Arturo Muñoz Meza MD, A Plastic Surgeon In Tijuana

A short visit with Dr. Arturo Muñoz Meza, a Guatemallan plastic surgeon practicing in Tijuana, Mexico.

Name: Dr. Arturo Muñoz Meza
Location: Tijuana, Mexico
Website: haimastemcelltherapy.com/
Facebook: Dr. Munoz

That’s Interesting: Dr. Munoz is a plastic surgeon at HAIMA Stem Cell Therapy Clinic which is located in Tijuana’s financial district; just 5 minutes from the international border of San Diego, CA.

Yes. In Mexico Stem Cell Treatment is currently being practiced at a clinical level; it is mandatory to have a license from the Health Department COFEPRIS (FDA in Mexico) This license allows the use of stem cell types beyond those approved in some western countries such as the United States, and some parts of Europe

Several years of education and training is involved to become a leader on the field. Can you share on how you started your career?

I was trained as a general surgeon in the Social Security General Trauma Center in Guatemala during the civil war. There was a large demand for medical services that time. That was the beginning of the acquisition of my expertise in the surgical arena. When I went to Mexico to complete my plastic surgery training, I was asked to stay and teach in the Resident Program by my mentor, Dr. Jose Guerrerosantos who is an all time recognized master in modern plastic surgery.

I was chosen by Dr. Guerrerosantos as his own Post-graduate fellow in Aesthetic and Cosmetic Surgery. This was considered to be a privilege in the Guadalajara University’s “Instituto De Cirugia Plastica y Reconstructiva de Jalisco”—an honor to be the master’s right hand.

Consequentially, I was exposed to the best plastic surgeons around the world, most of them are esteemed members of the American Society of Plastic and Reconstructive Surgery and the American Society of Aesthetic Plastic Surgery.

Why did you choose to specialize in aesthetic cosmetic surgery?

From what I remember during my younger years in school, I had exceptional A+ grades in Arts-drawing, sculpture and music. From then on, I felt that I needed to fulfill something in my life. When I started medical school, I wanted to be a Gynecologist so that I can advocate women’s health. But then, things changed when I was in my fourth year of General Surgery training. During a rotation in the Emergency Room, a patient came in with a chief complaint of cardiac arrest due to a gunshot wound. There were no vital signs so I had to proceed with a direct cardiac massage. In two minutes, we were in the Operating Room and I have successfully completed the anterior thoracotomy to access the pericardium and I found the right ventricle’s rupture and it took me seconds to set the suture. To cut the story short, my patient survived this!

The following day, I was asked by the Department Chief to report in his office. I admit that I was scared by the tone of his voice. The patient I treated wasn’t an ordinary citizen—he is an authority of the Police Department. I was a hero to my mates. After that, I was chosen as a candidate for the Cardiovascular Surgery Program.

I saw my patient again after 30 days for the revision of his scar. He brought me a thank you gift. I felt blessed. Before he left, he asked me a question:

“Can you please tell me why you left an ugly mark on my chest? Didn’t you promise that this will be removed?”

We just both laughed. I concluded my residency program with that in mind.

For some people, to live and be good looking is the same.

That’s where I began to look into plastic surgery. It is truly an art of giving the human body anatomical modifications to restore and rehabilitate until it is aesthetically pleasing.

Your practice is located inside HAIMA Stem Cell Therapy Clinic which is located just over the US border in Tijuana, literally five minutes from San Diego. Can you tell us more?

Several of us are business partners. We have a CEO who manages administrative issues and we have 80 attending doctors whose specialty range from Orthopedics to Neurosurgery.

Because of the geographical situation of Tijuana City, we are the first alternative choice of the American population in California as medical providers because of the cost and quality of our services. Before the crisis, this city was considered to be “Tiny Houston City” for medical services.

In my office, we have 3 nurses, 2 front desk assistants and 3 patient coordinators to run the consultation services. Before hiring them full time, we check their performance with a trial period to make sure that the're a fit.

I have a high compromise with my personal quality standards and try to radiate a persona that I’ve learned during the Guatemallan Civil War. It is something that the “Kaibiles”, the elite forces of the army, shout: “The possible is already done, the impossible is going to happen now.” It reminds me to do the best I can even without the latest ideal technological support and resources.

We give bonus's to our staff depending on the number of referrals that come in and the number of patients that decide to undergo surgery. For example, if we have 1-5 patients, they will have 5% of the total cost of services and treatments done. If we have 5-10 patients, they get 10% and if we have more than 10 patients, they get 15% per week.

Extra bonuses are given to our staff when we hear good comments from patients. They also get discounts on their own plastic or cosmetic surgery.

What IPL or laser technologies are you using?

I have SmartLipo which is a Nd Pulse Yag Laser, 1064nm WL,18W. It is expensive but this one’s a very useful state of the art tool for liposuction. We use this on selected body areas with limited adipose tissue like on the neck and waist. We also use this for axillary hyperhidrosis, lipomas and pseudogynecomastia. We also have Vaser for patients who have previously undergone more than 2 liposuction procedures. We have used the Microair machine in the past but it takes twice as much time in the Operating Room. Results are basically the same (or none at all) and patients reportedly had swelling, pain and numbness after the procedure.

You clinic is unusual in that it's inside a much larger clinic. How is it marketed?

Thankfully, word of mouth has been the most valuable resource for us. We always educate our patients with the procedures. I will never compromise quality over quantity. I take a number of patients I know I can handle daily. If I am saturated, I refer my patients to my colleagues. As much as possible, we try to be organized for our patient’s satisfaction.

We used to advertise in the Yellow Pages but that didn't pay off.

Personally I feel that my work is good enough to compete with the best. Patients feel that my services are also affordable when they evaluate the whole surgical experience.

The hospital has it’s own marketing program and we have commitments and policies in taking part to make it successful.

What is the most popular and profitable treatment in your clinic?

Sometimes, before we sleep,  I jokingly tell my wife “I am going to pray that everyday is “Lipo Day” because this particular procedure is in demand and very good in terms of outcomes. Basically, expenses are based in the O.R. charges and hospital rooms. Rhinoplasty is also perfect. We just need Lidocaine with Epinephrine, a couple of sutures, saline solution, nasal packs, antiseptics, micropore and external ferula.

We have good quality equipment and replace 1 or 2 pieces every year when we attend symposiums, congresses or meetings.

I left hair transplantation because it takes a considerable time of consultation and it requires me to train and supervise technicians as well. Honestly I don’t love this procedure enough to give this a substantial time in my practice.

I am a member of the Board of Specialists in Stem Cell Therapy. I am excited to offer this soon in our office.

What are the lessons you learned as a plastic surgeon? Can you share memorable moments?

Plastic surgery has given me a lot of experiences whether it be challenging, interesting or successful. But above all, the most fulfilling experience is observing the patient’s reaction when they look at the mirror for the first time to see the result.

On May 1997, I attended the ASAPS meeting in New York. I had the honor to meet many of my favorite authors like Jack H. Sheen and George C. Peck and took the courses with them. It felt great when I went back to Guadalajara and performed a reduction and balance rhinoplasty on Karla, an 18 year old who asked for rhinoplasty because she had a problem known as nose kyphosis. This is my most unforgettable experience, as this was my first rhinoplasty. 

After 4 weeks, I finally removed the patch and told her that it’s done. For me, the result was okay, a little swollen than normal. But I didn’t know what she was thinking and so I instructed her to look at the mirror on the next room to check her self. I couldn’t see her for a while and then suddenly I heard her crying. Jesus Christ!! I’m dead! I waited patiently for her to come back.

She looked at me and exclaimed “This is beautiful! All I can say is thank you!”.

For me, that is truly a gratifying experience.

What advice would you give to other physicians?

