The rise of medspas and a recent liposuction death in Florida in a young 37 year old nurse bring to light several issues our specialty is confronted with. Read the news story here.
Liposuction performed by untrained and non-certified doctors and paraprofessionals can lead to detrimental and possibly even fatal outcomes that can be prevented. This case illustrates that point, as a doctor who had only gone to an 18-hour training course in liposuction and was actually an occupational medicine physician performed the procedure on the Floridian woman. The procedure was performed in an unlicensed and non-accredited facility labeled “Tanning Salon” on the outside. Reports show that she likely had seizures from a lidocaine overdose, and she was also given Propofol in the medspa/tanning salon, which is against state law. Propofol is a powerful intravenous sedative and anesthetic agent (the one that killed Michael Jackson), and lidocaine is a local anesthetic that is injected into the subcutaneous fat, often mixed with saline to dilute it, prior to liposuction to cut down on bleeding and for pain control. The dose for a particular human body weight has to be specifically calculated so that overdose and fatality doesn’t ensue no matter what type of case is being performed. It is concerning because an occupational medicine doctor would likely have no specialty training in this particular facet of surgery.
A lack of oversight of medspa facilities has played a part in this young woman’s death after liposuction, as facilities that are not licensed or accredited by state and federal organizations such as JCAHO for hospitals and AAAASF for offices and small facilities should not be able to have practitioners of any kind administering powerful drugs such as Propofol and administering injections of lidocaine. Because this facility had no business performing these procedures, they had no back up emergency crash cart with medications in it to help resuscitate a person who may have complications from these types of drugs and surgeries.
Our state and federal governments are missing the ball in their lack of regulation of physicians, paramedical professionals and technicians performing cosmetic procedures and surgery without proper certification and credentialing. Patient safety is a major issue especially with physicians practicing outside of the scope of their training. Plastic surgery should be done by board-certified plastic surgeons, delivering babies by obstetricians, and workplace injury evaluations by occupational medicine doctors. Surgical training takes many years and requires a vigorous board certification and continuing education process. Israel has laws in place that enforce physicians to practice within their scope of training and advertise in keeping with their training and board certification; the US government should take cues from them.
Prospective patients also need to wise up and educate themselves by doing research on their treating physician. The discount that people get for untrained professionals to do their surgery or procedure is quickly offset by the complications that can be extremely costly, even to their life. Things to look in a plastic surgeon are for are board certification by the American Board of Plastic Surgery, experience with the procedure being performed, and hospital privileges at a local tertiary care center should complications arise that need to be expeditiously treated.
Now you may be able to find out! Here you can see Dr. Jennifer Walden featured on an educational DVD for the Natrelle Pre-consultation Kit on Breast Augmentation and Breast Reconstruction. As you may already know, Dr. Walden specializes in Breast Augmentation and Reconstruction in New York, NY and recommends this product for anyone who is looking to get surgery and is unsure about size. This kit was inspired by Dr. Elizabeth Kinsley, who is a plastic surgeon in Covington, LA. On Dr. Kinsley’s website she says, ” After trying on the implants and seeing themselves with a totally different look, many women who said they never considered augmentation changed their minds.”
The Natrelle Pre-consultation Kit was created for patients to find their ideal size for for breast implants. We’re all built differently and sometimes it can be hard to make such a big decision when you’re unsure about the outcome. This kit is the only home breast implant sizing kit designed to educate you about breast augmentation. And, the Natrelle kit is meant to educate people about implants and how to choose the size you desire without being disappointed after surgery. Dr. Walden has been quoted, “Why wonder about what breast enlargement can do for you when you can take a test drive with the Natrelle Pre-consultation Kit?” She also says, “However it’s the implants and sizing bra that make the kit by helping women visualize and get excited about what they’d look like after a breast enhancement”.
The Natrelle™ Collection offers over 140 breast implant combinations from type of filler and volume to base width and profile—to help you find the fit you want. The entire Natrelle™ Collection is FDA-approved, and produced by Allergan (makers of good stuff like Botox and Latisse!). This kit is available on the Natrelle website for $39.95 plus $5 shipping and handling and includes rebates for Botox, Juvederm, and Latisse. Search it on Natrelle.com!
Heidi Montag was featured on People Magazine’s cover this month regarding her “addiction” to plastic surgery. She has recently undergone 10 cosmetic procedures, in what seemingly is an endless quest for beauty or a publicity stunt in a naturally gorgeous young lady. Too often young women undergo multiple procedures in hopes for a transformation to an idealized or unattainable version of themselves or someone whom they idolize, which a surgical procedure can never bring. The Hollywood quest for fame and beauty in our culture today among young women adds to the pressure to look the same. Check out Inside Edition’s segment on Heidi Montag’s plastic surgery procedures, and see Dr. Walden interviewed on the topic.
Above you will see the latest updates from this week’s medical news on the first Medical Rewind of 2010 on Fox and Friends! Topics include the effect of ginkgo biloba on memory, an update on causes of chest pain, and the herbal supplement Kava and how it is being used in relaxation drinks for all those who want to put down the Red Bull! Dr. Walden is interviewed by Dave Briggs and Clayton Morris on morning’s top-rated news show.
Check out Dr. Walden on this week’s Medical Rewind on Fox and Friends. She is interviewed on the breaking health news this week including tap water contamination, several interesting things that may decrease the risk of prostate cancer, and public school meal quality and safety.
Watch the above video as Neil Cavuto interviews Dr. Jennifer Walden, Manhattan Plastic Surgeon, on Fox Business News on the proposed cosmetic surgery tax in the Senate version of the health care bill. Many plastic surgeons and surgical societies oppose this tax as discriminatory, arbitrary and ineffective.
As Dr. Walden explains, about 90 percent of cosmetic surgery patients are female so
elective surgery taxes unfairly target women. Contrary to popular belief, cosmetic surgery is no longer an
exclusive luxury reserved for the very wealthy – the vast majority of patients are women who work.
Research by the American Society of Plastic Surgeons targeting those who plan to have cosmetic surgery
within the next two years reveals that 60 percent of the respondents report an annual household income of $30,000-$90,000. Most importantly, 40 percent of those report income of
$30,000-$60,000. Only 10 percent of the respondents report
household income of more than $90,000.
It would be an inappropriate position for physicians to be put in to be tax collectors, and the government is in no position to determine medical necessity. A similar program in NJ is about to be repealed as it failed in that state with a huge administrative burden and budget shortfall. We hope the politicians come to their senses on this proposed tax and do not set this precedent of taxing patients and physicians to solve their budget crisis in healthcare reform.
In the above video, watch Dr. Jennifer Walden being interviewed at the by Neil Cavuto on Fox News. Dr. Walden discusses the proposed cosmetic surgery tax on working class women in the Senate Bill that is currently being debated.
An insightful article, Bo-Tax Backlash, was written this week in the New York Times by Judith Warner. Excerpts from it are below, as she describes a “newer” version of feminism that actually supports women trying to stay looking good. The reason being is that our society basically devalues aging of women in particular, and staying looking healthy and competitive can equate to more longevity and sustainability in the workplace for women which can lead to a better and more fulfilled quality of life for themselves and their children. Interestingly, we learn that the feminist icon Gloria Steinem herself has had a blepharoplasty, or eyelid lift. More power to her.
The health care reform bill currently being debated in the Senate contains a provision known as the Bo-Tax — so called because it would levy a 5 percent tax on cosmetic surgery procedures. This would be in order to tax those who indulge in medically unnecessary procedures in order to pay for medical necessities for everyone else. The government is ill-equipped to be the ones to determine what surgical procedures are necessary or not for patients whom they don’t even know, and this would be a huge administrative burden to place on physicians, their staff, and government officials. See the article below:
This sounded like a refreshingly good idea to me, until I read that Terry O’Neill, the president of the National Organization for Women, is against it.
