Gone are the days when plastic surgery was simply for the rich and famous and something you felt the need to sweep under the rug.

These days, it is popular and even hip to have something ‘done’. Women and men get it done for all sorts of purposes – to help feel great about themselves, to get rid of some type of medical issue, or just to shed pounds efficiently.

What ever the reason, it is fundamental that you take on simple protection measures since even though it’s cosmetic, the dangers will not be. So before you consent to change the way you look, here is what precisely you want to do:

Chose a capable surgeon: The most critical concern in plastic surgery is not the cost; it’s actually precisely how experienced your surgeon is. You’re doing this since you aspire to try to improve your physical appearance, and it is solely having a respectable and established physician that are you able to be sure that the outcomes are as predicted. So even should you are required to fork out a lot more, choose a cosmetic surgeon who is trained and qualified to do plastic surgery as well as someone that is experienced in the particular treatment that you’re keen on.

Insist on a safe setting: Cosmetic surgery is just like every other surgical treatment in that you’ll be under the effects of anesthesia and you’ll go through blood loss. Therefore, just in case anything goes completely wrong, it is ideal to have surgical treatments conducted in a clinic in which crisis care can be found at a 24×7 basis. If your surgery is actually slated at a private aesthetic surgical clinic, find out about medical facilities which might be in the area and where you might receive emergency care if needed.

Learn recommendations: And finally, it’s very important to stay within your physician’s recommendations ahead of as well as after the surgery. You might have to stop smoking and/or go off particular drugs (if you are on medicines). Also, after the treatment is done, you could be in a good amount of discomfort, but talk with your medical professional before you decide to commence swallowing painkillers all on your own. It may perhaps be some time before you start seeing results, primarily with liposuctions and alternative surgeries performed on the facial area, which means you need to be patient. It’s also possible to have to undergo physiotherapy in some cases, so consult your doctor to be able to provide you all the info prior to deciding to sign on the dotted line.

It could be aesthetic, nevertheless the hazards exist because it is surgery in the end. But should you consider the basic safety measures plus follow directions, there is very little need to dread cosmetic surgery.

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In a survey released today by the American Academy of Cosmetic Surgery (AACS), 71% of respondents think society is less judgmental about cosmetic surgery than it was just five years ago. Furthermore, about 62% said society’s attitude toward cosmetic surgery made them feel more comfortable about getting a cosmetic medical procedure at a skin clinic or medical spa.

“This is a confirmation of what many of us have felt for a long time; that cosmetic surgery has become mainstream,” said Dr. Mark Berman, AACS president-elect. “A variety of factors have contributed to the normalization of our industry, but the bottom line is that people are not afraid to talk openly about cosmetic surgery anymore.”

According to the survey, the most accepted invasive procedures are breast augmentation (42.4%), face lift (32.2%) and tummy tuck (32.1%). Among noninvasive procedures, the most accepted are laser hair removal (61.9%) and Botox (61.6%). Additionally, 52% of respondents said they would tell family about having invasive cosmetic surgery.

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Via KevinMD: This issue has come up before, most recently when the New England Journal of Medicine asked whether doctors should friend their patients on Facebook.

Pediatrician Bryan Vartabedian looks further at the issue, and sees it fraught with potential risk.

He points out that sharing privileged information requires written consent. But what if the patient initiates the conversation? Some attorneys say that can imply consent, but the laws in this area are not yet clear.

Also, every communication between doctor and patient needs to be documented. Dr. Vartabedian notes that “the documentation on most social platforms isn’t detailed enough for other medical professionals or auditors to follow what’s gone on between you and your caregiver [and] let’s not forget that Twitter has a habit of disappearing after a couple of weeks.”

And perhaps most concerning is the privacy issue. When someone shares personal medical information in a public forum, like Twitter or a Facebook page, it has to potential to get indexed by search engines, making it permanent on the web.

There’s tremendous potential for doctors to better use Twitter and Facebook to interact with patients. By guiding patients to reputable sources of medical information, for instance.

But social media isn’t mature enough for doctors to provide personal medical advice to patients. Yet.

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(UPI) — A new California law will prevent doctors from performing elective cosmetic surgery without an “appropriate” physical exam, authorities said.

The law, which takes effect Friday, is named the “Donda West Law” after singer Kanye West’s mother, who died a day after cosmetic surgery in 2007.

The law requires “an appropriate physical examination within 30 days of a procedure and “written clearance” from a doctor, nurse practitioner or physician’s assistant before cosmetic surgery is performed, The Sacramento Bee reported Saturday.

The law will change little since reputable cosmetic surgeons have always obtained a patient’s medical history and made sure the patient had a physical exam before a procedure, said Dr. Terry Zimmerman, head of the Greater Sacramento Plastic Surgical Society.

Autopsy results showed Donda West died of pre-existing coronary artery disease and “multiple post-operative factors” a day after she had an abdominal tuck, breast surgery and liposuction. The surgeon who operated on West surrendered his medical license in April.

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The editors of Consumer Guide to Plastic Surgery are gazing into the crystal ball once again to see what’s in store for 2010.

Even More Botox-Like Products Will Come to Market.

First there was Botox Cosmetic; then 2009 brought the Botox alternative Dysport. In 2010, expect to see a few more Botox rivals, including a topical form of the popular wrinkle relaxer and at least one more injectable. A couple of injectable Botox cousins are in development, but PurTox will likely be the next to get a nod from the Food and Drug Administration (FDA). The main difference in these injectables seems to be how long the results last and how quickly the products start to work on your crow’s feet.