I think the best advice I can give to everyone in the cosmetic industry is to never perform anything that you are not trained for. If you are not qualified and naturally skillful, you are not the best option available for the patient. What people expect from plastic, aesthetic and cosmetic surgeons are natural, longlasting results and safe procedures. There is no one surgeon who is good at every procedure. He doesn’t exist. In time, he may develop his specialty. The procedure you do often which have exceptional results are highly recommended to your patients. Always do your best when performing a procedure because patients want to achieve perfection.

Avoid disasters in the cosmetic industry by eliminating greedy thoughts. As for myself, I don’t feel good with calf or gluteal implants, neither with hair transplantation. I am knowledgeable of those procedures but I am not passionate of these. When a patient asks for those, I usually refer them to an expert in order to eliminate the potential risks and fake unnatural results. I want to be honest to the patient. In this way, we can increase our credibility and gain the public’s confidence.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers around the world. If you'd like to be interviewed, just contact us.

Lifestyle Lift & Posting False Reviews Online?

Was Lifestyle Lift "Astroturfing" (posing as clients and posting false reviews)?

I was looking around at a number of allegations of medical businesses that have been accused recently of using their employees to post fake comments on physician rating sites and was pointed to this Wikipedia entry about Lifestyle Lift and allegations by the New York State Attorney General's office that Lifestyle Lift had been 'Astroturfing' back in 2009.

(Via Wikipedia)

 Lifestyle Lift has faced numerous complaints about the accuracy of their advertising. The company and its procedures have been featured on ABC, NBC, CBS and Fox News, and in newspapers and magazines across America, some of which were critical of their practices. In 2006 Lifestyle Lift voluntarily participated in a review of its advertising materials with the Better Business Bureaus's National Advertising Division. This review produced a 10-page document which made several suggestions for improvement, all of which were adopted by Lifestyle Lift. One was that pictures taken of patients tended to amplify problem spots, and benefits post-surgery, by using different photographic techniques. The BBB summarized by stating that "disclaimers must not contradict the main message conveyed by an advertisement", and "'before' and 'after' photographs should be taken in a uniform manner". 

In 2008, the company brought suit in United States federal court against the website RealSelf.com, which solicits anonymous consumer reviews of cosmetic procedures. Lifestyle Lift claimed that RealSelf's practice of allowing competing cosmetic surgeons to advertise as offering a "Lifestyle Lift" was a trademark violation. The courts deemed the website's activities to be protected First Amendment speech, and the lawsuit was later settled. 

In July 2009, the New York State Attorney General's office charged Lifestyle Lift with "astroturfing," or posting fake consumer reviews on the Internet, and reached a settlement in which the company paid $300,000 in penalties and costs. According to the AG's office, Lifestyle Lift employees were instructed to create accounts on Internet message boards and pose as satisfied customers, and created web sites such as "MyFaceliftStory.com", designed to disseminate positive reviews appearing as if they were created by independent and satisfied customers. They also attacked genuine customers who posted critical messages about Lifestyle Lift on other sites, and took steps to get those posts removed. The AG's investigation discovered emails specifically instructing employees to engage to post on the web; one such message directed an employee to "devote the day to doing more postings on the Web as a satisfied client"

(Note: I've never been involved with Lifestyle Lifts or Swift Lift in any way but we did perform a different endoscopic suture plication facelift called Point Lift that we developed independently. Point Lift was eventually dropped after we found the results to be lackluster and the incidence of unhappy patients and complications to be higher than acceptable.)

In my experience, these kinds of lawsuits happen from time to time and it's more an inditement of some shoddy business practices than of the medical treatment.

I'm aware that there are a number of physicians who are performing Lifestyle Lifts now and I'm curious to find out what their opinion of the treatment and patient satisfaction in general.

This kind of stuff can quickly get out of control, even on an individual clinic level. The whole 'fake physician review' deal is one of the reasons that we're promoting Frontdesk's verified physician review and customer satisfaction marketing system that actually takes some steps to make sure that your happy clients have a voice that gives a clear representation of what your patients actually think.

Link: Frontdesk's Customer Satisfaction Review Marketing System

Symbol of Excess: Is Any Publicity Good Publicity In Medicine?

