Eyelash Transplants Big News

The press has soaked up the recent workshop in Los Angeles on eyelash transplantation. The techniques for transplanting eyelash hairs are now successful and reproducible and the aesthetic improvement can be dramatic. There are many patients who would like thicker eyelashes: people who have had diseases of eyelashes like alopecia areata and people who have pulled out their eyelashes either as a manifestation of anxiety or a preoccupation with appearance. There are also people who simply would like thicker eyelashes because they were not born with them.
Regardless, hairs can be removed from the head and carefully threaded into the ends of the eyelid. In the scalp recipient dominance combines with donor dominance to produce natural looking hair. This is much less true with the eyelids. Basically what you put into the eyelid is what you get. Hairs continue to grow and must be cut and shaped to desired length. In addition hairs usually maintain their curl so most people are not going to like the results of transplanting curly hair into their eyelid.
Like any new procedure the buyer must beware who is doing the procedure. Good experience in hair transplantation as well as good experience in cosmetic surgical enhancement is essential. Ask your surgeon about his experience and look at photos of before and after pictures. As always buyer beware and ask your questions before you decide.

Hair Transplants are Natural Looking

I just returned from the ISHRS meeting in San Diego. Hair restoration surgery is incredibly different from 10 years ago and the results are simply amazing. Undetectable hairlines and no evidence of plugginess are now achievable in most patients. There is so much more understanding of the causes of hair loss, diseases of the scalp, and the normal progression of hair loss. We have added hair transplantation to our services at MetropolitanMD and I have recruited a very experienced team of technicians to help with our procedures. I enjoyed the meeting very much for the hospitality and enthusiasm of the very experienced hair transplant surgeons who attended from around the world. The collegiality and comraderie that doctors at the ISHRS exhibit toward one another is only matched by the doctors at the American Academy of Cosmetic Surgery. Physicians are good people. The climate of restricitons of payments, insurance company antagonism, and medico-legal intimidation has made doctors increasingly less friendly toward each other and less willing to share knowledge. In spite of this we persevere as what I judge to be the most ethical and empathic profession that exists. And ISHRS and AACS exhibit kindness toward each other and concern for patient welfare to a greater extent than I have experienced elsewhere. I am looking forward to expanding our hair transplantation program.

How do skin care systems work

If there were a single product that would give you beautiful, healthy, youthful skin you would be using it already. In fact, everyone would be using it. It goes without saying that there is no such product. Cosmetic companies make money by constantly churning out new products to keep their cash flow going. Their statistics show that the average female will purchase a competitive product within 90 days even if they are satisfied with their old product. Look at the products on your shelf. It is likely that you bought at least one new product in the past 90 days. We Americans, especially, get bored with same and so we need change. The cosmetic manufacturers use this information to constantly provide new products which are competitive with their own so that when you change products you will still be buying from the same company.
Recently dermatology researchers and clinicians have become aware that only systems of care can provide healthy beautiful skin. The analogy is with the person who wants to build muscles. Before working out at the gym the nutritio9nal building blocks must be provided. One must eat adequate proteins, carbohydrates, and fats and have enough minerals and vitamins to grow muscles. Skin also needs to grow and it cannot get enough nutrition from your stomach. So a system of skin care is the only way we who live in a polluted environment to ever increasing age can maintain healthy and attractive skin.
There are 2 kinds of cosmetceuticals that are available to the public: maintenance and restorative. Most cosmaceuticals are maintenance and consist of good cleansers, moisturizers, and perhaps an antioxidant or two. Repairative systems are difficult to find outside of a dermatologist’s office. The best one I have used is the Obagi Skin Care Line. While it can be bought illegally online with little effort, it is usually not very effective unless used under a physician’s direction. Each person is different and the nuances of adapting the system to each user is an art form.
With a good repairative system, physical treatments like chemical peels, microdermabrasion, photrejuvenation, and so on are much more effective.

