Plastic surgeons surveyed have differing opinions.

Dr. Julius Few, a plastic surgeon in Chicago, thinks plastic surgery remorse is increasing. “I think in part it’s increasing because of the drop in reimbursement by insurance companies, which is driving doctors in other specialties into the plastic surgery market,” he says.

On the other hand, Dr. Timothy Miller, chief of plastic surgery at the David Geffen School of Medicine at UCLA, says he’s only seen it a few times in his practice and that it is very rare.

Those who do have “buyer’s remorse” after plastic surgery procedures are likely troubled by deeper issues, according to psychologist Ann Kearney-Cooke, who specializes in weight and body image issues. “[The surgery] changes the look, but if you have a problem that you haven’t resolved, you’ll have a temporary positive feeling, but then something else is the problem,” she says.

The plastic surgeons did agree that regret following a cosmetic procedure can potentially be avoided if patients and doctors recognize and address the problem.

“I have a therapist who works in my practice,” says Dr. Few. “We know in plastic surgery that if somebody has undue stress, the risk of complication is higher.”

“Most plastic surgeons will tell patients to work out their problems—go talk to a psychiatrist or confide in somebody else,” says Dr. Miller.

Dr. Malcolm Roth, a plastic surgeon in Brooklyn, N.Y. also stresses how key communication between the patient and doctor is. “It’s really important that both the patient and the physician understand what the motivation is behind the surgery,” he says.

Breast reconstruction after a mastectomy is covered by insurers in New York, but often poor and minority women do not seek out the procedure because they may be unaware of coverage. Congress passed the Women’s Health and Cancer Rights Act in 1998, which guaranteed universal coverage for breast reconstruction after cancer surgery.

“A disproportionate number of women who are at a socioeconomic disadvantage do not get breast reconstruction surgery after a mastectomy for one of several reasons. Either they are unaware of it as an option, they do not know it is covered by Medicaid and Medicare insurance programs, they do not know where to gain access to the procedures, or it is never mentioned to them by their other doctors,” said Dr. Evan Garfein, the plastic and reconstructive surgeon who authored the bill.

There are several reconstruction options for cancer patients, including saline and silicone gel implants, as well as reconstruction that uses the patient’s own tissues from the abdomen, thigh, back or buttocks.

“Breast reconstruction has been repeatedly shown to improve the quality of life and overall well-being of women who have been treated for breast cancer,” said Dr. Garfein. “This new law will ensure that breast cancer patients from all socioeconomic groups are informed about their options regarding breast reconstruction and about where to get the procedure.”

The discussion should involve both the cancer surgeon and the plastic surgeon, so the surgical team and the patient can then decide if reconstruction should be performed and in what timeframe.

Dr. Kim is double-board certified by the American Board of Plastic Surgery and by the American Board of Surgery and performs breast reconstruction in the Houston, Texas area.

The statistics, which were obtained and analyzed by independent statistical specialists, showed that liposuction represented about 19 percent of all surgery procedures. It was followed by breast augmentation (17%); eyelid surgery (13.5%); rhinoplasty (9.4%); and tummy tuck (7.3%).

The number of non-surgical procedures topped the number of surgical procedures, “reflecting both advances in cosmetic surgery innovation and the desirability of less expensive treatments,” according to ISAPS. The top five non-surgical procedures were as follows:

1. Toxins or neuromodulators injections (Botox, Dysport) (32.7%)
2. Hyaluronic acid injections (20.1%)
3. Laser hair removal (13.1%)
4. Autologous fat injections (5.9%)
5. IPL Laser Treatment (4.4%)

The top procedures do vary among countries. “It is not always liposuction and breast augmentation that are No. 1,” says ISAPS President Foad Nahai, MD, a plastic surgeon in Atlanta. For instance, silicone implants for nose reshaping and eyelid surgery are popular in countries such as Thailand and China, and injectables are not yet as popular in other countries as they are in the U.S., he says.

The statistics also showed that there were more plastic surgery procedures performed last year in the United States than in any other country. The top five countries by total number of procedures performed were as follows:

1. United States (17.5% of total procedures)
2. Brazil (14.3%)
3. China (12.7%)
4. India (5.2%)
5. Mexico (4.8%)

“It is no surprise to me that the United States has the largest number of aesthetic procedures, and same with Brazil,” says Dr. Nahai. “But countries like China and India with emerging economies are generating a lot wealth and as that wealth is passed around, people are choosing to their spend discretionary income on aesthetic procedures.”

For a full report on the international plastic surgery statistics, visit the ISAPS website.

Both cervical dystonia and blepharospasm are neurological disorders. Cervical dystonia is characterized by twisting of the neck and blepharospasm by excessive eyelid spasms.

A study on the efficacy and safety of XEOMIN cited in the Journal of Neurological Sciences concluded that XEOMIN is a safe and effective treatment for cervical dystonia. XEOMIN showed “non-inferiority” to Botox when used in the same doses to treat the disorder.

One way in which XEOMIN differs from Botox and Dysport is that it’s the only botulinum toxin that doesn’t require refrigeration prior to reconstitution. Merz therefore believes this may “simplify product distribution and storage and help ensure product integrity at the time of injection.”

While XEOMIN has not been approved for cosmetic uses, some doctors may start to offer it as an off-label option. Another indicator that Merz is moving into the aesthetic arena is its acquisition of BioForm Medical earlier this year. BioForm Medial makes the popular dermal filler Radiesse, and following completion of the acquisition of, Merz and will change its name to “Merz Aesthetics.”

Despite the competition to Botox—first from Dysport and now potentially XEOMIN—the product is still showing strong sales. Allergan’s latest earnings release reported that Botox sales rose 7 percent in the quarter to $360.5 million. The company is also hoping it wins U.S. approval to sell Botox to treat migraine headaches in the near future. In July it was approved for this use in the U.K.

Revance Therapeutics says that it will be two years before clinical trials of the product—called RT001—are complete. Then it will be up to the FDA to decide whether to approve the drug, which is being tested for use on crow’s feet. Patients in the early trials tended to see a moderate reduction in wrinkles around their eyes after using the product for a month.

Safety is a major concern for some of the doctors who have heard of the product.

Dr. David Colbert, a New York City dermatologist, told WCBS-TV that he worries that a Botox lotion would be so popular that black market versions would be sold online without oversight and that the potential muscle paralyzing effects could be dangerous.

“I think it’s a brilliant idea, but I’m more concerned about the welfare of people who would use it irresponsibly,” he says.

Revance’s website says that “We believe that we can significantly expand the market by providing an attractive alternative to the current treatment options.”

Dr. Scott Newman, a plastic surgeon in Manhattan agrees, comparing it to the “holy grail.”  He says the potential benefit is worth the risk. “If you can get a wonderful result with less downside, why wouldn’t that be an attractive option?”

Dr. Anthony Youn, a plastic surgeon in Michigan, sees a lot of potential in such a product. He writes on his website: “I think a huge application of this topical botulinum toxin is in sweat reduction. Could you imagine an antiperspirant stick with this product that lasts several months with each application and leaves no residue? I’d buy it!”

The segment can be viewed at http://wcbstv.com/video by searching for “Botox cream.”

(before & after use of RT001 for 28 days; image via WCBS-TV)

The authors were able to do the comparison because they had a surgery center where breast surgeries were done that closed in 2005, after which breast operations were done at a hospital.

The study compared 92 patients who underwent breast operations at the surgery center with 92 patients who underwent outpatient breast operations at the hospital and analyed the following factors: anesthetic techniques, recovery room events, and duration of stay (pre- through post-op times).

Age and recovery times were similar. Complications were negligible at both the surgery center and hospital. However, the preoperative and total facility time increased when breast cases were moved back to the hospital setting.

“Findings support a common perception, namely, that outpatient surgery can be more efficiently performed at a dedicated outpatient center rather than at a hospital setting,” according to the study. 

Some of the reasons for the efficiency of the surgery center include:

• Nurses at the surgery center only prep outpatients, whereas hospital nurses may process both outpatients and critically ill patients.
• The surgery center was limited to a small and uniform set of cases, whereas the hospital has a more varied and complex case mix, which can cause delays.
• The preoperative area in the surgery center was physically closer to the OR compared with the hospital setting.

The conclusion states that “the potential efficiency advantage of an ASC over a hospital has implications for patient and staff satisfaction, facility expense, and surgeon productivity.”

Dr. Kim performs several breast surgeries, including breast augmentation and breast reduction, in the Houston area.

In today’s economy looking good is something that can’t be dismissed as frivolous, according to author Jessica Bennett.

“Economists have long recognized what’s been dubbed the ‘beauty premium’—the idea that pretty people, whatever their aspirations, tend to do better in, well, almost everything,” she writes. She then gives the following statistics:

• Handsome men earn, on average, 5 percent more than their less-attractive counterparts
• Good-looking women earn 4 percent more, on average, than their less-attractive counterparts
• Attractive people get more attention from teachers, bosses, and mentors
• Babies stare longer at good-looking faces

Furthermore, economist Daniel Hamermesh says that a good-looking man will make some $250,000 more during his career than his least-attractive counterpart. It’s no surprise, then, that 13 percent of women say they’d consider cosmetic surgery if it made them more competitive at work, according to the American Society of Plastic Surgeons. Ten percent of men would consider it as well, according to a Newsweek survey.

In a Newsweek survey of 202 corporate hiring managers, 56 percent said that qualified but unattractive candidates are likely to have a harder time getting a job. Furthermore, more than half advised spending as much time and money on “making sure they look attractive” as on perfecting a résumé.

Asked to rank nine employee attributes in order of importance, managers placed looks above where an applicant went to school, but below experience and confidence.

In addition to the article, the online Newsweek special report includes online essays, photo galleries, and interactive features on the “beauty advantage.”

The U.K. is the first country to approve Botox for this use, and the U.S. may be next. The FDA is likely to decide this month whether the product can be sold for migraines, Aaron Gal, a Sanford C. Bernstein & Co. analyst in New York, said in May.

The clinical trial called the PREEMPT (Phase III REsearch Evaluating Migraine Prophylaxis Therapy) involved more than 1,300 patients diagnosed with chronic migraine. At the end of a 28-day baseline period, patients were randomized to receive either Botox injections or placebo.

By week 24 following treatment, patients who received Botox averaged 8.2 fewer migraine days, which was significantly greater than the change from baseline observed in placebo treated patients of 6.2 days.

The study concluded that Botox was generally well-tolerated and an effective preventative treatment for adults with chronic migraine, giving improved quality of life and reduced headache related disability.

Lee Tomkins, director of Migraine Action, stressed it was not a “cure” but it offered hope for those who suffer the most frequent migraines. “We have been following these studies really closely and the evidence is really pretty solid. These people spend half their lives in pain. Even if they get half the attacks, it can really improve their quality of life,” said Tomkins.

The American Society of Plastic Surgeons (ASPS) statistics revealed that Botox was the number one minimally-invasive cosmetic procedure in the U.S. in 2009. Dr. Kim, an ASPS member, performs the procedure in her office in the North Houston area.

Although sponsored by the cosmetic surgery society, the site aims to be about all things beauty—not just plastic surgery. Project Beauty is a video-on-demand website that will be updated weekly and features “a ‘who’s who’ list of experts on fashion, makeup, and skincare as well as news and first person stories on all things related to aesthetic surgery,” according to the ASAPS press release.

To kickoff the launch, the site is hosting a month-long giveaway contest called “30 Days of Beauty.” Each day from July 6, 2010 to August 4, 2010, Project Beauty will offer one prize—such as a Sonicare toothbrush, Mederma Stretch Marks Therapy, and SmashBox cosmetics—per day. To win, you must join the Project Beauty Community and enter daily to win the prize of the day.

The site debuted with a number of videos on a range of topics, including a teenager who shares her reasons for getting rhinoplasty at fifteen; a step-by-step guide to applying makeup for the day; and a  woman who explains her decision to get a breast augmentation and why it was important for her to have the procedure performed by a board certified plastic surgeon.

Project Beauty also launched a social media campaign on Facebook, Twitter, and YouTube. To join the Project Beauty community, sign up at www.projectbeauty.com.

Some of these “bargains” could be at the cost of safety. “To get the cost down, they could be cutting back on things like general anesthesia. They make you feel like the procedure must be easier and not so serious if you’re just getting local sedation. Nothing could be further from the truth,” says Dr. Marcel Daniels, a plastic surgeon in Long Beach, Calif.

Another thing to watch out for is doctors who studied a different branch of medicine, such as gynecology, who perform plastic surgery procedures, according to the article.

Dr. John Anastasatos, a Beverly Hills plastic surgeon, explains: “Many physicians not trained as plastic surgeons can legally perform a surgical procedure in their office. These people often claim that they can do the same procedure as a plastic surgeon under local anesthesia and may even claim they are more scientifically advanced. The truth is that they don’t have surgical privileges at hospitals and surgery centers because they simply are not surgeons and never trained as surgeons.”

You can avoid these plastic surgery pitfalls by researching your doctor to make sure he or she has plastic surgery training. Consumers can check any doctor’s board certification at the American Board of Plastic Surgery website. The article also recommends asking the doctor to see before-and-after photos; if they don’t have any, it’s a red flag.

Dr. Kim is double-board certified by the American Board of Plastic Surgery and by the American Board of Surgery; and she is a diplomate of American Board of Plastic Surgery.

“‘Free’ Plastic Surgery: The Dangers of Bargain Breasts and Botox” is available on Styleist.com. (Photo by Aaron Gruenert, courtesy of Stylelist.com)