Teens Are Getting Cosmetic Surgeries To Avoid Bullies

We're seeing a rise in the number of teens getting cosmetic surgery as a reaction to external stressors like bullying and social media.

Cosmetic surgery centers have seen a rise in teens seeking cosmetic surgical solutions. For some, it's somewhat aspirational, looking to try and improve what they see as a shortcoming or achieve a specific aesthetic. For others there are darker reasions like bullying.

In a study by Lee et al. (2017), bullying is one of the main factors in teenagers getting cosmetic surgeries. The researchers found that bullied teens can have long-lasting trauma that lead to a desire to change their appearance.

One example: Ear surgery is consistently...

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Labiaplasty... Where's The Line Around Genital Cosmetic Surgery

Labiaplasty... Where's The Line Around Genital Cosmetic Surgery

What's going on with the growing trend of labiaplasty and genital surgery?

aesthetic labioplasty

There's been a pretty dramatic increase in genital aesthetics in the last decade. What's up with that? Is it market demand or are aesthetic clinic just getting better at marketing to a deeply personal fear.

In the United States, it's being circulated that a labiaplasty surgeon can earn up to $250,000 a month (which seems unrealisticly high). Simone Weil Davis, professor of American studies, told Shameless magazine in 2005 that surgeons are perpetuating the idea that there is a right way for women's genitalia to look; because most women see only their own vaginas or pornographic images, it is easy to make them doubt themselves, and for cosmetic surgeons to provide an answer.

But not everyone is on the hooha beautification bandwagon...

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2016 Trends: Classic and Elegant Beauty

The year 2016 is predicted to be a time for putting forward a classy, elegant, and modern yet effortless look.

Beauty experts reveal that  the trend is leaning more on the "natural" look as complexions are expected to be taking a softer turn with a subtle quality.

Glowing and luminous skin will be a trend. According to Vogue, the recent call to natural beauty was given a windswept polish this season, with healthy washes of sun-kissed blush at Gucci and Michael Kors Collection meeting the breeze-tousled waves of Versace, Alexander McQueen.

Its all about bright and pouty lips this 2016, with classic reds and browns as "in" lip colors as they balance against a backdrop of a bare skin.

Hairstyles are expected to be going back to basics as natural and effortless look will be in style and buns and ponytails will be given a fresh twist. As they say, less is more.

With these trends, minimally invasive aesthetic procedures are expected to be popular among medspa patients to achieve a more enhanced yet effortless and youthful look.

Non-surgical facelifts, use of autologous fat grafting, botox injections, and fillers are among the procedures that are expected to be a trend in 2016.

Non-invasive procedures which offer less pain and quick recovery are also seen to be popular among patients. 

For more beauty trends in 2016, you may browse: http://www.vogue.com/13359453/top-beauty-trends-spring-2016-fashion-week/.

What's The Best Music For Face Lifts?

The next time you're performing a face lift, consider what music you're listening to.

A survey of surgeons in the UK revealed that a whooping 90% listen to music while they are operating on their patients; with half of respondents favoring up-tempo rock, 17% pop music and 11% classical.

In fact, an article written by Henley J, “Music for surgery,” published in The Guardian (2011) revealed that plastic surgeons play the most music. When asked, the surgeons revealed that music contributed to creating a "harmonious and calm atmosphere."

According to a 1994 publication of the Journal of the American Medical Association,

Surgeon-selected music was associated with reduced autonomic reactivity and improved performance of a stressful nonsurgical laboratory task in study participants.

Further, researchers from the psychology department at the State University of New York at Buffalo, found that listening to Pachelbel was better than not listening to any music at all. There was a decreased stress and increased performance after surgeons listened to music, especially when it was their own choice.

A recent study reveals that listening to music may reduce the time spent on surgical closures. The study was conducted with 15 residents performing layered closures on a simulated wound model on a pig's feet. These were done with and without their preferred music.

Twelve residents (five lower level and seven upper level residents) completed both sessions, performing 48 repairs. Blinded faculty completed 144 repair ratings.

