It's hard to outsmart mother nature.

Just thinking about the human body today.....

Reports in the medical literature continually reinforce my belief that it's nearly impossible to outsmart mother nature in terms of the bodies inflammatory response. The inflammatory response is critical to your bodies compensatory mechanisms for stress or infection, but it has a tendency to go haywire and (apparently) make things worse. Billions of research dollars have been invested in characterizing (and manipulating) this cascade of biochemical processes. Every time we think we've figured out the big picture, eventually we are humbled by the bodies' "counter offensive".

In an international study (summarized awhile back here ) comparing bare metal versus the fancy new metal stents coated with medicines to inhibit re-occlusion of the artery showed dramatic increases in post procedural deaths as these patients were followed out from their procedure. When these drug-eluding stents were first introduced in 2003, they became the fastest-selling medical device in recent history despite being nearly 400% more expensive then the older bare metal stents.

We've witnessed a lot of similar outcomes in the trauma and septic response literature as multiple stages of the inflammatory cascade are suppressed or modulated, only to come back with a vengeance thru alternate "work around" pathways that must exist somewhere in the body.

When you see diagrams of what we think the immune response looks like, it is a frighteningly busy graphic. Despite millions of man hours in labor and billions of research dollars, complete understanding of these processes is elusive.


The White Smile Diet

An English study is something you can use daily, according to The British Academy of Cosmetic Dentistry which has developed an eating regime known as The While Smile Diet. The routine promises to keep your pearly whites more pearly. The Academy claims eating more of the foods listed below can keep your “gnashes” (British slang for “teeth”) gleaming instead of gray.

Thus, just consume more of the following:

  • More raw veggies. They help remove surface stains on your teeth. (Besides, no cooking is involved!)

  • Strawberries also help whiten your gnashes.

  • Avoid stain producing foods and drink, most notably:

    • Coffee and tea

    • Red wines

    • Cola soft drinks

    • Blueberries

  • Drink from a straw and let liquids bypass your teeth.
    (Does that mean you can have coffee, tea, red wine and cola drinks after all? They wouldn’t say. But, hey, if you don’t feel silly in a restaurant drinking wine or coffee through a straw, go for it. As for the blueberries, I imagine they would be hard to fit through the straw. Just use your own best judgment on that one.)

  • Use sugarless chewing gum. It stimulates saliva which cleans the surface of your teeth.

  • Don’t smoke. If you didn’t already know, smoking stains your teeth and is hard on your gums and everything else in and around your body. Even your plants and pets will give up the ghost. Termites have been known to succumb to second hand smoke.
For more on what cosmetic dentistry is all about on this side of the big pond, check out this section.

Also, we here in the Colonies can offer something in dentistry you don’t find very often in Merrie Olde England. You can get a facelift via dentistry !

Tattoo Removal Docs Barely Keep Up!

Newer Tats are in Braille, on Eyes and Even Used on
Fingers to Create Instant Moustaches

Many plastic, cosmetic and dermatological surgeons offer tattoo removal for those times when people regret ever getting the body art in the first place. (READ: Grew up and got a job!)

Laser tattoo removal. It usually requires three to five or more
appointments to completely vaporize the tattoo ink.

If you’re in the market, read more about tattoo removal. (HINT: You’ll burn far more time and money taking it off than that mad, crazy moment back in the day when you first got it!)

Despite that booming trade in removal, more tats are being applied and in more creative areas of the body. No longer restricted to bulging biceps or on a lady’s trim ankle, tattoos are starting to appear on eyeballs and in Braille, too. Yet another trend is tattooing moustaches on fingers.

Hey, I know what you’re thinking. What’s that part about Braille tattoos? How does that work?

Well, say, you want “Mom” inked onto your bulging bicep. Or your best gal or guy’s name delicately inscribed onto your ankle.

It’s done with a series of raised dots, just like in regular Braille. Only no ink is used. The surgeon (if you can find one) just inserts implantable surgical steel, titanium or medical plastic under the skin.

“Mom” in Braille

And that naturally leads to another one of those “Why-did-nobody-ever-think-of-this-before!” moments.

If you have Braille tats on your hand like in the picture below, you can instantly learn the name of the person with whom you are shaking hands. Just don’t assume everybody is named “Mom.!”

Can’t you win some sort of prize for outside-the-box thinking like that?

And here’s another thought:
You gotta admit writing a “Mom” tattoo in dots, saying “This is mom’s name in a red heart with a wavy wreath and an arrow through it” in Braille is going to take up a lot of arm or ankle space. Not to mention all those hands feeling your biceps and ankles.

It probably would look something like this:

But, hey, more power to them. The sightless have enough challenges in life so if they want Braille tattoos, bring ‘em on!

Removal of Braille tattoos: top scientists have carefully analyzed the issues and ramifications involved and have announced they will think of something soon.

One of the hottest new trends in Tattoos is for men and women who want a moustache -- but only some of the time.

It works like this: just ask your favorite skin ink artist to tattoo your choice of moustaches onto your index finger.

Then, say, you want a disguise or you’re at the guest of honor at the annual Moustache Convention. Why, just hold your finger over your lip.
Presto! Instant soup strainer! How easy could things be?

Removal: Put your hand down.

Tattoos on your eyeball probably would not be your doctor’s favorite choice of body art for you. Besides, it gets unsettling with the needle in the eye and all so we’ll just skip that part.

