American Society For Aesthetic Plastic Surgery Research Articles

Your Favorite Technique: Time for a Change?

“If it ain’t broke, don’t fix it.” “The enemy of ‘good’ is ‘better.’” “Don’t upset the applecart.” These are all common expressions with a common meaning: Leave it alone. Be satisfied with what you’ve got. Stick to the status quo. As aesthetic surgeons, we are often faced with the dilemma of whether to try something new in our practices. It may be a new piece of equipment, a new surgical technique, or a new safety protocol. Sometimes opting for change is a relative “no-brainer.” For example, the recommendation to use intermittent pneumatic compression devices or venous foot pumps in any plastic surgery operative case lasting over 1 hour, as well as for all our patients receiving general anesthesia,1 appears to have been widely adopted. An aesthetic surgeon is likely to assess that there is essentially no downside to incorporating these specific measures, and there are potential benefits—added protection for the patient and a reduction in the doctor’s liability risk for an untoward venous thromboembolism (VTE) event. However, recommendations for the use of chemoprophylaxis have not been as broadly embraced, particularly by surgeons operating in nonhospital ambulatory surgery centers. When it comes to chemoprophylaxis, the risk-benefit ratio can be highly patient- and procedure-dependent, and thus the subject remains controversial. This is despite recommendations, albeit measured ones, for specific uses of chemoprophylaxis from as credible a source as the Venous Thromboembolism Task Force of the American Society of Plastic Surgeons.2 The question is, upon what should we base our personal “best practices”? The recommendations of “experts”? Our own clinical experience? What is the key to making us change, or not change—not just with respect to VTE prevention but in every aspect of our surgical practices? As an American Society for Aesthetic Plastic Surgery (ASAPS) Visiting Professor, I have had the …

A Snapshot of ASJ Reader Opinions

I love surveys. A survey, or poll, can provide valuable guidance for decision-making, and that’s usually the reason for conducting it. One can always argue about the reliability of surveys and polls, as there are many traps and errors that can skew results. That’s why polls on the same subject can vary greatly and why political candidates and pundits endlessly argue over which polls should be believed and which should not. The survey that is the subject of this editorial is, fortunately, far less controversial. It is merely a “snapshot in time” of the opinions of Aesthetic Surgery Journal ( ASJ ) readers. Such opinions are always evolving. This survey is one of several being conducted over the coming months to gauge ASJ readers’ perceptions and preferences. Aesthetic Surgery Journal ’s official sponsor, the American Society for Aesthetic Plastic Surgery (ASAPS), conducted this survey among a sample of ASJ readers late in 2011. The primary purpose was to gain insight into how well the Journal currently is meeting the needs of our subscribers in the key areas of content, quality, and accessibility. The survey results suggest that overall satisfaction with ASJ is high, with 95.1% of respondents rating their satisfaction with the Journal either a “4” or “5” on a five-point scale, with “5” being “extremely satisfied” (43.6%). Furthermore, an impressive 79% of respondents indicated Aesthetic Surgery Journal would be their first choice among professional journals for submission of an article on an aesthetic surgery topic. For a relatively young journal, that level of endorsement is truly extraordinary. Such positive evaluations are, of course, gratifying to the editors, authors, and staff who work so tirelessly to deliver the best possible journal content. However, there is always room for improvement. We wanted our survey to dig deeper—to suggest specific ways in which we …

The American Society for Aesthetic Plastic Surgery (ASAPS) Survey: Current Trends in Liposuction

The American Society for Aesthetic Plastic Surgery (ASAPS) Survey: Current Trends in Liposuction

Book Review: The Safe and Sane Guide to Teenage Plastic Surgery

Frederick N. Lukash The Safe and Sane Guide to Teenage Plastic Surgery. Dallas, TX: BenBella Books; 2010. ISBN-10: 1935618091 According to the American Society for Aesthetic Plastic Surgery (ASAPS), approximately 125,397 surgical and nonsurgical treatments (1.3% of total procedures in the United States) were performed on individuals younger than age 19 in the United States in 2010.1 Although the majority of these procedures are performed to treat acne or other skin problems, adolescents also undergo more traditional surgical procedures such as breast augmentation and liposuction. Performing these procedures on teens is controversial, both within the plastic surgical community as well as in the general population. Thus, there is a need for an informative resource for parents and families who are considering plastic surgery. Dr. Lukash’s book, The Safe and Sane Guide to Teenage Plastic Surgery , fills that need nicely. In the Introduction, Dr. Lukash addresses why he wrote the book. Providing the details of his career biography may come across as self-serving to some readers at first glance, but to a parent reading the book, they establish him as an informative and thoughtful voice of reason. As a recognized authority with decades of experience, he separates himself from other plastic surgeons who have written “guides to plastic surgery” that, more often than not, function primarily as marketing tools for their practices and are full of more “sizzle” than “steak.” As a psychologist who has interacted with plastic surgery patients in my research studies and clinical practice for the past 15 years, I was particularly interested to read what Dr. Lukash had to say about the psychological aspects of plastic surgery. Although the past two decades have brought a sizable increase in the number of studies investigating the psychological aspects of plastic surgery, much of …

Back to Basics: Understanding the Terminology Associated With Light- and Energy-Based Technology

How do we make sound decisions about when to acquire new technology in our clinics and which devices will most benefit our patients? There are many options but no formula or algorithm that works for every practice. Light- and energy-based devices provide us with many treatment alternatives, including options for hair reduction, vascular and pigmentation corrections, contour improvements for fat deposits, and nonsurgical wrinkle reduction. However, the sheer scope of the engineering advancements associated with these devices places a burden on the physician in terms of research and understanding. The companies promoting these technologies invest considerable resources in direct-to-consumer marketing to highlight their solutions to patients’ aesthetic concerns, but how do we as clinicians make a decision to incorporate a device into our practices? The first step is to evaluate our patient population and our budget. Next, we should evaluate our goals: Will this device allow us to provide a new service to our current patient base, or is it intended to attract new patients? A significant element in the decision process is our understanding of the mechanisms behind, and efficacy associated with, a particular technology or device. To this end, the American Society for Aesthetic Plastic Surgery (ASAPS) offers web-based presentations, printed literature, and peer-reviewed studies (through Aesthetic Surgery Journal ) as a foundation for education. Spending time with the manufacturer’s representatives can also provide valuable information. During any presentation from a manufacturer, be sure to remain wary of claims that seem unsubstantiated. Most important, be sure to …

Impact of the Current Economy on Facial Aesthetic Surgery

American Society for Aesthetic Plastic Surgery (ASAPS) survey data showed a 16.7% decrease in the total number of aesthetic surgical procedures from 2008 to 2009, whereas plastic surgeons have seen an increase of 0.6% in their nonsurgical cosmetic procedures. The authors describe the results of two surveys-one administered to potential patients, one to physicians-assessing the impact of the economy on patient choices in aesthetic facial surgery. Two surveys were conducted for this study-one from the American Academy of Facial Plastic and Reconstructive Surgeons (AAFPRS) and one from the Aesthetic Surgery Education and Research Foundation (ASERF). Both surveys utilized the unique maximum difference (MaxDiff) scaling format, which assesses respondent opinions through attribute/question grouping and multiple exposures to the same parameter, rather than traditional one-time questioning. In this way, MaxDiff analysis helped identify the varied drivers of patients' medical antiaging treatment (MAT) selection. The AAFPRS survey was conducted online through Synovate's Global Opinion Panel to identify an appropriate audience of potential patients. The ASERF survey contained both MaxDiff and traditional questions and was e-mailed to 2267 ASAPS members. Data from the AAFPRS patient survey showed that 53% of respondents had been affected by the economy in their decisions regarding MAT procedures, with many seeking out less-costly options such as microdermabrasion. An overwhelming majority (95%) also reported that they would prefer a longer-lasting treatment over an immediate effect with shorter duration; furthermore, 60% felt that duration of treatment was more important than cost in selecting a facial aesthetic procedure. In the ASERF surgeon-based portion of the study, 61% of plastic surgeons felt that patients preferred long-lasting results over immediate ones, but 63% also reported that cost was a more important factor for their patients than duration. Extrapolating from the patient-reported survey preferences, the authors conclude that nonsurgical facial aesthetic treatment plans should currently be focused more on longevity rather than on immediate impact. There is currently a disconnect between patient preferences and surgeon perception of those preferences, which may be remedied with increased education for both groups. It is worth noting that many patients would be willing to accept a higher cost if it was correlated with a longer-lasting result.

