March 5, 2014


A recent study published in plastic surgery’s leading journal demonstrated that “trained listeners” heard changes after surgery, but there was no change with speech function.


The study was done on individuals in Iran having “ethnic rhinoplasty.”  I wonder whether the change in size of those noses is representative of what the typical rhinoplasty patient experiences.


I’ve done rhinoplasty for over 17 years, and no patient or patient’s family member has ever commented that they noticed a change in their voice.  So I think this finding is interesting, but probably not applicable to the population of rhinoplasty patients whom I see in my practice.


March 5, 2014

The story of the young girl who died as a result of complications following a tonsillectomy is absolutely horrible.

But the way the flames were flamed by the media could be compared to, “Remember the Maine.”

The media kept referring to this, using some combination of, “…died following a botched routine tonsillectomy…”

But hemorrhage is a known complication of tonsillectomies; in fact I myself bled two days after mine and was rushed to the hospital. 

Was it “botched” because she bled in the hospital and wasn’t saved?  Getting an “airway” into a frightened and massively obese teenager bleeding from their mouth would be daunting for even the world’s best anesthesiologist.


Routine?  This girl had morbid obesity and had the surgery to correct sleep apnea.  That is a far cry from the typical tonsillectomy we all think of, an operation typically done on young healthy children suffering from chronic infections.


March 5, 2014

The “Dove Real Beauty Sketches”  is an absolutely wonderful video.  Women describe themselves to a police sketch artist who does a rendering.  Then someone who met the woman describes her to the artist.  Lo and behold, the women look much more beautiful in the photo in which they were described by the stranger.

Maybe the strangers were being unduly kind in their descriptions. And of course the sketch artist is in on this, so the project proves nothing.

But it certainly is very thought provoking and fun.

March 5, 2014

The California Society of Plastic Surgeons has been valiantly fighting for protections for plastic surgery patients, such as requiring surgery in accredited operating rooms, requiring insurers to cover breast cancer reconstruction, orthodontic treatment for cleft lip children, etc. 

In recent years we have been battling efforts to extend the licenses of relatively untrained personnel to perform more and more treatments with lasers, injections, and so forth.  We even lost a battle to protect patients from dentists doing facelifts.

The clear trend in California is to loosen training requirements and allow more people with inadequate training to dabble with lasers and fillers and botox.

In the meantime, regulators in the UK have recognized that they have a problem and are reducing what these unqualified people are allowed to do.

So while they are going in one direction, we are going in the other.

But plastic surgeons are but a small group.  There are more dentists than plastic surgeons, and far more nurses and cosmetologists in the state than plastic surgeons.  What does that mean? More votes.

So unless people speak up, things are going to get worse and worse until we have well-publicized disasters.  And those disasters will occur.  But just like the blind street corner that doesn’t get a stop sign until several people are killed, we are going to have to wait for more disasters until legislators to do the right thing.

February 27, 2014


The word “Laser” has enticed patients since the technology was first associated with medicine. Anything “laser” meant better, less pain, better technology, which of course meant that it was the best.

Lasers are an amazing technology.  But just because something has a laser does not mean it is better.  For instance laser liposuction devices such as SmartLipo have been fairly well debunked as marketing gimmicks.  Yet that never kept patients from flocking to have that procedure done.

The newest term that is the darling of unscrupulous medical marketers is the term, “Stem Cell.” With little doubt stem cells will end up improving health and lives as much as any innovation in the history of medicine.

But at this point there is no evidence to justify the use of the term “Stem Cell Facelift.”  Fat is injected to fill the face, and along with it some stem cells.  But does any technique that minimally increases the amount of stem cells make a difference from just using fat alone?

At this time absolutely no evidence suggests that current stem cell purification technology makes a difference in the face, and to suggest that it does is unethical marketing hype.

In any case, adding fat or stem cells is not a lift; it is a filling.  Adding volume is important to reverse aging.  But calling what at best is “Stem Cell Filling” a “Stem Cell Lift” is an example of “bait and switch” at its very worst.

The American Society for Aesthetic Plastic Surgery released a position paper on this.  The chair of the task force was Peter Rubin, the world’s authority on stem cells.

For a very nice discussion of this topic, see a recent video from the Plastic Surgery Channel.  It is interesting and a well-balanced story.