"Should I have my cosmetic surgery in a hospital?"

This is a very important question that we are frequently asked. It touches on three crucial areas that every aesthetic patient should know about.

SURGEON’S CREDENTIALS

Patients should ALWAYS double check the credentials of their doctors.
TV shows, ads, and websites of plastic surgeons are good resources, but patients should confirm the credentials of their doctor with state and national licensing boards. This is very easy to do! Patients can check whether or not their surgeon is board certified in plastic surgery by going to: www.isyourdoctorboardcertified.com Patients can check the practice history of any Florida doctor at: www.checkyoursurgeon.com

Another way to check your doctor’s credentials is to ask at which local hospital can they do your cosmetic surgery. A patient can then check with the hospital to make sure the doctor is on the Plastic Surgery staff there. Hospitals are very strict about checking each doctor’s credentials. A patient can take advantage of this strict screening process by seeing if their surgeon can operate there too. Patients should be careful with doctors who are only allowed to operate in their office. They may not have the highest level of certification. They may not even be real plastic surgeons. Although this group here in Miami never had hospital privileges or board certification in Plastic Surgery, it took the police to finally stop them from operating in their offices.

PATIENT SAFETY

The best place for a patient to have cosmetic surgery depends on the patient’s health and the complexity of the procedure. Simple procedures on a healthy patient can safely be done in an accredited operating suite in the surgeon’s office. Multiple procedures or a the patient with some medical issues may be a candidate to have surgery at an accredited ambulatory surgical center. Complex procedures should be performed in a hospital. During your consult and pre-op visits, patients should make sure that their health is fully evaluated, that pre-operative tests are performed, and that the appropriate facility is chosen.

Healthy aesthetic patients should also keep in mind that the hospital is not the safest place for elective surgery. Remember that as an aesthetic patient, you may be the healthiest person in the hospital! If the patient’s medical condition allows, an office OR or a surgery center can be the safest place to have an elective surgery so that a healthy patient can avoid catching an infection from the hospital setting. With the emergence of antibiotic resistant bacteria, this becomes even more important!

COST

The final issue that aesthetic patients should consider is cost. Hospital facility fees for aesthetic procedures tend to be 2 or 3 times as much as ambulatory surgery centers or office OR suites. Considering this and the higher risk of catching an infection in a hospital, you can see why patients and surgeons tend to avoid hospitals for simple elective surgery.

Although you may not ultimately have your surgery in a hospital, make sure that your surgeon has passed hospital criteria and can perform plastic surgery there!

Be sure that your whole health is evaluated before surgery and that the best and safest place is chosen for your aesthetic procedure.

Will Yoga Replace Plastic Surgery?

An interesting story by Natasha Singer in The New York Times today highlighted a new trend in the yoga world. It seems that people are now performing yoga exercises as an alternative to plastic surgery! These classes can be found in many parts of the country such as Manhattan, San Francisco, and Austin, Texas and come under names such as Yo-Tox, the Yoga Facelift, and Revita-Yoga.

These classes are billed as combinations of yoga and facial exercises that will combat frown lines, wrinkles, and sagging. One instructor, Annelise Hagen, states that “each pose, stretch or exercise is designed to relax the muscles and release the patterns people unconsciously etch into their skin.” To sculpt your nose, she recommends alternating breathing out of each nostril (I would take the class just to see how this can be done!). To remove crow’s feet the student must open the eyes wide to smooth the lines. Another yoga exercise called the “downward dog” can add color to the complexion. By teaching her students to consciously relax their facial muscles, they can get a similar effect to using Botox. Gary Sikorski, another instructor certified in yoga facial toning, notes that “Folks are realizing the face has muscles and that there’s a substitute to plastic surgery that costs less and can achieve similar results.”

Can these exercises possibly work?
Will yoga replace Botox and plastic surgery?
Can I learn to alternate breathing out of each nostril?

Very unlikely. While the yoga exercises may relax you and your facial muscles, muscles aren’t the only culprit in facial aging. Here in Miami, it’s plain to see that many of the effects of facial aging are the result of sun, gravity, smoking, and genetics. Juvederm, Radiesse and other dermal fillers are an excellent way to replace facial volume that has been lost due to the thinning of our skin or that has descended because of gravity. Surgical procedures such as a facelift, brow lift, eyelid surgery, etc are still the best way to remove excess or baggy skin and reposition soft tissue to create a more youthful look.

The GOOD news is that these yoga exercises can’t hurt- unlike many of the “alternative” therapy regimens out there (just ask Anna Nicole). In our hectic lives, we all need more opportunities to stretch, relax, and rejuvenate ourselves. Who knows? Maybe I’ll learn how to alternate my breathing out of each nostril after all…

Too Few American Women Receive Breast Reconstruction

A study from the University of Michigan Comprehensive Cancer Center revealed that fewer than 20% of American women who receive breast cancer surgery (mastectomy) undergo breast reconstruction surgery.

The study also noted that 44% of general surgeons DO NOT refer the majority of their breast cancer patients to a plastic surgeon before the patient’s breast cancer surgery.

This second finding may help explain the consistently low number of American women that receive reconstructive breast surgery after their mastectomies. (General surgeons or breast surgeons are the doctors who remove the breast cancer via mastectomies. Plastic surgeons are the doctors that reconstruct a woman’s breast after the cancer surgery. The large majority of women who receive a mastectomy are candidates for breast reconstruction.)

The survey was compiled from the responses of 365 general surgeons in Ann Arbor, Michigan and Los Angeles, California. 44% of these surgeons referred less than a quarter of their patients to a plastic surgeon before the patient’s breast cancer surgery. Only 24 percent of general surgeons referred three-quarters or more of their patients for reconstruction.

The lead author of the study, Amy Alderman, MD, MPH, made an excellent point about the importance of reconstruction in breast cancer management, “We need to help patients through this difficult decision-making process up front, through patient decision aids that include information about reconstruction and multidisciplinary approaches to care, where all surgical options are fully explained."

General surgeons in this study attributed the low rates of breast reconstruction to patients not wanting the procedure:

• 57% of surgeons said it was not important to patients
• 64% thought patients were not interested
• 39% thought patients were concerned that reconstruction takes too long.
• 50% felt patients were concerned about the cost of reconstruction.

These concerns about the cost of a reconstruction are particularly unfortunate. Patients need to be educated that insurance companies are REQUIRED by a 1998 federal law to pay for breast reconstruction and symmetry surgery (surgery on the opposite breast to make the breasts match after a reconstruction).

Interestingly, the study pointed out that the surgeons most likely to refer their patients to a plastic surgeon tended to be female, with a large volume of breast cancer patients. They were also more likely to work in a cancer center rather than a community hospital or teaching hospital. The study authors suggested that surgeons who do not refer as many patients for reconstruction may be more likely to treat patients with limited resources or to practice in settings with limited access to plastic surgeons.

This study highlights a really disappointing trend in American cancer care. As a plastic surgeon, I can tell you that breast reconstruction is one of the most rewarding surgeries we perform. When you embark on a breast reconstruction, you get to know the patient and their family very well. You allay their concerns and also share their sense of victory as they overcome the cancer and look forward to the rest of their life. It’s amazing to think back (not so long ago- just before 1998) when insurance companies would try to refuse to pay for a breast reconstruction because they considered this cosmetic surgery. Is having two eyes, two feet, two hands vanity? Would they choose to go through life with one eye, one hand, or one foot?

Today, there are so many options for breast reconstruction. During my consults, we go over all of these with each woman and let them choose the one that will fit their goals, lifestyle, and preferences in shape, size, feel, look, recovery period, etc. I do hope that more American women are referred for breast reconstruction- getting on board BEFORE their initial breast cancer surgery lets us coordinate with the general surgeon and make sure that the patient gets the best outcome.

Breast Implants Improve Sex & Self-Esteem!

A recent study from the University of Florida noted that women reported better sexuality and improved self-esteem after cosmetic breast augmentation surgery!

The study recruited participants by advertising for volunteers at the offices of local plastic surgeons. 84 women completed questionnaires on self-esteem and sexuality before and after cosmetic breast augmentation surgery.

The study noted that overall; the women did NOT have particularly low self-esteem or poor sexual function prior to surgery. But the women DID NOTE a significant improvement to both aspects of their lives after they got breast implants.

This highlights that body image is an important factor in a woman’s self-esteem. The author of the study, Cynthia Figueroa-Haas, PhD, bristled at the idea that it’s frivolous for women to want to improve their body image through surgery:

"A lot of people consider plastic surgery a procedure that doesn't need to be done. They say women should stay with their bodies and what God gave them and be satisfied. I don't agree," she says. "This procedure does change women's psychosocial issues. There are differences [in life satisfaction] between people with good and poor self-esteem."

