Medical Spa MD {4} Mr. Adrian Richards MBBS, MSc, FRCS (Plast.) - Cosmetic Medicine In The UK

A real eye-opener for physicians in the US... In this episode of the Medical Spa MD Podcast we discuss cosmetic medicine in the UK with plastic surgeon Mr. Adrian Richards.

Listen to this episide here.

Mr. Richards qualified as a Doctor in 1988 and for the last 12 years has specialised in plastic surgery. He has full registration with the General Medical Council No. 3286812 and is a Member of both the British Association of Plastic and Reconsructive Surgeons (BAPRAS) and the British Association of Aesthetic Plastic Surgeons (BAAPS), the leading British professional bodies for plastic surgery and reconstructive surgery. He is an author and has written a best-selling textbook ‘Keynotes on Plastic Surgery’. He is founder of Cosmetic Courses, a company accredited by the Royal College of Physicians, which provides training to medical practitioners entering the aesthetic market and was the lead investigator in recent clinical research into the use of Botulinum Toxin A (Botox) for cosmetic purposes.

In this episode we're discussing cosmetic medicine in the UK with Adrian Richards. It will probably come as something of an eye-opener for physicians in the US to learn that; most cosmetic surgeons in the UK don't really worry too much about informed consent, being sued by a patient is a rarity, filler injections are unregulated, and that physicians are routinely employed by non-physicians. I found the differences to be striking.

We also discuss how Adrian markets his services through social media, videos, and podcasts of his own as we delve into cosmetic surgery across the pond.

Some of what we talked about in this episode.

• Mr. Adrian Richards MBBS, MSc, FRCS
• Aurora Clinics UK
• Facebook Marketing for Physicians

Breast Reduction Surgeries on the Rise.......for Men

Men feeling self-conscious about the size of their breasts is nothing new—as members of the Seinfeld generation will recall, the episode in which Kramer invents "the Bro," or the "Mansierre" to tame oversized "man boobs" first aired in 1995.

This can't be good.

According to the BBC, in recent years discomfort over what are colloquially known as "moobs," is prompting increasing numbers of men to go under the knife. According to the British Association of Aesthetic Plastic Surgeons, the number of men who underwent breast reduction surgery in the U.K. increased from 323 in 2008 to 581 in 2009, a jump of 80%. Yet, instead of reflecting a surge in gynecomastia, the medical condition in which hormonal changes result in abnormal enlargement, swelling and discomfort in men's breasts, experts suggest that the uptick in cosmetic surgeries is more likely a reflection of both obesity, and increased media scrutiny of "man boobs." (Case and point, several gossip sites have entire photo galleries dedicated to male celebrities' fleshy breasts.)

Of course, for some men, surgery may provide relief from what can be an embarrassing and uncomfortable condition. Yet, as plastic surgeon Rajiv Grover points out to the BBC, for many men, it's not a hormonal imbalance, but simply being overweight, that is the root cause of bigger breasts. "Quite a few cases are caused by obesity, and we often say to men to look at their lifestyles before thinking about the scalpel," Grover said.

Is Taiwan Asia's Next One-Stop Plastic Surgery Shop?

Tourists who frequently return to Taiwan might recommend savoring succulent street food or exploring Taipei's boisterous night markets. Or they may pass along the business card of a favorite plastic surgeon or dermatologist....

And why not? Taiwan has long been popular with its expatriate population as a medical-travel destination. At Taipei's abundant health care facilities, the equipment is modern and sophisticated, and most importantly, prices are considered a steal. Some of the biggest savings are in liver-transplant surgery, which runs to around $91,000, compared with some $300,000 in the U.S.

Price tags like that have built a small but devoted following for Taiwan's niche medical-tourism market, and it's about to get a lot more customers. Taiwan's neighbors across the strait have been making their way to the island for a nip or a tuck since travel restrictions for Chinese tourists were lifted in mid-2008. Now, in the latest of a series of agreements and concessions between China and Taiwan, Taipei announced last week that Chinese tourists will soon be allowed to travel individually to the island — a development that many medical-tourism proponents are hoping will be a boon to their industry - especially the plastic surgeons.

Taiwan's current policy only permits controlled tour groups from the mainland, which limits options for Chinese who seek varied medical services.