Got Evidence? Stem Cells, Bias, and the Level of Evidence Ladder

O hateful Error, Melancholy’s child, Why dost thou show to the apt thoughts of men The things that are not? Shakespeare, Julius Caesar Stem cells have captured the attention and imagination of the public, appearing to be a “magic bullet,” sexy and omnipotent, capable of curing health concerns from cancer and cardiac disease to warts and wrinkles. While the scientific enthusiasm for the potential therapeutic impact of stem cells seems justified, the great hope currently placed on stem cell therapies makes the public vulnerable to emotional manipulation, deceptive marketing, or even outright fraud. Concerned by the cacophony of marketing for the so-called stem cell facelift, stem cell breast augmentation, and other “stem cell” procedures, the leadership of the American Society for Aesthetic Plastic Surgery (ASAPS) and American Society of Plastic Surgeons (ASPS) established the Joint Stem Cell and Fat Grafting Task Force in 2010. The task force was charged with gathering information about current stem cell procedures and marketing claims, monitoring stem cell training courses, initiating a dialogue with the Food and Drug Administration, and developing collaborations with key stem cell scientists within and outside the plastic surgery field. In addition, the task force was directed to perform a systematic assessment of the world’s peer-reviewed literature on the clinical uses of stem cells in aesthetic procedures. The “ASAPS/ASPS Position Statement on Stem Cells and Fat Grafting” resulted from that systematic review and critical analysis.1 While the stem cell future may be bright, there is currently scant peer-reviewed evidence to substantiate marketing claims for stem cell aesthetic procedures. What little information is present is mostly of lower levels of evidence (LOE). But why do we consider LOE in the first place, and what purpose do they serve? What does “lower” really mean, why might such evidence be inadequate, and what …

An Integrated Model of Patient Safety and Quality of Care

Our perceptions of the factors that contribute to deficits in patient safety and which strategies are effective in improving quality of care have evolved significantly. As we mark the 10th anniversary of the first dedicated patient safety teaching course at the American Society for Aesthetic Plastic Surgery (ASAPS) annual meeting,1 a reassessment of these changes could help shape educational and research endeavors going forward. There are at least two significant components of this shift in perspective. First, educational strategies in plastic surgery, as in all of medicine, have historically emanated from an apparent belief that deficits in knowledge are the source of patient safety and quality of care (QOC) problems; hence, disseminating knowledge is the logical key to improvement. However, in 1999, the Institute of Medicine’s Committee on Quality of Healthcare in America published a landmark report, To Err Is Human: Building a Safer Health System ,2 which was reinforced by a second report in 2001, Crossing the Quality Chasm: A New Health Care System for the 21st Century ,3 both of which challenged this belief. These reports brought into sharp focus the fact that patient safety and QOC issues in modern medicine often stem not from a lack of knowledge but from deficient systems, processes, and environments. According to the Joint Commission, more than 70% of patient safety issues are related to these factors.4 In essence, the problem is not so …

Management of Hypertension in the Facelift Patient: Results of a National Consensus Survey