One guy getting an eyeball Tat, concluded his description about creating a tattoo on his eyeball with the following words of wisdom:

“Now that this experiment has been started, please wait for us to either heal or go blind before trying it!”

Removal of eye tattoos?
No known method. Start by crying a lot.

Speaking of dots: at least one tattoo aficionado and artist had inked, numbered dots on the length of her lower leg, below. If you connect all 16,581 dots from the lowest to the highest number, the outline of a giraffe appears. Reason? She’s absolutely nuts about giraffes and has been since childhood. Plus, artists do things entirely for reasons of their own.

Unfortunately, the dots are not raised so the artwork is not accessible to readers of Braille. But with legs like that…..whoops! Never mind! Gee, I almost let loose with some highly politically incorrect male chauvinist pig sexism there. But you get the general concept, I’m sure.

Removal? Basic tattoo removal.

Top Five Weird Things that Happen to Doctors

The lives of doctors aren’t all yachts, golf courses, winter vacations in Monaco, Bentleys and high end dressing rooms for their own T.V. shows.

They actually go to work to work every day and interact with other people. So the occasional weird, embarrassing or you-won’t-believe-what-happened-to-me-today moments occur in their lives, too.

Here are the top five weird things that have happened to doctors, sent in by the physicians themselves!

1. A man comes into the ER and yells, "My wife's going to have her baby in the cab!" I grabbed my stuff, rushed out to the cab, lifted the lady's dress, and began to take off her underwear. Suddenly I noticed that there were several cabs -and I was in the wrong one.
Submitted by Dr. Mark MacDonald

2. At the beginning of my shift I placed a stethoscope on an elderly and slightly deaf female patient's anterior chest wall. "Big breaths," I instructed. "Yes, they used to be," replied the patient.
Submitted by Dr. Richard Byrnes

3. During a patient's two week follow-up appointment with his cardiologist, he informed me, his doctor, that he was having trouble with one of his medications. "Which one?” I asked. "The patch. The nurse told me to put on a new one every six hours and now I'm running out of places to put it!" I had him quickly undress and discovered what I hoped I wouldn't see. Yes, the man had over fifty patches on his body! Now, the instructions include removal of the old patch before applying a new one.
Submitted by Dr. Rebecca St. Clair

4. While acquainting myself with a new elderly patient, I asked, "How long have you been bedridden?" After a look of complete confusion, she answered..."Why, not for about twenty years - when my husband was alive."
Submitted by Dr. Steven Swanson

5. As a new, young MD doing his residency in obstetrics, I was quite embarrassed when performing female pelvic exams. To cover my embarrassment I had unconsciously formed a habit of whistling softly. The middle-aged lady upon whom I was performing this exam suddenly burst out laughing and further embarrassing me. I looked up from my work and sheepishly said, "I'm sorry. Was I tickling you?"
She replied, "No doctor, but the song you were whistling was, 'I wish I was an Oscar Meyer Wiener'!"
Dr. wouldn't submit his name

Give me you hungry, tired, and poor. Hold the fat, please!

Want to see a logical extension of federalized health care and the kind of rationing choices that will be made?

This story here is fascinating.

Richie Trezise, 35, a rugby-playing Welshman, lost weight to gain entry to New Zealand after initially being rejected for being overweight and a potential burden on the health care system.

His wife, Rowan, 33, a photographer, has been battling for months to shed the pounds so they can be reunited and live Down Under but has so far been unable to overcome New Zealand’s weight regulations.

Robyn Toomath, a spokesman for Fight the Obesity Epidemic and an endocrinologist, said the BMI limit was valid in the vast majority of people. She said she was opposed to obese people being stigmatised. "However, the immigration department’s focus is different," she said. "It cannot afford to import people into the country who are going to be a significant drain on our health resources.

"You can see the logic in assessing if there is a significant health cost associated with this individual and that would be a reason for them not coming in."

The implications of this are interesting. Is it discrimination or is it making people take personal responsibility when you treat someone different based on what are (often) controllable health risk factors?

We've already clearly made this value judgement with smokers and we're moving that direction with obesity. It's clear that obesity (as opposed to be merely overweight), much like smoking, is a devastating drain on our resources from a systems level. This was federally recognized in this example from New Zealand. Expect to see some incentives for BMI parameters to more frequently appear in your health insurance policy or be sponsored by your employer, as they've clearly fingered this subgroup as an area for cost containment in their employee costs.


Our New Plastic Surgery Gift Card

At Rodeo Drive Plastic Surgery we want plastic surgery to be as rewarding and convenient as shopping with our neighbors here on Rodeo Drive. In this spirit, we are pleased to present the Rodeo Drive Plastic Surgery gift card. The card is available for all amounts and can be used to give a present of any of our services.

Inspired by Patients

Our patients gave us the idea for the gift card. Many of our patients bring friends in for consultations that lead to plastic surgery with positive results and lifestyle improvements. Our patients do seem to enjoy giving friends and loved ones a gift of our services. Husbands give plastic surgery as a present to their wives, and wives give to their husbands. Children give to their parents. We see more and more people giving plastic surgery presents.

The gift Card can be used for any of our services -- from consultations to nonsurgical rejuvenation with Botox and skiin fillers and aesthetician services to our signature plastic surgery procedures such as Beverly Hills breast augmentation. You can even use it to give mom our Rodeo Drive Mommy MakeoverTM as a Mother's Day Present!

