Download AAFPRS News Jan 11 2005 - European Academy of Facial Plastic

Plastic Surgery for Men on the Rise
Guys Say They Hope Going Under the Knife Will Help Them Compete Personally and Professionally
Jan. 9, 2005 -- According to folklore, women are considered the fairer sex.
But increasingly, men are paying more attention to their appearance and going to great lengths to improve
it — even if it means going under the knife.
The number of men undergoing plastic surgery each year is on the rise, with rhinoplasty (better known as a
nose job), chin implants and less invasive procedures such as Botox injections and chemical peels
especially popular.
"There is no question there is a trend that men are coming in higher numbers and they're being more open
about it year over year," said Dr. Michael Rose, a plastic surgeon. "Whereas men only accounted for 9
percent of cosmetic procedures seven years ago, in 2003, they accounted for 14 percent. And the last year
alone has seen a 51 percent rise in minimally invasive procedures, such as Botox, among men. The stigma
of plastic surgery has lessened over time, and it has become more acceptable."
Driving the plastic surgery trend for both sexes is the flood of television shows featuring plastic surgery,
which make the often expensive procedures seem almost commonplace.
A Way to Compete
Steve Tauber took notice of the growing trend and decided it was time to do something about his
pockmarks and baggy eyes.
"If I'm going to be 45, I want to look the best I can at 45," said Tauber.
He hopes a laser facial procedure will help him both in the dating world and the professional world.
"I think it is, to some degree, a way to compete. I used to work as a salesman, and I know how important
image is in any job," said Tauber.
Men today not only feel pressure from their younger competitors in the workplace, but also from the
youthful faces and fit bodies staring at them from the covers of men's magazines and from celebrities on the
red carpet.
"Some men feel, 'why not?' " New York plastic surgeon Dr. Darrick Antell told "Good Morning America."
"As for why, there's increased popularity because there's more publicity about plastic surgery and plastic
surgery is getting less invasive than it used to be."
Antell said men often look at surgery in economic terms.
"Men think of it as an investment that gives immediate return," he said. "It's not enough just to have a good
resume. Men wear their resume on the face. We all like to think that people judge us from what's on the
inside, but we all know that our outside appearance is being judged too."
Consider the Risks
Before going under the knife there are some important risks to consider, said Antell.
"Some risks for surgery include the same risks of all surgeries, like bleeding, infection, swelling and
unsatisfactory healing," he said. "Remember, there will always be a scar, but there are always things we can
do in terms of scar management. And the most important way to get a good result is to pick someone who
is certified by the American Society of Plastic Surgeons."
Antell also said that word of mouth is often the best way to find a good surgeon.
"Start by asking friends and personal physicians for recommendations. It's often not a bad idea to interview
other surgeons," he said.
And finally, Antell stressed plastic surgery is not the time to cheap out.
"Plastic surgery is one area in life it pays to pay retail," he said. "Cost varies based on the experience of the
surgeon."
Possibility of face transplants raises moral, ethical questions
Tuesday, January 11, 2005
By Alana Semuels, Pittsburgh Post-Gazette
David McDowell has become accustomed to the stares and murmurs when he goes out to the mall, or to the
movies, or sits with his family on the beach.
More than 20 years after a jolt from a power line surged through his body while he was at work near
Weirton, W.Va., with the Monongehela Power Co., McDowell's face is badly scarred. He's missing an ear,
and he lost part of his hairline in the accident. He has undergone 28 surgeries, including numerous skin
grafts and other procedures to repair his facial tissue.
"I'm still a mess," said the Elkins, W.Va. resident of his appearance. "For a long time, I've been thinking I
need to do something about it." And so when he heard that doctors have received approval to perform a
drastic new procedure that could give him the face of someone else, McDowell was interested.
In October, the Cleveland Clinic was the first institution to receive approval from its institutional review
board to perform human facial tissue transplantation -- face transplants -- on severely disfigured patients.
