October 23, 2013

There’s another nut in the plastic surgery news, this time a kid who has had plastic surgery to look like Justin Bieber.

There are two myths about plastic surgery that I want to dispel.  The first is that we can actually make someone look like someone else.  The second is that there are many such patients who make such bizarre and pitiful requests.

This “child” already looked much like Justin Bieber.  Whatever was done had to be but small tweaks.  I’ll be impressed when someone can make Cy Young winner Randy Johnson look like Justin.

Other than when the sycophant starts out looking like the celebrity, the only time this goal can be realized is when the celebrity themselves looks like a caricature.  If you aggressively lighten the skin of a black person, give them painted on eyebrows, a broad chin, and a maimed nose, they will sort-of look like Michael Jackson.  That’s because no one else looked so weird, and emulating that will remind observers of him.

Patients will make a request for a specific nose, mouth, or breasts.  But in my entire career I’ve never seen someone want to look like someone else in particular.  If I ever saw such a person I would chase them out of my office.  Unless the celebrity themselves hired someone to be a stunt double or a security double, I can’t imagine a good reason to do that.  Even so, I wouldn’t do it.

But I have heard plastic surgeons say that they should fill their waiting room with celebrity doubles so that when real patients come into the office they will think they are seeing the plastic surgeons to the stars.  But they were only joking.  At least I hope they were.

The more interesting topic is what the laws should be concerning this when the day comes that a plastic surgeon can actually make a replica of another person.  Should they be allowed to do it?  Don’t we all own the rights to our own image?  Perhaps twenty-five years from now this will be a hot topic.

For now let’s realize that in reality plastic surgery is about improving self-esteem as ONESELF, and not to be a body-double for someone else.

October 21, 2013

It seems that a broken tort system and disreputable attorneys have grown like a cancer from the United States and crossed the Atlantic.



It turns out that since the disgraced and bankrupted manufacturer of junky breast implants, PIP, is no longer around to pay settlements, the lawyers are going after the individual doctors and clinics.


Doctors have no culpability whatsoever for manufacturing flaws unknown to them in medical devices that were legal for sale.


I agree that these patients should be entitled to compensation, but not from someone who isn’t responsible.  That PIP is defunct does not make the doctors more legally or ethically culpable than if the company still existed.


So in this case the patients are simply without an ethical bases for compensation.  That patients, lawyers, and courts are allowing this to proceed casts a shame over the judicial system of Ireland.


I guess the only things that are guarantees in life are death, taxes, and avaricious lawyers.

October 17, 2013

The plastic surgeon who performed Angelina Jolie’s breast reconstruction, Jay Orringer, is one of the most respected reconstructive guys in LA.  In this interview, he emphasizes the importance of selecting the plastic surgeon as well as the oncological surgeon.

Indeed the oncological surgeon is critical, as he or she does the life-saving part of the operation.  On the other hand, it is the result of the reconstruction that the patient will see and feel every day.  And often multiple future surgeries and follow-ups are involved with the breast reconstruction.  So a woman’s relationship with her plastic surgeon becomes very important in the long term.  As a plastic surgeon, I can also attest to the fact that the outcomes from breast reconstructions varies widely between plastic surgeons.  And while a good breast cancer operation by an oncologic surgeon is very important, survival from breast cancer is less the result of the oncologic surgery than it is from the underlying biology of each woman’s particular cancer cells.

I believe that when a patient is diagnosed with a cancer by an oncologic surgeon following a biopsy, that surgeon should quarterback the patient’s care, making the principle decisions about the plastic surgeon and medical oncologists with whom they think are excellent, etc.  But when a patient does not have cancer but finds out that they have the breast cancer gene, I believe they should first seek out a plastic surgeon, and ask that plastic surgeon to recommend the oncologic surgeon they think does the best mastectomy.  I slight difference in the mastectomy makes as much difference to the outcome of the reconstruction as does the plastic surgeon doing the reconstruction.  Indeed, many plastic surgeons themselves do beautiful mastectomies.

Angelina Jolie was lucky to find the best in both an oncologic surgeon, Kristi Funk, and her plastic surgeon.  Anyone can do their own research and find the best surgeons in their area.


July 25, 2013

I have lectured throughout the United States about the latest advances in plastic surgery. There is an adage that the teacher learns more than the student when preparing a talk and, with each lecture, I further synthesize and advance my understanding of plastic surgery.

July 2, 2013

This is an excerpt of an article by Plastic Surgery Practice interviewing me about cohesive implants.

 At first, surgeons and the manufacturers thought that they either couldn't leak or that if they were to break the highly cohesive silicone would stay in place. After a while, a few ruptures were seen. True, the rates are the lowest of any implant, but it can occur. Sometimes, when the shell broke, the gel stayed in place. But we have now seen a few cases where the gel has moved outside the shell, though to my knowledge no cases have been reported of the gel migrating outside of the capsule and into the breast. No doubt this notion of unbreakability is one that manufacturers and surgeons have been happy to hear, because fear of rupture has always been a barrier to women considering augmentation. No manufacturer has ever said they could not break, though I have read it in several surgeons' websites. The idea of "gummy bear" implants really blossomed in augmentation chat rooms and forums. This played a huge role. Some women go there and get medical advice from strangers. Bizarre, huh? As a result, gummy bear implants have achieved somewhat of a cult status.

To read the full interview, click here: