Richard D. Gentile, MD MBA, A Plastic Surgeon In Ohio

Our interview with Dr. Richard Gentile of Gentile Facial Plastic & Aesthetic Laser Center with three locations in Ohio.

Name:  Richard D. Gentile, M.D., M.B.A.
Location: Youngstown, Akron, and Cleveland, OH
Website: www.facialplastics.org

That’s interesting: Dr. Gentile is deemed as one of America’s Top Facial Plastic Surgeons by the Consumer’s Research Council of America. 

Profile: Graduate of Ohio State University, The University of Cincinnati College of Medicine and Baylor College of Medicine Residency Program. International lecturer and author of many publications including the 2011 Textbook “Neck Rejuvenation” published by Thieme. Dr. Gentile is a past member of the Executive Committee of the American Academy of Facial Plastic & Reconstructive Surgery and served as its Treasurer from 2004-2007.

How did you realize you were meant to practice cosmetic medicine?

As an undergraduate student I had the privilege of spending a week externship with a Plastic Surgeon in Columbus Ohio. It was really my first exposure to medicine and I was significantly influenced by the mentoring that occurred. During medical school I was equally influenced by head and neck cancer procedures and elected to pursue postgraduate residency studies encompassing both cosmetic head and neck and reconstructive surgery.

With three different locations in Ohio you must be busy. Can you describe how your clinics operate and how you staff them?

The Facial Plastic & Aesthetic Laser Center is a fully integrated aesthetic practice with a free standing state licensed and nationally accredited surgery center adjacent to it. There are satellite offices in Akron and Cleveland Ohio where consultation and minor surgery is offered. We are privileged to see patients from all regions of Ohio, Western New York, Western Pennsylvania and West Virginia. We also see patients from other states and foreign countries as well. A full service medical spa is located in the Boardman office and one of the largest private laser clinics with 20 different aesthetic lasers.

Our main office is not located in a large metropolitan area so staffing is sometimes a challenge. (Larger metro areas feature more cosmetic practices training staff who then have experience in medical spas or pastic surgery centers when they interview for new positions.)

Unless someone moves into our area we usually do not have the opportunity to hire experienced personnel so we have to train them on site. Another disadvantage is the smaller surgery centers need per diem or part time staffing patterns unless they operate five days a week and frequently it is difficult to find personnel who are interested in more limited schedules. Understanding these special needs allows us to zero in on those candidates who are interested in the employment opportunities we offer. We have several aestheticians, a cosmetic surgery coordinator who also assists our marketing efforts, two RN’s one exclusively dedicated to the surgery center and anesthesia staff who are retained from a national staffing firm. Our front office has a billing director and a receptionist.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

We have two Lumenis One platforms one in Boardman and one in Cleveland. They are equipped with IPL, Light Sheer laser hair removal diode laser and Nd:Yag. We also utilize three fractional lasers the Lumenis Ultra Pulse with deep FX , the Cynosure SmartSkin laser, and the Sciton Contour with ProFractional capabilities. We also utilize radiofreqency units for skin tightening with LumenisAluma and Pelleve. We frequently combine these modalities in multi-modality laser skin rejuvenation. The Cynosure Med Lite is one of our most frequently utilized lasers and is used for Tatoo removal, non ablative skin rejuvenation and dermal toning. A 532 nm diode laser is used for non-ablative treatment of vascular and pigmented lesions. Laser Lipolyis is a big part of our practice particularly in the head and neck and we developed many of the facial surgery protocols for laser assisted facelifting procedures or Smartlifting™ procedures.

Have your marketing efforts successfully increased the volume of patients coming in your clinic?

We use or have used virtually all media to market our practice and find particular success with internet based, social media, and seminars to educate the public about the procedures we offer. Being features on the websites of our technology partners also helps to let patients know about the services we offer.

Our favorite referral are those that come from a satisfied and happy patient sending their friends and family members to us and those make up about 50% of our new patients.

Are there particular treatments that have increased your profits dramatically?

Our services are divided about 50-50 between surgical services and the other office based non surgical services including neurotoxins (Botox), dermal fillers and laser procedures. Among our surgical procedures 90% are facial plastic & reconstructive in nature but primarily cosmetic and not as much reconstructive surgery as previously.

A small percentage of our practice revenue comes from skin care products and related sales.

What lessons have you learned in your practice that you can pass on to those who have just started their medical spa?

Listen to your patients. I think it is important that they are not always in your office so that you can give them the result you think they should have. They are there to hear about how you can best help them achieve the result they are interested in. The closer you come to achieving their goals the more satisfied and happy they will be. Learn from the unhappy patients so that it can help you to either modify your approach or better select patients so as to not try to please the difficult to please patients.

It has been a great privilege to practice Facial Plastic & Reconstructive surgery for nearly 25 years and the greatest development from early practice to later practice is the accumulation of wisdom from the early years of practice. When first starting in practice you sometimes carefully walk into the exam rooms of post op patients not quite sure what the result is going to be like or whether there will be complications. 25 years later you pretty much know what to expect and the kinds of results that will be achieved. We are always innovating and trying to add modifications to our techniques that will enhance our patients post- operative results. So while we are getting closer all the time our practice continually strives to obtain the best surgical and non surgical results available anywhere.

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

Interview: Lila Bratani MD, Plastic Surgeon In Germany

AA look at plastic surgery in Germany with Dr. Lila Bratani.

Physician:  Dr. Lila Bratani
Location: Karlsruhe, Germany
Website: www.drbratani.com, http://www.estheticon.de/chirurgen/dr-lila-bratani

That's interesting: Dr. Lila Bratani is recognized as a member of Stanford's Who's Who for having demonstrated outstanding leadership and achievement in her field.

How did your cosmetic medicine training kick off?

Back when I was a teenager, I was attracted to aesthetic medicine and of course beauty and anti-aging. My first step in Plastic Surgery was when I got a good training by my teacher, Prof. Muehlbauer, one of the leading aesthetic surgeons in Germany and recognized worldwide. I also completed a fellowship in advanced aesthetic medicine and got trained in cadaver courses in Brazil (Sao Paulo and in Brasilia). I was working with great colleagues and I am still learning a lot of new techniques in the aesthetic medicine field. The art of this profession gives the ultimate satisfaction.

Can you tell us more about your surgical clinic and how it's organized?

I’m the chief of the Plastic and Aesthetic Department in a private clinic. The owners are dermatologists and it works perfectly. We offer plastic surgery, hand surgery as well as non invasive treatments such as laser. We also have 3 cosmeticians in our skin cosmetic center. The clinic consists of: 1 plastic surgeon (me), 6 dermatologists, 3 cosmeticians, 1 practice manager, 1 PR and clinic manager, 1 OR nurse, 3 frontdesk assistants and 8 physician assistants. We serve to a mix of private and state health care patients.

The requirements for hiring staff in our plastic and aesthetic surgery clinic are very high. PA’s and nurses have to understand that they need to have this extra “service” for extraordinary plastic surgery patients. We like them to have a corporate identity that represents our clinic well and of course a fabulous attitude and behavior.

We use commission on the cosmetic sales.

What laser technologies are you using? What are your thoughts about the technologies you’re using now?

We don’t use IPL, but we are using Alexandrite, Ruby, NdYag laser and Fraxel, CO2-Laser. I like most of the Fraxel  and new devices of Radiofrequency (Thermage and BodyTite). I have a lot of experience on the smooth liposuction with radiofrequency using the BodyTite device and so far, I'm seeing great results with skin tightening.

Where do you spend money on advertising? What works best for your practice?

We have websites, social media as Facebook, publications on newspapers and  journals such as Vogue. We also distribute e-newsletters for existing patients via email. In the waiting rooms, we showcase programs with different techniques of aesthetic procedures. This kind of advertising works much better than handing out external flyers or ads. 