“Now they are going to put a tax on middle-aged women in a society that devalues them for being middle-aged?” she complained to The Times.
Could this possibly be the voice of NOW, the country’s premier women’s rights group?, I wondered. Could this be the same feminist movement that in 1968 filled a “Freedom Trash Can” outside the Miss America Pageant in Atlantic City with bras, girdles and false eyelashes to protest the “ludicrous ‘beauty’ standards we ourselves are conditioned to take seriously,” as Robin Morgan, an organizer of the protest, put it at the time?
Yes, standing up for the rights of middle-aged women to have access to cosmetic enhancement is part of the work of contemporary feminism, O’Neill told me this week. It’s the sorry consequence of a number of sorrier truths: The economy is terrible. Middle-aged women, many of whom reduced their working hours, limiting their earning power and ambition, when they had kids or, later, found themselves having to care for their parents, are in a particularly vulnerable spot these days, as they’re increasingly called upon to supplement or take over the lion’s share of family money-making. And any number of studies have shown that people with better (read: younger) looks have a better chance of getting a good job. Particularly women.
“I am 57 years old. I really sympathize with women who are out of the job market, wondering, will anyone even take me seriously?” O’Neill explained. “The women’s movement is not overly concerned with the more superficial aspect of clothing or beauty or fashion trends. The more important question is whether we are participating fully in the lives of our communities. And middle-aged women really aren’t. I know a lot of women whose earning power stalled out or kicked down as they entered into their 50s, unlike their male counterparts’, whose really went up.”
And now a lot of men are out of work. Which means that, in this economy, getting the old face and belly looking tighter may, for many middle-aged women, be as crucial as having an eye-catching résumé.
“I’ve met women who’ve had to lie their ages down as much as 20 years to get or keep jobs as everything from waitresses to high-level consultants,” Gloria Steinem, who herself had cosmetic eye surgery some decades ago, told me this week. “They gave up pensions and benefits because they couldn’t produce documents, and employers colluded because they saved money.”
How disfiguring it can be when reality bites.
We are constantly hearing about the different phases, themes, lives and deaths of feminism. First wave, second wave, “victim,” “raunch,” etc.
“Looks are the new feminism, an activism of aesthetics,” Alex Kuczynski wrote in the introduction to her 2006 book on America’s obsession with cosmetic surgery, “Beauty Junkies.” At first glance, this seems ridiculous. And yet it says something true enough about the way many younger women understand feminism at a time when organized, real-world activism has hit wall after wall of political impossibility. Sneaker ads teach that feminism is all about taking control — of your figure.
This is what happens when equal pay stalls, abortion rights wither, and attempts to improve child care and workplace flexibility die on the legislative vine year after year. Women’s empowerment becomes a matter of a tight face and a flat belly. You control what you can control. And so many middle-aged women feel particularly out of control now, as indeed they are, in these life plan-wrecking economic times.
“Bag-lady syndrome,” the fear many women have that their financial security will disappear in a heartbeat, leading them to live out their remaining years on the streets, is shockingly pervasive. In 2006, before the current economic crisis hit, 90 percent of women surveyed by a Minnesota life insurance company said they felt financially insecure; 46 percent of those women overall said they had a “tremendous fear of becoming a bag lady,” including 48 percent of those with an annual income of more than $100,000. These days, more women than men — following a recession in which the men, overwhelmingly, lost the jobs — report being significantly stressed about money.
The inner bag lady, wrinkle-faced and unkempt, is no joke. She’s the worst-case scenario future. And while it’s easy to point to her as an irrational creation of women’s overly self-doubting imaginations (how else to explain the fact that wealthy, successful women like Katie Couric, Lily Tomlin and Steinem herself have all admitted to carrying around the fear — long after it was even remotely rational — of finding themselves one day, in old age, out on the streets?), she points to something very real: women’s economic status in this country is not what it should be. Middle-aged women with families shouldn’t be so scared.