An Elegant and Memorable Present

To make the giving process as elegant and memorable as possible, we designed our electronic gift card. The card comes packaged in a custom-designed card holder insert and envelope, designed by a local artist. We hope that when you give friends and family this present, it will provide an opening glimpse of the attentive and caring service we deliver throughout the plastic surgery process. Of course our plastic surgeon will examine the recipient of your gift to decide if they are a candidate for a given procedure, and make recommendations based on their goals, exam, and overall medical status.

A Product of Our Rodeo Drive Environment

As the only plastic surgery center on Rodeo Drive, we are very attuned to the service imperatives of our neighbors – the finest tastemakers and stylists in the world. Our goal is to bring this same superb taste and service to our plastic surgery. We designed our plastic surgery gift card in consultation with managers from several neighboring Rodeo Drive shops to provide you with the same elegance you find at Rodeo Drive boutiques.

Happy Turkey Day!

Happy Thanksgiving to you and yours! I've got a lot of ideas floating around for some interesting (to me) writing coming up here on Plastic Surgery 101

Stay Tuned!

Scalpel! Clamp! Crochet hook!

To develop a new technique, Peter Lawrence, M.D., chief of vascular surgery at University of California, Los Angeles, bought a size 7 crochet hook.

However, Dr. Lawrence wasn’t knitting; he saw a way to use a crochet hook as a new surgical tool to remove varicose veins.

The old surgical methods involve some pain, stitches and time off for recovery. Lasers and radio frequency, using heat and energy are also employed along with vein stripping, tying off the vein or injecting a solution that would make the varicose vein whither and die.

This crochet hook is for knitting,
not surgery.

Using the crochet hook method, Dr. Lawrence has done 268 cases in the last two years. He makes a very small incision, reaches in with the crochet hook (which has been adapted for surgery) and snags and pulls out the vein. The incision is so small, no stitches are needed and the resulting scar looks like a freckle. Read more.

Some English doctors are using the same method to pull large veins out of aging hands but Dr. Lawrence advises against it. Many other plastic surgeons routinely make older hands look younger.

“The day may come when you will very much need those veins in your hands to insert I.V. needles,” says the doctor.

Internet Plastic Surgery Giveaways

Ever hear of “owning a piece of the rock?” Well, the same concept is being applied to plastic surgery.

Back in 2004, Linda Peacegrove, a Swedish model, suffered a personal and professional loss when medical treatments following a thyroid gland surgery left her, well, let’s just say, severely bosom challenged.

So she put up a website, asking for donations toward a breast augmentation. We would love to tell you the name of the now-404 website but it currently redirects to an XXX-explicit Web site you would not want your ten-year-old to see. (Hey, you would not want your 40-year-old husband to see this site!) And the Web site is in Sweden. Enough said?

Anyhow, Linda tossed in the towel when she only received $808 from a tight-fisted public toward the $6000 needed for surgery.

Help a Girl Fill a Sweater!”

The next Internet donation request for plastic surgery came from the United States where a 23-year-old student -- who identifies herself only as “Michel” with a 34A bosom -- bemoaned her lot and asked computer users to “help a girl fill a sweater!” and pass the electronic hat for her breast enhancement fund.

Results? The milk of human kindness never flowed so abundantly!

In about a year, total strangers donated the required $4500. After the procedure, Michel posted tasteful (READ: with clothes) before-and-after pictures on her website as an all-purpose thank you. (We would also love to mention the name of her website but in the last two years, nasty, nasty X-rated ads have been added to this site, too!) However, we have posted pictures of Michel (below) that give you an idea of the, er, full impact that random acts of kindness can achieve.

Michel shows the results wrought by her adoring public:

The bottom picture shows Michel before she started asking for donations. She’s wearing the same top in both pictures.



You may think a 23-year-old having rejuvenation surgery is pretty unusual. However, somebody as young as Michel having plastic surgery is becoming more of a trend. For a closer look at people in their 20s having plastic surgery, take a look at our article, Restylane & Juvederm: New Accessories for 20-Somethings.

(By the way, we did not crop her pictures. Michel may be bold about asking for help but she’s also shy about showing her whole face on the Internet.)

After that, Nicole, another student, then 26, noted Michel’s success and publicly decried her own bony haunches by putting up a now-defunct website. Her purpose? Nicole wanted $6,000 for a buttocks augmentation, declaring her rear end was as thin as a Jenny Craig instructor in Bangladesh during famine. But Nicole called it quits after the milk of human kindness could only squeeze out a paltry $155.

Breast Implants: No Charge!

The latest and largest Internet attempt to draw on the kindness of total strangers is

Here’s how it works: Women over 18 post their clothed head-and-body shots along with a two or three line bio and plea for donations while identifying themselves by first name only.

Guys -- known on this site as “benefactors” -- chip in with whatever they can afford. But first, they must shell out for “message credits” priced at $1.20 each. To send the women emails, benefactors pay with the message credits. When the donations beyond message credits are sufficient, the woman has a breast enhancement surgery and then posts thank you notes, along with more-or-less clothed, before-and-after pictures. (They aren’t X-rated but they are also pretty far from PG13!)

Eight women are posted on the home page with the amounts they claim to have raised, from $145 to $5765.

