The growing media attention paid to the married between cosmetic surgery and stem cells has been very upbeat and almost blissfully "forward thinking." PSP is no stranger to this interpretation of where we are headed -- adding stem cells into the aesthetic medicine mix sounds very promising. Therefore, it satisfies my journalistic senses when a physician offers a common-sense view of where we stand with this "marriage." From WFAA-TV: Dallas doctor uses stem cell injections in cosmetic surgery:

Dr. Jeffrey Caruth, an OBGYN practicing cosmetic surgery, started the procedure by removing fat from several parts of her body to create volume in her face and chest.
 
Under local anesthetic, she was awake during the entire surgery. Her hands were strapped down to keep her from touching the sterile area. It was a procedure Jones called painless.
 
“You know when you're hungry and your tummy is grumbling before it's time to eat, it kind of felt like that,” she said.

Caruth said stem cells help solve a problem that has plagued prior procedures.
 
“The problem has been with traditional fat grafting that you put a volume of fat into the face, the buttocks and then in a month or two or three there is significant volume loss due to death of the fat cells you put in,” he said.
 
To help the fat survive, it was injected with Jones' stem cells for regenerative purposes. Caruth used an enzyme to pull the stem cells out of her fat. A machine then created a concentrated solution of stem cells, which are injected into a fresh batch of fat for double the power.
 
“You're going to get twice the graft survival versus other methods,” Caruth said.

Jumping down the page, I appreciate the comments from Jeffrey Kenkel, MD, a well-known aesthetic practitioner who puts the whole stem cell slash plastic surgery debate into perspective:

...While he has great hope for stem cells, he said they aren't predictable enough yet to guarantee results.
 
“There is a tremendous amount of excitement about stem cells," he said. "We just don't have a lot of information about them, about how they work and how we control them to do what we want them to do."
 
Kenkel agrees stem cells will change medicine in the near future, but said more scientific and objective research is needed.
 
“Are the stem cells going to stick around and actually control how that person heals and what kind of results they have?" he said. "We just don’t' have the answer to those questions yet."

Read it all.

 

 

The media has gone totally overboard is covering a non-news story in celebrity Heidi Montag, who apparently as a publicity stunt recently allowed a plastic surgeon to perform 10 procedures on her in a single sitting. A quick blast across Google search reveals possibly thousands of news pieces on this self-absorbed woman -- one need not look any further for a bonafide example of the news media as accuser-stalker-devourer of public figures. In this case, Montag has been begging for this sort of negative publicity (which has a tendency to backfire on people).

PSP does not usually cover the shenanigans of celebrities using plastic surgery to maintain their "looks." However, there is an angle to the Heidi Montag saga that is worth covering, as brought out in this guest editorial by one of PSP's editorial advisory board members, Joseph Niamtu, DDS:

The tabloids have been ablaze about a 23-year-old B-list reality show star who had 10 simultaneous cosmetic surgery procedures.  How could a 23-year-old have any cosmetic surgery, let alone 10 procedures on the same day?

Montag responded that she is in the entertainment business and she needs these assets to ply her trade. I have to give her credit in that she actually responds quite intelligibly to the sharp pointed questions from her interviewers. She seems to see the situation no less different that an athlete who comprehensively trains in all aspects of physical demands to become and remain competitive in their sport. The difference here after all is that thousands of athletes train and that is normal, but few 23-year-olds have 10 cosmetic surgery procedures in a day.

Does she look better? The improvement was minimal by my eye, but for Heidi it was apparently like night and day.

What really looms here is the bigger question -- why does our society place so much emphasis on physical attributes that young people feel a need for major body alteration to pursue perfection? Being a cosmetic surgeon, this trend is in my best interest. However, it is nonetheless disturbing and I witness it first hand on a weekly basis.

Over the past decade, the Internet has thrust my business from a local to global platform. Whereas in the past I rarely saw patients from out-of-town, I know see many from other states and even countries. Although I consider this an honor, it also brings many young patients to my doorstep with extremely unrealistic expectations and accompanying psychological problems.

I have 20- and 30-somethings that have had 5 and 6 cosmetic facial procedures and are bent on a quest to emulate a celebrity or starlet. I recently saw a 19-year-old who wanted a browlift, a mini-facelift, and cheek and chin implants. Obviously, I refused this surgery but I really felt bad for this guy because he has severe body dysmorphic syndrome and is headed for a lifetime of unhappiness. I am no double for Brad Pitt nor do I aspire to be, but I continually see male and female patients that bring in celebrity photos and want Arnold's jaw, or Johnny Depp's cheeks, or Brittany's eyes. Not only do they bring in pictures but have also taken the time to Photoshop their own face into an anticipated outcome.

