In the fall season opener of “Nip/Tuck,” the sleek Los Angeles office of McNamara/Troy sat forlorn and empty, a voice-over reminding that when times are tough, one of the first things to go is the luxury of elective cosmetic surgery.

That same scene could be played out in plastic surgeons’ offices all over, as people seem to be passing up big-ticket beauty procedures — face-lifts, liposuction, breast augmentation — and seeking less expensive ways to achieve beauty ideals.

According to both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, the number of cosmetic surgical procedures done in 2008 was lower than in 2007 — by 9%, according to the ASPS, and 15%, according to the ASAPS. And although 2009 figures will not be available until late February or early March, plastic surgeons say, anecdotally, that business for the year was down at least 20% from 2008.

As a result, cosmetic surgery practices are finding themselves acting somewhat as financial consultants to their patients, helping them work out payment plans, negotiating fees and making out lists of priorities — a Brazilian butt lift can wait, but those wrinkles under the eyes need to be dealt with right away. In addition, plastic surgeons who previously only focused on the expensive and invasive procedures have had to turn their hands to the quick fixes — fillers, peels, laser treatments — which are increasingly in demand now.

Nonetheless, and partly because of an increasingly competitive job market, people still want to get work done, Mayer said, but they need cheaper options. Among them: Botox, Restylane and other injectibles that minimize wrinkles are proving especially popular and, at about $1,000 a treatment, are more affordable than the average $10,000 for a face-lift.

Experts are seeing trends across the board that are providing an insight into how people are choosing to spend their beauty dollars: Injectibles are holding their own, expensive products are not. The time between haircuts and mani/pedis is being stretched out, and massages and other body treatments are being postponed. But while fewer people are signing up for pricey liposuction surgeries, treatments such as laser liposculpture are proving popular.

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Laser Clinic MD: High Cost Treatments Taking a Backseat

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Patients don’t have to wait for the economy to get better in order to look their best…

In a tough economy where many are turning to cosmetic surgery to help “lift” their job prospects, more patients are turning to scaled-down versions of face lifts to get some of the results of the traditional procedure without the traditionally larger price tag.  Facial liposuction is quickly growing in popularity with patients who want noticeable results but cannot commit to taking much time away from work for recovery.

“I think what we’re seeing now is a second wave of patients who have decided they aren’t going to wait on the economy to improve their appearance,” explains Dr. Andrew Salzberg. “We’ve seen a number of patients who decided to switch over to short-term, noninvasive treatments like injectables, but I think a lot of these patients now are taking a second look at their options and going for longer-term results that still fit their budget.”

To many of these women and men, facial liposuction seems like an ideal solution. “For the right patient, this procedure is a great alternative to the traditional face lift because it creates a few key adjustments without requiring patients to take a lot of time off of work to recover,” says Dr. Salzberg.

A face lift adjusts sagging muscle tissues, skin, and fat, but facial liposuction focuses instead on eliminating excess fat in areas like the lower face to ease signs of aging like wrinkles, jowls, and neck “wattles.” While facial liposuction is not as extensive as a face lift, it can often improve the lower face dramatically by tightening up the jaw line and minimizing some of the more noticeable wrinkles around the mouth.

“With a traditional face lift you get multiple levels of correction, and for many patients those changes will be more appropriate,” explains Dr. Salzberg. “For the right patient, though, the results of facial liposuction can be very impressive.”

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Face lift alternative in facial liposuction

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Winter is a blessing for women wanting to cover up their cankles….

(CNN) – ”Cankles” is slang for the part of the leg where the ankle meets the calf when there is no definition or indentation.

Cankles? What are cankles? We’ve heard about saddle bags, muffin tops and love handles, but it seems that some women and men of the 21st century are now focused on the chubby joints of their lower extremities.

Far from being a medical term, “cankles” is slang for the part of the leg where the ankle meets the calf when there is no definition or indentation. In most cases, cankles are just large ankles — what used to be called “big bones.” But in society’s quest for all things thin and shapely, big-boned ankles have taken on a name — and a life — of their own.

