Category Archives: Face


Permalink to Liposuction for Transgender Feminization

Liposuction for Transgender Feminization

Liposuction is a powerful tool in the art of body sculpting. Especially Smartlipo TriPlex and Vaser Hi-Def Liposuction. Nowhere is this more evident than when I’m faced with the challenge of shaping common features of one gender into another!

Transgender cosmetic surgeries are becoming more popular as more and more transgender people are seeking plastic surgery that can help them look more “passable.” (“Passable” is a term used among the transgender community and admirers to describe a person who is seen and treated as their desired gender identity.) The more common patients that I see are the male to female gender change. I do not deal with the actual reproductive organ changes as that is a very specialized surgery which is only done in a few centers across the country. However feminization is a subject with which I am well acquainted. There are various ways of feminizing the male face and body. In the face these include brow lifting, rhinoplasty, eyelid surgery, liposuction and occasionally facelift surgeries. With these surgeries, the idea is to change an angular male face to a softer, more rounded feminin face.

In the body, the same concepts apply. Men generally tend to have more angular obviously more muscular bodies. As they get older and heavier they carry their fat in different areas. Typical male fat distribution is in the abdomen hips and chest. This creates a large waist. This is the exact opposite of what is desired in the female physique. An hourglass figure is the desired shape with a small waist and curvy hips and buttocks. This can be achieved with aggressive liposuction of the back flanks and abdomen and if necessary performing a Brazilian Butt Lift to create fullness and curves in the hip and buttocks area. This is typically a four hour procedure that can be done under sedation and as an outpatient. The downtime is about five days before going back to work. However if the Brazilian Butt Lift is performed it does mean that there is limited sitting for at least the first month. The patient can lie down on her side or stomach but not on the back. Sitting when that is done is on the sit bones and not fully on the area where the fragile new fat has been transferred.

An example shown below is a male to female transsexual who had a rather square abdomen and hips. She had had previous buttock injections and gluteal implants which were removed. (I never recommend gluteal implants due to a large percentage of complications). The only surgery performed was a very aggressive liposuction using SmartLipo TriPlex. The results speak for themselves.

transexual liposuction feminizationliposuction transexual feminization

Transgender surgeries are becoming a more more popular form of cosmetic plastic surgery with more patients seeking improvements. It is becoming much more sophisticated now. In the past adjustment breast implants and genital reassignment surgery. Now different aspects of the face and body can be treated to have a much more subtle and natural looking results. It is becoming easier with time and science to become passable and there are transgender resources all over the internet that can help with all the finer details required to make that transition smooth.


Permalink to Plastic Surgery Timeline – When Will I Heal By?

Plastic Surgery Timeline – When Will I Heal By?

In plastic surgery, often one of the biggest questions patients will ask me is,”how long will I be down after this procedure?” Of course, this depends on the surgery and partially on an individual basis although for the most part, it is pretty predictable.

I recently found a little straight-forward article by a husband and wife plastic surgery team out in Columbus Ohio who summed it all up very nicely. Drs. Christine and Michael Sullivan of The Sullivan Centre are certified plastic surgeons and this is what they wrote:

Breast Augmentation or Liposuction (Including SmartLipo TriPlex)
To be ready by New Year’s, have surgery by December 1.To be ready by Valentine’s Day, have surgery by January 14.To be ready for Graduation, have surgery by April 20.To be ready by Independence Day, have surgery by June 4.To be ready by Labor Day, have surgery by August 1.To be ready by Thanksgiving, have surgery by October 22.To be ready by Christmas, have surgery by November 25.
Facelift or Rhinoplasty
To be ready by New Year’s, have surgery by September 1.To be ready by Valentine’s Day, have surgery by October 14.To be ready for Graduation, have surgery by January 20.To be ready by Independence Day, have surgery by March 4.To be ready by Labor Day, have surgery by May 1.To be ready by Thanksgiving, have surgery by July 22.To be ready by Christmas, have surgery by August 25.
Tummy Tuck or Breast Lift
To be ready by New Year’s, have surgery by November 15.To be ready by Valentine’s Day, have surgery by December 31.To be ready for Graduation, have surgery by March 5.To be ready by Independence Day, have surgery by May 15.To be ready by Labor Day, have surgery by July 15.To be ready by Thanksgiving, have surgery by October 7.To be ready by Christmas, have surgery by November 10.
I found this to be very accurate and helpful! Good job, Drs. Sullivan!

About The Sullivan Centre: The Sullivan Centre, co-founded by Drs. Christine and Michael Sullivan, is the first free-standing ambulatory surgical center dedicated to cosmetic surgery in central Ohio. It is located at 97706 Olentangy River Road in Columbus, Ohio 43235. Reach them at sullivancentre.com or by phone at 614-436-8888.


Permalink to Lisa Rinna Lip Augmentation Repair

Lisa Rinna Lip Augmentation Repair

Lisa Rinna lip augmentation repair

Lisa Rinna before her lip augmentation repair

Lisa Rinna is in the news again this time because she has had her lips fixed, i.e. reduced after a lip augmentation gone very wrong. Not coincidentally, this announcement comes at the same time that she is starting a new reality series with her husband called, “Harry Loves Lisa” on TV Land. Any publicity is good publicity especially since so much attention has been paid to her lips in the past. Her lips were always a topic of conversation. And why? I would suggest it is because she is a very attractive, vivacious woman with incredibly ugly lips. I’m sure at some point right after the injections they were attractive, but over time as always happens with silicone injections they changed into scarred distorted things. They looked like they belonged on a puffer fish. Lips like that have never naturally appeared on a human being since we appeared on the planet. Nevertheless, why did they look so bad? Because they simply did not look natural. Big lips are pretty when they are shaped well but not just because they are big.

If you look at the anatomy of beautiful lips you will see that:

  1. There are three ovals in the upper lip.
  2. There are two ovals in the lower lip.
  3. The upper lip has three distinct parts.
  4. The lower lip is always larger than the upper.
  5. Lips are full not inflated six the central portion of lip actually hangs down little bit and is not concave.
Lip Augmentation in Sacramento

Lip Augmentation at Advanced Concepts in Plastic Surgery

The worst thing about her lips is that she had silicone injections because she thought other fillers look good for a while, why not get something permanent. Well, there are actually a few problems with that line of thinking.

  1. Silicone injections into the body or face, i.e., lips, are illegal.
  2. They have always been illegal. In the past very few doctors had permission to use them experimentally in tiny amounts called microbe droplets, never for plumping up lips.
  3. They are indeed permanent—permanent results and permanent complications.
  4. The results of silicone may initially look good but will become scarred, irritated and filled with nodules of scar tissue causing the lips to appear bigger and odd shaped.
  5. The only way she could fix this problem now is to have all the silicone cut out and that’s exactly what she had done. Her surgeon Garth Fisher actually did a very nice job of removing what silicone he could and reshaping the lips. She now looks normal and attractive and her lips complement her face very well, returning her natural beauty and symmetry. Removing the horizontal wedges and taking out as much silicone as he could has restored her symmetry. However, she isn’t out of the woods yet because there is likely silicone still in her lip because silicone migrates and moves. The only way to remove it completely is to remove the entire lip. I’ve actually had to deal with this with patients who had silicone injected into their breasts by other doctors. At some point in time when it gets bad enough the only treatment is total mastectomy and reconstruction.

So, what can you learn from this if you are considering lip augmentation?

Never gets silicone injections of any kind.

Ask to see examples of your doctor’s work. If he shows you a picture like, Donatella Brassard who looks like too bloated leeches are feasting horizontally on her face, then run.

Getting as much content as you can afford is not getting your money’s worth.

Balance and proportion creates beauty not bulk.

The search for beauty is pervasive and there are always unscrupulous people willing to take advantage of that. Do your homework on anything that you would have injected into your body.


Permalink to Bridalplasty – Brides Compete for Extreme Plastic Surgery

Bridalplasty – Brides Compete for Extreme Plastic Surgery

BridalplastyJust when you thought our TV entertainment culture had hit rock bottom, some network executive somewhere comes up with yet another lower level of low! Bridalplasty is that new low. Bridalplasty is a new reality TV show soon to be offered by E! that will show soon to be brides competing in various ways in an attempt to win extreme plastic surgery. I don’t even know where to begin in regard to the obnoxious lack of ethics on every level that this sad excuse for entertainment brings up. Celebrity surgeon Terry Dubrow, who will be performing the surgeries on Bridalplasty, really needs to rethink this.

