There's a New Yorker article detailing the commencement address Atul Gawande Atul Gawande delivered this commencement address, titled “Money,” to the graduates of the University of Chicago Pritzker School of Medicine. It expands on the themes he touched on in his recent article about health-care costs in McAllen, Texas, which figured in President Obama’s speech on health care.
The text of this speech is available in this Medical Spa MD: best medical spas?
The political aspects of health care reform march on.
Not every doctor is qualified to perform every procedure. Do you really want to turn your body over to someone who doesn’t really know what they’re doing? Here are five questions you should ask before you get a cosmetic tweak from a doctor working outside of her specialty.
How many times have you done this procedure?
Ideally, you should hear “hundreds” or “thousands,” not “dozens” or something vague like “more than I can count.” Also ask the doc how long she’s been doing the procedure (less than a year means there’s still a learning curve) and how many times a week she does it (too few times a week means she’s less likely to have fresh product or offer you free touch-ups if you aren’t happy).
Do you own or rent your laser?
Renting may be a tip-off that the doctor isn’t doing the procedure often enough to make owning worth it. Rented lasers aren’t always calibrated correctly, which could mean an increased chance of a burn. Also, not every laser is suitable for every skin type, so be wary of the physician who has only one. Ask about the number of fillers being offered, too.
What muscle causes the lid to droop?
If a doctor can tell you it’s the levator muscle, then he probably knows enough facial anatomy to avoid or fix this problem that can result from a poorly placed Botox injection.
How did you learn how to do this procedure?
If the answer is, “I took courses,” ask: Who taught them? How long did they last? Look for the MD who has completed multiple courses and takes continuing-ed classes in the field. If she trained with a top plastic surgeon, ask, “How did you find time for that?” She may let it slip that the training only took one afternoon.
Will you be the one doing the procedure?
It doesn’t matter how many hours of training your gyno has in fillers if his assistant is the one shooting you up. If something goes wrong, you want to know that the med school grad is right there to manage the complications. Remember: You’re paying for the expertise of the best-trained person in that practice.
Of course you'll want to be somewhat circumspect when asking all of theses questions. You don't want an angry plastic surgeon performing your liposuction or boob job.
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Photos: Above, recent online photos of Rachel Uchitel. (Photos courtesy of Gala.de and TheImproper.com) Below, Rachel Uchitel yesterday in Los Angeles. (AP photo)
Plastic surgeons and celebrity watchers gave party hostess Rachel Uchitel a once-over as soon as the tabloids thrust her into the spotlight last week as the alleged mistress of golfing great Tiger Woods.
She flatly denies the allegation, but Uchitel’s photos on the Web have provided evidence for cosmetic doctors to analyze. For example, plastic surgeon and blogger Dr. John Di Saia of San Clemente and Huntington Beach wrote:
[Her photos] show her to be an attractive woman who has probably seen the inside of a plastic surgeon’s office before. She seems to have had breast implants at the least from the images we have seen.
The online Plastic Surgery Channel commented on the uncertainties surrounding Uchitel:
Her lips do suggest lip injections, and her chest suggests breast augmentation. Uchitel would likely deny rumors of plastic surgery, just as she has denied other rumors. But, in all cases, she may be telling the truth.
The Talk Surgery site went far beyond what the photographic evidence supports when it called her a “Surgery Diva.”
More of this tragedy playing out today.
Argentine model dies after plastic surgery:London, England (CNN) -- Following the death of a former Miss Argentina after complications arising from plastic surgery, questions are being raised about the risks of cosmetic surgery.
Solange Magnano, 37, died in hospital, after being transferred from a clinic where she underwent an elective surgery on her buttocks last Wednesday.
Nigel Mercer, president of the British Association of Aesthetic Plastic Surgeons, last month described the cosmetic surgery industry an "unregulated mess" in the journal Clinical Risk.
Following revelations of Magnano's death, he told CNN, "Unfortunately, the things we're saying about this type of surgery keep being proven right by people having major disasters."
Magnano is reported to have died from a pulmonary embolism, a blockage of the blood supply to lungs.
It is currently not known if Magnano's death was a result of her surgery and there is no suggestion that it came about through surgical error, but there are risks associated with buttock-enhancement surgery.
Mercer said Magnano may have had a solid implant in her buttocks, a relatively low-risk procedure, but he said it's possible that she had liquid silicone injected into her buttocks -- a "highly unpleasant" procedure that is banned in most countries. An alternative would have been to extract fat from another part of her body using liposuction, and then inject the fat into the buttocks.
"With a pulmonary embolism something blocks blood supply to the lungs and circulation literally stops dead," Mercer told CNN.
"The lump in the lungs can be stuff you've injected into the patient -- their own fat or a lump of silicone -- or it can be clots from leg veins as a result of deep vein thrombosis (DVT)."
While DVT is not common with cosmetic surgery, Mercer said that operations on the pelvis, buttocks and legs carry a much higher risk of causing the condition.
"No cosmetic surgery is totally risk free," Mercer told CNN. "Even having botox and fillers is not risk free. There's a chance of infection, bruising or bleeding with any procedure."
via cnn.com
The result is sometimes a tragedy, like the death of Solance Magnano, a former Miss Argentina.
From a news story.
38-year-old former Miss Argentina Solange Magnano died after complications arising from plastic surgery on her buttocks.
Solange Magnano, the 1994 winner and a mother of 8-year-old twins, died of pulmonary embolism Sunday three days after having a gluteoplasty, a procedure that involves placing implants to enhance firmness. News of her death shocked her fans. The cause of her death was under investigation, the authorities said. Officials said the injected liquid went into her lungs and brain.
In the past half decade, the number of people seeking plastic surgery in Argentina has soared by 60 percent, to around 50,000. Estimates say that 1 in 30 Argentines has gone under the knife, making plastic surgeons in Argentina some of the most experienced on the globe, attracting large number of medical tourists.
Medical tourism in Argentina has seen a huge jump over the past decade, and is projected to be a 100 billion dollar global industry by 2010, according to the Deloitte Center for Health Solutions, a U.S. research center focused on trends in the health care system.
What a tremendous waste. Perhaps the worst quote of the story is that the 'injected liquid went into her lungs and brain'.
Less-acculturated Latinas with breast cancer are less likely to have reconstruction surgery after a mastectomy, say researchers at the University of Michigan Comprehensive Cancer Center.
Amy Alderman, MD, MPH, assistant professor of plastic surgery at the U-M Medical School and lead author conducted a study to examine trends in breast reconstruction among different races, including white women, African-American women, and Latina women. The group of Latina women was further divided into women who were either highly acculturated into American society or less acculturated.
After looking at 806 women who were treated for breast cancer, researchers found 41% of white women and 41% of highly acculturated Latinas underwent reconstruction, while only 34% of African-Americans and 14% of less acculturated Latina did.
The study authors found that the lagging reconstruction rates did not correlate to lack of interest. More than half of the less-acculturated Latinas said they would have like more information about breast reconstruction.
When patients' satisfaction with their surgery was measured, the highest satisfaction rates were among white women who were satisfied with their treatment (94%) compared with the lowest rate, 56%, among less-acculturated Latinas who did not receive reconstruction.
Furthermore, this group was also less likely to report that their surgeon explained breast reconstruction, and they were less likely to be referred to a plastic surgeon than the other racial groups. The study also showed similar trends for African-American women, although the most significant data was among the less acculturated Latinas.
“Reconstruction is important to these women, but significantly more of the less-acculturated Latinas did not know how to get it. It suggests significant unmet needs for this vulnerable group. They have a desire for reconstruction, but no one's telling them about it,” Dr Alderman suggested.
The study authors suggest that more efforts be made to present breast reconstruction options to all patients, including those who speak only Spanish. Further research is planned to understand how language and other cultural issues affect whether women receive breast reconstruction.
Unfazed by a recession and rampant inflation, image-conscious Venezuelans show no signs of cutting back on the facelifts, liposuction, and breast augmentation that have become de rigueur beauty treatments.
"There is never a question of not doing it, but of how you can do it. We all want to get everything done," said Helen Patino, a 37-year-old former model who had her first breast augmentation when she was 21 and her third about three months ago.
Venezuela's inflation is the highest in Latin America, up more than 20 percent in the first 10 months of this year and the South American nation is in recession after a five year boom.
Hard times may even encourage cosmetic procedures as people look for ways to lift their spirits, with many dipping into savings or taking on debt to get operations, surgeons say.
"The financial crisis has spurred people to spend more on themselves ... to console themselves in this crisis. I have not seen demand diminishing," said Peter Romer, a plastic surgeon in Caracas.
For Iris Delgado, a 57-year-old dental technician, a lack of funds was not an obstacle to getting a recent eyelid tuck.
"With the economy, one has to make sacrifices, because you don't have the money. So, you get it from credit cards, from family and you pay for it," said Delgado, who borrowed 7,000 bolivares -- about $3,250 -- for the procedure, a move she saw as a hedge against inflation in plastic surgery prices.
Like Delgado, many go into debt to finance plastic surgery, according to those in the industry.
"It's an investment that people make and they look for money everywhere," said Romer, adding that one of his patients moved into a smaller apartment to get a makeover and another traded her car for a facelift.