By Patricia Walling

Once upon a time, cosmetic surgery was talked about in hushed tones.

Hollywood starlets were whisked through back doors into surgical suites, swathed in scarves and sunglasses to protect even the whisper of an identity. Then celebrities began talking, and soon Americans were seemingly obsessed with the transformative promises of cosmetic surgery. From requests for Nicole Kidman’s nose to Angelina Jolie’s lips, cosmetic surgeons were soon being asked to transform patients into lesser versions of their favorite stars. Larger breasts, higher cheekbones and a smaller chin soon became normal requests. Yet some may wonder, has this quest for perfection taken a toll on the American psyche? When is cosmetic surgery a beneficial procedure, and when is it simply one more symbol of excess and vanity in an increasingly image-oriented society? There are no easy answers.

When reality TV starlet Heidi Montag announced in January of 2010 that she had undergone a marathon of cosmetic surgery, racking up 10 procedures in a single day, many wondered if her dreams of the perfect body and face hadn’t become an obsession. However others in the medical community, such as those in medical transcription, saw in the 10 surgical procedures something more terrifying, addiction.

By all accounts, Montag was beautiful, a blonde-haired, blue-eyed young woman with a natural smile, but when discussing the plastic surgery procedures with People Magazine, she referred to herself as “an ugly duckling.” From a mini brow-lift to Botox to liposuction to breast and buttock augmentations, the procedures nearly killed Montag, but she stood firm behind her decision, saying Hollywood’s visions of beauty had pressured her into it. However, apparently 10 surgeries were still not enough. When the hoopla died down around the reality star’s new look, her husband announced later that year that she wanted to augment her breasts again. The surgery was to be filmed for a new reality show they were shopping. Was her subsequent admission to a plastic surgery addiction just another reality show ploy or did the superficial nature of Hollywood push her to a true addiction?

These days, it seems that more and more women feel the need to get some type of plastic surgery to order to achieve the Hollywood beauty ideal. According to an article in Medical News Today cosmetic surgery procedures increased an astonishing 700 percent between 1995 and 2005. Similarly, in an in an article discussing the psychological ramifications of Montag’s procedures, Fox News noted that 91 percent of all patients opting to have elective cosmetic surgery were women. While the average age of a patient wanting plastic surgery has not skewed younger, it has become far more socially acceptable for individuals, generally women, in their teens and 20s to have plastic surgery procedures.

A teenager going under the knife is hardly news anymore, but even children are getting in on the act. One mother recently made headlines when her seven-year old daughter had her ears pinned back and a fold on one ear corrected. An article in the New York Daily News details the mother’s decision, which she said was made to prevent bullying. She recounts adults making comments about her daughter’s ears, in front of her daughter. Oftentimes other children would refer to the girl’s ears as “gross” and wonder what had caused them to look strange. The plastic surgeon that performed the procedure, Dr. Steven Pearlman, agreed that children born with seemingly minor differences can face major harm in terms of the “development of their self-identity” if such deformities are not corrected. All of this raises the specter of a major ethical conundrum. At what point is it appropriate to refuse a patient’s cosmetic surgery procedure? What problems can be fixed through therapy or friendships rather than rhinoplasty and brow lifts? There is no easy answer.

A list of guidelines published by Mayo Clinic notes a number of things that individuals considering cosmetic surgery should keep in mind. Beyond considerations about expense and risk, individuals should think about what they expect the procedure will accomplish. If a woman believes that having Angelina Jolie’s lips will make her look like Angelina Jolie, she will be disappointed with the results. Likewise, if she believes that the procedure will make her happier, she is likely to be equally as disappointed.

While it is possible that a patient with reasonable expectations will experience a boost in self-esteem, cosmetic surgery is not the panacea of the average and aging as portrayed by popular culture. A patient’s depression won’t improve just because her chin no longer juts out. Plastic surgery won’t turn a patient into the epitome of female beauty, nor will it save a marriage or improve a social life. It short, no amount of plastic surgery can buy happiness.

