Explore Plastic Surgery

I read a recent article in People magazine this week entitled the same name as this blog. The fundamental premise of the article was that plastic surgery today is done on the ‘average person’, not necessarily the rich and famous. They go on to cite five people who had differing plastic surgery procedures and their stories.
This article was refreshing because they all had positive experiences, which is usually the norm, as opposed to many articles which talk about patient’s problems and complications which is not the norm. But the underlying theme of the article is what is most poignant for me. The large numbers of plastic surgery procedures done today could occur for only one reason….that the typical plastic surgery patient is just reflective of the average person in society. There is only a very small fraction of society that is famous or wealthy. The plastic surgery numbers of today, which total in the millions of procedures (surgical and non-surgical), could not come from that segment of society. In the past twenty years we have seen plastic surgery work its way into the mainstream of society and is much a part of American culture as Starbucks, cell phones, and My Space. The typical plastic surgery patient in my practice is just a normal person from the middle fabric of society, the range goes from the unemployed to a company CEO. Nearly 40% of my patients now use financing for major procedures, reinforcing the concept of the ‘average’ patient having plastic surgery. That number is starting to approach finance numbers for major appliances or other big ticket home items.
You may ask yourself why…..why do so many people undergo plastic surgery today? Is it the marketing hype from surgeons, is it the media convincing us that me must look better and younger through their projected images, or is our society just so vain? Probably all three of these have some responsibility, but there is one bigger reason. The main reason, in my practice experience, is that most plastic surgery procedures simply work and deliver what they purport to do. Breast implants make breast bigger and more shapely, tummy tucks really do flatten stomachs, facelifts do turn back the clock and tighten that jaw and neck line, and noses do get better shapes that look better on one’s face. Yes, plastic surgeons and plastic surgery procedures are not perfect. Every result is not ideal and some patients do experience complications. And yes sometimes plastic surgery procedures are overhyped. But, on average, most plastic surgery patients are very satisfied and would repeat the experience. A phenomenon that I call accompishment feedback. This explains why 30% of my plastic surgery operations in any given year is ‘repeat business’. Such positive experiences very directly promotes plastic surgery as a satisfied patient is very likely to consider another procedure or tell a friend, who may then go on to have plastic surgery themselves. Every business and profession recognizes the tremendous influence of such word of mouth referrals.
Plastic surgery today is and will continue to be for real people. Its benefits are wide reaching and the ability for all of society to benefit, from the child born with a cleft defect to the middle-aged sales representative who wants to look more refreshed, will continue to be more pervasive. The propagation of plastic surgery has as much to do with its overall effectiveness and high patient satisfaction as it does with marketing and media promotions.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

One of the very common questions that many patients ask, either through the internet or in actual consultations, is….how many of (whatever procedure they are interested in) do you do or have you done? On the surface, this question seems logical and appropriate and one that should lead to a level of greater or lesser confidence on the patient’s part. But is it really a meaningful question?

First and foremost, you have to assume that the plastic surgeon actually knows how many they have done. While I am sure many plastic surgeons have a general idea, very few could give you a reasonably accurate number. There is also the phenomenon that most of us surgeons think we have done many more surgeries than we actually have. Do you know how many times you have been in a Starbucks this past year? The specific number is not as important as the trend….either very few (every couple months), a modest amount (once every few weeks or so), or a lot. (at least once a week) That is how you should think about surgical numbers. Either your surgeon does the procedure a lot (once a week or so), frequently (at least once a month), or infrequently. (every couple of months) The point is…ask your plastic surgeon about how often they do the oepration in question…not how many have they done or do per year. You are much more likely to get an accurate assessment to the intent of your question.

Secondly, the commonality of the procedure has a lot to do with how often it is performed by any plastic surgeon. Some operations (e.g., breast implants) are done in high numbers across the country and is much more commonly done in any plastic surgery practice. Other procedures (e.g., calf implants) are not common operations at all and a plastic surgeon’s low ‘numbers’ may be more a reflection of the regional frequency of that specific procedure. 

