WSJ: Plastic Surgery decreased in 2009

Nice summary of 2009 plastic surgery trends in the Wall Street Journal, showing the effect of hard economic times on elective plastic surgery volume.

I've reproduced it, below. I've added some editorial comments in parentheses.

In addition, you can see the latest ASAPS statistics on plastic surgery, by clicking the link here.

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By ANJALI ATHAVALEY, Wall Street Journal

The number of cosmetic-surgery procedures in the U.S. sagged for the second year in a row in 2009, according to an annual survey released Tuesday by a plastic surgeons' association.

There were 10 million surgical and nonsurgical procedures last year, down 2% from 2008, according to a survey of 928 board-certified physicians by the American Society for Aesthetic Plastic Surgery, a Garden Grove, Calif., group of plastic surgeons specializing in cosmetic surgery. (ASAPS is the largest, most important group of cosmetically-oriented plastic surgeons.)

Driving the decline was a 17% drop in surgical procedures, to 1.5 million surgeries. "People just couldn't go for the big items," said Renato Saltz, the association's president.

Tummy tucks, rhinosplasty and other surgical procedures can cost thousands of dollars more than nonsurgical measures, and they require a longer recovery. (But of course, the surgeries do much more than any non-surgical alternative.)

Indeed, fear of job loss is the main reason people are putting off their surgeries, says Phil Haeck, president-elect of the American Society of Plastic Surgeons, a separate group that has yet to release its annual survey. Dr. Haeck, a plastic surgeon in Seattle, said that marks a shift from last year when consumers cited cost as a primary hurdle. This year, "job priority is number one, cosmetic surgery is number two," he said.

Breast augmentation beat out liposuction as the most popular surgical procedure for the second year in a row. Dr. Saltz attributes renewed popularity of breast augmentation to the 2006 Food and Drug Administration decision to lift the ban on cosmetic use of silicone breast implants. Breast augmentations numbered 311,957 last year, down 12% from 2008; liposuctions numbered 283,735, down 17%.

Nonsurgical procedures, such as injections of Botox or hyaluronic acid to fill facial wrinkles, were flat, inching up 0.6% to 8.5 million.

Two surgeries are surging in popularity. Buttock lifts, which involve reshaping of the bottom, increased 25% to 3,024 procedures, and buttock augmentations increased 37%, to 4,996. Increasingly, people want to reshape their rears after losing weight, Dr. Saltz said.

The procedures, costing from $4,000 to $5,000, are fairly new, with both benefiting from recent technique improvements, he added. As the economy recovers, more baby boomers are expected to seek procedures, and more physicians will likely offer nonsurgical options. Surgical procedures have increased by 50% since 1997, while non-surgical procedures grew 231%. Places like health clubs and spas are already offering minimally invasive procedures. (Not recommended!) Cosmetic-surgery associations recommend that consumers seek out procedures that are conducted under the supervision of a board-certified physician.

They should also do research before going overseas for cheaper rates for surgical procedures, which physicians say is a growing trend. "Right now, there is not an association that verifies that the physician is appropriately trained to do what they are doing," said Dr. Haeck. "Very few of the countries where these are being offered have anything that approximates the rigorous boards in the United States." (Canada is one exception - their training standards are equivalent to the U.S.)

Spring Specials 2010

Yes...they're here!! Plastic Surgery specials for Spring 2010 (Feb - Apr).

You can find all the details on our website (link)

Included are discounts on breast augmentation, Botox, Juvederm, microdermabrasion and laser hair removal.

Now you can get the best - for a little less! Yay!!

CNN article on "wanna-be" cosmetic surgeons

Here's an article from CNN Health, which talks about how many physicians are trying their hand at cosmetic medicine and cosmetic surgery, regardless of their training, board certification, or experience.

Link

It's clear that some physicians think that the "grass is greener" on the plastic surgery side of the fence...but they don't want to invest the time to train properly in plastic surgery, since that takes years. So, more and more frequently, these docs take a one-day course on saturday, then start using their new laser or liposuction machine on monday. It's a recipe for problems, and the patient is the one who suffers.

I think the most insightful quote in the article is this one, from Dr. Brent Moelleken, a plastic surgeon in California. "If patients heard about a plastic surgeon expanding his practice to include Pap smears and hysterectomies, they would be horrified. But they think little of having laser procedures or liposuction done by a gynecologist. And there is no law against either."

Remember, just because it's cosmetic doesn't mean it isn't real surgery, with real potential for complications. Do your research. Stick with experienced, credentialled surgeons who practice within their field of training. Review their before and after pictures. Talk to some other patients. Extra time taken when selecting your surgeon pays dividends later.