(Sponsored: See Frontdesk waiting room videos for plastic surgeons and dermatologists.)

What are the in demand treatments in your clinic? Are you planning to add something new?

All kind of aesthetic surgery procedures like breast augmentation, facelifts, liposuction and face skin rejuvenation with radiofrequency as well the small procedures as fillers such as Botulinum toxin therapy.  I will be adding more fat grafting and liposculpturing techniques soon.

What have you learned about practicing cosmetic medicine? What stories can you tell?

I have learned to offer what I think is good for the patients and not to please the unrealistic demands of someone. Sometimes patients bring their own drawings of unrealistic body parts. I’m aware of dysmorphophobic patients and refuse to do anything on those. 

What advice would you give to other physicians based upon your experiences?

Working hand in hand with other colleagues is a benefit for starting into aesthetic medicine. You may share the cosmetic lasers and IPLs (which are very expensive) when starting your own clinic. Never underestimate the non-invasive procedures, even we plastic surgeons love it than being in the operating room with the scalpel in the hand.  Set your own “branding” so that patients will be pleased with your work and aura and will bring you more patients via word of mouth, which is also a great marketing tool.

About: Dr. Lila Bratani completed her Craniofacial and Plastic Surgery fellowship in Nova Southeastern University. With over 10 years of experience in Plastic, Aesthetic, Reconstructive, Laser and Hand Surgery, she is a university lecturer, medical manager and an esteemed health care consultant in New York,USA. She specializes in burn surgery and tissue engineering. Other than that, she is an active member of the Society of Plastic Surgeons of Germany DGPRAEC, WOSAAM (World Society of Anti Aging Medicine), IPRAS (International Society of Plastic Reconstructive and Aesthetic Surgeons) and DGBT (German Society for Aesthetic Botulinum Toxin Therapy.

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

Interview: Dr. Samir Ibrahim Abu Ghoush, Plastic Surgery In Poland

Plastic surgeon and hair transplant physician Samir Ibrahim Abu Goush who practices in both Poland and the Middle East.

Physician: Dr. Samir Ibrahim Abu Ghoush
Plastic Surgery Clinic: Mandala Beauty Clinic
Location: Poznań, Poland
Website: www.mandalaclinic.pl

That’s interesting: Dr. Ghoush is a trainer for Cool Lipo in the Middle East and Central Europe and a pioneer of LVR (Laser Vaginal Rejuvenation) in the Middle East and Poland.

Profile: Dr. Ibrahim was awarded twice by the International Society of Hair Restoration Surgery for presenting the best clinical case and poster. Aside from that he is recognized worldwide for planting facial hair, moustaches and beards. He is a distinguished Faculty member and Chairperson of many live workshops in HAIRCON and OLSW (Orlando Live Surgery Workshop). Dr. Samir has performed thousands of Aesthetic, Plastic Surgery, Reconstructive and Hair Restoration Procedures in a career spanning for more than 15 years. His patients are women and men from different countries, from all facets of society, many celebrities. Dr. Samir trained and worked with world renowned specialists in their fields.

We hadn't really thought of Poland as a hotbed for cosmetic medicine, until we met plastic surgeon and hair transplant specialist Dr. Samir Ibrahim Abu Goush.

Can you tell us more about your clinic? What are the services available?

Mandala Beauty Clinic is located in the heart of Poznan, Poland. It is very modern, with an integrated operating room with inpatient services. We offer a wide spectrum of innovative methods of treatment, and lasers that include: Vaser Hi def. Liposculpture, Laser Assisted Liposuction, Laser Vaginal Rejuvenation and Aesthetic Gynecology, CTEV Endovenous Laser, Aesthetic Plastic Surgery, Facial Surgery, Breast Surgery, Body Procedures, Hair Transplants, and Dermatology & Aesthetic Medicine 

How is your clinic organized? How do you manage your staff’s salary?