Thirdly, I think pictures (before and after photos) are more relevant than a surgeon’s estimate of their operation rates. If a plastic surgeon can show you a number of before and after photos (their photos!) of the procedure and can go over what is right and wrong with a representative sampling of patients, that suggests a good familiarity with the procedure.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis

I got a call yesterday from a news agency from the East Coast who was doing a story on patients who undergo plastic surgery procedures for career concerns/advancement. Over the years, I have had a few patients who openly stated so although I suspect many more of my patients have had surgery for that reason without so stating. (and I am not talking about here a breast augmentation for a dancer!)
As one approaches middle-age, the usual signs of aging (often perceived as tiredness even though the patient isn’t) are visible around the eyes, jowl, and sometimes the neck areas. The visibility of the face makes it a more marketable item than the body which can be ‘dressed up’ and camouflaged…the face can not. Makeup can only cover so many flaws. I have heard patients say repeatedly that they get tired of people telling them that…they look tired. This is where the eyes and brow areas play such an important role in societal perception. While Botox is very effective at temporarily improving that angry scowl or those lines between the brow taht come from squinting and concentrating, only real surgery can tighten up the eyelids, lift the brow, or get rid of that sagging jowl. These seem the be the areas that patients focus on when they want to look better and be more competitive in their career and marketplace.
How shallow you say? Perhaps, but the reality is…everything else being equal…tall men have more opportunities than shorter men….more attractive people are hired more frequently than those judged as less attractive…and looking refreshed and energetic can give one an edge in any sales situation. (which is just about every situation is life) On-site performance may be the foundation of one’s job, but one’s appearance is certainly complementary to it. If that is not true, how do I account for the large number of younger women in pharmaceutical sales jobs? Plastic surgery is fundamentally self-image surgery, it is all about making you feel better about yourself. As the old saying goes…you will not succeed beyond how you see yourself.
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 have seen numerous patients over the years who are positive with the HIV virus, otherwise known as the acquired immunodeficiency syndrome (AIDS) and probably some that had the virus but it was unto them or they did not disclose it. Thesd patients fall into two categories of procedural requests; those patients seeking typical cosmetic procedures and those patients who have the adverse effects of antiretroviral therapies known as the lipodystrophy syndrome. In either case, there is always the question of the adviseability of performing elective plastic surgery. Are the patients healthy enough so that they are not at increased infection and complication risks?….and….What is the real risk to the operative team in terms of potential disease transmission?
In an excellent article in Plastic and Reconstructive Surgery (May 2008), Dr. Steve Davison of Georgetown University reviews these basic issues. In HIV positive patients, they can safely undergo elective plastic surgery provided that a thorough preoperative workup has been performed. Patients with CD4 counts greater than 200 and low viral loads have surgical risks that are similar to the general population. There is no evidence to support the historic contention that they have poor or compromised wound healing. Increased surgical risks are in those patients whose CD4 counts are less than 200 or have viral loads greater than 10,000. The risk of disease transmission to the surgical team is not precisely known but is estimated to be around 0.3% for penetrating injuries from surgical sharps, a rate that is less than 10% that of hepatitic C exposure which is far more dangerous.
In my practice, I generally see known HIV-positive patients for facial lipoatrophy of the cheek and temple areas and fat accumulation of the back of the neck (buffalo hump). Both of these can be managed by non-surgical options although I find the surgical alternatives to give superior results. Injectable fillers, such as Scuptra, Radiesse, and ArteFill can be used to correct the typical patterns of facial wasting but they do require large volumes of injectate and numerous sessions. They quickly become as costly as surgery. A surgical alternative are submalar implants and fat grafting whichi I have found quite satisfying even if 100% of the fat does not survive. Buffalo hump reduction (dorsocervical fat accumulation) can be treated by LipoDissolve injections if the area is not too large but it usually takes at least 3 sessions over a greater number of months to get a reasonable result. Ttraditional liposuction is far more efficient and can take away a larger amount of excess fat in an obviously shorter time.
I have found performing plastic surgery on HIV positive patients to be rewarding and well appreciated. They often suffer the stigmata of their disease and wish its improvement to improve their self-esteem and improved social acceptance. I have seen no greater incidence of complications in this patients than any other types of patients.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Next to orthopedic surgery, plastic surgery as a medical specialty uses a significant number of implants and implant materials to help achieve its surgical outcomes. Whether it is breast implants or an injectable filler, the use of synthetic or foreign materials is common in plastic surgery. Often when a plastic surgery patient needs an implant for their procedure, they will ask the question….’What if my body rejects the implant?’…..or…..’What are my chances that I will react (adversely) to the implant?’ This understandable concern is reflective of a basic misunderstanding of how the body reacts to implanted foreign materials and what type of complications can develop.
In reality, the rejection of an implanted synthetic material (that has been evaluated and approved for human implantation by the FDA), in the most scientific sense, does not happen. A true rejection reaction in humans is an autoimmune response to an ‘implant’ that is composed of live or organic material. Therefore, you will develop a rejection or autoimmune reaction, for example, in any type of organ transplant which is from other human or animal origins. Your body’s cells mount a massive response to what it recognizes as foreign or an invading organic source. The body is quite smart and protective as this type of response is necessary for survival.
Synthetic implants are composed of inorganic materials, which do not cause a true allergic or autoimmune response. These are not live materials and were never composed of living organic materials. As a result, they can not elicit an allergic response. They may never become part of you or integrate into your body’s tissues, but they can safely occupy a space to do their job. Synthetic implants, while not causing allergic responses, can cause a different set of problems which patients mistakenly interpret as ‘rejection’.
Synthetic implants can get infected, exposed, or migrate, all of which are complications of the surgical implantation process not due to rejection. If bacteria inadvertently get on the surface of the implant, an infection can later develop.Most implant infections occur within weeks of the surgery as it takes time for the bacteria to multiply and become evident. Synthetic implants can migrate or move from their location where they were surgically placed if the implant material is very smooth or the tissue pocket into which it is placed is very big. This potential migration can be eliminated if the implant is secured into its desired location by some method such as sutures or metal screws. Implant exposure can result from migration of the implant, getting close to the original incision through which it is placed. Or implant exposure can result from not having enough good tissue closed over it or tissue that breaks down over the implant due to too much pressure that the implant exerted on it or the overlying tissue is of poor quality and it doesn’t heal well and then breaks down, thus exposing the implant.
The patient will understandably interpret these synthetic implant complications as ‘rejecting the implant’. In reality, the patient’s body has little to do with the development of these complications. They are more a function of surgical technique and not due to a patient’s immune response to them. The risk of these potential implant complications can be reduced by pre-surgery antibiotics, a properly sized implant that does not stress the surrounding tissues, and careful surgical implantation technique.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