Under group-travel restrictions, tourists are told where they can go and when. They can't deviate from the set itinerary," says David Wang, a plastic surgeon and chairman of the Taiwan Medical Tourism Development Association. "I've heard of a few people who will secretly come [for plastic surgery], perhaps under a fake name or by claiming they are here on business."

Now, Chinese patients seeking operations can plan ahead and book Botox treatments and eye-bag or double-eyelid surgery at Wang's offices on their own schedule.

Mainland tourists could be a huge boost. According to Taiwan government statistics, just over 972,000 tourists from China journeyed to the tear-shaped island in 2009 — a 195% jump from the figure in the previous year, when the two sides made transit and tourism agreements. Further encouraging cross-strait exchanges, last month Chinese aviation officials announced a 10% to 15% reduction in airfares for flights between the two sides. With over a million projected to visit this year, even more mainlanders will be emptying their wallets into Taiwan's service sector.

Wang, the plastic surgeon, already travels to China about once a month to promote his practice, and he isn't the only one. Many enterprising proponents of Taiwan's medical tourism have been making the cross-strait journey in the hopes that they, too, might entice more mainlanders to seek medical care on the island.

Not many people know about the quality of Taiwan's health care system," says Richard Wu, CEO of Taiwan Task Force for Medical Travel. "It's our priority to first put out Taiwan as a brand name and then promote individual hospitals for services."

The fact that these customers will now be able to travel to Taiwan solo will only help. "No one would join a group tour that lets everyone else know they are going for plastic surgery or other medical reasons," Yen says. "With individual travel, you can just tell your neighbor you are going to Taiwan for vacation."

Plastic Surgery Trends For 2010

The Consumer Guide to Plastic Surgery thinks they know what’s in store for cosmetic medicine in 2010, from how the newly proposed “Botax” could affect your self-improvement plans to which new products will come to market. Here's what you might see in 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.

Lipodissolve Study Results Stun Skeptics
Lipodissolve, an experimental "fat-melting" technology, is being billed as a non-surgical alternative to liposuction. Also called mesotherapy, lipodissolve is performed via injection of a cocktail of chemicals into muffin tops, saddlebags, love handles and other trouble spots to dissolve fat cells. Critics were outspoken, which is why the American Society for Aesthetic Plastic Surgery started a rigorous scientific study of lipodissolve, using standardized ingredients. And while even the trialists were skeptical at first, and the final results have not been tallied, it works. The study results – to be released in 2010 – may encourage many doctors to offer lipodissolve. Still, lipodissolve is only for small areas of localized fat and will never replace liposuction.

“Botax” Will Raise Eyebrows
A health care reform bill will be passed in 2010, and it just may include a five percent tax on all cosmetic surgery procedures (except those deemed medically necessary). Let’s say that breast augmentation with implants costs $10,000 in 2008; add a five percent levy, and the total becomes $10,500 in 2010. With business already down, most plastic surgeons are up in arms about the Botax. There is also fear that taxing cosmetic surgery in the U.S. will encourage many to seek out services abroad or through unskilled providers who offer procedures at cut rates in America, compromising their safety.

Surgery-Free Tummy Tucks Trim Waistlines
Non-invasive body contouring procedures such as Thermage, VelaShape, UltraShape, LipoSonix and Zerona will continue to grow in popularity in 2010. Once reserved for the face,

Thermage also uses radio waves to lift and firm skin on your stomach, knees, arms, legs, hands or butt. VelaShape employs bipolar radiofrequency energy to reduce the size of the fat cells, along with infrared heat to tighten the skin. And Zerona uses a “cold” laser to painlessly zap the fat cells beneath your skin. These technologies (and more) may give tummy tucks and lower body lifts a run for their money in 2010.

Face Transplants Face Upsurge
Face transplant surgery was once nothing more than fodder for sci-fi thrillers like the movie Face/Off, but they are now becoming a reality. Eight have been performed so far in the United States and abroad, but there will likely be many more as reconstructive facial surgeons further hone their skills and work toward perfecting their highly complicated techniques.

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).

Consumer Guide to Plastic Surgery is published by Ceatus Media Group LLC, an online provider of health information and physician directories. Consumer Guide to Plastic Surgery is a registered trademark of Ceatus Media Group LLC. http://www.yourplasticsurgeryguide.com

Cosmetic Surgeons enlist patients to fight the Botox Botax.

Cosmetic surgeons are asking for patient help to fight the Botox Botax. Here's what the ASDS (American Society for Dermatologic Surgery) is giving it's members to solicit the support of Botox consumers: Here's the form.

