Lifestyle Lift Abruptly Shuts Down

According to the Better Business Bureau's website, Lifestyle Lift is believed to be out of business.

The Wall Street Journal reports that the company, which claims to offer a “minor one-hour procedure with major results,” abruptly shut down a majority of its 40 surgery centers Monday and announced it would consider filing for bankruptcy.

The company, founded in 2001 by Dr. David Kent, had 40 surgery centers nationwide offering what it billed as a less-invasive face-lift procedure that required only local anesthesia and a shorter recovery time. Its advertisements boasted that the services are affordable for everyday people who want to “look as young on the outside as you feel on the inside.”

In a letter to employees sent Sunday and reviewed by The Wall Street Journal, Dr. Kent said the company “has made the decision to temporarily cease operations until further notice.” The letter tells employees not to report to work “until further notice unless otherwise instructed.”

In a letter sent to employees over the weekend, Dr. David Kent – the founder of the company – said he made the “decision to temporarily cease operations until further notice.”

“The future of the Company is uncertain and therefore it is currently developing both a wind down plan to close the business and a reorganization plan to accommodate a new investment,” the letter states.

A spokesperson for Michigan-based Lifestyle Lift tells the WSJ that the company is considering its options, one of which is filing for bankruptcy.

As of Monday, Lifestyle Lift is only providing some post-operation checkup procedures.

As one of the 'franchise model' cosmetic medicine businesses Lifestyle Lift saw dramatic growth before a series of setbacks. In 2008 it sued Realself for allowing negative reviews to be posted on the site. Realself countersued claiming that Lifestyle Lift employees were posting fake counter-reviews in violation of the sites user agreement (commonly known as 'astroturfing').

Santa Clara University School of Law professor Eric Goldman, who advised RealSelf on the case, posted about the issue on his personal blog:

No matter how many times I see it–and in the Internet era, I see it all too frequently–I always shake my head in disappointment and frustration when a company uses trademark law to lash out against unflattering consumer reviews. To these companies, trademark law is a cure-all tonic for their marketplace travails, and trademark doctrine is so plastic and amorphous that defendants have some difficulty mounting a proper defense. As a result, all too frequently, the threat of a trademark lawsuit causes the intermediary to capitulate and excise valuable content from the Internet.

In its answer, RealSelf goes on the offensive and alleges that Lifestyle Lift directly or indirectly posted shill reviews to the Lifestyle Lift discussion, thereby breaching RealSelf’s user agreement. Off the top of my head, I can’t think of another lawsuit where the message board operator sued a company for shill postings, so I think this case may be breaking important new legal ground.

The bruhaha led to an investigation by the New York Attorney General’s office and in 2009, then-attorney general Andrew Cuomo announced Lifestyle Lift would pay $300,000 and stop posting fake reviews online.

Cuomo said in a statement at the time that Lifestyle Lift’s “attempt to generate business by duping consumers was cynical, manipulative and illegal.”

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.

Understanding "Core" Physicians

What is the definition of a 'core' physician?

On April 30th, I conducted a webinar for Palomar Medical, Inc. on the topic of optimizing Local Search Engine Optimization tactics to boost your practice on local internet placement and ranking. Soon after the webinar, I was contacted by many physicians with many questions. I felt confident in answering all of them, except for one. And, that question was "what is the definition of a "core" physician"?

I was stumped.

I've searched the Internet for a documented answer and found none. I then perused quite a few physician's websites where it was clearly stated they were "core" physicians. It was also clearly stated that those medical specialties that were not deemed as being "core" were not qualified to perform certain aesthetic procedures. Not to be accused of being "flippant" by a physician as in one of my previous posts, I had thought that it was experience, training and number of successful procedures performed that made a physician "core" in that particular aesthetic modality?

Even on review and educational websites such as RealSelf, all non-"core" specialties were removed.

The answer I received from RealSelf stated : "RealSelf is no longer hosting profiles for participants who do not meet specialty designation criteria set forth by updated RealSelf policies. We have encountered problems with doctors and other medical personnel answering questions far outside their expertise or specialty and, in some cases, even dispensing inappropriate and dangerous advice to our readers. The aforementioned changes have been implemented in an effort to prevent these situations from arising."

Not to elicit any aggressive comments here, and I mean no disrespect to any medical specialty in particular, I just would like to be enlightened as to where the definition of "core" was derived from and what medical specialties that includes?

Realself.com

Tom Seery of realself.com and I had a fairly long discussion a few days ago about both Realself.com and Medical Spa MD's approaches to the marketplace and strategic directions.

Of course one of the topics we touched on was realself.com's decision to remove all physicians from the site that were not board certified plastic surgeons or dermatologists.

Tom didn't get into much detail on this point other than to say it was a long story and that keeping only board ceritified plastic surgeons and derms was the decison they'd made, and they're going to stick to it.

While I don't really have a decision staked out on this I made the point that physicians get good at what the do a lot of. If I were a Botox patient I'd much rather have a non-core doc with a lot of experience shoot me up than a fantastic plastic surgeon who almost never does it. (Truth be told, I can't see the flaw in that logic.)