And doctors in Louisville, Ky. published an article in the American Journal of Bioethics last fall
announcing their intention to move face transplants from the realm of speculation to clinical trials.
At the University of Pittsburgh Medical Center, doctors have been researching the surgical issues
surrounding hand and face transplantation for more than 20 years, and could apply for approval to begin
these transplants as early as 2005.
But unlike transplants of organs such as kidneys and intestines, which are routinely performed in Pittsburgh
and at other centers around the world, facial tissue transplantation raises unique questions and moral issues.
The ethical quandary is so great that after reviewing the ramifications of face transplants, teams of doctors
in England and France put the issue on hold indefinitely.
Side effects 'too great'
UPMC's chief of plastic surgery, Dr. W.P. Andrew Lee, agrees with those European ethics review boards.
"If it's not a life-sustaining organ transplant," he said, "the potential side effects are too great for the
operation to be justified."
The procedure is technically a composite tissue transplant that consists of connecting small nerve and blood
vessels through microsurgery. Doctors have been doing such microsurgeries since the 1970s, said Lee, but
the biggest hurdle in the issue of face transplants is an immunological one: that the recipient's body would
reject the new face.
Face transplant recipients would need to take drugs to suppress their immune systems indefinitely to avoid
rejection. In the long term, these drugs can cause cancer, infection and liver and kidney failure.
There's also the issue of what could happen should the immunosuppressant drugs fail. In that case, the face
might have to be removed, or could actually slough off the recipient's head.
"When we make more progress -- and the patient no longer needs to take all those medications -- then it
could become a reality," Lee said. "The risk-benefit balance is key here."
Some ethicists argue that this risk and benefit analysis should be extended to evaluate how a face transplant
might affect the donor and his or her family.
"Surviving family members will be at risk of having psychological trauma because of what the donor did,"
said Arthur Caplan, the chair of the University of Pennsylvania's department of medical ethics.
Caplan also points out the impossibility of an open casket funeral for a face transplant donor, and notes it
might be difficult for a donor's family members to adjust to seeing their relative's face on another person.
Although the recipient will not look like the donor, the appearance could be a hybrid between the two.
Caplan also is concerned about potential repercussions on the organ donor community should this
procedure move forward, since a donor technically agrees to donate all organs and tissues.
"No one intended faces when this law was written," he said, and so "you can see people tearing up donor
cards all over the country" to avoid being a facial tissue donor.
A green light on face transplants might also signal to burn victims that living with a badly scarred face is
not socially acceptable, argue some ethicists. In a response to the article published in the American Journal
of Bioethics, Sara Goering, of the University of Washington, argued that facial transplants might put a
burden on those with disfigured faces to get a transplant or alter their appearance, instead of encouraging
society to adjust to seeing a scarred face.
Goering, Caplan and other doctors and ethicists argue that until procedural safeguards are established, face
transplants should not be attempted.
Quality of life issue
Still, doctors at the University of Louisville estimate that there are thousands of patients around the country
whose faces are disfigured because of trauma, major burns, infections or congenital birth defects. To
improve the quality of their lives, the Louisville doctors want to proceed.
While the doctors at West Penn's burn unit are able to reconstruct most badly burned faces, burn unit
director Dr. Harvey Slater says there are some exceptions -- patients who lack adjacent tissue for skin grafts
because of burns covering their entire face and neck. Others may lack a nose, ears or eyelids.
Patients with severe scarring and a stable state of mind would be first in line for a face transplant, Slater
said. Doctors would have to determine that the transplant would improve the person's life by improving his
facial appearance.
Slater has seen severely deformed patients go on to have productive and happy lives, but he understands
why a patient might desire a face transplant.
"Your appearance and your personality are in some ways inseparable" he said. "It's hard to get past that."
And although face transplants will likely not save anyone's life, he says they "might enable some people to
have a life."
"There's a perception that we should be able to make ourselves perfect again," said Amy Acton, a burn
survivor who is the executive director of the Michigan-based Phoenix Society, the largest burn survivor
organization in the country. "There's a myth of what plastic surgery can do to people."
Acton would rather see more of an effort to help burn survivors re-enter society than face transplants. But
she acknowledges that some survivors struggle with depression and isolation, and have not recovered
psychologically even five decades after the incident that left them scarred.
"The hope of a face transplant is an exciting possibility," she said. Acton, a former burn nurse and burn
survivor with injuries to her neck, limbs and torso, still gets questions from well-meaning people who want
to refer her to a good plastic surgeon.
McConnell, the West Virginia survivor, gets the questions about plastic surgery as well. But in a recent trip
back to West Penn, he was told that doctors could not make any more progress in reconstructing his face.
Even after 20 years, the news bothered him, and caused him to mull his other options.
"The vanity issue -- it will just wear you out if you don't have anything else to keep you occupied."
Surgery Can Reduces Migraine Symptoms
Wed Jan 12, 2005 02:14 PM ET
By Karla Gale
NEW YORK (Reuters Health) - Surgical removal of trigger points on the face and head can significantly
reduce the frequency and severity of migraine headaches, and in some cases totally eliminate them,
investigators report.
The team at Case Western Reserve University in Cleveland, Ohio, first tried this approach after patients
undergoing plastic surgery or treatment with Botox reported that their headaches had disappeared, lead
author Dr. Bahman Guyuron told Reuters Health.
"The patients can guide us as to where the headaches are coming from," Guyuron explained. Up to four of
these sites are then injected with Botox. If this produces at least a 50 percent reduction in intensity and/or
frequency of headaches for at least 4 weeks, the site was considered for surgery.
"Depending on the response, we decide if they are good candidates for surgery," Guyuron said.
In the current study, reported in the January issue of Plastic and Reconstructive Surgery, 89 migraine
patients were randomly assigned to surgical treatment while 19 others served as a no-surgery control
group.
After 1 year, 31 (35 percent) in the treatment group reported that they were completely free of migraines,
while 51 (57 percent) reported improvement, compared with three control patients (16 percent).
The average number of days lost from work fell from 4.41 each month to 1.2 each month in the treatment
group, but there was no change in the control group.
The annual cost of treating migraines was reduced from $7612 to $925 in the active treatment group.
Temporary side effects of the surgery included a dry or runny nose, intense scalp itching and minor hair
loss.
Guyuron said patients who might be considered for surgical treatment are those who do not benefit from
over-the counter medications, have side effects from conventional migraine medications or have
headaches so frequently that they interfere with day-to-day activities.
"Even with a conservative estimate of 30 percent of migraine sufferers, we are talking about 9 million
patients in the US who could benefit" from surgery, he said.
SOURCE: Plastic and Reconstructive Surgery, January 2005.
Plastic Surgery For Men
from Lifts To Tummy Tucks
by William McCall , Associated Press
Craig Sowash, a 43-year-old sales manager with a pulp and paper company, says he feels
more confident with customers ever since he had the wrinkles on his face smoothed out
with a few injections.
And if he ever needs a little surgery at some point to produce permanent results, he says,
"I won't be shy about pulling the trigger."
Competition for corporate jobs among aging baby boomers, along with quicker, cheaper
and less invasive techniques, and greater attention to grooming among men are helping
drive an increase in cosmetic procedures among the male of the species.
Botox injections, which won Food and Drug Administration approval for wrinklereducing in 2002 but had already come into fairly widespread use by the end of the
1990s, were the most popular cosmetic procedure for both men and women in 2003, with
nearly 334,000 procedures for men and 2.56 million for women, according to the
American Society of Plastic Surgeons. Botox treatments typically cost about $200 to
$400.
Traditional plastic surgery rose about 10 percent among men and 14 percent among
women from 2002 to 2003, according to society figures. Nose jobs were the most popular
surgical procedure among men, followed by eyelid surgery and liposuction.
Doctors say they are seeing more and more men trying to take years off their looks.