According to podiatrists, the average ankle size is about 10 to 11 inches around; men’s ankles may be a little larger. The American Podiatric Medical Association does not recognize cankles as a medical problem, but according to Dr. Kathya Zinszer, a physician at Temple University’s School of Podiatric Medicine, cankles can be caused by all types of medical issues.

“Things like diabetes, hypertension, cardiovascular risks, sometimes just lymphedema,” says Zinszer. “All of those can lend themselves to deformed ankles or what people are [calling] cankles.” But Zinszer says that most cankles are “God-given.”

Zinszer has seen patients try to alter their cankles. Some people turn to ankle liposuction, which can cost anywhere between $4,000 to $8,000, depending on how extensive the ankle-shaping need is.

But Zinszer doesn’t recommend liposuction because it can do more damage than good. “The foot, the lower extremity, has a lot of neuromuscular structures,” she says, explaining that by removing some of the tissue, nerves and vasculature can be damaged, creating an even bigger problem.

There are exercises that can keep your ankles firm. However, they don’t always work. Jeff Timmons, a personal trainer from Harrisburg, Pennsylvania, says he has clients who constantly complain about the size of their ankles. Many plead with him to help them shape their legs and give their ankles definition.

Although some exercises can make a little difference, he says, most cankles are stubborn and stay put because they’re part of a person’s anatomy. “Sure, if you’re heavy, you’re going to have heavy ankles, so losing weight will make a difference,” he says. “But to be honest, most of my clients who want to get rid of their cankles are already in pretty good shape.”

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Laser Clinic MD: Cankles are the new love handles

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In this article, I will give you several tips and tools to evaluate your laser centers culture and operations, so you can successfully navigate any economic downturn… And live to sell another day when the inevitable upturn comes around.

What is the Passion and Purpose of Your Medical Spa?

You reap what you sew. When you engage proactively and passionately in your business you will undoubtedly be successful and see your practice expand. It helps to articulate your passion for your medical spa.

At Assara Laser, our passion is to “help clients look and feel great, not fake.”

Why the Recession Drastically Affects Your Laser Clinics Bottom Line

You’ve probably noticed that generating revenue is not as easy as it once was. There are myriad reasons for this; from the decline in disposable income, to unemployment hitting record highs and tanking real estate valuations. As if these facts were not bleak enough, credit markets are virtually frozen so business owners are finding it nearly impossible to obtain small business loans and lines of credit. Refinancing current loans has become difficult for small businesses.

In short, we’re operating in the perfect storm.

Accepting Reality and Responsibility Today

The easy way out is to close up shop and blame the recession. This will not help you going forward, it will not pay your devoted employees their wages, and most of all, it will not help your clients “look and feel great, not fake.” So, accept responsibility.

The hardships of the recession create a fact-pattern, problem to be solved; not a reason for failure. To paraphrase Michael Jackson, start, first, with the man in the mirror. Think about the following questions. And pay attention – there will be homework at the end of this article!

Finding Your Medspas Winning Competitive Difference?

Let’s be honest. The quality of your laser clinc’s treatments are probably not drastically better than that of your competitors. The proprietary equipment and IPL or laser systems (Thermage, Fraxel, Titan) that you use are, for the most part, available to the competitive skin clinic market at large.

You may believe (and tell clients) that your microdermabrasion treatments are better because you use a diamond-tipped wand or aluminum oxide crystals. You may think that your IPLs or laser hair removal treatments are better because you use cryo-cooling or because you use chilled air cooling, or because you use a diode laser or because you use alexandrite lasers . . .

BUT . . .

Step in to your clients’ shoes. To them, the bells and whistles of your Thermage or Fraxel device don’t matter. Your clients already expect expert advice and cutting edge cosmetic lasers, IPLs and skin tighening equipment, so merely meeting this fundamental requirement is not a winning competitive difference.

What does matter to your clients are presentation, client interaction, customer service, reliability and consistency. Consider this carefully.

What is each of your medspas clients worth?

