Until someone debunks the recently published study suggesting botulinum toxin Type A (Botox) can move from its injection site to the brain, the general public will be left to fret over the safety of the popular nonsurgical temporary treatment for facial lines and creases.

Shaken consumer confidence can lead to a fall-off in business that could extend for weeks, months, or years, depending on the cause.

Well-established aesthetic surgery practices usually come through these episodes little worse for the wear, thanks to the inoculating power of a good reputation.

However, for young, up-and-coming practices still in the process of becoming known, the consequences of a public stampeded by sensationalistic news reports can be ruinous.

Not all the time, though.

One nascent practice not likely to be wounded by the Botox imbroglio is the still-budding practice of Shirley Madhère, (pronounced Muh-DAIR), MD, in New York City.

In addition to a retinue of invasive face and body work, Madhère—who launched her solo practice, SoHo Aesthetics and Plastic Surgery, in 2003—also performs Botox injections. She notes that some of her patients have expressed concerns about Botox safety.

To their delight, though, Madhère can offer them alternatives to Botox.

Madhère is a young leader of the movement to complement conventional plastic surgery procedures, such as Botox injections and breast augmentations, with homeopathic treatments.

“The idea is to improve postoperative recovery, better control pain, and avoid complications by taking a more holistic approach with patients,” she says.”By blending conventional and complementary approaches, it’s possible to harmonize aesthetics, wellness, and form-and-function, and, in so doing, optimize patient care and maximize outcomes.”

The holistic approach, she explains, encompasses homeopathy along with yoga, biofeedback, megavitamin therapy, acupuncture, and other means “to help achieve restoration, wholeness, and greater health.

“It’s an alternative strategy that focuses on the state of the whole individual, and explores all aspects of a person’s health—mental, environmental, social, cultural, psychological, and physical. It aims to balance the mind and the body with external forces to help the body heal itself.”

“APPROPRIATE” MEDICATIONS

As with allopathic medicine, homeopathy is an FDA-regulated system of treating illness, Madhère notes.

“The key difference is it uses minute doses of natural substances to assist the body in self-recovery, a process based on the law of similars, in which like cures like,” she says.

“Homeopathy stimulates the body’s innate defense mechanisms and restore homeostasis when that natural state is threatened by disease,” she adds.

Figure 1. Madhère aims to complement conventional aesthetic surgery procedures, such as Botox injections and breast augmentations, with homeopathic treatments.

Homeopathic substances include plant and animal extracts, sometimes administered with vitamins, minerals, and/or small doses of traditional medicinal agents, Madhère explains.

Doses are highly diluted, so toxicity is a virtual impossibility, she adds.

A somewhat extensive pharmacopeia exists for homeopathic medications. Madhère uses only about a half-dozen of such medications in her practice.

“Those that I’ve included in my armamentarium,” she says, “are the ones that have applicability to skin issues, surgery, and wound healing.”

One is arnica montana, a substance derived from a flower that normally grows on the cooler mountains and plains of Europe.

Madhère gives it in oral pellet form preoperatively to help decrease the incidence and extent of swelling and bruising.

“Independent clinical studies have demonstrated the effectiveness of homeopathic arnica montana in reducing ecchymosis after surgery,” she says.

Another of her favorites, Gelsemium, has been shown to help reduce anxiety. This, too, she administers preoperatively.

She also uses graphites and Staphysagria in combination to promote wound healing and scar formation.

Madhère offers Bellis perennis to her breast and abdomen patients for reducing swelling and muscle soreness, as well as facilitating deep-tissue healing.

After performing a blepharoplasty, she routinely gives homeopathic eye drops (Optique 1) to relieve the sensation of dry eye and foreign-body feeling. Calendula ointment is a hypotensive, antiplatelet, anti-inflammatory, antiseptic, antibacterial, antifungal, and antiviral derived from the garden marigold Calendula officinalis.

Madhère uses it to help treat skin irritations and minor burns following chemical peels, laser resurfacing, and dermabrasion.

Additionally, she sometimes employs a phosphorus preparation to prevent postoperative nausea and vomiting. (This is important because these events can induce hematoma after breast augmentation or, in facelift cases, bleeding and subsequent flap-tissue loss.)

“Patient satisfaction is usually very high with homeopathic medicines because there aren’t any side effects, they’re inexpensive, no prescription is necessary, and they’re easy to take or apply at home,” she says.

WROTE THE BOOK

Madhère’s interest in homeopathy traces to the time before she entered practice. Behind her: a plastic surgery residency at New York’s Albert Einstein-Montefiore Medical Center and fellowship training in aesthetic surgery at the New York Eye and Ear Infirmary.

However, Gotham was still digging out physically and economically from the 9/11 attacks on the World Trade Center towers, which had occurred less than a year earlier.

Given the mood in the city, during that time, Madhère thought it was not the ideal time to open a practice.