And why would guys make donations to a total stranger? Even if it is a lovely stranger? Who becomes a very well-endowed stranger? Guys being guys, don’t they ask for something tangible in return for their money?

“There are a million different reasons why men donate,” says co-founder Jay Moore, an M.B.A. who helped put up the website as a hobby. “Some expect sexy pictures, others just want to chat, establish a friendship, talk about problems and some are just philanthropists.”
The site claims five million page views monthly.

Rita Rudner

But before contributing anything, it might be a good idea to mention one of comedienne Rita Rudner’s on-point observations about human nature. She said: “Some people think having large breasts makes a woman stupid. Actually, it’s quite the opposite: A woman with large breasts makes men stupid.”

Why Doctors do not trust the government to administer health care?

Exhibit A: Wisconsin Democrat governor, Jim Doyle, is trying to do an audacious end run around the intent of a state-administered trust fund meant to control medical malpractice costs.

In 1975, the Wisconsin legislature set up a fund for physicians, hospitals, and other health professionals to contribute to called the Injured Patients and Families Compensation Fund. It was essentially a self-insurance "buffer" against rising med-mal costs and has been widely credited with stabilizing Wisconsin malpractice insurance premiums.

The assets of this fund are substantial, in excess of $735 million in 2007 (covering an estimated $685 million in potential liabilities). Such a large "pot of gold" has proven irresistible for Democrats in Wisconsin, and Gov. Doyle has proposed pillaging nearly $200 million to cover budget deficits the state is running up on their Medicaid program. While it's noble to fund a state's uninsured & under-insured, raping a successful program whose mandate and charter is very specific to the med-mal relief program is going to lead to a bitter court fight in Wisconsin between the Wisconsin medical association and Gov. Doyle.

In 2003 a state law declared the trust "for the sole benefit of health care providers participating in the fund and proper claimants. Monies on the fund may not be used for any other purposes of the state". Keep in mind that individual doctors have essentially been paying into this pool at somewhere between $8-10,000 annually for nearly 30 years. So in a nutshell, this Democratic proposal would turn an insurance program into a massive retroactive tax hike on providers while potentially causing the whole program to go insolvent (as assets would drop ~ $150 million below liabilities).

Gov. Doyle, you're the proud recipient of the inaugural Plastic Surgery 101 cheesehead award!
There are at least five. Here are the most commonly done.

1.Eyelid surgery

With more baby boomers -- the largest percentage of our population -- passing the half century mark every day, legions of upper and lower eyelids are starting to sag like fleets of Mac trucks crossing rope bridges.

What your insurance company doesn’t want you to know: if your upper eyelids are starting to fall over your eyeballs so that your vision is obscured, they should cover the procedure. Average cost of eyelid surgery in the United States: $3825.

Number of blepharoplasties done in 2006: 210,000 according to the American Society for Aesthetic Plastic Surgery (ASAPS).

Sagging eyelid

2.Breast reduction

Extremely large breasts cause back and other health woes and
will eventually cost your insurance company even more money if left

The magic words that cause even the stingiest insurers to let their cash
flow like fountains: “I have back, neck and shoulder pain due to my
extremely large breasts.” But don’t try to bluff. You may have
to show a doctor’s report, proving the condition exists.

Some breasts are so large, the weight on the woman’s bra straps have
worn notches into her shoulder bones. Medically, the condition is known
as shoulder grooving.

The total cost of breast reduction surgery averages about $8500 in the United States. That usually covers the surgeons’ fees, facility costs, the anesthesiologist, post-op visits and medicines.

In 2006, plastic surgeons performed 104,455 breast reduction procedures, according to the ASPS.

3. Breast reconstruction

That is a four-to-six hour procedure that is usually done in one of
four ways to rebuild the female breast, or breasts, after a mastectomy.

The procedure can keep you off your feet for one to six
weeks, depending on the reconstruction method used.

As far as your medical coverage is concerned, there is simply no wiggle room for the insurance company. Current law requires them to cover the operation. Be sure and say you’ve read the Women's Health and Cancer Rights Act.

Fees vary widely depending on whether mastectomy is included.
Number performed in the United States in 2006? 56,176, according to the ASPS.

4. Hand Surgery

Plastic surgeons are highly skilled in operating on tiny bodily structures so many also perform hand surgery, usually to relieve carpal tunnel syndrome. But the surgeons may also rejoin amputated fingers or even move a toe to a hand so a person can work again.

Hand surgery rejoins nerves, muscles, tendons and bones to bring back normal function and feeling. The various types of hand surgery vary so much in costs, an average cost can’t be pinned down.

What does your insurance company need to know? Easy! You can’t work without your hands functioning properly. (That way, you can continue writing checks to your insurers!)

2006 saw 155,810 hand surgeries, according to experts.

A 57-year-old English woman shows the difference cosmetic hand surgery can make. The age revealing veins in her left hand have been removed by plastic surgery. Compare the treated hand to her other hand for a sense of before and after. We hope she likes it because a U.S. insurance company would not pay for it.

5. Facial tumor removal.

A plastic or dermatological surgeon may have to take off a dangerous facial growth -- like basal cell carcinoma -- and then transplant some donor skin over the wound.

Your insurance company needs to know the plastic or dermatological surgeon is preventing a much more, expensive condition, something that will cost them even more money in the long run.

