Top 10 Countries For Cosmetic Procedures

According to the International Society of Aesthetic Plastic Surgery, here are the top 10 countries ranked by number of cosmetic procedures.

Top 10 Countries For Cosmetic Procedures - Medical Spa MDSome interesting facts according to the report:

  • Japan moved from #6 in 2009 to #4 in 2011.
  • France moved from #14 to #9 in the same period.
  • The US dominates with just under 18% of procedures worldwide.
  • Asia performs the most treatments by continent with 28.8% of plastic surgeons and 31.7% of total procedures. North America is second with 24.3% of the worlds plastic surgeons and 24.6% of the total procedures.

Dr. Roy Kim - Plastic Surgeon In San Francisco

Dr. Roy Kim San Francisco,Board Certified Plastic Surgeon

Dr. Roy Kim shares his thoughs on social media, marketing, technologies and treatments including the Iguide neck lift system.

Name: Roy Kim, MD
Location: San Francisco, CA
Website: drkim.com

That's interesting: Dr. Kim has gone to Guatemala several times, and he has operated on patients from Rwanda as well. 

Dr. Kim is also an investigator in several elite clinical trials regarding facial fillers, the Iguide system, and cohesive or “gummy bear” implants and is a member of Operation Access, a way for local San Franciscans to get free health care.

You've got a blog on your site, you're on Facebook, Google +, LinkedIn and Twitter. You seem to be comfortable with social media and reaching out to patients online. How much of your marketing efforts are now online and are they working?

Most of my marketing efforts are concentrated on

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"Hello Doctor. I Wouldn't Hesitate To Sue You."

medical malpracticeGuest post by Dr. Mandy Huggins

How many times during your day does the specter of a malpractice law suite rear its ugly head?

“I wouldn’t hesitate to sue you.”

"I’m sorry, what?"

That is what I heard from the mother of one of my patients. At the time, I was only 2-3 months into practice, and I was evaluating a high school athlete who had recurrent stingers and a possible episode of transient quadriparesis . I wasn’t on the sidelines for these injuries, so I had to go on the reports given to me by the athlete and the school’s athletic trainer. However, with that information, I did not want to clear this player to return to football until I could be certain he didn’t have cervical stenosis or any other abnormality that might put him at risk for permanent damage if he suffered another neck injury. I told the athlete and his mother that I needed to get an MRI of his cervical spine in order to determine this. The athlete was understandably upset with my decision, but his mother supported my decision to proceed with caution. She explained to me that if her son played again, sustained another injury, and something “bad” happened, she would be more than happy to take legal action against me.

Fantastic.

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The Other Side Of Medical Tourism - A Surgeons Nightmare

The Other Side Of Medical Tourism - A Surgeons Nightmare

Medical TourismGuest post by Samuel Bledsoe MD

There is an element of a gamble inherent in the medical tourism industry as it currently exists.

An interesting thing happened to me at work the other day.  It was Friday afternoon, and I received a call from a primary care doctor. The phone call began with, “I’m really sorry about this, but I have a surgeon’s nightmare in my office.”

This is not a good way to begin a conversation.

He began to tell me about the patient. This particular woman had a Lap Band placed several years ago. For one reason or another, she decided that she would like this converted to a different procedure. She drove by my hospital to get to the airport, hopped on a plane and flew over hundreds of other well-qualified bariatric surgeons in order to reach a surgeon in Mexico where she had her Lap Band removed. She then returned 6 months later and had a sleeve gastrectomy. This is where things go bad.

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Dr. Carey Nease, Southern Surgical Arts In Chattanooga, TN

Dr. Carey Nease Board Certified Tennessee Cosmetic SurgeonDr. Carey Nease's goal is to impact the lives of his patients in a way that they are transformed, but not different. 

Name: Carey Nease, MD
Clinic: Southern Surgical Arts
Location: Chattanooga, TN
Website: southernsurgicalarts.com

That's interesting: Dr. Nease is a Fellowship Director of the American Academy of Cosmetic Surgery and trains surgeons from around the country the latest techniques in cosmetic surgery. The fellowship is a one-year training program open to current ABMS-certified general surgeons, plastic surgeons and head and neck surgeons. He is also a board-examiner and trustee of the American Board of Cosmetic Surgery and trains other surgeons around the United States in SmartLipo and Affirm fractionated CO2 laser resurfacing.

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Is Technology Changing The Doctor-Patient Relationship (for the Worse)?

The first point of contact for a patient to ask post-surgical questions should be the surgeon who performed said surgery. The trend seems to be in exactly the opposite direction.

I've noticed a concerning trend. I participate in websites like RealSelf.com that connect plastic surgery patients and cosmetic surgeons. These sites are allowing patients to have near immediate access to expert plastic surgeons from across the nation and plastic surgeons to interact with potential patients.

In the past few months an increasing number of patients in the early post-operative period (some with dressings still in place!) have posed questions to “online surgeons” seemingly before seeking follow-up with the plastic surgeon who just performed the procedure. It is concerning that a patient would seek advice from a surgeon they do not have a doctor-patient relationship with and who is unfamiliar with the specifics of the surgery that they've recently undergone. Patients have even gone so far as to inquire about where to seek second opinions and whether revision surgery will be necessary all within the first post-operative week.

The early post-operative timing of this phenomenon is most concerning. This is the period in which we need to reassure our patients that bruising and swelling will resolve, dressings and sutures will be removed and that they truly will look great once they’ve healed. This period can cause patients significant distress and many require a lot of hand holding at this point.

We’re obviously failing some of our patients if they're reaching out online during this period instead of calling our offices and dropping in to be evaluated. I agree that second opinions are highly valuable and would not hesitate to arrange such for a concerned patient. However, a patient-initiated second opinion from an unfamiliar, online surgeon who has an incomplete picture of the patient's history is problematic at any time point let alone while the compression dressing is still in place!

What could possibly be responsible for this trend? As cosmetic surgeons are we so difficult to reach that our patients need to seek online advice from others? As we become more amenable to interacting with potential patients online are we failing to care for those who have already made a trip to our operating room? Is it simply easier for our patients to log onto a website rather than call the doctor's office? What can we do to direct those online inquires back to our own practices rather than into the digital ether?

As a Facial Plastic Surgery practice, my entire team is in the business of building relationships. If a patient has a professional, responsible and ethical plastic surgeon, the first point of contact to ask post-surgical questions should be the surgeon who performed said surgery. This trend seems about as far astray of that goal as one could imagine.

Has anybody else noticed this trend online? Have you experienced this with one of your own patients? What you have done to prevent this from happening in your practice? Please contribute your thoughts.

Posting Comments On Medical Spa MD: Do's & Don'ts

We get the occasional email asking why someone's comment was deleted. Here are some answers.

Deleted comments are most often the result of someone committing one of the henious crimes on the list of "dont's" below, but there can be other fouls result in a comment being edited or deleted. (We usualy try to leave a comment notifying readers that a comment has been edited for violating our terms.

Here are some do's and don'ts that we use to help manage the comments on the site.

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Fairwarning: The LipoTron 3000 FDA UnApproved $85k Massager

Lipotron Medical Spa MD

According to a new story on Fairwarning.org, RevecoMED claims that their LipoTron device is really being marketed and sold as an $85,000 massager.

I just got off the phone with Myron Levin or Fairwarning.org who contacted me about Advanced Aesthetic Concepts attempts to have comments and reviews about the Lipotron 3000 and their business removed from Medical Spa MD claiming that some negative comments were costing them sales. It was an intersting discussion and Myron filled me in on some of the background that went into the story which has some interesting twists including anonymous calls to the FDA and secretive meetings with criminal investigators.

Read the entire article here: Fat-Melting Device a Weighty Matter for FDA on Fairwarning.org

From the Fairwarning.org article: 

According to interviews and records, Reveco first sought a green light from the FDA in 2007. It chose the FDA’s market clearance procedure, which is less demanding than the formal approval process.

To get a new device cleared this way, the manufacturer must show it is similar in safety and effectiveness to products that are already on the market.

However, Reveco’s bid failed. The company’s initial application “wasn’t in-depth enough,” Rosen said, and the FDA repeatedly sought additional data. Finally, according to Rosen, “We said, ‘You know what, it’s not worth it.”

According to interviews and a document reviewed by FairWarning, the FDA then told Reveco that the device could not be marketed.

LipoTron sales continued, however. Rosen wouldn’t disclose how many of the devices have been sold, but the number is believed to be in the low hundreds.

In 2011, Reveco took another tack with the FDA. It classified the LipoTron as a massager used for relief of minor pain. That would make it, in FDA parlance, a Class 1 device — a category that includes such simple, low-risk items as elastic bandages and examination gloves.