Physicians are working with us as partners on the (win/win) basis. We have at least 25 medical spa staff. The permanent staff is paid a monthly salary while the rest are paid on a per case/per hour basis.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

I use a German made IPL (smart plus). I have the Vaser machine from Sound Surgical Technologies, the Cool Lipo Laser and the CTEV Endovenous Laser from Cool Touch, a Laser for LVR (laser vaginal rejuvenation) from Innogyn.

I am very happy and much satisfied with these technologies. I use the Vaser all the time.

How do you market your clinic?

First of all, we have our website that has great medical spa SEO and generates a lot of traffic. We also get featured in both print magazine and TV shows and we always look for ways to make our practice more visible through interviews or PR. However, I still believe that the most important way of spreading word about our clinic is word of mouth. Patients are the most valuable asset you will ever have. If they are happy with your services, there’s a higher probability that they will recommend you to their friends and family and we take every effort to provide both the best medical services, and the best patient care..

What treatments attract the majority of your patients?

The Vaser body sculpturing remains to be the most profitable treatment in my clinic, which delivers amazing results and achieves a high patient satisfaction. Hair transplants are in demand as well. I am always looking into adding new services and innovations to my practice. I am planning to purchase a Fraxel Laser soon.

Can you share your thoughts on what you have learned in the cosmetic industry?

I believe that practicing this profession requires continuous learning. I never stop learning new things, new technologies and how others do the same procedures. If you are in doubt, ask your physician colleagues in the industry and share what you know! Attend workshops, seminars and webinars to keep your self updated.

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

Interview With Brazilian Plastic Surgeon Alan Landecker, MD

Visiting Brazil with plastic surgeon Dr. Alan Landecker in his Sao Paulo clinic.

Physician: Alan Landecker, MD
Location: Sao Paulo, Brazil
Website: www.landecker.com.br

That's interesting: In 2005, Alan Landecker, M.D. specialized in primary and secondary rhinoplasty at the University of Texas Southwestern at Dallas, Texas, USA, under Jack P. Gunter, M.D. and Rod J. Rohrich, M.D. For a period of 2 years, he was part of the Adjunct Faculty at the world-renowned Dallas Rhinoplasty Symposium and participated actively in the production of the second edition of the Dallas Rhinoplasty: Nasal Surgery by the Masters book. This book is currently the world´s best-seller in rhinoplasty.

Brazil has some of the busiest plastic surgeons anywhere in the world and it's not uncommon to find those who have been trained in the US.

When did you decide to specialize in plastic surgery?

The attraction began during medical school, when I rotated in the Plastic Surgery Department. The precision, difficulty, and level of detail of the operations enchanted me. However, I believe that an important personality trait (visual attraction to beautiful things) contributed significantly.

Can you tell us more about your clinic and how your staff operates it?

The clinic offers last generation plastic surgery and cosmetic procedures that can be surgical or non-surgical to all age groups. Some of the latter include laser, skin treatments, and postoperative physiotherapy. The clinic is located in one of the most sophisticated areas in São Paulo and is run by professional managers. Most remarkable 'inside' the clinic is the contemporary architecture and interior design, offering patients a unique experience.

The clinic offers IPL for hair removal, dark circles around the eyes, and some vascular lesions. We also have diode laser machines for rejuvenation and hair removal. Our newest machine is a radiofrequency device that is combined with electromagnetic energy. This kind of machine is very popular because splendid body contour is a priority for both men and women in Brazil. So far all of them have worked well for us.

How are you finding staff?

We've had some real issues with staff and due to past problems, we currently hire using only professional headhunters. Although more costly, this increases the chances of getting it right the first time! All staff have top class working conditions and receive a fixed salary plus bonuses depending on how well they perform. The secret is keeping them motivated!

How do you market your clinic?

In terms of marketing, the best is always to do a good job. In other words, the most solid marketing consists of word-of-mouth referrals. Complementary strategies should include a good website with SEO, use of social media, internal programs, and good exposure in the press. If all these are well structured, precise, and especially ethical, good results are inevitable.