Fat Injections to the Breast Will Be Used Cosmetically.

After being condemned by plastic surgery associations, fat injections to the breast were deemed OK for “touch-ups” after breast reconstruction in 2008. But these once controversial injections may soon play a role in cosmetic breast augmentation. Taking fat from a part of the body where there is too much (your thighs or butt, for example) and injecting it into your breasts where there is too little, may replace the need for breast implants when done in conjunction with a breast lift. Some kinks still need to be worked out, but fat injections to the breast are likely here to stay.

Surgeons Will Invent – and Perfect – Body Contouring Surgeries to Follow Massive Weight Loss.

More and more people are undergoing bariatric surgery to lose weight, only to be left with hanging fat and flab in highly visible areas. As plastic surgeons put on their thinking caps to better address these issues, expect to hear about many new procedures, including the corset trunkplasty. This new surgery targets above-the-belly-button flab, to recreate an hourglass silhouette in formerly obese women and get rid of love handles in men who have lost massive amounts of weight. This area has been ignored by many traditional body contouring procedures that target the lower abs, buttocks and/or thighs. We will hear more about corset trunkplasty and other innovative body contouring procedures in 2010.

Fat Freezing Heats Up in 2010.

Fat freezing (or cryolipolysis) may give liposuction a run for its money in the coming years. This technology works by freezing fat cells and breaking them down. Zeltiq is in clinical trials now, and results look promising. Stay tuned.

Cohesive Gel Breast Implants Receive FDA Approval.

These so-called “gummy bear implants” have been making their way down the pike for some time, and they just may get the long-awaited FDA nod in 2010. Filled with cohesive silicone gel, these leak-resistant implants – used in Europe and Brazil – are being studied in the United States. Gummy bear implants have the positive attributes of silicone gel, but the gel doesn’t migrate. This is a good thing, because if the shell should fail, the gel wouldn’t leak into surrounding tissue.

Minimally Invasive Cosmetic Procedures Experience Rebirth.

As our economy starts to show signs of life again, more people may opt for cosmetic surgery procedures, reversing the steep decline of the last two years. Don’t expect the numbers to reach their record highs anytime soon, though. There will likely be a slight increase in plastic surgery procedures – especially minimally invasive ones such as injectables that allow people to put off more invasive (and expensive) procedures like face lifts until they really need them (and can better afford them).

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Your plastic surgeon of dermatologist may be asking for your help to fight the Botox Botax shortly. Here’s what the ASDS (American Society for Dermatologic Surgery) is giving it’s members to solicit the support of Botox consumers:

The U.S. Senate health care reform bill  (Patient Protection and Affordable Care Act) contains a proposed 5 percent tax on “elective cosmetic medical procedures.”  While this may look like an attractive option to Senators looking for ways to pay for health care reform, we know that:

• Cosmetic medical procedures taxes are an unreliable and risky revenue source, which has proved to be a failure at the state level;
• A tax on cosmetic surgery discriminates against working women;
• The definition of cosmetic procedures is arbitrary and almost impossible to administer; and
• enforcement would necessitate review of patient medical records by tax collectors, a clear invasion of privacy.

Please enter your zip code below to be connected to an automatic email system which allows you to send a quick message to your Senator asking him/her to vote against this tax.

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Via Tyler Cowen, it turns out that the proposed tax on cosmetic surgeries (like Botox) might be highly regressive:

… look around. See that cosmetic surgeon down the street? The walk-in Botox clinic next door? That’s because cosmetic surgery spread from the rich and famous to the rest of us because of increasing access to credit. That’s right- the deregulation of banking that happened in the 1980s meant more and more Americans were taking out credit- either on credit cards or with medical credit companies like GE’s “CareCredit.”

What this means is that cosmetic surgery is now primarily consumed not by the rich, but by the working and lower-middle classes, sometimes even by the poor. According to the American Society for Aesthetic Plastic Surgery (ASAPS), about 1/3 of cosmetic surgery is consumed by people who make less than $30,000 a year. About 70% of it is consumed by people who make less than $60,000 a year. It is mostly women (90%) and mostly white, middle-aged women (80% and between 35-55 years old).

It would be interesting to know if these trends vary depending on the procedure. I would suspect, for instance, that nose jobs and facelifts are common among the affluent and highly-educated, whereas breast implants, which still carry something of a class-based stigma, are a more heavily downscale phenomenon. And I would imagine there are interesting regional variations as well. (Perhaps some of these questions are addressed in the forthcoming book from the author of the post quoted above.)

Riffing on the data, Tyler writes that “cosmetic surgery is not just a zero-sum game but rather it leads to better matches, more matches, and more people who are happy with their looks or with the looks of their partner(s).” I would go halfway with him, and say that it’s certainly a rational response to a culture where airbrushed images of perfect beauty flood the airwaves and supermarket aisles, where male instincts about sex are increasingly influenced by the siliconed imagery of hard-core pornography, and where high divorce rates (which are especially high among the working class) ensure that large numbers of women find themselves re-entering the dating pool in middle age. Whether it’s something to be welcomed, though, is another question entirely.

Question: Should Botox, Restylane, Juvederm, liposuction and cosmetic surgery be taxed like you luxury car?

