BEWARE THE HYPE IN PLASTIC SURGERY CLAIMS

Written by Dr. Lane Smith M.D.

As an extremely busy plastic surgeon in Las Vegas, one of the plastic surgery capitals of the world, I am frequently amazed and dismayed by the inaccurate and outright false claims being made about new plastic surgery procedures and technologies. 

Unfortunately, more than any other field of medicine, plastic surgery relies on a certain amount of competition to obtain patients.    Cosmetic surgeries are elective.  The patient has to want your product; and, as a surgeon there is great pressure to obtain patients who want surgery.   To an extent, the more patients a surgeon has, the wealthier he or she becomes.

In an attempt to Awin@ patients, unscrupulous doctors or medical companies may advertise certain products in ways that are misleading or outright false.   The general premise is to create an illusion that a particular doctor has a new product, new surgery or new technology that is vastly superior to his or her competitors and implies that the patient must come to him or her to get this Aspecial@ plastic surgery. 

Fortunately the majority of Board-Certified Plastic Surgeons are honorable and hard working, giving good service and reliable information to their patients and public.  These surgeons, like myself, rely mostly on good work and word of mouth for patient referrals. More frequently, it is the non-board certified surgeon, or a surgeon who is not board-certified in plastic surgery or non-qualified physician who is guilty of participating in the hype of certain surgeries or technologies.    Often photographs shown and testimonials are skewed in ways that are simply inaccurate and create a false sense of expectation among patients.   Frequently, I seriously wonder if the technology of the computer imaging is being misused to alter photos.

Almost daily, I am confronted by patients who have been sadly misled.  They have wasted time and money after falling prey to the hype of an unscrupulous advertisement.   Often the patients have little or no permanent results, but sometimes there has been damage done that cannot be repaired. Because I feel these injustices could have been prevented, I feel a need to warn the public.  With this in mind, I have created a list of things that are currently being hyped that patients should beware of:

1.   T.V. Doctors:  I am about to be in a reality show called Sin City Surgeons, so I can speak candidly about AT.V. Doctors.@  By that, I am referring to physicians who are featured on T.V. or in T.V. reality shows such as those set in Beverly Hills or any other plastic surgery reality show.   It is sad that the public automatically assumes that the physicians in the shows were chosen because of their skill and accomplishments.   Truth be known, the majority of these physicians were chosen for reasons other than their skill or fame among the surgical community. Perhaps the most popular of all the physicians featured on T.V. had almost no clientele until he had the good fortune of opening an office in Beverly Hills and looking good on camera.  Some of these physicians pretend to have been AHarvard Trained@ when the truth is that they simply took a short one or two week course at Harvard and would not be considered by any reputable physician or by Harvard themselves to have been AHarvard Trained@.    Also, beware of the results shown in these shows.  They are often Adoctored@ (pun intended) and the surgeons that are featured are frequently not even board certified by any reputable surgical board.  It is important to always check a physician=s credentials even if he or she is featured on T.V.  I will also candidly state that my practice is extremely busy prior to the beginning of our show, Sin City Surgeons, and I would like to assume it is because I have been well-trained, worked hard, and get favorable operative results, not because I may appear to be a good doctor on T.V.   The bottom line is that you should not always believe what you see on T.V. and definitely do not entrust your health to a physician just because he or she appears on T.V.

2.    Thermage 7 :    This technology claims to tighten skin without incisions and with little or no down time.   The theory is that skin that has become loose due to things such as massive weight loss, pregnancy or aging can be tightened while avoiding the need for skin-removing operations.   Quite often, amazing results are shown.    While there are physicians who truly believe this works, the vast majority of plastic and cosmetic surgeons have been greatly disappointed in the results of this technology.   When reputable physicians show their very best results using these technologies at plastic surgery meetings, I often have to look very hard to see any difference between the before and after pictures.   I definitely have not seen the results that are often shown in advertisements.   This particular treatment is actually more difficult and painful than is usually advertised and may require deep sedation or general anesthesia.  In reputable hands, patients report more pain and swelling than expected. They are also generally disappointed when the results are minimal or completely absent.  When patients ask me about this technology being offered by another physician, I encourage them to try it as long as they can get their money back if they are not satisfied.    When some have bravely tried this treatment, every single patient has returned to me disappointed.   The bottom line is that if you try this treatment; expect little or no improvement for most patients and certainly not the type of improvement shown in advertisements.

3.   Laser Surgery or ALaser@ anything else.   Unfortunately the public associates lasers with an almost magical quality and assumes that anything done with the laser is automatically superior to any other way to do it.   It is important to understand that a laser is simply highly focused light of a single wavelength. It works by selective absorption of heat by the target tissue.   Put much more simply, it is light that works by burning things. There is nothing magical or wondrous about that. Physicians will advertise such things as ALaser Breast Augmentation,@ when in fact the laser is only used to make the initial incision. The remainder of the surgery is done exactly the same.   Multiple scientific studies have shown that it is probably better to make the incision with a scalpel and that the complication rate is often higher when lasers are used (especially with certain types of cosmetic surgery).    Lasers can however be extremely useful.  Conditions in which they are useful are more often for the treatment of certain skin conditions such as fine wrinkles, birthmarks, and port-wine-stains.   The bottom line is that when the laser is advertised for use in a surgical procedure, be wary.  It is probably more hype than help.