These were the results of the pig's feet study:

  • There was an 8% overall reduction of operative time among all residents.
  •  There was a 10% decrease in the operative time of surgical closure for upper-level residents who were listening to their music of choice.
  •  A resident took an average of 11.5 minutes to complete the surgery without music. On the other hand, it only took 10.6 minutes to complete the repairs with music. 

The study further revealed that there was also an improved efficiency and repair quality for those who listened to music.

For patients, music reduces anxiety before surgery. A research done by Yale University anaesthetist Zeev Kain reveals that music decreases the amount of pain or the patient's needs for anxiety medication. A study by the department of anaesthesia at Glasgow's Western Infirmary surveyed 200 anaesthetists; it found 72% worked in theatres where music was played regularly, and around 63% generally enjoyed it.

Some 26%, though, said they thought music, especially music they didn't know and like, could at times "reduce vigilance and impair communication".

On the other side...

It's a distraction. Junior surgeons who are performing new tasks may be distracted by operating room music. This was reported in a November 2008 issue of Surgical Endoscopy.

For patients, it may also be a cause for discord and anxiety, especially when the music is not to their liking. The results are ultimately related to the surgeon's preferences as to the kind of music and its volume.

It is important that both create a harmony in the operating room between and among the surgeons and the patients. The reduction in the amount of time to perform a surgery finds a positive welcome in the healthcare environment.

The September 2015 issue of the Aesthetic Surgery Journal says that

In the current health care environment, where cost reduction is center stage and operative time is money, every second counts.

Read more on:

http://www.theguardian.com/lifeandstyle/2011/sep/26/music-for-surgery http://cosmeticsurgerytimes.modernmedicine.com/cosmetic-surgery-times/news/music-improves-surgical-closures

Fear of the Unknown in Cosmetic Surgery

A study commissioned by CCR Expo reveals that only half of the women who are interested in cosmetic surgery actually undergo the procedure.

Aside from cost, CCR Expo research reveals that there is actually fear of botched treatment as seen in media, wariness in the results (patients fear that they might not like what they will see in the mirror), and not knowing if the practitioners themselves are qualified to perform the procedure.

The annual CCR Expo, or the Clinical Cosmetic and Reconstructive Expo 2015, will be held on October 8-9, 2015 at the Olympia National Hall, London, United Kingdom. Prior to the event, three surveys were conducted among to know the opinion of various individuals including aesthetic practitioners, medics such as general practitioners and dentists, and the women patients who constitute majority of the patients undergoing such treatments.

Notwithstanding the governments efforts to regulate and "clean up" the cosmetic surgery arena, research revealed that patients and practitioners alike have a lot of fears. This is attributed to the fact that the aesthetic sector is largely unregulated.

Practitioner's View 

  •  There are too many untrained cosmetic providers who perform procedures that damage the reputation of credible and qualified practitioners.
  •  There is a lack of training and expertise in the following: facial anatomy, diagnosing and coping with complications, wrong treatments, and the use of unproven products.
  • Medical colleagues see that there is a strong prejudice for practicing aestheticians and the later are regardes as "beneath them". On the other hand, the survey also revealed that colleagues saw the field as lucrative but they got scared to enter because of lack of knowledge.
  • 90% of the surveyed GPs and dentists had considered providing aesthetic treatments, yet they did not push through because of: lack of specialized training, concerns in tax regulations and botched jobs, not understanding its legal frameworks, and the marketing involved.

According to CCR Expo organizer Peter Jones:

We don’t necessarily encourage more clinicians to join the aesthetics arena, but our research clearly shows there is a strong desire for more clarity in the sector, alongside some understandable concerns. At CCR Expo our logic is, if you’re going to do it, then do it right! This is why we have put together a full programme and roster of experts who can offer support and guidance to those who do wish to enter this field, so they have the tools enabling them to practise ethically and safely.

Clinicians have honed their careers over many years – sometimes decades, and being protective of their reputation is entirely natural. We are here to help them train andmaintain their hard-earned standing, whilst also helping keep the public safe. They certainly deserve no less.

More on: https://www.prime-journal.com/fears-continue-to-grow-around-aesthetics-sector/

SIMON Says: “Run Forrest Run!”

