Top Ten Famous Quotes about Beauty

At the end of the day, plastic and cosmetic surgeries are about beauty. Consequently, a solid 85 percent of patients receiving cosmetic plastic surgery are women.

The remaining 15 percent are guys who don’t care about beauty. Being guys, they are more concerned about the times when beauty was in the eye of the beer holder.

Take a look at what some of our most clever thinkers and writers have envisioned about female beauty. (Verses about so-called “male beauty” are never written because their visions are always too bleary.)

10. “I'm tired of all this nonsense about beauty being only skin-deep. That's deep enough. What do you want, an adorable pancreas?”
-Jean Kerr

9. BEAUTY, n. “That power by which a woman charms a lover and terrifies a husband."
- Ambrose Bierce

8. “Sex appeal is fifty percent what you've got and fifty percent what people think you've got.”
- Sophia Loren

7. "Did my heart love till now? Forswear it, sight! For I never saw true beauty until this night!”
- Romeo when he first sees Juliet

6. “Whatever you may look like, marry a man your own age -- as your beauty fades, so will his eyesight."
- Phyllis Diller

5. “If truth is beauty, how come no one has their hair done in a library?"
- Lily Tomlin

4. "Competence, like truth, beauty and contact lenses, is in the eye of the beholder."
- Dr. Lawrence J. Peter

3. “Beauty is only skin deep, but it's a valuable asset if you're poor or haven't any sense.”
- Kin Hubbard

2. “Never purchase beauty products in a hardware store."
- Miss Piggy

1.” She got her good looks from her father. He's a plastic surgeon.”
- Groucho Marx

The Top Five Strangest Spa Treatments

Caviar, Chocolate, Tea and Beer Hops

Beauty treatments seem to use up everything in the above average kitchen, including green and white tea, newspapers (The Aqua Vitae Spa in New York City offers a “Page Six Facial!”) Dead Sea salt, chocolate and beer in addition to “scrubs” using Bikini Sugar, cous-cous, sesame, ginger and sugar maple leaf.

Question: how did everybody get so dirty? And doesn’t scrubbing with soap and hot water work any more?

Anyhow, we’ve surveyed the offerings used in some day spas and medispas and found the following:

5th Strangest Spa Treatment: Beer pedicure

The Exsalonce Spa in Chicago says it will revitalize your tired dogs and even “work wonders” on calluses. Seems like a real strain on a vital and complicated system of supply at time when huge supplies of beer are urgently needed during the very height of football season.

4th Oddest Spa Treatment: Egyptian Mud

The MiSpa in Chicago imports mud from Egypt, presumably from the Nile River, and slathers it all over their clients’ bodies in the name of health. Meanwhile, Egyptians are laughing up their sleeves because the Nile has always been used for a sewer and they were stumped on how to get rid of the polluted mud until somebody offered to buy it.
Meanwhile, in Calistoga, Califonria, Mud Mujita is said to relieve the rigors or jet lag at Spa Solage’s mud bar.

3rd Most Off-The-Wall Spa Treatment: Chocolate Manicure

Offered by the DeFranco Spagnolo Salon in Great Neck, N.Y., the chocolate manicure is for when you are feeling like something sweet but you don’t want it to melt in your hand. Instead, it just melts all over your fingernails.

2nd Most Unusual Spa Treatment: Sweet Cheeks Derriere Facial.

The Detroit-area Euphoria Spa gives your other cheeks -- the ones you sit on -- exfoliation, then applies a masque, waxing and wraps it up with a warm paraffin treatment. Questions: After all that trouble and expense, do you really want to sit on it? And hide it? The YOUnique Medical Spa in Santa Monica, California, refers to this as “Booty Buffing,” which is a required process to -- and I quote -- “get your booty bikini and mini-dress ready.”

And the Number 1 Oddest Spa Treatment: Caviar Pedicure

Spa Newbury in Boston offers this tasty treat. Now, caviar probably will never replace more vital and substantial nutrition schemes like potato chips.

Nonetheless, some people like caviar on a cracker with lemon juice and some champagne. Or, you can do the next most obvious thing and just rub it all over your feet.

The spa’s owner seems to think caviar is somehow related to the skin on your feet and may nourish your tootsies. Or, perhaps there’s a cushioning effect while walking on caviar. It’s never worked for me because the little fish eggs always break, allowing gooey stuff to ooze out and totally mess up my socks.

It looks like a creature that got all mixed up going through Jeff Goldblum’s transporters in his version of the 1986 movie, The Fly.

But some of the most far reaching work by plastic surgeon researchers use hairless mice to grow human ears and noses. (NOTE: This is NOT PhotoShop. These are genuine scientific data!)

Scientists are asked to tip-toe around this lab mouse that is extremely sensitive to loud noise, thanks to the size of his extra ear.

Why do this at all? Some children are born without ears. Plus, new artificial noses are used for accident victims and, well, frankly, for people who have unwisely had too much plastic surgery on their snoozes. (Are you paying attention, Jacko?)

The best part is that the host mouse lives on once the new ear is removed from its back and sewn onto a human. The research takes place at the University of Massachusetts. Read more about how scientists grow human ears for donation on mice.

The November issue of the journal, Annals of Plastic Surgery, features an up to date comprehensive review article on the state of research involving issues of safety surrounding silicone gel breast implants. Researchers from the Vanderbilt University Medical School-Ingram Cancer Center review several hundred related studies to produce this magnum opus. A story interview the lead researchers can be read on the Vandy News Service here.

This "snapshot" is the most thorough review of this topic since the landmark 1999 Institute of Medicine report and addresses the ongoing epidemiology studies thru the Fall of 2007. The body of literature continues to be remarkably consistent in that the weight of the epidemiological evidence does not support a causal association between breast implants and breast or any other type of cancer, definite or atypical connective tissue disease, adverse offspring effects, or neurological diseases.

From lead author, Dr. Joseph McLaughlin,

Few implantable medical devices have been investigated for safety hazards more extensively than silicone gel-filled breast implants,” said McLaughlin. “For almost three decades researchers around the world have been conducting in-depth studies on the health of women with implants to determine if there are significant health risks. The evidence is clear that implants are not linked to serious disease.”

An increased suicide rate from patients implanted 20-30 years ago has been the only consistent finding across several large follow-up studies. I've touched on that issue before on Plastic Surgery 101 (read here) on how inferring causation is likely incorrect as epidemiology suggested significantly higher psychiatric co-morbidity among women in those studies from the 1960's to early 1990's (so you'd expect higher suicide rates/attempts). I cannot imagine how you could ever effectively study this subject prospectively, particularly in the United States where medical records aren't centralized. Confusing things even more I'd submit is the recent rise in the United States of pharmacological treatment with mood-altering drugs (Prozac, Daypro, Xanax, anti-depressants, ADHD drugs, weight-loss medicines, etc...) for people who don't have classic or formally diagnosed depressive disorders. I see women (and men) all the time on such medicines prescribed by their family doctor or internist who would not meet strict medical criteria for what they're medicated for.

It would seem to me at this point that the most important issues left to characterize about existing silicone implants would be:

  1. Late rupture rates - what can we expect durability-wise at 12-15+ years out?
  2. Suicide rates - how to most effectively screen out unstable patients?

Nip/Tuck Joins Us On Rodeo Drive

Nip/Tuck is joining Rodeo Drive Plastic Surgery on our famous street. This is truly a case of fiction meeting fact: We are the only real-life plastic surgery center on Rodeo Drive and now TV's most famous fictional plastic surgeons are coming to our location.

I imagine the writers on the show chose to move to Rodeo Drive for the same reasons we built our plastic surgery center here. The street represents style and glamour, perhaps like no other in the world. We try to bring the same sense of luxury, great service, and innovation to plastic surgery that our neighbors bring to fashion and shopping. It will be interesting to see the storylines that develop around this theme. While we love being here and our patients seem to enjoy coming to see us here, it does appear certain that the plotlines will be pretty far afield from what we see day to day here at Rodeo Drive Plastic Surgery doing Beverly Hills tummy tuck and other procedures..

Nip/Tuck does have some pretty outlandish goings-on. It will be fun to watch. But it is probably for the best (both for our doctors, staff, and patients) that in some ways real-life is different from fiction. After all, who wants to get a Beverly Hills facelift and during their recovery encounter the sorts of strange twists and turns that befall people on television.

Stay tuned!

Spatial Perception - Is your surgeon left or right brained?

At right is the mind-bending work, Bond of Union, by M.C. Escher , who made a career of challenging his audience's spatial perception. I thought about this artist when I was thinking/daydreaming about how to make better incisions for tummy tuck operations on weight loss patients. The key to those operations is trying to figure out ways to equalize differing lengths of skin with your incision over a cylindrical object (your trunk) while compensating for it's movement and elastic properties.

I saw reference to spatial relations and how we percieve them on theFreakonomics blog. Freakonomics was a best-selling book in 2005 written by a University of Chicago economist who applies economic models to mundane things which will leave you thinking about things like you never did before.

The picture below links to an animation of a dancer rotating which is supposed to be a proxy for whether you're left or right brain "dominant".

Left brainers (who see the dancer rotating counter-clockwise)are supposed to be stereotypical logic-oriented, better at math and 3-d spatial relations, and overall more conservative.

Right brainers (who see the dancer rotating clockwise) are more intuitive, imaginative, risk-taking, and artistic-minded.

Click on the picture to start the animation in a new window.

They say you can make yourself reverse the spin you perceive if you concentrate properly (much like the state you have to get in to see those "magic picture" images). I see the dancer going clockwise most of the time, and I'm pretty convinced that the image reverses itself on some interval to see it the other way.

I'm dismissive of the right vs. left brain dichotomy, at least in a rigid view of it. There's philosophic debates in Plastic Surgery about measurements versus "artistic taste" when performing procedures. I find that argument tedious. Much like an artist, athlete, or even a pool hustler we actually do process these spatial and ma thematic relationships internally, so in some sense it's all about the math. Recording or marking that (when possible) seems likely to achieve reproducible, predictable, and quantifiable results. Complicating all that analysis is that in Plastic Surgery are the variables that are outside of our control - scarring, contracture, elasticity, gravity, atrophy, and motion.

We noticed the wonderful article about men’s fashions on another hip blog, Beauty Chat.

It just so happened that some recent news about women’s fashions came our way. In particular, cosmetic surgery T-shirts.

You know something has really caught the fancy of the public when a street or a sandwich is named after it.

But that same item is as firmly established in the American culture as the 4th of July, Billy the Kid or the Liberty Bell when its name appears on a T-shirt.

Cosmetic surgery T-shirts were created by CosmeTees, a firm where designer and owner Lee Dequeira of Philadelphia observed something noteworthy about people who have plastic surgery.

They blab about it. While we ordinary mortals blithely stroll the malls with, say, plaster casts on our newly straightened noses, or huge bandages swathed around our heads due to freshly pinned back ears, celebrities do everything possible to hide their surgical rejuvenation.

(I Love My New Boobs, a toned down Tee for the less ostentatious.)

You’ve seen it all before where the celeb watchword is deny, deny, deny. Nobody uncovers this trend better than the blog awful plastic surgery.

(Here’s an example of the expressions on the Tee)

So Lee got to thinking. Why not just go with the Everyman flow and, since you’re telling anybody who will listen about your recent nip ‘n’ tuck, just boldly announce your enhancement on a special Tee? Like another one, just below:

Once you see the all-black Tees with the words spelled out in glittering rhinestones, you might get the shirts are intended to be brash. So the Tees don’t so much announce your rejuvenation surgery as shout it. The fashionable shirts go for $39.95 a pop.

So-o-o-o-o, depending on your particular surgical rejuvenation, you can wear a Tee that offers additional bold and brash statements, including:

• “Nipped/Tucked in the USA”

• “My PS is Better than Your PS (Plastic Surgeon)”

• ”I’m Under Construction”

• “It’s All About Me”

• ”Work in Progress”

Top Five Urban Myths About Plastic Surgery

Has anyone ever told you an outlandish story, saying it happened to an uncle or a friend of a cousin while absolutely swearing it’s true? But it seems you could never track down the source of the story.

All too often, these told, retold and told yet again stories are urban myths. They just did not happen even though everybody believes them.

Consequently, we’ve set the filter to high on our high-tech plastic surgery news gathering gizmo and have uncovered the top five urban myths about plastic surgery.

PLASIC SURGERY URBAN MYTH NUMBER 5. Cher had her lowest pair of ribs surgically removed so she would have a true hour glass figure and tiny waist.

REALITY: Cher admits to having a lot of plastic surgery on her breasts and face but the ribs are really off limits. Other stars who have also been rumored to remove a rib or two include: Elizabeth Taylor, (“Hanoi”) Jane Fonda, Tori Spelling, Pamela Anderson, Janet Jackson and Britney Spears.

PLASTIC SURGERY URBAN MYTH NUMBER 4: NASCAR champ Kurt Busch had trouble getting his crash helmet on so he had an operation to pin his ears back.



REALITY: While Busch’s helmet always fit just fine, thank you, Kurt did have otoplasty, cosmetic surgery on his ears just because he has always wanted to look better. Plus, he was getting married soon. Weddings probably cause more plastic surgery than all the television shows about cosmetic plastic surgery combined. It’s because wedding pictures are handed down for generations. Well, in at least 50 percent of the cases, if you factor in the current divorce rate. (My own thrifty, Great Depression survivor parents just took scissors and cut the despicable bride from the wedding pictures after the divorce.)

PLASTIC SURGERY URBAN MYTH NUMBER 3: If you can donate skin from your tummy tuck to the Shriner’s burn center for skin grafting, the Shriner’s will cover the cost of your procedure.

REALITY: Not true. For more about how urban myths can turn into an absolute flood of bogus email, stay on Dr. Oliver’s most excellent website, Plastic Surgery 101 and read about the numbers of misinformed people who write in on this topic.

PLASTIC SURGERY URBAN MYTH NUMBER 2: 73-year-old former astronaut Buzz Aldrin -- and the second person to walk on the face of the moon --recently had a face lift so his death mask would look handsome and because, if selected for a postage stamp, he would look good there, too.

REALITY: Buzz had a face lift O.K, but it had nothing to do with a death mask or postage stamps. Buzz says he has a “trophy wife” who is actually his same age but looks much younger. The moonwalker especially wanted his “droopy jowls” to look firmer.

AND THE TOP PLASTIC SURGERY URBAN MYTH: (that almost everybody believes!) A huge, muscular man had a hard time texting on his new iPhone due to his huge hands so he had plastic surgery on his thumbs to make them skinnier. Below, a six- footer grabbed onto the hand of the surgery patient in question just to show just how big his hands really are. And check out that giant thumb!

REALITY: Never happened. Plastic surgeons don’t offer a “thumioplasty” because there’s nothing to remove, lift, augment, nip or tuck. You need everything on your thumbs just where it is, exactly like Mother Nature designed it.

The Boston Herald last week did a "gee whiz" piece on a dermatologist(!) promising to start performing breast enlargement via fat grafting despite the fact that there is no literature documenting it's either safe or effective. Over the last year I think I've mentioned this idea once or twice commenting on some of the technology evolving to better harvest stem cells from liposuction aspirate.

Irrespective of whether it's appropriate for your average dermatologist to do large volume liposuction (which is required for harvesting the graft material) and go anywhere near your breasts, there's a couple things that are really troubling with this.

1. Is it a good idea to out pleuripotent stem cells in a cancer prone organ like the breast?

2. What's the effect on mammograms from (inevitable) areas of fat necrosis?

3. Does fat grafting and the internal breast tissue scarring/distortion that will result, prohibit conventional techniques for breast surgery from being performed?

4. Can touch-up grafts be successfully done?

5. Can predictable volumes of graft be obtained in a material (fat) who's success rate traditionally hovers around 50%?

6. Has this doctor established an IRB (internal review board) protocol for this kind of human experimentation (which is what this is?)

Call me a cynic, but I find it unlikely that these kind of issues have really crossed the mind of this dermatologist from the rather flip quotes in the newspaper story. Fat grafting of the breast has a role in the armatarium of breast surgery and is being studied, but "cowboy medicine" like this article describes sticks in my craw. Fat grafts for primary breast augmentation is a subject that demands carefully designed multi-site studies.