She decided instead to indulge her love of foreign travel while waiting for life in New York to return to normal.

One of her destinations was France (Madhère speaks the language fluently). While enjoying her Gallic holiday, she ran into a fashion model friend of hers who, in the course of conversation, casually mentioned a Paris clinic engaged in mesotherapy.

Figure 2. Madhère sees patients primarily in an office she shares on the second floor of a West Broadway building in the SoHo district of Manhattan.

Madhère had never heard of mesotherapy, but was intrigued enough to look into it. This quest for knowledge led her first to a physician in New York who was a mesotherapy practitioner and later back to France, where she met with the foremost experts in mesotherapy for further instruction.

This was followed in short order by training and, ultimately, collaboration.

Mesotherapy, she explains, employs multiple injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients into the subcutaneous fat or mesodermal tissues, depending on the indication.

French physician Michel Pistor pioneered the process, which has been in the public consciousness since the late 1950s. France’s Academy of Medicine—the approximate equivalent of the American Medical Association—accepted mesotherapy as a legitimate specialty in 1987.

More than 15,000 physicians worldwide, but especially in Europe and South America, practice mesotherapy.

However, in the US medical community, skeptics abound. Many physicians have questioned mesotherapy’s safety and efficacy, noting a dearth of scientific evidence in support of either.

Upon her return to New York and following the 2003 launch of her practice, Madhère did not attempt to build her brand around mesotherapy. She did, nonetheless, find it a potentially beneficial adjunct in aesthetic surgery.

“At first, I offered at no cost a very holistic treatment called Vitaglow, which involved microinjections of vitamin infusion all over the face,” she recalls. “I did this for a number of patients who presented with concerns regarding facial aging. The results of this treatment are subtle but appreciable. But I remember being a bit apprehensive at first about how well it would be accepted by my patients.”

The first time she used the treatment on a patient, “I received a phone call from her just a short time after she left the office, and she was calling from a taxi,” Madhère says.

“She gave out this deep gasp. Right away my heart stopped, and I’m thinking she must have had some truly horrible reaction to the injections. But, no, that wasn’t what happened. She said ‘My face is gorgeous. I can’t believe this. This is amazing.’ “

Needless to say, soon Madhère’s Vitaglow treatment was one of the most in-demand services at SoHo Aesthetics and Plastic Surgery.

Figure 3. Madhère’s holistic approach encompasses homeopathy along with yoga, biofeedback, megavitamin therapy, acupuncture, and other means.

Today, Madhère travels to Paris at least twice per year to attend mesotherapy conferences and other continuing education offerings in order to ensure that her knowledge and skills remain top-notch.

“It’s something I do because I feel I owe it to my patients,” she says. Her expertise is now so broad and deep that mesotherapy conference-goers have been learning from her.

In addition to being asked to give presentations, she was not long ago invited by a London-based publisher to assemble and edit the first English-language textbook on mesotherapy, Aesthetic Mesotherapy and Injection Lipolysis in Clinical Practice (Informa Healthcare; 2007).

“I collaborated on the book with mesotherapy authorities from around the world, which made it a great experience,” she says.

WHY GO SOHO?

For Madhère, mesotherapy provides a bit of an edge in the hyper-competitive Manhattan market.

Other services she offers include breast augmentation (reconstruction and reduction); cellulite management; chemical peels, dermabrasion, laser facial resurfacing and general skin care; ear and eyelid surgery; forehead and eyebrow lifts; facelifts, as well as facial and body implants; fat injections; injection lipolysis, conventional liposuction, and postbariatric body contouring; hand surgery; gynecomastia; rhinoplasty; scar revision and tissue expansion; skin tumor/mass removal; and tummy tucks.

Madhère sees patients primarily in an office she shares on the second floor of a West Broadway building in the SoHo district.

“I decided to be in SoHo not because I thought it would give me better access to patients, which it doesn’t,” she confides. “Many of the people in this arts-oriented downtown neighborhood don’t put much stock in going under the knife or having injections to look young. The main reason I’m in SoHo is because it’s young, modern, and fresh. I relate to this neighborhood and the people. It’s a place that makes me feel good to come in to work every day.”

Madhère has made plans to move from her current location to a comparably sized office just a few blocks away. Still in SoHo, it too is a second-floor space and measures about 2,300 square feet, but will be dedicated for her use only.

Her new place will be awash in a color scheme of natural neutrals and comforting earth tones punctuated by serenity-inducing plants and a waterfall.

“Interior design matters to me, and I know it matters to many of my patients,” she says. “The new office has more of a Zen aesthetic.”

The new office, as with its predecessor, lacks surgical facilities. Accordingly, Madhère performs procedures minor and major at a secondary office/ambulatory surgery center on E 69th St, between Park Ave and Madison Ave on the Upper East Side.