Leoncio Barrios, a social psychologist at the Central University of Venezuela, said such stories are the exception. "The majority of middle and lower-income women do not have property to sell or the capacity to save," he said.
Su Huiqing, 32 shows the cut lines drawn for a liposuction procedure to be carried out at a plastic surgery hospital in Fuzhou in southeastern China’s Fujian province. Plastic surgery has become commonplace practice in China as a quick fix solution to looking more beautiful or losing weight. Su became obese after years of taking hormones to treat an illness. She now weighs 150kg and plans reduce her weight to 75kg in a year.
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”.
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”.
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.
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.
The authors of these articles have argued several opinions, including that:
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.
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.
An estimated 100,000 cosmetic surgical procedures are performed in Britain each year, many by doctors who have had no specialist training in cosmetic surgery. In addition, hundreds of thousands of non-surgical procedures are done, including Botox for wrinkles and laser treatments to rejuvenate skin, many by non-medical staff with little or no training.
The 200-member Baaps represents the top surgeons in the business who performed 34,187 surgical procedures in 2008, twice the number in 2004. More than 90 per cent of them were on women. The most popular procedure was breast augmentation, demand for which rose 30 per cent last year.
But Mr Mercer, who combines private practice as a cosmetic surgeon specialising in facelifts with his work as an NHS consultant in reconstructive surgery for cancer patients, said the market for cosmetic surgery, of which Baaps surgeons account for less than one third, was an "unregulated mess".
He added: "There has been a massive increase in marketing, including discount vouchers, two-for-one offers and holidays with surgery. In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a two-for-one advert for general surgery. That way lies madness."
Mr Mercer, in the journal Clinical Risk, which publishes articles on cosmetic surgery today, he warns that "the doctor's first duty to protect the patient" has been forgotten in the headlong rush to cash in. "The motive for performing any procedure must never be financial gain ... if we cannot self-regulate then regulation will eventually be imposed."
Citing experience in France, where all advertising of cosmetic procedures is banned, he says: "Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic surgical procedures, including on the internet search engines."
Among those who can testify to the dangers is Jill Saward, the former lead singer of 1980s group Shakatak, who last year agreed to a facelift in the hope of reviving her career after her divorce. But she suffered complications aggravated by her high blood pressure and bitterly regretted the decision. Three months after the operation she still did not have full feeling and was warned full recovery could take a year.
"Surgery is not a quick-fix solution," she said. "The simple truth is that I could have died. I was an idiot, I should have thought much more carefully about the operation and its dangers. It was pure vanity."
Foad Nahai, president of the International Society of Aesthetic Plastic Surgeons, backed Mr Mercer's warning, and called for tougher regulations to prevent doctors practising without specialist training. A code of practice backed by self-regulation of cosmetic clinics was announced by the Government in 2007. Clinics are also subject to inspection by the Care Quality Commission. But Baaps says the measures do not go far enough.
Medical Spa MD is the premier community destination for physicians and medical providers offering cosmetic medicine with 2,000+ Members & 1.3 Million full page views in the last 12 months.
Our Members are the physician-architects and individuals behind the development of some of the current medical spa businesses models and non-surgical medical technologies. Best of all, it's free, which is a terrific price. Join us.
Well, it truly doesn't have to be that way... and on Medical Spa MD it's not.
You know, Medical Spa MD started as nothing. No Members, no community, no partners... Nothing. Just a single voice of sanity in the cosmetic medical wilderness.
But that's no longer the case. Medical Spa MD now has more than 2,000 Medical Members and is visited by more than 50,000 people every month. In the last 12 months Medical Spa MD has more than 1.3 million page views, making it the single premier community for plastic surgeons, dermatologists, and aesthetic physicians practicing retail cosmetic medicine. And that's just the public facing side. As a Medical Spa MD Member, you'll have access to exclusive information, reports, forums and content that's not available to non-members.
Where there are a host of other sites built for patients, Medical Spa MD is built specifically for physicians and medical providers. There's no doubt that Medical Spa MD is absolutley the best library of information available for medical providers in the business of retail cosmetic medicine. We don't say that as a demonstration of ego but as a statement of fact. Medical Spa MD has been built over the last 5 years into a community that's almost unknown in medicine, a place where you can get real information without the marketing spin that comes from companies and the advertisers that have to bow to them.
Too good to be true? Maybe, but there's method to the madness. Yes, you'll receive some marketing, special offers, products and services put in front of you, but you'll now be part of a huge purchasing group that weilds some real clout with suppliers. Nice for once.
Join us now and start making your cosmetic practice more profitable, and your life a little easier.
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