My wife wants a new set of dining room chairs

My wife wants a new set of dining room chairs. She says our old chairs are not good because if she leans back in the chair her clavicle falls through the openings at the back of the chair. She doesn’t know that her clavicle is in the front of her body. That really wouldn’t matter to her anyway, and if I told her where her clavicle is she would say that when she falls through the chair her whole body falls backwards and so her whole clavicle falls through the chair and that is why we need new chairs.
Isn’t that the way it is? We want something so we think up a reason to justify our want. I want to play golf with the guys. Of course that isn’t what I say. I say I want to get out in the sunshine and admire the beauty of the golf course. God created mountains and sea to admire and behold. Arnold Palmer made golf courses to admire and behold. God’s magnificence is free, Arnold charges.
Everyone agrees that beauty comes from within. A smile is worth a thousand words. Clichés yet true until we look in the mirror. My wife says she likes my protruding belly. I sure don’t. Short is a huge advantage because short people try harder and probably we are smarter. I never feel that way when I am sitting behind a tall person at a concert or when I used to play my version of basketball. Bald is beautiful. Guys with lots of hair waste so much time grooming. This works until I look at the pictures of the past presidents of the American Academy of Cosmetic Surgery and I am the only one with the reflection off my head.
Look, it is good that we like what we like and want what we want. I think perspective is what counts and priorities must be set. It is appropriate to want a youthful face. Cosmetic surgery is a blessing. Then don’t lie in the sun and argue you look better when you are dark. Liposculpture is a huge promoter of self esteem. Then don’t tell me that your biweekly tennis game is exercise and the weight you have gained is muscle. Enjoy who you are and take care of the blessings you have.
I am still figuring out how to convince my wife it is good that her clavicle falls through our dining room chairs.

You Don't Need a Doctor

A funny thing has happened to the medispa industry. They now feel you don’t need a doctor for your cosmetic medical and surgical needs. Their thinking and marketing promotes technician expertise to the public. They often have an emergency room doctor or other non-cosmetic trained physician listed as a medical director. This legitimizes the practice of medicine in the medispa according to state requirements. Often they employ nurses or other paramedical personnel but as near as I can tell a squirrel with its fur shaved is still a squirrel and a nurse who takes a job as a sales lady is still a saleswoman.
About 8 weeks ago I got a call from one of these spas asking if I would be interested in working with them. The deal is they sell surgery to a client for an average fee of $10,000.00 (according to the spokesman who had contacted me) and they schedule the surgery at my surgicenter. They pay me $1500.00 to perform whatever surgery the salesperson has sold the client and after Drs Lack, Rachel, or Franco take care of this person the client returns to the medispa. I actually forgot about the offer until 2 days ago when I consulted with 2 patients who had already had consults at that medispa and had come for a second opinion. Both related the same story. The saleswoman at the spa listened to their requests and outlined a surgical plan. They were each told they would meet the doctor the day of surgery and they were not given the name of the doctor. There was no attempt at education and no discussion comparing risks and benefits and no pictures of before and after patients. One of the patients was quoted $20,000.00 for her fee, but was offered a 50% discount if she would sign up that day. I forgot to ask the second patient what her charge was. Both patients were unhappy with the interview they had received and both said they would not have surgery performed by such a clinic.
Questions arise in my mind:
Why would someone go to a medispa for surgical concerns?
Why is this business venture not prosecuted by the state as fee splitting?
Why are so many doctors employing paramedical technicians to inject fillers and Botox? Are they mimicking the medispa business plan: profit at any cost? What is their training in injections, dosing, methodology, taking care of complications?
What about doctors who do Botox parties. Are patients receiving good medical care or is this the new spa mimic?
Idle thoughts:
You get what you pay for in life
Generation Y, ala Obama administration, is changing the way society seeks expertise and evaluates it. You think I exaggerate? Think about what the Clinton administration did to sexual mores and the proliferation of sexually transmitted diseases among young people. Think about the apathy of the Bush administration and the desecration of small business and subsequent recession.
Edward Lack MD

An Ode to Cellulite: Can a Cure Be in the Offing

Cellulite: Your dimpled past
Has left onlookers quite aghast
When you show your puckered face
The bearer feels herself disgraced.
Away you beggar, you sloth of vision
I will erase your every impression
Whether by sleuth or slight of hand
Your fate is sealed to my command!

Were that I could will cellulite away, I would be rich, I would be famous, I could be King. Alas, it is not yet to be, but not for lack of trying. I had a technique in 1995. It never failed ... except that 3 months later the problem returned. Cutting the fascial fibers that cause cellulite always resolves the problem, a problem I might add that is almost unique to women. It appears that the anchoring fibers from the muscle to skin run more perpendicular in women and more horizontal in men (no aspersions to men behaving in a more predictable straight line and women up and down). Also men have little subcutaneous fat and get beer bellies instead. Women store fat beneath their skin, ostensibly as a competitive advantage to child bearing (as in most things female I am willing to concede this advantage and wish no part of it).

So I have a new solution. Dr. Mitchel Goldman at the University of California, San Diego and I have separately treated several cases of cellulite using laser lipolysis (smartlipo at MetropolitanMD) and the results have been excellent. Once again the technique involves cutting the anchoring fibers inserted into the skin. Then I heated the fibers and the overlying skin by warming injected tumescent fluid with laser energy. The heat presumably shrinks the skin, but I do not think that is the mechanism for treating cellulite. I am guessing that if the fibers are altered in some way they will not re-attach to the skin. I have now treated 4 patients, two of whom were thin and two of whom had excess subcutaneous fat. All 4 patients were pleased with their results. The patients are now up to 3 months post surgery and I will closely monitor these results. I am in a quandary whether I would prefer wealth or fame if I solve this problem. Any suggestions will be appreciated.
Edward B. Lack MD