In the facelift patient, uncontrolled perioperative hypertension is a difficult, acute condition that can lead to significant complications. Although the treatment of hypertension in the ambulatory medical setting has been standardized, its management in the cosmetic surgery setting has been ambiguous. The authors evaluate the results of a survey to assess current national trends in perioperative facelift hypertension management. A 13-question survey regarding perioperative hypertension management was sent by postal mail to 1776 members of the American Society for Aesthetic Plastic Surgery (ASAPS). Respondents were queried about their geographic location, caseload volume, facelift method, and hematoma rate. A 35.4% response rate was attained (629 respondents). Superficial musculoaponeurotic system (SMAS) plication performed under general anesthesia as an outpatient procedure was the most common facelift technique. Perioperative blood pressure management was consistent among all respondents. Beta-blockers were commonly utilized throughout the preoperative period. Administration of alpha agonists was reported more frequently by surgeons with higher-volume caseloads and more years in practice. Reported hematoma rates did not vary with medication. Medical treatment at an intraoperative systolic blood pressure (SBP) threshold below 100 (p < .04) and a postoperative SBP of greater than 139 (p < .05) significantly increased reported hematoma rates. The data generated from the survey suggest that the timing of treating hypertension deserves more attention than the actual medication administered. Proper perioperative care of the facelift patient is paramount in the reduction of hematoma rates. Preexisting hypertension correlates with a higher hematoma rate, though this study also suggests that normotensive anesthesia, as well as strict postoperative blood pressure control did contribute to a reduction in hematoma rate.

The American Society for Aesthetic Plastic Surgery (ASAPS) Survey: Current Trends in Liposuction

The emergence of new technologies necessitates a study of current trends in liposuction and other methods for fat removal. The American Society for Aesthetic Plastic Surgery (ASAPS) conducted a survey of its members to gain valuable information from Board-certified plastic surgeons about their experience with new technologies for fat removal and managing complications after liposuction. The ASAPS Current Trends in Liposuction Survey was emailed to 1713 ASAPS members. Data were tabulated and examined to determine current trends in liposuction and other fat removal techniques performed by ASAPS members. The response rate for the survey was 28.7% (n = 492). Most ASAPS respondents reported performing between 50 and 100 liposuction procedures annually. Most plastic surgeons currently employ or have previous experience with suction-assisted lipectomy/liposuction (SAL), ultrasound-assisted liposuction (UAL), and power-assisted liposuction, but fewer reported experience with laser-assisted liposuction (LAL), mesotherapy, or external, noninvasive devices. SAL was the preferred method of fat removal for 51.4%. UAL, LAL, and SAL were most commonly associated with complications. Only 10.5% of ASAPS members employ LAL; 38% have treated a patient with complications secondary to LAL. Valuable information about current trends in liposuction and other fat removal techniques has been gained from this survey. Although many studies have been published that review issues related to safety, morbidity, aesthetics, and recovery after different methods of fat removal, more prospective studies with standardized objective outcome measures comparing these techniques, particularly newer modalities, are needed to continue improving safety-related standards of care.

A Cross-Case Comparison of Hypothermia Prevention Methods and Continuous Improvement Culture Between Aesthetic Plastic Surgery Sites

The Patient Safety Committee of The American Society for Aesthetic Plastic Surgery (ASAPS) has initiated a new patient safety training program. The pilot module of this program will focus on hypothermia prevention, with the goal of decreasing the negative effects of hypothermia for surgery patients. Previous literature has shown that hypothermia can result in a higher incidence of surgical wound infections and longer postanesthesia recovery times, among other adverse effects. Therefore, educating medical personnel on patient safety techniques like hypothermia prevention is important for achieving positive patient outcomes. However, organizational research indicates that implementing and sustaining improvements system-wide requires a "continuous improvement culture." Earlier research has identified concepts such as double-loop learning, problem-solving, error management, and organizational routines as key elements of a continuous improvement culture. Antecedent to the ASAPS training program, a case study analysis of three surgery practices was performed to better understand the relationship between organizational structure, hypothermia domain knowledge, and continuous improvement culture characteristics. The data analysis indicates a positive correlation between hypothermia prevention and elements of a continuous improvement culture. These findings suggest that a patient safety training program, which includes learning objectives directed at improving organizational culture in addition to specific research-based preventative techniques, is more likely to achieve sustained improvements in patient outcomes than training focused on preventative techniques alone.