Removing a facial growth by electrodessication and curettage runs from $250 to $500.
By excision with a scalpel, about $1200.
By Mohs surgery from $2000 to 2500.
If you have a Mohs surgery in an operating room as an outpatient, plan on about $4000.

The American Academy of Dermatology says about one million cases of facial skin cancer crop up yearly. Overall, 3.9 million tumor removals were done in 2006, says the ASPS.

HINT: Most insurance companies routinely reject the first request for coverage on almost any procedure. It’s because most people then forget about it all together.

Those in the know send a second request which is often approved, especially if you show the procedure is not to make you look better but for serious medical reasons.

Changing Your Appearance -- Japanese Style

After your plastic surgery, you expect to look younger, more rested, more refreshed and just better.

But would you want to look like, oh, say, a vending machine?

That’s doable in Japan. A top designer of women’s clothes has created a fold up camouflage sheet for wear under skirts. When you are alone at night on a dark street and feel threatened, you just pull out the camo sheet, turn your back to a wall and hold the sheet up over your head.

Presto! You’re a vending machine! Well, you look like one, anyhow. The creep goes sauntering on by, thinking you’ve vanished into thin air. The deluxe version (pictured below) has four sides for a more complete camouflaging experience.

Let’s just hope street creeps are not thirsty and try to stick coins in your eye!

The vending machine closest to the camera is a woman waiting for danger to pass. Maybe next time she should pull her toes in under cover, too! Oh, and by the way, never, never rock these machines -- even the camouflage models are top heavy and can topple over, causing injury! (DISCLAIMER: Trembling might give you away. Most vending machines stand as still as a statue.)

Club of the Month: Italy’s Ugly Club

Sounds like a plastic surgeon’s dream, doesn’t it? An entire club of people whose looks could use more than the average amount of professional nipping and tucking.

Actually, the club was started by Telesforo Iacobelli, a man with a small nose. He is considered less attractive because Italians really dig a big schnozzle.

So, every year, the Ugly Club in Piobbico, Italy, holds the Festival of the Ugly and picks a new president. Want to guess who wins? You got it, ‘ol Telesforo himself. It’s because he has spent his entire adult life fighting for the recognition of the ugly in a world that prizes physical beauty.

But here’s the secret the Ugly Club does not want you to know: the club was originally started 40 years ago for the town’s single women who felt they could not find mates because they, the women, were not lovely enough.
That might have something to do with the choosing of the club’s motto: “Ugliness is a virtue, beauty is a slave.”

Actually, the only absolute, mud-fence ugly thing about the club is the clubhouse door, pictured, below.

The sign above the door reads, “Abandon Hope, All Ye Who Here Enter!”

Whoops, that’s Dante. Wrong Italian! The sign really says, “National Association of the Ugly.”

Vultures circling over Kanye West's mother's death after surgery

The tabloids are in overdrive digging up dirt on the surgeon who performed Kanye Wests' mother's surgery. The surgeon in question was kind of a minor media figure, having hosted some TV shows on plastic surgery. In an instant, this doctor's career has been reduced to "the guy who killed Kanye's mom" which is kind of sad.

Still to be determined is what exactly was the cause of death?

The implication being circulated is that she should not have been done as an outpatient surgery. That's a judgment call, but it's one that has to take into consideration her age, medical comorbidities, type of proposed surgery, and length of surgery. Her surgery was apparently almost 8 hours long, which while longer then you like, is certainly not outside the vague notion of "standard of care". Publicized cases like this tend to lead to reactionary measures, and I would not be surprised with some fallout in California as to how office surgery is regulated.

A woman her age (almost 60) who dies shortly after this kind of surgery would make me think of a few things

  1. Did she have a post-operative heart attack( MI)?

  2. Did she have hypovolemic shock from intra-operative or post-operative bleeding?

  3. Could she have had toxicity from lidocaine (a local anesthetic) used in high volume liposuction?

  4. Did she get nauseated, throw up, and subsequently go into respiratory arrest from aspiration?

There's a couple of less likely things that can happen, but they usually don't present quite like Mrs. West's case. Those would be pulmonary embolism (a blood clot which migrates to the lungs & usually happens a few days later), bowel perforation (usually has a more gradual onset of sepsis), and acute necrotizing infections (usually from Streptococcal group A or B bacteria).

Post operative deaths are rare, but tragic. They reportedly occur in only one of 51,459 cosmetic procedures, according to the journal Plastic and Reconstructive Surgery. It's been suggested that number may actually slightly under-represent the problem as not all deaths get reported accurately. For example, a study a few years ago by some dermatologists claiming no deaths from high volume office-based liposuction cases performed by dermatologists flew in the face of numerous anecdotal reports by General & Plastic Surgeons having to deal with major complications which showed up in the hospital from some of these same dermatologists.

Elf Ears = Better Hearing?

Hungarian plastic surgeon, Dr. Lajos Nagy, (now allegedly working in NYC) says on his website he surgically creates elf-like ears for people like these two supposed patients, below.

Plastic Surgery Before Birth?

Next, we read in the plastic surgery news that the latest trend in rejuvenation surgery is prenatal plastic surgery.

Surgeons are now allegedly repairing body parts before birth as evidenced by this sonogram of an unfortunate fetus with a long, unattractive nose in the picture, below.

But miracle of miracles, look at the nice nose job in the after picture. And performed while the patient is still in the womb!

