While over 14 million plastic surgery procedures were performed in 2012, the types of procedures differed considerably across the various age groups. The age group of 35 to 50 year-olds makes up the highest percentage (43%) with efforts being made to slow down the effects of aging which are now unavoidable to overlook. This is why this age group accounts for almost 50% of Botox and injectable filler use. Concomitantly, the use of laser, chemical peels and light therapies are also prevalent in an effort for skin improvement and wrinkle reduction. Reversing the effects of childbearing are seen in the high number of  breast augmentations, tummy tucks and liposuction in this age group as well. The age group 51 to 64 year olds are the next highest users at 28% of the cosmetic pie. As 60 is the new 50, facial surgical procedures dominate with nearly two-thirds of all eyelid lifts, browlifts and facelifts occurring in this group. The 19 to 34 year-old age group accounted for 20% of procedures done with breast augmentation, liposuction and rhinoplasty being common surgeries and laser hair removal and microdermabrasion being the most commonly done non-surgical procedures. At the opposite ends of the age groups, the 65 and older group (9%) and under the age of 19 (1%) made up the rmaining 10% of the procedures performed.

Almost every week there are reports from somewhere in the U.S. of ‘botched’ cosmetic surgery. This does not refer to the patient who has a slightly uneven facelift, prolonged forehead numbness after a browlift, liposuction irregularities, concerns about breast lift scarring, or a dog ears after a tummy tuck. Not that these are completely trivial to the patient who has them but these are within the scope of expected outcomes from the procedure and are largely aesthetic in nature. ‘Botched’ cosmetic surgery pertains to disasters resulting in severe medical complications including death.

Some of the most recent botched surgery examples include include full-thickness scalp loss from a hair transplantation (loss of the scalp on the back of the head), hand paralysis due to severed nerves from a transaxillary breast augmentation, liver lacerations from liposuction and death from caulking compounds injected into the buttocks- just to name a few.  While the internet makes just about any story newsworthy and exposed, these are well beyond being a sensationalized story. Such tragedies would have been news even back in the days when there were only three TV stations.

At the heart of these tragic events were the qualifications of the physician, or more specifically, the lack thereof. The definition of incompetence during  a truly botched surgery is either having little anatomic and technical knowledge of how to perform the surgery (training) or technically knowing how to complete the procedure but performing it in a completely reckless manner (temporary or prolonged incompetence).  The tragedy of these botched cosmetic surgeries is that almost all of them were done by doctors who had no formal training in plastic surgery – or who received any surgical training-  or were not even licensed physicians at all. Lack of adequate, specialty-specific training is the major crux of most dire cosmetic surgery complications.

The compelling questions are 1) how can this happen in the U.S, the most regulated medical industry in the world, and 2) what can I do to avoid being the next victim? Adequate and specific training of the  physician  is the first and most important requirement for the procedure. There are some controversies regarding what constitutes ‘adequate’ training,  and there are conflicting opinions as to the differences.   For example, between a plastic and a cosmetic surgeon; in title alone they may or may not be the same – the training is reflected in whether the surgeon has Board Certification.  But a little investigation and some common sense will go a long way toward protecting yourself from bad outcomes. Few doctors-  unless they are incredibly bold- would call themselves  board-certified plastic surgeons without the qualifications to back up this claim. By the way, the validity of that claim can be quickly verifeid  (contact the American Society of Plastic Surgeons – ASPS.org) and false claims of this level of certification are typically dealt with very seriously.

The claim of being a ‘cosmetic surgeon’ is the confusing one because it is an unregulated concept. It is a general  marketing term that may imply an extension of the doctor’s basic training into cosmetic work on similar anatomic regions (reasonable training),  some training in certain procedures from a twenty-five year-old society (may be reasonable) or just a doctor who chooses to do some cosmetic ‘work’ without any real training at all (unreasonable).   Either way, their base training is not the regulated training of plastic surgery but in some other medical field. Arguments are made that some of this work is equivalent to those doctors with more formal training. That is a debate for another day. The bottom line is… don’t count on doctors to help you evaluate their qualifications.

Ultimately it is the patient’s responsibility to investigate and use common sense. Should a gynecologist be doing hair transplants or breast augmentations? Conversely, would you choose a plastic surgeon to deliver your baby simply because he or she is a physician?  Should an internist or emergency room doctor being doing your liposuction? Should an ear nose and throat doctor being doing your tummy tuck? Should an eye doctor perform your rhinoplasty?  These examples occur daily in most large cities simply because many patients are unaware of the underlying difference in training.  Choosing to have surgery with a physician who has not had the most advanced specialty training does not mean you’ll have a bad aesthetic result, but it does greatly increase the risk that you’ll have a seriously life-changing complication.  When things go wrong during surgeries as they sometimes do, a lack of knowledge may not only be what creates a problem but will make it extremely difficult or impossible to reverse what has happened.

 Beyond a doctor’s training, a red flag or warning sign is price. Low prices for cosmetic procedures are understandably attractive to prospective patients but all too often are low for a good reason. This does not mean that high prices guarantee great results or safety either. But low prices for procedures, often incredulously low by industry standards, exist to ensnare the most undiscerning of patients.  Bear in mind that medical care – whether for an elective cosmetic procedure or an angioplasty- should never be sought at a ‘bargain’ price.   An undiscerning patient who will overlook a doctor’s training to have a chance to undergo the cosmetic changes they have dreamed about. But in some cases that are becoming all too frequent, that dream turns into a nightmare.

Dr. Barry Eppley

Indianapolis, Indiana

The cosmetic surgery field continues to expand both in the number of doctors performing procedures as well as in the types of procedures being performed. Conventional cosmetic procedures, such as breast augmentation, facelifts and tummy tucks, are well known and represent a few of the mainstream procedures. There are many other niche procedures, like earlobe reduction, lip lifts and nipple reductions to name a few, that are not as well known but are also commonly done. But like everything else in life, cosmetic enhancement marches forward and new innovations regularly appear. 

I was asked recently to be interviewed on a local radio show about the internet news article which appeared on the cosmetic surgery topic of ‘Toebesity’. While normally I might not have read this article even if I came across it perusing the internet, I was actually aware of it and had read it. A friend of mine who works for an internet marketing firm had sent it to me as a joke, incredulous that such an entity could actually exist.

Toebesity refers to the surgical procedure of defatting the toes. For those bothered by a fat toe or two, they can be reduced in size. I was aware of toe shortening but not actual toe size reduction. While I am not a podiatrist or a foot and ankle surgeon and do not perform this procedure, I can not comment on its merits and the risks involved in doing it. But I am not surprised that it exists or has been developed. Ultimately if there is a concern, a surgical procedure will appear to try and change it.

The normal comment to such a procedure would be ‘who would want to do that’…or ‘someone must be crazy if that bothers them’. But what you learn with a lot of experience in cosmetic procedures is that there is no accounting for what or why some physical feature bothers people. Trying to understand the  reasons why a certain physical feature is concerning cannot be logically done by another person.. Such concerns are undoubtably muiltifactorial but are deeply emotional. How you may feel about their physical concerns is just that…how you feel about it.

This is well illustrated to me by a set of procedures completely opposite to that of the toes…skull reshaping. I perform a fair number of skull or head reshaping procedures over the pasts few years and the number is growing. These are largely not reconstructive skull procedures per se, like from a craniotomy or a traumatic accident, but are cosmetic concerns about the way their head is shaped. Such issues may be a flat spot on the back of their head, protruding brow bones or a prominent midline skull ridge to name a few. Some of these issues are obvious to outside observers while others are clearly more discreet and are more ‘internalized’ concerns.

But what strikes me about the issue of skull reshaping is the deep emotional concerns and scars that their physical issue has caused them. Patients write me and describe why they want the procedure and how much it has bothered and embarrassed them over the years. Some of these skull issues have appeared as men lose their hair or now completely shave their head, exposing the full shape of their skull. Others, however, have hair and modify their hairstyles to try and hide these concerns.

The point being is that people have physical concerns and will try to change them if a surgery exists to address it. Like skull reshaping, just because cosmetic toe surgery is new doesn’t mean it doesn’t have great emotional value to certain people. The number of people wanting toe modifications today are small, but twenty years from now the procedure may be quite common. Placing breast implants in 1969 was far from how it is perceived and practiced today. Cosmetic surgery continues to evolve and really does cover the gamut of all concerns from head to toe.

Dr. Barry Eppley

Indianapolis, Indiana

Each year more and more Americans, as well as those around the world, undergo cosmetic surgery. While there are many considerations that go into why and how one may head to the operating room table to change their facial appearance or body shape, cost is always a significant issue.Even amongst the most ardent detractors of cosmetic surgery, if cost was removed as an obstacle some would soften their opinion.

In a recent published study from Harris Interactive on behalf of Coupon Cabin, their survey study showed that nearly one fourth (23 %) of American adults said they would have cosmetic surgery if not for its costs. Not surprisingly, more women (28%) than men (18%) stated they would. The management of such costs over the past decade has been softened by the emergence of numerous health financing companies, Care Credit being one of the most well known. Such financing has allowed many to have cosmetic surgery and pay for it just like a car or major home appliance.

The impact of financing for cosmetic surgery over the past decade has been huge and is one of the major factors in the frequency and popularity of these surgical manipulations. I have seen the percent of patients who finance cosmetic surgery in my own practice change from around 10% in 2000 to over 40% by 2010. This does not include patients who pay for their surgery on their own credit cards. Whether they pay it off before interest accrues or effectively finance it by paying off over time is unknown.

But the past few years has seen the emergence of a new method of affording cosmetic procedures, the coupon. Coupons or the ‘daily deal’ has rapidly emerged as  a method for doctors and aesthetic practices to entice new patients by offering a cosmetic procedure at a lower cost for a limited time period. Popularized by Groupon, numerous clones of the same concept have rapidly sprung up. This has become particularly popular in lower cost procedures done in the office such as Botox, injectable fillers and skin treatments. According to this survey report, nearly 10% of women between the ages of 18 and 44 said they had used a coupon to help pay for a recent cosmetic procedure. Equally relevant is that an additional 22% of adults said they would consider doing it even though they had not yet done it.

Couponing, if you will, has spread from their historic use in the grocery store to cosmetic care today. Between the high costs of surgical and non-surgical procedures and the recent and ongoing economic recession, many people shop for the best deal using the coupon approach. More significant savings are usually realized on lower cost procedures (under a few hundred dollars) than more costly ones due to the overhead expenses of the providers. This is why actual surgery appears less frequently than something like Botox in a coupon sales approach.

Coupons for cosmetic procedures, while sparking great interest from consumers, is highly controversial amongst cosmetic practitioners. While the coupon company earns a nearly equal amount from the coupon sale as the provider, the doctor has to do all the work and assume all the risks of making a satisfied patient. If there is unhappiness with a coupon-generated service, the doctor must accommodate the patient secondarily not the coupon company. In addition, the theory of generating a repeat patient based on exposure to the practice because of a coupon is largely theoretical. These new coupon patients are coming in for the deal and often nothing more. Coupons do not generate patient loyalty…other than to the next coupon deal.

Dr. Barry Eppley

Indianapolis, Indiana

The interest in cosmetic plastic surgery worldwide is reflected in the increasing numbers of people who have undergone such changes over the past decade. This is not just a U.S. phenomenon but is seen in many countries ranging from Brazil to Estonia.  People are interested in looking and feeling better in record numbers. There is a lot of reasons why this is occurring from advancements in surgical techniques and materials to the internet and marketing.

There is no single reason that explains the rise in cosmetic surgery but one can not exclude the power of celebrity and star influence. Just as you read about them in the supermarket checkout counter or on innumerable internet websites, how the many stars and entertainers look and what they do commands a lot of attention. Their influence is undoubtably greatest on the young, who are the most impressionable. But many are known to those much older even if by comparison they don’t want to look like them.

In the November issue of the Journal of Adolescent Health, a study was published on ‘Adolescents, Celebrity Worship and Cosmetic Surgery’. The purpose of the reported study was to determine if young adults who admired celebrities was a predictor of whether cosmetic surgery was done later. Over 130 adults filled out questionnaires which measured their attitudes towards a celebrity that they admired and their attitude and experience to cosmetic surgery. Eight months later, they were then asked whether they had undergone cosmetic surgery. The investigators found that intense personal admiration for the body shape of celebrity was a strong predictor of future cosmetic surgery being done.

To a plastic surgeon today, this study is no surprise. In the eighteen to thirty-five year old age group, it is extremely common for a prospective patient to ask if they get the shape of a body part of a certain celebrity. Or they may use a picture or advertisement of a celebrity or model to show what they would like. Some of the most typical examples are the lips of Angelina Jolie, the buttocks of Kim Kardashian, the nose of Jennifer Aniston or the breasts of Halle Berry. Conversely, celebrities can serve as the antithesis of what a young adult wants such as the nose of Michael Jackson, the lips of Melanie Griffith, or the breasts of Heidi Montag.

While one may disagree with such attention to highly visible and well known people, their influence is undeniable. This is nothing new and has always been this way. It is only extremely evident today because of the internet and the instantaneous access to endless venues that choose to highlight them. Perhaps the coverage of poor or undesired cosmetic surgery outcomes will also serve to educate that these procedures have real risk of complications and are not as simple as airbrushing or Photoshopping one’s desired result.

Dr. Barry Eppley

Indianapolis, Indiana

The great boom in plastic surgery over the past decade has been largely spurned by the use of injectable treatments and lasers for aesthetic facial rejuvenation. This has arisen to a shift in the average age of patients seeking cosmetic changes with a younger age group than ever before. Recent statistics put forth by the American Society of Aesthetic Plastic Surgery confirms what most of us have known for some time…patients are getting younger.

According to the Society’s numbers, Generation Xers as defined by those 31 to 45 years of age accounted for nearly 45% of all reported procedures. Conversely, the Baby Boomers as defined by ages 51 to 64 accounted for less than 30% of all reported procedures. This is a major shift from a decade ago and throws out the historic perception of plastic surgery being for the older crowd.

With this younger patient population, it is now clear that Americans are thinking in droves about early treatment and prevention of facial aging. While facelifts and other true surgical approaches will always be around, much more effort in numbers is directed towards minimalistic techniques. Whether it is light therapies, fractional laser resurfacing, Botox, fillers or skin tuck-up procedures, people now want to embark on treatments early to allay the both the onset and the severity of the physical signs of aging.

One aspect that underlies much of these newer aesthetic facial treatments is skin rejuvenation. Besides light, laser and chemical peels, there has been a virtual explosion of topical agents. Many of these skin therapies have provided antioxidant, growth factor and even purported stem cell compositions. Women, and a few men, are investing in their skin early with the knowledge that they will need to make a continuing effort over their lifetime.

From a surgical standpoint, this newer generation is more body conscious than ever before. From breast implants, Smartlipo fat removal to mommy makeovers, women are being driven by the trends seen in the fashion world and Hollywood. Men, particularly those younger, want to have a more defined facial shape and athletic-appearing bodies.

One thing that is very clear in the shift to the younger ages is that patients are no longer seen as a one-time surgical effort, but rather more of a lifetime. What starts as Botox and skin care today may eventually become a tummy tuck or a facelift a decade later. This makes seeing patients as a concept over decades rather than an isolated surgical procedure. Patients should also see their plastic surgeon as a lifetime resource, providing suggestions and solutions to their aging concerns over their lifetime.

Dr. Barry Eppley

Indianapolis, Indiana

Inadequate training and poor judgment account for a disproportionate number of complications and unsatisfactory results that occur annually from cosmetic surgery procedures. With so many different types of doctors doing cosmetic surgery, how can one make a safe and wise choice? In days gone by, the use of the terms such as ‘board-certified’ and ‘specializing in’ were enough to demonstrate to the public a doctor’s expertise, but today that is not enough. Often these physician descriptors can actually be confusing and even deceiving.

I would advise potential patients to research the following categories for any cosmetic surgeon that they are going to see. Some but not all of information can be obtained but doing a little research online.

What Are They Board-Certified In?

Are they board-certified in plastic surgery or another specialty? Many new cosmetic surgeons are board-certified but not in plastic surgery. Their board certification may be in General Surgery, Dermatology, Oral Surgery or Ob-Gyn to name a few. Some may even have an additional board-certification in cosmetic surgery. But this self-created board should not be assumed to be equivalent to those certified by the American Board of Plastic Surgery. There is a significant difference between board-certified plastic surgeons and board-certified cosmetic surgeons that makes them not equivalent at all.

In established medicine, board certification is the result of doctors being educated through long-established training programs sanctioned by the American Board of Medical Specialties. This governing board sets the standards for the education, training and testing of doctors. Of the 24 recognized specialties and boards, plastic surgery is one of them but cosmetic surgery is not. Years of residencies done in hospitals under experienced physician mentors is what is needed to qualify for plastic surgery board certification. Cosmetic surgery allows one to use their basic training in any medical specialty, with or without some private training, to quality for their boards. This is why knowing whether the doctor has hospital privileges for certain cosmetic procedures is so valuable to know. (if you can access that information)

The American Board of Plastic Surgery is the only cosmetic surgery board recognized by the American Board of Medical Specialties. The two exceptions are the American Board of Facial Plastic and Reconstructive Surgery, which is a sub-specialty of otolaryngology-head and neck surgery and the American Board of Opthalmologic Plastic Surgery, which is a subspecialty of ophthalmology. This does not mean, however, that facial plastic surgeons are trained to be doing breast augmentations or ophthalmologists are trained in facelifts or rhinoplasty surgery.

How Often Does The Doctor Do Your Procedure of Interest?

This is a hard piece of information that is not easy to ascertain. Certainly asking the doctor seems the most obvious route to learning how many they have done, but that is not the exclusive source I would use. Look at their websites and see how many before and afters of the procedure are posted. Ask for before and after photographic results and to talk to some more recent patients. (done in the past 3 to 6 months) Word of mouth still remains as a good method of recommendation. Willingness to easily and quickly divulge this information is a good sign. Hesitancy or avoidance of doing so would be of concern.

The premise of asking or having an idea of how often the surgeon performs the procedure has, at its foundation, that there is some magical number. In reality, there is no specific number for any procedure but it should suggest some degree of frequency of it being performed. This will vary based on the type of cosmetic surgery procedure and how commonly it is requested and performed on a more global basis.

Is The Surgery Being Done In a Nationally Accredited Facility?

Hospitals are obviously certified and have to meet highs standards of care and comply with stringent regulations. Surgery centers can be quite different and you want to go to one that has been accredited by either the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This accreditation and a state license to operate means the facility adheres to safe and clean operating conditions. Doctor’s office are fine for minor surgery but most are not accredited for more significant surgeries and any anesthesia that may be needed.

Who Is Doing The Surgery?

I am often surprised after a long consultation that a new patient asks me if I would be doing their surgery. Not understanding who else would be (and having had this long discussion why I would let someone else do it), I have come to learn that this may not always be standard practice. In some cosmetic practices or centers, most of the interaction may be done with other people than the surgeon themselves or they may not see the surgeon until the day of the surgery. Insist that you meet with the ‘real’ surgeon before the day of surgery.

Is The Lowest Cost A Good Choice?