Visual Loss After Blepharoplasty: Incidence, Management, and Preventive Measures

Although rare, instances of visual loss after cosmetic blepharoplasty have been previously reported in the literature. The goal of this study is to summarize the existing literature and report the results of a physician survey in order to provide appropriate guidelines for preventing, diagnosing, and treating this unfortunate complication. A 13-question survey was sent to all members of the American Society for Aesthetic Plastic Surgery (ASAPS) and the British Association of Aesthetic Plastic Surgery (BAAPS). Surgeons were queried about their number of years in surgical practice, their average annual caseload of blepharoplasties, and the number of cases of visual loss. The survey also contained questions about the type of anesthesia administered, surgical technique, the presence of risk factors or comorbidities in patients, symptoms, time of presentation, management, and final outcome. A total of 648 responses were received from ASAPS members and 72 from BAAPS members. The overall number of blepharoplasties reported by these respondents was 752,816. Thirty-nine cases of visual loss were reported: 25 permanent and 14 temporary. According to this, the overall incidence of visual loss following blepharoplasty was calculated at 0.0052% (five of 100,000 cases, or one in 20,000). Permanent visual loss was calculated at 0.0033% (three in 100,000, or one in 30,000) and temporary visual loss at 0.0019% (two in 100,000, or one in 50,000). The most common symptoms in affected patients were pain and pressure. Development of symptoms was reported to occur within the first 24 hours, with two peaks: intraoperative to one postoperative hour, and six to 12 postoperative hours. Hypertension was the most common risk factor for postoperative visual loss. Retrobulbar hemorrhage was reported to be the main cause of blindness. The most common management technique reported was orbital decompression, followed by steroids and canthotomy. According to this study, blindness after blepharoplasty is a rare event. However, every step should be taken to prevent it. Prevention should begin in the preoperative period and should continue intraoperatively and postoperatively. Once the diagnosis of impending visual loss is made, it should be treated as a true surgical emergency, since early treatment has proven beneficial.

Contemporary Techniques in Inferior Turbinate Reduction: Survey Results of the American Society for Aesthetic Plastic Surgery

Nasal airway obstruction is a frequently-encountered problem, often secondary to inferior turbinate hypertrophy. Medical treatment can be beneficial but is inadequate for many individuals. For these refractory cases, surgical intervention plays a key role in management. The authors evaluate the current trends in surgical management of inferior turbinate hypertrophy and review the senior author's (SS) preferred technique. A questionnaire was devised and sent to members of the American Society for Aesthetic Plastic Surgery (ASAPS) to determine their preferred methods for assessment and treatment of inferior turbinate hypertrophy. One hundred and twenty-seven physicians responded to the survey, with 85% of surveys completed fully. Of the responses, 117 (92%) respondents were trained solely in plastic surgery and 108 (86.4%) were in private practice. Roughly 81.6% of respondents employ a clinical exam alone to evaluate for airway issues. The most commonly-preferred techniques to treat inferior turbinate hypertrophy were a limited turbinate excision (61.9%) and turbinate outfracture (35.2%). Based on the results of this study, it appears that limited turbinate excision and turbinate outfracture are the most commonly-used techniques in private practice by plastic surgeons. Newer techniques such as radiofrequency coblation have yet to become prevalent in terms of application, despite their current prevalence within the medical literature. The optimal method of management for inferior turbinate reduction should take into consideration the surgeon's skill and preference, access to surgical instruments, mode of anesthesia, and the current literature.

The Quality of Internet Advertising in Aesthetic Surgery: An In-Depth Analysis

The aesthetic market is a growing business, as evidenced by the American Society for Aesthetic Plastic Surgery (ASAPS) reporting an increase of 147% in the number of cosmetic procedures performed by members since 1997. This market is consumer-oriented, relying heavily on advertising for survival amid the increasing provider competition. The authors evaluate trends, ethics, and efficacy of Internet advertising in aesthetic surgery. Medical cosmetic providers in Southern California and their Web sites were catalogued through sales lists from manufacturers (Medicis and Allergan) and combined with advertised providers of surgical treatments. Using the ASAPS/American Society of Aesthetic Plastic Surgeons (ASPS) and American Medical Association Codes of Ethics as guidelines, scores were assigned to each Web site and evaluated with the provider's board certification. A geographical analysis determined whether the presence of high numbers of competitors had an impact on the adherence to ethical guidelines for advertising. To examine patient preferences in physician advertising, a survey was conducted online. Board-certified plastic surgeons showed the highest total ethical scores, followed by otolaryngologists, oromaxillofacial surgeons, and ophthalmologists. No decrement in the quality of the advertising was found in densely competitive environments. A consistent correlation was found between superior compliance with ethical guidelines and board certification in plastic surgery. The patient preference survey of 208 individuals demonstrated their desire for a well-trained, board-certified plastic surgeon to perform their cosmetic procedures. Although plastic surgeons demonstrate greater overall compliance with the ASAPS/ASPS Advertising Code of Ethics, they can continue to improve. With the large variety of cosmetic physicians offering the same procedures, maintaining open, honest, and forthright communication with the public is essential.