What these two items really have in common is not plastic surgery but PhotoShop. All the above before and after plastic surgery pictures are “100 percent PhotoShopped,” according to Beverly Hills Plastic Surgeon Jason Diamond, M.D., F.A.C.S., a Dr. 90210 plastic surgery star in Beverly Hills.

The amazing thing is how many blogs first fell for Dr. Nagy’s hoax. Swallowing it hook, line and sinker were Plasticized;;;;; and, among others.

But eagle-eyed blog Meisters seeing right through the stunts -- in addition to your humble scribe at blog -- include and

Say, I’ve got a nice bridge in Brooklyn for sale and it’s real cheap, too! Any takers?

Top Ten Things Your Plastic Surgeon Won’t Tell You

1. You’re going to get old anyhow.
Cosmetic plastic surgery does not stop the aging process. Read more.

2. Sure, I’m board certified -- in geriatric medicine.
Many board certifications don’t mean anything for plastic surgery patients. Ask what the surgeon is certified in. More.

3. You need a shrink, not a plastic surgeon.
Some patients are never satisfied and can’t get enough rejuvenation surgery.

4. You can get this procedure for 15 to 30 percent less out of town.
Overhead -- rents, salaries and the cost of operating a business -- are higher in large urban areas. But if you drive out of town you can get the same quality for less.

5. Future effects of surgery? Who Knows?
If you have a breast augmentation, you will have at least one more operation some time in your life to replace the implant. Medical science does not know the future implications of all procedures.

6. Sure, I’ll do your forehead lift. But my specialty is breasts.
Ask your surgeon how many times weekly he or she does the procedure you want. Odds of a good outcome increase if the surgeon performs that operation two to three times a week.

7. It’s the anesthesia you really need to worry about.
If you are put under a general, ask if the anesthesiologist is board certified in anesthesiology. If you will be put to sleep, ask who is going to monitor you. Sometimes, a nurse anesthetist is O.K.

8. My office is not really the best place for surgery.
Some procedures should be done in a certified surgical center or a hospital. Ask if the surgery center is AAAHC or JCAHO certified. Read more.

9. Me? I went to dental school.
Some states allow dentists to perform plastic surgery.

10. You could have four more procedures overseas at
the same price.
Going oversees for plastic surgery can be much, much cheaper but is fraught with risk. Dr. 90210’s Dr. Kotler adds the seven smart questions to ask before having cosmetic surgery overseas.

Our Art Collection

We are very pleased to have created an appealing and special art collection here at Rodeo Drive Plastic Surgery. Because our focus is on aesthetics, we apply this to our environment just as we do to our work doing Los Angeles plastic surgery. To that end, we have taken time and effort to make our office setting warm, inviting, and elegant. Part of this includes our art collection.

We have three original Andy Warhol lithographs, as we show on the images here. These are part of his series on flowers. The suite of three pieces is called Kiku, which is Japanese for crisanthamum. They provides striking images with luscious colors and warmth.
We also have several paintings by the esteemed local artist Adolfo Girala. I have one his beautiful pieces in my personal office, and we have other pieces by Adolfo in each of our exam rooms. Adolfo is originally from Cuba and this background has helped inform his work. He has many images of the sea, with interesting fish characterizations, and also does wonderful abstract work. We were pleased to present an art show of his works last year at our office. We are looking forward to putting together more of these art shows to feature local artists.

We hope that when you are visiting us for such procedures as Beverly Hills breast augmentation, you will enjoy the art and the entire environment of our office here on Rodeo Drive!

From The Newsvault:

A teenage schoolboy in the UK was pulled around his classroom on a leash and spanked by a stripper after a birthday surprise mix-up. The teen's mother had ordered an agency to give her son a 'surprise' on his 16th birthday - and the teacher had also agreed to allow the surprise. But it all went wrong when the company sent a stripper dressed as a policewoman instead of a man in a gorilla suit - in what it called a booking error.

One student told Sky News: "She asked the lad to stand up, which he did, and told him he had been a very naughty boy because he hadn't been doing his homework."

"Then she put on some Britney Spears music and got out a collar and leash from her bag and told him to put them on." After walking the boy around the classroom and spanking him with a whip, the action got even more steamy.

"She took off some clothes until she was down to her bra and pants, pulled out some cream, put it on her buttocks and told him to rub it in," the student said. It was at that point the shocked teacher - who had not been told what the surprise was - called an end to the show. A spokeswoman for the school in Nottinghamshire said they were investigating how the incident happened.

What strikes me as so surreal is that up until the massaging cream on the butt, that the teacher was just watching this kid being lead around in a dog collar while being spanked with the rest of these 16 year olds. Too, too funny!

While doing "research" looking for a picture to frame this post with, I stumbled across something funny about how strippers and business tactics. It made me reflect that cosmetic surgery/medicine and strippers are alike in how sales are done.