My office often gets asked if we perform the ‘LifeStyle Lift’, ‘S-Lift’, and a variety of other names that end in -lift. The callers and patients don’t know, of course, that all these names really refer to the same procedure, otherwise known as a limited facelift. Their interest is peaked by the allure of improvement in sagging jowls or loose neck skin but without the downtime of a full facelift.
The confusion about this procedure stems from general misconceptions about what an actual facelift is. Most patients envision a facelift as a procedure that starts at the top of the head and ends somewhere below the neck. Visions of weeks of seclusion, obscene facial swelling and bruising, and ruinous financial strain make many patients feel that they definitely don’t want a facelift. They don’t understand that a facelift is really a misnamed procedure. A better name which more accurately describes what it is….is a necklift or a jowl-necklift. A facelift, in isolation, does very little above the jawline or for most of the face. It is a procedure that changes the neck and jowl line only. Many patients will have other facial procedures done in conjunction with a facelift, such as the brow, eyes, nose, cheeks, or lips (often referred to as total facial rejuvenation) but these do not constitute a facelift. As a stand-alone procedure, a facelift is really about the neck and jowls and creating a sharper neck angle and a clean jowl line again.
Therefore, a limited facelift is a scaled down version of the full facelift. It has gotten, for a variety of marketing purposes, many catchy names as previously mentioned. Some plastic surgeons even put their own name on it. But, in the end, there are all the same procedure. A limited facelift is…..limited. Meaning the length of the incisions used (in front of the ear), how much skin is undermined and removed, and the amount of subsequent after surgery care and recovery is much less than a full facelift. And an important concept to grasp here is….the result is also less than that of a full facelift. For this reason, the best candidates for a limited facelift is someone younger who has minimal jowling and loose neck skin or someone older, who really needs a full facelift, but prefers a smaller procedure for any number of reasons.
I have found that one-half of the facelifts I do today are of the limited variety. They are very popular due to their quick recovery, lack of pain, and minimal swelling and bruising. They are a great stopgap measure that will substantially delay the need for a facelift is some patients and may, in others, potentiallhy eliminate the long-term need for a full facelift. Whe combined with other small face procedures, such as eye tucks and peels, they really make a nice change with no chance of getting that ‘operated look.’

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

One of the most important things we do as plastic surgeons or any surgeon for that matter…is to match the solution to the problem. Large operations for small problems run the risk of creating complications that exceed the scope of the original problem. Small operations for big problems simply will not work and are destined for failure and more surgery. Learning this judgment skill can only be done through experience…otherwise known as mistakes.
I have learned to carefully match the magnitude of the operation to the size of the problem. Small problems need small operations. Big problems require big operations. You cannot make a big problem better by a small operation…no matter how much the patient would prefer it. The allure and excitement of a big operation (to the plastic surgeon) is doomed to likely create a problem for the patient which is just as significant, if not more so, than the original problem.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Cosmetic plastic surgery is very unique from traditional medicine in one significant way….it is elective. The ‘problems’ treated do not absolutely need to be treated, operating on them is elective. Therefore, one of the contributing factors used in deciding whether to go with one treatment or another is the concept of value. What result am I going to get for what I am paying? That is a key question. While not talked about in most other areas of traditional medicine (if you break your leg, you don’t debate with your doctor about the economics of one treatment option versus another), the issue of value and outcome is actually of great significance in cosmetic treatments/surgery. While it is rarely talked about, I find it to be a very significant issue in most patient’s minds.
In discussing various treatment options for any particular problem in cosmetic plastic surgery, I always compare the various treatment options in terms of outcome and cost. I have learned over the years that one of the issues that makes a contribution to a patient’s interpretation of a satisfactory result is their assessment of….did I get a good result based on what I paid? Did I get good value for my economic efforts? Patients can live with less than a perfect result if they think they got a good value. Patients tend to get unhappy, even with a reasonable result, if they feel that they ‘overpaid’.
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 have noticed over the years an occasional relationship between the economics of a patient, affordability if you will, and the potential satisfaction from a procedure.The less likely a patient can really afford the procedure, the less likely they will be completely satisfied with it.
To give a good example, I had a lady last week that wanted injectable filler placed into her nasolabial folds but all she had to spend was $425. At the current time, I usually placed Radiesse, a particulated filler which lasts longer than many other fillers. In my experience, it usually takes a full syringe at the price of $850 to really do a good job of filling it out. Since she could only afford half a syringe, that is what I placed and I indicated to her that that amount would help but it would not be an ideal amount to do the job well. I did the procedure and sure enough……one month later she came back and felt that it didn’t work well and wanted it fixed. What I had said at her initial consult had long been forgotten.
Morale of this story….sometimes it is just better to tell patients that the amount of plastic surgery they can afford will not produce enough of a result to make it a worthwhile investment. Saying no to patients is always tough, but you can’t make a small investment turn into a big result.
Dr Barry Eppley

http://www.eppleypalsticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Like all businesses, I get many accolades for services provided as well as a lesser number of complaints about services or results. That is the nature of plastic surgery where everything we do is visible. All results can be easily judged. But I got a very kind note from a parent about a conversation that I had with her son while he was in the office. I was seeing him for long-term follow-up from repair of facial scars sustained as a child. He happened to ask me about my feelings on marijuana as a medical professional. I interpreted this as a serious question from a young man who was obviously trying to sort the issue out in his own mind. As I expressed my views (which were not negative from a medical viewpoint), I left him to ponder this question. Will partaking of marijuana take you closer to…or further from… your objectives and goals in life? That is the real question of any habit. You do become the end product of what you do, think, and whom you associate with. I hope it gives him serious pause.
Dr Barry Eppley