What treatments or services are most profitable for you?

Plastic surgical procedures are the most profitable, followed by Botulinum toxin (Botox) and dermal fillers. We are currently developing a high-end aesthetic center to give patients a more complete type of treatment.

What have you learned about practicing cosmetic medicine? What stories can you tell?

The most common situations involve patients who bring tons of photographs of their noses into the consultation. They flog themselves trying to find minute imperfections which are normally invisible to most of us.

On the 'most unusual' side, one patient actually brought the head of a clothing store mannequin to the office, wanting a nose just like that one. As a result, we took the head into the operating room and used it as reference during the rhinoplasty. (Fortunately, the patient was extremely satisfied with the final outcome!)

What advice would you give to other physicians?

Based on my experience, it is very important to get the best training possible and preferably in something that no other surgeon performs. That will necessarily include tremendous dedication and inevitable sacrifices but you just can't succeed if you only do what everyone else does and you don't have a reputation for being the best at something specific.

Physicians must always be ethical and honest, keeping in mind that the most important outcome is patient satisfaction. In other words, never make decisions based on financial factors instead of doing what is best for the patient.

About: Alan Landecker, M.D. is a member of the Brazilian Society of Plastic Surgery and the the prestigious International Society of Aesthetic Plastic Surgery (ISAPS).

Dr. Landecker obtained his medical degree and general surgery training at the University of São Paulo Medical School, Brazil. He was then trained in plastic surgery at the Pontifical Catholic University of Rio de Janeiro and the Ivo Pitanguy Clinic, where he worked directly with Professor Ivo Pitanguy for 3 years.

After passing the ECFMG/USMLE examinations, Alan Landecker, M.D., spent a total of 2 years refining his plastic surgical training in the USA. During this period, he participated in clinical rotations, Research Fellowships, and Clinical Fellowships with some of the country's best surgeons at the Universities of Miami, Alabama at Birmingham (UAB), Pittsburgh, New York (NYU) and Texas Southwestern.

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

Interview: Anthony Youn, MD, FACS

Medspa MD's interview with Dr. Anthony Youn, MD, FACS, a plastic surgeon and author practicing in Michigan.

Physician: Dr. Anthony Youn, MD, FACS
Location: Troy, Michigan
Website: www.dryoun.com
That's interesting: Dr. Youn has been named one of the top three plastic surgeons in the United States by askmen.com and the only Michigan plastic surgeon named as a Top Doctor by U.S. News and World Report.

Profile: I am a board-certified plastic surgeon in private practice in Troy, Michigan. I am a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, and an Assistant Professor of Surgery at Oakland University / William Beaumont School of Medicine.

Can you tell us a little bit about your background and how you got started as a plastic surgeon?

My first taste of plastic surgery was when I underwent major reconstructive surgery to my jaw in the summer between high school and college.  Prior to this surgery, my mandible was so large it was twice the size of Jay Leno’s and dubbed “Jawzilla.” At the time I hoped that this surgery would transform me, a skinny Asian American nerd with no nerve, no game, and no clue, into an Adonis: A ladies’ man.  Unfortunately, this surgery started a four-year dating drought, and didn’t really teach me that changing your appearance could change your life until much, much later.

My real introduction to plastic surgery came in the form of an eight-month-old boy who was mauled by a raccoon. His face was literally eaten off. The moment I saw the plastic surgeon make plans to reconstruct this poor child’s face, I was hooked. I describe this scene in great detail in my book.

I completed my plastic surgery residency at Michigan State University in Grand Rapids, a fellowship in aesthetic plastic surgery in Beverly Hills, and stared my private practice in Metro Detroit.

Can you tell us more about your practice and how it's organized?

Youn Plastic Surgery, PLLC is a private practice plastic surgery clinic. I have six employees: a receptionist, a patient coordinator/scheduler, a medical assistant, two aestheticians, a nurse injector, and myself. The office inhabits 4000 sq feet on the 12^th floor of the tallest high rise building in Metro Detroit. We offer a full range of surgical and non-surgical plastic surgery treatments, including laser treatments, injections, cosmetic and reconstructive plastic surgery.

