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April 2011

April 21, 2011

6 International Consensus Statements on Plastic Surgery Controversies

The International Confederation for Plastic, Reconstructive, & Aesthetic Surgery (IQUAM) recently published consensus statement regarding controversies in plastic surgery.  I thought that my readers might find this list interesting...

  • Multiple "medical studies have not demonstrated any association between silicone-gel filled breast implants and carcinoma or any metabolic, immune, or allergic disorder."

Translation:  Silicone breast implants are safe.  They do not cause breast cancer.  They do not cause lupus, rheumatoid arthritis, psoriasis, etc.

  • "Silicone-gel filled breast implants do not adversely affect pregnancy, fetal development, breast-feeding or the health of breast-fed children."

Translation:  If you have had silicone implants, feel free to breast feed your babies.

  • "Phosphatidylcholine has been used for prevention and treatment of fat embolism for many years, but it is currently being used 'off label' for dissolving fat in aesthetic applications.  Data concerning the efficacy, outcome, and the safety of its use for aesthetic indications in subcutaneous tissue have not yet been established. Further basic science and clinical trials are needed."

Translation:  "Lipodissolve" and "LipoZap" injections have not been shown to be either effective or safe.  While I know that everybody wouldn't mind getting rid of a "love handle" or two, don't submit to any unproven injection technique.  Liposuction remains the gold standard.

  • "Botulinum toxins (BTxA's) have been used extensively for aesthetic purposes. BTxA's in high dosages have been used in various therapeutic clinical applications with minimal reported significant adverse effects. Current clinical data confirm the safety of BTxA’s for aesthetic indications when used by experienced doctors under sterile office environment. Patients should be provided with detailed information, and a signed informed consent should be obtained prior to performing the procedure."

Translation:  Botox and Dysport kick ass!

  • Regarding injectable fillers...  "Today, more than 35% of the procedures performed by plastic surgeons are no longer purely surgical.  The use of resorbable substances is preferable to the use of nonresorbable fillers, as recommended by many national health authorities or academic societies....Permanent fillers (excluding autogenous tissue) can give a definitive correction, but have been reported to be associated with long-term, irreversible complications and should be used with extreme caution."

Translation:  Fillers are increasingly popular.  Choose one of the common resorbable fillers (such as Restylane, Juvederm, and Radiesse) rather than a permanent filler (such as Artefill or liquid silicone) because the temporary fillers are safer.

  • "IQUAM urges governments to pass legislation to prohibit the use of non-certified products and to protect patients from untrained physicians and nonmedical personnel injecting or implanting materials for various indications."

Translation:  Board Certified Plastic Surgeons wish that patients were protected from poorly trained injectors.  However, there are few laws that limit the practices of doctors and nurses, many of whom suck.  Make sure that your injector is certified by an appropriate specialty board.

(By the way, the only board recognized by the American Board of Medical Specialties to certify phyisicians in the practice of plastic surgery is the American Board of Plastic Surgery.)

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April 13, 2011

Tax Deductions for Cosmetic Surgery: Legal?

Maybe.

According the IRS, if you itemize your deductions on Form 1040, Schedule A, you may be able to deduct expenses you paid that year for medical care for yourself, your spouse, and your dependents.  Specifically, you may deduct the amount by which your total medical care expenses for the year exceeds 7.5% of your adjusted gross income.

Technically, deductions are allowed only for expenses primarily paid for "the prevention or alleviation of a physical or mental defect or illness."  The IRS specifically states that you may not deduct "most cosmetic surgery."

However, many of the surgeries that I do are both cosmetic and functional.  Examples:

  • Breast reductions:  Not only are the breasts lifted and made cuter, but also the removal of the excess weight greatly relieves neck, upper back, and shoulder pain.
  • Breast lifts:  Elevating the breasts (so that a woman fails the "pencil test") diminishes sweating and rashes in the folds beneath the breasts.
  • Tummy tucks:  Certainly, flattening the tummy is the primary goal, but also removing the apron of excess skin diminishes sweating and rashes.
  • Blepharoplasties/Eyelid surgery:  Trimming the excess skin and fat from the upper eyelids creates a more rested, awake appearance, and also improves sight by ridding the patient of tissue that directly obstructs the visual fields.

So, for many cosmetic surgeries, I could honestly write a letter to the patient's accountant stating that the surgery alleviated a physical ailment, and, therefore, consideration should be given towards a tax deduction.

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