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.

I've received an number of emails about this over the last 48 hours. Is anyone worried that this 'Botax' will hurt your medical spa, skin clinic or cosmetic practice?

Medical Spa MD: Burned out & depressed plastic surgeons more likely to commit medical errors?

Surgeons who are burned out or depressed are more likely to say they had recently committed a major error on the job, according to the largest study to date on physician burnout.

The new findings suggest that the mental well-being of the plastic surgeon is associated with a higher rate of self-reported medical errors, something that may undermine patient safety more than the fatigue that is often blamed for many of the medical mistakes.

Although surgeons do not appear more likely to make mistakes than physicians in other disciplines, surgery errors may have more severe consequences for patients due to the interventional nature of the work. Some estimate that as many as 10 percent of hospitalized patients are impacted by medical errors.

"People have talked about fatigue and long working hours, but our results indicate that the dominant contributors to self-reported medical errors are burnout and depression," said Charles M. Balch, M.D., a professor of surgery at the Johns Hopkins University School of Medicine and one of the study's leaders. "All of us need to take this into account to a greater degree than in the past. Frankly, burnout and depression hadn't been on everybody's radar screen."

Nine percent of the 7,905 surgeons who responded to a June 2008 survey commissioned by the American College of Surgeons for a study led by researchers from Johns Hopkins University School of Medicine and the Mayo Clinic reported having made a major medical mistake in the previous three months. Overall, 40 percent of the surgeons who responded to the survey said they were burned out.

Researchers asked a variety of questions, including queries that rated three elements of burnout -- emotional exhaustion, depersonalization and personal accomplishment -- and others that screened for depression.

Each one-point increase on a scale that measured depersonalization -- a feeling of withdrawal or of treating patients as objects rather than as human beings -- was associated with an 11 percent increase in the likelihood of reporting an error. Each one-point increase on a scale measuring emotional exhaustion was associated with a 5 percent increase.

Mistakes also varied by specialty.  

Surgeons practicing obstetrics/gynecology and plastic surgery were much less likely to report errors than general surgeons.

Researchers acknowledged the limitations of self-reporting surveys, saying they couldn't tell from their research whether burnout and depression led to more medical errors or whether medical errors triggered burnout and depression among the surgeons who made the mistakes.

The results are being published online on November 23 in the Annals of Surgery and will be published in the printed journal in an upcoming issue.

Notably, the research shows that the number of nights on call per week and the number of hours worked were not associated with reported errors after controlling for other factors.

"The most important thing for those of us who work with other surgeons who do not appear well is to address it with them so that they can get the help they need," says Julie A. Freischlag, M.D., chair of the Department of Surgery at the Johns Hopkins University School of Medicine and another of the study's authors.

via sciencedaily.com

Perhaps the most relevant items here are the decreased reporting of problems by plastic surgeons and the fact that 'depersonalization' has entered the discussion.

I'm really curious about what plastic surgeons think of this study.

Botax: Taxes on Botox and plastic surgery?

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 surgeries 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.

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Plastic Surgery Product Placement

Be Born Again

To promote Dr. Kim's plastic surgery office, this life scale poster was placed at the entrance of his office and by the elevator in the main lobby of the hospital building.

via dfckr.com

A slick little promo for a plastic surgery practice. You have to love well done attention-getting advertising and medical spas and plastic surgery clinics are certainly rife with products that lend themselves to great advertising and marketing. I've got perhaps hundreds of these types of ads that I keep as something of a library.

Do it yourself Botox? ABC News wants to talk to you.

Have you tried do-it yourself plastic surgery or home Botox injections?

In tough economic times, many try to cut costs, including in their beauty regimen. Despite the risks, some people have decided to skip the doctor -- and obtain and self-administer cosmetic treatments.

If you have self-injected products like Botox, Restylane, Juvederm, silicone, and other substances, 20/20 would like to hear your story.

Please fill out the form below, including information about your experience, and a producer may be in contact with you.

You can tell ABC all about it here.

Young Medical Spa: Further Developing the Breasts

When the first laser lipolysis device was approved by the FDA it started a whole new revolution in the medical spa industry.

