’ liposuction is theoretically appealing but currently impractical.

Skin quality remains a very important determinant of liposuction outcomes. Looseness of skin, stretch marks, and cellulite over a treated area does not bode well for the needed skin contraction of deflated areas. One must appreciate that it is highly likely that the smoothness of overlying skin will never be better after liposuction and, in some cases, can be made worse. Liposuction, by any method, is not a treatment method for cellulite as some patients mistakenly believe.

To work around these limitations, there are some presurgical and intraoperative  techniques that are used to get the best results possible. Marking the surgical sites immediately prior to surgery is critical. One must look at the planned treatment areas like a topographic map. The marks will indicate how far one has to go as the body areas shift and distort when one lies down. Marking the high and low spots also indicates how much time should be spent or tissue removed from one encircled area to another. Positioning the patient on the table can help see the marked areas more ‘three-dimensionally’. For example, it is better to treat the lateral thighs or the flanks with the patient turned on one side. While this is more difficult for the surgical team, it is the best way to avoid seeing irregularities and missed areas of fat when the patient is seen standing weeks later in the office.

While new liposuction technologies appear fully capable of improving how well and even fat is removed, they are not magical devices. The use of laser liposuction (a.k.a. Smartlipo) is one example of how using a thermal approach (melting and liquefaction) may produce more consistent and even fat removal. The heat that it creates is promising for helping skin contraction, but it will not transform skin that is already damaged.

Liposuction is an improving plastic surgery technique but it is not yet an absolutely precise art. Patients should appreciate that perfect symmetry and evenness throughout a treated area can not be guaranteed and the desire for secondary improvement through touch-up procedures is not rare.

Dr. Barry Eppley

We are exposed everyday to incredulous claims about health and cosmetic products and services. Advertisements from radio to infomercials bombard us on the weakest aspect of our inner selves…how we look and feel. We all want to look better and feel healthier and to do it with the least effort possible. It is this cross between desire and effort that results in many retail sales that usually benefit the manufacturer or seller the most.

I saw an infomercial just yesterday on an abdominal stimulator device. Being able to read a book, watch TV, or even eat dinner while the device delivers perfect abs certainly seems appealing. With testimonials by six-pack endorsees and seeing their abdominal muscles twitch through their nearly transparent skin made even me as a physician a near believer. After all, their muscles were actually moving and surely that is more muscle activity than I can produce with a series of half-hearted sit-ups. But the price was the clincher…$14.95! Six-packs at the price of less than a week of Starbucks…how could one go wrong?

Or the radio commercial from earlier in the week where another topical potion espouses how it can make cellulite and stretch marks disappear…and it starts working with just the first application! After all, it is so effective that it was given away in bags at a recent film festival. If that isn’t scientific evidence then I don’t know what is. The demon of many a women’s belly and thigh skin, the search for an effective treatment for cellulite and stretch marks has been more elusive than real evidence on Ghost Hunters.

But grandiose claims about cosmetic surgery are not so apparent. Because these services are provided by physicians and always cost more than $19.95, the public’s acceptance of treatment claims is far less discriminating. The use of needles, sophisticated lasers, and actual surgery strongly suggest that the desired outcome will surely happen.

The last decade has seen the merging of two highly compatible themes- busy lifestyles and non-invasive to minimally-invasive cosmetic procedures. The potential for big improvement in appearance with little to no recovery time is the cosmetic holy grail. The concept of a little effort (time, money, and pain) with a big result is what most patients want. But short of Botox and injectable fillers, most other hyped ‘quickie’ cosmetic treatments fail to deliver so successfully.

Lunchtime surgery and weekend recovery procedures, while providing some benefits, do not produce results that are as dramatic and long-lasting as many of the established and well known cosmetic surgery procedures. One really cannot get inches off one’s waistline in a few weeks without real liposuction or a tummy tuck, breasts will not grow larger or become uplifted with pills and injections, and that neck wattle won’t disappear with a laser treatment, suspension sutures or an exercising device. The allure of some of these procedures preys on exactly what that infomercial does…the greatest selling tool of all time…hope.

Marketing is an essential part of elective plastic surgery and all cosmetic procedures. But when the promotional content gets ahead of proven medical science, it is almost always too good to be true.

