According to a recent plastic surgery society survey, plastic surgeons are not immune to the economic and credit crises. Overall declines are widely reported in major cosmetic procedures. However, even in these tough times, the survey found that both men and women are continuing to spend money on non-surgical procedures to look and feel refreshed. The primary motivations to continue to do so are to be competitive in the workplace, to be more attractive to their partners, and for special events such as weddings, anniversaries, and reunions.

The most common non-invasive cosmetic procedures included Botox and injectable fillers as well as microdermabrasions, chemical peels, and intense pulse laser (IPL or BBL) treatments. All of these office-based procedures are effective, have little to no visible recovery, and generally provide a good value for the investment.

Women, not surprisingly, continue to make up the vast majority of patients seeking these procedures. While cosmetic procedures have historically been dominated by older women fighting the effects of time, increasing numbers of women under 35 are signing up for injectable therapies, specifically Botox. Younger women appear to be seeking Botox to improve their youthful appearance and prevent deeper wrinkles from appearing later in life. With more men working longer (and perhaps really longer after the recent downturn in the stock market), men are also seeking these non-invasive treatments but only about 1/10 the numbers as women.

During these difficult economic times, the trend of numerous non-plastic surgeons marketing their services and treatments at a lower cost or discount rate continues to be prevalent. Many medical personnel are running from traditional medicine due to decreasing reimbursements. The ease of performing injectable and light and laser treatments and the willingness of device and drug manufacturers to sell to anybody has made this transition possible, Many such ‘cosmetic practitioners’ use advertising that is misleading and deceptive and is easy to promulgate on the internet. This has resulted in an increasing number of local complications including clumping and granulomas from injectable fillers, burns and hypopigmentation from light and laser treatments, and asymmetrical or inadequate results from Botox injections.

The future of non-invasive cosmetic treatments appears bright. Consumer demand will continue, almost regardless of the economy, and novel treatments are undoubtably forthcoming. Competitive analogues to Botox, such as Reloxin, will make facial expression management even more popular. Newer versions of injectable fillers that last longer and light and laser therapies that improve skin rejuvenation results are inevitable.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

I read an article on MSN’s Health and Fitness section on the internet today, which while covering relevant cosmetic topics, did a disservice and injustice to many of them. The article was intended to suggest that the nine procedures/treatments reviewed were either unsafe or were not effective. As such, you should rethink them. Having either performed them in patients or studied the evidence, I think a critical review of the article’s content is in order. I will do so based in the orer they were covered in the article.

BOTOX BREAST LIFT

This one I would completely agree with everything said in the article. This is a ridiculous idea and anyone that knows anything about breast lift surgery would concur. This is simply someone trying to push the envelope of what Botox can do. Botox may be a miracle drug but it has no place or role in trying to lift a breast. Anyone that uses it as such should be ashamed of themselves for such chicanery….and subjecting patients to such a terrible waste of money.

FISH PEDICURES

Obviously a novel marketing idea from the nail industry but no small fish could do as good as job as a human with a file and scissors. Their mention of possible fish contamination is valid but I have enough trouble thinking of using instruments and baths that have been used and cleaned from other people….let enough a tank full of smelly fish.

EYEBROW WAXING

This is commonly done and highly sought after from many patients. To condemn it as unsafe or at high risk for causing burns flies against broad experience in many good facilities with well trained people. This remains a simple and highly effective cosmetic procedure for shaping the eyebrows and getting rid of that ‘unibrow’.

LATISSE

This eyelash enhancer, while new, is FDA-approved and perfectly safe. Yes, some patients will develop eyelash or eyelid sensitivity with its use and be unable to use it. This is clearly on the packaging inserts and is discussed with all patients to which we prescribe. To the few patients who develop sensitivity to the problem, they are quickly and easily treated to resolve their mild allergic reaction.

TEETH WHITENING

Teeth are whitened primarily by different concentrations of hydrogen peroxide. The higher the concentration, the quicker and whiter most teeth become. But with higher concentrations come increased risk of tooth sensitivity. UV (blue light) lights enable lower concentrations of hydrogen peroxide to be used which enhance their effectiveness while keeping down sensitivity. In my teeth whitening protocol, we use two 20 minutes light sessions (with eye protection)  with a 7% hydrogen peroxide solution, followed by a final 20 minute session with 35% hydrogen peroxide without any light. This is perfectly safe and exposes the patient to less UV radiation than a single series of dental x-rays.

PERMANENT MAKEUP

The placement of permanent tattoo pigments into the lashline and eyebrows has now been successfully done for nearly 20 years. I have yet to see a single case of  an inflammatory reaction to the implanted pigments. Patients are fully educated beforehand as to the irreversibility of their decision and that is why we spend time reviewing pigment placement and color before actually doing it. Patients are generally thrilled with the use of permanent makeup…so much so that they always come back for touch-ups over the years when there has been some fading of the color.

CHEMICAL PEELS

Despite the advent of the laser, facial skin exfoliation and rejuvenation is still done largely by chemical peels. There are numerous chemical agents in many different concentrations that can be tailored to the amount of improvement and recovery that the patient wants. A chemical peel is…..well it is a burn plain and simple. The depth of the burn is chosen between the provider and the patient. Light chemical peels, such as fruit acids (AHA) and glycolics, are always done by an aesthetician in my practice. They are perfectly safe and produce very gratifying results with little to no downtime. Moderate depth and stronger peels, such as trichloroacetic acid (TCAS), are done by me exclusively under the guise of more improvement with an accepted longer recovery time.

BRAVA BREAST ENHANCEMENT

The issue here is not one of safety but of effectiveness. Most patients will not be happy with a 1/2 cup size improvement taking a long protracted time to get there. But for those small number of women who are ardent opponents of surgery and implants, this is their only real option.

THERMAGE

Thermage touts some mild skin tightening of the face and select body areas. In some patients, they do get visible results, in others no real long-term improvement is seen. While it is possible to create too much heat and cause an injury, the issue with Thermage is one of expectations and value in my opinion. Most patients are motivated to get some jowl improvement. Limited facelifts or jowl lifts cost a little more with proven results. When the two are compared in terms of value, Thermage falls short.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis