The Marin County Facelift Cunundrum

OK, you have decided that you want a facelift.  Easy enough, but now you are worried.  Should you have the Lifestyle Lift or maybe the Quicklift or possibly the Acculift?    These procedures can be viewed on slick advertisements with glowing testimonials on TV and in print ads.  Of course, all of these are names for facelift type of procedures.  Why are they named?  Well, it’s the new (pardon my pun) wrinkle in cosmetic surgery, the copyrighted procedure!  The government in its wisdom has, appropriately so, prohibited the use of patent restriction of any surgical procedure.  However, anyone can take an existing surgical procedure, alter it or not alter it and give it a name, which is then copyrighted.  What this means is, any doctor who performs facelift procedures, can do any procedure on you but cannot call it by the name that has been copyrighted.  Only a franchise doctor can use the copyrighted name.  This then is an advertising and promotional gimmick.  There is no secret magic to the surgical procedure.

So you ask, what is different when evaluating these cleverly named procedures?  All facelifts are not the same.  Most of the procedures currently performed were developed over many years, by a variety of contributors.  Traditionally cosmetic surgeons named the procedures with rather unsexy but descriptive names such as the SMAS  facelift, the deep plane facelift or the minilift.  Facelift procedure techniques  have always been reported upon at professional meetings and in medical journals.  Techniques evolved because of the willingness to share knowledge and to further the skill sets of both cosmetic surgery colleagues and new physicians.  In the current advertising market,  old techniques are renamed and branded as spanking new techniques that may only be performed by a select few doctors.  The truth is that any real plastic surgeon that is certified by the American Board of Plastic Surgery and a member of the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgery has been well trained in all of these techniques, regardless of whether or not he utilizes the cool new name.  The choice of which technique would most benefit the individual patient is what is truly important.  In my industry, one size does not fit all.

The facelift procedure by any name is designed to rejuvenate your facial appearance.  The problem with your facial appearance may be skin, muscle and/or neck laxity possibly combined with fat excess and/or atrophy.  Some patients may need only a skin tightening procedure.  Others may need a procedure that tightens both skin and muscle or possibly the neck bands.   Of these,  some may need an extremely limited procedure and some may need an extensive procedure to achieve maximum benefit.  The skin itself may need to be resurfaced to correct aging changes.  The facial skeletal structure may need to be supplemented with fat or a dermal filler,  or perhaps a chin or cheek implant.   The bottom line… multifactorial facial aging changes means one procedure does not serve all needs.

If you go to a heavily advertised facelift mill or copyright promoted surgeon and receive only the promoted procedure, you are generally receiving a minimally invasive procedure that does little more than skin tightening (often costing more than the same procedure with your local plastic surgeon).   The allure of many of these promoted procedures is that there is minimal downtime,  minimal cost, rapid recovery and can be done under local anesthesia.  This sounds wonderful.  It’s kind of  cheap and quick with no anesthesia risks, and I can go back to work in a couple days.  Who would not want that?  Cosmetic surgeons who are well-trained and aware of all the variables that are involved in achieving an optimal outcome, would be doing these lesser procedures without the copyrighted name on every patient,  if indeed they were all you needed.  Also,  in my many years of performing cosmetic surgery in Marin County, I rarely have seen a facelift that does not require at least a week of downtime to look socially presentable.

In some of the TV and print ads that I’ve seen  for procedures with copyrighted names, the results as shown were wonderful.  However, most often the individual in these ads  has obviously also had a brow lift, a blepharoplasty (eyelid lift) , dermal fillers,  fat removal and/or repositioning and a neck band revision.  The cost of these additional procedures  would certainly exceed the baseline advertised price.  The time involved to perform the additional surgeries would monumentally add to the  complexity of the case.  The advertised 1 hour procedure would certainly be extended to  four or five hours, making it virtually impossible to perform the procedures comfortably or safely on a patient without general anesthesia.  Is this a bait and switch?  Consider this as well, if you read the fine print on the bottom of the TV screen, the advertising physician is not the one who has performed the surgery on the individual shown.  And, your chances of getting the doctor who did perform the surgery that you are admiring are slim to none.  You have seen a great before and after that was not performed by the doctor advertised.  Also, if you have the surgery at that facility, you may never see the doctor who operated on you again.  Follow-up, even if you have problems, may be done by ancillary personnel.

