Tag Archives: mini facelift


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.


Permalink to Free Facelift Preview

Free Facelift Preview

Considering a Facelift? Here at Advanced Concepts in Plastic Surgery, we like to give things away free if at all possible.  Since we almost never get that chance, after all, body sculpting tends to have many fixed costs associated with it, I thought I’d let everyone in on a little secret.

Everyone considering facelift surgery wants to know what he or she will look like after the facelift surgery is performed.  It is only human nature that if we are going to pay for something, we want some idea what we will be getting!

Of course as a plastic surgeon in Sacramento, I’ve performed thousands of face-lifts over the last 25 years but as hard as I may try to describe what I will be doing, words can only go so far.  You will look more rested, this or that will be lifted, skin will be smoother and more relaxed. The mental picture a patient will get will likely be somewhat accurate but they may still have a hard time picturing.

Over the years a lot of software has been developed to duplicate what the result of facelift surgery will be.  However the facelift preview software still relies on the surgeon’s ability to manipulate the software and may exaggerate or understate what the final result may be. It also only shows a two-dimensional image.

What if there was a way to preview the result of a facelift in a simple, cost-efficient way?  In fact, what if it were free and you didn’t even have to visit a plastic surgeon for a consultation? Well there is.  In plastic surgery, this method has been known for years.  In fact, I learned about it in my residency years ago.  Another plastic surgeon recently published and article about it although the idea has been around for decades.

And the fancy, high tech method to previewing what your facelift surgery will end up looking like? –Lie down.  That’s it.  Lie down on your back with a mirror and look at your face.   Most of the sagging effects are due to gravity and lying down takes some of that out of play.  Pictures taken of this position nicely preview a future facelift.    Now if you’re a real stickler for accuracy you could say lying down only accounts for some of the effects of gravity and ideally you would actually do well to stand on your head.  This is true and some doctors have actually written about this as well.  Dr. PatrickTonnard, when talking about the MACS facelift, one of the best facelift innovations of the last 10 years, has a picture showing this in his book.  However, from a practical standpoint not many people can stand on their heads for very long, or want to.


Permalink to Plastic Surgery Best of 2009 – Advanced Concepts in Plastic Surgery

Plastic Surgery Best of 2009 – Advanced Concepts in Plastic Surgery

This is a belated summary of the big ideas and new procedures in the field of plastic surgery that were important in 2009.  2010 is in and who knows what it will bring in terms of plastic surgery innovation advances and controversy.  Everywhere you look there are best of lists: movies and music books television you name it.  I thought I would take a little time to go over my best in plastic surgery of 2009 list.  These are the ideas that have come to the forefront in my practice and from what I have seen at meetings and in the medical literature.  It’s a very subjective list.  But what list isn’t when it comes to best of ?

#1. The BoTax.  The “BoTax” as it was referred to by the media was almost a part of the healthcare bill the Democrats hope to pass this year.  Basically it was going to be a 5% tax on all cosmetic surgeries: Botox, fillers and plastic surgery procedures   The  fact it was defeated is huge for the plastic surgery industry and patients.  It was wrong on so many levels.  It was the entry into the luxury/sin tax model regardless of the fact that most people using cosmetic services make less than $90,000 per year.  Privacy concerns would have been a huge issue and it would have been a logistical nightmare.  Doctors as tax collectors?  It also would have opened the door to other specific luxury taxes.  Why not Harley-Davidsons, golf clubs, massages, facials, etc.?  The possibilities are endless.  In addition the one place this actually was tried was in New Jersey and the plan just plain didn’t work and brought in nowhere near the projected income.  The only thing it really accomplished was increasing the numbers of surgeries performed in the state next door, New York.  I was very happy to see cooler heads prevail and the BoTax dropped from the healthcare legislation.

#2.  Fat is back.  Fat grafting has been around for over 20 years but was always treated as the poor stepchild of liposuction.  Because, in the beginning the results were variable so it was concluded that fat grafting was not scientifically consistent.  Over the years since there have been many more studies successfully supporting the science.  In addition, now there have been several reports that show that what is being transferred are actual stem cells in addition to the fat.  In fact, the stem cells may be the main source of what remains six months to a year later.  There is now more attention being paid since stem cells are the current darlings of scientific research.  There are even efforts being made to purify the stem cells out of the fat to increase survival of the fat cells.  In addition breast augmentation by fat grafting has become an accepted procedure and several investigators showed impressive results.  It’s not going to replace silicone breast augmentation nor is it for everyone.  This is because it is time consuming more expensive and may even require several procedures to get the final result.  Nevertheless there are a number of people who are candidates and would benefit from this procedure which would basically be permanent as opposed implants which have a limited longevity.  I have used fat grafting in Sacramento both for covering small defects and for breast augmentation at Advanced Concepts in Plastic Surgery with wonderful results.

#3. Vaser Hi Def liposuction.  I’ve been doing liposuction in Sacramento for over 20 years, Vaser liposuction for five and Vaser Hi Def liposuction for 1 ½ years.  There is a very confusing array of new technology, six different laser light machines a brand-new water jets Liposuction system and most recently radiofrequency.  However after reading the information and same salinity systems in action as well as speaking to my colleagues in the field of plastic surgery I’ve come several conclusions.

First of all, for multiple area liposuction skin shrinkage and maintaining viability of fat cells transferred Vaser Hi Def liposuction is the most advanced solution.

Second, laser liposuction works for small areas but is too time-consuming for larger areas.  It’s still unclear which wavelengths of light works the best despite all the claims.  There appears to be a lot at heat damage from the laser.  This does not allow viable cells for transfer.

Third, waterjet liposuction seems promising but it’s still really too new to say much about.

#4.  Thermage has had major technological advancements that have changed the game.  The new Thermage is not the same as the old Thermage.  Thermage has been around for years.  It is now in its third generation.  The first generation was effective but quite painful and needed considerable sedation.  Second generation was uncomfortable but manageable with a little sedation.  The new generation is not painful due to vibration of the tip which confuses the nerves in the skin and also has a cooling apparatus.  I’ve had this tested on myself and it is comfortable.  It is an ideal skin tightening: noninvasive, no downtime, procedure.  With the new changes it is now very patient and doctor friendly.  I recommend Thermage in Sacramento at Advanced Concepts in Plastic Surgery for my patients who need a little skin tightening but are not requiring the more dramatic results that can be a result of a tummy tuck, a face lift, arm lift or thigh lift.

#5. The Mini Lift, they’re back with a vengeance.  To paraphrase Shakespeare, ‘a rose as a rose is a rose.’  Mini face lifts have been around forever.  Actually, it can be argued that the mini face lift have been around since the beginning of the last century.  When I was at UCLA as a medical student, the chief made a lot of Hollywood happy by doing mini lifts every few years because they were small surgeries with minimal downtime.  Now there is a   huge move: for mini lifts, cheek lift, S lift or any other letter.  There have been some changes recently such as using deep purse string sutures that considerably improved the result.  Do they work?  For the most part they do.  However if all you have is a hammer everything in the world is a nail.  In other words, one must be prudent in determining whether a mini lift will work based on advice from a knowledgeable plastic surgeon who can offer other solutions if a mini lift will not achieve the desired results such as a regular face lift. Do I perform mini lifts on my patients in Sacramento?  Yes, I have been performing mini face lifts in Sacramento for about the last 25 years.  Now there are some newer features to a mini lift such as vertical vectors, barbed deep sutures and Vaser liposuction   Would they work for everyone?  No, that’s where the judgment comes in.

#6.  Acellular Dermis.  Acellular dermis is a manufactured product, most commonly made of porcine skin which has been treated to remove any chance of reacting with the immune system  This is then placed underneath the skin in breast augmentation revisions for cases of wrinkling or rippling.  It is also used for breast reconstruction to prevent those same problems.  Patients with thin-skin and implant problems have always been difficult because there was so little to work with.  With the acellular dermis there is now a solution that can solve these problems.  It also seems to prevent capsular contracture recurrence after breast augmentation surgery.  The times I have used acellular dermis on my plastic surgery patients in Sacramento in the last year I have been quite pleased with the results.

So there it is.  Some new ideas, some old ideas, and some ideas that have simply come back with a new angle.  It was a very interesting year with the common denominator being progress for plastic surgery patients, better plastic surgery results and safer and easier surgeries.

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  • Andrew Kaczynski, MD

  • Advanced Concepts in Plastic Surgery
  • 77 Cadillac Drive, Suite 170
  • Sacramento, CA, 95825
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  • 9719 Village Center Drive, Suite 110
  • Granite Bay, CA 95746
  • (916) 925-5522