I can understand realself.com's decision on a purely business decision. Realself.com's looking for some level of credentials to make sure that the laymen who are the real target market of the site are getting at least some level of 'trained' physician.

Realself.com is great for patients who are researching treatments. The consumer-centric focus differs from our physician-centric community but there's some small overlap.

One of the thoughts I opined to Tom was that I could see it would be challenging for new physicians who were just coming on to the site to be motivated to contribute with the way their ranking system works. If you're answering a lot of questions you get greater visibility and promotion internally on the site. While it stimulates some docs to write a lot of answers, it's hard to see how any new physicians could come up with the number of answers to gain some placement. Tom says they're going to launch some new initiatives that will 'promote' new physicians. (This might anger some docs who have spent endless hours writing answer about Botox or liposuction.)

Anyone here have an opinion about realself.com?

Plastic Surgery & Plastic Surgeon

Very interesting discussion on the RealSelf.com has kicked out all non-core doctors thread.

TF and Botoxdoc have, er... differing postions on who is able to provide the best plastic surgery care. (Perhaps 'best plastic surgery care' is not the most appropirate term and I should use 'appropriately safe level of plastic surgery care'.)

Anyway, there's been a lively exchange of which the following comments are only a fraction.

Link to the RealSelf.com kicks out all non-core docs thread:

TF:

I have never claimed that plastic surgeons are the only ones who can do aesthetics, which includes laser work, botox and injectables, as well as surgery. I am very supportive of non-plastic surgeons who do botox, injectables and lasers. I have only made the point that plastic surgery training is currently the best method for training surgeons who want to do total body aesthetic surgery. It may not be perfect, but it's still the standard.

There are no shortcuts in learning how to be a master surgeon. Only those, like yourself, who seem to think that there are shortcuts.

Good luck to you - and your patients....

Botoxdoc:

While you say, I am wrapping my self in the cloak of the "free market" flag and have forgotten the fundsamentals of being a physician "doing no harm", nothing could be further from the truth. I only take cases in which I am proficient. I would never put a patient in harms way, nor perform a case which is not appropriate. I have refered many pts to a plastic surgeon when I felt they needed something more than I could provide them. (At the loss of significant revenue, I might add.) On the contrary, I beleive you are wrapping yourself in the cloak of "patient safety" . It is hubris to beleive I would not have the same concerns as you about patient safety. But because I am not a board certified PS or Derm, I must be, in your mind, a sub-par physician with no regard to my pts well-being, or safety. In fact there is absolutely no hard evidence that supports the argument that having Botox, or any other cosmetic treatment performed by a non-core physician results in more complications. Instead of me showing you my before and afters, why don't you show me a paper (randomized, case controlled, or even a retrospective study) that supports the commonly held belief that non-cores are dangerous. In fact, the complication rate in my clinic is better than what has been documented in the literature. While several months ago at a local hospital, a board certified plastic surgeon performing lipo under general aneasthesia penetraed the viscera and killed his pt. For that he received a reprimand. If I did that, I would probably loose my license or worse. Now I ask you, how fair is that?

In my opinion there needs to be a fundamental change in the system which will allow the acceptance and acknowledges "non-core" physicians performing aesthetics. Until that day arrives, those that judge my work will be my pts. and their families.

TF:

You want science - OK, here's some for you.

Subglandular breast augmentation has a higher rate of capsular contracture. Proven in multiple studies.

Subglandular breast augmentation has a higher degree of interference with mammograms. Proven.

Subglandular breast augmentation has a higher rate of unsatisfactory ripples and wrinkles, especially with saline implants. Proven.

Do you offer this procedure because it's the only one you can technically perform?
Do you even offer your patients a choice of sub-pectoral or dual plane techniques?
Do you give a truly informed consent about the other options....Or do you slant it your way, so you can get the patient to book with you?

You claim you are all about patient care - and then you say it's fine to take a weekend course, and then practice unsupervised on the first 100 or so paying customers, so you can master it. Wow. That's messed up!!

RealSelf.com's blogged about how that site is only the 'dispenser of information' (my name not theirs) and has removed more than 3000 physician accounts because they were not boarded in plastic surgery or dermatology. I wonder what the majority of realself.com questions are about? Liposuction? Breast augmentation?  Or, Botox? I don't think that there's any real disagreement that if you're looking for real plastic surgery you want a plastic surgeon (or cosmetic surgeon). The arguement arises over what is 'real' plastic surgery.

The inclusion of technology starts to blur the lines beween what a plastic surgeone does with a scalpel, and what a non-core doc can do using a laser, IPL, or RF technology. The boundries will only be blurred more as more IPLs and lasers are introducted.

RealSelf.com Doesn't Want You Doctor

It seems that if you're not a boarded plastic surgeon or cosmetic derm, you're no longer wanted to participate on RealSelf.com.

I guess that eveyone who didn't identify themselves as a boarded Derm or Plastic found their account uncerimoneously deleted without warning. Nice. All the docs who worked to answer questions evidently weren't answering them 'correctly' or to Real Selfs satisfaction and they're out.

There's some lively discussion on the physician forums: RealSelf.com has kicked out all non-core physicians!