"Men feel that doing some of these procedures gives them a foot up in the business
world, a competitive edge," said Dr. Marla Ross, a dermatologist in suburban Tigard who
gave Sowash wrinkle-reducing injections of Restylane.
Ross also said the age range of her patients has widened, with most of them between 35
and 55. Occupations vary dramatically, from waiters "right up to CEOs of big
companies."
"You see a lot in the media about `metrosexuals,' or men who are dressing well and
taking care of themselves," Ross said. "Probably 15 years ago that would have been
ridiculed and now it's acceptable."
Dr. Darrick Antell, a leading plastic surgeon in New York City, said women patients tell
him they have always compared themselves to the models they see on fashion magazine
covers. But now men are making the same kind of comparisons.
"From Calvin Klein ads for underwear to GQ, I think the media have made men more
aware of how good they should look," Antell said. "They see an ad and say, `I don't have
abs like that.'"
GMI Inc., a market research firm in Seattle, said a survey in the major industrialized
nations found that Americans are more likely than the British or the French to consider
cosmetic surgery a negative trend.
"Cosmetic surgery is more negatively viewed by Americans because it is threatening to
become so commonplace," said Pepper Schwartz, a University of Washington
sociologist. "People feel pressured to look a certain way if everyone you know who is 50
is having surgery to look 40."
©Associated Press 2005
Wrinkle treatment warning crimps business
By John Pacenti and Jane Daugherty
Palm Beach Post Staff Writers
Monday, January 17, 2005
JUPITER — Until the botulism poisonings of four South Floridians by knockoff Botox,
the only worry for the lucrative anti-aging cosmetic industry was ironing out crow's feet
for patients and counting the cash.
Since the four were hospitalized with nearly complete paralysis Nov. 26, federal and state
investigations discovered use of research-grade botulinum neurotoxin by certain
practitioners in lieu of the federally approved Botox.
As a result, Dr. Jean Malecki, Palm Beach County's top health official, has warned
people to forgo any wrinkle-fighting injections until all the unapproved toxin sold can be
recovered.
The fallout can be seen at AIM Spa of the Palm Beaches, which had the misfortune of
using an acronym consisting of the initials of the Oakland Park clinic where the poison
injections took place: Advanced Integrated Medical Center.
While that clinic's conditions shocked investigators, AIM in Jupiter sports flat-screen
televisions in its lobby and state-of-the-art therapeutic equipment.
AIM says the clinic stole its name, but owners didn't see it as a threat to business until it
was linked with botulism. On a recent weekday morning, the spa did not have one
appointment in the early morning. Business is down as much as 70 percent for what is
supposed to be the spa's busy time of year.
"There is a definite carry-over. I know for a fact we should have been busier in
December," said Ken Brown, AIM's spokesman.
Many of AIM's customers are senior citizens, and the spa fears they are confusing it with
the Oakland Park clinic and passing the misinformation around.
Dr. Supriya Tomar, who administers Botox at another clinic, Advanced Aesthetics
Institute in West Palm Beach, said there now are concerns among her patients about the
safety of the procedure.
"The new patients definitely have more questions than they have had before, and that's
appropriate," Tomar said.
Another company unhappy with the turn of events is Irvine, Calif.-based Allergan Inc.
Allergan is the only federally approved company to use botulinum neurotoxin as a
cosmetic product. Its product, Botox, uses a tiny bit of botulinum to relax the muscles
around wrinkles.
A suspended physician at Advanced Integrated used a research-grade botulinum toxin not
meant for human use, paralyzing himself and three others, authorities say. All four
remain at least partially paralyzed. Allergan has had to deal with the fact that the
poisonings can't be discussed without naming its well-known product.
County Health Director Malecki's recommendation for consumers to refrain from any
facial injections for at least six months does not sit well with Allergan. Douglas Ingram,
the company's vice president, called it "unnecessary and inappropriate."
"The issue of unsafe alternatives to Botox involves unethical health-care professionals
who, for reasons of greed and total disregard for their patients' well-being, knowingly
choose to use unlicensed, unapproved and dangerous products," Ingram said in a
statement.