The advantage for Reveco is that massagers can be sold without a green light from the FDA. They automatically are exempt from FDA review and can be put on the market once a notice is filed.

Yet doctors and med spas have been promoting the device on the Internet not for massages but for removing fat.

Rosen said that was not Reveco’s responsibility, stating that the company can’t dictate what doctors do or “police everything out on the Internet.”

Asked who would pay $85,000 for a massager, Rosen replied: “Anybody that wants to buy it.”

Wow. It would take some really big cajones to claim that you're selling an $80k+ device named LipoTron to cosmetic clinics from a company named RevecoMED but you're only marketing it as "a massager for minor pain" and that it's the doctors who are running around uncontrolled promoting it for fat-melting. I'm actually somewhat impressed. I guess the real lesson is that if you can't get your device approved by the FDA as a medical device the first time, reclassify it as a band-aid and declare yourself in full compliance. That seems simple enough. 

Of course it also seems fairly clear from the article that if you have one of these devices and you're promoting it as FDA approved or as a treatment for anything other than a 'massager' you might not be in lock-step with the FDA, a fact that might be exacerbated by the fact that this story has been picked up by major media outlets like MSN.com.

I'm curious; Does anyone have one of these Lipotron devices that they're using as a massager for minor pain? You might want to see if it works on yourself because I'm guessing you have a headache about now.

Stem Cells & The Vampire Facelift

If you attend medical conferences, or read the trade journals, you’ve no doubt heard about stem cells and their incredible potential in the healthcare industry. These cells have the ability to repair or replace damaged cells, reduce inflammation, and possibly even have a role in disease prevention and cure.

Lately, these cells have been the target of much interest in the cosmetic field. Platelet-rich plasma (PRP) is the portion of the blood that remains after centrifugation has separated out the red cells. This fraction is unusually rich in growth factors and stem cells, that have the ability to repair damaged skin, and act as a long-lasting filler to volumize the face. The PRP is activated using calcium, and then is immediately injected into the donor’s face.

At Canyon Lake MedSpa, we have been using the patented “Vampire Facelift” technique (Regen Labs) in conjunction with standard HA or CHA fillers. We inject the filler using standard technique and then layer the PRP on top. Although still very new to this technique, we believe we are seeing the early effects including improved skin tone and color. Research has documented significant prolongation of filler effect, but we have not been doing this procedure long enough to attest to that yet.

Since we are only minimally manipulating the blood (centrifuging and decanting off the PRP) in a completely closed system, and re-injecting it into the same patient, there is virtually no risk.

In our next article we will discuss, in greater detail, tips on collecting and injecting PRP, how to educate patients and the outcome of our patients’ results.

There has been tremendous interest in the very-well marketed “Vampire Face Lift” and we have experienced an increase in our Med Spa new-patient visits as a result of this interest.

Sun Exposure & Sunblock: Great Info For Your Patients

Importance of Sunscreen/Sunblock

I reviewed a Special Report insert in the April 2011 The Dermatologist journal that was very informative about the need and use of sun protection. It details the difference in effects of UVA vs UVB rays. I will summarize the main points. It is critical to educate patients about the following information.

UVA and UVB are the rays that are important in skin disease and aging. UVA comprises 96.5% of UV radiation and UVB comprises only 3.5%. (Remember that SPF only tells you how much of the UVB is blocked, although UVB is important in damage to the skin). UVA can penetrate glass and reach the skin’s dermis, while UVB cannot. UV radiation causes DNA damage, immunosuppression, and sunburn.

After UV exposure, melanin (pigment) synthesis is a mechanism to combat UV damage. Melanin blocks UV and scatters UV radiation to prevent damage. This is why darker skinned individuals do not sunburn as easily and do not show as much sun-induced aging and skin disease/cancer. UV-induced immunosuppression is associated with increased risk of skin cancer.

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Sun Protection

“But I love the sun!” ….is a phrase I hear in my office all too often - especially this time of year. My usual reply: “well, the sun doesn’t love you…” Skin cancer rates are on the rise. During the recent past, doctors have become increasingly aware of the increase in the rates of skin cancer in the United States, and have stressed the importance of the need for protection from ultraviolet (UV) radiation. The harm caused by UV includes premature aging (such as wrinkling and age spots), skin cancer, and permanent, sometimes blinding, damage to eyes. Doctors everywhere agree that education is critical to stopping the epidemic of sun related diseases - especially skin cancer. As to the actual physiological effects of UV radiation on the skin, I’ll spare the scintillating details. Suffice it to say that the sun ages our skin undoubtedly more than any other environmental factor. So, just in time for the summer, let’s come with and implement a sun safety program.
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Dr. Anna Rosinska Of Body Focus Laser & Longevity Center In Midland Texas

Dr. Anna Rosinska Board Certified Physician Midland, TexasOA dermatologist from Poland, Dr. Anna Rosinskas aesthetic practice also offers medical weight loss and wellness medicine in Texas.