Staff compensation is often a question for docs. How do you handle that?

All of my employees are paid hourly, with no pre-set incentives or commission. Full time employees get full benefits, including health insurance, 401K, and profit-sharing. I work with a practice management company to help with payroll and other employment issues.

What are your thoughts about the IPL and cosmetic lasers that you’re using in your clinic?

Due to my frequent media appearances, I often have new technology come through my office, usually for limited periods of time. I frequently present the newest laser and light-based technology for several television programs, and have partnered with various companies who supply them to me on a trial basis. That being said, I also own several ‘workhorse’ devices that are used on a daily basis.  I have the Cynosure Cynergy laser, which combines pulse dye and Nd-YAG lasers in one, and the Syneron eLight with Refirme, hair removal, and skin rejuvenation treatment heads. My office also uses the Dermosonic device for the temporary reduction of cellulite and a microdermabrasion machine as well.

Sound's like you're fortunate in that you're really busy which leads to the next question: How are you marketing your practice?

I’m fortunate that the only advertising I purchase is the maintenance of my three websites:dryoun.com, celebcosmeticsurgery.com, and institchesbook.com.  I’m often featured in local and national media, which has given me a significant amount of exposure. In the past I’ve used many sources of advertising, including newspapers, local magazines, internet SEO, local TV and radio, all with varying results. I find that internal advertising using Constant Contact (email software) has been our most effective means of getting the word out. The yellow pages is the one media source I recommend other providers not waste their money on.

I recently went on a book tour to promote my book which included articles in several magazines and newspapers, including Plastic Surgery Practice and Plastic Surgery News.  This exposure has been really valuable for my practice.

What treatments or services are most profitable for you?

No question, Surgery. The vast majority of the profits of my practice come from surgery. Although approximately 25-30% of the gross practice revenue stems from non-surgical treatments, approximately 60-70% of this revenue goes to supply costs, like Botox vials, Restylane syringes, and laser maintenance costs. 

Plastic surgeons, like all doctors in cosmetic medicine, usually have some interesting patient stories to tell. Do you have one that really stands out?

As a plastic surgeon, I often encounter patients whom I suspect suffer from Body Dymorphic Disorder, or BDD. Typically, I encourage them to seek counseling and avoid plastic surgery. Unfortunately, most BDD patients don’t believe they have the disorder and refuse to see a therapist. I remember a patient I’ll call “Jane.”

Jane was a librarian in her mid-forties who consulted me for eyelid surgery. It didn’t take long for me to diagnose her with BDD.

“So what would you like to talk about today?” I asked her.

“Don’t act like you don’t know, Dr. Youn. I see you staring at my eyes.  Just like everyone who comes into the library. They pretend to read books or go through the card catalogue, but the moment I look away they stare at me. I catch them doing it all the time. I need you to fix my hideous eyes.”

“What’s wrong with them?  I think they look fine.”

“Don’t patronize me. You know what’s wrong with them! I’ll pay you five thousand dollar cash to fix them. I hear you’re the best. I want you to make them perfect.”

I spent an hour trying to convince Jane that she didn’t need surgery and that she should seek professional counseling instead. She wouldn’t listen.  She became increasingly agitated. Finally she said if I didn’t operate on her, she would take a scalpel and perform the surgery on herself in my office right then! 

Cue creepy horror film music here.

I would never operate on Jane, who clearly seemed mentally imbalanced. But I wanted to say no to her as tactfully as possible. I pulled out my trump card. When things get ugly, I go to the one excuse that always defuses a situation, guaranteed to reject a patient for surgery without making her upset. 

Sadly, it’s the same excuse countless women used on me during high school and college.

“Jane, it’s not you, it’s me. I’m not ready to do your surgery. I don’t think I’m a skilled enough surgeon to make you happy.

