Psychology of Plastic Surgery

May 06, 2011

Cancer Alert: Why Are You Still Tanning?

According to a new survey from the American Academy of Dermatology, more than 80% of young, white women use tanning beds or intentionally tan in the sun--despite their full cognizance of the deleterious effects of UV light.

3800 white, non-Hispanic females aged 14 to 22 years were asked about their UV exposure....

  • 81% had tanned outdoors frequently or occasionally in the past year
  • More than 32% reported using a tanning bed in the past year
  • 25% reported using a tanning bed at least weekly

When comparing ages, 18-22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14-17 year olds (22%).

Yet, most of these women recognized that tanning is not good for their skin.  Most know that UV light causes skin cancer, and certain skin cancers (like melanomas) can kill.  Public education has been effective, but education has not been enough to effect behavior change.

Looking tan is a fashion--a dangerous fashion.  Media images are obviously more impactful than physician admonishments.

Certainly, then, other measures are necessary.  More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

Additionally, perhaps, there should be a waiting period for tanning bed treatments.  Or, maybe, any person interested in using a tanning bed should, just before a session, be required to watch a video expressing the deleterious effects of UV light--and there should be lots of gruesome photos.  I am not usually a fan of Big Brother, but this is an example of when people need to be saved from themselves.

Besides, white ain't so bad!  Certainly, better than cancerous.


October 26, 2010

When Perfect is Not the Goal...

Have you ever noticed that the best plastic surgery is subtle?...

  • Botox between the brows looks best when it softens wrinkles but leaves some motion.
  • Juvederm or Restylane in the lips is most attractive when the "smoker's lines" are softened, and the natural curves and pillows are only gently enlarged.  "Pneumatic" lips look ridiculous.
  • Breast implants look great when they produce C or D cups; DDDs are excessive.

So too with teeth.  Check out this article in The New York Times....

Dental patients are also "pursuing perfectly imperfect teeth"!

I agree with the dentists quoted in the article.  Just like the face and the body, the teeth look most attractive when they are not excessively white or straight.  Mild imperfections actually enhance the appearance, because they provide the illusion of naturalness.


May 11, 2010

Few Breast Cancer Victims Opt for Reconstruction

Over the past few decades, plastic surgeons have documented that breast reconstruction improves the emotional well-being of breast cancer victims.  Creating an attractive breast mound after a mastectomy is not only possible, but is beneficial.  Some studies have even demonstrated that the decrease in depression that results from being "made whole" can minimize anti-depressant usage and maximize compliance with adjuvant cancer treatments, such as chemotherapy.  The net effect is increased longevity; breast reconstruction can help breast cancer victims live longer.

Recognizing the value of breast reconstruction, the State of California passed legislation in 1996 mandating insurance coverage for reconstructive surgery.  The federal government followed in 1998.

However, a number of recent analyses suggest that only about 20% of mastectomy patients opt for breast reconstruction.

Researchers from the City of Hope Medical Center, in Duarte, California, recently reported the problem is especially acute in...

  • women older than 40
  • certain ethnic groups (especially African Americans)
  • public insurance (especially MediCal or Medicaid)
  • smaller hospitals

Obviously, the results indicate that it is very important to get information out to patients about reconstruction options.  Breast reconstruction is a right!

I would suggest that most breast cancer victims at least consult with a plastic surgeon before cancer surgery.  They need to know that breast reconstruction does not delay cancer treatment, does not minimize the effectiveness of chemotherapy, and does not indicate that they are "vain."  I always want women to really think about their choices.


May 05, 2010

Plastic Surgeon Sex Offender?

Over the past few years, I have ranted and raved that patients should search for Board Certified Plastic Surgeons.  While my reasoning has been sound, it hasn't been sufficient.  Even real Plastic Surgeons can have emotional problems.  Check out this article from the Orange County Register.


Plastic surgeon accused of sexual misconduct:  The state medical board is seeking to revoke the license of Dr. Mark Anthony Knight.

by Courtney Perkes

A Santa Ana plastic surgeon could lose his license over sexual misconduct allegations, including having sex with a patient while her husband and children waited outside.

The California Medical Board is seeking to revoke the license of Dr. Mark Anthony Knight. Knight, 41, declined to comment Tuesday until he consulted his attorney.

Article Tab : image1-

Legal documents made public Tuesday by the board give the following account:

In late 2008, a woman underwent a tummy tuck.  During a follow-up appointment last year, Knight told the patient, 32, to undress for the exam.  Her husband and children waited in the car.  While the patient was seated on the exam table, Knight kissed her and pulled down his pants, the documents allege.

After waiting for an "extended time," the patient's husband took the children inside the office to use the bathroom.  He heard noise from the exam room and opened the door to see his wife having sex with the doctor.  Knight allegedly pushed the door closed and told the husband, "I'm sorry, I'm sorry."

In a second instance, according to the documents, Knight is accused of sexual abuse of a woman, 36, who came to him in 2007 for breast implants and liposuction.  Knight sent her a text message to change her appointment time.  While her son waited in the lobby, the woman disrobed for the exam.  At one point, Knight kissed her without warning, the documents allege.  The woman pushed him away and told him he had the wrong idea.  He then continued with the exam before kissing her a second time, the documents allege.  She again rebuffed him.  After he tried to kiss her a third time, she got dressed and left the exam room.

Later, the documents show, the woman sent Knight a text message that said, "My view of our relationship is strictly doctor-patient. I would appreciate if you didn't come on to me like that again. You have made it a very awkward situation."

Knight wrote back that he understood. He then followed up shortly with a text that said, "Its ok with me...still feeling down...need open heart surgery now."

To check a California doctor's disciplinary record with the medical board or file a complaint, visit

Scary.  It's not enough for you to confirm that your cosmetic doctor is certified by the American Board of Plastic Surgery.  You better make sure that he or she is not a whack job!


November 13, 2009

Breast Implants: Consideration #1: How to Find the Right Doctor

Finding the right doctor can be tricky.  By some estimates, there may be as many as 60,000 doctors in the United States who perform some type of cosmetic surgery.  However, there are only 6,000 Board Certified Plastic Surgeons!  Therefore, 90% of cosmetic physicians do not have formal training in plastic surgery.

I have blogged about this topic before:  At a minimum, you should ask your physician the following questions:

  1. Are you certified by the American Board of Plastic Surgery?

  2. What training did you have after medical school?  Was it actually plastic surgery?

  3. How many breast implant surgeries do you perform each year?

  4. What hospitals do you work in?  Where do you admit your patients?

  5. If you prefer to operate in your office or ambulatory health care facility, is it accredited?

  6. Who administers the anesthesia?  Is this person a Board Certified Anesthesiologist?

  7. What do you do if there is a complication?

  8. What's your financial policy for complications?

  9. Are you academically affiliated?

  10. Is the state medical board investigating you for any complaints or malpractice suits?

But sometimes, even the right credentials are not enough....

Continue reading "Breast Implants: Consideration #1: How to Find the Right Doctor" »


October 12, 2009

Pamela Anderson Has the Best (and Worst) Breasts

Paradoxical results from the International Society of Plastic Surgeons:

  • When plastic surgery patients are asked, "Which celebrity has the best breasts?" Pamela Anderson tops the list.
  • When plastic surgery patients are asked, "Who has the worst breasts?" Pamela Anderson also tops the list.


Obviously, some people like "the fake look," and others hate it.  Nobody seems to lack a strong opinion!

The tops of the 2 lists:

    The Best:

  1. Pamela Anderson
  2. Britney Spears
  3. Xuxa (Brazilian singer)
  4. Gisele Bundchen

    The Worst:

  1. Pamela Anderson
  2. Dolly Parton
  3. Victoria Beckham


September 21, 2009

Who Gets Botox and Plastic Surgery? Regular People!

My practice is in Ventura, California--70 miles away from Los Angeles.  However, my high school and college buddies always assume that my patients are more Beverly Hills and less Ventura County.

I repeatedly explain how "normal" are my patients, but I'm not sure that my statements ever get through.  However, now I have some research to back myself up.

The Aesthetic Surgery Education and Research Foundation (ASERF) recently reported what I have always known.  Plastic surgery patients are regular people.  Typical plastic surgery patients tend to be...

  • women
  • between 41 and 55 years old
  • usually married
  • with 1-3 children
  • almost always employed
  • with a household income < $100K

Oh, but those ladies must stuck-up, over-sexed, or crazy--just like on Nip/Tuck.  Wrong...

  • Philanthropy and charity tend to be high priorities.
  • Exercise and healthy eating are part of their routines.
  • Most disdain the "unnatural" look of many Beverly Hills matrons.
  • Their typical goals are to look "fresh," "less stressed," "more relaxed," and "rejuvenated."

In fact, most of these patients are comfortable enough with their procedures to talk about them freely...

  • Nearly 9 out of 10 openly discuss Botox and injectable treatments.
  • 7 out of 10 receive support from the people they have told.

So, let's put to rest the myth that Hollywood and corporate wives are the only plastic surgery patients.  Even if you don't believe me, believe the ASERF demographic data.  It is true that plastic surgery has become mainstream and acceptable for regular women (and men!).


