Renaissance Plastic Surgery | Dr. Joseph Fata

Branding is a term that is more commonly associated with marketing, not plastic surgery. However, the explosive growth of non-plastic surgery practitioners anxious and willing to provide plastic surgery services has increased the demand for cosmetic surgery patients. Whereas plastic surgeons were once found by word of mouth, marketing is now an important component of success, whether we like it or not.

Branding in plastic surgery takes traditional advertising one step further. A surgical procedure, which may be the same as or slightly different from a known, established procedure, is given a catchy name. That name is then heavily marketed.If enough marketing power (read money) is put behind it, this "new" technique may even find its' way to a television talk show like Oprah. At this point, it becomes a "must have" procedure, performed by only the best plastic surgeons.

Traditionally, new innovations in plastic surgery were presented at meetings or in journals and shared freely. When a procedure is branded, the rights to using it (or at least using the name) are licensed, and the entry fee for plastic surgeons is substantial. To protect against plastic surgeons who may want to borrow these techniques, the technical details are closely guarded and as such are never subjected to any scientific scrutiny or peer review.

The most outrageous example of how low branding can go was recently provided by the company 'Lifestyle Lift', who promotes their version of a facelift. This company has multiple locations across the U.S. and has branded what it claims to be a new procedure with better results and less down time than a traditional facelift when by all accounts it appears to be a minor variation on known techniques.

Lifestyle Lift was accused by the New York Attorney General's office of the fraudulent activity of "astroturfing", in which its' employees went to internet message boards and posed as satisfied customers with rave reviews for Lifestyle Lift. They also developed separate websites, such as myfaceliftstory.com, under the deception that they were independent websites created by satisfied customers. Lifestyle Lift settled the case for $300,000 in fines and agreed to refrain from such practices.

Other companies have branded technology, such as laser liposuction under the brand "Smart Lipo", suggesting that this was a new and improved version of liposuction, although there is no clear evidence that it is any better than existing techniques. At least they resisted partaking in any fraudulent internet activity.

If there is a lesson in all of this activity it is the old saw "Let the buyer beware." Potential patients should understand that branding in plastic surgery is a marketing ploy just as it is in any other business. They would be better served by choosing a plastic surgeon based on his or her credentials, reputation, and previous results, and then trust that they would be given a recommendation based on what would best suit their individual needs.

Patients who suffer from migraine headaches often find a migraine event incapacitating, totally disrupting their lives until it passes. A cure has been elusive and sometimes it seems as if there have been as many treatments as patients.

What does this have to do with plastic surgery? It begins with a shift in the thinking of the cause of migraines from vascular (blood vessel) changes to muscle tension surrounding the skull. Also, since we began using Botox for the cosmetic treatment of wrinkles between the eyebrows, almost every plastic surgeon has had patients who have found relief from their migraine headaches after injection of the muscles between the eyebrows. Since Botox relaxes the muscle fibers that are injected, this pain relief is consistent with the theory that migraines are triggered by muscle tension.

These findings among others have resulted in a shift in treatment models, and now one of the approved uses of Botox is the treatment of migraines. In fact, many large migraine treatment centers, including the Mayo Clinic, use Botox injections as part of their treatment protocol.

Another link between plastic surgery and migraines is the procedure Endoscopic Brow Lift. In this cosmetic procedure, surgical endoscopes are used to elevate and reposition a sagging brow through small incisions behind the hairline. During a Brow Lift, which may be done with or without a Facelift, many plastic surgeons also perform various techniques to weaken or remove the small muscles responsible for the "squint line", the same muscle targeted in Botox injections. They have found that some patients have gotten relief from their migraines. The effectiveness of this procedure for migraine relief is currently being investigated.

Throughout its' history, the field of plastic surgery has been deeply involved in reconstructive procedures that improve function as well as form, and the treatment of migraines is just the latest example of this rich history of innovation.

For the past few years, I have been using a rapid recovery program, or "24 hour Recovery Program", for breast augmentation. This program has stimulated a great deal of interest because patients looking for breast augmentation are in a very active stage of their lives and no one wants the down time anymore. But the most common question is: How is it possible?

The answer is that Yes, it is possible, and it's really just a situation in which a lot of small changes can add up to one big change. The big change is the recovery time, and it is based on a time-motion study of breast augmentation by a plastic surgery group in Texas. Since that study, plastic surgeons have added their own modifications, and I have personalized my approach as well, although the principles remain the same.

The main sources of pain after breast augmentation are trauma to the ribs and muscles, bleeding, and external pressure. In my current protocol, I use muscle relaxants during surgery to reduce the strain on the chest muscles and I protect the ribs from any trauma. I also take extra time to minimize bleeding and I have eliminated restrictive bandages in favor of a comfortable bra to avoid pressure on the breast implant. By introducing these changes, all of the main sources of pain have all been addressed.

After surgery, this attention to detail is continued. Much of the post-operative pain is inflammatory, and so anti-inflammatory medications (ibuprofen) are used as the first line of pain control, ahead of narcotics. The other source of post-operative pain is muscle spasm, and so muscle relaxants (I think Valium is the best) are continued.

This approach has eliminated the need for narcotics in over 90% of patients. No narcotics means no drowsy, "doped-up" feeling and no nausea, which are the two most common side effects. In other words, you get to feel like yourself again very quickly. The only restrictions are no heavy lifting or strenuous exercise for two weeks. Other than that you can do anything you feel up to. This includes going out to dinner or shopping the night after you surgery. The same guidelines are used for silicone gel breast implants and saline breast implants.

Does everyone get back to work and play in 24 hours? Not everyone, but the majority of patients do, and the rest just take another day or two. Once in a while someone might take a little longer to bounce back, but that has been the exception, not the rule. No one approach works for everyone, but my "24 Hour Recovery Program" has reduced the average recovery time after breast augmentation in my practice from 7-10 days to 24-48 hours. Now that's progress.

Yesterday Michael Jackson was finally buried, 2 months after his death. He is gone but will not soon be forgotten, and his name is forever linked to plastic surgery. This link began the first time he had surgery on his nose (rhinoplasty). After the first surgery, his nose was smaller and less ethnic, but whatever you thought about it, everyone generally agreed that it looked reasonable and normal. Unfortunately for Michael Jackson, like many who become obsessed with plastic surgery, it was not good enough and would never be good enough. Even more unfortunately, there was always a surgeon who could not say no to Michael Jackson, which is probably a not too uncommon scenario when dealing with the rich and powerful.

Several rhinoplasties later, his nose was irreversibly deformed and it was hard to look at it and not feel sadness for him. There was also damage to the general reputation of plastic surgery, as Michael Jackson became a capsule summary of all that can go wrong with cosmetic surgery. Michael Jackson unknowingly became the poster child of how patients don't want to turn out. What to learn is difficult to say, but at the very least we all need to be able to say no to ourselves and others, and both patients and their doctors need to know that sometimes less is more and enough is enough.

The second intersection of Michael Jackson and plastic surgery is his cause of death, recently classified as a homicide. It appears that his private physician was administering a powerful anesthetic, propafol, that is used as part of a general anesthesia in almost all surgical procedures. This drug is very commonly used in plastic surgery procedures that require general anesthesia, such as breast augmentation, tummy tuck and liposuction, and it would be easy to think that using propafol must be risky if it could kill Michael Jackson. The truth is that propafol is very safe and short-acting, but anyone receiving it must be closely monitored and have breathing assistance available in a medical environment, which did not appear to be the case. It was never meant to be used as a sleep inducing medication as it apparently was for Michael Jackson. This appears to be yet another case of a patient and a physician who were not willing, or able, to say no.