Many physicians who invested in the technology believe it saved their practices from succumbing to the downfall of the economy. Soon after the approval, an array of new lipolysis technologies began to develop over time. Wavelengths were altered to find the optimal "melting point", ultrasound technology was applied, high-powered water jets were developed - all in the name of technological advancement. At that time I wondered, "What the industry could possibly develop to top this?".

It wasn't long until I received my answer! Enter, the Natural Breast Augmentation procedure utilizing fat transfer under local anesthesia! Hard to believe this procedure wasn't perfected sooner! Take the fat from one body area and put it in another - perfect! Up until this point, there was a lot of controversy regarding fat transfer. In fact, for 20 years it was denounced by U.S. plastic surgery societies as being a "dangerous" procedure. Unfortunately, this declaration was based on the technology and techniques utilized over 20 years ago. Heck, even our laptops are obsolete after 3 years!

Dr. Todd K. Malan of the Innovative Cosmetic Surgery Center in Scottsdale, AZ developed new techniques which resulted in the lifting of this "ban" in March of 2009. Many dispute the success rate for the survival of the fat after the transfer. However, with the latest technological advancements in fat harvesting, adipocyte survival rates have proven to be 85% to 90%. With the addition of adult stem cells to enhance the fat transfer and breast splinting technology, adipocyte survival rates have shown to be even higher. In fact, Dr. Malan states that when the fat transfer is concentrated with adult stem cells harvested from the patient's own fat, and is injected into the fat that is already within the breast, the result can equal a permanent increase of 250cc to 500cc in overall breast size equating to a 1 to 2 cup size increase.

Of course there are many facets to this procedure not covered in this post. I just applaud innovative technology when I see it for my own eyes. So much so, that Young medical spa (our medspa) is now performing this procedure after being trained by Dr. Malan himself and others like Dr. Jeffrey Caruth of Plano Aesthetics in Plano, TX. Technology is wonderful, isn't it?

I wonder what the industry could possibly develop to top this?

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Plastic Surgery Statistics: What's in a Number?

The American Society for Plastic Surgery released their 2008 statistics on cosmetic procedures performed in the U.S. and stated there is a 12% decline in the number of surgical and non-surgical procedures.

The ASAPS reports the top five non-surgical cosmetic procedures are: 

1. Botox Cosmetic - 2.46 million procedures, down 11%
2. Laser Hair Removal - 1.28 million procedures, down 9%
3. Hyaluronic Acid Fillers (including Restylane, Perlane, Juvederm, Hylaform) - 1.26 million procedures, down 13% (is Radiesse and other fillers included in this research as well?)
4. Chemical Peels - 591,808 procedures, up 3%
5. Laser Skin Resurfacing - 570,880 procedures, up 12% 

According to the ASAPS, breast augmentation has now taken the number 1 spot over liposuction. Here’s the top 5 surgical rankings for 2008 as compared to 2007: 

1. Breast Augmentation - 355,671 procedures, down 11%
2. Liposuction - 341,144 procedures, down 25%
3. Eyelid Surgery - 195,104 procedures, down 19%
4. Rhinoplasty - 152,434 procedures, not much change
5. Abdominoplasty - 147,392 procedures, down 20%

It’s no surprise this decline is directly related to our economical status, but to what extent? Is the economy actually discouraging people from having procedures performed, or, are they simply making more financially sound choices? There have been major technological advancements in the arena that is aesthetic medicine and I found it interesting that the research did not mention these newer procedures performed by plastic surgeons, as well as non-core physicians.

While liposuction numbers are down; it appears as though the number of body shaping and sculpting procedures in the U.S. is on the rise as evidenced by all of the new devices at ASLMS and THE Aesthetic Show, our own data in our practice, and the new laser lipo centers popping up all over the place.

As patients become more educated about the newer procedures available, they now have the advantage of making an educated choice to forego general anesthesia, the lengthy time off of work for recovery, and the high price tag that comes with liposuction and tummy tucks, and are choosing to have minimally invasive procedures instead.

Maybe these newer procedures are so far down on the list that they weren't worth mentioning? Or, maybe the ASAPS’s data is not truly reflective of the current practices of aesthetic medicine in the U.S. as performed by all aesthetic physicians? I’d like to see the ASAPS, along with their “independent research firm”, realize that other physicians besides plastic surgeons perform a variety of aesthetic services that are continually evolving into more cost-effective, efficacious and safe procedures for today’s savvy consumers.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

Submit a guest post and be heard.

Plastic Surgery Face Lift.. Or Stem Cells From Korea?