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A general practitioner who performed a botched breast reduction that left a woman disfigured learnt how to do cosmetic surgery by reading text- books, attending meetings and assisting other surgeons.

Dr Christiaan Botha, who is not qualified to perform plastic and reconstructive surgery, yesterday admitted that he started performing cosmetic surgery after 10 years of “self-study” and assisting qualified surgeons.

He faced charges of unprofessional conduct before the Health Professions Council of South Africa (HPCSA) relating to a breast reduction procedure performed on a patient in July 2007.

He pleaded guilty yesterday.

In July 2007 Zelna Venter went to Botha to have a breast reduction because her breasts were causing neck and back pain.But the operation left her scarred – one of her nipples fell off and both areolas had to be removed – after an infection set in and the wound began to smell soon after the procedure.

Follow-up visits to Botha saw Venter being put on two courses of antibiotics and having the wound restitched several time before a second opinion was sought, and Venter was sent for an emergency operation.

It was during this operation that Venter’s areolas and a chunk of skin were finally removed.

Venter’s husband last night barred her from speaking to the media and said they had gone through great trauma in the past two years.

The HPCSA accused Botha of practising outside his scope and failing to recognise complications that arose from the surgery, and of failing to refer Venter to a plastic and reconstructive surgeon.

The council also accused him of treating Venter’s complications in a negligent or incompetent manner.

HPCSA spokeswoman Bertha Peters-Scheepers confirmed they were still investigating other complaints against Botha.

In his plea explanation, Botha said he had trained himself to become a cosmetic surgeon and that when he started performing the surgery, the understanding in the medical fraternity at the time was that GPs like him could do the procedure “with adequate training and experience”.

“Following my entry into private practice I developed an interest in cosmetic surgery. In consequence I acquired and studied textbooks on the subject and commenced assisting plastic and reconstructive surgeons in the performance of cosmetic surgery.

“After about 10 years of self-study, I commenced performing cosmetic surgery, limited however to breast augmentation surgery, breast reduction and abdominoplasty.”

Botha said that as a registered GP he believed he was permitted to perform the procedures.

“Neither I nor other members of the general medical fraternity believed it necessary, on the strength of the ethical rules, that a formal postgraduate qualification in plastic and reconstructive surgery was required.”

Cliff Nkuna, legal adviser for the HPCSA, argued that Botha did not manage Venter’s complications properly due to inadequate training and that he had put her life at risk.

But Botha’s lawyer, Steven Farrell, disagreed.

“There are no facts that Dr Botha put the patient’s life at risk. You do not have before you a medical practitioner who just takes a scalpel and starts a procedure. He developed an interest in the field.”

Farrell said that when Botha became aware of the HPCSA ruling that GPs were barred from performing plastic and reconstructive surgery, and that only specialist plastic and reconstructive surgeons could, he wound down his cosmetic surgery activities.

Botha stopped performing cosmetic surgery two months ago.

However, Peters-Scheepers said the HPCSA ruling was made in April last year, and they had sent a newsletter to all the doctors.

The matter has been postponed to May 4 for sentencing. Botha could be struck off the roll and could also be slapped with a fine.

Via: The Star

Plastic Surgery, Botched Plastic Surgery, Plastic Surgery Problems

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Photos: Above, recent online photos of Rachel Uchitel. (Photos courtesy of Gala.de and TheImproper.com) Below, Rachel Uchitel yesterday in Los Angeles. (AP photo)

Plastic surgeons and celebrity watchers gave party hostess Rachel Uchitel a once-over as soon as the tabloids thrust her into the spotlight last week as the alleged mistress of golfing great Tiger Woods.

She flatly denies the allegation, but Uchitel’s photos on the Web have provided evidence for cosmetic doctors to analyze. For example, plastic surgeon and blogger Dr. John Di Saia of San Clemente and Huntington Beach wrote:

[Her photos] show her to be an attractive woman who has probably seen the inside of a plastic surgeon’s office before. She seems to have had breast implants at the least from the images we have seen.

The online Plastic Surgery Channel commented on the uncertainties surrounding Uchitel:

Her lips do suggest lip injections, (perhaps Botox) and her chest suggests breast augmentation. Uchitel would likely deny rumors of plastic surgery, just as she has denied other rumors. But, in all cases, she may be telling the truth.

skin clinic, plastic surgery, Botox

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A 38-year-old former Miss Argentina died after complications arising from plastic surgery on her buttocks, according to media report Wednesday.

Solange Magnano, the 1994 winner and a mother of 8-year-old twins, died of pulmonary embolism Sunday three days after having a gluteoplasty, a procedure that involves placing implants to enhance firmness. Officials said the injected liquid went into her lungs and brain.    

News of her death shocked her fans. The cause of her death was under investigation, the authorities said.

In the past half decade, the number of people seeking plastic surgery in Argentina has soared by 60 percent, to around 50,000. Estimates say that 1 in 30 Argentines has gone under the knife, making plastic surgeons here some of the most experienced on the globe, attracting large number of medical tourists.

Medical tourism in Argentina has seen a huge jump over the past decade, and is projected to be a 100 billion dollar global industry by 2010, according to the Deloitte Center for Health Solutions, a U.S. research center focused on trends in the health care system.

Plastic Surgery, Cosmetic Surgery, Plastic Surgeon, Gluteoplasty

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Restylane, Juverderm and filler injections tips for physicians running medical spas and laser clinics.

