A Blog by Kenneth Rothaus, MD

Since the publication of Angelina Jolie’s New York Times Op-Ed regarding her prophylactic double-mastectomy, there has been much discussion, praise and debate surrounding Ms. Jolie’s choice and the procedure itself.  Personally, I believe that publicizing her procedure was an extremely brave and commendable action on her part. The decision to undergo a prophylactic mastectomy, however, is deeply complex and extremely personal. It should never be made without extensive research, consideration of your family history and genetic risks, and discussions with doctors from all the relevant medical specialties, family and friends.

As with any complex and potentially controversial topic, there has been coverage of varying quality, usefulness and objectivity. I couldn’t possibly discuss all of the coverage, but the Mayo Clinic provides a clear and credible, if basic, introduction to the topic. I found this additional discussion of Ms. Jolie’s particular case with two prominent oncologists to be as thorough as lay coverage of complex medical issues can be. Many of the major news organization published elementary overviews of the BRCA1 gene as well.

Given the nature of this procedure, the cosmetic outcome will likely weigh heavily on the mind of most patients.  Thus, in addition to consultations with medical and surgical oncologists, patients contemplating such surgery should also seek consultation with a plastic surgeon. In a future post, I will discuss more thoroughly the various reconstructive procedures and aesthetic concerns and available procedures.

The idea of personal transformation is extremely seductive. It speaks to deeply held values of social mobility and self-determination. Combine those more lofty concepts with a society increasingly interested in maintenance of a more healthy and youthful appearance, and it’s no wonder that there is so much coverage of the cosmetic surgery industry. Unfortunately, the flood of articles, internet postings and television programs is rife with mischaracterizations and misinformation.

Shows like “Dr. 90210” and “Nip/Tuck” are examples of perhaps entertaining but less-than-academic coverage on TV. In print and on the web, where production costs are far lower, there is an even greater quantity of articles that favor public relations over research. I recently reviewed an article that I found to be a perfect example of the type I find disturbing.

This article in the Harper’s Bazaar summer issue was entitled “Best Body Firmers,” and was divided into 4 sections: flabby arms, thick thighs, belly fat and cellulite.  The author discusses a procedure that she calls “micro-liposuction.” Reportedly, one uses a cannula the size of a pen point to create immediate correction of “bat-wings…permanent Spanx for your arms.” There are so many areas with which I take issue in just that short first paragraph that a full response would be too long for this article. I have written and presented peer reviewed, controlled studies using liposuction alone to achieve skin tightening of the upper arm. It is neither consistent nor immediate nor permanent.

Furthermore, cannulae the diameter of a pen point (0.1-0.2 cm) would not be efficient tools to achieve liposuction easily, if at all, because of clogging. I will try to comment on all my other disagreements with this article in a future posting on this blog, but it is only one example of a category that I encounter frequently.

However, there is also a lot of well-written, carefully researched information available – articles that meet both journalistic and scientific standards. The American Society of Plastic Surgeons and The American Society for Aesthetic Plastic Surgery give out annual Journalistic Achievement Awards to writers who meet those standards. This is good for both journalists and consumers, but ASPS and ASAPS can’t individually vet every article you read. Even without a medical degree, however, you can make a reasonable evaluation by weighing a few considerations. 

Who wrote the article? Is the author a board-certified plastic surgeon? Frequently, magazine articles and blog posts are written by PR professionals working on behalf of a particular doctor or other group. If the article was written by a journalist, rather than an MD, look to see if the author writes frequently on cosmetic and plastic surgery, or on health issues more generally.

Consider what “studies” the piece cites, if any at all. Were these studies published in a peer-reviewed scientific journal? Were they performed at an accredited research university? Your average Glamour article isn’t going to include regression tables, but use your common sense. Extraordinary claims require extraordinary evidence. 

Unfortunately, lay press articles do not contain the conflict of interest disclaimers that are required at presentations at medical meetings or in the peer-reviewed literature. Many of the names that are seen over and over again in the media have lucrative consulting contracts and other financial arrangements with companies whose devices they are promoting.  Sometimes it is difficult, even when presented with the disclaimers, for the professional audience to accurately assess the magnitude of these financial relationships. I question how the public can reasonably be expected to do so.

Finally, if you really aren’t sure, ask a board-certified plastic surgeon. A practicing surgeon should be keeping apprised of the latest advances in his field. Although one certainly can’t be expected to be an expert in every procedure out there, he or she should be able to tell if a claim passes the sniff test. You can also email your questions to me here, and I can get back to you, or address them in a future post.

In my practice, I spend a significant amount of time either correcting misinformation or contextualizing studies about which patients have read in the consumer media. I believe it’s important to teach my patients how to separate the wheat from the chaff, so to speak. This motivation to empower my patients to make the best choices for themselves was why I wrote “Hospital Smarts” in 1997, and why I continue to speak and write about this topic with my patients.