Back in 1962, a 30-year-old Texas woman allowed doctors to surgically place silicone implants into her sagging breasts. But the patient really wanted her large ears reduced. The patient, Timmie Jean Lindsey, then a young housewife with six children, agreed to go ahead with the breast procedure if the surgeons would later perform an otoplasty, the ear pinning operation.

The Daily Mail in London recently told Timmie Jean’s life story and showed the very first before and after breast augmentation photos.

Read more about the world’s first breast enlargement with implants.

PS 101's break from serious stuff - featuring Travis

I've got about a dozen half-finished blog-post drafts laying around. I;ve decided to take the easy way out today and do a quick hitter.

If you've never heard of the British band, Travis, you're missing out. It's ironic that prior to hitting the big time, Coldplay was considered too derivative of Travis to make it. The video for their single "Closer" is absolutely sublime and features a cameo appearance by actor, Ben Stiller.

Click on the image below to watch Travis' "Closer" via the magic of You-Tube.

This should have been a big hit stateside for Travis IMO. It really reminds of the wonderful Spike Jonze-directed video for Weezer's "Buddy Holly" from the mid-90's. To sample the body of work of Spike Jonez see Wax's "Southern California", Levi's jeans "Tainted Love" commercial, Fatboy Slim's "Weapon of Choice" (featuring a tap-dancing Christopher Walken)

Blog Watch

Read the Beauty Chat Blog to learn how Restylane is now being added to fashionable feet for extra padding while the first Botox only clinic has opened in NYC.
Plus, this is a great spot to stay current with the comings, goings and doings of Dr. 90210 surgeons.

Wendy Lewis, the “Knife Coach” probably knows more about plastic surgery that any other lay person. She has two anecdotes about how breast implants saved a couple of lives. In one case, a female Israeli soldier stopped a shard of shrapnel from an exploding shell when it struck her silicone implant. Her surgeon reported the shard would have otherwise gone into her heart. In the other case, after a head-on auto accident in Bulgaria, rescuers found a woman’s large (40DD) breast implants acted like airbags and prevented damage to her internal organs in the crash. The implants burst upon impact and, like the car, were a total loss.

Breast implants tripped up a murderer and solved a case

NYC detectives found a body packed inside a suitcase but had no clue about her identity. However, the woman had breast implants….which carry registration numbers. Now equipped with her identity, detectives then noticed a quack doctor lived close to where the body was found. A little more sleuthing revealed the doctor had already been busted for practicing medicine without a license. And when all the pieces were put together, they found the victim went to the see the doc on the day she disappeared and died under his “care” because of an unusual antibiotic reaction. The doctor then hid the body, never dreaming the woman actually carried registration numbers.

Dr. John DiSilva’s blog carries a video of a lineup of women (READ: top models) in bras. The idea is to spot the one or ones, if any, who’ve had breast augmentation. You have to sit through an obnoxious commercial before the somewhat surprising truth is revealed.
In happier news: a recent development will speed things up in Beverly Hills, the world Mecca of plastic surgery.

So many people travel to and from Beverly Hills, a new-high speed thoroughfare has been built to insure the timely arrivals of surgical rejuvenation patients at their many destinations in and about the Golden Ghetto.

Pictured below is the Plastic Surgery Freeway. Of course, that moniker is slang -- the roadway’s real name is the Beverly Hills Freeway. Nonetheless, the thoroughfare features convenient off-ramps at Tummy Tuck Parkway, Rhinoplasty Place, Botox Circle, Dermabrasion Drive and other favorite motoring destinations.

(Well, O.K., we made up the part about the Plastic Surgery Freeway, but the rest of the column is totally true! The above picture is actually a ‘fridge magnet. ((Photo courtesy of But the Beverly Hills Freeway could be real some day, don’t you think?)

What a world we have in modern medicine! Machines that perform heart surgery on a patient in outer space while the surgeon-operator remains on earth. Diagnostic machines that can show you crystal clear pictures of your brain’s insides. Not to mention plastic surgeons who can turn back the clock on just about any aging face or body.