From the Wise Camel Blog

Sales Technique #1 - Give them something for nothing One of the first things a stripper will do is come up to you and flirt with you. She will likely sit on your lap or do something to raise your excitement level. For this, you have to do nothing. But you do get a sample of the service and if it is a good one, your chances of buying the service increases. This also applies to the dances they do on the stage.
Sales Technique #2 - Understand your customers Strippers get to know their customers by asking questions. This allows them to develop a rapport and tailor the sales pitch…
Sales Technique #3 - Tailor the Sales Pitch Strippers will try different sales pitches to different people based on what she thinks they like. “I like to get dirty” or “Have you seen my great ass?” or “My tits are real”. Each pitch may be the one thing that converts the potential customer into a buyer. (Pointing out a tight ass works well for me). And she revises her pitch based on experience.
Sales Technique #4 - Make sure you are selling a great product/serviceShe knows she has to have a great product. If she put on 30 pounds or hadn’t showered for the past 4 days, she would likely not get as many customers. Regardless of how great of a salesperson you are, you can’t do much with a crappy product/service.
Sales Technique #5 - Provide Good Customer ServiceShe will make sure you are happy on your first dance or she won’t get repeat business or won’t be able to do what she ultimately set out to do…Upsell.
Sales Technique #6 - Upsell She sells the customer on a relatively cheap service, a lapdance, but then markets her other services to them. She tries to get them to the “champagne room” and sell an upgraded service, which is where the money is at. However, without the first sale, she would never get the larger sale. Customer acquisition is tough. Once she does it, she needs to get as much business as she can.
Sales Technique #7 - Closing Techniques. She will use a variety of closing techniques to get you to buy her services. There are a variety of closing techniques, but two popular ones used by strippers are the compliment close (usually flirting with you) and companion close (getting your buddies to push you into closing the deal).
Sales Technique #8 - Target your audience Strippers market to individuals that are interested in her service. First, she works in a strip club where guys go specifically for her service, that is obvious. But she also knows which guys to go after within a group or which groups will likely spend the most money. Spending time with cheap-asses only wanting to pay a dollar for a dance will not be a wise use of he precious time.
Sales Technique #9 - Persistence Even though the audience is qualified, she knows she will get rejections. Even so, she will go up to every guy and ask if they need a lap dance. She also knows that the more guys she asks, the more yes’s she will get.
Sales Technique #10 - Branding I don’t know any strippers that are named Ethel, Mildred or Agnus. Instead, you will get the pleasure to do business with Cookie, Destiny, Candy, or Raven.

Plastic Surgery Greeting Cards

Remember our former blog, wherein we talked about the new plastic surgery CosmeTees shirts? Those spiffy, rhinestone-studded Tees announcing your surgical rejuvenation?

Well, supposing your best gal pal undergoes some plastic surgery and starts wearing one of those shirts? You gotta admit she’s crying for attention. So what DO you do?

How about sending her a plastic surgery greeting card?

The cards hit breast augmentation pretty hard, but, hey, why not? So many women are having breast enhancement, it has become the nation’s top surgical rejuvenation.

Anyhow, greeting cards like the ones just below are for your friend’s breast enlargement:

For fat transfer patients:

*I though we could sit around and chew the fat!

For rhinoplasty patients:

*Your Nose Looks Great!

For sclerotherapy patients:

• You’re so Vein!”

For Botox patients:

• A card with a drawing of two women spraying each other with starch

And an all-purpose card for any procedure that has made a real difference, concentrating on the magic words healed patients love to hear from others:

(Greeting cards, courtesy of Lee Sequeira and

NEXT TIME: How offshore plastic surgery can make your passport invalid and the Top Five Clubs for Plastic Surgery Patients……who want to take chances.

A real gauntlet was thrown down this past week with the publication reviewing the effects of excess weight and morbid obesity on our health. Dr. Walter J. Willett, a professor of epidemiology and nutrition at the Harvard School of Public Health, and 20 co-authors, compiled the 500+ page report, entitled "Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective".

Their meta-analysis of several thousand existing studies found that "excess body fat influences the body's hormones, and these changes can make it more likely for cells to undergo the kind of abnormal growth that leads to cancer." In short, "[t]he risk from excess weight begins at birth." Therefore, obese girls who begin menstruation earlier in life "will have more menstrual cycles. This extended exposure to estrogen is associated with increased risk for premenopausal breast cancer."

This staggering review, which took over five years to develop, indicates that "excess body fat increases the risk of cancer of the colon, kidney, pancreas, esophagus, and uterus as well as postmenopausal breast cancer."Obesity seems poised to become the number one risk factor for cancer in America, as obesity increases and the number of smokers decreases.

What can we do surgically about this?

Well, it appears the weight loss procedures, gastric bypass & gastric banding, can significantly reduce or eliminate many associated comorbidities including diabetes, hypertension, obstructive sleep apnea, and progressive osteoarthritis from excess weight load. In 2006, almost 180,000 patients underwent bariatric surgery of some type.

Last year researchers found that gastric bypass surgery patients were 40% less likely to die from any cause during a mean 7 years of follow-up, compared with the obese controls. It's kind of intuitive that there should be some risk reduction for some of these cancer risks associated with obesity, but I don't believe we have evidence to leap to that conclusion. It might be a very small effect statistically unless it was done on an obese adolescent in whom you'd have decades to track this.

I found a nice collection of review studies re. to Gastric Bypass here at Thinner Times if you're interested.

What about plastic surgery?

Unfortunately there is fairly poor evidence that plastic surgical treatment of weight, whether by resecting excess skin/fat or by liposuction, has an effect on any of these benchmarks. What we can do is cosmetic changes only. A paper from Washington University (St. Louis) published in the New England Journal of Medicine in 2004 found no benefit from high volume liposuction (as you''d expect from weight loss via other methods or diet), where as much as 20% of patients subcutaneous fat stores were removed via liposuction. There have been a small handful of lesser quality papers (like this) suggesting that large volume liposuction may improve glucose control in some type-2 obese diabetics, but the evidence is weak and the studies not really well done (it's a hard subject to study with any uniformity).