True appearance vs. reality

How do we explain the excitement of going to a wedding. We dress in our finest wear, we spend time in the mirror making our hair just-so, and our skin just right, and if we are women our make-up well styled. We go to the event feeling very beautiful and handsome. And then a photographer stops by and takes our picture and we see the picture and all of a sudden we don’t look so good. Our lips are too small, our nose too big, our pores too large, and the lines of our face are too prominent. So what is the difference between the before and the after picture.
Snow White’s evil step-mother tells us the answer. “Mirror mirror on the wall, who’s the fairest of them all”. “Why you are, no you are, no you are” says the mirror to everyone.” No wonder then we are disillusioned when we see our photograph. The mirror in our head lies. Not only do we not see ourselves in reality in the mirror on the wall, we do not see ourselves as we truly are in the mirror in our heads. We are neither so beautiful nor so homely as we would pretend by looking in the mirror. And it is the discrepancy with the photograph, not actual imperfections that make us more or less attractive.
I recently had an unhappy patient who complained that after lipoaugmentation she did not look any better. To be sure the photographs proved her cheeks were higher, she had more proportion in her face, and her skin appeared softer and smoother. Yet she did not smile, did not fix her hair, did not dress any different. With the same dour appearance in her before photo she changed nothing for the after photo. The only difference was in the improved proportion of her cheeks.
If any of us wants to appear more attractive, smile first and look to cosmetic surgery after.

A rose by any other name ... let's cut the hype

Skin care and cosmetic enhancement/cosmetic surgery
Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

An ever increasing phenomenon in cosmetic surgery is trademarking procedures by doctors so that other physicians cannot use that reference to their patients or in their marketing. The quick-lift and the feather-lift for example, are trademarked names used in advertising that purport to be special procedures. In reality they are the mini-lift, the S-lift, the short-flap lift and so on. Where this has really become pernicious is when doctors publish papers in peer reviewed medical journals or give lectures at medical society meetings using their trade-marked names. The speciousness of these asserted names doesn’t even stop there as certain cosmetic surgeons teach courses to other surgeons of how to use their trademarked procedures and even license other surgeons to use their trademarked descriptions in advertising their expertise. The problem has reached such irrationality that non-physicians are trade marking names of procedures and instrumentation to promote their own organizations which they sometimes describe as professional societies and other times describe as medi-spas. Unscrupulous physicians lend their names to these practices for a small sum of money or for the hope that they will somehow generate continuing profits. Our government, which is made up of attorneys find these alliances and trademarks another source of income for themselves and their financial supporters and so they are unconcerned about the misinformation delivered to the public.

The American Academy of Cosmetic Surgery has decided to not allow any trademarked names in lectures at any of its courses. Similarly it will not allow trademarked names to appear in articles in its peer-reviewed literature. Such a stance is to be commended and I would hope other professional societies would follow suite. Once again- buyer beware!

Malpractice Crisis Impairs Medical Care

Skin care and cosmetic enhancement/cosmetic surgery
Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

A friend of mine was describing his apprehension at getting married again. He said, “when you have stepped on the rake once, you are hesitant before you do it again”. Doctors are basically good people who get their self-esteem from satisfied patients. Most of us have good intentions and work hard to please our patients. So you can imagine how we must feel being bombarded every day by the Trail Lawyers Association (friends of Hilary Clinton and our 2 senators from Illinois) in attempts to make money from someone’s misfortunes at the expense of physicians. They would not support legislation to get rid of bad doctors in the state because that would deprive them of their rationalization that patients are victims of doctors. They like having bad doctors in the state so these few bad apples can generate the news that allows unscrupulous lawyers to sue good and well meaning doctors. And this supports the few selfish citizens who hope that a doctor lawsuit can be their lottery pick. I had a patient a few years ago who angrily told me she wanted to sue her obstetrician because her C-section scar was not as smooth as she wanted it. She said a plastic surgeon she consulted said the OB did a terrible job. “Oh”, I said. “And was the plastic surgeon there for your delivery so he knows if the OB did a poor job? And did you have a healthy baby after the delivery?” She said she had so I added, “then I suggest you call your OB and thank him for your lovely child which he brought safely into this world”. This is certainly more nonsensical though no less pernicious than parents and lawyers getting rich after a child develops cerebral palsy from a lack of oxygen and sues the physician who labored to deliver the child safely.
Physicians are not Gods. When we take care of patients, whether it is to cure disease, make the infirm more comfortable, or to enhance appearance we are doing our best. Perhaps not our perfect best, our best none-the-less. Physicans win more than 80% of malpractice cases yet we pay a toll in the form of malpractice premiums and emotional distress. When you hear that doctors are concerned with the malpractice crisis and we request relief in the form of tort reform remember that we have already stepped on the rake. And it is the mission of the Trial Lawyers Association and our legislators who come from their ranks to keep putting the rake in front of us in the hopes that one day we will step on it again.

BEFORE DECIDING ON COSMETIC SURGERY, FIND OUT WHAT IS WRONG

Skin care and cosmetic enhancement/cosmetic surgery
Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

One of the paradoxes in patient requests for enhanced appearance is who knows more: the cosmetic surgeon or the patient. After all, the patient knows what bothers him/her, so who is the better judge? The answer lies in who understands the problem. A doctor would hopefully not treat a symptom without having a diagnosis. The same should be true for cosmetic enhancement. Let’s take a look at some obvious pitfalls for consumer confusion. An adult (over 50 year old) woman comes to the office complaining that her face looks too long. She sees many models on the covers of magazines and she likes their long silky hair so she copies their hair style. No need for surgery here. The patient is framing her face with long hair which makes her face look longer and older. Cut the hair, please, and look more youthful and cheerful. Another patient comes to the doctor complaining that her buttocks are too large. On profile her breasts and buttocks balance each other as they should, but viewing from the back her hips and thighs protrude laterally. That makes her buttocks look very wide. Removing part of her buttocks would make her top heavy breasts produce a penguin-like posture. Sculpting her hips and lateral thighs will give definition to her buttocks and make the buttocks look more compact.
When presenting a complaint to a cosmetic surgeon it is wise to have some idea of what you desire. At the same time describe your dissatisfaction and have the surgeon explain the problem. In other words, give you a diagnosis for which there should be a remedy. And while you are at it, check with more than one surgeon. You may find a difference in their opinions that helps you to choose the doctor who understands your needs.

Genreal Anesthesia Is Not Necessary for Cosmetic Surgery

Skin care and cosmetic enhancement/cosmetic surgery
Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

The first tenet of ethical and compassionate medical care is “do no harm”. One would think this direct statement is unequivocal and easy to follow, yet that is not true. Physicians and surgeons are human and are subject to their individual beliefs and prejudices. A case in point is the use of general anesthesia in cosmetic surgery which I oppose with specific exceptions. For the last half of the 20th century surgeons performed their tasks with patients asleep. Risks were known, but the need for complete anesthesia outweighed those concerns. As a result surgeons became comfortable operating on patients who were asleep and did not move. Recent studies have shown that general anesthesia doubles the risks of death and injury for a given surgical procedure. Twilight sleep or IV sedation greatly reduces that risk. Local anesthesia, specifically the tumescent technique of local anesthesia, completely eliminates that risk. Liposuction, breast surgery, face lifts, hair transplants, eyelid surgery to name a few can all be easily and comfortably performed without general anesthesia. Yet many surgeons are uncomfortable with a patient who can talk or move and they reject learning how to do pleasant surgery on a patient who is partially or fully awake. Besides the increased safety, an awake-patient can turn and give the surgeon more artistic opportunity to sculpt or fashion tissue. And the patient feels better when they return home and walk around without the risks of falling or feeling ill due to after effects of anesthesia. Surgeons have the same prejudices when using post-operative narcotics instead of early walking and exercise- but that is a subject for another blog. Suffice it to say that patients have a choice of whether to add another risk to their contemplated cosmetic surgery. At the least everyone can seek a second opinion when their surgeon tells them they will need general anesthesia for cosmetic surgery.