Toronto Plastic Surgeon, Wayne Carman, MD, FRCSC

Dr. Wayne Carman opens up about his thoughts on Canada's medical health system and his own cosmetic surgery clinic.

Name: Dr. Wayne Carman, MD, FRCSC
Clinic: Cosmetic Surgery Institute
Location: Toronto, Canada

That's interesting: Dr. Wayne Carman is Past President of the Canadian Society for Aesthetic Plastic Surgery and is the Secretary-treasurer of the Canadian Society for the Accreditation of Ambulatory Surgical Facilities. Other prestigious positions include membership on both the editorial board of the Aesthetic Surgery Journal and also the Premises Inspection Committee of the College of Physicians and Surgeons of Ontario.

Your practice is relatively close to the US border. Do you have patients coming from the US? Is this increasing or decreasing? Do you see this as 'medical tourism'?

In the past, I have had the opportunity to treat many American patients and have enjoyed the opportunity to contribute to their care. More recent restrictions on our professional insurance have curtailed the ability of plastic surgeons to see foreign patients. Those of my colleagues in border cities have sometimes chosen to make individual arrangements to allow treatment of Canadian non-residents, but most plastic surgeons have...

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Brian Howard MD FACS, North Fulton Plastic Surgery

Dr. Brian Howard FACS

Dr. Brian Howard runs his solo-practice in Roswell, just outside of Atlanta, Georgia.

Dr. Brian Howard is boarded in both plastic surgery and otolaryngology. In this interview we got together to find out what he thinks of his practice, cosmetic technologies and staff compensation.

Name: Brian Howard, MD, FACS
Location: Roswell, GA

That's interesting: Dr. Howard is a recipient of the Outstanding Research Award given by the American Academy of Facial Plastic and Reconstructive Surgery and was recognized by the Consumer Research Council of America as a Top Physician.

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Interview With Brazilian Plastic Surgeon Alan Landecker, MD

Dr. Alan Landecker, Plastic SurgeonVisiting Brazil with plastic surgeon Dr. Alan Landecker in his Sao Paulo clinic.

Physician: Alan Landecker, MD
Location: Sao Paulo, Brazil

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.

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.

Plastic Surgery & Cosmetic Surgery Trends For 2008

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.”


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)
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)
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)
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

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
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.