A Fox News article discussed the specific implications of Heidi Montag’s surgery shortly she revealed her totally remodeled body. Among those who weighed in on the pros and cons of plastic surgery was Debbie Then, a psychologist who specializes in women and appearance. She fears that many people who go under the knife, especially at a young age, want to change who they are as individuals, something that is simply not possible to do through cosmetic procedures. A new nose might give an individual confidence, but it will not suddenly transform her from a wallflower into a social butterfly. Yet, that’s just what popular culture seems to teach.

From teasing about big ears to beliefs that women lose something of themselves as they age, the reasons individuals opt for cosmetic surgery are numerous. Yes, there is an element of vanity to their decisions, and certainly plastic surgery is more common in cultures with significant disposable incomes, but the heart of the matter is in the values that are placed on beauty above personal substance. If a woman wants to fix her nose or plump her lips, she should not be reviled for doing so, no more than a man should be reviled for getting hair plugs. Improving one’s appearance in an effort to feel better about oneself is perfectly acceptable. However when that need to better oneself physically surpasses any belief in the intrinsic values of each individual’s personality, it is time to question the role cosmetic surgery has assumed in the popular conscience.

About: Patricia Walling is a contributor for several healthcare related blogs, including http://MedicalTranscription.net. She self-identifies as a perpetual student of health care, and is based in Washington state.

Opportunity In Surgitels & Medical Travel?

By Arlen D. Meyers MD

Building a chain of Surgitels

Jackie G, a 23 y/o investment banker and avid tennis player, has arrived at the Meyers Palo Alto Surgitel following her arthroscopic shoulder surgery in a facility across the street from the hotel. Jackie lives in Denver, but came to Palo Alto because of the reputation of her surgeon, Dr. Meyers, who charged a lot less than her Denver based orthopedist. MedVoy has recommended she spend the first postoperative night at  the Meyers Surgitel Suite because of its reputation for catering to patients needing accommodations following discharge from a medical facility or needing a place to stay while getting outpatient treatment. Jackie is accompanied by her girl-friend, Sara, who will be watching over her.

Fortunately, everything went smoothly with Jackie’s operation and she was discharged from the Palo Alto Surgicenter at about 3Pm that afternoon. A hotel van takes Jackie and Sara from the Surgicenter to the Meyers Surgitel. They arrive via a private entrance with a wheelchair ramp and are met by a hotel greeter who wheels Jackie in her wheelchair to her room. Jackie and Sara have been preregistered. The room is on the ground floor with spectacular, soothing views , just right for a patient who needs rest and relaxation. The room looks like no room she has stayed in before…part hospital, part hotel. All the surfaces are antibacterial and the bedroom and bathroom have guard rails, walk-in tub and antibacterial soap to clean her wounds. The sink in the bathroom has fixtures that allow her to turn on the water with her elbows, an advantage for someone who arm is in a sling. Her friend, Sara, is staying next door and can enter through a common door. There is a small kitchen so Sara can make Jackie a bowl of oatmeal for breakfast.  The room service menu accommodates her special post op needs as does part of the menu in the hotel restaurant. An inconspicuous storage locker has medical supplies and wound dressings for medical professionals who might come to the room to visit her before she leaves for home. Her postoperative pain medicine has been delivered to her room, thanks to an arrangement made with a local pharmacy chain. She attaches her cooling shoulder apparatus.  A computer monitor allows her to communicate with her doctor and the doctor’s staff as well as her children back home. It also asks her to review a video of postop instructions before she leaves and confirms that she has done so.

During the night, Jackie is awakened with pain in her shoulder. She calls the medical concierge who has the contact information for the orthopedist taking call for Dr. Meyers. Within minutes, she gets a call and is reassured that this is a normal event following her surgery. Soothed by the presence of her Shetland sheepdog, Charlotte, sleeping next to her, she has an uneventful night.