However, there is some rationale for a mechanism of how it could work. Large areas of lipodystrophy (fat deposits) are essentially your bodies "batteries" for energy storage. Obese people have a resistance to the effect of insulin mediated in part by their excess fat. In more than 80% of patients who are severely obese and have diabetes and then have gastric bypass surgery, the diabetes is cured. So remove the fat, remove the diabetes, right? Well it turns out it's not quite that simple. It appears the visceral fat (fat inside your abdomen and liver) may be the bigger culprit then the fat outside that you remove with excision or liposuction.

Below is a photo of a visceral fatty deposits in a mouse liver in two different species of mice involved in obesity research. The upper photo shows an "obese mouse", while the lower photo shows the "fit mouse" liver. You can clearly see the "marbling" of the fatty liver.


Today's entry is kind of an "inside baseball" thought that occured to me reading an article on medicine.

There was a breathless article on the news wire "Participants Left Uninformed in Some Halted Medical Trials" (syndicated from a New York Times story) earlier this week about the fate of patients who were enrolled in clinical trials for devices or drugs that had been discontinued. In many instances these patients (and occasionally their doctor) were apparently unaware of this fact. They used two medical devices as examples - vascular stents used to treat aortic aneurysms and a type of breast implant used in cancer reconstruction.

The stents are a potential big problem in that if they don't perform as designed, the patient will die. The breast implant patients (two women in south Florida) seem to be having much less an urgent issue. From the thumbnail description it sounds like the women were having some degree of capsule pain, which is not terribly uncommon especially in breast reconstruction patients who've been radiated. Capsular contracture is also the way some silicone implant ruptures present.

Implied in the NYT article is the implication that these women are "sitting on a time bomb" with their implants which is really silly and makes the juxtaposition from the stents scenario kind of ridiculous. In this instance, I'm not sure you'd do anything at all different for these women other then checking for rupture. No one would recomend "prophylactic" removal of those implants in the abscence of documented rupture, particularly if the implants were less then 10 years old. We have plenty of information about the treatment of silicone breast implant ruptures, and it's well established that the problems you get are local issues to the chest wall. A capsular contracture or ruptured implant is it's own issue, but to hold it up next to potential life-threatening device failures misses the real serious problems with medical devices and their surveillance.

They don't really go into much detail other then identifying the implant manufacturer, Allergan, and that the particular implant had been discontinued recently (~2005). If I had to guess, it's probably the Inamed "Style 153" implant these women had, which was an anatomically shaped silicone gel device that preceded the more advanced Style 410 "gummy bear" implants. Those implants, which were voluntarily pulled from the market by the manufacturer during their approval process negotiations with FDA for their conventional type of silicone gel breast implants.

The style 153 implant had an innovative "double lumen" core that had an apparent higher failure rate when you studied them on MRI scans (the best test for rupture). Confusing the issue is the resemblance of the double shell for some of the described signs of intracapsular implant rupture which is well described in this full text American Journal of Radiology article. There are a great many surgeons who strongly believe MRI's (or at least the radiologists reading them) have a tendency to over-estimate ruptures, particularly with this specific implant. At the end of the day Inamed made the decision in 2005 to "cut bait" on such a minor product to better their chances of FDA approval for their other products. The style 153 was a good implant for it's time, but it really was just a transitional model to the form-stable devices like the 410.

* Below is an MRI showing the characteristic "double lumen" sign confused for rupture occasionally with style 153 device


So that’s it! I always wondered why guys spent so much time pacing and fretting over girls and women. Now it’s been studied and classified as a scientific fact. So declares The National Academy of Sciences who sponsored a study of 26 men and 20 women, aged 26 to 40, to find out just what all the fuss has been about.

The conclusion was actually limited to: men like good looks in the woman they choose for a mate. It might even explain why plastic surgery remains so popular. (What did the women like? Another surprise! Guys with lots of money. Sorry guys, cosmetic surgery is no help if you’re broke.)

It’s like organizing 30 professors with 10 centuries of higher education and a combined I.Q. of 96,000 to find out things things like, oh, are the oceans wet, is the sky blue (Los Angeles not included, of course,) do dogs bark or cat meow.

Actually, unusual scientific studies are nothing new. Unless I miss my guess, many university professors don’t have enough papers to grade and dream up these intellectual studies to fill time.

Study: English Layabouts

The Sunday Telegraph in London took a poll of 1,000 men for Opinion Health and found that 41 percent do no regular physical exercise whatever and eat “appallingly.” (READ: exist on potato chips and beer.) When asked what they intend to do to counter the ill effects of two decades of slothful living, 23 percent said they would just have rejuvenation procedures and never mind the cost of plastic surgery.

Unfortunately, it really doesn’t work that way. The chairman of the National (U.K.) Obesity Forum reminded everybody that improving your health is “bloody hard work.”

Remember, plastic surgeons are trained to look for people who want plastic surgery for the wrong reasons. Their guideline is the SIMON Profile (Single, Immature, Male, Obsessive and Narcissistic.) Read more about how some patients are screened out as candidates for surgery.