Saying ‘No’ to Prospective Cosmetic Medical Patients

Certainly, everyone is entitled and should have access to cosmetic medical and surgical services. However, depending on your particular risk tolerance, there are certain times when you might want to just 'pass' on treating a patient.  Knowing which patients to sidestep is a gray art and is frequently based on hunches and ‘gut’ feelings.  This subtle impression, as described in Malcolm Gladwell’s book 'Blink: The Power of Thinking Without Thinking', is correct more often than not.  However, there are more objective guidelines available to help decide whether or not to dance with a particular patient. Several of these tips have been developed and expounded upon in numerous papers by Dr. Mark Gorney and in the book 'The Patient and the Plastic Surgeon' by Dr. Robert Goldwyn.  Consider running for the hills if:

  • The patient is a SIMON – single,immature, male, overly expectant, and narcissistic.  Even worse if they answer to SIMON-SLAP (SIMON + still lives at parents). 
  • You don’t click with the patient – or just plain dislike them
  • The patient is critical of previous physicians but thinks you hung the moon.
  • The patient is rude to your staff.
  • The patient demands a guarantee.
  • You are asked to do something you can’t deliver.
  • Anyone in a hurry to have surgery – gotta do it now!
  • The surgiholic patient.
  • Patients wanting procedures because they are prodded by friends or family members.
  • The out-of-town patient who has to bolt before you are comfortable with them leaving.
  • The patient who is vague, indecisive and leaves the driving to you.

Unfortunately, patients don’t walk into your office with a label on their shirt saying ‘I’m going to be a real problem’.  Listen to the voices in your head and apply the above principles.  Cosmetic medicine is supposed to be fun – don’t let a rogue patient slip through the cracks and haunt you.  It just isn’t worth it!

American Cosmetic Surgery Numbers By Region

American cosmetic surgical procedures in the U.S. by region.

North East: 302,000 cosmetic surgeries


  • 29% Nose Reshaping
  • 20% Facelift
  • 18% Eyelid Surgeries
  • 17% Liposuction
  • 15% Breast Augmentation

South East: 289,000 cosmetic surgeries

  • 23% Liposuction
  • 23% Facelift
  • 22% Eyelid Surgeries
  • 16% Breast Augmentation

South: 258,000 cosmetic surgeries

  • 17% Breast Augmentation
  • 17% Nose Reshaping
  • 16% Tummy Tuck
  • 15% Liposuction

Midwest: 242,000 cosmetic surgeries

  • 31% Dermabrasion
  • 17% Breast Augmentation
  • 14% Nose Reshaping
  • 13% Eyelid Surgeries
  • 13% Liposuction

West: 485,000 cosmetic surgeries

  • 36% Breast Augmentation
  • 34% Eyelid Surgery
  • 32% Liposuction
  • 31% Facelift
  • 27% Nose Reshaping

* Percentages may aggregate to more than 100% do to the same patient having multiple types of treatments.

Dealing With Anonymous Patient Reviews As A Physician

Reputation Management for Doctors

The internet is a double edged sword to the Plastic Surgeon.

Patients from near and far can read about and research our skill and services but at the same time a handful of malicious people can significantly tarnish a great reputation which we have strived to achieve and maintain.

As a surgeon and as a human I have always strived to maintain the highest ethical and moral pathway. Most of us went into medicine to help people. What we do as cosmetic surgeons may not save lives but it does save quality of life and that is evident in our patients' smiles and behavior after successful cosmetic surgery. As doctors we strive to achieve and maintain a pristine reputation but as in anything else in life, it is impossible to please all the people all the time.

The internet has given a voice to everyone but it seems like angry, bitter, malicious people take advantage of this soap box and platform much more often than normal happy folks. You can see this on comments on YouTube or blogs or chat rooms of all kinds - not just medical or plastic surgery related.

But in our field, we depend on our reputation and while you may have thousands of happy patients, a small handful of unhappy ones can affect your reputation. Personally I have seen that the vast majority of my negative online anonymous patient reviews or ratings are from people who I have either never seen in my office or have seen but refused to operate on as patients. I recently had a "1 star negative review" on YELP from a person who has never even come to my office nor met me but decided that she did not want to pay $100 for an hour of my time for a consult and felt obligated to give me a negative rating for not offering free consults! We have all had such occurrences. But how do you deal with it?