Part of the Bridalplasty’s concept includes the bride first showing her results to the groom at the “unveiling” during the actual wedding ceremony.

“Viewers will witness his emotional and possibly shocked reaction as they stand at the altar and he lifts her veil to see her for the first time following her extreme plastic surgery,” says E!, according to the Hollywood Reporter.

This, of course just takes the whole idea of the groom not seeing the bride in her wedding dress until the ceremony to a whole new level. A nose job, breast augmentation, lip augmentation and some liposuction and he may not even recognize her! That shouldn’t make an intimidating moment any more difficult, should it? Unfortunately, this is what the network and potentially, the audience,  is after. They are selling the shock of emotional vulnerability.

This concept trivializes plastic surgery, important life decisions, and it makes a mockery of the institution of marriage. It is beyond sad how far entertainment corporations, audiences and participants are willing to go in search of money and the cheap emotional thrills.

Surgery, whether it is cosmetic or otherwise is a serious life and death issue, (although I have personally never lost a patient during cosmetic surgery in 28+ years). Surgery is not entertainment and marriage is not trivial. The very concept of the TV show Bridalplasty trivializes both and knocks our culture down a few more notches in the ranks of civilized societies.


Permalink to Kim Kardashian Fesses to Botox but NOT Breast Augmentation

Kim Kardashian Fesses to Botox but NOT Breast Augmentation

kim-kardashian-plastic-surgery

Kim Kardashian says she has only used Botox

Kim Kardashian, of Keeping Up with the Kardashians, admitted to using Botox, in an interview with ABC News show Nightline. However, she says she has not had a nose job or breast augmentation.

“Trust me honey, if I take this bra off you will tell me I need to get them done. I’m totally not against plastic surgery. … I’ve tried Botox before. That’s the only thing that I’ve done.”

Just the way she says that, I tend to believe her and while a great breast augmentation will look very natural, natural, can look natural as well! ;)

However, Kim Kardashian’s sister, Courtney Kardashian says that she has had breast augmentation and seems to be very proud of it!

“I have had breast implants, but it’s so funny ’cause it’s not a secret, I could care less. It’s so funny because the ‘before’ picture that they [In Touch magazine] showed was after I had my boob job, so I’m like, they should have written ‘before Mason’ and ‘after Mason.’ Like my boobs have like tripled since breastfeeding.”

They go on to say that none of the Kardashians have had nose jobs and from looking at pictures on the Internet, even the “before and after” pictures that argue that she has, I tend to believe they haven’t. So much of what you see in those pictures can be explained by lighting and make-up. Kim Kardashian says that she actually did want to get her nose done but decided against it.

“But what’s funny is about my nose, it’s my biggest insecurity. I always want to get my nose done. … I went to a doctor, I had them take the pictures, he showed me what it would look like and it just didn’t– It– I wouldn’t look the same.”

I agree with Kim Kardashian here, if that is her natural nose, she does not need anything done to perfect it. If anything, there is more risk in changing it and it not looking as nice or as individual as it does naturally. Perfection doesn’t have to be generic, people all look different for a reason, plastic surgery is not about trying to make every face look perfectly the same, it is about enhancing what you do have or fixing issues that bother you. In Kim’s case, I would keep that nose, it looks great on her.


Permalink to Cher – Plastic Surgery & The VMA’s

Cher – Plastic Surgery & The VMA’s

CHER- Video Music Awards 2010 - VMAs with Lady Gaga

CHER at the 2010 Video Music Awards "VMA's"

Cher presented Lady Gaga with the Video Music Award for Video of the Year Award last night at the 2010 MTV Video Music Awards. When Cher first walked out wearing a similar or the same outfit she wore for her 1980′s video, “If I Could Turn Back Time,” you could almost hear a collective, “wow,” as the entire country watching realized she is now in her 60′s! Indeed, Cher is 64 years old and looks, even on my high definition T.V., like she’s in her early 40′s. Is plastic surgery the secret? Actually, no… as in, “no, it isn’t a secret.” Cher takes care of herself, but she also has been very open about her use of plastic surgery to maintain her looks.  Make Me Heal reports, “Cher has had a breast augmentation, rhinoplasty (nose job), blepharoplasty (eyelid surgery), and possibly many others including enhancing the appearance of her teeth, liposuction, and a facelift. Although speculation revolved around Cher getting cheek implants, a tummy tuck, and a rib removed, she has completely denied the truth in those rumors. However, Cher openly admits she has become “the plastic surgery poster girl”.

