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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Laser lipo is boasting many advantages over traditional method…

Laser Liposuction is a minimally invasive, cosmetic surgical procedure which combines traditional liposuction techniques with laser treatment. Compared to older or traditional liposuction methods, laser-assisted lipolysis is generally thought to be safer, easier and quicker, providing more precise body contouring along with a skin tightening effect and minimal downtime.

Laser liposuction can be performed on many areas of the face and body, including the abdomen, arms, back, buttocks, chin, flanks, hips, knees, male chest, neck, thighs and waist. The laser enables many more individuals to be treated who previously would have needed surgery along with liposuction, often due to loose skin. Smaller areas and contour deformities not suitable for treatment with traditional liposuction are ideal for treatment with laser liposuction due to the enhanced precision of the laser. Laser liposuction can also treat areas with little or no fat like the submental area, or the area beneath the chin, as well as areas which have previously been treated with liposuction for improvement of contour deformities and skin laxity. Individuals who cannot afford the lengthy recovery associated with other treatments will find laser liposuction to be a particularly appealing treatment due to the rapid recovery and minimal downtime.

Laser liposuction is most often performed on an outpatient basis with local anesthesia, thus eliminating the risks associated with general anesthesia. Each targeted area can typically be treated in less than one hour. During the procedure, a small cannula fitted with a single laser fiber is inserted through small incisions in the treatment area. Because the incisions are small, there are no visible scars. Once the cannula is inserted, the energy from the laser liquefies the fat cells which are then drained away. The laser provides an additional skin tightening effect for improved contour, and the precision of the laser also helps to preserve the surrounding tissue.  This new approach to fat removal uses precisely controlled cooling of fat cells for removal without harming the surrounding skin or tissue. This technology can be used to safely remove fat cells near nerves, muscle and bone.

There is little downtime or recovery associated with laser liposuction and most patients are able to return to their normal routine and work within one to two days. Patients report less discomfort, bruising and swelling than with traditional liposuction. The results of laser liposuction are long-lasting with sensible diet and exercise.

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Laser Clinic MD: Laser Liposuction advantages

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The rejuvenating effects of oxygen can also be put to use as a form of skin rejuvenation, designed to help make skin more radiant and to reduce fine lines and wrinkles.

How It Works

Therapeutic oxygen has long been used to aid in healing and to prevent infection after surgery or a wound. In traditional oxygen therapy for medical conditions, patients are placed inside an oxygen chamber in which they breathe concentrated oxygen to help stimulate their body to heal.

When oxygen is used as a skin-rejuvenating tool, this same therapeutic oxygen is used. However, as a cosmetic procedure, the concentrated therapeutic oxygen is applied to the face using hyperbaric pressure. Often, other supplements are also added to the oxygen infusion in the form of a binding agent called hyaluronic acid. These supplements include vitamin C or amino acid complexes, which also serve to improve the appearance of the skin.

Application

Doctors administering oxygen therapy typically use on oxygen infuser that releases this concentrated oxygen. The infuser is held at a 90-degree angle approximately 1 millimeter from the skin’s surface and oxygen is applied to the face.

When the infuser is held at the appropriate angle, a pressure bubble forms, causing more oxygen to enter into the epidermis of the skin. This outer epidermal layer is stimulated by the increased presence of oxygen. Collagen formation is also encouraged by the presence of the oxygen and other compounds. The overall result is healthier skin that is plumper, smoother and fresher looking.

Results

Many patients report an instant improvement in the appearance of their skin. Results improve with repeated applications. Most doctors recommend a series of six treatments in order to achieve maximum benefit.

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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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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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Be Born Again

To promote Dr. Kim’s plastic surgery office, this life scale poster was placed at the entrance of his office and by the elevator in the main lobby of the hospital building.

A slick little promo for a plastic surgery practice.

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Plastic Surgery Product Placement

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Have you ever wondered what you would look like with bigger breasts or poutier lips? Now you can find out using a simple app made for the iPhone. There are now two plastic surgery applications for the Apple iPhone that offer users information, games and the chance to see what they would look like with a face lift, new nose, and many other procedures.

The firs plastic surgery app – The Shafer Plastic Surgery App – launched in October. It’s the first app of its kind amongst Apple’s 85,000 offerings in the iPhone App Store. It was created by Dr. David Shafer of New York, and taps into more than 1,000 questions and answers about specific cosmetic procedures.

The second iPhone plastic surgery app will soon hit the iPhone App Store, and it’s called “iSurgeon”. iSurgeon was developed by Miami cosmetic surgeon Dr. Michael Salzhauer, who is also well known for authoring the 2008 book “My Beautiful Mommy” – a book aimed at helping 4 to 7 year old children cope with their mother’s plastic surgery.

iSurgeon will feature a fun game mode that allows users to try their hand at surgery, giving people the chance to instantly modify images of themselves or their friends through breast augmentations, lip enhancements and dozens of other procedures.

The Shafer Plastic Surgery App is available for $2.99. iSurgeon will be free during its first month of release later in November.

Nice to see that your iPhone can manage more than just phone calls from your plastic surgeon or medical spa.

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iPhone Plastic Surgery

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Facelifts have become a common cosmetic surgery for men and women. But surgery patients face a number of unwanted effects. Scarring, extensive recovery time, that artificial "stretched" look, and a permanent result that may be unwanted.

Fortunately, newly developed medical alternatives offer results to people wanting look younger without going under the knife.

As a leader in non-invasive cosmetic medicine, many medical spas, laser clinics and skin clinics now specialize in innovative new medical treatments for a youthful lift without the messy and painful recovery. Some medical spas have developed a unique non-surgical facelift for patients looking to gain the dramatic results of a surgical facelift but avoid a surgical facelift. Non-surgical facelifts include Thermage or Fraxel Skin Tightening followed by their signature Surface Point Lift as the non-invasive, yet exceptionally effective substitute for any surgical facelift. (Botox is also used.)

Thermage is an FDA approved radio-frequency technology that has been proven to tighten and contour the skin and its many underlying tissues without surgery. The treatment has the added benefit of stimulating the growth of new collagen throughout the skin. But there's a caveat. Thermage results are highly dependant upon the way the treatment is administered. Surface has developed specialized protocols that produce results that attract patients from other areas of the country who are looking to achieve maxim results.

Nonsurgical facelifts can be just as spectacular.

Point Lifts were created by specialists in non-surgical cosmetic medicine to replace the traditional invasive facelift. It can also be used for brows, jaw lines, necks, breasts, and even the derriere. They're perfect for the patient who does not want to undergo the harsh effects of a traditional surgical facelift including the associated, frustrating recovery period. Point Lifts are a physician procedure that "lifts" the treatment area in exactly the same was as surgical lifts, only there's no surgery.

The procedure involves placing a small, special suture under the skin through a tiny needle hole, leaving the skin to smooth with its own tension. The theme here is "No cutting. No stretching. No Stitches. No scars!" Most importantly, Point Lifts will not leave the face with that "stretched look" of traditional surgical lifts. Patients can resume their normal activities immediately with only minimal discomfort. Best of all, Point Lifts are completely reversible. Most people never knew they could have a fresh, younger lift without the troubles of surgery.

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Avoid A Facelift: Medical Spas, Laser Clinics, Skin Clinics & Laser Treatments.

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