My method has always been dealing straight forward with any and all comments.  If it is out there then it begs clarification and a reply from my staff or office managers or even myself.  There has to be accountability.  In the restaurant industry, restaurants can actually review and rate their patrons, not just vice versa! As physicians, we have to respect patient confidentiality and HIPAA but that does not mean we must be silent and let any anonymous person's comments go without a reply or clarification especially when most of us work so hard to do the right thing and practice with skill, ethics and integrity.

Resources for physicians:

Dr. Kevin D. Light: Cosmetic Surgery & Anti-Aging Medicine In Dallas, TX

Kevin D. Light, DO, MBABio-identical hormone therapies, cosmetic surgery, aerospace medicine and battling insurance policies with Dr. Kevin Light.

After meeting Dr. Light at the Medical Fusion Conference last year, we decided that we wanted to know more about this former vet turned cosmetic doc.

Name: Kevin D. Light, DO, MBA
Location: Dallas, TX
Website: tifm.com

That's interesting:  As a board certified General Surgeon, he practiced internationally with the US Air Force for 8 years. He was also lucky enough to be selected to attend the USAF Aerospace Medicine program early in his Air Force career, so he also served as a flight surgeon, that put him in the back seat of T-38, F-15 and F-16 fighter jets for 8 years. He was one of the first medical teams placed in Saudi Arabia during Operation Desert Storm and has received two Air Force Commendation Medals. He was Chief of Surgery during extended assignments in Germany, the Kingdom of Jordan and Guantanamo Bay, Cuba.

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Top 5 Cosmetic Surgery Treatments In 2011

According to the American Society of Plastic Surgeons cosmetic surgical procedures increased 2 percent, with nearly 1.6 million procedures in 2011. The top five surgical procedures were:

• Breast augmentation (307,000 procedures, up 4 percent) 
• Nose reshaping (244,000 procedures, down 3 percent)
• Liposuction (205,000 procedures, up 1 percent)
• Eyelid surgery (196,000 procedures, down 6 percent)
• Facelift (119,000 procedures, up 5 percent)


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: Stephen Weber MD, PhD of Lone Tree Plastic Surgery

Sitting down with Dr. Stephen Weber of Lone Tree Facial Plastic & Cosmetic Surgery Center outside of Denver, Colorado.

Physician: Stephen Weber MD, PhD
Location: Lone Tree, CO
Website: http://www.lonetreefacial.com

That's interesting: Dr. Weber has participated in the "Face to Face" program where local plastic surgeons donate their services to the victims of domestic violence and has participated in the annual humanitarian mission surgical trips providing free care to medically isolated, indigent patients.

Profile: I am a double board-certified Facial Plastic and Reconstructive Surgeon practicing at Lone Tree Facial Plastic & Cosmetic Surgery Center in the Denver metro area. My practice involves all aspects of facial cosmetic surgery including facelift, browlift, blepharoplasty, rhinoplasty, otoplasty, facial implants, facial resurfacing and scar revision. Our office also provides comprehensive treatments for facial aging including Botox and Dysport to reduce facial wrinkles, dermal fillers to minimize facial lines and folds as well as fractional laser (Fraxel and MiXto) resurfacing.

Can you tell us a little bit about you and how you got started in cosmetic medicine?

I became a Facial Plastic & Reconstructive Surgeon by a very circuitous route. In medical school, I planned to become an Infectious Disease specialist and even obtained a Ph.D. in Immunology and Microbiology in pursuit of that goal. However, my first rotation after successfully defending my thesis was in head and neck surgery. I knew that first day that I wanted to become an Otolaryngologist (Head & Neck Surgeon, ENT). During my residency training in Otolaryngology and Head & Neck Surgery I realized that my goals of performing a diversity of procedures in a technically demanding sub-specialty made Facial Plastic Surgery a very well suited specialty. I trained as Dr. Shan Baker’s fellow in Facial Plastic Surgery at the University of Michigan and then entered practice.

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

My practice is a single specialty clinic. We have two plastic surgeons here at the practice, myself and Dr. Rick Schaler who is my partner and practice owner. We have eight other staff including one nurse, five estheticians, one front desk staff member and a billing manager. We offer the full range of facial reconstructive and cosmetic surgery. Our office has a fully functional operating room in which we perform all of our cosmetic procedures under IV sedation. On the medical spa side, we offer all of the available injectable treatments including Botox, Dysport, Xeomin, Restylane, Perlane, Juvederm, Radiesse and Sculptra. We perform laser services including Fraxel and MiXto (fractional CO2) resurfacing, vascular laser and laser hair removal treatments. We also perform a full complement of facial peels and facial treatments. Our patient population comes from the surrounding suburbs of Lone Tree, Highlands Ranch, Littleton, Parker as well as Denver proper.

How are you dealing with staff in your clinic?

Fortunately, we have not had the need to fire staff. The reason for this is that we’re very careful with the hiring process. The communication between members of our office is very clear. When we set out to hire a new member of the office we have a clear, articulated goal regarding our needs and the type of person we want to hire. Everybody in the office has a chance to veto a potential new member of the office staff. Each member of the office also has the opportunity to veto that potential candidate. We tend to hire from a pool of people already familiar to the office or from strong referrals from friends of the practice. We have avoided print advertising of open positions of late as this always leads to a huge response with relatively low yield of the type of candidate that we need.

For the front desk staff, compensation is hourly. For procedure or treatment oriented members of the office, including physicians, compensation is heavily weighted toward production. This is the most fair compensation method and encourages productivity. The formula is simple, clearly articulated and fair. Employees are paid a percentage of net collections. An employee can review their production at the end of each month, if requested. I review my own production at the end of every pay period and encourage the rest of our staff to do the same.

What laser technologies are you using now? How do you decide on new purchases?

We perform laser treatments including Fraxel and MiXto (fractional CO2) resurfacing, vascular laser and laser hair removal treatment. In terms of new purchases, laser companies really need to show us a substantial improvement in results before we will purchase new technology. We are marketed to by phone, mail, email and at conferences. I am interested in new radiofrequency technologies but I think the jury is still out and we’re holding out on making that purchase.

How do you market your clinic?

In terms of social media, we market on Facebook , Twitter, as well as LinkedIn. We’re trying to determine whether Pinterest can be leveraged with pre- and post-op photos and other images. We use social media to communicate with current and prospective patients with informational posts and product samples/ give-aways. Our email list of current patients is our most valuable marketing tool. Providing current patients with updates that they can forward to friends is invaluable. We also put on open houses and seminars that allow us to provide education, meet new patients and learn more about our current clients.

In the pay-per-click arena, we use Google AdWords with a relatively conservative budget. That has drawn a lot of traffic to our website and helped generate surgical cases. We have been testing the waters of direct mail and print advertising. Direct mail has had moderate result. Print advertising has been disappointing. We do not currently take part in Groupon, Living Social or any other daily deal sites. The main reason for this is cost and questionable ability to develop lasting relationships with users of these services.

What are the most coveted treatments/services in your practice? Have you tried removing some of your services?

The sun and dry air in Denver are the reason why people flock to this area. However, they wreak havoc on facial skin. As a result the demand for lasers and peels here is tremendous. On a volume basis, Fraxel skin resurfacing and Botox are the most common services in our office. However, the fixed cost associated with these services is significant. From a revenue perspective, surgery provides the greatest revenue and greatest profit for the practice. About 75% of our cases are elective in nature. We have not dropped any procedures recently. When I joined the practice, I introduced Sculptra facial injections and Radiesse hand rejuvenation and we’ve seen high demand for these treatments. 

What have you learned about practicing cosmetic medicine?

I’ve developed a thicker skin and learned not to take things personally. In the past, when a patient booked surgery with a competitor I assumed that I had erred in some way or not provided excellent photos of patient results or …. I’m noticing today more and more patients that will meet multiple surgeons and come back to book surgery with me. When I’ve asked why, the answers that patients provide are incredibly vague. It really is a gut feeling that people have that you are or are not the surgeon that will provide what they’re looking for. All we can do is provide as much information and education, quality photos of surgery results, a top notch facility and a warm, caring environment to convince patients that we’re the right team for them.

