Plastic Surgery

ASAPS. Where Fairy Dust And Fact Collide

American Society of Plastic Surgeons

In your face Coachella.

While the rest of the world was at some desert music festival requiring a macramé  dress code, I was kicking it with some science at ASAPS.

That’s right, on behalf of Real Self, I was at the American Society of Aesthetic Plastic Surgeons getting the scoop on what’s next in the world of medical cosmetic procedures.

Dress code:  Power suit, circa 2003.

Armed with objective curiosity, I secretly hoped that a magic wand on the brink of FDA approval would be unveiled.  A non invasive magic wand that could be squeezed in over lunch, without downtime.  One that would render me 10 years younger faster than I could say bippity boppity boo.

We’re getting close, but we’re not there yet.

Instead, I learned that despite excruciating consumer demand for anti-aging procedures, science has a slow moving innovation pipeline for a reason.  A new device, procedure, laser or injectable has to safely deliver real results, over time, in clinical trials in order to get FDA approval.

Your Creme de La Mer does not.

Sobering reality aside, here’s what landed on my radar screen for further investigation:

1. Your face ages in 4 dimensions.  And we’re probably treating the wrong ones.  Dr. W. Matthew White, Director of Facial Plastic Surgery at NYU was on hand to talk about experiences with Ulthera, but what perked my ears up was his approach to the aging face which he tells me his practice studies intensively.

Dr. White explains, “The anatomy is important.  If you start at the deepest layer, you start at the bone.  The next layer up is the SMAS.  When you have bone remodeling [aging], everything starts to droop”.   Dr. White goes on to tell me that our faces ages on four dimensions; the bone, the SMAS (which is the connective tissue that holds it all together), the fat and then, finally the skin.

What this tells me is that it’s easy to default to Botox, fillers or clamor for the latest hype.  But maybe a nip tuck more is more effective than injection or another laser?  In my case, it seems like I have an adorable little prejowl sulcus that’s adding a few years to my otherwise smooth face.

2.  Your vagina may be aging faster than you are.  Vaginal rejuvenation is up *64% versus last year.  Yes, even in this economy.   Dr. W. Grant Stevens says “I’ve seen an increase of about 500% in elective cosmetic female genital surgery over the past four years”.

After a riveting presentation from Dr. Christine Hamori on vaginal cosmetic enhancement (and staring at a Power Point full of labias for 20 minutes), I pulled her aside to ask why women are flocking to make minor enhancements to something that isn’t on display.   Frankly, I’m pissed because as a lifetime vagina owner, I always assumed those special visitors were just happy to be there.

Dr. Hamori gently explained that there are those who have a deformity and use the surgery to correct, while others have always felt self-conscious about having an large labia, but they didn’t know there was a solution. What’s interesting are those looking to not correct, but enhance.  Dr. Hamori goes on to tell me it’s largely the rise of the hairless, vajazzled vagina that puts the spotlight on our Georgia O’Keefe.

Interestingly, the decision to have this done comes from women’s internal pressure – not from the men in their lives – and has incredibly high patient satisfaction.

Your fault

3. Non-invasive and minimally invasive procedures may have real potential.  Lets clear something up.  When the industry talks about “non-invasive”, they basically mean without surgery requiring general anesthesia and substantial downtime.  However, minimally invasive procedures can also lumped into that category by the media as well, for procedures like Cellulaze.   What this means to you is that the procedure can be done in the doctors office with limited down time.  This does not mean it’s as effective, better than, or cheaper than traditional surgery.

Still, there’s a lot to look forward to in this space:

Ulthera is showing some real promise to lift a sagging face, especially now that they’ve figured out how to get the same result with less pain thru Ulthera’s Amplify study.   The results presented by Dr. White were encouraging, especially on the lower face.  Ultherapy has a 75% worth it rating on Real Self, so I’m interested in learning more about the trade-offs versus Thermage.



Coolsculpting had a big presence and a lot of buzz at ASAPS, but there are skeptics who question whether or not it’s an effective treatment over liposuction.

For the uninitiated, Coolsculpting is a non-invasive alternative to liposuction that requires only an hour at your doctors office.  Fat cells are frozen, and then eliminated by your body over a period of a few months.