4.  Laser liposuction, Smart Liposuction 7, Intelligent liposuction, etc.   There are many clever names now being given to the technology where a laser fiber is being used in attempt to melt or destroy fat.  Just as I stated above, laser use is not magical. The claims are that the laser tightens the skin more and somehow (this is never really explained) does a better job at removing fat.    In actuality, laser use in liposuction is limited to just the area beneath the skin (usually 1 to 1.5 centimeters only).  In fact, the areas most often treated with the laser are followed with traditional liposuction.    To my knowledge, there is no conclusive evidence that the skin is tightened to a greater degree than other forms of liposuction.   However, there is a growing body of evidence that the complication rate may be higher.   The bottom line is to wait until this technology is improved and skin-tightening results are proven in objective medical studies.

4.  Lipodissolve or lipoinjections:  The claims state that a patient can have a few simple injections and the fat will magically melt away without surgery, pain, bruising or swelling.   This method of treatment is most often used by non-surgeons who wish they were true plastic or cosmetic surgeons.   The truth is that multiple injections are needed, (often as many as 50 to 150), each being somewhat painful. Also, there is often a significant amount of swelling, bruising, redness and discomfort.   Sometimes there can even be significant nausea after these treatments.  I have seen patients who after single series of painful injections looked far more swollen, red and bruised than any of my patients after liposuction of the same area.  The results are usually less than impressive and most of my patients would be dissatisfied with the results after this treatment.   To get any visible results, at least 3 treatments are needed (i.e. 150 or more injections).   Even the foremost practitioners (the European physicians who pioneered this treatment) readily admit its use is better for small areas (Aesthetic Journal XXX).    This is a tactful way of saying it=s not a powerful method of removing fat.   Also the question remains that when the fat cell is damaged by the injection and the fat released, where does it actually go?    There are physicians that worry it is simply taken up by other fat cells in the body.    Traditional forms of liposuction actually physically remove the fat and cells from the body and there is no question it has been removed.  The bottom line is that traditional liposuction works much better for most areas and is more cost effective.   Lipodissolve may work well for very small areas, but then again, a small amount of liposuction done with local anesthesia probably works just as well or better.

5.  Thread lifts.  The claim here is that by using a special barbed thread (suture), it can be placed under the skin and when thread is pulled back, the barbs in the thread will grasp pull and lift the sagging skin, giving nearly the same effect as a facelift with much less bruising, pain and recovery time.    Like lipodissolve, these procedures are often done by non-surgeons wanting to be plastic or cosmetic surgeons.  Unfortunately, there is more bruising and pain than is usually admitted.  The threads are quite expensive and the usual cost is often not much less than with a traditional facelift.   As you might suspect, there are many problems with these threads.    First, the excess skin is never actually removed and is simply bunched up in a higher place. While some physicians think that this excess skin simply tightens up, the effect is probably minimal.   Another disadvantage is that the threads pull through and eventually loose their Agrip@ so that even the strongest proponents of this procedure admit that the effect lasts only six to eighteen months at best.    Most skilled plastic surgeons think the actual effects last closer to six months or even less.   To add more problems, the threads can cause creases or lines in the face.    They can even become infected, which creates a huge dilemma because they are extremely difficult to remove.  I have seen all of these problems in many patients who have come to me unhappy with the Athread lifts@ that they received from other physicians.  While this procedure was initially extremely popular and heavily advertised, a large number of physicians have stopped doing the procedure because of the number of complications and failures they have observed within their clinical practice.    Now, even some of the largest companies that made these Athreads@ have gone out of business.   The bottom line is that it is probably better to avoid thread lifts or to expect a short term, underwhelming result.

6.  Lifestyle 7 lift, Lunchtime 7 facelift, Quicklift 7, Weekend facelift 7 and other infomercials regarding facelifts:  These probably would be better names as Adis-infomercials@.   The basic premise is the same for all of these Amini@ facelifts; there is a stated or inferred message that only certain doctors can perform them, and that impressive results can be had with a one hour procedure and almost no healing or downtime, i.e., the patient can usually return to work after only a day or a weekend of healing.    Large companies run these almost like a McDonald=s for facelifts.   They typically recruit young starving physicians whom they employ in each city and then set them up to do the surgeries.   The procedures are actually not even standardized, and vary from patient to patient, city to city, and surgeon to surgeon.  That is probably not all bad, as patients are vastly different in their facelift needs.  However, the healing times are usually closer to a week or two and not a weekend, which makes these mini-lifts similar in healing time to full-facelifts.   There is no such thing, and thank goodness this is so, as a copyright on a surgical procedure.  Hence any skilled surgeon can perform any of these types of facelifts.  The bottom line, choose a reputable surgeon and ask for a mini-lift.   You might have to pay a little more, but your service, follow-up and results will usually be better and more safely performed.