Dr. Barry Eppley

The recovery from our recent and ongoing recession has been speculated by numerous economic experts. The recent State of the Union address assures us that the worst is over and better days are ahead. Quite frankly, I take solace in any of the above pontifications about as much as I trust giving the government 1.5 trillion dollars in an ill-conceived overhaul of our health care system.

A recent manufacturer survery that I read has indicated that the number of cosmetic procedures were up during the fourth quarter of 2009 since the downturn in the economy began in mid-2007. Manufacturers of Botox, injectable fillers, and lasers have reported that their sales increased in the fourth quarter of 2009 for the first time in years, up anywhere from 2% to 8% depending upon the product.

Are these survery results a sign that the economy is really improving? Luxury and discretionary spending are often viewed as a sign of renewed consumer confidence. But I would take these apparent positive signs with a grain of salt. These numbers are likely up for a different reason.
As the most expensive plastic surgery offering…operations…are being temporarily (and maybe permanently) shelved by some, patients and cosmetic doctors are turning their attention to lower-priced treatments. One may have to pass on that facelift or eyelid tuck, but Botox and fuller lips remain within the budget. Consumers appear to be still trying to hold on to their cash in these troubling economic times, but haven’t given up completely on some more economical forms of feeling and looking better.
A better yardstick of economic recovery as viewed from a plastic surgery perspective is in the number of breast implants being sold. Larger amounts of discretionary spending are a better indicator of how people are really feeling about the economy. When these elective medical device sales, which remain down in 2009, returns to more familiar territory of brisk double digit growth, we will have more than one reason to be optimistic.

The use of Botox and injectable sales as a gauge of economic recovery is just one way that numbers and statistics can be twisted to support one’s perceptions…and hopes. They are up because the bigger ticket items that often come with them are done. This is like saying the economy is improving because Starbucks coffee sales are up… while customers frequenting Ruth Chris’s is down.
While the government may be hinging optimistic forecasts on upswings in graphs and charts, I will look for more familiar enlargements in different indicators before feeling better about where the economy is headed.

Dr. Barry Eppley

As of Jan. 1 this year, a new law took effect in California whose intent is to provide greater safety for patients undergoing plastic surgery.

Known as the “Donda West Law”, it is named after rap artist Kanye West’s mother who died a day after cosmetic surgery in 2007. According to reported autopsy results, Donda West died of pre-existing coronary artery disease and other unspecified postoperative events a day after she had undergone a tummy tuck, breast surgery and liposuction.

This new law requires a physical examination within 30 days before a procedure and clearance from a doctor, nurse practitioner or physician’s assistant before cosmetic surgery is performed. In essence, this makes it illegal for doctors to perform elective cosmetic surgery without a physical examination and clearance from a medical professional.

This new law will actually change very little in most plastic surgeon’s practices because reputable plastic surgeons do take a medical history and perform a physical examination before any major procedure. But it does bring to light and reinforce several important concepts about cosmetic surgery and a patient’s preparedness for it.

First, a cosmetic procedure like Donde West went through is major surgery. It should be viewed in the same light by a patient as having a hip replacement or gastric bypass surgery. While it may not be exactly the same, the extent of the procedure does pose risks which can be magnified based on one’s medical history or pre-existing health conditions. It is therefore paramount that any medical problems be well controlled, one should try and be in the best physical condition as possible and make sure that your own physician is aware of what you doing. While the desire for privacy and discretion is understandable, this should not be done at the expense of your own health.

Secondly, while not every procedure needs laboratory testing beforehand, many do and that expense should be seen as just part of the procedure. In an otherwise healthy person (no known medical problems) under age 50, no laboratory testing is needed. This will change based on if the patient has medical problems. For any patient over 50 years of age, preoperative labs are needed and include blood work and and EKG. More may be needed if other medical problems warrant it.

Lastly, be concerned if this information is not required of you before any major cosmetic surgery. Taking a medical history and filling out such on forms is almost always the very first step you do even before you ever see a plastic surgeon in their office.

While the potential changes that cosmetic surgery can create can be somewhat euphoric when one is pondering the procedure(s), the most important consideration is your safety. If a plastic surgeon suggests that you should not have the operation or recommends a less extensive approach than you want, you would be wise to heed those suggestions. This is usually an issue in major body contouring surgery. In some cases, doing the procedure in stages is both easier and safer for you. It may cost somewhat more to do so and be an additional inconvenience to your life, but that is a small sacrifice to pay for your health.

Dr. Barry Eppley

Indianapolis Indiana