Dr. Fiala interviewed in "Cosmetic Surgery Times"

In the most recent edition of "Cosmetic Surgery Times", the second of a three part special on the obesity epidemic, metabolic syndrome and their potential treatment with various cosmetic surgery techniques features an short interview with....yours truly. (link)

I mentioned how a striking number of patients who present for liposuction and tummy tuck surgery turn out to have metabolic issues, such as high fasting blood sugars, actual diabetes, elevated cholesterol, and other risk factors for heart disease and stroke. It should be something that all plastic surgeons remember to check for, when examining these patients.

We've talked about this topic previously at PSB, in an earlier post (here).

Apparently, Cosmetic Surgery Times reads "PSB - the Plastic Surgery Blog" too! :)

Save Money! Look Great! - New Internet Discounts

I'm pleased to announce two new specials for our Botox and filler (Juvederm, Restylane, Sculptra, etc.) patients.

Special #1: Bring a Friend and Save.

Book a filler or Botox appointment for yourself and a good friend at the same time. If the friend is a new patient to our practice, we'll give you a credit of 15% of the value of your friend's first completed treatment, which can be used for your own botox or filler treatment, or used in our medi-spa, either on the same day, or sometime in the future.

One small restriction: The credit can not be applied to surgical procedures.


Special #2: Internet special for loyal patients

Have you had three or more treatments with Botox in the past 15 months with us? Or three or more treatments with injectable fillers in the past 15 months in our office? Then you are a loyal patient and we'd like to give you a reward. Just mention the internet-only password of "PSB" when you come in, and we'll give you 50% off your next maintenance treatment with botox or fillers, up to the average dose that you usually get.

This is only for our loyal patients, as defined above.

See, it pays to read PSB - the plastic surgery blog!

Scars: Part one - Keloids and Hypertrophic scars

Many people have heard the word "keloid", and think it means "any bad looking scar". This is a common misconception. Scars fall into a couple of categories. Since different types of scars and scar problems are treated differently, it's important to diagnose the scar situation accurately.

A keloidal scar is a scar that continues to enlarge and spreads beyond the borders of the initial wound. They are more common in African-American patients as well as Hispanics, Philipinos and Orientals, but can occur in patients of any race. Keloids often recur after excision, and do not tend to improve with time on their own. They are common on the face, earlobes and the chest. They are more common in women than men.

A hypertrophic scar may be thick, raised or reddish in color - but the key diagnostic difference is that they do not spread beyond the boundaries of the original wound. Most of the "bad scars" that patients show me are in this category. Hypertrophic scars may partially regress over time, becoming more flat and pale. They usually show up during the first few months after a surgical incision. They occur in equal frequency in both men and women.

A third type of scar, called a "wide-spread scar", is also common. These are typically surgical incisions that remain flat, but widen out, like a stretch-mark. They do not have the ropey consistency of a hypertrophic scar. These scars have a normal amount of collagen in them (unlike keloids and hypertrophic scars). They typically have widened out from mechanical tension (pull) across the incision. These usually respond quite well to surgical re-excision.

Commonly used treatments for these abnormal scars can involve scar massage, pressure application, use of topical silicone sheeting or gel, use of steroid injections into the scar, in addition to various surgical excision methods. Since the recurrence rate with surgical excision alone in keloid scars is about 50%, surgical excision is usually combined with one or more of the other listed techniques.

We'll discuss more about surgical scar revision in future chapters of the blog.

Redheads & Surgery

Back when I was a general surgery resident, one of the sayings passed down from our surgery professors was that "redheads were trouble", because they seemed to bleed a bit more than the average patient during a typical procedure. It was like a surgical superstition, a part of surgical lore that hadn't been proven scientifically, and yet was well known by all wise surgeons.

In the last few years, some researchers have started to look at the connection between natural redheads and surgery, and it actually turns out that there ARE some interesting findings - if you are a true redhead, and not just a shade of auburn.

For those that like the technical details, red hair color results from one of several mutations in a hormone receptor known as the melanocortin-1 receptor (MC1-R). The MC1-R plays a key role in determining the type of melanin (eumelanin vs pheomelanin) that is produced within melanocytes (pigment containing cells) - and hence plays a major role in skin and hair color. When the receptor is defective, it's postulated that melanocortin levels rise - which also seems to make the body more sensitive to pain.

Researchers at the University of Louisville have published 3 separate studies on this topic. They've found that red-headed volunteers had:

1. Higher anesthesia requirements, requiring about 20% more inhaled anesthetic agent than brunettes to eliminate responses to noxious stimuli;

2. Higher resistance to lidocaine (a common numbing agent). Subcutaneous injection of lidocaine was less effective in redheads than brunettes, and the redheads were more sensitive to painful hot and cold stimuli.