At Assara Laser, one of the most popular packages is our $449 per month Unlimited Laser Hair Removal Program. On average, a client that signs up for this program will remain a member of the Program for 7 months, depending on the results they wish to achieve. How much is a single unlimited client worth to us?  A client in the program for 7 months, making a monthly payment of $449 is worth $3,143. For many laser clinic owners, a single laser hair removal client is worth more than a home mortgage payment!

Do you treat every single potential laser treatment client that contacts your laser clinic as if they’re worth $3,000?

What is your time and effort worth?

Before my partners and I built Assara Laser, I was an attorney. I still practice corporate law as a labor of love, when a friend or business contact has an exciting deal. I normally discount my rate to about $400 per hour, as law isn’t my primary source of income.

Assume an hour of your time is worth $400.  Assume further that, every time your customers complain, you are willing to give a discount, or a free treatment and that, collectively, free and discounted treatments account for a 20% loss in your revenue. To make up for this lost revenue, how much more work do you have to do?

Well, let’s add 20% to your 10 hour day, which now makes it a 12 hour day. If annual sales are $1,000,000 per year, you’ve lost $200,000. This translates into 500 hours more of work you must do to bring your revenue back to status quo!

Is there a big difference between a day that starts at 9:00 a.m. and ends at 7:00 p.m. versus ending at 9:00 p.m.  You betcha there is!  Is there a big difference between a loss of $200,000 and a loss of zero. You betcha there is!  And these differences drastically affect your quality of life.

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Laser Clinic Operations

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Cosmetic surgery can carry risks as well as benefits

Several newspapers have reported the dangers associated with cosmetic surgery, including a lack of regulation in some areas of the industry. The reports also feature warnings from Nigel Mercer, the president of the British Association of Aesthetic Plastic Surgeons, who voiced his views as part of a series of medical articles on cosmetic surgery.  Mr Mercer called for tighter regulation and testing of drugs, procedures and implants to offer more protection to patients.

The Times reported that the number of cosmetic surgical operations conducted by “audited members of the profession” has more than tripled to 34,000 since 2003, but that many additional procedures are being carried out on the black market. The newspaper says that these are “fuelled by internet promotions, magazine advertising and aggressive discounting”.

What is the basis for these news reports?

The reports were based on a special edition of the journal Clinical Risk, which featured several articles on the issues surrounding cosmetic surgery. These issues include the potential for physical and psychological harm, and the need for tighter regulation of the industry, better training programms for surgeons and measures to improve patient experience.

Nigel Mercer, president of the British Association of Aesthetic Plastic Surgery, wrote an accompanying editorial arguing that the availability of consumer credit and a change in public attitudes has led to an explosion in cosmetic surgery in recent years. According to Mercer, this growth, combined with increasing public expectation and media hype, has resulted in “the perfect storm in the cosmetic surgical market”.

What is cosmetic surgery?

Cosmetic surgery, sometimes called aesthetic surgery, was described by a doctor in the journal Clinical Risk as being “purely elective, a lifestyle choice undertaken to enhance physical appearance, improve self-esteem and boost confidence”. Another doctor says that it differs from all other forms of surgery in that it is a treatment for “want” rather than for “need”.

In the 2005 Regulation of Cosmetic Surgery report, published by the Department of Health, cosmetic surgeries are defined as “operations and other procedures that revise or change the appearance, color, texture, structure or position of bodily features, which most would consider otherwise to be within the broad range of ‘normal’ for that person”.

Cosmetic surgery differs from plastic surgery, which is generally surgery to repair or reconstruct tissue or skin damaged by congenital (inherited) disease, injuries or burns. The primary role of plastic surgery is to restore function, and aesthetic improvement is secondary.

How is cosmetic surgery currently regulated in the UK?

At present, there are measures and standards to help regulate the industry but some cosmetic surgeons operate outside these regulations. Some treatments and procedures are unlicensed for cosmetic use, but can be given the discretion of doctors, or “off license”, by some clinics.

Surgical practice in the UK is regulated by the General Medical Council (GMC) and practicing surgeons should be enrolled on its specialist register. However, some concessions are made for private cosmetic surgeons who have been practicing since before April 2002. By satisfying certain criteria, these doctors can practice without the need to be on the specialist register.