After breakfast on the deck of her room, Jackie and Sara check out online, the bellhop takes their bags and they leave through a private exit to a waiting vehicle that will take both Sara and Jackie to her surgeon for a postop check (if she can’t come to her room) and then to a relaxing three day recuperation at a local spa arranged by MedVoy as part of her medical travel experience. They even allow pets. Much to her surprise, a few months after returning home, Jackie receives a check from her health insurance company as a reward for helping them keep down medical costs. Jackie bought a new tennis racket.

About: Arlen D. Meyers is a founder of Medvoy and blogs regularly at Freelance MD

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Cosmetic Surgery For NY Teachers: No wonder our school taxes are so high!

Now I know why there seems to be a reprieve in the economic status of the medical aesthetic market. I just couldn't believe this article on FoxNews.com so I am posting it in it's entirety for your viewing pleasure:

Buffalo, N.Y. Teachers Spend $9M in Taxpayer Cash in '09 on Cosmetic Surgery 

Buffalo teachers rang up nearly $9 million worth of taxpayer-covered cosmetic surgery in 2009, according to the state-appointed authority overseeing public school finances.

The Buffalo Fiscal Stability Authority found that last year's costs for elective procedures such as chemical peels and other skin treatments were up $8 million over 2004's $1 million tab for cosmetic surgery.

The procedures, provided under the teachers' union contract, accounted for 9 percent of the district's total spending on health benefits for employees and retirees, The Buffalo News reported Thursday.

About 10,000 school employees are eligible for the benefit. District officials said teachers or their dependents accounted for 90 percent of the approximately 500 people who received cosmetic surgery last year.

The president of the Buffalo Teachers Federation said the union has agreed to give up the benefit in the next contract and said teachers may be simply rushing to use the benefit while they can.

Board of Education member Christopher Jacobs said the cost increase "smacks of abuse" and is asking the district and the city comptroller to investigate.

 - I'm thankful for the boost to our industry, but not this way! Unbelievable!

This guest post is written by Paula D. Young RN, author of Advanced IPL & Laser Training For Non-Physicians and co-owner of Young Medical Spa in Center Valley PA.

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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.

Medical Tourism: $100B and growing

Smartlipo in Mexico, a nose job in the Philippines or a kidney transplant in India.....

Medical tourism is generally defined as leaving home for care. It can be inbound, (someone from Mexico coming to the US), outbound (leaving the home country to go to another country) or domestic. There are local, regional, national and international medical tourism clusters developing throughout the United States and around the world.

It is estimated that global medical tourism is a $100B global industry expected to grow significantly over the next few years. While no one can know for certain the effects of the recent US healthcare reform bill, rising costs, lack of supply of physicians and the demand for technologies and treatments continue to expand and fuel the growth of the industry.

There are several ways for physicians to get involved in medical tourism. The first is as a provider, either in their home location or in a remote site doing surgery. Second, physician entrepreneurs are creating service companies like medical tourism facilitators or aggregators. Other potential business opportunities exist in supporting the medical tourism supply chain by providing insurance products, healthIT infrastructure, real estate projects, quality ratings agencies, accreditation and marketing arms and other consultation services. In addition, more and more payors and employers are offering voluntary medical tourism benefits to their employees and insureds, driving the demand for talent who can do medical tourism quality improvement and utilization review.

The most common procedures sought by patients considering medical tourism are cosmetic surgery and dentistry, bariatric surgery, IVF and short stay procedures in urology, orthopedics, ENT and ophthalmology. That said, because of the onerous costs of some procedures in the US, patients are seeking life saving cardiac surgery in India, proton beam irradiation in South Korea and living donor liver transplants in Asia.

A recent report from the Center for Medical Tourism Research in San Antonio, Texas called medical tourism "arguably one of the fastest growing industries in the US"  Maybe it's time for you to take a look.

Arlen Meyers, MD, MBA is Cofounder, President and Chief Medical Officer for www.medvoy.com.  He will be a speaker at the Medical Fusion Conference in November.

Medical Spas & Cosmetic Crimes

From our friends over at Healthy Aging Magazine, an article that may or may not surprise you......