After the breast augmentation, women also experienced every aspect of their sexuality more intensely. They noted significant increases in arousal, sexual desire, sexual satisfaction, and lubrication.

These findings are consistent with what patients have told me at our center, as well. Women who receive breast augmentation often do so to improve or correct (for deficiency, asymmetry, etc) one aspect of their body that they may feel self-conscious about. Once their concern has been corrected, they feel more comfortable in their own skin.

It’s really rewarding to see a happy patient after a breast augmentation- they are more confident and tell us that they enjoy ALL aspects of their lives more. They usually leave it at that- we don’t pry for details…

I think that the importance of this study is to show that if there is a SAFE and EFFECTIVE way to fix something you don’t feel comfortable about… you should do it.

Personally, I encountered this 6 years ago when I decided to have LASIK surgery- did I NEED to do it? No. Could I have worn glasses for the rest of my life? Sure. But the glasses and waking up with contacts glued to my eyes bothered me, so after a lot of research I found a great, board-certified ophthalmologist and did it. The surgery was a miracle- everything turned out great and I have never regretted that decision.

Cosmetic surgery can make a great, positive change in your life. The important thing is to do your homework first- make sure that you are a candidate for that procedure and that the doctor you have selected is qualified to perform it. More on this later...

62% of Americans Approve of Cosmetic Surgery: An All- Time High!

The American Society of Aesthetic Plastic Surgeons (ASAPS) released its 10th Consumer Attitudes Study. This is a study that takes the pulse of the nation on cosmetic surgery.

In asking 1000 Americans ages 18 and above about their attitudes and perceptions of cosmetic surgery, the survey found a continuation of a ten year trend. 62% of Americans approve of cosmetic surgery! This is an all time high and is an 8% increase from last year.

The study also found that 61% of men and 63% of women approve of cosmetic surgery. Females are 16% more likely to consider plastic surgery than men. This is consistent with the 2006 statistics just released by ASAPS which show that 92% of those who received cosmetic procedures in 2006 were women! In a related survey (see post below) the most common cosmetic surgery for women was breast augmentation- this is the first time this has happened since they started this survey. I think American women are satisfied with the beautiful results we can achieve with aesthetic breast surgery and the safety of these procedures.

As Americans learn more and more about the safety and effectiveness of cosmetic surgery, we can expect the popularity of plastic surgery to continue to grow!

The 2006 Plastic Surgery Statistics Are In!

(Click graph above to enlarge!)

Hello all! 2006 was another great year for aesthetic plastic surgery. The American Society of Aesthetic Plastic Surgeons (ASAPS) has just released their 2006 statistics. The survey noted that in 2006, there were nearly 11.5 million surgical and nonsurgical cosmetic procedures performed in the United States! This was a 1% increase since 2005. Since 1997, surgical procedures have increased 123% and nonsurgical procedures have increased 749%!

These results are a testament to the continued popularity of aesthetic plastic surgery in America. The study also highlighted some very interesting trends. They noted that in 2006, surgical procedures actually decreased by 9 percent. Nonsurgical procedures (such as Botox, dermal fillers, and laser therapy) increased by 3 percent. We have seen this increased demand in noninvasive techniques in our center- their popularity continues to grow because of their proven safety record and their effectiveness. There’s a lot you can do today with just a syringe, a peel, or a laser these days!

Surgical Procedures- Break down by men and women.

The survey noted that women account for 92 percent of these aesthetic procedures.

The Top 5 Plastic Surgery Procedures for Women are:

1. Breast augmentation
2. Liposuction
3. Eyelid Surgery
4. Tummy Tuck
5. Breast Reduction

For the first time since the beginning of this survey- breast augmentation proved more popular than liposuction! This was due in part to the FDA approval of silicone gel breast implants in late 2006 (the use of silicone gel implants increased by 18% from 2005). We have seen this at our center as well. We have A LOT of women requesting silicone gel implants because of their softer feel and natural results.

Men accounted for 8% of all cosmetic surgery.

The Top 5 Plastic Surgery Procedures for Men are:

1. Liposuction
2. Rhinoplasty
3. Eyelid Surgery
4. Breast Reduction for a fatty chest (gynecomastia)
5. Facelift

Top 5 Nonsurgical Procedures are:

1. Botox
2. Hyaluronic Acid (Juvederm, Restylane)
3. Laser Hair Removal
4. Microdermabrasion
5. Laser Skin Resurfacing

Because of the safety and effectiveness of the surgical and nonsurgical techniques, we can expect continued growth through 2007 and beyond! Stay tuned!