If you are considering responding to ads that you’ve seen, I would ask that you first see a local board-certified plastic surgeon (names readily obtainable from the ASAPS online).  During this consultation, have the doctor explain what needs to be done:  skin, muscle, fat, fillers, resurfacing.  Ask specific questions regarding scar placement and what your anticipated recovery time will be.  Remember that just because an ad makes a claim, reality may look very different.  Make sure that you view before and after photos of actual patients that have had a procedure performed by the doctor that you are considering.  If your budget is limited, tell him what you can afford and ask what his recommendations would be.  Remember, if a surgical procedure is quick, minimally invasive, and cheap;  you usually don’t get much no matter where you have the procedure.  You may indeed benefit if you need  minimal correction from less of a procedure.  However, if the procedure will do little or nothing to correct your concerns (example:  sagging neck skin),  it is unethical for the doctor to take your money.  The maximum benefit that you will receive is best called, a wallet lift.

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Breast Lift Or Breast Augmentation, Maybe Both!

What is the best choice of cosmetic surgery procedures in San Francisco and Marin County for the woman that has sagging breasts and would like to restore or add some volume to the breasts?  A breast lift (mastopexy) or a breast augmentation.  Maybe both!

I see many variations of patients in my San Francisco Bay Area/Marin County plastic surgery practice that are primarily seeking correction of sagging breasts and often looking for  more youthful and fuller upper breasts.  Often because of pregnancy, breast feeding or simply a weight loss, the breasts begin to look flattened at the upper poles, the cleavage is much less firm and the general volume of the breast itself is greatly reduced.   At the cosmetic surgery consultation, I am often asked if a breast augmentation alone will “fill up” the breast enough to correct the sag.  The answer is sometimes.  Not a very definative answer and here is why.  A minor amount of sag in a small to medium sized breast is often correctable with an implant.  The implant diameter must be appropriately sized in order to achieve a natural cleavage.  If  too small diameter implants are placed, the breasts seem as if they are spaced too far apart.  When the implants are too large, the breasts seem very close and the breasts appear too large for the woman’s chest.  Sometimes,  the best solution is to lift the breast while enlarging it to a naturally full and youthful size again.  The desired outcome of breast augmentation is a larger breast with the nipple at a natural position.  It is not aesthetically pleasing to have a nipple that continues to point downward, even though the breast is fuller. A quick consultation can confirm the appropriate solution to accomplish the desired correction.

Recent years have also brought the advent of implants with moderate to high projection.  These are valuable tools because I often see small chested women that request large breasts.  When a standard moderate implant is used, the diameter of the implant may be too large for the chest.  The patient almost always is desiring projection rather than breasts that fill the entire chest wall.  A high profile implant will have the same amount of fill volume but with a smaller diameter.  Thus, more projection is achieved with a more natural look to the chest wall.

I perform a variety of different breast procedures but always recognize in the surgical planning that the outcome should correlate to the patients lifestyle, athletic choices and desired result.  

 

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Plastic Surgery Taxation Discussed By Terry L. Hand, MD

Help me understand this.  I choose to have a Botox injection.  You choose to have your hair cut and colored.  I save Read the rest of this entry »

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Some Thoughts About Healthcare Reform

After  a bit of a hiatus, OK four months, I am back to blogging.  Sorry about the stop and start but I realized that I did not just want to blog about current plastic surgery topics and procedures.  I wanted to share my opinions as I said I would.  Soo ….. forget about the PC safe subjects only, today I have another issue on my mind.  I’ve been following closely the national debate over health care reform.  As a practicing plastic and reconstructive surgeon, I have been amazed by some of the statements I have heard.  A couple of examples: When the insinuation that doctors perform certain medically necessary surgical procedures solely for the purpose of greater financial remuneration was made, I almost jumped out of my seat. When I heard President Obama state that if hospitals sent a patient home and he became ill 2 weeks later, they didn’t do it right and should be penalized financially, again I was livid. The suggestion that maybe the American public would have to get used to the usage of generic instead of brand named medications, only added to the absurdity of the generalized explanation of the problems with health care.  I can only speak definitively for my practice and experiences in providing health care, but I know many of my colleagues in most specialties practice the same standard of medicine as I and are hesitant at best to have this group of bureaucrats deciding the future of American health care.Â
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Doctors as a group are a hardworking and ethical group, following a standard practice of conservative care first and surgically intervening only when a non-surgical course does not or cannot solve a problem.  Sometimes, a patient is in eminent danger or the problem cannot heal itself without dire consequences.  Do I operate on folks that I don’t think need surgery, NO!  What great gain is in it for me if I do?  When I do a surgery that is insurance related, the visits within the following 90 days after surgery are considered follow-up care, as they should be.  There are no additional charges for visits (which can be frequent depending on the surgical issue) , dressing changes, suture removal, etc.  I can charge anything I want, but what insurance will pay is the real factor. Most physicians base their charges on standard billing amounts for the appropriate descriptive codes.  Medicare sets the trend for physician reimbursements and the health insurance companies follow.  How many of you have gotten the note from your insurance company that a bill is “beyond the reasonable and customary amount”?  I can’t count the number of patients that are amazed at how little I was paid given the level of time and expertise it took to put them back together.   Â
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As for the hospitals, human beings are protoplasm that is constantly changing.  Most will leave the hospital and continue to do well, some will become ill again.  There are multiple factors in recovery from any illness and some individuals will struggle because of preexisting health issues or chosen behaviors.  Think about this example, a 65 year old diabetic smoker with a wound infection.  He goes home, does not monitor his blood sugars, has a few drinks and lights up.  Oh, and he only takes his antibiotics once a day instead of 2 times.  He doesn’t come in to his doctors office for his follow-up appointment.  Guess what happens, it is the weekend and he starts running a fever and has a large red area around his wound.  He heads off to the emergency rooms to “fix it up again”.  Is the hospital at fault? Perhaps the doctor?  Maybe the patient? Regardless, if this man has insurance, he is and should be covered for this problem.  The slippery slope of 2nd guessing fault instead of accepting responsibility for the delivery of health care to an insured individual,  is one that most of us probably do not wish to start down.  What happens next?  Will it cost more for health insurance to be 10 pounds overweight, to ride a motorcycle or to have a genetic propensity for high cholesterol? 

I do believe that presidential speechwriters do alot of research and are masters of wording, but, and it is a big but, they are not physicians and neither is he.  There are many times that I believe a generic medication can be used, but often a brand named drug is the most recent addition and the most appropriate.  What is the difference?  The brand name is “on patent” for 10 years, the generic is no longer on patent.  Why does the brand name cost more?  Of course, there is profit involved, but also expensive research and development and the process of safety checking and research studies needed to gain approval by the FDA.  I and most of my colleagues understand the importance of making prescriptions financially reasonable for our patients.  Almost daily, my office deals with an insurance company that will not honor a prescription unless it is changed to a less expensive one on the drug formulary.  This is the part of health care that is broken and what does our government do?  Agree with the insurance companies!  There might be more to worry about in my opinion like the salaries of health care company CEO’s that range from a paltry 3 million to 24 million dollars a year.  Maybe if that was regulated too, we could all get the name brand medications!

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San Francisco Bay Area Plastic Surgery

Welcome to my inaugural blog! For so many years I have had the privilege of treating wonderful patients from all over the San Francisco Bay Area and beyond. My challenge has always been keeping up with new and old faces (sorry for the pun!) and making my patients aware of the latest in interesting cosmetic surgery procedures as well as what is happening in our practice. I will share with you innovative research and techniques in the plastic surgery community and my opinions regarding their value. I can most often be found with a medical journal in the evenings and have seen in my years of practice, many variations on almost every procedure. Some are time tested and true. Some are hype. I will share my honest opinions and experiences.

My Marin County plastic surgery practice provides face, breast and body recontouring procedures as well as non-invasive procedures such as Botox, injectable fillers and Latisse.  Thanks for checking out my blog, more soon!

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