The great thing about Cher is that she doesn’t expect anyone to not realize how old she is, she’s been a celebrity since the mid 1960s! Instead, she’s realistic about her age and the fact that time and gravity tend to be harsh on us all. But this is where great plastic surgery can work. Of course, when we look at Cher we think, “wow, she must have had a lot of work done.” But we don’t think, “YIKES!” like we do with some of the really bad celebrity plastic surgery we are all familiar with. To me, She looks great. She looks like she’s had very talented plastic surgeons and beyond that, she also obviously listened to their recommendations. I’m sure a lot of those scary celebrity plastic surgery cases are more a result of the celebrity insisting on procedures than doctors may have recommended against. At 64, Cher is an example of plastic surgery as an art.

What did/do you think of Cher’s plastic surgery and her overall look? Please weigh in below!


Permalink to Chelsea Clinton Plastic Surgery – Awkward Teen to Lovely Bride!

Chelsea Clinton Plastic Surgery – Awkward Teen to Lovely Bride!

Chelsea Clinton plastic-surgery

A refined Chelsea Clinton

A lot has been written lately about Chelsea Clinton and her recent wedding. The dresses, the schedule, the expense, the choreography of the wedding dance. All the little details our celebrity obsessed public thrives on and the media is happy to dish out 24 hours a day. There’s also been commentary about possible plastic surgery. Indeed if you look at photos of her growing up you can see that there are some changes. Most noticeably she seems to have had a chin implant and a correction of her somewhat gummy smile, probably with Botox.

So what’s the big deal? The media are always obsessed with celebrity plastic surgery. Mostly they discuss which celebrity is getting what plastic surgery and whether it is good, bad or ugly. In some cases, when it is good plastic surgery or you can’t quite tell whether the celebrity has had a nip/tuck or not and what they might be doing to maintain or enhance their appearance.

But for the vast number of people in the United States that have plastic surgery it’s not about beautiful people getting more beautiful or going to extreme lengths with plastic surgery in a desperate attempt to get that next big roll. It’s more often about people who just have a few details about their body or face that they’d like to change in an effort to be a little more confident about their physical appearance. One way to look at it is that we sort of work from the impression that there is a bell curve of appearance. We all want to be inside the bell curve ideally as far to the right of the top as possible, but most of us understand that that position is occupied by a few actors, actresses, supermodels and genetically blessed people. For the rest of us were content to be within two standard deviations of normal, whatever that is. The fact is that our brains are programmed to recognize attractiveness and symmetry as part of our genetic programming to search for a healthy mate. There is a correlation between attractiveness, health and lack of genetic diseases. So therefore we are programmed to recognize beauty and attractiveness, and instinctively know what falls within the bell curve. At the same time, we tend to assess our own placement on that bell curve and we often have little things that we consider changing in order to move ourselves just a little bit more toward the right. Now this can be complicated by various psychological issues of self-doubt or self worth but for most of us, we see ourselves fairly realistically and can make rational decisions about what plastic surgery might offer us.

Chelsea Clinton as a Teenager

Ah, the awkward teen years :)

Chelsea Clinton, as a teen, had a few challenges with her features and tended to look a bit awkward. Many teens experience an awkward phase as their features mature on the way to adulthood. As she has grown up and matured her looks  improved but she still had a receding chin and a rather “gummy” smile. With the plastic surgery that was performed, she successfully moved herself a standard deviation in the right direction of the bell curve. Her features look much more proportional and most would agree that she looked very pretty in her wedding photos.

So what does this have to do with the big picture? One of my staff members recently told me that before she started working for me she thought that plastic surgery was about bringing in a photo of your favorite movie star and having the surgeon make you look like that. That is absolutely not what plastic surgery is about. Plastic surgery is about restoring or improving balance, symmetry and aesthetic beauty. Like Chelsea Clinton, it is about fixing just a few of those little things that tend to make a positive difference. It’s about optimizing the attractive features that you have and balancing the rest. That is good plastic surgery. It worked for Chelsea Clinton!