3. More self-reported bruising after surgery or injury, even though all the usual lab tests for coagulation and platelet function were within the normal range.


So, the surgical lore of our senior surgery professors was right all along - watch out for those red-heads!

Cosmetic surgery and the competitive edge: looking good and the job market

Here's some interesting data from a press release from the American Society of Plastic Surgeons:

"Faced with news of difficult economic times, and a belief that hiring is based on looks, millions of American women are looking at cosmetic medical procedures to give them a competitive edge in the workplace. In a new telephone survey compiled by the American Society of Plastic Surgeons (ASPS) of 756 women between the ages of 18 and 64, many reveal cosmetic plastic surgery procedures now appear to be an important rung on the success ladder.

- 13 percent (more than 1 out of 10 of the 115-million working-age women) say they would consider having a cosmetic medical procedure specifically to make them more confident and more competitive in the job market.

- An astounding 3 percent (nearly 3.5-million working women) say they've already had a cosmetic procedure to increase their perceived value in the workplace.

- 73 percent (almost three out of four or, 84-million working women) believe, particularly in these challenging economic times, appearance and youthful looks play a part in getting hired, getting a promotion, or getting new clients.

- 80 percent (four out of five or 92-million working women) think having cosmetic medical procedures can boost a person's confidence."


Actually, this trend is not really that new. Men have been coming to me for years, getting their upper eyelids fixed, so they don't look like the "sleepy, old-guy-past-his-prime". Executives often have specifically told me that they want to look more like their youthful and energetic business competition, and want to have surgery to give the appearance of still being in their prime, rather than being perceived as being "tired" or "over-the-hill".

Investing in yourself is always a wise investment!

"We Fix Cheap Haircuts"

True story: I was walking around downtown Orlando recently, and I came across an old-time barber shop. "Haircuts for men and boys", the sign said, "eight dollars". Seemed like quite a deal.

About a block further down the same street, I came across another barber shop. This one had a sign in the window, "We fix cheap haircuts".

I laughed at the sly reference to their low-cost competition down the street. If you think about it though, the world of plastic surgery is not that different.

Sometimes the "cheap haircut" is surgery that has been performed outside of the U.S., usually in South or Central America, with the patient returning to Florida with an infection, an open incision, thick scars, or a crummy-looking result. (I've seen all of these issues!)

Sometimes the "cheap haircut" is cosmetic surgery that was performed locally, by people that advertise ridiculously low-cost liposuction or breast augmentation surgery.

These patients with complications from inexpert surgery all tell the same sad story: "It seemed like a good idea at the time. I was hoping to get a deal on cosmetic surgery....and look what happened".

Either way, the total price for the initial surgery PLUS the required fix-up procedures is far more expensive than having it done right the first time, by a real board-certified plastic surgeon in an accredited surgery facility with U.S. level standards of quality. Worse yet, sometimes the problems can't be undone.

It's unwise to gamble with cheap cosmetic surgery....or cheap haircuts, for that matter. While some patients are satisfied with their discount surgery, why spin the roulette wheel with your health? Like that old slogan, "It may cost a little more, but I'm worth it!"

Herbal Supplements and Surgery - Safe or not?

Herbal supplements are everywhere. And cosmetic surgery patients love them - in a recent survey, 55% of cosmetic surgery patients surveyed took 2 or more supplements, compared to only 24% in the general population. The most commonly used supplements in the survey were: chondroitin, ephedra, echinacea and glucosamine.

Some supplements have some serious side effects that may be problematic, if you are having general anesthesia and surgery.

Here's a quick guide to which supplements should be stopped, and the reasons why. The general recommendation is to stop these supplements two weeks before surgery.

These supplements can cause bleeding problems:
Chondroitin / Glucosamine --- can also cause low blood sugar
Fish Oil
Garlic
Ginger
Gingko
Ginseng --- can also cause low blood pressure under anesthesia
Saw Palmetto
Vitamin E

These supplements affect drug metabolism and can cause excessive sedation:
Echinacea
Goldenseal --- can also cause photosensitivity reactions from laser light
Kava
St. John's Wort --- can also cause low blood pressure under anesthesia
Valerian

Ephedra ("Ma-Huang") - can cause cardiac arrhythmias, stroke, heart attack, low blood pressure under anesthesia


Since the whole idea of cosmetic surgery is to have a wonderful outcome and to minimize the risk of complications, the problems these seemingly-innocent supplements can cause are just not worth it. Please avoid them - and have a smooth recovery!