How about this? A bit more low-tech to be sure but perhaps useful. Learned researchers working in certified ivory towers at a major university reveal that warts can be removed with duct tape. (My advice: just watch out for the quacking that goes along with using the tape!)

Warts Lost to Duck Tape

University of Minnesota researchers studied the old folk cure technique of covering warts with sticky, fibrous duct tape. Results? It only works a scant 21 percent of the time.

But researchers back in 2002 found the technique worked on the warts of young adults and children 85 percent of the time. That study was reported in a 2003 issue of American Family Physician.

The, ah, sticking point? The 2002 used gray duct tape which contains rubber. But the 2007 study used clear duct tape without rubber. It was a true eureka! moment in science. I can hear the television commercial for wart healing now: “Gray heals! Clear Flops!”

Said one of the researchers: “Theoretically, the rubber adhesive could somehow stimulate the immune system or irritate the skin to attack the wart in a different manner.”

One of the other researchers (we are not making this up) also told of a folk cure which worked for him when he was a mere lad: he found a slug and let it slither across his warts from right to left three times.

Want a preview of that commercial? “Get fast, fast relief from warts! Use Ajax Slugs! More Slime! More right-to-left crossings!”

Women: ever get tired of misplacing your bras?

Medical science is hard at work on this pesky question.

While researchers worldwide have devised several types of internal bras, the latest is from noted Israeli plastic surgeon Eyal Gur who thinks his own design for an internal bra will be approved by this time next year. Oh yeah, not to forget: there’s another selling point: in addition to never losing your bra, you receive a breast lift too. Dr. Gur calls the coming procedure, “TheCup&Up.”

It works like this: Dr. Gur’s internal bra has a thin titanium frame implanted just under the skin. The gizmo also has silicone cups to hold the breasts up.

According to Dr. Gur, implanting an internal bra will be quick -- about 45 minutes -- and less invasive, requiring local anesthesia only. Compare that with today’s breast lifts which usually leave long scars and remove a lot of skin. The new procedure should be cheaper, too.

Not to mention the huge savings on bra bills.

Next -- Super high fashionable cosmetic surgery T-shirts for women.
Sorry for the dearth of writings! I've been in California all week.

An interesting and ironic story in the New York Times today "Rules to Collect Care Costs Are Coming Under Attack."

In summary, in a number of instances where complications involved with indigent medical care resulted in large medical malpractice judgements against municipalities, the cities have subsequently turned around and presented bills for their care to be subtracted from the judgement. I LOVE IT!

The case discussed in the article involved a psychiatric patient who's estate sued a city after he gauged his own eyes out in a treatment center (because obviously it must be the cites fault according to trial lawyer logic).

“This is a matter of fiscal responsibility,” said George Valentine, the Washington district’s deputy attorney general for civil litigation, explaining that city taxpayers deserved to be protected from expenses that could be shouldered by patients. Payment from Ms. Motley would have been due only if a jury found in her favor and the city would not have collected more than what was awarded, Mr. Valentine said."

Trial lawyers have complained that such attempts to re-compensate cities for free care gives too much leverage to the city when they're trying to negotiate settlements from them (and removes much of a potential windfall from their share of the settlement). This is just one more example of just how crazy our med-mal system has become.


Doctors flock back to Texas after tort reform. Well DUH!

The New York Times chronicles the massive success of Texas' tort reform efforts have had on the climate for medical practice in their state. They've answered one of those "Who's buried in Grant's tomb?" stupid questions about the real-world positive effects of tort reform on medicine. Since 2003, when sensible med-mal caps for non-economic damages were enacted, Texas has seen an increase of nearly 20% of Physicians becoming licenced there. This includes a disproportionate number of critical specialists including 186 obstetricians, 156 orthopedic surgeons and 26 neurosurgeons.

For pain and suffering Texas patients can sue a doctor for no more than $250,000 each. Plaintiffs can still recover economic damages, like the cost of medical care or wages, but the amount they can win was capped at $1.6 million in death cases. Those are numbers I think most people consider reasonable, especially when the primary goal of the med-mal system is not to be some punative wealth-redistribution process.