Occasionally, Madhère makes house calls. “I go to where the patients need me to be,” she says, indicating that her mobile medical service is essentially confined to performing Botox and filler injections, chemical peels, or facial vitamin injections.

These patients “are a day or two away from attending a major social event and need to look their absolute best but can’t squeeze in the time for a last-minute plastic surgery office visit,” she notes. She remains very selective about which patients receive this service.

At first, she decided that physicians don’t go to patients; that’s not the way things work. “But my patients were insistent. And I finally asked myself to listen to what the consumer was expressing. That convinced me this service would be helpful,” she says.

Madhère also quickly realized that such a service would be feasible only if it were provided sparingly.

“My priority is to take care of patients in-office, with full and appropriate medical capability, so the making of house calls has to be coordinated around the priority of my office schedule,” she adds.

Nonetheless, the house-call service—and the accessibility it represents—comports well with Madhère’s formula for success.

See also “Homeopathy in Plastic Surgery” by Shirley Madhère, MD, PC in the October 2006 issue of PSP.

However, in her estimation, success is not something measured in terms of income and office size. Rather, it is quantified on the basis of the intangibles, such as job satisfaction, personal balance, and inner peace.

“I’ve been on an incredible personal journey,” Madhère says of her livelihood. “I see plastic surgery as something very spiritual. It’s easy to forget that aspect of what we do. Economics, politics—those sorts of things tend to crowd out what’s most important about our profession.” That is a big reason why Madhère has embraced the holistic approach to aesthetic. From all appearances, it serves her—and, most importantly, her patients—very well.

Rich Smith is a contributing writer to PSP. He can be reached at [email protected].

Dance with Me

Prior to medical school at Dartmouth and Brown universities, and even before undergraduate course work at Boston University, Shirley Madhère, MD, was a promising young ballet dancer.

“Dance was what I thought I wanted to do with my life,” she says.

As much as she enjoyed the art form, it left her intellectually unfulfilled. Moreover, she knew that any career she might have in ballet would last only as long as her legs held out.

(For most professional ballet dancers, lower-extremity muscle strength and bone-and-joint integrity degrade after about a decade or less on stage.)

Madhère discovered that to be the gospel truth—a year or so into medical school, she developed chondromalacia patella and was forced to hang up her pointe shoes for good.

Nevertheless, ballet served a purpose in Madhère’s life. “It was the beginning of my appreciation of the human body—the ability to express beauty and the limits to which you can and can’t push that expression,” she says.

Madhère’s decision to become a plastic surgeon was reached well into her general surgery residency training, after first having contemplated specialization in pediatrics and then surgical gynecology.

“Something I learned about myself was that I needed to be in an environment where there would be robust, two-way communication between doctor and patient—communication being absolutely essential in order for me to understand how to help my patients,” she says. “I discovered that communication on this level was at the heart of plastic surgery.”

The creative aspect of aesthetic surgery attracted her as well. “I liked the idea of helping improve people’s lives with my hands,” she says.

It helped, too, that the physicians she encountered during her plastic surgery rotation were upbeat and patently satisfied with their jobs. Moreover, they were supportive of Madhère, offering her encouragement every step of the way.

HOSPITAL HOPE

Madhère comes from an affluent extended household, in which everyone seems to be a left-brained analytical type. “My family—they’re accountants, bankers, engineers. Numbers people,” she muses.

Her family originally lived in Haiti. Shirley Madhère is part Haitian, Italian, and Spanish, and can claim as relatives Brits, Swedes, Pakistanis, and others.

She was born in that Caribbean island country, but grew up in New York City from the time she was 1 year old.

“We lived for short periods in Queens and then Brooklyn before moving to Manhattan, where I spent most of my childhood,” she says.

Although her dancing days are over, Madhère’s love of ballet and the other terpsichorean arts has not diminished in the least.

Her other interests include travel and fitness (yoga and Pilates being her primary means of achieving the latter). She is a voracious reader with a seemingly unquenchable thirst for knowledge.

In addition, Madhère has a heart for philanthropy and hopes to one day open a hospital in Haiti for the poor and needy.

“I’ve been back to Haiti a number of times for weddings and other family events,” she says. “It has an effect on you to grow up in privilege in the United States and then make periodic visits to a country where there is widespread hardship. You learn from that to know what’s truly important and to value it. And one of the things I value is helping people.”

In one of her plans to generate the funds needed for the hospital project, Madhère would construct a resort medical spa right on the Caribbean Sea. Such a facility would be patronized by the wealthy—the wealthy of Haiti, if Madhère has her way.

“Even though there is much poverty there, Haiti also has a sizable population that has plenty of disposable income,” she claims.

“If they come to my medispa, I hope to be able to use some of the profits to seed a foundation that would pay for construction of the hospital and a nursing school. I think it’s important that the hospital be initiated with at least some of the money that comes from Haiti itself.”

—RS