The same company in Korea that's cloning dogs and cats is now offering anti-aging treatemtns that are being touted as a delaying tactic for plastic surgery and face lifts:

Those who view aging as an ugly inconvenience usually turn to plastic surgery to nip and tuck their troubles away. Little do they know the answer for reversing the aging process might be found in their own stomachs.

Run in conjunction with the Beijing Tian Tan Puhua Hospital, which offers stem cell therapies to last-hope Parkinson’s and spinal cord injury patients, the RNL Puhua Plastic and Cosmetic Medical Center offers stem cell therapy for the face that may reverse the aging process using the patient’s own body matter.

Using a treatment developed by Korean company RNL Bio—the same company that clones dogs and sells them on the international market for upwards of USD$150,000—the Puhua Center offers non-invasive beauty treatment alongside traditional plastic surgery staples like liposuction, face peels and eye tucks.

For a cool ¥28,000, patients can have fat cells removed from their abdomens using a needle and local anesthetic. Two weeks later, after doctors have grown a crop of stem cells from the collected fat cells, patients return to have doctors inject the stem cells into their faces in a series of shots that plump out skin, erase wrinkles and generally take a decade off your appearance, says Ingela Palomäki, a former Beijing Tian Tan Puhua Hospital marketing representative and current director of Fortune Cookie, a stem cell product import/export company. Included in the price is a stem-cell top-up six months later. Patients can also have their stem cells stored at the clinic for ¥1,500 per year. Stem cells have a shelf life of about 15 years. The clinic is currently the only place in the world offering the therapy, Palomäki says.

RNL Bio flew in aging South Korean celebrity Kyung-gyu Lee for a test-run of the treatment at the clinic’s inauguration less than half a year ago.

“Koreans are flocking here by the busloads for the treatment,” Palomäki says. “It’s buying time.”

Because the treatment uses the patient’s own cells, there is no risk of the body rejecting the injections, she points out. The only concern is that the stem cells could copy cancer cells in the body—so cancer patients and survivors will want to take a pass.

While the U.S. and other countries weigh the benefits of stem cell therapies, many patients from abroad are already coming to Beijing for therapies they hope might make them forever young.

This use of technology solutionos around bio-engineering and stem cells could well percipitate a break through. Nanotechnology is an other area that offers the promise of using a nonsurgical medical technology in lieu of traditional plastic surgery.

Thermage and Botox are examples of technology that sprang from other areas of medicine in just this way.

Plastic Surgery & Beauty

Plastic surgeons and even med spa physicians offering Restylane and Juvederm would be well intentioned to make sure that they understand the cannons of what beauty actually is. In many ways it's the elimination of asemmetry or extra 'noise' like wrinkles or pigment.

Via CNN: It's hard to pinpoint what distinguishes a gorgeous face from an average one, but some researchers are getting pretty close. Psychologist Lisa DeBruine, Ph.D., of the University of Aberdeen in Scotland says she's found that women's faces get more attractive to men when they are ovulating. "We're not entirely clear why there's this difference, but we think that the women might look healthier, have a bit of a healthier glow when they are ovulating."

Symmetry is another factor that determines a face's attractiveness. Kendra Schmid, an assistant professor of biostatistics at the University of Nebraska Medical Center, says there is a formula for the "perfect" face. She uses 29 different measurements to determine someone's appeal on a scale of 1 to 10.

To start, Schmid says the ratio of the length of the face to the width of the face should be 1.6, also known as the golden ratio."The face should also be divided into three equal pieces vertically," she says. "The forehead, then [the bottom of the forehead to] the nose and then from the nose to the chin."

Who's face is the most "perfect," according to Schmid's measurements? No big surprise here! "Brad Pitt's is the highest that I've ever used the [formula] on," she says. "He was a 9.3 [out of 10]."

Brad's partner, Angelina Jolie, didn't fare too badly either. "Angelina was a 7.67, and that's pretty high," Schmid says. "Most people rate about 4 to 6. ... The thing that is probably lowering her score is the thing that she's most famous for -- her full lips." Schmid says that ideally the width of a mouth should be twice the height of the lips.

Other celebrities Schmid tested were Halle Berry, who scored a 7.36, and Hugh Jackman, a 6.45. "There's never been anyone who was a perfect 10," Schmid says. "If you're out there, we're looking for you!"