“Really?”

“Yes. Jane, I’m not good enough for you.”

Don’t laugh. She bought it.    

Any final words of advice for other physicians running their own clinic?

I think the best advice I can give is this: When you are done with work, do things you enjoy.  As physicians, we are accustomed to delayed gratification. It’s always a challenge for us to find balance in our lives. I currently split my time between my family, my work, and writing. We’ve each undergone over 23 years of schooling to become practicing physicians, and now is the time to enjoy the fruits of our labor. Find moments of happiness in your work and at home. I think the turtle in Kung Fu Panda said it best, “Today is the present, and that’s why it’s a gift.”

About: Dr. Youn is the author of a plastic surgery tell-all, In Stitches, recently published by Simon and Schuster and  a regular contributor to CNN.com, MSNBC.com, and USA Today.  Dr. Youn has been featured on the Rachael Ray Show, Good Morning America, the Dr. Oz Show, the CBS Early Show, and many others.

Dr. Youn has authored or co-authored several papers and scientific manuscripts on plastic surgery, including such procedures as the Volumetric Facelift and Facial Reshaping. In addition, throughout his career he has conducted scientific research on a variety of topics, extending from cosmetic surgery, to laser treatments, to reconstructive trauma surgery, to HIV medications.  He is a member of the Editorial Advisory Board for Plastic Surgery Practice Magazine and has lectured throughout the country.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. 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

Korea & Plastic Surgery

Plastic surgery to create 'Western' eyes for Korean children?

Via CNN

The definition of pretty, explains their plastic surgeon, is not the standard Asian face, but closer to a Caucasian face. Dr Kim Byung-gun is the head of Seoul, South Korea's biggest plastic surgery clinic, BK DongYang. The clinic is a dozen stories tall, with all of its operating rooms full on the day of Min kyong's surgery.

Dr Kim says his clinic, one of the most successful in a city dubbed the "plastic surgery capital of Asia," performs 100 surgeries a day, ranging from eyelid surgery to nose reshaping to facial contouring.

The Chinese and Korean patients tell me they want to have faces like Americans
--Dr Kim Byung-gun

"They always tell me they don't like their faces," says Dr Kim, explaining what his patients request prior to surgery. "They want to have some westernized, nice faces. They want to have big eyes like westernized people, high profile, nicer noses.

"The Chinese and Korean patients tell me that they want to have faces like Americans. The idea of beauty is more westernized recently. That means the Asian people want to have a little less Asian, more westernized appearance. They don't like big cheekbones or small eyes. They want to have big, bright eyes with slender, nice facial bones."

The surgeries, already popular among Koreans, are booming among newly rich, globally competitive, mainland Chinese, explains Dr Kim. About 30% of his patients are international and of that group, 90% are Chinese. It's why he speaks Mandarin and is partnering with two clinics in China.

"We can see potential huge growth, with the number of patients from China. The Chinese people want to have the westernized face. They don't like their faces. They have big cheekbones, big mandible angle without double fold, and a low profile nose. They are seeking to have westernized face, high profile nose, slender nice cheekbone, and mandible bone."

Dr Kim believes in the global economy, investing in plastic surgery to slightly westernize the face will bring a return on the investment of 100 times, through more confidence, a better job and obtaining a better marital partner.

A global ideal doesn't stop at the face, says dental surgeon Jung Hak. Dr Jung says he's been fighting a trend. Korean mothers who have been bringing in their toddlers to have the muscle under the tongue that connects it to the bottom of the mouth surgically snipped.

The belief, explains Dr Jung, is that it will help a Korean speak English more clearly. People from the Asia Pacific region have difficulty in pronouncing the "L" sound, says Dr Jung. But he calls the surgery, if it's only for pronunciation, misguided, and caused by the hyper-competitive drive in Korea.

"For 10 years, there's been this crazy drive for early English education. Mothers long for their kids to have better English pronunciation," says Dr Jung.

(Bold copy mine)

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.