I was not originally going to comment on all the media hype on patients seeking rhinoplasties (nose jobs) so that they could have Kate Middleton’s nose.  Unfortunately, the story does not seem to go away and I can no longer avoid it.  Reports such as in the following link (http://newyork.cbslocal.com/2013/01/31/copy-kate-increasing-number-of-women-seeking-plastic-surgery-to-replicate-duchess-nose/ ) are rampant in the media.  I personally believe that when a patient seeks consultation with a plastic surgeon because they want to look like somebody else, the plastic surgeon has an obligation to dissuade the patient from that particular goal.  It is OK to seek a rhinoplasty because you want your nose to look better, but not, in my opinion, because you want to look like someone else. Fortunately, a few voices are starting to at least partially articulate this more “conservative”  message. ( http://www.csmonitor.com/The-Culture/Family/Modern-Parenthood/2013/0201/Kate-Middleton-s-nose-Latest-plastic-surgery-inspiration  ).

31 January 2013  I am probably not going to get a chance to comment on many plastic surgery articles exclusively dealing with male patients, so I could not let this one pass! (http://www.khou.com/news/health/Daddy-makeovers--More-men-getting-touch-ups-with-plastic-surgery-188707761.html )  We read a lot about the Mommy Makeover.  This video and article from KHOU in Houston discusses the flip side of the coin: “The Daddy Makeover”.  In most cosmetic plastic surgery practices, male patients represent less than 10 percent of the patient population. As pointed out in the article, the most common procedures that men usually want are fillers and injectables (Botox), laser hair removal and liposuction.  It is interesting that this percentage of male patients seeking cosmetic  procedures has stayed relatively constant over the years.  It is probably not that men don’t want these procedures as much as women, men just are not as brave in the doctor’s office!

                                                                        The Ageless Muse

30 January 2013: Sometimes the article is OK, it is just the headline that is misleading-  “Los Angeles Plastic Surgeon on the Benefits of Liposuction Alternative” (http://www.marketwatch.com/story/los-angeles-plastic-surgeon-on-benefits-of-liposuction-alternative-2013-01-29 ) .  This is really a press release talking about this surgeon’s new laser liposuction device.  The problem is that the headline is misleading because they present this as a liposuction alternative. I am a big fan of using lasers to do liposuction and I think it has many advantages; however, it is still surgery and it is still liposuction! I guess it is just as important to read the “big print” as the fine print!

                                                                        The Ageless Muse

29 January 2013:  I am pleased that my first posting is a positive one which comes from our British colleagues.  The Royal College of Surgeons  ( http://www.guardian.co.uk/society/2013/jan/29/royal-college-surgeons-cosmetic-surgery-guidelines ) has issued guidelines on who should be performing cosmetic procedures, the proper evaluation of patients and called for an end to offering financial incentives to entice people into surgery.  Bravo!!! (Of note: The American Society of Plastic Surgeons Code of Ethics has set similar standards for some of these items for many years.)

                                                                        The Ageless Muse

January 29^th 2013

Welcome to the first posting of  The Ageless Muse.  Each day the media stream seems to spew an endless volume of articles, news videos, tv shows, etc. all on plastic surgery, cosmetic lasers, and skin care.  Some of it is interesting and informative, some of it is plain silly, and some of it, unfortunately, is plain wrong and at times dangerous.  The Ageless Muse is a concept which I have had for several years, but have finally decided to launch at the urging of my friends, family, and, most importantly, my patients.  In it I will try as often as possible (I decided not to commit to a schedule quite yet as I do not want to make promises I cannot keep!) to comment on those media offerings that I come across and strike me as particularly good and informative or particularly awful.  I hope I will be able to post more of the former than the latter, but I fear not.

 Within the Ageless Muse, there will occasionally be a column or posting under the heading The Rothaus Report.  In this column, I will be discussing those articles from the plastic surgery literature that I think might be most pertinent for my patients.  I will try to interpret and translate the findings in the selected article in a manner that will make them informative, understandable, and interesting.  Wish me luck!!

Having children is one of life’s most treasured experiences.  It always has, and will be, a great source of pride and reward for most couples.  In the past, many mothers accepted the changes in their body as the price they had to pay for the joy of motherhood. However, in recent years, moms began to realize that they could not only be a parent, but also restore their bodies and figures after their years of pregancy and breast feeding were over. Thus, the “Mommy Makeover” has emerged as a top trend in plastic surgery. 

The popular demand for mommy makeovers includes procedures for enhancing or restoring the breasts (breast augmentation and/or breast lift), tightening the abdomen (tummy tuck or abdominoplasty) and removing excess fat (liposuction). Although there is no stereotype that fits the mommy makeover candidate, there is a common link between them: the opposition to succumb to the physical changes that occur with their bodies after childbearing.

Some people consider all the attention that the press is giving the mommy makeover the driving force behind it.  In reality, however the demands for the the mommy makeover procedure(s) evolved from the numerous requests from moms.  Many women interested in mommy makeover surgeries frequently are seeking referrals through friends or even internet searches. The response from the plastic surgery community has been gratifying as it seeks to provide the greatest level of safety and outstanding care for those who undergo mommy makeovers.  The American Society for Aesthetic Plastic Surgery (ASAPS) issued their annual plastic surgery statistics, and four of the five most common procedures among women in 2011 included those procedures commonly sought in the mommy makeover.

As with any surgical procedure, meticulous preparation and post-operative care are essential.  When the patient is young, healthy, and determined, a mommy makeover can be achieved with an irrefutably positive result!