Any last thoughts on advice for your physician colleagues in the cosmetic industry?

I would urge physicians, especially in the plastic surgery realm, to compete by providing exceptional service. With Groupon and other daily deal sites, there is increasing pressure to compete on cost. Some of these deals will temporarily drive patients into the practice. However, few are likely to be loyal patients when the practice down the road runs an even cheaper deal. The daily deal trend has provided consumers with cheap (not necessarily quality) services. However, this has come at the expense of sustainability for practices that jumped in without doing enough research. The bottom line is that daily deals will lead to a spike in volume composed of largely price-oriented patients. Further, the deal seeking crowd is unlikely to see the value in your services. Continuing to drive down prices when our costs are fixed is not only unsustainable but diverts your attention from providing services, such as surgery, that are the profit engine for the practice. When you offer services at cost, you CANNOT "make it up on volume."

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.

Dr. Joe Niamtu III, Cosmetic Facial Surgeon

Our interview with Dr. Joe Niamtu, III, about his cosmetic surgery practice in Virginia.

Physician:Dr. Joe Niamtu, III DMD
Midlothian, VA
That's interesting:
Dr. Niamtu and his wife April have been chairpersons for Noah's Children, Operation Smile, Richmond ARC and are also active in the Safe Harbor Women's Shelter, March of Dimes, Conner's Heroes and other charities.

Profile: Dr. Joe Niamtu III is well known in international cosmetic facial surgery circles as surgeon, teacher and author and is regarded as a key opinion leader by academics and clinicians worldwide. He is a fellow of the American Academy of Cosmetic Surgery and the American Society for Lasers in Medicine and Surgery. He is board certified by the American Board of Oral and Maxillofacial Surgery and lectures internationally on cosmetic facial surgery. Dr. Niamtu has taught on six continents and has written four textbooks as well as 22 chapters on other textbooks. He has authored hundreds of publications on various cosmetic facial surgery topics and a has served on the board of directors of the Cosmetic Surgery Foundation and chaired numerous committees with the American Academy of Cosmetic Surgery.

Dr. Niamtu was kind enought to talk to us about how he got started in cosmetic medicine and how he's grown his practice.

Thank you for joining us today Dr. Niamtu. Can you fill us in a little on how you got started in cosmetic surgery?

My maxillofacial training included 5 years of complex facial operations including, trauma, reconstruction, cancer, TMJ and other procedures. I always enjoyed the aesthetic part of this, but I trained before lasers, endoscopic surgery, neurotoxins and modern fillers. Cosmetic training began to become core in numerous specialties including plastic surgery, ENT, Dermatology, ophthalmology and oral and maxillofacial surgery. I noticed that the maxillofacial surgery residents were getting cosmetic facial training and it was part of the oral and maxillofacial surgery board exam and also covered by our malpractice insurance. Being friends of Jean and Alastair Carruthers, I got onto the Botox bandwagon early. By the mid 1990’s I was proficient at endoscopic surgery from TMJ procedures and browlifting was a natural step. I was one of the early surgeons to use lasers for cosmetic procedures and I simply just got bit by the cosmetic surgery bug. I loved anything having to do with cosmetic facial surgery and spend hundreds of hours and tens of thousands of dollars learning contemporary facial surgical procedures.  This became a bigger and bigger part of my practice and in 2004 I limited my practice to cosmetic facial surgery, which it remains today.

I'm a teacher at heart and almost went into academics. I have always enjoyed writing and lecturing and quickly began lecturing and publishing on cosmetic facial surgery. I have written hundreds of articles on cosmetic facial surgery, written 4 textbooks, and lectured on 6 continents. I currently lecture over 20 times a year and cosmetic facial surgery remains not only my job, but my passion.

Can you tell us more about your cosmetic clinic?

My office is a 5,200 square feet state of the art, fully AAAHC accredited office ambulatory surgery center.  We have a spa like environment, but have no formal spa or aesthetician. Our environment caters to upper class females and males (but we also do significant pro bono work). We have two operating rooms that rival any hospital and a recovery suite to accommodate same day or 23 hour patients. We have 4 consult suites, two of which can double as minor procedure rooms. There are several employee offices and a business room to deal with patient consents and finances.