Plastic Surgery Rising In Africa

In previous years, local patients would travel to Asia and Europe to have these procedures done but with more hospitals introducing cosmetic surgery and having competent plastic surgeons, more patients are having it done locally.

Currently Africa has about 600 plastic surgeons with Egypt, Nigeria, South Africa and Libya leading. Kenya and Uganda have seven plastic surgeons each, Sudan has four while Tanzania and Rwanda have none.

According to the Kenya Society of Plastic, Reconstructive and Aesthetic Surgeons chairman Dr Bernard Githae, the high demand for plastic surgeons locally has forced them to establish a curriculum for training institutions in the country.

“Kenya has been sending students who aspire to be plastic surgeons to South Africa but in the next two years we will be opening a training institution for plastic surgeons,” states Dr Githae.

There are less that 50 plastic surgery institutions in Africa and they are mostly in South Africa, Egypt and Libya.

Full Article

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.

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."

ASAPS 2009 Statistics Are In

In case you don't have easy access to the statistics posted yearly by the American Society for Aesthetic Plastic Surgery, here's the recap of their analysis of aesthetic procedures performed in 2009.

Keep in mind, the survey was performed on plastic surgeons.

• In 2009, there were approximately 10 million surgical and nonsurgical cosmetic procedures performed in the US. Surgical procedures accounted for 15% of the total with nonsurgical procedures making up the other 85%.
• From 2008-2009, there was a 2% decrease in the total number of cosmetic procedures performed. Surgical procedures decreased by 17%, and nonsurgical procedures increased by almost 1%.
• Since 1997, there has been over a 147% increase in the total number of cosmetic procedures performed. Surgical procedures increased by 50%, and nonsurgical procedures increased by 231%.
• The top five cosmetic surgical procedures in 2009 were: breast augmentation (311,957 procedures); liposuction (283,735procedures); eyelid surgery (149,943 procedures); rhinoplasty (138,258 procedures); and abdominoplasty (127,923 procedures).
• The top five nonsurgical cosmetic procedures in 2009 were: Botox injection (2,557,068 procedures); hyaluronic acid (1,313,038 procedures); laser hair removal (1,280,031 procedures); microdermabrasion (621,943 procedures) and chemical peels (529,285 procedures).
• Women had over 9 million cosmetic procedures, over 90% percent of the total. The number of cosmetic procedures for women decreased over 3% from 2008.
• The top five surgical procedures for women were: breast augmentation, liposuction, eyelid surgery, abdominoplasty and breast reduction.
• Men had over 900,000 cosmetic procedures, over 9% of the total. The number of cosmetic procedures for men increased over 8% from 2008.
• The top five surgical procedures for men were: liposuction, rhinoplasty, eyelid surgery, breast reduction to treat enlarged male breasts, and hair transplantation.
• People age 35-50 had the most procedures – almost 4.5 million and 44% of the total. People age 19-34 had 20% of procedures; age 51-64 had 27%; age 65-and-over had 7%; and age 18-and-younger had 2%.
• The most common procedures for age 18-and-under were: laser hair removal, microdermabrasion, rhinoplasty chemical peel and Botulinum Toxin Type A (including Botox and Dysport).
• Racial and ethnic minorities, as of last year, had approximately 20% of all cosmetic procedures, a decrease of 1 percent from 2008: Hispanics, 9%; African-Americans, 6%; Asians, 4%; and other non-Caucasians, 3%.
• Where cosmetic surgeries were performed: office facility, 58%; hospital, 18%; and free-standing surgicenter, 23%.
• Of the doctors surveyed, 75% say they do not offer “spa” services (e.g. wraps, facials, massages) in conjunction with their medical practices. 88% of the doctors say they do not work in conjunction with legitimate medical spas where nonsurgical procedures, such as injections and laser procedures are performed.
• Americans spent almost $10.5 billion on cosmetic procedures in 2009

Figures may not add exactly to totals and percentages may not equal 100% due to rounding.