As a result of these, the average malpractice premium reduction physicians has seen is 21.3%, and I suspect for some of the surgical specialties it may in fact be much more then that. It's hard to argue against that as more evidence of the correlation between tort reform and the malpractice crisis unless you're a trial lawyer.

More on the "Cadillacs for all" post

I got a couple emails and posts about the last entry here on Plastic Surgery 101 on the lawsuit over breast reduction asking some questions about the cost of these procedures. Particularly, people (me included) feel this woman's lawsuit is sympathetic but feel the cost difference is indeed something that should be factored in, especially as it's over 15 years out from her original surgery.

A colleague pointed out some of the long-term costs associated with implants that you don't necessarily have with autologous (your own tissue) reconstruction (ie. need for replacing ruptured implants or the need for revision surgery for capsular contracture).

Here's my take.......

Trying to figure out the actual costs & morbidity of surgical procedures is difficult. There are tremendous variables all playing into this. A number of studies have compared the cost of different reconstructions at their institutions and come to different conclusions on long term costs. Implant based reconstruction is clearly cheaper up front, but over the course of many years (and further revision surgeries) this evens out assuming no major complications from flap-based surgery. These studies have never addressed scenarios like the one involved in this lawsuit.
It becomes silly at some point to try to translate the cost of these surgeries at a place like MD-Anderson or Sloan-Kettering Memorial (the most well-known cancer centers in the country) to how much it costs to do the surgery in some non super-tertiary center. Length of stay, routine post-op care, and operating times in these papers are all over the place and most Plastic Surgeons reading these analysis just don't believe the numbers reported (or at least don't believe those numbers are reproducible at their hospital).

In this case consider the up-front costs of the two proposed surgeries:

1. An hour-long outpatient bilateral implant exchange/minor revision prob. has a true cost (not what you'd seen on charges to an insurance company) between $5-10,000. I say "true cost" as I know what it would cost to do this as a cosmetic case where all fees are out in the open. For comparison of what an implant costs (not the surgery fee, but the price tag for just a single device): a saline implant is ~ $300, a traditional silicone implant is about $850, and the not currently available Inamed 410 "gummy bear" implant will be almost $1100

2. a traditional bilateral pedicled (where you keep the blood vessel attached) TRAM flap is a surgery that would likely take 5-7 hours for one surgeon to do and require closer to a week in the hospital. Charges for this might run closer to $100,000. Associated with harvesting both rectus muscles is a fair incidence of abdominal wall hernias requiring future surgery.

3. a microsurgical bilateral "free" DIEP flap could take 10 hours of surgery depending upon the difficulty of the microsurgery, require ICU admission for flap monitoring post-op, require a week in the hospital, and bring a bill over $150,000. This procedure spares the muscle harvest of a TRAM at the expense of a longer and more complex surgery with higher rates of flap loss.

Implant reconstruction brings some "legacy costs" which autologous reconstruction does not. Now modern implants life-expectancy is still a moving target, but 15 years is a reasonable expectation. (The gummy-bear implants still pending approval may extend that life-span indefinitely). Worse-case scenario, a young or middle aged-woman might have to have her implants exchanged 2-3 times over the course of her life. Reoperations from hardening (capsular contracture) are also going to add some number of reoperations to this figure.

From my crude estimate of costs in this case, even though immediate implant-based reconstruction may be more expensive in some cost-analysis decades out from surgery (when reoperation costs are figured in) then doing a TRAM or DIEP at the time of mastectomy, you can imagine that the costs in this particular scenario will never make sense from a cost perspective, especially when the system has already been hit once with the first reconstruction cost. It's for this reason I find it most compelling to expect the patient to self-finance part of this when other less expensive options are available.
Current notable entries:

While we’re on the topic of feet: Check the Beauty Chat Blog to learn how Restylane is now being added to fashionable feet for cushioning. You’ll also see news of a Botox-only clinic. Plus, this is a great blog to stay current with the comings, goings and doings of television’s Dr. 90210 surgeons.

Dr. George Berka’s blog observes that cosmetic plastic surgery can improve your mood and even reduce the need for depression medication. You can find a longer take about how psychology, moods and Cosmetic Surgery are all intertwined in the article, Does Plastic and Cosmetic Surgery Cure the Blues? One patient in the article was thrown into many years of depression because she suffered a botched nose job. Unfortunately, it happens more often that you may think. So carefully, carefully check the doctor’s credentials. Here’s how.

