So, Ms. Montag’s surgical escapades bring up interesting questions for doctors and patients. Her plastic surgeon went on TV after the negative media stories started coming out in force and said that people get multiple plastic surgeries at once all the time and this is nothing extraordinary. I agree with that. He also said that she had a rational understanding of what she wanted him to do and that she felt that these procedures would help her career. He characterized it as a business decision on her part. He said that he did extensive psychological testing on her and she does not have body dysmorphic disorder or an addiction to plastic surgery. Anyway, these are all elective procedures and people do it because they want to, not because they have to.

I do have a bit of a problem with this line of reasoning.

He is absolving the surgeon of responsibility in the plastic surgery decision making process. As long as the patient is not floridly crazy, the plastic surgeon is ethically OK to do anything the patient wants and can afford. Plastic surgeons and all aesthetic physicians are already walking on the edge between doctor and luxury salesman. If we are just technicians providing a specialized service to any who are willing to pay (assuming they are not foaming at the mouth lunatics), then we should be willing to abandon the title of physician.

And that is fine for those willing to do that.

The consequences of that kind of attitude would, of course, be disastrous for public relations. Plastic surgeons are already seen as remorseless vultures preying on the insecurities of their patients.

As an aesthetic physician, I can sleep with an unwrinkled brow only if I feel that I am in no way harming my patients. I realize that I am not saving lives, relieving pain (except for migraines and teeth grinding – to be precise) or bringing new lives into this world. But if I am helping people feel good about themselves in small ways without significant risk, I am happy with what I do.

And this is what is missing in Dr. Ryan’s argument. It’s not that he did 10 procedures at once. It’s that he did them on a 23 year old girl who is under the delusion that these procedures will make her a star. Everything we do in medicine involves a risk to benefit calculation. Life threatening cancer warrants the considerable risk of a 10 hour surgery. This clearly does not. Aside from the anesthesia risk of a lengthly operation, doing these procedures so early exposes her to complications many years later as her features change with time. For example, doing a second rhinoplasty for what this surgeon admits to be a very minor cosmetic defect means that the tissues of her nose are much more scarred than before. Scar tissue behaves unpredictably over time. As she ages, her nose will probably start to look more and more bizarre as the scar tissue deforms the natural aging changes of her tissues. As her skin thins with time (and I mean when she is 40, not 70), the scar tissue will become more visible and the contours of her nose will become more asymmetric and irregular. I see this in my clinic on a daily basis. Sometimes I can help by filling in the irregularities, and sometimes I can’t.

to be continued

At 23, she has begun the journey that will, undoubtedly, take her into a region of our culture that is becoming more and more densely populated. She is currently rubbing imaginary shoulders with the likes of Michael Jackson, Joan Rivers and Donatella Versace. Unfortunately for Heidi, her virtual neighbors have talent and accomplishments. They are, for the most part, beloved and celebrated despite their plastic surgery debacles, not because of them.

Poor Heidi has a different fate in store for her.

As she undergoes the inevitable corrections, re-do operations and “upkeep” procedures over the next 40 years, she will find herself hanging out in the smaller rooms of this cultural clubhouse. If she doesn’t stop the madness, soon enough, she will be sipping virtual FIJI water with Jocelyn Wildenstein (the cat lady) only!

And trust me, she will have more operations.

Her boobs will expire in 10 years and will probably have to be replaced, resulting in more scar tissue formation and further hardening of a chest that currently feels like a car bumper, I’m sure. In terms of her boobs, I am speaking of the best possible scenario, where she never actually goes through with her rumored desire to march down the tata alphabet from her current DDD (that’s 3D – i.e like Avatar, viewing them can be an immersive experience) to H because “I actually want H for Heidi” (you can’t make that kind of stuff up!).

….. to be continued…..

http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2010/01/10/national/a072814S79.DTL

Admittedly, these cases result mostly from large volume injections of impure product in unsanitary conditions from untrained and unlicensed injectors. However, it seems that the way silicone maims, disfigures and kills is via migration of the substance to distant parts of the body. In the case described by this article, a Dominican woman died from silicone travelling through her bloodstream and into her lungs. She was injected in the buttocks.

I do not see a role for silicone injection outside its FDA approved opthalmic indication. The quantities used in the eye are miniscule and therefore bear little danger if there was blood borne migration. Injecting it into the lips, nose, cheeks or anywhere else for cosmetic purposes seems foolish to me, considering that we have fantastic fillers currently FDA approved for cosmetic use.

And one last note. I have seen what it looks like when, after twenty years of sitting in place, a large amount of silicone migrates from the cheek to the jawline. It looks like someone took a blowtorch to the poor woman’s jaw. And there is not much we can do to restore her appearance. Cutting it out would leave considerable disfigurement.

So we know it migrates when large volumes are injected. Why would we think that some of it doesn’t migrate when small amounts are injected?