Invasive cosmetic surgery and laser treatments are also regulated under the Care Standards Act 2000. The Healthcare Commission inspects all registered establishments that carry out invasive procedures and laser surgery in the UK, and has the power to revoke practice licenses and to take enforcement action.

Some cosmetic surgical procedures are not covered by current regulations, such as Botox injections and injections of aesthetic fillers. Botox is not licensed for cosmetic use, but it can be prescribed “off license”, in which circumstances the doctor assumes liability for its use. Most fillers are tested in the UK as “devices” rather than as drugs. This means that they are regulated based on the standard of their production and not on whether the treatment works.

The Department of Health report concluded that the regulatory situation for cosmetic surgery was not satisfactory because of the group of doctors who can practise without being on the GMC specialist register and the lack of clarity around the definition of “fillers”. Although practitioners of cosmetic surgery must demonstrate certain competencies, these may not be the equivalent standard of NHS consultants.

What do these journal articles say about cosmetic surgery?

The authors of these articles have argued several opinions, including that:

• Patient psychology should be considered by clinical staff as issues of mental health and body image may be behind the desire for cosmetic changes. These could also arise in people who feel disappointed or upset by the results of their surgery.
• Surgeons should keep records detailing their patients’ expectations and provide them with guidance on whether these are realistic.
• There are risks associated with any type of surgery and patients should be informed of these and their surgeon’s success rates when considering procedures.
• It is important that patients are given time to consider their options. Doctors should also inform patients about alternative treatments that may be available.
• Before procedures are carried out, it should be clear who will be financially liable for the correction of any complications.
• There may be some merits to adopting a regulation system similar to that in France. Under this system, patients must be given information on costs, risks and the surgeon’s qualifications to perform their selected procedures.
• The way that cosmetic surgery is marketed should also be regulated.

What is the problem with plastic surgery marketing?

Mercer says that cosmetic procedures are often marketed using special offers, including vouchers, two-for-one deals and surgery holidays, and that these practices contribute to an “unregulated mess”.

The articles also feature a call to ban advertising of cosmetic procedures, stating that, like tobacco, there should perhaps be a Europe-wide ban on advertising all cosmetic surgical procedures, including on internet search engines. While advertising can be powerful, says Mercer, it is often misused by the cosmetic surgery industry and misinterpreted by those it is aimed at.

Where can I find more information on reputable plastic surgeons?

The British Association of Aesthetic Plastic Surgery is a not-for-profit organization based at the Royal College of Surgeons. It was established to advance the education and practice of cosmetic surgery for public benefit. While it is not a regulatory body, it has long been involved in giving the public information on the safety of cosmetic surgery.

Its research into cosmetic surgery tourism was discussed at a recent conference and its press releases highlight a number of dangers associated with unregulated procedures, including DIY injectable treatments available over the internet.

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Plastic surgery advertising regulation push in Britan.

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A study in the Journal of the American Academy of Dermatology says if you want to see a skin doctor about a changing mole, get ready to wait. The average wait time is 26 days. But if you want a Botox shot, it’s just eight days, two-and-half weeks shorter. Here in mid-Missouri, two dermatologists say that’s not true.

“There’s a shortage of dermatologists nationally,” dermatologist John Despain said. ”Also, patients have direct access to dermatologists for skin care.”

Dr. John Despain owns Despain Dermatology Center and Skintuition Medical Spa in Columbia, focusing on cosmetic dermatology like Botox. He says at his practice, clinical appointments always come before cosmetics.

“They are seen on a priority basis within a few days,” Despain said. ”If they’re a new patient, if there’s the ability to put them in a new patient slot, they priority over anyone calling for cosmetic concerns, of course.”

At Dr. Lindall Perry’s practice in Columbia, they treat all appointment requests the same.

“We don’t have, quote, ‘cosmetic appointments,’” he said.

Although Perry is booked through January, he says patients with skin problems can get appointments.

“We have open appointments in two weeks with our newer staff and they would take both a cosmetic patient, an acne patient, a wart patient,” Perry said.

Perry says it can be a challenge juggling business and patient care.