Next time:
  • Breast implants that protected the owner in a car crash and another that stopped an exploding shell
  • Yet another breast implant (hint: it has a serial number) identified an unknown body
  • Plus, the Beverly Hills Freeway
  • New plastic surgery research. (Another hint: scientists have proven beyond a shadow of a doubt that the right kind of duct tape can cure warts!)
For all who are breathless about the aesthetic state of their tootsies and may be considering a foot facelift:
There is finally hope for anybody who suffers from dreaded maladies like turf toe or tiny toe syndrome (also known as stubby toe disorder.) The toe stretcher puts your little piggies back into proper shape and length -- and without expensive surgery!

But wait -- there’s more! According to the manufacturer, The Toe Stretcher additionally promises to align foot muscles, straighten bent toes, realign bones and increase circulation by performing Yoga on your toes. (Mantra not included.)

There’s only one downside: walking is a little tricky. In fact, you might not want to remain under treatment while driving because you would be too wobbly to walk a straight line if the police ever stopped you. And do we have to mention anything about watching out for broken glass? We think not!

Dental Appointment! Phone Home!

There’s a cool new way to be reminded about cosmetic or regular dental appointments. Instead of posting a note on the ‘fridge or jotting something on your already crowded calendar, you can have a reminder pop up on your cell.

Smile Reminder alerts you to upcoming dental appointments. Just give your cell phone number or email address to your dental receptionist and you’ll see timely -- if not altogether welcome -- reminders about those oh-so-easy to forget dentist appointments.

We’re also told your dentist will send electronic birthday and holiday greetings, thereby keeping your mind off any new schemes of pain avoidance. Of course, cosmetic dentists are a little different because you will really have something to show -- brand new pearly whites -- in return for what you’ve spent in cash, patience, worry and, yes, avoided and forgotten dental appointments.

Breast reconstruction lawsuit - Can we afford Cadillac's for all?

There's an interesting philosophic debate being played out in a lawsuit in New Jersey over an insurance companies refusal to pay for a patients breast reconstruction surgery. You can read the news wire story here.

Short Version: Patient has double mastectomies with saline implant reconstruction almost 15 years ago. One of her implants deflates, and her insurance company is refusing to now pay for a conversion to a reconstructive procedure using her own tissue.

Replacement of her implants with either saline or silicone implants (which they would agree to cover) would be able to be performed quickly and done as an outpatient surgery with little morbidity. The type of surgery she wishes to have covered, a DIEP flap (deep inferior epigastric artery perforator) is a complex microsurgical procedure (where tissue from her abdomen is transferred to her chest wall) which would involve a long, expensive operation and a number of days in the hospital.

Last fall I profiled a case in People magazine where such a DIEP flap was performed on identical twin sisters, with one twin's abdominal tissue transferred to the other's breast. You can see that story here "Breast Reconstruction Using Your Twin."

What are the issues involved with this as I see it:

1. Should breast reconstruction after mastectomy be covered?
Well that issue was settled a number of years ago via federal legislation, the Women's Health and Cancer Act (WHCA) of 1998, ensuring that reconstruction was a mandatory obligation of insurers.

2. Should all types of reconstructive surgery be covered?
Again, that's part and parcel of the WHCA, which includes reconstruction after mastectomy for benign disease, usually done for painful cystic breast tissue.

3. In a scenario like the one involved here, should someone have the right to demand complex and expensive surgery when less expensive options are available?
I'm conflicted here. It does not seem completely outrageous to me for this company to deny this request or at least ask the patient to pay part of the balance difference given the particulars as I understand them. She had an acceptable reconstruction with implants, and needs a quick & relatively inexpensive surgery to maintain her result.
In other countries with state-funded ("universal") health care programs, I suspect there's no way in hell this would be approved. In an era of cost-containment, all health care costs are going to be scrutinized and there will be hard choices to make. Luxuries like exotic breast reconstruction almost two decades after the initial surgery seem hard to justify in that context.