Plastic Surgery & Plastic Surgeon

Very interesting discussion on the RealSelf.com has kicked out all non-core doctors thread.

TF and Botoxdoc have, er... differing postions on who is able to provide the best plastic surgery care. (Perhaps 'best plastic surgery care' is not the most appropirate term and I should use 'appropriately safe level of plastic surgery care'.)

Anyway, there's been a lively exchange of which the following comments are only a fraction.

Link to the RealSelf.com kicks out all non-core docs thread:

TF:

I have never claimed that plastic surgeons are the only ones who can do aesthetics, which includes laser work, botox and injectables, as well as surgery. I am very supportive of non-plastic surgeons who do botox, injectables and lasers. I have only made the point that plastic surgery training is currently the best method for training surgeons who want to do total body aesthetic surgery. It may not be perfect, but it's still the standard.

There are no shortcuts in learning how to be a master surgeon. Only those, like yourself, who seem to think that there are shortcuts.

Good luck to you - and your patients....

Botoxdoc:

While you say, I am wrapping my self in the cloak of the "free market" flag and have forgotten the fundsamentals of being a physician "doing no harm", nothing could be further from the truth. I only take cases in which I am proficient. I would never put a patient in harms way, nor perform a case which is not appropriate. I have refered many pts to a plastic surgeon when I felt they needed something more than I could provide them. (At the loss of significant revenue, I might add.) On the contrary, I beleive you are wrapping yourself in the cloak of "patient safety" . It is hubris to beleive I would not have the same concerns as you about patient safety. But because I am not a board certified PS or Derm, I must be, in your mind, a sub-par physician with no regard to my pts well-being, or safety. In fact there is absolutely no hard evidence that supports the argument that having Botox, or any other cosmetic treatment performed by a non-core physician results in more complications. Instead of me showing you my before and afters, why don't you show me a paper (randomized, case controlled, or even a retrospective study) that supports the commonly held belief that non-cores are dangerous. In fact, the complication rate in my clinic is better than what has been documented in the literature. While several months ago at a local hospital, a board certified plastic surgeon performing lipo under general aneasthesia penetraed the viscera and killed his pt. For that he received a reprimand. If I did that, I would probably loose my license or worse. Now I ask you, how fair is that?

In my opinion there needs to be a fundamental change in the system which will allow the acceptance and acknowledges "non-core" physicians performing aesthetics. Until that day arrives, those that judge my work will be my pts. and their families.

TF:

You want science - OK, here's some for you.

Subglandular breast augmentation has a higher rate of capsular contracture. Proven in multiple studies.

Subglandular breast augmentation has a higher degree of interference with mammograms. Proven.

Subglandular breast augmentation has a higher rate of unsatisfactory ripples and wrinkles, especially with saline implants. Proven.

Do you offer this procedure because it's the only one you can technically perform?
Do you even offer your patients a choice of sub-pectoral or dual plane techniques?
Do you give a truly informed consent about the other options....Or do you slant it your way, so you can get the patient to book with you?

You claim you are all about patient care - and then you say it's fine to take a weekend course, and then practice unsupervised on the first 100 or so paying customers, so you can master it. Wow. That's messed up!!

RealSelf.com's blogged about how that site is only the 'dispenser of information' (my name not theirs) and has removed more than 3000 physician accounts because they were not boarded in plastic surgery or dermatology. I wonder what the majority of realself.com questions are about? Liposuction? Breast augmentation?  Or, Botox? I don't think that there's any real disagreement that if you're looking for real plastic surgery you want a plastic surgeon (or cosmetic surgeon). The arguement arises over what is 'real' plastic surgery.

The inclusion of technology starts to blur the lines beween what a plastic surgeone does with a scalpel, and what a non-core doc can do using a laser, IPL, or RF technology. The boundries will only be blurred more as more IPLs and lasers are introducted.

Plastic Surgery & Cosmetic Surgery Trends For 2008

The ASAPS (American Society for Aesthetic Plastic Surgery) reports 10.2 Million Cosmetic Procedures in 2008. The Aesthetic Society, after collecting multi-specialty procedural statistics since 1997, says the overall number of cosmetic procedures has increased 162 percent since the collection of the statistics first began. The most frequently performed nonsurgical procedure was Botox injections and the most popular cosmetic surgical procedure was breast augmentation.