“I like to think I have sound business practices,” she said. ”I do schedule myself very fully. My staff would say too full. My patients would say too full. We pay attention though to the frustration of long waits.”

With a heavy focus on clinical treatments, Perry says he tries to see as many patients as possible. Often leaving the Botox appointments for after hours. He says money is a benefit of his practice, not the motivator.

“My desire everyday is to find every melanoma that’s in front of me and not to miss that,” he said. 

As for Despain, he likes biopsies just as much as Botox.

“I view them as a compliment to each other,” he said. ”If I had to choose how to spend my time out of enjoyment or profitability, they’re probably equal.”

Both doctors say there’s certainly a demand in mid-Missouri for cosmetic dermatology, but most of their patients and profits stem from clinical work. In the meantime, if you want to see a dermatologist, the best idea is to plan ahead.

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Cosmetic Dermatology: No wait for Botox or Photofacials.

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An estimated 100,000 cosmetic surgical procedures are performed in Britain each year, many by doctors who have had no specialist training in cosmetic surgery. In addition, hundreds of thousands of non-surgical procedures are done, including Botox for wrinkles and laser treatments to rejuvenate skin, many by non-medical staff with little or no training.

The 200-member Baaps represents the top surgeons in the business who performed 34,187 surgical procedures in 2008, twice the number in 2004. More than 90 per cent of them were on women. The most popular procedure was breast augmentation, demand for which rose 30 per cent last year.

But Mr Mercer, who combines private practice as a cosmetic surgeon specializing in facelifts with his work as an NHS consultant in reconstructive surgery for cancer patients, said the market for cosmetic surgery, of which Baaps surgeons account for less than one third, was an “unregulated mess”.

He added: “There has been a massive increase in plastic surgery marketing, including discount vouchers, two-for-one offers and holidays with surgery. In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a two-for-one advert for general surgery. That way lies madness.”

Mr Mercer, in the journal Clinical Risk, which publishes articles on cosmetic surgery today, he warns that “the doctor’s first duty to protect the patient” has been forgotten in the headlong rush to cash in. “The motive for performing any procedure must never be financial gain … if we cannot self-regulate then regulation will eventually be imposed.”

Citing experience in France, where all advertising of cosmetic procedures is banned, he says: “Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic surgical procedures, including on the internet search engines.”

Among those who can testify to the dangers is Jill Saward, the former lead singer of 1980s group Shakatak, who last year agreed to a facelift in the hope of reviving her career after her divorce. But she suffered complications aggravated by her high blood pressure and bitterly regretted the decision. Three months after the operation she still did not have full feeling and was warned full recovery could take a year.

“Surgery is not a quick-fix solution,” she said. “The simple truth is that I could have died. I was an idiot, I should have thought much more carefully about the operation and its dangers. It was pure vanity.”

Foad Nahai, president of the International Society of Aesthetic Plastic Surgeons, backed Mr Mercer’s warning, and called for tougher regulations to prevent doctors practising without specialist training. A code of practice backed by self-regulation of cosmetic clinics was announced by the Government in 2007. Clinics are also subject to inspection by the Care Quality Commission. But Baaps says the measures do not go far enough.

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Cosmetic surgeons demand ban on advertising… cosmetic surgery!

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There is mounting concern about a vaginal plastic surgery procedure more and more Australian women are having.

Each year more than 1,200 Australian women undergo surgery on their genitalia in a procedure known as labioplasty.

Doctors and surgeons fear that some women may be having the operation unnecessarily and there are concerns about operations being done by unqualified medical professionals.

In Britain, where the procedure is equally popular, medical experts are warning of a shocking lack of information about the risks and long-term impact.

It is controversial surgery but it is booming nonetheless.

For some, labioplasty is an exercise in Hollywood-style vanity, while for others it is a transformative procedure that trims, sculpts and restores a woman’s genitalia.

But there have been no studies to prove its long-term safety and doctors are worried about its ballooning popularity.

Dr Ted Weaver from the Royal Australian College of Gynaecologists says there are concerns.

“We put out about a statement from our college a couple of years ago, highlighting concerns about this designer vagina craze because we felt that often it did prey on fears of women and women’s insecurity about their particular genital appearance,” he said.

