Steven Teitelbaum, MD, FACS, is not afraid to speak his mind
By Denise Mann
Ask Santa Monica, Calif-based plastic surgeon Steven Teitelbaum, MD, FACS, anything, and he will tell you what he really thinks. This is one of the reasons that his Hot Topics segments at the annual American Society for Aesthetic Plastic Surgery (ASAPS) meetings are the industry equivalent of Must-See TV.
Teitelbaum, also an associate clinical professor of plastic surgery at the David Geffen School of Medicine at UCLA, is as astute as he is blunt, and what really gets him riled up is the hyping of gimmicks and ineffective technology in the absence of hard data.
Make no mistakes, Teitelbaum is not anti-technology. He is simply pro-evidence-based medicine and really keen on surgeon artistry and skill. “Plastic surgeons will say, ‘It’s the man, not the machine,’ but when it comes to marketing, promoting devices is more lucrative,” he tells Plastic Surgery Practice. “My tennis game won’t improve from a better racquet. It will come from practice, practice, and practice. None of the new liposuction technologies of the past decade is nearly as meaningful to the outcome as is surgeon skill.”
Unfortunately, there is still a pervasive fantasy that the answer to any problem is a “magical” new technology. “Some of this is the fault of the doctors who aggressively promote these gimmicks, much is due to the patients who have magical thinking about newfangled devices, some is the fault of manufacturers unabashedly making claims, and much is the irresponsible way some media covers the industry,” he says.
|Teitelbaum is known for his tell-it-like-it-is style.|
AS SEEN ON DR. OZ?
Today, plastic surgery is no longer a “beat,” and many news and feature stories lack appropriate, or any, context. Where there were once seasoned columnists and beat reporters who knew how to approach these stories, now there are inexperienced reporters and bloggers who are easy targets for über-aggressive publicists.
Some cast stones at TV shows like Dr. Oz and The Doctors and call them “medutainment,” but these shows are persuasive. Unfortunately, they rarely showcase a doctor’s technical expertise. Rather, they feature new technologies. “In the rush to be first, and with no experienced reporters to know better, fads can be created,” he says. “The so-called Threadlift was never embraced by experienced plastic surgeons and now is in total disrepute. No company even makes those sutures any longer!” he says. Yet they were featured on Oprah and just about every network morning news program, and a fad was born, he says.
Patients no longer look for a skilled surgeon; they ask for a particular kind of liposuction or other brand-name product. “If the doctor doesn’t offer it, they hang up and call someone else,” he says. “This pressures doctors to buy and promote these devices, and gives non-plastic surgeons a way to put their foot in the door of aesthetic surgery.”
This, of course, leads to the commoditization of plastic surgery procedures, and devalues the provider—something that many in the aesthetic arena are fighting an uphill battle against to begin with.
“If the machine does the work, why go to a qualified doctor?” Teitelbaum asks. “It allows doctors who couldn’t attract patients on the basis of their education and credentials to buy a machine and suddenly get busy.”
|According to Teitelbaum, technique trumps technology every time.|
OFF THE CUFF, AND ON THE RECORD
Allure editor-at-large and veteran plastic surgery reporter Joan Kron is grateful for this tell-it-like-it-is attitude when it comes to technology. “Everybody is so polite at these meetings, but Steve is the only one who stands up and says what he thinks,” she says. “It is a breath of fresh air. He is very passionate about what he thinks is good and bad, and he dares to disagree.”
Kron has quoted Teitelbaum a handful of times and spoken to him on deep background even more. “He is honest, and what he has to say is not so polished and prepared,” she says. “You want someone to tell you the truth. I am writing for five or six million readers, and I really have to worry about what I am telling them. I need to know if something is dangerous, painful, or overhyped,” she says. “So few people tell it in such a frank way as Steve.”
And frank he is, especially when describing how aggressive marketing is hurting patients, doctors, and potentially effective technologies in the long run.
|“He is honest, and what he has to say is not so polished and prepared,” –Joan Kron, Allure editor-at-large, on Teitelbaum|
“Wall Street-traded companies want to get in on the health and lifestyle, non- reimbursable medicine to take advantage of the aging Baby Boomers,” he says. “There is a huge amount of profit to be made in lifestyle medicine, and there is a lot more great innovation in our space because of this.”
SHOW ME THE MONEY
There’s also a lot of jockeying for position and profits. Drug and device companies have to promote to stay afloat. According to Teitelbaum, many are very good at self-promotion, maybe too good. “Companies that don’t make erroneous claims will have a hard time gaining traction.”