Readability of ASPS and ASAPS educational web sites: an analysis of consumer impact.

Patients use the Internet to educate themselves about health-related topics, and learning about plastic surgery is a common activity for enthusiastic consumers in the United States. How to educate consumers regarding plastic surgical procedures is a continued concern for plastic surgeons when faced with the growing portion of the American population having relatively low health care literacy. The usefulness of health-related education materials on the Internet depends largely on their comprehensibility and understandability for all who visit the Web sites. The authors studied the readability of patient education materials related to common plastic surgery procedures from the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) Web sites and compared them with materials on similar topics from 10 popular health information-providing sites. The authors found that all analyzed documents on the ASPS and ASAPS Web sites targeted to the consumers were rated to be more difficult than the recommended reading grade level for most American adults, and these documents were consistently among the most difficult to read when compared with the other health information Web sites. The Internet is an increasingly popular avenue for patients to educate themselves about plastic surgery procedures. Patient education material provided on ASPS and ASAPS Web sites should be written at recommended reading grade levels to ensure that it is readable and comprehensible to the targeted audience.

The Wrinkles of the "Bo-Tax"

On the surface, the recent proposal by the Senate Finance Committee to place an excise tax on cosmetic surgery to increase government revenues for funding the new health care proposal seems to be a reasonable idea.1 As support for the administration’s health care plan wanes, debates about funding the plan echo throughout the Capitol. This “Bo-tax,” however, will likely come up short and will certainly hurt the plastic surgery community. In 2008, the American Society for Aesthetic Plastic Surgery (ASAPS) reported a 12% overall decrease in cosmetic surgery compared with the previous year.2 Clearly, in the current economic climate, raising the price on procedures for which …

Primary Breast Augmentation Today: A Survey of Current Breast Augmentation Practice Patterns

A study was undertaken to survey current practice patterns concerning primary breast augmentation. Members of the American Society for Aesthetic Plastic Surgery (ASAPS) were electronically surveyed concerning issues such as incision location, implant size and type, and complications, as well as information about the surgeons, their practices, and where procedures are performed. The survey response rate was 30%. Plastic surgeons from the South and Southwest made up 40% of respondents. Forty-six percent of respondents had more than 20 years of experience in practice. Forty-three percent of primary breast augmentations were performed in outpatient surgery centers. An anesthesiologist was in attendance in 60% of cases. The average operative time--indicated in 80% of responses--ranged from 45 to 90 minutes. Thirty-three percent of responding plastic surgeons used the base diameter to determine implant size and respondents most commonly used a smooth saline implant placed through an inframammary incision in a submuscular pocket. The most frequently reported complication was nipple sensation changes. Although the reintroduction of silicone gel implants was accompanied by expectations of a sharp increase in their use, this survey revealed that among ASAPS members, saline implants currently are used more often than silicone gel implants. However, both saline and silicone gel implants are used frequently, safely, and reliably. This survey represents a snapshot of current practice and future trends in primary breast augmentation will require additional assessment, although increased use of silicone gel breast prostheses over time is expected.