“The surgery’s potentially damaging. It could potentially lead to further problems for a woman as a result of surgery and may not fix her insecurity.”

Dr Kourosh Tavakoli is a member of the Australian Society of Plastic Surgeons and a fellow of the Australasian College of Surgeons.

He has been performing the labioplasty for seven years and is seeing a 100 per cent increase in that number year on year.

“Let’s not kid ourselves. The last survey in my practice was 80 per cent for cosmetic and I would say for psychological reasons – that’s what I see as a function,” he said.

“There are two reasons [women give for having the surgery] – I can’t get comfortable during sex and the number two reason is essentially pure physical, in terms of running or jogging and not being able to wear a leotard or cossie.”

Labioplasty can cost between $4,000 and $6,000 and is often covered by Medicare.

Safety fears

Dr Tavakoli says it is a lucrative field, but he fears some practitioners are not up to the task.

“I have seen horrendous results from them. I mean there’s three groups doing it – plastic surgeons, gynaecologists and GP surgeons in their offices, without proper lighting or sedation or anything,” he said.

“I think the last group is a concern because they can take excess tissue and cause problems.”

Research published in the British Journal of Obstetrics and Gynaecology is questioning the value of the labioplasty, with concerns that many women seek the surgery without fully understanding the risks. British medical experts are also questioning the ethics of the surgery.

Dr Weaver says some women are being exploited.

“We think anybody performing these procedures certainly should be well trained, not only in the surgical technique but also have the training in the ability to try to perhaps dissuade a woman from having it done,” he said.

“[They should] also be able to counsel the woman that there is a variation in normal appearance and that she doesn’t have to confirm to a picture that she might have noticed in a girlie magazine or something equally ridiculous.”

He believes there are women in Australia who are having the procedure unnecessarily.

Dr Tavakoli says patients must be psychologically screened and they must have realistic expectations. But either way, he says the procedure is here to stay.

“I believe it’s a good operation. I stand by this operation. I’ve had enough experience to see the mental transformation that this operation can bring and it will become a mainstay operation in cosmetic surgery,” he said.

“But again it needs to be very heavily scrutinised and patient selection is imperative. In the right patient, it will have benefits and patient selection is paramount.”

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Designer vagina craze worries doctors.

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People are risking death or serious injury by using an illegal Botox equivalent without prescription, a CBD cosmetic doctor warns.

Dr Mario Soteriou, of Cosmetic Image Clinics, said self-administering the goods obtained at a new US-based online store was equivalent to playing “Russian roulette”.

He said neither the Botox equivalent nor the dermal filler sold on the website was approved by the Australian Therapeutic Goods Administration, which also decrees the products must only be administered under medical prescription.

The website also sells needles and an instructional DVD to enable buyers to self-administer the do-it-yourself Botox equivalent, with the promise of wrinkle free skin.

The dermal filler is also being marketed with a DIY guide for plump lips.

Dr Soteriou, who has specialised in cosmetic medicine since 2000, said he was “severely shocked” by the shonky website.

He said injectable treatments such as Botox and dermal filler should only be administered by qualified practitioners.

“The big problem with these drugs is that we don’t know what they are made of and they can’t guarantee you safety or results,” Dr Soteriou said. “Self-administering them is essentially like making a life decision without putting any thought into it.

“I wouldn’t even advocate for doctors and nurses to be injecting themselves.

“You are also risking your own death if you have an adverse or severe allergic reaction to the drugs.”

Dr Soteriou believes the website is a “money grab” and fuels people’s desperate desires for quick-fix anti-ageing products.

“I’ve never heard of these products before and I attend a lot of medical conferences to ensure I’m up-to-date with the latest in facial rejuvenation techniques,” he said.

Related Laser Clinc & Botox articles

• DIY Botox: Site Offers Injectable Drug Without Prescription – With How-To Video (lifetoup.com)
• DIY Laser Hair Removal And DIY Botox Markets Expanding [Household] (gizmodo.com)

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Do it yourself Botox: People are injecting themselves with fake Botox.

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