Part of the issue is the federal Food and Drug Administration (FDA) process for approving new devices. On the one hand, there is the Section 510(k) Clearance, which requires device manufacturers to notify the FDA of their intent to market a medical device if it is substantially equivalent to a legally marketed device. Companies can piggyback on other devices in the space, even if they are not exactly equivalent, he says. “This is too easy.”
But premarket approval (PMA), on the other end of the spectrum, is often too onerous, lengthy, and expensive. Companies are asked to submit excessive amounts of material, and the FDA takes years to give approval, which has caused a chilling effect on the development of new technology.
“It took the FDA more than 11 years to approve the latest breast implants,” he says. “The fact that American women were deprived of implants used around the rest of the civilized world for an entire decade is the least of the problems,” he says. “The real problem is that there are no other implants awaiting approval by the FDA. What company in their right mind would take that sort of risk? We’ve seen the last of improvements in breast implants for the foreseeable future.”
Something has got to give. There should be real data made available to let surgeons assess the technology before they pull the trigger, because the next best thing may end up being a practice-killer.
“The doctor is responding to what patients are asking for. No one bought a Smart Lipo because it gives a better result, but patients were asking for it.” (Don’t even get him started on this technology…)
Sure, some practices can eat the costs quicker and more easily than others. “Big offices with big patient bases have more space and staff to help do bookings and send out newsletters, and even operate the machinery,” he says.
Common questions asked of salespeople at the exhibit hall of a meeting rarely focus on efficacy and safety. “Instead, doctors will ask, ‘How much is the lease? What are the consumables? What is
my net revenue per month? Do I do it? Does a tech do it? How much do I pay them?’ ” he says. “Even if it did work, the initial motivator for purchase was the patient request.”
But there is a spin cycle, and it’s on a timer. So investing in one technology or product is only good for as long as the cycle lasts—unless, of course, it really is the next best thing.
In medicine, it’s often said that penicillin isn’t discovered every day. This discovery in the 1940s, of course, was one of the true watershed moments in therapeutic medicine.
Perhaps a similar analogy can be drawn to Botox in cosmetic medicine. “When Botox came out, we did not need patients to ask for it. We were like, ‘Holy s–t, this treats something we have never been able to treat before,’ ” he says. Other game-changing procedures include distraction osteogenesis. “We can now put pins in a kid’s jawbone and have the mom turn a little crank each day, and this replaces some facial surgery for bad deformities,” he says. “That is a huge thing.”
Microsurgery also changed the specialty. “We can reattach digits, move tissue from the tummy to the breast, but patients don’t come in and say, ‘Can I have microvascular reconstruction of a scalp defect, or a superficial muscular aponeurotic system (SMAS) lift, please,’ ” he says. They rely on the surgeon’s skill and expertise to develop and execute a treatment plan. “And when there is a real development, the surgeon will tell the patient. That cycle has been reversed with lifestyle medicine,” he says.
Another roadblock is that techniques take time to master. For example, “The biggest improvement in breast augmentation is that we can give patients a 24-hour recovery and reduce the need for revision surgery to very low levels. They don’t need narcotics, and we can have them out to dinner that night and get the capsular contracture rates down. But this demands that surgeons go back and learn, and they don’t want to do it,” he says.
BIRTH OF A SALESMAN
Some doctors will also have an easier time selling technology to their patients. “Even when these treatments don’t work, by and large, many patients are actually not disappointed. They like coming in. They like being pampered. They feel better, and feel that they look better.”
And a lot of this has to do with the surgeon and his or her staff. “If the doctor has the personality to manage the expectations, make them feel good, and give them a great experience, the patients feel good and have a positive impression of the treatment and the office,” he says. “People like to get massages even if their sore neck starts hurting again on the way home.”
It’s like a haircut in that sense, he says. “If they treat you like royalty, offer you cappuccino, and make you feel so pretty that you left with a positive feeling, you’ll go back—even if in hindsight, it wasn’t really the best cut or color.”
The opposite is also true. You can probably get a better and cheaper haircut at many hole-in-the-wall salons, but people like the buzz and energy of an expensive Beverly Hills salon.
This customer service savoir faire can really pay off. “A satisfied dissatisfied customer is the most loyal in long run because their dissatisfaction created an opportunity for you to impress them with your kindness and service,” he says.
Teitelbaum won’t play this game. “When I operate, I am comfortable managing dissatisfied patients. But with non-invasive technology, all I can do is follow the instructions. So when patients don’t get a good result, I don’t know quite how to handle it,” he admits. “Some doctors are really good at this [and] may offer discounted surgery or some free Botox,” he says. “But I don’t like seeing my patients disappointed, even if that means passing up money.”
How many surgeons really say that?
Denise Mann is the editor of Plastic Surgery Practice. She can be reached at firstname.lastname@example.org.