Booster Shots

Oddities, musings and news from the health world

Category: cosmetic surgery

Study blasts lack of training in cosmetic surgery marketplace

April 2, 2010 | 11:38 am

LipoCosmetic procedures like Botox, facial fillers and liposuction are big money-makers for physicians. Not surprisingly, doctors other than plastic surgeons and dermatologists also offer cosmetic treatments. According to a new study, nearly 40% of doctors offering liposuction in Southern California had no specific surgical training.

The study, published in the April issue of the journal Plastic and Reconstructive Surgery, examined 1,876 cosmetic practitioners from San Diego to Los Angeles. Only 495 of them were trained in plastic surgery. Primary care physicians made up the fourth-largest group of liposuction providers following plastic surgeons, dermatologists and otolaryngologists.

There is no law to prevent doctors from offering these services, especially in a doctor's office (doctors need to apply for privileges to perform services in hospitals). Many non-surgeons take a course or participate in some form of limited training to perform liposuction or inject fillers. But such training is not required and is often inadequate, according to the American Society of Plastic Surgeons.

Though providing Botox or facial fillers is unlikely to be dangerous, liposuction can result in serious complications, the authors state. "We feel that the provision of such a potentially hazardous treatment by physicians with no training in surgery poses a genuine threat to the safety of patients."

Further, the authors state, aesthetic franchises have sprung up that have no association with one particular provider, making it more difficult for patients to know just who is responsible for their care.

"The practices are often named after a geographic location with a cachet of affluence,such as Rodeo Drive, Beverly Hills or La Jolla. In these practices, the practitioners are employees of the owner of the clinical facility, and are pushed to produce revenue. The divorce of the practice from the name of the responsible physician has the potential to have a profound impact on the doctor-patient relationship and how patients select a provider," the authors state.

Still, the authors say more legislation is not what's needed, calling government meddling "a guest who may never leave." They suggest more effort to educate the public on who is or isn't qualified to perform various cosmetic procedures.

I vote for whichever method -- education, legislation or perhaps both -- will protect consumer health and safety regardless of professional turf wars. 

-- Shari Roan

Photo: A woman gets liposuction on her stomach. Credit: AP Photo  /  Lauren Greenfield  /  VII

What recession? Bring on the rhinoplasty

March 9, 2010 |  3:20 pm

Botox It's good to know the economic downturn isn't leaving Americans down in the mouth -- or thick in the thigh, for that matter. Statistics released Tuesday by two cosmetic surgery groups found no lack of takers for Botox, liposuction, face-lifts and other body fixes.

According to the American Society for Aesthetic Plastic Surgery, procedures declined only 2% last year, despite the recession. The most popular surgical procedure was breast augmentation, followed by liposuction. Rhinoplasty -- nose jobs -- increased 74% in 2009, however.

The most popular non-surgical procedure was Botox injection followed by hyaluronic acid injection. Men make up 9% of the customer base. Only 7% of the procedures are among people age 65 and older.

Another group, the American Academy of Cosmetic Surgery, found its most common surgical procedure was liposuction. Tummy tucks and eyelid surgery, however, are gaining ground.

The most common age for Botox is 47, and the most common age for breast augmentation is 36. As for cost, face-lifts are more than $7,000, on average, while tummy tucks are almost that much. Hair transplants are a whopping $6,000, on average. Wow. Either the recession isn't that bad or Americans really like their hair.

-- Shari Roan

Photo: A Botox injection. Credit: Ken Hively / Los Angeles Times

Demise of Botox tax brings applause from AMA leader

December 21, 2009 |  8:47 pm
As Senate Democrats look to close debate on the healthcare bill, an epic battle that has drawn in pharmaceutical companies, the insurance industry and ordinary Americans bearing personal horror stories, American Medical Assn. President-elect Cecil B. Wilson applauded a concession on the left's part: to drop the "Botax" from the bill. 

It almost sounds too Jerry Springeresque to be part of this months-long political saga, but it's true. Plastic surgeons and Botox manufacturer Allergan beat back a 5% levy on breast implants, face-lifts and other types of cosmetic surgery. Tanning salons, hit with a 10% tax, were not so lucky: indoor salons made for easy pickings, reports said, because of the link between ultraviolet radiation and cancer.

Forget Medicare, insurance premiums or the ill-fated public option. Clearly our representatives and medical professionals have their priorities straight, and our best interests at heart.

-- Amina Khan

Old blood raises death risk in trauma patients receiving transfusions

September 23, 2009 |  4:10 pm

A victim of severe trauma who gets as little as a single unit of blood that's been stored for more than a month is twice as likely to die as an equally injured patient who gets transfused with fresher blood, a new study finds.

Red blood cells stored longer than 28 days significantly increased trauma patients' risk of developing fatal deep vein thrombosis or multi-organ failure for six months after transfusion, a team of pediatric intensive-care specialists in Connecticut reported today in the journal Critical Care.

The new study is the latest to raise concerns about rules governing the use of about 29 million units of blood transfused every year in the United States. The American Red Cross says donated blood has a "shelf life" of 42 days, after which it must be discarded if not used.

Two earlier studies -- one looking at a general hospital population requiring transfusion and a second at heart surgery patients -- found that the use of longer-stored blood in transfusions resulted in poorer outcomes. Hospital patients administered blood stored longer than four weeks were three times as likely to acquire an infection in the hospital than those who got fresher blood. Heart patients infused with blood stored longer than two weeks were 64% more likely to die than those whose red blood cells were more briefly in storage.

Though hospitals typically use their longest-stored blood first to avoid wasting the precious resource, the authors of the Critical Care study suggest that physicians might consider the "preferential use" of younger blood on the most critically injured trauma patients. The result would likely mean more blood reaches its expiration date before it can be used. But lives could be saved.

-- Melissa Healy

Chemotherapy drug a new age-reversing face cream?

June 15, 2009 |  3:19 pm

A drug used to treat deadly cancers of the colon, pancreas and head and neck may be the next new wrinkle in wrinkle reversal -- if you're willing to put up with several days of unsightly and irritated skin.

For all but one of 20 subjects (aged 56 to 85 years old) at the University of Michigan in Ann Arbor, Fluorouracil, a chemotherapy agent formulated as a topical cream, improved the texture and look of sun-damaged facial skin after subjects applied it twice daily for two weeks, reports a study published in this week's Archives of Dermatology. The subjects' own assessments were seconded by the clinical observations of the study authors, as well as by a committee of dermatologists who reviewed photos of the subjects' faces, as well as by a molecular assessment of the patients' facial skin by researchers.

But make no mistake about it: The 13 men and seven women who underwent the Fluorouracil treatment were having no day at the spa. Twelve of the 19 subjects who completed the skin regimen reported that the treatment was very or moderately uncomfortable, bringing to the skin's surface many more irritated, scaly patches of pre-cancerous skin lesions than had been evident before treatment.

 As the subjects endured itch, redness and fiery irritation, however, a biochemical analysis of their skin cells revealed they were mobilizing for an epidermal renewal. The building blocks for new layers of skin, including Type I and Type III pro-collagen, shot up. By Week 6 following the beginning of treatment, fine wrinkles appeared to relax -- a change that continued to progress at 10 and 24 weeks after treatment. By Week 10, subjects' skin was judged to be significantly softer -- and got softer still 24 weeks after treatment. Darkened "age spots" lightened as did the yellow tinge of sun-damaged skin.

"The remodeling of the dermal matrix, which follows the inflammatory phase of wound-healing, is the mechanism for the improved appearance of photo-damaged skin," the authors wrote.  By all accounts, the Fluorouracil cream had injured the subjects' skin, calling forth the body's natural defenses to rebuild it. 

"The observed biochemical changes are typical of a wound-healing response," wrote the authors.

Flourouracil has been used since the mid-1960s to treat actinic keratoses, the scaly, patchy, rough skin lesions that are a sign of sun damage and considered the earliest stage in the development of skin cancer. For cancer patients taking Flourouracil as systemic chemotherapy, physicians have noted for many years that after an initial outbreak of red, patchy skin, patients' skin texture changes to resemble the skin of someone decades younger.

Despite complaints about skin irritation and redness, 17 of the subjects in the University of Michigan study said they'd try the treatment again for cosmetic improvement of their skin. And 11 even said they'd pay for it out of their own pocket. The study was funded by Valeant Pharmaceuticals International, one of several generic pharmaceutical companies that manufactures Fluorouracil.

-- Melissa Healy

The economy is hurting our looks too

March 17, 2009 | 12:06 pm

Botox2The demand for cosmetic surgery fell 12% last year in the United States, according to statistics published this week by the American Society for Aesthetic Plastic Surgery. Nearly every procedure declined in popularity, typically by 10% to 20%. Drops were noted in all groups and genders, but the decline in procedures among men was especially stark.

"Demand for these procedures is still strong and it's still up significantly from 10 years ago," says Dr. Sanjay Grover, a Newport Beach plastic surgeon and past president of the Orange County Society of Plastic Surgeons. "But I think people are being more careful about what they're spending money on."

Locally, Grover says, plastic surgeons are reporting dips in business from 20% to 40% in the first few months of 2009.

Nationwide, even might Botox fell by 8.4% among women in 2008, the ASAPS reported, although surgical procedures declined more than nonsurgical procedures, such as injectables and Botox. That doesn't mean there wasn't a whole lot of fixing going on, however. Overall, 10,258,557 surgical and nonsurgical cosmetic procedures were reported in 2008. And, for the first time, breast augmentation was the most popular surgical procedure, outpacing liposuction for the first time. The increase in breast augmentation is likely due to the return of silicon implants to the market, Grover says. Requests for laser skin resurfacing also soared last year, reflecting the use of fractional lasers that cause patients less recovery time compared with the resurfacing lasers used in the past.

As demand wanes, prices for some procedures are dropping, Grover says. But consumers should still shop cautiously.

"Even though the economy is tougher for everybody, patients still shouldn't let price be the driving factor," he says. "It's important for patients to select a board-certified plastic surgeon who has a particular interest in aesthetic plastic surgery."

The ASAPS consists of plastic surgeons certified by the American Board of Plastic Surgery. The statistics can be accessed on the group's website.

— Shari Roan

Photo credit: Kirk McCoy / Los Angeles Times


Chart: American Society for Aesthetic Plastic Surgery

Vote early, vote often and get your freebies while they last

November 3, 2008 |  4:51 pm

Voting is a reward unto itself. Since many people around the world can’t vote, or are forced to vote in meaningless elections, it’s something we should never take for granted.

VotingThat said, some people in the health realm apparently do want to reward those casting ballots Tuesday with a little something extra. From the bottom of their hearts. Really.

Let’s start with O!burger. O!burger bills itself as "the first organic fast-food burger joint in Los Angeles," (even though it’s in West Hollywood) and is offering free 100% organic fries or fresh organic cookies with any burger order to everyone who votes, no matter who’s elected. That’s right — you could secretly back the Stay Puft Marshmallow Man and still get the healthy stuff free, between 11:30 a.m. and 9:30 p.m. on election day, providing you have that little sticker.

But that’s not all! What could be better than free food? How about discounted injectibles? Yes, a Beverly Hills plastic surgeon is offering 50% off Botox and $100 off Juvederm treatments through Nov. 15 to those who show an "I Voted" sticker. Is this a great country or what?

Dr. Payman Simoni, the doctor who’s offering the deal, says this is his way of saying thanks "to people who take this seriously."

Simoni, who became a U.S. citizen in 1997, says that in his native Iran, "We didn’t have the freedom that a person really needs," and adds that he’s always appreciated his right to vote.

This being Los Angeles, we told Simoni that he might have people lined up around the block waiting for those marked-down procedures. Maybe he should have considered free doughnuts instead.

"This is too precious to do it with doughnuts," he says.

Krispy Kreme doesn’t think so. It's offering a free star-shaped doughnut with patriotic sprinkles (i.e. red, white and blue) on Tuesday to customers with a sticker (at participating locations). Not that Krispy Kremes are the healthiest things around, but hey, they are cooked in "zero grams trans fat shortening," according to the company’s website. Not so sure about those sprinkles, though.

-- Jeannine Stein

Photo credit: Laura Rauch / AP

This bar serves booze and Botox

May 14, 2008 | 12:09 pm


Several years after Botox parties raised eyebrows, a San Diego County bar has begun holding a spa night in which patrons can order up a shot of Botox. One doctor calls it the "next not-quite-so-logical step" in society's embrace of Botoxed faces. reported last week that WineStyles Bar in Coronado has invited a doctor to deliver Botox shots one evening per week. According to the website article, the doctor will not drink during the visit and will refuse to treat patrons who have had too much to drink. These stipulations are unlikely to impress medical societies, such as the American Society of Plastic Surgeons, which warned consumers against receiving Botox treatments in nonmedical settings in a 2002 statement.

"Botox injections should be performed in a setting with appropriate medical personnel and necessary equipment to safely observe patients and deal with potential complications, as well as provide for the disposal of medical waste as required by Occupational Safety," the organization's statement says.

New York plastic surgeon Kevin Tehrani told the Los Angeles Times that Botox should be administered in a confidential setting, where a patient's complete health history is recorded; by a qualified health professional and where record-keeping, including photographs, and emergency care is available. Those medical and ethical considerations, he says, should deter most doctors from setting up shop in bars, adding a final objection: "This is not even entertaining the idea of BWI (Botox While Intoxicated)."

-- Shari Roan

Photo: Ken Hively / Los Angeles Times


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