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Cosmetic surgery trend report: the treatments I don’t offer.

Hi all,

This month I thought we could discuss some current trends in plastic surgery that are popular, and perhaps controversial. Some of these trends are fantastic and show real initiative and promise. Others I might describe as bordering on the magical! In other words, if it sounds too good to be true, it probably is. Plastic surgery is well known for pushing the limits of accepted norms, and this often leads to innovation and progress. However, this entrepreneurial spirit sometimes leads to therapies that make many promises but come up short on facts and results.

Thread Lifts

A great example of this type of treatment is the thread lift. Under local anesthesia, small barbed sutures that are passed under the facial features and pulled up under the skin to provide lifting, with minimal to no downtime. Of course, this sounds great and we get a lot of requests for this procedure. Unfortunately, the plastic surgical peer reviewed data and experience do not support these promises. The results are often short-lived or imprecise and are not able to replicate the results offered by more complex surgical procedures. To make matters worse, these seemingly simple procedures that look easy to perform will attract some health care providers who are otherwise unskilled and uninformed in performing aesthetic surgery and medicine to give the procedure a try. This has led to some severe complications involving inadvertent placement of these threads into important structures lying below the surface of the skin, sometimes irreversibly damaging these structures. These lifts were very popular when I began my practice 20 years ago but did not hold up well and were dropped from most practitioners’ armamentaria. They seem to have resurfaced, though I do not believe the technology has changed significantly. As such, I do not offer this procedure, as I can offer more predictable and safe options to my patients. 

Permanent Fillers

Another popular request is the use of “permanent” fillers, as compared to temporary hyaluronic acid based fillers which are most commonly used. While a permanent filler has the obvious advantage of maintaining its effect indefinitely, most permanent soft tissue fillers share the same potential for negative outcomes and complications, and as such we do not offer them at our office. These devices offer similar immediate outcomes, but often are more irritating to the soft tissues, and eventually become recognized as foreign. The body will then wall them off with surrounding scar tissue, and may ultimately extrude them through the skin, leaving nodules, infection and scarring behind. Though unusual, complications from injection of fillers can occur during or soon after injection, which may result in loss of or damage to tissues. With the temporary fillers we use, these rare complications can be well managed by immediate injection of materials to dissolve the injected filler. However, this is not possible with permanent fillers – they require surgical excision to be removed and can lead to devastating negative aesthetic results. As such, I do not offer this procedure, as again I can offer more predictable and safe options to my patients! 

CoolSculpting

Lastly, another really popular device in use is the CoolSculpting fat removal system. This device promises removal of fatty tissue without surgery, using cold temperature technology. While I think that this does work for some patients, in my experience, the results are often quite subtle or not visible, and only work on small areas at one setting, requiring multiple treatments for say a full abdomen or hips and flanks. I also find that the removal of fat in a smooth fashion is highly operator dependent and may leave contour irregularities (the treatment head is rectangular, so I would expect a rectangular shape of fat removal if it indeed works, which is not an anatomical or aesthetic shape). I have seen many disappointed patients who have spent much time and money on this procedure, now seeking more traditional methods of fat removal such as liposuction or a tummy tuck. While I believe that this procedure has some merit and application, it has been my experience that the cost, recovery and downtime compared to the modest results achieved do not add up well, and I know that I can deliver a more precise and thorough result using liposuction. As such, I do not offer this procedure, as I can offer more predictable options to my patients. 

While this is a controversial topic, and there may be some who will disagree most strenuously with me, I believe that you get what you pay for (or sometimes much less!) and that as a consumer, one must be careful not to be taken in by marketing and overly optimistic promises. Surgery is surgery, and real investment, risk and recovery is usually required in order to achieve real results. I don’t mean to pick on any particular procedure unfairly, and just chose three examples of items that are frequently requested from my practice that we don’t offer. There are many more that I could have discussed as well. To those of you that have had these procedures and are pleased, lucky you and I’m glad they worked for you! However, I believe that the number of patients who are disappointed, or even injured, from uninformed decision making and surgical planning is significant. Stay safe out there! 

— Dr. Howard Silverman

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