Some surgeons may relish this opportunity, but I cannot in good conscious or ethics get sucked or trapped into this situation for several reasons. One, they usually don't need the surgery. Granted, I have performed facial implants or ear pinning on younger patients, but these were procedures that could be reversed or that truly had merit.

Another reason not to operate on this young age group is that they aren't happy now and won't be happy in the future. They will be unhappy with themselves and I will by default become the next “bad” surgeon and get assassinated on the cosmetic surgery online chat sites.

I have seen numerous healthy younger patients that have been disfigured by Dr Givemeadollar and they look extremely unnatural. Don't get me wrong, some young patients will benefit aesthetically and gain self-esteem by having a nasal hump reduced or enhancing a weak chin, but these young patients are not the problem. It is the patient who is seeking aesthetic enhancement for the wrong reasons.

Some people think they are ugly and are not. Others see it as a way to gain attention and yet others have a serious issue with other aspect of their life and are attempting to compensate.

It is difficult for a surgeon to say no, but good ones do it weekly. Unfortunately there are many cosmetic surgeons with open schedules, and when a patient is standing in front of them waving money they can't say no. Most of the younger surgeons will make this mistake once or twice until they perceive the comprehensive picture of this unfortunate cycle.

Some of my patients got angry at me because I refused to operate. I have seen others who I turned down return several years later begging for correction of disfigurement from the surgeons that said yes. With experience, a surgeon can “feel” the legitimacy or lack thereof associated with patients.

As with any good detective who can tell if a suspect is lying, experienced surgeons can tell if a prospective case is or is not a good fit or surgery. I love cosmetic surgery and I love the energy and exuberance of young patients. For years, I performed a lot of reconstructive surgery on this slice of the population. I feel a responsibility for what I do and I don't want to bear the burden of pointing a young patient down a path that I would not want my own family to follow.

Back to Heidi. I frequently see patients that have their hair colored, wear colored contact lenses, wear fake eyelashes, and dental veneers; and boast tanning bed tans, breast implants, and artificial nails. Now they are seeking cosmetic surgery at an age too young. There just needs to be a basis of acceptance of one's real self. We all need to be somewhat grounded in this way – and here is where the biggest problem lies. Heidi may look hot now, but someday she is going to be saggy and wrinkled. We can't avoid it. It is all a result of having birthdays. When a person puts their entire self-esteem in physical attributes, it is a losing game because they are not always going to be attractive. They are going to age and there will be other beauties out there stealing the limelight. When all you have is artificial beauty, there is nothing to fall back on because your happiness will be temporary.

Look at yesterday's icons. We are harsh on our celebrities and idols because we expect them to be eternally youthful. When they age, the same media that put them on a pedestal crushes them for being wrinkled, grey-haired, or overweight. They have been cast from one end of the beauty scale to the other, very often accompanied by psychological problems.

Beauty is youth and youth is temporary. This is not to say that we cannot be attractive seniors; however, that type of beauty is usually well coupled with nonphysical attributes, such as self-confidence, an engaging and mature personality, and simply staying fit. High school reunions can be brutal testament to prom queens and quarterbacks who bear no resemblance to the popularity that embraced them year ago.

My message to younger patients that are wondering too far in cosmetic land is to find peace within. It is okay to improve minor distinct deficiencies, even at a younger age. But multiple cosmetic surgeries won't make up for psychosocial deficiencies. It is hard to undo bad or unnecessary cosmetic facial surgery. I have seen too many people that were unhappy with their appearance regret their actions and wish they could revert back to their natural look.

For younger surgeons who may be struggling to keep a full schedule, always remember that the best way to become busy is to make the best decisions for your patients. Be ethical, treat them better than anybody else, and say no to those who seek cosmetic surgery for the incorrect reasons. With a good reputation you will become busy the right way -- by serving your patients in their best interest.
 

Haideh Hirmand, M., FACS. a plastic surgeon who has been in private practice in New York City since 1999, has come out swinging against laser and other aesthetic device makers that have "gone the way of Big Pharma" with direct-to-consumer marketing rather than direct-to-physician. Is Non-Invasive Liposuction a Fat Lie?

None of the technologies presently have FDA approval for specific body contouring/fat reduction applications. Some are approved for dermatologic purposes for example. As a plastic surgeon who is familiar with these latest technologies, I have been excited about their arrival for a while, but I am also skeptical about how some of these machines are being marketed directly to the consumer ahead of their FDA approval and scientific data. In the old times, you had to first convince doctors that a machine worked by showing results and clinical data and then doctors offered it to their patients.

Read it all.