The following is from a string of emails that were circulating among some of Medical Spa MDs Members. I’ve edited this somewhat to make it readable and get rid of all the extraneous copies. I’m also not displaying the identity or email addresses of the physicians in this thread.

Note: Some of the comments below might be out of order from the original thread. Emails’ somewhat difficult to follow as a thread but you’ll get the gist.

Filler Injection Discussion & Tips: Restylane | Juevederm | Evolence

1. When I use the “push ahead” technique, I feel that I get better “plumping” per cc of filler.  I learned this from Kevin (thanks Kevin).

2. When I use the “push ahead” technique, the filler fills a few millimeters in front of the needle tip.  You need to realize this to be able to put the material exactly where you want it.  Sometimes you have to “feel” the injection because you can’t “see” the plumping.

3. I mix 0.1 cc of lidocaine with epinephrine with my Juvederm.  This helps with bruising (epinephrine) and when the lidocaine goes away and the Juvederm attracts water, the two effects cancel each other and there is not as much enhancement after the injection due to the hydrophilic nature of the Juvederm.

4. I use Juvederm Ultra under the eye and above the lip.  I use Juvederm UltraPlus everywhere else.

5. I constantly complain to my Juvederm Rep about the 0.8 cc syringes.  I use lots of Radiesse because you get almost twice as much material for the same price.  Volume, volume, volume.  Please complain to your rep, maybe we can get them to change.

6. I hear the Evolence is very good.  We will be getting trained and start using it next month.

Thanks for the filler tips.Can you explain how you get the Lido with epi mixed into the Juvederm syringe? –PD

Fluid Dispensing Connector from Braun Medical Inc (you can get from PSS)

BD 1 ml Luer-Lok Syringe

This syringe allows you to get very precise amount of lidocaine (swish back and forth 20 times).

I use this syringe to put exaclty 1 cc of saline in my Botox Bottle. When I reconstitute the Botox (this gives it full strength per unit). The chances of intravascular injection might be lower with push ahead because the material will push the vessels out of the way as you advance –  Jeff

Hi Jeff,–I agree w/ #6.  I seem to get good augmentation, less redness, swelling and bruising with Evolence.  I use it for deeper fills in cheeks, NLF, etc.  Don’t use it for lips or under eyes.  I do same with Lido w/ epi.  I tend to use Juvederm in lips.  Perlane / Restylane for other areas.  I agree w/ why Allergan uses 0.8 cc syringes. I’ve moved away from Radiesse.  I feel that the duration is not that much longer than a good correction with the HA’s.  Besides, I believe a fair amount of the volume of Radiesse is a gel carrier, thus needing touch-ups at 2-3 months.  Perhaps that’s why the went to the larger syringes? — Don

The push ahead technique also moves small blood vessels out of the way, so you may notice less ecchymosis is overall pts. — Greg

Jeff: –”Push ahead” has a higher risk of vessel cannulation & potential for vascular effects – skin necrosis in glabella, even potential for retro-grade flow to eye (causing visual loss).  I wouldn’t recommend that technique for the periorbital area.

Restylane is recommended for the tear troughs;  it’s less hydrophilic than juvederm – which means less post-treatment swelling.–Tom  –  [note from Jeff:  Tom is a plastic surgeon]

I would not use push ahead around the eye, I agree with Tom’s comments. It works great for NLF. I was actually taught this by a PS — Greg

Thanks Jeff for your kind comments. However I must make a few points in regards to fillers:

1) There are some areas that one has to still do the retrograde injection either b/c the purpose was to make a straight line (eyebrow lift and vermillion border and the bow-tie (the vertical lines connecting the base of nose and the upper lip border) AND when injecting the most inner 1/3 of the tear-trough to avoid risk of filler getting into the orbital space due to its close proximity to the orbital rim.

2) On the glabellar injection, it is best to first push and pull the needle thru the space underneath to break up the tissue before actually injecting the filler both in an anterograde and retrograde pattern

3) I ONLY use the 1/2 inch needles in all my injections

4) One can inject even Radiesse and/or Perlane via an 1/2 inch 30 gage needle. Why is this noteworthy to mention?? When I work on the lips and Marrionette’s lines, I ususally first build the Vermillion border with Radiesse or Perlane (I get the best “lifting outcome” with heavier filler). I push the 1/2inch needle all the way forward then slowly and steadily inject while withdrawing (retrograde method). Then I re-evaluate how much of a correction I already get of the Marrionette’ line and lifting up of the lip body. My next step is to inject into the most lateral lip section (about 1 cm distance) starting at the corner (using Perlane or Restylane or Juverderm). This time I inject slowly as I push forward (anterograde). Often I ended up correcting about 50% of the marrionette’s line by going after the lip’s border and most lateral body. Besides, the patient loveto see that they now could see their lip body all the way to the corner and more “smiley shape”. The last step is the trickiest one, I use either Radiesse or Perlane on an 1/2 inch 27 gage needle. First placing my left thumb at the patient’s lower half NLF’s I retract the skin upward (about 2-3cm upward) then I approach my needle in an upward (vertical) position at about one centimeter lateral and one cm below the mouth corner of that same side. Then I aim diagonally toward the corner and start injecting anterograde just 1-2 mm below the imaginary horizontal line of the mouth corner (about 0.2 cc), then I withdraw the needle and reaim straight up and inject just below the horizonal line (0.2cc) then I do it one more time aiming diagonally outward (0.2cc). What was I attempting to do?? I was laying down a new flooring along the imaginary horizontal line. After the injection, release the left thumb. You will be surprised to see the retracted portion just rest right along this new floor, thus the Marrionette’line has been corrected. This is different from the common fanning technique of using the filler to “blow up” around the Marrionette’s line. If you look carefully at those company’s issued photos, the area around the Marrionette’s line now appeared very swollen and puffed up. It is aesthetically unpleasant. It looked like the patient was beat up below the mouth. It reduced the profile of the chin.