The cost of cosmetic surgery is always of concern and no one wants to overpay for their procedure(s). But the cost of cosmetic surgeries is influenced by market factors just like any other retail business. This makes a fairly consistent price range for procedures in any given geographic region. If after getting several consultations one price is considerably lower than another, the question should be why. Where are the costs being reduced to offer such a lower price? This is what makes the whole concept of Groupon and other discount programs for cosmetic surgery so unnerving. (or they should be to patients)

Dr. Barry Eppley

Indianapolis, Indiana

A front page article in USA today reviewed a burgeoning problem in the world of cosmetic surgery…a growing number of complications spurned by surgeons of dubious training backgrounds. As insurance reimbursements have continued downward to abysmal levels, doctors who are trained in many other medical specialities than plastic surgery are either doing or opening their own cosmetic surgery practices.

Because federal and state laws have little to no governance over what goes on in an office setting, cosmetic operations are popping up everywhere. When combined with the ease of having a professional and slick-looking presence on the internet, it is seemingly hard for the public to separate legitimate from questionable doctors and practices. With a growing age and body conscious society, there is no shortage of potential patients who are willing to spend money on a wide variety of cosmetic procedures.

We live in world now where just about anything seemingly goes. ER doctors and internists are performing liposuction, Ob-Gyns are inserting breast implants, Dermatologists are practicing facelifts and Eye doctors are having their hand at rhinoplasties, to name just a few incongruous combinations that a decade ago were unthinkable.

The unsuspecting general public understandably asks how can this be? With no oversight in a doctor’s office or in some private surgery centers, any doctor with a medical license can do whatever they want. With the allure of cash payment upfront and no interference from insurance companies which don’t oversee cosmetic surgery, little more than a doctor’s conscience separates some cosmetic operations from prospective patients.

For those procedures that require expensive equipment to perform, the manufacturers actually exacerbate this problem. They will sell any piece of equipment, lasers and liposuction machines as the most common devices, to any doctor that has a medical license regardless of their background. With such devices that cost anywhere from $25,000 to $150,000, they apparently need to expand their potential sales market. In my city of Indianapolis, I know of ENT surgeons that perform breast augmentations in their own facilities. When asking the local sales representative why would a breast implant manufacturer sell breast implants to a doctor with no formal breast surgery training, he shrugs and says we have to because that is company policy.

When you don’t have good training and a long history of satisfied patients, one of the most appealing pitches is that of a lower cost. Offering steep discounts over many board-certified plastic surgeons, lower prices help drive many non-discerning patients through the doors. With the growing discount concept like Groupon, price will continue to be a driving motivation for new cosmetic patients. But lower prices almost always reflect that the procedure will be done in the office under local or sedation anesthesia where costs can be saved. But it may also reflect that the doctor lacks adequate training and qualifications to perform the procedure in a hospital-associated or accredited facility.

While on the surface this appears nothing more than a turfbattle between board-certified plastic surgeons and cosmetic surgeons, the issues go way beyond trying to stifle competition. This is an issue of adequate training, competency, and patient safety. Being trained in a plastic surgery residency program (cosmetic surgery has no residency program and is not a recognized specialty of the American Board of Medical Specialities) assures patients that the doctor has already done his/her learning on other patients beforehand.

Dr. Barry Eppley

Indianapolis, Indiana

As of Jan. 1 this year, a new law took effect in California whose intent is to provide greater safety for patients undergoing plastic surgery.

Known as the “Donda West Law”, it is named after rap artist Kanye West’s mother who died a day after cosmetic surgery in 2007. According to reported autopsy results, Donda West died of pre-existing coronary artery disease and other unspecified postoperative events a day after she had undergone a tummy tuck, breast surgery and liposuction. The exact details of these events is not known by this writer but the surgeon who performed this surgery has apparently surrendered his medical license, suggesting there are deeper issues at work here as well.

This new law requires a physical examination within 30 days before a procedure and clearance from a doctor, nurse practitioner or physician’s assistant before cosmetic surgery is performed. In essence, this makes it illegal for doctors to perform elective cosmetic surgery without a physical examination and clearance from a medical professional.

This new law will actually change very little in most plastic surgeon’s practices because reputable plastic surgeons do take a medical history and perform a physical examination before any major procedure. But it does bring to light and reinforce several important concepts about cosmetic surgery and a patient’s preparedness for it.

