Medical Spa MD: Physician community of skin clinics, laser centers, plastic surgeons, dermatologists and aesthetic doctors practicing nonsurgical cosmetic medicine.
Plastic Surgeons today are using various types of liposuction. I prefer tumescent liposuction with thin cannulas instead of laser lipo. This is a manual method of liposuction that I believe yields the best liposuction result because the surgeon has the most amount of control.
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.
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.
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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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.
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.
Who’s your nipple role model?
Have no idea what I'm talking about? (Nipple surgery to change the shape, color or size of your areolae.)
According to the Daily Mail, a cosmetic surgery clinic called the Harley Medical Group in London has reported a 30 percent rise on nipple surgeries in the past year, including more from women who haven’t recently undergone mastectomies.
With a price tag of roughly $3,200: ‘padding’ the areola with extra skin as to push the nipple out, ‘popping out’ inverted nipples, and even getting tattoos to change the areolae’s pigmentation.
One doctor from the clinic thinks celeb nipple slips are the cause. “Until now celebrities didn’t expose their nipples so they were no ‘nipple role models,’” explained Dr. Riccardo Frati, a plastic surgeon with the Harley Medical Group.
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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PermaTox? I was sent a link to this page by a patient who was asking my opinion about this treatment.
Has anyone heard of this Permatox proceedure? The last line of this pitch discloses that it was developed by prominent cosmetic surgeon named Guillermo Blugerman. In looking up Guillermo Blugerman on Google it seems that he's a surgeon from Argentina.
Any plastic surgeons on the boards here heard of PermaTox or have an opinion on it?
Here's the pitch for PermaTox from a medical spa web site:
PermaTox – A Brand New Procedure That Promises Botox-Like Results That Are Permanent
Tired of frequent Botox injection visits? PermaTox might be the long-term wrinkle solution for you! A new procedure that promises to give you longer lasting results without the needles!
PermaTox - has been tipped as a possible future anti-wrinkle remedy that uses a thin surgical thread to sever the specific nerves that cause frowning, which results in less movement and fewer lines.
While PermaTox patients might still receive periodic Botox® injections in other forehead areas, sometimes keeping the glabella (frowning nerves between the eyes that makes that annoying furrow between the brows) relaxed can, over time, soften wrinkles in other forehead areas, as well.
An observed effect of this treatment has been that eyebrows gradually tend to become more elevated and horizontal forehead lines reduced, potentially eliminating the need for elective surgery or Botox injections entirely for some patients.
PermaTox , is safe and quick, taking only 30 minutes in the office to perform.
Dr. B_____ is the only one performing this procedure and trained by the prominent cosmetic surgeon Guillermo Blugerman, who developed this technique.
Interestingly, all of the Google search results for PermaTox are for pest control.
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:
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:
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.
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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 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!"
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.
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.
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.” 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
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
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.
Melanie Berliet, a Vanity Fair writer, went undercover to test her hypothesis that plastic surgeons try to sell additional procedures to patients that they don’t “need.” The 5’9”, 120-pound 27-year-old, who wears a size 34B bra, went into the consultations under the guise of wanting breast augmentation.
Some of the plastic surgeons did not come out looking very good. The three surgeons had different reactions to her physique, but all of them recommended procedures she hadn’t originally asked for.
The one plastic surgeon who did fair pretty well had this exchange with the author:
He goes through the standard health questions, then asks, “How can I help you today?”
“I was just hoping to get a professional opinion about my options in terms of plastic surgery.”
The doctor squints and replies, rather emphatically, “The way it works is: you tell me if something specifically bothers you, and I’ll tell you if I can address it. But I’m not here to sell you services or goods, because there may be something that you don’t see that I see.”
“And you won’t share?,” I ask, somewhat startled.
Dr. Racanelli explains that he has an ethical problem with pointing things out, because he’s heard of cases in which patients felt they were talked into a procedure. He continues, “If there’s a specific area of concern, then you and I can discuss it at length ... I’m not here to, like, pitch you.”
“Is it a legal problem?,” I ask.
“No. Not a legal problem. It’s just the way I like to do things.”
In that case, I tell him, I’d like to talk about my nose and boobs.
Satisfied, the doctor proceeds. Most of what he says is familiar. He says I’m tall enough to carry a full C-cup, and observes that my nose has a “dorsal hump” and a “bulbous tip.”
“Is there a way to image what it might look like?”
“There’s a way to image, and it’s a very successful marketing tool,” he replies. “I do not do it, and the reason is: the only person who knows what your nose is going to look like after surgery is God.” Despite my general discomfort with superfluous references to a higher power, I feel the urge to jump out of my seat and give Dr. Racanelli a standing ovation.
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