Dr. Brandith Irwin, one of my favorite dermatologists for unbiased opinions speaks very highly of Coolsculpting on Skin Tour, and  it has a 71% approval rating on Real Self, but critics question the before and after pictures, suggesting it’s difficult to tell what is weight loss caused by diet and exercise versus the actual procedure.  The big question will be if the money and time is equal to or better than the results from lipo.


A brave volunteer gets Coolsculpting in the middle of the Javitz center

And here she is after, with a frozen brick of fat that gets massaged (it flattens out)

Immediately after with a frozen brick of fat

Post treatment message to warm up the fat and flatten out the appearance

Post treatment message to warm up the fat and flatten out the appearance

And then we have  Cellulaze, a minimally invasive laser treatment that treats cellulite (not weight loss).  It takes one to two hours in the doctors office, done under local anesthesia and you may be able to be able to get back to normal the right way.  But it’s still surgery, albiet more minor and with a laser, not a scalpel.

Most of the doctors I spoke to seemed encouraged, but cautioned that the results take time to see, it’s pricey and it’s not for everyone.  The best patient is someone who’s around their idea weight and struggles with a little too much orange peel dimpling.  Still, Real Self shows a 75% approval rating although this has declined from the original 85% rating.

Only more time, studies and patient reviews will tell.

4. Sometimes, validation of the tried and true can be the biggest discovery of all.  Innovation isn’t a bad thing at all; we want doctors and drug companies to strive for better results with less cost in time and money.  But in the world of medical cosmetic enhancement, the road to innovation is littered with gimmicks that didn’t live up to the hype (looking at you Smart Lipo, Stem Cell Facelift, Vampire Facelift and Zerona).

Unlike getting the latest iPhone, the stakes are higher with cosmetic medical innovation, and sometimes irreversible (hey there migrating silicone lip injections).   What this means for you, the patient, is that newer isn’t always better when it comes to cosmetic procedures.

“There’s a good balance between innovative and responsible” says Dr. Brent Moelleken.  “Patients should shop the doctor, not the procedure.”

5. *Cosmetic medical procedures have increased by 250% since 1997.  And are up 3% versus last 2011.  The numbers say the growth is driven by the advent of non-surgical procedures, the 35-50 year old demographic and men, who grew 107% since ’97.

What’s curious to me is why Americans spent over $11 billion on what they look like in the worst jobs market and economy we’ve experienced since the Great Depression?  I suspect it’s deeper than being the hottest girl or boy in the room.  My guess is that it has to do with survival of the fittest, and looking as vital as we feel to stay in the game.

2012 plastic surgery growth


Which bring me to this; ASAPS, doctors, manufacturers, listen up!

If we’re spending BILLIONS on cosmetic procedures, the conversation needs to change to serve the patient, not just the industry.    Hearing some of the doctors call out that the need for standardized before/after photography during the Hot Topics session was encouraging, as well as the Smart Beauty guide that ASAPS is launching in September.  And a round of applause for Dr. Steve Teitelbaum and Dr. Brian Reagan for drawing the distinction between gimmickry, hype and progress.

But patient education has to go beyond the sanitized party line we’ve seen to date.

And patients, you listen up too.  Before you fall head over heels in hope, realize plastic surgeons and dermatologists aren’t fairy godmothers.  That thing in their hand isn’t a magic wand, it’s probably a cannula, scalpel or a needle.  There is no substitue for common sense, arming yourself with some education (my resources page is a good starting place) and a good doctor who cares about YOU and as you age will.

To be continued.

*Sources: American Society of Aesthetic Plastic Surgery

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    Mel R.
    July 24, 2015 at 11:51 PM

    Ultherapy is wrecking women’s faces, causing nerve damage and shrinking the eyes and eye sockets. Should be ripped off the market asap. This is the first year that the press are using the word”unrecognizable” when it speaks about celebrities..Uma Thurman, Nicole Kidman, Jada Pinkett Smith, and let’s not forget Renee Zellweger. Ultherapy changes the face drastically, volume and character loss, etc I think there is a class action law-suit going on. It’s the freakiest invention in history and will be gone before you know it.

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