Mazel tov!

Chelsea Clinton Wedding

The beaming bride, Chelsea Clinton on her wedding day.


Permalink to Megan Fox Plastic Surgery Mysteries

Megan Fox Plastic Surgery Mysteries

Megan Fox Plastic Surgery Controversy

This time it’s Megan Fox - another, “does she or doesn’t she? Has she or hasn’t she?”  Unlike Heidi Montag’s obvious cosmetic surgeries, Megan Fox has a more refined look.  Megan Fox is a beautiful young woman by anyone’s standards – you don’t have to be a Transformers fan to enjoy that!  But, has she had some “refining”?  The beauty of good plastic surgery is that it is subtle, and it often begs the question, “Did she or didn’t she?”

As a plastic surgeon here in Sacramento, I get questions all the time as to whether I think this starlet or that celebrity has had cosmetic work done. One thing I often say is that pretty much everyone in that line of work has or will have something done to improve their appearance. Because Megan Fox has been in the news a lot lately, combined with the fact that she is one of the most beautiful starlets in Hollywood, I get asked about her a lot! If you look at pictures of Megan Fox on the Internet, you can come to several conclusions fairly quickly.  In my medical opinion, I believe I can spot a few procedures she’s undergone.  The important thing is that if she has undergone these procedures, they were performed very well so kudos to her doctor!

1. Megan Fox most definitely has had breast augmentation with breast implants. That’s fairly obvious even to a non-plastic surgeon, but her enhancement matches the rest of her figure, and it is not over the top literally like Heidi Montag’s breast augmentation.  It enhances her body without distracting from her other features.

2. She has also probably had two rhinoplasties.  The first rhinoplasty looks to be slightly unsuccessful.  There is an inverted V look on her upper nose in several photos that were taken after the bump was removed from her nose. This inverted V comes from the bones not coming together after being fractured. This was corrected the second time around, and further refinement appears to have been done on her nose, especially the tip.

3. Megan Fox likely has regular  Botox injections in her forehead. Even young people have some expression lines, but her forehead is incredibly clear without even a hint of a line. By using Botox at her age, she will avoid lines appearing in the future. She also seems to have had some shaping with advanced Botox techniques to raise a lateral and give her an exotic Angelina Jolie -type look.

4. Megan Fox also appears to have had a very good lip augmentation. Unlike many lip augmentations, Megan Fox’s lips are not over-the-top.  Her lips are definitely fuller, but it still looks relatively natural.

5. There has also been some suggestion of cheek implants, but unless they are very small, she just appears to have gotten older and a little more defined with some weight loss.

So what does this all mean?  It means that plastic surgery has something for everybody: for a middle-aged woman who wants to take in her neck a bit, or a young woman who wants a flatter stomach after having babies… or an aspiring superstar just shy of perfection. Were the changes reasonable?  I think she managed to fine tune her already attractive features and she did so without going way overboard like Heidi Montag. Is she more beautiful?  You can judge for yourself. But generally speaking a straight nose, fuller lips, a curved brow, and fuller breasts are often considered to be more attractive by our culture’s current standards of feminine beauty.


Permalink to Heidi Montag Lessons

Heidi Montag Lessons

Heidi Montag Breast Augmentation

Heidi Montag's Breasts Are Too Big!

Some stories just won’t go away. The Heidi Montag saga seemed like just another fifteen minutes of fame for a desperate starlet. And it makes for a great story: D-list celebrity trying to get an edge with an extreme makeover that will catapult her to stardom… or not.

But now, after the initial stories cataloging her surgeries mini brow lift, nose revision, facial and buttock fat grafts, breast implant revision, ear pinning, neck liposuction, the stories continue. She’s in pain. She’s happy. She’s not happy. She wants bigger implants. She’s going outside the U.S. for implants she can’t buy in the U.S., and the stories just continue on and on, probably fed by her publicist.

Since Heidi Montag and her drama are not going away anytime soon, what can we all learn from this modern-day tale of transformation that will help us in our thinking about plastic surgery?