Introduction

Introduction Bernadette Wegenstein (bio) A woman is more authentic the more she looks like what she has dreamed for herself. The transvestite Agrado in the film Todo sobre mi madre (1999) by Pedro Almodóvar Cosmetic Surgery According to the American Society for Aesthetic Plastic Surgery (ASAPS), nearly 11.5 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2006. Since 1997, the overall number of procedures had increased 446 percent.1 The demand for cosmetic surgery products has been growing roughly 11.2 percent yearly, reaching a market size of $2 billion by the end of 2007—driven mostly by new product approvals, favorable cultural and demographic trends, and improved technology.2 The sensational character of these statistics could be extended ad infinitum when reading the details published by the ASAPS. We could highlight the fact that patients have been undergoing cosmetic surgery procedures at increasingly young ages; take, for instance, the fact that in 2006, 16,477 rhinoplasties, 7,915 Botox injections, and 5,423 Hylaform/Restylane injections were performed in the United States on adolescents. Or, if we want to analyze the data in terms of gender dynamics, we might note that while the most popular invasive procedure for women in 2006 was breast augmentation, [End Page 1] followed by eyelid surgery and abdominoplasty, men—who had only 8% of the total 11.5 million procedures done—underwent mostly liposuction, eyelid surgery, and rhinoplasty. The most popular noninvasive procedure for men and women in 2006 was Botox injections (3,181,592 procedures), and the most popular invasive procedure was liposuction (403,684 procedures). But what is really of interest in the context of this special issue on the reality TV makeover phenomenon is the impact that these shows (starting in 2002 with ABC’s Extreme Makeover, followed in 2003 by FX’s Nip and Tuck, and in 2004 by FOX’s The Swan, E! channel’s Dr. 90210, and MTV’s I Want a Famous Face) have had on the overall consumption of cosmetic surgeries. The data speak volumes. In 2003, overall cosmetic procedures were at 8.3 million, with an increase of 12% in surgical procedures and 22% in nonsurgical procedures from the previous year. The year 2004, however, which is also the peak of the makeover show genre, featured a 44% increase, totaling 11.9 million procedures, with surgical procedures, increased by 17% and nonsurgical by 51%! ASAPS President Peter Fodor attributes this growth to media coverage, including the dramatic increase in surgery shows: I believe at least some of this upward trend may be attributable to increased media coverage of plastic surgery in 2004. . . . People have had many more opportunities to see, first hand, what plastic surgery is like and what it can do for others. That can be a strong incentive for them to seek the same benefits by having cosmetic procedures themselves.3 In 2005 and 2006, however, surgical and nonsurgical procedures increased by only 1% (in 2005, nonsurgical procedures even declined by 4%, to 9.3 million), and they have remained stabilized at 11.5 million per year since then. To give a practical example of this market movement: rhinoplasty for men increased from 38,989 procedures in 2004 to 45,945 in 2005, but decreased to 33,143 in 2006. In other words, the heyday has been reached. We are now facing the age of a normalized, slowly progressing growth in cosmetic procedures. This collection of papers aims to trace—with the help of authors who are true forerunners in the fields of cultural and literary theory, philosophy, sociology, and clinical psychology—the nature of this upheaval and its connection to our culture Reality Television Nielsen Media Research indicates that 56% of all of American TV shows today are reality television programs, and that about 69% of [End Page 2] TV programming worldwide (cable and broadcast) is devoted to reality television.4 Within the spectrum of reality TV, there are documentary-style shows, in which ordinary people are followed into their daily lives, as in Family Plots; docu-soaps starring celebrities, such as Britney Cam with Britney Spears; talent searches, in which ordinary people try to...

Aesthetic Facial Surgery of Male Patients: Demographics and Market Trends

Evaluation of member survey data from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and the American Society for Aesthetic Plastic Surgery (ASAPS) from 2000 through 2004 reveals several procedure-specific as well as overall trends regarding utilization of aesthetic facial enhancement services. This gender-specific 5-year retrospective review indicates that males undergo significantly fewer procedures than females except for surgical hair restoration and otoplasty. There is a slight general trend toward decreased surgical but increased nonsurgical facial enhancement procedures. On a case per physician basis, AAFPRS physicians performed significantly more procedures for both males and females for every procedure and every year evaluated. Evaluation of age group data indicates that the 40- to 59-year-old age group accounts for the majority of surgical and non surgical facial enhancement requests. Despite anticipated growth of the 60- to 79-year-old age group, the 40- to 59-year-old age group is projected to remain relatively stable. Although continuing to pursue aesthetic facial enhancement services in significant numbers, men still represent a vast untapped market. This study yields important demographic and trend information that has implications for the current and future delivery of aesthetic facial enhancement services.