Dr. Catherine Navarro, who specializes in skin care and vein removal in West Palm
Beach, said Malecki might be overcautious, but she is only concerned with public health.
"If she wants to err on the side of conservatism, it's fine with me," Navarro said. "No one
is going to suffer if they delay getting anti-wrinkle treatments for a few weeks or a few
months."
Navarro and a few other practitioners say their Botox appointments have increased since
the poisonings.
Dr. Kenneth Beer, who practices in West Palm Beach, says he orders more of Allergan's
product than any other physician in the county. He described it as "a flight to quality," as
patients who would get Botox at champagne parties or clinics like the one in Oakland
Park are seeking medical doctors for the treatment.
On Miami Beach, Dr. Fredric Brandt, who has been called the king of Botox for the
number of injections he administers, said he believes those who want to look younger
will forget the South Florida botulism poisonings in the long run. "Most people realized
what occurred in this situation, and there's the overwhelming desire to look better."
Doctors suggest those who want Botox treatment seek out a board-certified physician and
refrain from bargain offers. Botox treatment should cost from $250 to $450 a site. A site,
for example, is the brow line.
Dr. Frederick W. Storer, the medical director at AIM, said he knows the bargains could
be dangerous because Botox has a set price. "They're either under-injecting or not using
the genuine Botox," he said.
Investigators discovered bogus Botox was sold to non-physicians, such as nurses. Last
week, a federal judge ordered an Arizona firm peddling the neurotoxin to recall more
than 2,000 vials.
Some of those who had bought the research-grade botulinum from Tucson-based Toxin
Research International were well-known physicians, though. Wellington plastic surgeon
Harold Bafitis bought four vials, according to invoices from Toxin Research. He said he
used it only on volunteers in his office and then decided it wasn't adequate for patients
because the dilution factor was too high.
Bafitis, who has not returned phone calls from The Post, told WJNO-AM News Radio
1290 radio last week that patients can ask the doctor to mix the Botox in front of them.
He said the common dosage is 40 to 80 units of the Allergan product.
Allergan's vials also have a hologram stamped on them.
"You don't know what you are getting if you don't watch them mix it up," said Bafitis,
who owns the Plastic Surgery Institute of the Palm Beaches.
What does it cost to fix your face … or other body parts?
Tuesday, January 18, 2005
By JESSICA ADLER
HERALD NEWS
As recently as five years ago, such an event would have been unlikely: a cosmetic-surgery information
session in the heart of inner city Paterson. Such things as tummy tucks and liposuction were almost
exclusively the terrain of the wealthy. But here we are, fresh into 2005, and on Sat., Jan. 22, board certified
plastic surgeon Dr. Paul Rosenberg will meet face-to-face, one-on-one and free-of-charge with prospective
patients at Paterson's Barnert Hospital.
"Plastic surgery is not only for the exceedingly rich," says Rosenberg, who is chief of the division of plastic
surgery at Barnert and medical director of Palisade Plastic Surgery Associates in Fort Lee. "Regardless of
one's income status, all people are interested in their appearance."
The tendency to act on that interest is clearly growing. Consider the 32-percent increase in the number of
cosmetic procedures performed between 2002 and 2003, according to the American Society of Plastic
Surgeons. That jump is typically attributed to economic and cultural factors. More and more procedures are
relatively affordable -- non-invasive treatments such as botox injections and chemical peels, for example,
can be performed on an outpatient basis for between $100 and $500. Plus, shows like "The Swan," which
incorporates cosmetic surgery as one element of a "makeover," have opened up Americans' eyes to the
prospects of medically applied beauty.
But there's more to the boom than affordability and pop culture. Not only does cosmetic surgery appeal to
more patients now, but more specialty doctors - eager to escape the catacombs of low insurance
reimbursements - are opting to perform the elective procedures. Thanks to newly emergent financing
companies offering monthly payment plans for cosmetic procedures, the target market is ever-widening.