If you are considering plastic surgery, it is important to be realistic about what you are considering and why.  Number one, if you don’t want to set yourself up for disappointment the only reason you should have plastic surgery is for yourself.  No one should be considering plastic surgery because someone else is telling you to.  Plastic surgery should not be undertaken to get or keep a husband or boyfriend, nor to get a specific job. The procedure, and your new image, should be its own reward. It should give you a positive self-image and give you more confidence. To expect secondary gain is setting yourself up for disappointment. The exception to this rule may be a situation where someone is looking prematurely old and seeks facial surgery for better competitiveness in the job market. Heidi Montag is not prematurely old.

Less is more–rule one: I don’t know exactly how long Heidi’s ten procedures took, but I try to limit my procedures to less than six hours. The medical standard for safe elective surgery is less than six hours. This means that after six hours the risk of medical complications rises. It is also more difficult to recover when you can’t get in a comfortable position because of the pain resulting from your multiple procedures. Performing fewer procedures in two operations makes for two shorter, safer operations with quicker recovery time, as opposed to one long one with a much longer and more uncomfortable recovery.

Less is more–rule two: As you age you should only have the minimum amount of work done to correct the problems. There is no such thing as prophylactic facelifts, although some people claim to do them. I’m okay with the chin and nose changes. But the brow lift and fat grafts actually made her look older boring here and harsher. Nothing can replace the freshness of youth and once it’s gone it’s gone.

Less is more—rule three: And important thing to remember about breast augmentation is that breasts can be too big! The only kind of movie Heidi Montag’s new breasts will get her into is the kind with three X’s, rather than snagging Meghan Fox’s roll in Transformers 3! I’ve put in large implants, even the maximum size, 800cc, but these are cases where the woman could handle them because of her height and the size of her chest. If Heidi wants to go bigger than her current 700cc implants, in order to really see a difference she would need to go to 1000cc which is way too much for anyone, much less a thin woman who is 5’2.

The downside of really big implants: Bigger scars to put them in for silicone implants. Putting in 1000cc  saline implants would be a nightmare. They would come down to her knees in no time.

What goes up must come down. Implants that large would have minimal muscle support. There is no breast lift that would lift them up for any significant length of time. She will have to downsize in order to have a successful breast lift.

Implants that big would make her skin tissues paper thin over time. Wrinkles and ripples would be visible.

Implants that large would actually pull down on her shoulders and neck. They would likely cause severe back pain. Most women who naturally have breasts that size eventually come in for breast reduction.

Just because a surgery can be done, doesn’t necessarily mean it should be done. She’s not yet in the ranks of plastic surgery monsters but if she keeps this up, there is little doubt she will be listed on one of many scary plastic surgery Websites.  Good plastic surgery is designed to makes people look like themselves and doesn’t make you look like a different species. Is she on her way? Only time will tell.


Permalink to Facelift By OBGYN?

Facelift By OBGYN?

With the current wave of “Alice in Wonderland” mania, a recent email from a friend reminded me of a scene in that classic book.  In that scene, Alice is talking to the caterpillar and he keeps asking her, “who are you?” This reminder, in my mind, led to my impressions of a current phenomenon I’ve been seeing and reading about lately regarding the business of plastic surgery. It occurred to me that it seemed apropos to ask any doctor, offering plastic surgery, that very same question. This is because the answer to that question can be very vague.

There is a disturbing trend in medicine where internists, family doctors, gynecologists and other specialists are offering to do plastic surgery procedures as a way of making a little cash, “on the side.”  Dermatologists and E.N.T. (ear, nose & throat) doctors are expanding into areas where they have little or no training.  Because of this, complications are escalating like never before.

I know someone who went in for a yearly checkup and found her internists now owned a roomful of lasers next-door and was promoting their use.  The largest liposuction clinic in my community is run by an internists and an emergency room doctor.  Family practice doctors are opening, “med spas.”   Some E.N.T. doctors are beginning to perform breast augmentation surgery and gynecologists are doing face-lifts. What’s going on?

A recent article in Plastic and Reconstructive Surgery by Matthew Camp, titled Who is Providing Aesthetic Surgery? A detailed examination of the geographic distribution and training backgrounds of cosmetic practitioners in Southern California put some insight into this question.

So what is going on?