Depending on what statistics you read, tight economic times can either produce crime increases or decreases. However, a particularly peculiar variety of crime seems to be increasing these days—vanity crimes.

No, I’m not talking about the crime of going too big on your lip plumper or stripping 20 years off your skin when 10 would look more natural. I’m talking about people ripping off the dermatologists and plastic surgeons they’ve gone to for aesthetic procedures. 

A newspaper in Florida reported recently on several cosmetic crime cases:

• A woman came in for Botox and fillers totaling $3,300 then pulled a dine and dash. When she walked out of the office to visit an ATM to get the money, she bolted and never returned. Although she declined the before and after pictures, the office captured her on security video.

• A women received a $9,000 breast augmentation and tried to pay for it with a stolen credit card.

• A Fort Lauderdale women was charged with using a stolen credit card to pay for a tummy tuck.

• In a similar case, a Des Moines woman was accused of identity theft when she used a credit card to pay for over $6,000 in cosmetic surgery. She took out the credit card in her estranged husband’s name—probably not a good way to win him back.

An article on MSNBC cites Botox bandits Newport Beach, CA; Port St. Lucie, FL; Tampa, FL; Brisbane, Australia and Kenton, England. Jeff Karzman from the American Academy of Cosmetic Surgery states that it's a problem happening "coast to coast."

Dallas plastic surgeon Rod Rohrich, MD, says he's having patients pre-pay for procedures to prevent what he calls "runners." Many medical spas have turned to an up-front payment system. 

Is smoother skin or a slimmer figure really worth a crime? How many months or years in the slammer would you do for a breast job or Brazilian butt lift? What should practice owners do to protect themselves against this kind of thing? Post security guards? Perform preemptive credit and background checks? Charge for procedures up front? If charge up front, should that apply to all patients or just new or suspicious ones? 

Guest post by Grant Clauser, Editor of Healthy Aging Magazine.

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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."

Twilight Craze Brings The 'Vampire Facelift'; Selphyl

A new cosmetic procedure may just "eclipse" its competition. They're calling it the "Vampire Facelift", and it's increasingly available at medical spas.

It's not really a facelift, though, it's an injectable filler called Selphyl (get it? Sounds like cell-fill). It's generating lots of buzz.

It works by temporarily plumping up lines, much like its older cousins Juvederm and Restylane. But unlike the competition, Selphyl uses the patient's own blood to do the plumping.

Twilight enough for ya?

First, an amount of the patient's blood is extracted. Then, according to the maker, the platelets are separated from the red blood cells. The platelets are blended with a proprietary synthetic mixture and injected into your frown line.

This happens to coincide with all this fascination people have right now with blood - the whole vampire craze," says Dr. Tabasum Mir, who specializes in cosmetic dermatology and cosmetic laser surgery in Manhattan. Her patients are not requesting it, she ads, but inquiring out of curiosity. "I don't think my patients are interested in a two-step procedure when there are a lot of other fillers around that have been tried and tested."

Besides, one can't help but thinking that a real vampire wouldn't need Sephyl or any other wrinkle filler, because the undead stay out of the sun and never age. Anyway, is it safe for humans?

We certainly looked into it, but I think there probably isn't much of a problem when it comes to safety," says Dr. David Bank, President of the New York State Society for Dermatology and Dermatologic Surgery. "And by now, if any of our members were coming in with problems or complaints they would be reported to the society and those reports would be then shuttled to me. I haven't heard anything bad. But that's not a guarantee. The jury is still out."

Liposuction Technique: Thin Cannulas

Liposuction Training Video: Why thin liposuction cannulas give the best result.

Dr. Ricardo Rodriguez is a Yale trained, board certified plastic surgeon specializing in multiple procedure makeovers. He performs unique procedures such as the body lift, brazilian butt lift, stem cell facelift, endoscopic brow lift, and lip lift. He is Medical Director of his own AAAASF accredited surgery center in Baltimore, Maryland.

Link to this video on Vimeo.

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.