First, a cosmetic procedure like Donde West went through is major surgery. It should be viewed in the same light by a patient as having a hip replacement or gastric bypass surgery. While it may not be exactly the same, the extent of the procedure does pose risks which can be magnified based on one’s medical history or pre-existing health conditions. It is therefore paramount that any medical problems be well controlled, one should try and be in the best physical condition as possible and make sure that your own physician is aware of what you doing. While the desire for privacy and discretion is understandable, this should not be done at the expense of your own health.

Secondly, while not every procedure needs laboratory testing beforehand, many do and that expense should be seen as just part of the procedure. In an otherwise healthy person (no known medical problems) under age 50, no laboratory testing is needed. This will change based on if the patient has medical problems. For any patient over 50 years of age, preoperative labs are needed and include blood work and and EKG. More may be needed if other medical problems warrant it.

Lastly, be concerned if this information is not required of you before any major cosmetic surgery. Taking a medical history and filling out such on forms is almost always the very first step you do even before you ever see a plastic surgeon in their office.

While the potential changes that cosmetic surgery can create can be somewhat euphoric when one is pondering the procedure(s), the most important consideration is your safety. If a plastic surgeon suggests that you should not have the operation or recommends a less extensive approach than you want, you would be wise to heed those suggestions. This is usually an issue in major body contouring surgery. In some cases, doing the procedure in stages is both easier and safer for you. It may cost somewhat more to do so and be an additional inconvenience to your life, but that is a small sacrifice to pay for your health.

Dr. Barry Eppley

Indianapolis, Indiana  

We are exposed everyday to incredulous claims about health and cosmetic products and services. Advertisements from radio to infomercials bombard us on the weakest aspect of our inner selves…how we look and feel. We all want to look better and feel healthier and to do it with the least effort possible. It is this cross between desire and effort that results in many retail sales that usually benefit the manufacturer or seller the most.

I saw an infomercial just yesterday on an abdominal stimulator device. Being able to read a book, watch TV, or even eat dinner while the device delivers perfect abs certainly seems appealing. With testimonials by six-pack endorsees and seeing their abdominal muscles twitch through their nearly transparent skin made even me as a physician a near believer. After all, their muscles were actually moving and surely that is more muscle activity than I can produce with a series of half-hearted sit-ups. But the price was the clincher…$14.95! Six-packs at the price of less than a week of Starbucks…how could one go wrong?

Or the radio commercial from earlier in the week where another topical potion espouses that it can make cellulite disappear…and it starts with just the first application! Atter all, it was so successful that it was given away in bags at a recent film festival. The demon of many a women’s belly and thigh skin, the search for an effective treatment for cellulite and stretch marks has been more elusive than real evidence on Ghost Hunters.

But grandiose claims about cosmetic surgery are not so apparent. Because these services are provided by physicians and always cost more than $19.95, the public’s acceptance of treatment claims is far less discriminating. The use of needles, sophisticated lasers, and  actual surgery strongly suggest that the desired outcome will surely happen.

The last decade has seen the merging of two highly compatible themes- busy lifestyles and non-invasive to minimally-invasive cosmetic procedures. The potential for big improvement in appearance with little to no recovery time is the cosmetic holy grail. The concept of a little effort (time, money, and pain) with a big result is what most patients want. But short of Botox and injectable fillers, most other hyped ‘quickie’ cosmetic treatments fail to deliver so successfully.

Lunchtime surgery and weekend recoveries, while providing some benefits, do not produce results that are as dramatic and long-lasting as many of the established and well known cosmetic surgery procedures. One really cannot get inches off one’s waistline in a few weeks without real liposuction or a tummy tuck, breasts will not grow larger with pills, and that neck wattle won’t disappear with a laser treatment or an injection. The allure of some of these procedures is much like an infomercial…promising much with little effort and cost.     

Marketing is an essential part of elective plastic surgery procedures. But when the promotional content gets ahead of proven medical science, it is almost always too good to be true.

Dr. Barry Eppley

Indianapolis, Indiana