We have a single surgeon (me!) and 8 staff. This includes 2 receptionists, 2 R.N.’s, a manager, 2 surgical assistants and a cosmetic coordinator. We work, work, work.  We probably see enough patients for 2 docs, but it is just me. We rarely eat lunch as we “take all comers” and my staff is great at making it all work.

That sounds like a your staff runs the clinic like machine. What have you learned about managing staff?

I, (like any doc that has been in practice for 30 years) could write a book about staffing. It is truly the biggest challenge to any successful practice. It is such a complex topic, it is difficult to even discuss in a short space like this. I think the basics are to find employees that need to work. Keep them excited by making the game big enough. Anything that is not moving forward is moving backward! Never accept mediocrity and always strive to be the best. I tell my staff that if they don’t think we have the best office in town, they should send our patients somewhere else. I think that salary is important, but finding staff that enjoys the job is more important. We still pay health insurance which helps attract good staff.  Basically, doctors are poor HR people and we insist on a manager experienced in staff issues.

One problem that many doctors make is keeping a substandard employee because they want to be a good guy or girl. A poor employee can drag down the entire staff and be the bad apple. If an employee does not seem to be working out, it is important to terminate them soon. It is never easy, but if the doctor and other staff is not happy, the poor employee is probably not either. We always do this with respect and simply tell the employee that they are not progressing in the same direction of our practice vision. I really need sharp staff.  A “ten” employee at some offices may be a “six” at my office. Although this is easier now, it was leaned on the back of hard lessons. Many of them involved me and my behavior as well. We all learn what it takes to lead and manage a successful, winning team, it takes years for most of us.

What are your thoughts on the IPL and laser technologies you’re using now?

I have used IPL for years and used the Lumenis 1 machine. It performed fine but my practice is limited to head and neck surgery and that rules out a lot areas that the machine could potentially service. Due to this I have sold the machine and currently do not offer IPL. I think it is a great therapy, but my experience was that for every 10 patients you treated, 3-4 did not appreciate the gain or feel it was worth it. I have a surgical practice and my patients expect big changes with single treatments, so the IPL did not fill that requirement.

I am a huge CO2 laser fan and use the Lumenis Encore. I have the Lumenis Active and Deep FX fractional machine, but just don’t use it much. Unlike most of the planet, I am currently unimpressed by fractional laser treatments. I am a still a fan of “old school” laser resurfacing and last year I performed 60 full face CO2 laser treatments. I am talking about high fluence, high density, multipass treatment with a two week recovery. Many surgeons have embraced fractional technology, but nothing can touch the results of traditional CO2 resurfacing. Yes, the recovery is 2 weeks, but that is pretty reasonable to turn back a half century of aging. I have to laugh when I hear surgeons forsake the two week recovery and then in the same breath say they are doing 4-6 fractional treatments on the same patient.  That is bad math. Some of my friends that have minimally invasive practices love fractional treatment and again, I have a surgical practice and my patients expect results that can be seen in a before and after picture. In my experience most fractional treatments show little result. and Aggressive CO2 is still the gold standard for rejuvenation and scar improvement. I have the Lumenis Active and Deep FX fractional machine, but just don’t use it much. I have instituted numerous steps to make “old school” laser treatment easier on the surgeon, staff and patient which could be the subject of a future article.

I also have a Iridex 940/532 laser and really enjoy it. The 940 wavelength is awesome for spider veins and pigmented lesions and I don’t utilize the 532 much as the 940 is superior, especially with deeper and or bluer veins. It also works well with venous lakes and small hemangiomas.

Finally, this is a confusing time to buy new devices as I think that the promotion by media and companies has gotten out of hand and is not evidence based. Young practitioners need to be very careful about investing in unproven technology as it can come back and bite you. If you buy some “miracle” laser or fat melter and begin a big media campaign, you can drive patients into your office and if the technology does not live up to your hype, you can permanently ruin your credibility. My advice to novice surgeons “stay on the cutting edge and avoid the bleeding edge". Every time some new miraculous device appears on The Doctors, or some morning show, our phones immediately light up. The public is hungry for big results with no down time, but we are not there yet.

Question: How do you market your clinic?

My marketing budget in 1999 was $200, and has obviously grown significantly as my practice progressed. There is no doubt that my marketing has contributed to my success, but you have to be a good surgeon to make it work. You can spend millions on marketing and if you can’t back it up, it does not work.

Also you have to walk before you run. For new offices, internal marketing with web and social marketing can be effective for very little cost. As the offices progresses, the next step is to branch out into other media. Print advertising is the next most cost effective with radio and TV being more expensive. I believe in a shotgun approach, throw some seeds everywhere.  I divide my budget between newspaper, magazines, mailers, radio, TV, and other outlets. I think a good goal is to invest a certain amount of your gross to marketing and keep the formula going.

Also remember, treating people great and special is free and there is no more powerful marketing than patients sending other patients.

I am one of those nerds that does their own website and blog. Yes, I spend a lot of time doing it, but I really benefit from it as well. You can’t get any more personal touch than directing your own material.

Getting known for your work is also great marketing. I love to teach and lecture over 20 times per year. I give courses at my surgery center twice a year (www.cosmeticsurgeryeducation.com) and also market a cosmetic facial surgery DVD series.  I have written 4 textbooks, 22 textbook chapters and hundreds of articles on cosmetic surgery. Patients like to see their surgeons name in print and it bolsters your reputation.

What treatments or services are most profitable for you?

Profit is not a four letter word in surgery but loss is.  Some doctors feel uncomfortable about discussing money, but in the end, we are all running a business. I would guess that cosmetic eyelid surgery, radiowave mole removal and neurotoxin injection are among the most profitable procedures considering time spent and monies collected.  Fillers are less profitable because I numb every patient with topical, then local anesthesia and it takes longer, but pays for itself in bringing patients in.  As I stated earlier, I have stopped performing IPL as I do all treatments myself and it was too time consuming.

What have you learned about practicing cosmetic medicine that can help other docs?

Cosmetic medicine is an upper class luxury and elective and these patients expect to be pampered and catered to. It is truly a different clientele from the patients that practitioners may see within their specialty. When I was doing a lot of facial trauma, patients would be grateful just to be treated and look normal. On the other hand, a facelift patient with a tiny scar may complain incessantly. In some respects, it is high stakes poker as many our patients are not happy with themselves and may poses body dysmorphic traits which makes rational treatment and results difficult to convey. All cosmetic doctors also practice psychiatry in a sense as you must figure out and manage the mental game of many patients. This is also a highly litigious group.

Luckily there are many grateful patients that make it worth going to work everyday,

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

Do what you love and love what you do. I truly have a passion for cosmetic facial surgery and on Sunday night, I am psyched up about going to work on Monday.  To me that is the definition of success! Winning is not that hard.  Treat your patients better than anyone else, always put the patient and patient safety first, follow the Golden Rule, back up your work, stay on the cutting edge, give back to your community and be an humble and approachable person and you will be successful.

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.

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The BODY Conference & Aesthetic Summer Ball At The Royal Society Of Medicine In London

If you're in the UK and in aesthetic medicine, the BODY Conference would be the place to be this November 5th and 6th.

Now in its third year, BODY2011 is the sister conference to& FACE – the UK’s largest conference on facial aesthetics. It follows the same format in aiming to provide the highest quality national and international speakers in their respective fields of scientific interest to update your clinical knowledge and explore new market opportunities in the dynamic BODY aesthetics industry.

Many practitioners attend events focused around their individual specialty or area of expertise, and do not often meet practitioners with different training and backgrounds working in the UK aesthetic industry.

BODY provides a broader scientific agenda that brings all specialties together at one meeting to provide a unique opportunity for debate and to learn more about the specifics of the many different market segments that make up the BODY aesthetic market place. BODY 2011 will be the largest UK congress this year devoted to the rapidly expanding non-surgical and surgical BODY Aesthetics sector of the Cosmetic Market, and is a must attend event for practitioners and clinics operating in this exciting market segment.

Why can't we have some medical conferences with a Ball over here?

I've been in email contact with Raffi Eghiayan who puts on these conferences and maybe we can get something done.

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.

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

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

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

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

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

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

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

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

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

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

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

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