21 is the new 40: Men in the tech industry benefit from looking like teenagers

Here’s an interesting regional trend in plastic surgery from an article in New Republic: men in their 30s in Silicon Valley are getting plastic surgery and non-surgical treatments to look like they are in their early 20s.  The goal is to combat the reverse-ageism in the tech industry that equates youth with intelligence and entrepreneurism. 

Here in Washington DC, we see more traditional plastic surgery goals- a desire to look refreshed, not necessarily young.  In this town, where age often correlates with experience, there is no advantage to looking very young. 

I’ve written about cultural standards of beauty and the varied aesthetic demands they create, but most of those differences are international.  This Silicon Valley trend is particularly interesting because it’s a micro-trend, a hyper-regional phenomenon that wouldn’t translate anywhere else in the country.  Here are a few other plastic surgery micro-trends that I’ve seen:

-“New York nose” circa 1980:  There was a time when every rhinoplasty in New York City looked exactly the same- a tiny, pinched ski-slope.

-“L.A. trout pout”: The Real Housewives made this one famous in the mid-2000s- For a while it seemed like every woman in L.A. was over-injected in the lips with collagen or other fillers. 

-“Texas tatas”: Everything really is bigger in Texas! 

What do you see?  Any local standards of beauty that wouldn't make sense anywhere else?

Surgical tourism strikes again... another death from cheap plastic surgery abroad

Every few months, a news report surfaces about someone who dies after traveling to another country for cheap plastic surgery.  Most recently, this Bronx woman died from a suspected pulmonary embolus after abdominoplasty in the Dominican Republic.  Proponents of travel-based medicine insist that many physicians abroad are qualified and well-trained, and can offer the same services for a fraction of the cost due to low overhead.  Patients are lured by aggressive advertising, low price tags, and picturesque locales. 

The problem with surgical tourism, as I see it, is not the lack of qualified practitioners.  It’s the lack of follow-up.  The truth is, every surgeon in the world has complications.  Any surgeon who claims to have no complications is lying.  But when a patient of mine has a complication, the patient calls ME.  I see them in my office and we make a treatment plan together to address the complication.  If there’s an infection, I start them on oral antibiotics or admit them to the hospital for intravenous antibiotics.  If there is a bleed, I take them back to the operating room emergently to stop the bleeding.  If a patient is short of breath after surgery, they go straight to the emergency room for evaluation and treatment.  I call the ER physician myself to give them the backstory on my patient before the patient even arrives.  The care of a surgical patient doesn’t end when the last stitch goes in. 

When patients travel to other countries for surgery, they don’t have access to their surgeon after they come home.  A localized infection that should be treated immediately with oral antibiotics may go untreated because the patient doesn’t know where to seek care.  Sometimes patients are embarrassed to see another surgeon after they have traveled abroad for their surgery.  Sometimes surgeons are reluctant to treat patients that do not “belong” to them.  The combined effect is usually a delay in treatment that can lead to a much bigger problem.

I believe that there are qualified practitioners all over the world who practice safe, ethical, state-of-the-art medicine and surgery.  But no amount of talent or skill can eliminate the risk of complications.  Nobody can guarantee you that you wont have a complication after surgery. What I can guarantee is that if you’re my patient, I will be the one to care for you until you’re completely healed.  Any conscientious surgeon would do the same.

The cost savings of traveling to a foreign country for surgery pale in comparison to the costs incurred by late presentation of a complication.  Unfortunately, as in the case highlighted above, some patients end up losing much more than just money.

What's Hot in Cosmetic Surgery: New Stats for 2013

Credit: American Society of Plastic Surgeons

Ever wonder which cosmetic surgery procedures are gaining in popularity and which ones are falling by the wayside? Every year the American Society of Plastic Surgeons puts out detailed statistics about all the surgical and non-surgical procedures that were done in the previous year. The new 2013 stats just came out. 

Some of the results are expected: non-invasive treatments like Botox and fillers continue to gain popularity. Some of the results are surprising: rhinoplasties (nose jobs) are down 9% from 2012. This trend has been going on for several years. Since the year 2000, rhinoplasties are down 43%. Breast augmentation, on the other hand, has been steadily rising. Primary breast augmentation is up 1% from last year, and up 37% since the year 2000. 

Other interesting tidbits from the report:

-The top 5 cosmetic surgical procedures in 2013 were breast augmentation, rhinoplasty, blepharoplasty, liposuction, and facelift.

-Lower body lift, most often performed after massive weight loss, is up 3,417% since the year 2000. (That’s not a typo- the number is three thousand four hundred and seventeen percent.) This probably reflects an increase in the number of weight-loss surgeries performed over the same time span.

-Facelifts are up 6% from last year, but show no change from 2000. I wonder if this reflects the changing economic climate. Patients often delay costly elective procedures when times are tough, so perhaps facelifts are a marker of the improving national economy.

The full report is available here. What do you think?  Why are some procedures up and others down? 

From one mom to another: All about the "Mommy Makeover"

Being a mommy :)

Today on the blog, a little education about a topic near and dear to my heart: the “mommy makeover.” As a plastic surgeon, I try not to show favoritism to any one operation, but I have to admit that I’m a bit partial to this one. “Mommy makeover” is a generic term used to describe surgery on the breasts and belly to address the changes of pregnancy. These are changes that exercise and diet alone can’t fix, because they are usually due, at least in part, to excess skin.

So, let’s spend a few minutes talking about what happens in a mommy makeover…

1. You actually make it to the office for a consultation! Most of you moms spend all your time focused on the family, the kids, the job, and everything else except yourself. You never get to think about your own needs, your body, and what might make you feel good about yourself again.
2. We figure out exactly what pregnancy did to YOUR body starting from the top down.
   1. BREASTS
      1. Almost everyone, whether you breastfed or not, has droopy, saggy breasts after having a baby. You have lots of extra skin and your nipples might point down instead of out. If this is you, then you might need a MASTOPEXY or breast lift.
      2. If you breastfed, you probably lost a lot of breast volume in addition to the stretching of your skin. So, the full breasts you had while you were nursing went away and somehow took your old breasts with them. What you’re left with is flat on top and loose on the bottom. When you bend over in front of the mirror, your breasts look like socks filled with sand. If you have no idea what I’m talking about, lucky you! If this sounds familiar, you might need a BREAST AUGMENTATION with or without a MASTOPEXY.
      3. Every so often, a woman’s breasts get huge during pregnancy and never really go back. This might sound like a good thing to those of you in category 1 or 2, but extremely large breasts are just as big a nuisance as small, droopy breasts. If this is you, then a BREAST REDUCTION might be in order.
   2. BELLY
      1. Your belly stretched like crazy to accommodate your baby, and after the baby got out, it didn’t quite go back to normal. For most women, the extra skin shrinks back down some of the way, but not all the way. There’s a little pooch of skin and fat below your belly button that never seems to go away. An ABDOMINOPLASTY or tummy tuck takes away all that extra skin and fat and replaces it with a scar. The scar is long and low from hip to hip. It’s a tradeoff that most mommies are willing to make.
      2. Your six-pack (rectus) muscles stretched out and split apart in the midline as the baby grew. For some women, the muscles never go back together completely, and instead stay a little split apart. This is called rectus diastasis, and it makes the upper abdomen stick out. In extreme cases, you still look a little pregnant even after your baby’s not a baby anymore. When you make the rectus muscle tight like you’re doing a sit-up, you can feel a gap between the muscles in the midline. That split can be fixed during a tummy tuck with a RECTUS PLICATION, or suturing together of the muscles in the midline. The added benefit of this part of the operation is that it nips in your waist and brings a little shape back to your midsection.
      3. You can’t blame this one entirely on the baby, but some women have stubborn pockets of fat in the flanks (muffin-top) that don’t respond easily to diet and exercise. LIPOSUCTION can address these pockets.
   3. MISCELLANEOUS
      1. Every woman’s body responds to pregnancy in a different way. Some women want to address other parts of their body, like the butt or thighs, at the same time. These decisions are made on a case-by-case basis.

Bottom line? The operations are different, but the goal is always the same: to restore your body so you can feel good about yourself again. It can be very hard to take a step back from everyone else’s needs and focus on your own. But let’s be honest, nobody deserves to do that more than hardworking moms!

"I'm a DC Lady and a Plastic Surgeon": Guest Post on The DC Ladies

I had the opportunity to write a guest post on The DC Ladies about being a DC lady and a plastic surgeon. You can see the full post here. Thanks, @thedcladies, for the opportunity to share my story!

2-for-1 Plastic Surgery...

The UK Mirror is reporting on a new push to regulate the cosmetic surgery industry in Britain.  The article cites widespread unethical use of cosmetic surgery including “cut-price deals that don’t allow patients to be refunded if they change their mind, and mother-and-daughter offers – two operations for the price of one.”

It may sound absurd that anyone would sign up for a 2-for-1 deal for something as serious as surgery, but I have actually seen this exact deal in the US.  When I was a resident at theUniversity of Michigan, we took care of a patient who fell victim to one of these “mother/daughter” scams.  She and her daughter had matching tummy tucks by a surgeon who offered them a 2-for-1 deal.  He aggressively liposuctioned her abdominal wall before doing her tummy tuck, which effectively cut off the blood supply to the skin on her belly.  She showed up in our emergency room with a dead abdominal wall that had to be completely removed.  This left her with a foot-long, gaping wound that required two months of dressing changes and an eventual skin graft to heal. Needless to say, her body is permanently disfigured from her botched operation.

I can tell you with certainty that no ethical, conscientious surgeon would ever offer this kind of gimmick.  The same can be said of cosmetic surgery as a raffle prize.  In fact, the American Society of Plastic Surgeons expressly forbids offering any surgical procedure as a prize. A surgeon who does this risks losing board certification (if they had it in the first place).

The UK National Health Service report brought to light a number of other issues about the lack of regulation in the cosmetic surgery industry.  You can read more about their findings here. If you read the report, you might be surprised to find out that the U.S. is not much better when it comes to regulation of cosmetic procedures.  If you ask me, we need to do better. Perhaps we should follow their lead and take a stand in protecting our patients.

Extreme Facial Reshaping- cultural trend or freaky sideshow act?

Plastic surgery trends are strongly influenced by cultural standards of beauty. Nowhere is this more apparent right now than in East Asia, where extreme facial sculpting is gaining popularity.

Women are lining up at plastic surgeons’ offices to have “V-Line” surgery in an effort to create a triangular doll-like face. While this kind of facial reshaping is rare in the rest of the world, it is commonplace in Asia. To be fair, some of the women start with fairly masculine jaws that actually benefit from a feminizing reduction. But, in my opinion, many of them are taking a natural variation in facial shape and turning it into something distinctly un-natural.

Take this South Korean reporter (click here for more images).

Before surgery, she had a full, heart-shaped face with lovely proportions. I think most people would agree that she was beautiful. After her extreme mandibular shave, her absurdly sharp chin unambiguously gives away its surgical origins. She looks cartoonish and a little freaky, especially in the photo where she doesn’t have full hair & makeup.

Obviously my opinion of this trend is shaped by own cultural bias, which favors Western beauty ideals. I’m sure that some of our routine procedures wouldn’t gain traction in other parts of the world. For example, the breast augmentation patient I saw yesterday might not notice her small breasts if she lived in Korea or Japan. Then again, she might come in demanding to have her face turned into an octagon. Maybe her jaw would end up in this crazy clinic’s thousand bone tower displayed for all the world to see. What do you think? Is facial sculpting just a different cultural choice or does it take plastic surgery too far?