Name: Anna Rosinska
Clinic: Body Focus Laser & Longevity Center
Location: Midland, TX
Website:askDrAnna.com

Personally, I’m most interested in integrative medicine, which is the combination of traditional medical therapy with complimentary natural components that address each patient in a holistic way.

That's interesting: Dr.Rosinska was voted a Silver Medalist in Midland’s Top 100 Businesses and Personalities in category for Midland’s Favorite Physician in Year 2008. Dr.Rosinska was also voted a Gold and Silver Medalist in Midland’s Top 100 for 2009 (Best Physician and Weight Loss Clinic) and Silver Medalist in Weight Loss Clinic category in 2010 .

Can you tell us a little bit about how your interest grew in cosmetic medicine?

I always had an interest in weight loss and as one of the very few female physicians at that time in our area I had huge female patient population. My ladies were frequently complaining about

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Interview With Serbian Board Certified Plastic Surgeon, Dr. Gorana Kuka.

Gorana Kuka MD, Board Certified Serbian physician

Dr. Gorana Kuka works in private plastic surgery practice at the Colic Hospital with patients coming from around Europe.

Name: Gorana Kuka, MD
Clinic: Colic Hospital
Location: Belgrade, Serbia
Website: dr-colic.com

That's interesting: Dr. Gorana Kuka is board certified by Serbian Medical Society.
She is a member of ISHRS (International Society for Hair Restoration Surgery), IPRAS (International Confederation for Plastic, Reconstructive and Aesthetic Surgery) and a women for women organization that aims to supply help by female surgeons to patients.

Your website is translated in eight different languages including English, German, French, Russian and Italian. Where do your patients come from? Are you seeing 'medical tourism'?

Since around 60% of our patients are coming from abroad, we had to translate our webpage into different languages. Most of our patients come from Switzerland, Germany and Austria. Some of them are of Serbian origin and some of them are foreigners. They have found about us either from their Serbian friends living abroad, or looking through internet for aesthetic surgery of best quality and lower fees.

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What's Your Gimmick Doctor?

Anyone running a private practice in plastic surgery now should be quick to realize that the media can be a powerful resource. 

The sad fact is that the public does not know of your talents unless you let them know about them. My father's long held statement that "the cream floats to the top" is naïve to say the least. People do not know the best. They only know the doctors of whom they have heard. They just assume that they are the best. Sometimes they are. Sometimes they aren't.

Early in my interactions with the media, it was apparent that they prefer to feature "breaking news items." Their definition of breaking news is something new and different.  Most of us in medicine know that these "breaking news items" we see tend to more often be not-so-new news. Some are factually incorrect. You may also add unadulterated bull pucky. Breaking this news to your friends in the media will get you rarely featured unfortunately.  They want what they want.

When dealing with the media, they in essence want to know "what's your gimmick?' They want a pitch. They want a story. Those who are more successful with them give them what they want. I give them the truth branded somewhat with my opinion. So I have made the truth my gimmick. It may not be so frequently successful, but I sleep well at night.

Adipose-Derived Stem Cells In Cosmetic Surgery: Ready For Prime Time?

Are adipose-derived stem cells in cosmetic surgery ready for prime time use in your cosmetic practice?

Google “aesthetic stem cell treatments” and you will be greeted with a panoply of therapeutic offerings ranging from mundane to fantastic. Injecting your own adipose derived stem cells can lift your face, tighten your skin, enlarged your breast, slow the ageing process and even put some zip in your libido if injected into anatomically correct nether regions. Cosmeceutical manufacturers are even putting non-viable stem cells into facial creams hoping to knock 10 years off your visage. These marketing claims have captivated the public with the promise of a minimally invasive fountain of youth.

Adipose-derived stem cells are multipotent and possess the ability to differentiate into fat, bone, cartilage, nerves and pancreatic tissue.  They also secrete cytokines that are angiogenic, antioxidative and immunosuppressive. They release a whole host of growth factors that facilitate wound healing and tissue regeneration. Stem cells hold great clinical potential and offer considerable commercial possibilities.

We are all very enthusiastic about the promise and potential offered by the emerging field of adipose- derived stem cell science. Encouraging data from hundreds of ongoing international trials support a bright future for aesthetic and regenerative applications and real progress has been made in developing methodologies and protocols for every day clinical use. Yet many are advising caution.

A recent review in Plastic and Reconstructive Surgery notes that there is considerable uncertainty about the true clinical potential of adipose-derived stem cells and too much remains unknown about their fundable biology to be used safely and reliably. There are several contradictory studies about whether these cells promote or repress cancer growth. There are no standard protocols yet developed for adipose-derived stem cell applications. We still are unsure of the number of cells required per treatment or how many treatments are needed to achieve a desired clinical outcome predictably. In short, we are not quite sure what we are doing yet with adipose-derived stem cells despite the encouraging science and our best intentions.

A lot remains unknown about how to effectively and safely use this new technology. To market aesthetic stem cell procedures outside of clinical trials to the public seems a bit deceptive considering the current state of the art. What do you think??

5 Years Of Good Experiences With Artefill (PolyMethylMethacrylate)

I've been using Artefill for volume with good results for the last 5 years.

On a recent chart and procedure review, I looked critically at the use of fillers in my practice over the past 5 years. I use HA's (Hyaluronic Acids) mainly for lips; some Sculptra (activator) for volume in thicker facial tissues; lots of Radiesse-everywhere except the lips; some PRP and an increasing amount of Artefill (except for lips) to take care of patients suffering from both "filler injection fatigue" and significant volume loss.

As part of a regieme of (re)creating Beauty using the CT3+V=Beauty, Color Correction, Texture, Tightness, Tone + Volume, VOLUME is a key player for rejuvenating the facial shape and contours, putting the skin on stretch-which restores texture, tone and luster, and is often more economical (social down time and real money) for patients with less risk. When coupled with smaller lifts, blephs and various resurfacing, the overall result is synergystic, less traumatic, equally dramatic and probably more rejuvenating than any other single element taken to it's maximal benefit alone.

It is illegal to inject silicon for aesthetic use in Nevada, so Artefill is my only choice for "permanent" revolumization. Interestingly, when I discovered how well my early Artefill patients were doing, I started using even more of the product and pricing it aggressively so that patients could afford to get significant corrections with 6 to 12 syringes. Overall, it ends up being less expensive for the patient than what they spend on restoring volume with temporary gels.

We have patients out nearly 5 years, who have maintained good correction from their initial injections with this FDA approved version of poly-methyl methacrylate. While the FDA approval of this filler is for correction of nasolabial folds, I have used it off label all over the face, the dorsal hands, for horizontal necklace lines and depressed scars.  I have learned from other talented physicians, the techniques of deeper, comfortable injections that lead to significant permanent correction of temple, peri-orbital, glabellar, zygomatic, malar and "tear trough" volume. More deflated patients have avoided rhytidectomy by using up to 20 syringes. My own 56 year old, jolly cheeks enjoy 6 syringes of this material done over a year ago. My wife, though a Grandma, appears more than a decade younger than her stated age. She is a walking example of combining modalities without major surgery and a great educator for my patients.

Perhaps physicians are rightfully afraid of long lasting/permanent fillers considering the horror stories of previous products. However, any laser or scalpel carries the risk of permanent poor aesthetic outcome. And this ain't your traditional, poorly tested filler. It's got data approaching 10 years outside the US which is devoid of serious complication. The risks that do show up with this filler are generally avoided with good technique. Last year, I shot nearly 600 syringes of Artefill without any unexpected issues-just some bruising and discomfort. No granulomas, lasting nodules, sloughs, Tyndell Effect or infections... ever, so far.

So maybe the well trained hand, wielded by an artful and educated physician in the service of the well educated patient is a mitzvah (a good and honorable deed). After all, what patient enjoys quarterly mammograms or DRE's, anymore than the patient who comes to the office every 3 to 6 months to maintain their lip and tear trough filler?

Lasting corrections, done conservatively, with safe, evidence based products, should be more widely offered and utilized. They benefit select patients by allowing them the chance to (re)build their volume once and maintain it, rather than recreate it over and over. They still top off the small volume we all continue to lose, but they now find other services in the practice to utilize because they are so happy with their Artefill results.

I know I am.