Just wondering.

The link is: http://www.esarcasm.com/7220/nipped-tucked-8-new-iphone-plastic-surgery-apps/

The story you’re about to read is not (entirely) true. It is, however, more accurate than most things on network television.

We know, your face looks like five miles of bad road. You’ve got a nose like a turnip, breasts like empty sandbags, and from behind your ass looks like a sack of cats being dragged to the river.
If anybody was a candidate for surgical augmentation, you my friend are it.
But getting a total body makeover is a big step. Why not try it out first on your iPhone? There are now two apps that let you envisage what a new, improved you would look like before you go under the knife. Per Reuters:

The Shafer Plastic Surgery App … is aimed at modern patients who are “sophisticated, inquisitive and information seeking,” and it taps into a database of more than 1,000
questions and answers about specific cosmetic surgery procedures.
The Shafer app will soon be joined by iSurgeon, developed by Miami cosmetic surgeon Dr. Michael Salzhauer, who authored the 2008 book “My Beautiful Mommy” aimed at
helping 4-7 year-old children cope with plastic surgery. iSurgeon combines a game mode allowing users to try their hand at surgery with a feature that gives people the chance
to instantly modify images of themselves — or their friends — through lip enhancements, breast augmentations and dozens of other improvements.

eSarcasm has learned these apps are just the tip of the proverbial noseberg.
We spoke with Dr. Eileen Dover, noted plastic surgeon and author of Babies and Botox, a probing look at the benefits of pre-emptive cosmetic procedures for the rug-rat generation, and Mommy’s Got New Tits, a guide for adolescent children whose friends have started noticing their mother’s smokin’ new rack.
According to Dover, several promising iSurgery apps are about to be introduced:

LipRip: This accelerometer-based app simulates actual collagen implants by having you bang the iPhone repeatedly against your lips until they swell up like Angelina’s. Even Brad will be fooled.

ManGina: Feel like you’re a woman trapped in a man’s body? With ManGina, you can at least pretend to have a hooha. The app’s patented Weenie-B-Gone technology makes any penis disappear when viewed through the iPhone’s camera. Also great for gags on really drunk friends.

iLaser: Get rid of unwanted body hair without an expensive laser procedure. iLaser temporarily increases the iPhone’s radiation level to the undocumented ‘Chemo’ setting, guaranteeing follicle loss. Not recommended for use on testicles or other valued body parts.

The MJ: Named for the dearly departed pop icon, this app cycles through an ever shrinking series of virtual nasal alterations until your nose looks like two holes in a bowling ball. Companion app WhiteLikeMe simulates bleaching your skin until it reaches a state of near translucence.

Grey Me: Named for the Dirty Dancing star who changed her unique appearance and ruined her career in the process, Grey Me allows you to remove any prominent facial feature and look like a completely different person in minutes! (Note: Electric saw available for an additional fee.)

MyBicep: Flex your way into the ladies’ hearts with MyBicep, the app that makes your man-guns massive without the cost and hassle of a gym membership. Follow its easy-to-use fitness program, and after approximately 294,322 reps of MyBicep-directed iPhone-curling, your bicep may grow by as much as 0.000000001 percent.

iPhallus. This manliness enhancer requires two or possibly three iPhones, stacked end to end. Though unlikely to fool potential partners, it can show you what you might have looked like if those pills you bought on the Internet actually worked.
nicole-kidman-botox3

Blowtox: Put your lips around this app’s iWind sensor and you can literally blow the years away, erasing lines and wrinkles from your profile photos with a few strong puffs. You’ll still be an old hag, but your digital doppelganger will be smokin’ hot. Endorsed by Nicole Kidman.

We are very proud to have just been named best of Los Angeles Citysearch 2009 for Laser Hair Removal!

The online community is very important to us and its a real honor to receive such nice feedback.

experience matters!
injections of filler under the eyes can be technically tricky. although blindness is extraordinarily rare (i have never seen this, nor has any doctor i know seen it, but i have heard of a case being reported in the literature), it is theoretically possible. the filler should be placed deep against the bone by an injector who is very experienced in filler injections under the eyes.

No way!
Sculptra is a collagen stimulating agent that adds volume to the face. If you have no issues with your appearance, there is no reason for you to do anything to your face. Especially not anything that lasts 3 years and is not reversible if you were to decide that you didn’t like it.

New York Times

The Doctors TV show

MedEsthetics Magazine

About.com

Enjoy!

Perlane is a good choice for injectable filler cheek augmentation. It lasts for a while and is reversible. I also like Radiesse. Your bruising experience does not rule out further injections. You should just take precautions – take Arnica Montana for 2 days beforehand and 2 days after, make sure the doctor mixes lidocaine with epinephrine into the filler (either Perlane or Radiesse), use ice during the procedure and, most importantly, make sure that the doctor is experienced in facial filler injections.