Top nonsurgical cosmetic procedures among men and women in 2008:
Botox - 2,464,123
Laser Hair Removal - 1,280,964
Hyaluronic Acid (including Hylaform, Juvederm, Perlane/Restylane) - 1,262,848
Chemical Peel - 591,808
Laser Skin Resurfacing - 570,880

Top surgical cosmetic procedures among men and women in 2008:
Breast Augmentation: - 355,671
Lipoplasty (liposuction) - 341,144
Eyelid Surgery - 195,104
Rhinoplasty - 152,434
Abdominoplasty - 147,392

source: ASAPS press release

“For the first time in the twelve years these statistics have been collected liposuction is a runner up in popularity to breast augmentation. There is no doubt that this turnabout will generate discussions in the medical community and the public at large,” Alan Gold, MD, Aesthetic Society president, reflects that “changes in fashion, i.e. décolletage baring styles, might be a factor behind this change.”

TRENDS AND DEMOGRAPHIC DATA

Top surgical and nonsurgical cosmetic procedures among men and women in 2008:
Surgical	# procedures	Nonsurgical	# procedures
Breast Augmentation:	355,671	Botox	2,464,123
Lipoplasty (liposuction)	341,144	Laser Hair Removal	1,280,964
Eyelid Surgery	195,104	Hyaluronic Acid (including Hylaform, Juvederm, Perlane/Restylane)	1,262,848
Rhinoplasty	152,434	Chemical Peel	591,808
Abdominoplasty	147,392	Laser Skin Resurfacing	570,880

Top cosmetic procedures for WOMEN:
Surgical	# procedures	Nonsurgical	# procedures
Breast augmentation	355,671	Botox	2,239,024
Lipoplasty	309,692	Hyaluronic Acid (including Hylaform, Juvederm, Perlane/Restylane)	1,200,420
Eyelid surgery	166,426	Laser Hair Removal	1,101,255
Abdominoplasty	143,005	Chemical Peel	554,492
Breast Reduction	139,926	Laser Skin Resurfacing	532,008
____________________________________________________________________________________________________
Women had almost 92 percent of cosmetic procedures. The number of procedures (surgical and nonsurgical) performed on women was over 9.3 million, a decrease of over 11 percent from the previous year. Surgical procedures decreased 15 percent; nonsurgical procedures decreased by 11 percent. Since 1997, surgical procedures increased 104 percent, while nonsurgical procedures have increased 233 percent.

Top cosmetic procedures for MEN:
Surgical	# procedures	Nonsurgical	# procedures
Liposuction	31,453	Botox injection	225,099
Rhinoplasty	30,174	Laser hair removal	179,708
Eyelid Surgery	28,678	Hyaluronic Acid (including Hylaform, Juvederm, Perlane/Restylane)	62,428
Gynecomastia	19,124	IPL laser treatment	46,887
Hair transplantation	18,062	Microdermabrasion	39,824
____________________________________________________________________________________________________
Men had over 8 percent of cosmetic procedures. The number of procedures (surgical and nonsurgical) performed on men was over 800,000 a decrease of over 21 percent from the previous year. Surgical procedures decreased 18 percent; nonsurgical procedures decreased 22 percent. Since 1997, surgical procedures have decreased over 15 percent while nonsurgical procedures have increased 239 percent.

Frequency of cosmetic procedures by AGE GROUP:
% of total	Age	# procedures	Top surgical procedure	Top nonsurgical procedure
45%	35-50	4.6 million	Liposuction	Botox
26%	51-64	2.7 million	Eyelid Surgery	Botox
22%	19-34	2.2 million	Breast augmentation	Laser Hair Removal
6%	65 and over	634,667	Eyelid Surgery	Botox
2%	18 and under	160,283	Rhinoplasty	Laser Hair Removal

Racial and Ethnic Distribution

Racial and ethnic minorities accounted for 20 percent of all cosmetic procedures in 2008. Hispanics again led minority racial and ethnic groups in the number of procedures: Hispanics, 8 percent; African-Americans, 6 percent; Asians, 4 percent; and other non-Caucasians, 2 percent.

Location and Fees
Over fifty-three percent (53 percent) of cosmetic procedures in 2008 were performed in office-based facilities; 26 percent in freestanding surgicenters; and 19 percent in hospitals. Americans spent just under $12 billion on cosmetic procedures; $7.2 billion was for surgical procedures, and $4.6 billion was for nonsurgical procedures.