Teenage Breast Augmentation: Validating Outcome Data and Statistics in Plastic Surgery

When a controversial topic arises, such as teenage breast augmentation for purely cosmetic reasons, it is important to have reliable statistical methods and sound data to report to the media and other interested parties. Recent public interest and media coverage of teenagers seeking breast augmentation was a result of reports that point to statistics stating that teenage patients may account for up to 4 percent of breast augmentations. This does not seem valid based on our personal practices or those of our colleagues. The American Society of Plastic Surgeons (ASPS) issued a statement that breast implant surgery for purely cosmetic reasons is not commonly performed by board-certified plastic surgeons on patients under 18 years of age. The ASPS does not recommend teenage breast augmentation except after careful and thoughtful discussion with the patient and the patient’s family. The Food and Drug Administration’s position is somewhat more strident, stating that teenage breast augmentation before age 18 should not be done. Obviously the controversy over this topic is broad and deep and would fill another editorial or article; however, it does point out that one can be burdened, challenged, and even misled by statistics. The way statistics are derived and presented can be misleading to physicians, the public, and the media. When we look at outcomes data from the ASPS/Plastic Surgery Educational Foundation (PSEF) Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, for cases reporting only bilateral breast augmentation Current Procedural Terminology, or CPT, codes and no other procedures, it is interesting that the number of teenage breast augmentations actually declined from June of 2003 to June of 2004. Although the time frame for data capture is slightly different, these data are in sharp contrast to procedural statistics reported by both the ASPS and the American Society for Aesthetic Plastic Surgery (ASAPS). For example, ASAPS data for the year indicated that 4 percent of total breast augmentations were performed on patients under 18, in contrast to 1.6 percent in 2002. If true, that would represent a 195 percent increase over the period. ASPS media releases presented similar but lower estimates. In resolution of this issue, the data from TOPS, the outcome-based system developed by ASPS/PSEF and the American Board of Plastic Surgery, present a different message. According to TOPS data, the rate of teenage breast augmentation went from 0.31 percent in 2003 (95 percent CI, 0.19 percent to 0.46 percent) to 0.19 percent (95 percent CI, 0.12 percent to 0.28 percent) of the total number of breast augmentations performed in 2004. The estimated total number of breast augmentations performed on patients under 18 years of age in 2001/2002 was approximately 640. The estimated number in 2002/2003 and 2003/2004 dropped by 21 percent to approximately 505, even though the estimated number of breast augmentations overall rose by 8 percent to 264,495. This statistic is more in parallel with observations of our clinical practices. These statistics affirm that plastic surgeons, overall, are abiding by the Food and Drug Administration’s guidelines when teenage girls approach them to consider breast augmentation. These patients are given all the information and the procedure is discussed with them in detail. Clearly in some cases these underage girls and their parents decide to proceed with surgery after an informed discussion of the procedure, but the incidence is low, and decreasing, while the overall frequency of breast augmentation is increasing. This controversy validates the role and importance of having a valid mechanism for collecting outcomes data from all board-certified plastic surgeons. Only this rigorous contemporaneous collection of data can provide truly scientific data for all plastic surgeons, regulatory bodies, and the media. It is important for all plastic surgeons certified by the American Board of Plastic Surgery not only to input data but also to remain involved in the TOPS database. We have been involved in providing data to TOPS for more than 2 years, and the ability to resolve questions such as those related to teen breast augmentations is proof of the value of the process for plastic surgery. Acquiring such data is not only important for enhancing overall safety in plastic surgery, it also helps to provide grades of difference between plastic surgeons and other cosmetic surgery providers. The magnitude of this simple difference becomes more important every day. It signifies that board-certified plastic surgeons care about their patients and are willing to prove it with their own efforts. Plastic surgery also wants to maximize its interests in statistical and outcome-based medicine and to generate valid measurements of practice performance, for this is the yardstick by which we will be judged in the future.