5) For those of you that use fillers on the highly vascularized and shallow areas such as the temporal, crow’s feet, undereye area lateral to the submalar area and along the lateral border of the cheek prominence (especially in those older skinny Caucasian ladies with much excessive very thin skin) I now emulate the same technique used in the hand. I would pinch to levitate the skin itself above the bony structure, then I bolus Restylane into the empty space. Then I massage it down. This elimates the risks of injecting into the vessels and nodules.

Interesting discussion.  So Kevin, how do you account for the difference in that anterograde injection you need less filler than in retrograde injections, assuming all else being equal?

Second, I am understanding one group claims anterograde injection carries a higher risk of vessel cannulation and possible intravascular injection, while another group claims that anterograde injection “pushes away” blood vessels, thus decreasing the risk. Not sure how anterograde increases risk of intravascular injection any more than retrograde.  If you push the needle ahead, transfixing a vessel, then begin injection, you can still conceivably deposit some material intravascularly, can you not?  Am I missing something here?

I also found an interesting idea of sub q bolus technique in areas of thin skin, ie crowsfeet, etc.  Anyone else try this method? ~ Don

Tom:

I do agree with you about those risks with anterograde injection. The key is always the skills in doing it, be it retrograde or anterograde. One always has to be very carefully doing anything around the eyes. However, the anterograde techinique has been advocated some of the best known experts such as Arnold Klein, MD and Kent Remington, MD. I also believed that the filler amount used was critical. It takes much more amount to get the same result with the often taught retrograde technique compared with the anterograde one. For example, I almost never required more than one full syringe in correcting bilateral NLF’s vs what was typically used ( 2 syringes) by most others. I attached the before and after of a case wherein I used Readiesse to correct her NLF’s and Marrionette’s lines with anterograde technique. The after photo was taken right after. You can still see some of needle marks. I used one full 1.3 cc syringe, 1/2inch 30g for the Vermillion border and 1/2inch for NLF’s and Marrionette’s line. Notice also there was no “puffy/swollen look” medial to the Marrionette’s line often seen with retrograde and fanning technique used by most others. ~ Kevin

All interesting comments.  The only place, I use “push ahead” is in the cheeks when doing them via the intra-oral route. (Apparently Radiesse is no longer teaching this method because may practitioners couldn’t get the hang of it but it works for me.)  I might try it in the “safe” areas such as NL folds.  We use only Radiesse and Juvederm and  I find that neither filler lasts as long as advertised in “first-timers”.  I’ve also had disappointing longevity in my older patients (>65) with both types fillers despite using numerous syringes.  I’m sure this has to do with their inability to generate collagen around the filler once the carrier gel is gone.  Does anyone know the age range of patients done in the filler studies? ~ SD

I came across this old thread way down in my inbox and read it again.  I’m not sure who wrote #4 below.  It sounds interesting but I’m having a hard time visualizing it.  Do you steadily move the needle forward  toward the lip edge as you are injecting or do you hold it in place while the area fills?  I’d love to see a drawing on where you start.  ~ SD

SD: I wrote those threads. The techniques that I described were similar to what you could see watching the video instruction on www.thederm.org by Kent Remington and his colleagues (lower face injection portion) THe only thing new from my thread was when fixing the Marrionette’s line, his doctor (Nowell Solish) injection upward and anterograde from the lower part toward the lip corner only one time vs what I now do is I do the same thing but with a fanning pattern where (with the skin lifted about 1-2cm upward with the other thumb) I laid down “three such “anchoring points” along an imaginary horizontal floor starting from the lip corner going laterally for about 3-5cm long. Here I used something firmer such as Radiesse or Perlane. Having done this, you would release the thumb letting the skin go back down. Often you will see the Marrionetter’s line is much improved because “part of that Marrionette’s line” now is positioned along the horizontal flooring that you just created. ~ Kevin

PS: It is hard for me to send over some graphic illustration but I will attempt to do this in the future

Something worth knowing. How is your plastic surgeon or dermatologist communicating with other physicians to keep abreast of the latest information about treatments?

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The medical spa and plastic surgery community is in an uproar over some proposed legislation that could make a trip to the plastic surgeon or a Botox injection at the medical spa more expensive.

People are calling it the Botax. It’s a 5 percent tax on elective procedures such as Botox, Juvederm, Restylane, laser hair removal, facelifts, breast augmentation and other nips and tucks that lawmakers are hoping will help fund the nearly $1 trillion health care plan.

The bill says the tax would not apply to cosmetic surgery to fix a deformity either from birth, accident, or disease. It would apply to procedures like face lifts, liposuction, cosmetic implants and teeth whitening.

But as Dr. Paula Hicks points out sometimes cosmetic surgeries have very medical purposes.

“Certainly breast reduction surgery is a very good surgery for a lot of women and a lot of them will get denied by the insurance company as cosmetic surgery,” said Dr. Hicks of the Ave Medical Laser Spa and Laser Clinic.

Under the proposal, Dr. Hicks says an eyelid tuck, which can help with vision, would cost an extra $100 in taxes on top of the $2,000 price tag for the procedure.

She says that could be a big hit to her business since most of her clients are not wealthy.

“Most of these procedures are not done on people that are rich and have endless amounts of money, it’s middle class working women that would be targeted with this tax and it’s really not fair.”

According to the American Society of Plastic Surgeons 86 percent of cosmetic surgery patients are women. Sixty percent of them have annual incomes between $30,000 and $90,000.

The tax, if approved, would raise $6 billion over 10 years.

Allergan, which sells Botox, took a civil rights angle: The tax “discriminates against women,” the company said in a statement. Some 86% of cosmetic surgery patients are working women ages 35-50, with an average annual income of $55,000 per year, according to Allergan.

“What’s next? Are we going to tax people who color their hair?” the CEO of Medicis, a drug company that sells fillers, told Dow Jones Newswires.

The American Academy of Cosmetic Surgery, which is fighting the provision, says “a large portion of those being taxed would be the baby-boomer generation. And as this age group continues to age, the more interest will be generated in cosmetic procedures.”

A spokesman for the 2,500-member group said they were surprised to see the provision in the Senate bill this week, because it had already surfaced and sank in July. The tax is not in the House bill.

The tax is on elective procedures, and would not apply to any procedure to correct birth defects or issues arising from disease, accidents or trauma. The CBO says it would raise about $5 billion over the next decade.

via medicalspamd.com Follow Medical Spa MD on Twitter

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Cosmetic surgery can carry risks as well as benefits

Several newspapers have reported the dangers associated with cosmetic surgery, including a lack of regulation in some areas of the industry. The reports also feature warnings from Nigel Mercer, the president of the British Association of Aesthetic Plastic Surgeons, who voiced his views as part of a series of medical articles on cosmetic surgery.  Mr Mercer called for tighter regulation and testing of drugs, procedures and implants to offer more protection to patients.

The Times reported that the number of cosmetic surgical operations conducted by “audited members of the profession” has more than tripled to 34,000 since 2003, but that many additional procedures are being carried out on the black market. The newspaper says that these are “fuelled by internet promotions, magazine advertising and aggressive discounting”.

 

What is the basis for these news reports?

The reports were based on a special edition of the journal Clinical Risk, which featured several articles on the issues surrounding cosmetic surgery. These issues include the potential for physical and psychological harm, and the need for tighter regulation of the industry, better training programms for surgeons and measures to improve patient experience.

Nigel Mercer, president of the British Association of Aesthetic Plastic Surgery, wrote an accompanying editorial arguing that the availability of consumer credit and a change in public attitudes has led to an explosion in cosmetic surgery in recent years. According to Mercer, this growth, combined with increasing public expectation and media hype, has resulted in “the perfect storm in the cosmetic surgical market”.

 

What is cosmetic surgery?

Cosmetic surgery, sometimes called aesthetic surgery, was described by a doctor in the journal Clinical Risk as being “purely elective, a lifestyle choice undertaken to enhance physical appearance, improve self-esteem and boost confidence”. Another doctor says that it differs from all other forms of surgery in that it is a treatment for “want” rather than for “need”.

In the 2005 Regulation of Cosmetic Surgery report, published by the Department of Health, cosmetic surgeries are defined as “operations and other procedures that revise or change the appearance, color, texture, structure or position of bodily features, which most would consider otherwise to be within the broad range of ‘normal’ for that person”.

Cosmetic surgery differs from plastic surgery, which is generally surgery to repair or reconstruct tissue or skin damaged by congenital (inherited) disease, injuries or burns. The primary role of plastic surgery is to restore function, and aesthetic improvement is secondary.

 

How is cosmetic surgery currently regulated in the UK?

At present, there are measures and standards to help regulate the industry but some cosmetic surgeons operate outside these regulations. Some treatments and procedures are unlicensed for cosmetic use, but can be given the discretion of doctors, or “off license”, by some clinics.

Surgical practice in the UK is regulated by the General Medical Council (GMC) and practicing surgeons should be enrolled on its specialist register. However, some concessions are made for private cosmetic surgeons who have been practicing since before April 2002. By satisfying certain criteria, these doctors can practice without the need to be on the specialist register.

Invasive cosmetic surgery and laser treatments are also regulated under the Care Standards Act 2000. The Healthcare Commission inspects all registered establishments that carry out invasive procedures and laser surgery in the UK, and has the power to revoke practice licenses and to take enforcement action.

Some cosmetic surgical procedures are not covered by current regulations, such as Botox injections and injections of aesthetic fillers. Botox is not licensed for cosmetic use, but it can be prescribed “off license”, in which circumstances the doctor assumes liability for its use. Most fillers are tested in the UK as “devices” rather than as drugs. This means that they are regulated based on the standard of their production and not on whether the treatment works.

The Department of Health report concluded that the regulatory situation for cosmetic surgery was not satisfactory because of the group of doctors who can practise without being on the GMC specialist register and the lack of clarity around the definition of “fillers”. Although practitioners of cosmetic surgery must demonstrate certain competencies, these may not be the equivalent standard of NHS consultants.

 

What do these journal articles say about cosmetic surgery?