August 11, 2009

Package Deals in Plastic Surgery: Why They Make Sense

I have increasingly seen advertisements for plastic surgery "packages":

  • New mommy makeovers:
    • Breast enhancement
    • Tummy tuck
    • Liposuction
  • Surgical facial rejuvenation:
    • Browlift
    • Eyelids
    • Facelift
    • Necklift
  • Non-surgical anti-aging:
    • Fotofacial/intense pulsed light lasers
    • Botox or Dysport
    • Fillers (like Juvederm, Restylane, Radiesse, or Sculptra)

My wife has been skeptical.  "Aren't those packages just gimmicks to sell additional services?"

Yes, but that's a good thing.  These bundled procedures do work well together.  Combining services can lead to results that are greater than the sum of their individual parts.

Consider the "new mommy makeover."  All women know that pregnancies and breast feeding cause both the breasts and the abdomen to swell.  In many women, the skin never snaps back to its pre-pregnancy elasticity.  Lifting or augmenting the breasts makes the chest look great.  However, the whole torso is not balanced until the tummy is also flattened and tightened.  So, combining breast enhancement with a tummy tuck does produce the best proportions.

Non-surgical solutions can also be performed concurrently to optimize results.  For example, the "11's" between the eyebrows will usually respond to Botox or Dysport; a 60-80% improvement is typical.  However, for some patients, 60-80% is not good enough; they want 90% erasure of the wrinkle.  So, adding a little bit of filler beneath the relaxed wrinkles (such as with Restylane or Juvederm) can nearly eradicate the 11's.

Fillers can even be used to enhance a surgery.  Everybody knows that a face/neck lift can improve the cheeks, jowls, jaw line, and neckline.  However, the area around the mouth is usually not rejuvenated.  So, I will often recommend Restylane or Juvederm to minimize the "smoker's lines" radiating from the lips.  Combining these fillers with the face/neck lift can produce the most harmonious result.


June 22, 2009

Gravity is Over-Rated in Facial Aging

At a recent plastic surgery conference in Paris, most physicians admitted that we have been wrong.  Gravity is not the primary cause of facial aging.

Surely, as the face ages, muscles and ligaments do grow more lax.  Therefore, the skin is definitely subjected to the vicissitudes of gravity.

  • As we age, the eyebrows do tend to descend--by a few millimeters.
  • 3% of aging patients have a downward movement of the corners of the mouth--by 1-2 millimeters.
  • In many patients, the upper lip does tend to lengthen.

"Just a few millimeters?  And just 3%?!  Then, why do I look so old?" you might be thinking.

Here are the real reasons why the face ages:

  1. volume loss (wasting of fat and osteoporosis of bone)
  2. repeated contractions of facial muscles (muscle hyperactivity)

  3. skin damage (especially from sun and tobacco)

While the eyes of an observer may perceive significant downward movement in facial structures, objective measurements do not support these common assumptions.  What we are seeing is a combination of cutaneous aging and structural aging that gives the illusion of descent.

Since gravity is not a primary cause of facial aging, should you cancel your lift?  Not necessarily.  Sometimes, a surgical lift does give a great result, even if it is not addressing the issue of aging entirely appropriately.  Plastic surgery is, in truth, as much art as science, and sometimes art does trump science!

However, with this new information, I am going to recommend to my patients in Ventura that they consider...

  1. more fillers (especially Sculptra) to increase the facial volume
  2. more muscle relaxants (like Botox and Dysport) for over-active muscles
  3. more skin care and lasers to minimize skin damage


May 05, 2008

My Beautiful Mommy: Explaining Your Plastic Surgery to Your Kids

I do feel bad for Dr. Michael Salzhauer.  He is the Board Certified Plastic Surgeon who authored My Beautiful Mommy, the much maligned children's book which explains cosmetic surgery to patients' 4-8-year-olds.  To hear the television pundits, you would think that he was single-handedly responsible for foistering unrealistic body images on our nation's elementary-school kids.

While Dr. Salzhauer probably didn't realize that his book would stir up such a cultural maelstrom, I am glad that the ensuing controversy has created a forum for discussing plastic surgery with the under-10 crowd.  Certainly, grade-school children are concerned when their mothers are gone for a day or two, and then return with bruising and bandages.  Children under 10 are very concrete, and they need to know that their mothers are safe and are making rational choices.  Having an honest conversation with children, both before and after any procedure, is helpful for their understanding.

Continue reading "My Beautiful Mommy: Explaining Your Plastic Surgery to Your Kids" »


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