Medicine is hard-pressed for fair reimbursement by health insurance companies.  Despite any statements to the contrary, it is likely going to get worse in the future.  More and more doctors will be attempting to supplement their income by offering plastic surgery procedures in which they have little or no training.

Plastic surgery is literally the only cash business left in medicine, especially if you include hair transplants, laser hair removal, varicose veins, and all noninvasive treatments under that umbrella.

Individual magazines devoted to different specialties routinely promote, “boosting your income by adding cosmetic services.”  Medical meetings also promote one-day workshops in different procedures and technologies.

Makers of cosmetic products and devices are actively promoting their goods to non-plastic surgeons as a way of expanding their markets.  Moreover, those that are not intentionally marketing to these doctors are none-the-less bound by law to sell to these doctors if the doctor orders from them.  This is because in California, a medical doctor has a license that entitles him or her to do anything they see medically fit in the office.  He can do brain surgery, heart surgery, or sex changes.  If something goes wrong, let the lawyers sort it out after the fact.  There is no restraint of trade for physicians.  Hospitals monitor doctors and only allow them to have privileges for those procedures in which they have actual training and/or certification.  This is why most of these practitioners who are expanding their offerings work only in their offices where they are completely unsupervised and unregulated.

The economic situation that is leading gynecologists to start offering facelifts is also placing very young plastic surgeons, just out of school, in a difficult situation.  Therefore, they are vulnerable to being scooped up by franchise corporations that have catchy names and usually offer one specialty procedure at what they suggest is a discount price that an established and experienced plastic surgeon cannot compete with. The reality is that in most cases they are at or very near regular market prices for these procedures.  These “McFacelift” shops or “LipoKing” franchises perform procedures with pressure on the doctors and staff to do as many per day and as fast as they possibly can.  To quote from the Camp article, “the development of aesthetic practices with individual providers are considered to be interchangeable and replaceable is becoming ever more prominent.”  This is particularly the case among the “medispas.” The practices are often named after a geographic location with the cachet of affluence such as Rodeo Drive, Beverly Hills or La Jolla.  In these practices, or perhaps better described as “mills,” the practitioners are employees of the corporate owner of the clinical facility and are pushed to produce revenue.  The divorce of the practice from the name of a responsible physician has the potential to have a profound impact on the doctor-patient relationship and how patients select a provider.

Therefore, as the Romans said, “caveat emptor;” Let the buyer beware. This is especially true in California since there is essentially no enforcement by the medical board, which has recently been stripped of most of its funding.  Many complaints and many bodies must pile up before anything will be done.  Any doctor can do virtually anything in his office and will not be stopped until there are large numbers of complaints or he kills or maims a patient.  It is amazing that we require such tight restrictions on many other fields such as airline pilots.  What is happening is the equivalent of allowing someone who knows how to fly a single engine plane to go ahead and sit at the controls of 747, bringing it down for a landing into a major metropolitan area without any training.  Do you want the professional airline pilot with a complete education or someone who had a one-day course in the 747 before he takes your life into his hands? On the flip side, I am a trained plastic surgeon who has had thousands of hours of training and experience in plastic surgery but I have also had some training in many other aspects of medicine.  Legally, I can perform brain surgery and heart transplants in my own operating room, but would I be your best choice if you needed these procedures?  What if I were to offer to do the surgery at a discount?  …Yeah, I didn’t think so.

If you’re considering a plastic surgeon, do what the caterpillar did.  Ask, “who are you?”  “Are you board-certified?”  “Are you board-certified in plastic surgery?”  “How many of these procedures have you done?”  “How long have you been providing this procedure?”  “Do you have hospital privileges?  Or is plastic surgery just another way to boost your income.”  Or, “are you a cosmetic surgeon” which is essentially a meaningless term since there is no recognized Board of cosmetic surgery.

Caveat emptor. Do your homework and trust your gut feelings.  If you feel unsure or apprehensive, regardless of whom the person is, move on.  Plastic surgery is not like having your hair done.  Some people spend more time researching a vacation then researching a plastic surgeon, don’t be one of them.

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  • Advanced Concepts in Plastic Surgery
  • 77 Cadillac Drive, Suite 170
  • Sacramento, CA, 95825
  • or

  • 9719 Village Center Drive, Suite 110
  • Granite Bay, CA 95746
  • (916) 925-5522