The authors of these articles have argued several opinions, including that:

• Patient psychology should be considered by clinical staff as issues of mental health and body image may be behind the desire for cosmetic changes. These could also arise in people who feel disappointed or upset by the results of their surgery.
• Surgeons should keep records detailing their patients’ expectations and provide them with guidance on whether these are realistic.
• There are risks associated with any type of surgery and patients should be informed of these and their surgeon’s success rates when considering procedures.
• It is important that patients are given time to consider their options. Doctors should also inform patients about alternative treatments that may be available.
• Before procedures are carried out, it should be clear who will be financially liable for the correction of any complications.
• There may be some merits to adopting a regulation system similar to that in France. Under this system, patients must be given information on costs, risks and the surgeon’s qualifications to perform their selected procedures.
• The way that cosmetic surgery is marketed should also be regulated.

What is the problem with plastic surgery marketing?

Mercer says that cosmetic procedures are often marketed using special offers, including vouchers, two-for-one deals and surgery holidays, and that these practices contribute to an “unregulated mess”. 

The articles also feature a call to ban advertising of cosmetic procedures, stating that, like tobacco, there should perhaps be a Europe-wide ban on advertising all cosmetic surgical procedures, including on internet search engines. While advertising can be powerful, says Mercer, it is often misused by the cosmetic surgery industry and misinterpreted by those it is aimed at.

 

Where can I find more information on reputable plastic surgeons?

The British Association of Aesthetic Plastic Surgery is a not-for-profit organization based at the Royal College of Surgeons. It was established to advance the education and practice of cosmetic surgery for public benefit. While it is not a regulatory body, it has long been involved in giving the public information on the safety of cosmetic surgery.

Its research into cosmetic surgery tourism was discussed at a recent conference and its press releases highlight a number of dangers associated with unregulated procedures, including DIY injectable treatments available over the internet.

via nhs.uk

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Botox becomming more popular in India?

A pointed nose and taut skin seem to have emerged as the two most important assets for Indians going by the number of people opting for rhinoplasty or “nose jobs” and botox injections in the country.

Though there are no official records of plastic surgeries in India, a study of hospital records show that cosmetic procedures like rhinoplasty and liposuction have seen an increase of 150 per cent in the last five years.

Other popular surgical procedures include abdominoplasty and male breast reduction.

Among the non-surgical procedures, some of the widely practised procedures include Botox injection, microdermabrasion (a non-invasive procedure that uses a spray of micro crystals to remove the outermost layer of dry, dead skin cells and reveal younger, healthier-looking skin), collagen injection, laser hair removal and chemical peel.

Vanity is constant as the norther star… So is Botox. Just the kind of thing you can get at any laser clinic or skin clinic.

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Thermage is FDA approved for tightening and thickening skin without surgery. This non-invasive choice is particularly attractive for patients who don’t want to undergo the more drastic effects of a traditional surgical facelift and its associated recovery period.

Thermage uses a radiofrequency (RF) technology to heat the deep layers of the skin while protecting the skin’s outer layers with a cooling cryogen spray. This deep heating promotes immediate collagen contraction beneath the skins surface and generates new collagen growth over time.

Thermage: Key Points

• Thermage is approved by the FDA for skin tightening and collagen growth.
• Thermage provides an alternative to traditional surgical face lifts.
• Thermage not only treats existing conditions, but is also a preventative treatment for future problems including wrinkles, loose skin and collagen loss.
• Thermage can treat any area of the body but is most commonly used on the face, around the eyes and forehead, cheeks and jowls, and the neck. Results actually increase over time. With maximum results usually achieved up to 6 months after the treatment.
• Thermage “Vectoring” can be used for more specific results. Vectoring uses a second, double row of pulses to tighten skin along specific lines or “vectors”. In this way we can perform eyelifts, neck lifts, bags around the eyes, crows feet, or any part of the face where loose skin is unwanted.

Thermage: Key Benefits

• Thermage tightens skin and stimulates new collagen growth.
• Thermage can be performed in 2-3 hours under local anesthetic.
• Thermage actually “tightens” skin rather than stretching skin.
• The results look completely natural
• The cost is less than traditional, surgical facelifts
• The results are very long lasting or permanent.
• Additional treatments can maximize the effects or just maintain results.

Thermage: Benefits in comparison to traditional surgical face lifts

• No cutting. No stretching. No stitches. No scars.
• Thermage requires no physical recovery time.
• The skin is tightened rather than stretched, eliminating the pulled look that can happen with traditional face lifts.
• The chance of complications or infection is almost nil.
• Thermage can be combined with other treatments like filler injections and Pointé Lifts for more dramatic effects.

Possible Complications with Thermage Treatments:

Thermage complications are very rare. The device contains three computers that constantly monitor the amount of energy being delivered. However, as with any medical treatment there exists the possibility of other results, including:

• Burns; in clinical trials for Thermage less than 1% of patients received any burns. (There were only two that healed completely and without complication). At Surface, we have never seen a burn.
• The effect is less dramatic than the client wants: However, Thermage can be used as a treatment more than once. Results can be improved or enhanced with additional treatments like Botox or Surface Pointé Lifts.

NOTE: Thermage has received mixed reviews from both patients and physicians. In our opinion this is because of the way that Thermage has been marketed to physicians as an "add-on" to their practice. Thermage results are highly dependant upon the treatment you receive. While Thermage is now widely available, our recommendation is that you only have a Thermage treatment from a physician who specializes in non-surgical cosmetic medicine and has a laser clinic, skin clinic, or laser treatment center with experience with this treatment.

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EuroDoc emailed me to ask for a list of physician blogs that I read. While I don't know exactly how to export all the blogs I visit, Here's a partial list of doctors who are blogging on a variety of medical topics, from Family Practice, Cosmetic Surgery, to Oncology.

List of Physician Blogs:

In alphabetical order:

• About a Nurse
• Aggravated Doc Surg
• Anatomy Notes
• At Your Cervix
• Barbados Butterfly
• Bioethics Discussion
• Blogborygmi
• Blood Letting
• Borneo Breezes
• Breath Spa for Kids
• Budding Emergencist
• California Medicine Man
• Cat Scan Man
• Chance to Cure
• Chocolate and Raspberries
• Code Blog
• Corpus Callosum
• Cricoid Pressure
• DB's Medical Rants
• Diabetes Mine
• Doc Around the Clock
• Doctor
• Doctor Anonymous
• Doctor Helen
• Doctor Mental
• Doctor On Call
• Doctor RW
• Dr. Deborah Serani
• Dr. Dork
• Dr. Flea
• Dr. Jest's Case Blog
• Dr. Kannan
• Dr. Pak
• Dr. Wes
• Dust in the Wind
• Emergency Medicine Doc
• Emergiblog
• Examining Room of Dr. Charles
• Fat Doctor
• Fine Art Doctor
• Fingers and Tubes
• Fixin' Healthcare
• Future Dr. House
• Geek Nurse
• Girl MD
• Grunt Doc
• Health Care Renewal
• Health Psych
• Homeschooled Med Student
• In a Doc's Mind
• Information is Free
• Inside Surgery
• It's A Nursing Thing
• Kevin MD
• Kidney Notes
• Knight Doctor
• kt living
• Life in Qualicum
• Live Love Laugh
• Marketplace MD
• Mavistown 3.0
• Mediblogopathy
• Medical Pathetical
• Medlogs
• Medskool
• Medviews
• Mental Notes
• Mexico Medical Student
• Michael C. Hébert, MD – Journal
• Movin' Meat
• Mr. Hassle's Long Underpants
• MSSP Nexus Blog
• Musings of a Dinosaur
• Musings of a Distractible Mind
• Neonatal Doc
• NeoNurse Chick
• NHS Blog Doctor
• Nurse Ratched's Place
• OB/GYN Kenobi
• oncRN
• Orthodoc
• Over My Med Body
• Parallel Universes
• Point and Shoot
• Rangel MD
• Rebel Doctor
• Respectful Insolence
• Retired Doc's Thoughts
• Ripple of Hope
• Scalpel or Sword
• Scared To Health
• Shrinkette
• Stork Doc
• Sumer's Radiology Site
• Surgeon's Blog
• Tales from the Womb
• The Cheeful Oncologist
• The Doctor is In
• The Haversian Canal
• The Healthy Child
• The Mote in the Light
• The Patient's Doctor
• The Star Chamber
• Treat Me With Respect
• Trust Me, I'm a Doctor
• Tundra Medicine Dreams
• Unbounded Medicine
• Unintelligent Design
• Wandering Visitor

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Facelifts have become a common cosmetic surgery for men and women. But surgery patients face a number of unwanted effects. Scarring, extensive recovery time, that artificial "stretched" look, and a permanent result that may be unwanted.

Fortunately, newly developed medical alternatives offer results to people wanting look younger without going under the knife.

As a leader in non-invasive cosmetic medicine, many medical spas, laser clinics and skin clinics now specialize in innovative new medical treatments for a youthful lift without the messy and painful recovery. Some medical spas have developed a unique non-surgical facelift for patients looking to gain the dramatic results of a surgical facelift but avoid a surgical facelift. Non-surgical facelifts include Thermage or Fraxel Skin Tightening followed by their signature Surface Point Lift as the non-invasive, yet exceptionally effective substitute for any surgical facelift. (Botox is also used.)

Thermage is an FDA approved radio-frequency technology that has been proven to tighten and contour the skin and its many underlying tissues without surgery. The treatment has the added benefit of stimulating the growth of new collagen throughout the skin. But there's a caveat. Thermage results are highly dependant upon the way the treatment is administered. Surface has developed specialized protocols that produce results that attract patients from other areas of the country who are looking to achieve maxim results.

Nonsurgical facelifts can be just as spectacular.

Point Lifts were created by specialists in non-surgical cosmetic medicine to replace the traditional invasive facelift. It can also be used for brows, jaw lines, necks, breasts, and even the derriere. They're perfect for the patient who does not want to undergo the harsh effects of a traditional surgical facelift including the associated, frustrating recovery period. Point Lifts are a physician procedure that "lifts" the treatment area in exactly the same was as surgical lifts, only there's no surgery.

The procedure involves placing a small, special suture under the skin through a tiny needle hole, leaving the skin to smooth with its own tension. The theme here is "No cutting. No stretching. No Stitches. No scars!" Most importantly, Point Lifts will not leave the face with that "stretched look" of traditional surgical lifts. Patients can resume their normal activities immediately with only minimal discomfort. Best of all, Point Lifts are completely reversible. Most people never knew they could have a fresh, younger lift without the troubles of surgery.

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