Michelle Obama Not Ruling Out Plastic Surgery, Botox

Several headlines from major news outlets including ABC and CBS proclaimed “Michelle Obama Not Ruling Out Plastic Surgery, Botox.” The headline was pulled from an interview Mrs. Obama gave to People magazine regarding her 50^th birthday in which she said “never say never” when asked about plastic surgery and Botox. She shared a number of other thoughts about turning fifty, but this particular sound byte proved most interesting to the mainstream media.
I wondered why, of all the things she said, an offhand comment about not ruling out plastic surgery got so much traction. Cosmetic surgery is far more prevalent and public now than it was even a decade ago. Public figures routinely discuss personal experiences with plastic surgery, yet Mrs. Obama’s admission of “not ruling out” aesthetic surgery was surprising enough to generate a news story.

I think the media’s reaction is a direct result of the way America sees Michelle Obama. Her mission as first lady is to eliminate childhood obesity in one generation. Her “Let’s Move” campaign focuses on lifestyle changes like improved nutrition and physical activity. Perhaps because of her stance on these issues, the public expects her to reject any treatment that might be seen as “unnatural.”

It’s no secret that we place a high value on beauty and youth, but the reaction to Mrs. Obama’s comment reveals that society is deeply ambivalent about discussing it openly. What do you think? Is Michelle Obama’s attitude about plastic surgery in line with her public image? 

What's New in Breast Reconstruction?

View from my balcony in Kauai

I recently attended a conference in Hawaii (yes, I actually attended the conference!) for the American Society of Reconstructive Microsurgeons.  I was there presenting a technical paper on breast reconstruction, but more importantly, I had the chance to hear about what’s new in the field.  It was exciting to see what other surgeons are doing around the country and around the world.

I attended a fascinating lecture by Bob Allen, who is widely regarded as one of the pioneers of advanced breast reconstruction.  His talk was entitled “25 Options for Breast Reconstruction when the Abdomen is not enough.”  With a procedure like breast reconstruction, it’s important that patients know about all the possibilities before they make a decision.  Believe it or not, there are dozens of ways to re-build a breast after mastectomy.  Here is just a sampling of the list compiled by Dr. Allen for his talk.

Using your belly:

1. SIEA: Superficial Inferior Epigastric Artery flap
2. DIEP: Deep Inferior Epigastric Artery Perforator flap
3. MS-TRAM: Muscle-sparing Transverse Rectus Abdominis Myocutaneous flap
4. TRAM: Transverse Rectus Myocutaneous flap

Using your butt:

1. SGAP: Superior Gluteal Artery Perforator flap
2. IGAP: Inferior Gluteal Artery Perforator flap

Using your thigh:

1. TUG: Transverse Upper Gracilis flap
2. ALT: Anterolateral Thigh flap
3. PAP: Profunda Artery Perforator flap
4. scTFL: Tensor Facia Lata (septocutaneous) flap

Using your thorax:

1. TDAP: Thoracodorsal Artery Perforator flap
2. ICAP: Intercostal Artery Perforator flap
3. LAP: Lumbar Artery Perforator flap

These are called “flaps,” because we take a flap of tissue attached to its blood vessel and disconnect it from the body.  We then move the flap up to the chest wall to make a new breast, and reconnect the blood vessels to the vessels in the chest or armpit.  The reconnection is done under a microscope because the vessels are tiny, usually only a couple of millimeters in diameter.

Most women are good candidates to use the belly, because most women have a little extra fat in the belly area.  That fat is nice and soft, mimicking a breast beautifully when it’s moved up to the chest.  However, some women are pear-shaped, or have large abdominal scars that prevent us from using the belly.  For those patients, it’s good to have all these options to choose from based on a woman’s body habitus and breast size.

All in all, a great meeting, and a great review of all the options available to our patients!