"It's the money," says Karena Rybarczyk, marketing and communications director for the American
Academy of Cosmetic Surgery.
Since its inception in 1985, AACS - a member organization of dermatologists, ophthalmologists, OBGYNs and other specialists who practice cosmetic surgery - has grown from 150 members to 1,500
members.
"Physicians have a lot of insurance issues today, and a lot of malpractice insurance," Rybarczyk said.
"Cosmetic surgery is an elective procedure, so the malpractice insurance drops."
Any licensed medical doctor can legally perform cosmetic surgery. So ear-nose-and-throat doctors are
performing facelifts, eyelid surgeries and chin augmentations; OB-GYNs are doing tummy tucks.
"The real question is, what is their training, what is their experience?" said Dr. Gary M. Brownstein, who
heads Cherry Hill Cosmetic Surgery and is a member of the American Society of Plastic Surgeons and the
American Society of Aesthetic Surgery. "In my opinion, I'm not sure I'd let a plastic surgeon do my Csection. And I think if I wanted liposuction, I'd want a plastic surgeon to do it."
Repelled by the time-consuming process of filing insurance reimbursement claims, more and more
physicians are lured by the prospect of receiving direct payment from patients for performing cosmetic
procedures. Such surgeries, being elective, often mean patients pay out-of-pocket, rather than through thirdparty payers. .
"Health care workers and physicians are driven to do good," said Dr. George Agich, professor of medicine
in the department of bioethics at the Cleveland Clinic Lerner College of Medicine. "But the system is really
designed differently than to do good. It's a system that's designed to function as a business."
That being the case, Agich says, when it comes to cosmetic surgery, "It's hard to draw a hard and fast line
between enhancement and treatment. To improve appearance may improve someone's psychological wellbeing."
Whatever the underlying motivation, more people are willing to look further than their own wallets in order
to fulfill cosmetic desires. Five years ago, borrowing money for something like a facelift was virtually
unheard of. Now, 20 percent of Rosenberg's patients finance their procedures with some form of credit.
That's where companies such as AmeriFee and Unicorn Patient Financing come in.
They work with doctors and patients to establish monthly payment options for cosmetic procedures not
generally covered by insurance, such as breast enlargements and rhinoplasty (a nose job).
"Medicine is becoming sort of the cutting edge of what it means to have a consumer society," Agich says.
"We've taken for granted that any and all goods should be at our disposal."
But borrowing money for elective surgery is usually less defensible than borrowing money for a necessity
like a house, Agich says. "The individual making the choice needs to face the question, 'What need is this
meeting?' I could die if I don't have adequate housing. One doesn't die if one doesn't have a handsome
estate... A relatively young parent who decides on cosmetic surgery but isn't making savings for retirement
may be behaving imprudently."
According to Rosenberg, the "optimal goal" of cosmetic surgery is to enhance quality of life, to "get you to
look in the mirror every morning and say, 'I like what I see.'" And that privilege, he maintains, should not
be limited to the wealthy.
The lower one's socioeconomic level, the more likely they are to be misinformed about health issues,
including the ins-and-outs of cosmetic surgery, Rosenberg says, adding that the major purpose of Barnert's
upcoming screening session is to provide reliable information from a professional.
Although the complimentary session is aimed at local residents, the majority of interest has come from
hospital staff, Rosenberg says. Eventually, though, he envisions major surgeries such as abdominoplasty - a
procedure that removes excess skin from the abdominal area - to be one of the more popular at Barnert,
since bariatric surgery and weight-loss programs are major areas of care there. (Insurance sometimes pays
for the procedure, Rosenberg says.)
"If you have a job and you have credit, you should be able to buy a home just like anyone else or a car or
any luxury item. And cosmetic surgery, let's face it, is a luxury item; it's a quality of life issue, just like
having a Jacuzzi, a flat screen TV," Rosenberg says.
Still, he adds, "One does need to be careful about depleting one's resources, either for buying a flat screen
TV or getting your face lifted."