I wonder if we haven’t entered into a period of what should be called “adjustment” feminism. The women’s movement is having to adjust to the realities of life in our culture, where many of its basic goals — including the very basic liberation of women from their pop culture status as a “mindless-boob-girlie symbol,” to borrow a phrase again from Robin Morgan — have stalled or are even backsliding. This week, for example, not only brought a public statement by the head of NOW acknowledging that the fight to have women valued for their inner beauty is essentially a wash; it also found NOW in the very bizarre position of urging senators to preserve the dictates of the Hyde Amendment, which for over 30 years has guaranteed that Medicaid funds would not be used to pay for most abortions for poor women. The House of Representatives’ recently-passed the Stupak amendment, which effectively prohibits both private health insurance plans participating in the future-envisioned insurance “exchange” and whatever public option may come into being, from offering abortion coverage to any woman, and the Stupak-like proposals currently circulating in the Senate are so much worse, after all. Hyde suddenly seems bearable.
Or maybe we should talk about having entered into the middle age of feminism — a moment when stock is taken, dreams are deferred and real life is faced in all its ugliness. Because to do otherwise is no longer youthfully idealistic, just foolhardy. Because you’ve got to hold onto what you’ve got, consolidate your gains and avoid potentially disastrous future losses.
With so much male unemployment, so much underemployment, so many people “lucky” to have jobs with reduced hours and benefits, women need good work options like never before. We need flexibility with security, options that will let us build wealth while taking sufficient care of our families.
Barring this, I guess we’ll go for eye lifts and Botox.
So the debate over the benefit of screening mammography has been ongoing the past several years and has recently heated up due to a study in the Journal of the American Medical Association that was discussed earlier this week in the New York Times. There have been several recent papers like this one stating that some women (1 in 3–a disputed figure) are overdiagnosed by screening mammograms, and some women are in age groups that do not necessarily benefit from screening of their breasts by mammography (the under 50 and over 70 year-olds). Click above for the Youtube video where Alisyn Camerota of Fox and Friends top rated morning show interviews me on this hot topic. I am reluctant to fully accept a change in the screening mammography recommendations of the American Cancer Society at the present moment for the following reasons:
-Breast cancer is a lethal disease that occurs in 1 in 7 women. Deaths from breast cancer have fallen to the lowest levels in 50 years, although the overall # of cases has risen due to early screening and detection. When dealing with cancer, you want to avoid people dying unnecessarily by performing screening tests (in this case, mammography). When patients are faced with a diagnosis from a screening test, they are usually going to opt for treatment. Screening saves over 1000 lives per year. Unfortunately, we cannot predict which cancer will go on to develop into a more dangerous and life-threatening cancer and which won’t. It would be very difficult to say “no, let’s go ahead and just watch that” to a woman with a suspicious lesion on her mammogram.
Many researchers and clinicians still think the benefits of screening mammography outweigh the risks. Doubts raised by the authors of these studies that question mammography in 40-50 year olds and over 70 year olds are still too weak shake many experts’ belief in breast screening. Women cannot take the risk of not being diagnosed and treated and screening is a major way for this to happen. One of the troubles with any screening program is that it turns up people whom the disease would run a benign course…you overdiagnose in some instances and therefore overtreat that person. As it is not possible to distinguish between lethal and “harmless” cancers on an imaging study, all detected cancers are treated. Overdiagnosis and overtreatment are therefore inevitable. As the author of the JAMA study said, more studies will be needed to distinguish between slow growing and very aggressive tumors. But for now, if a woman wants to reduce her odds of dying of breast cancer (by at least 24%), then the current screening regimen should be followed. Besides just a cookie cutter approach to every female going to get an x-ray of the breast, public education campaigns should also be reinforced to teach women how to assess their own risk including not having kids till late in life, dense breast tissue, family history of breast cancer, genetic testing for BRCA gene, aging, taking female hormones for menopause symptoms, etc. This should be addressed on a case by case basis between an individual and her health care provider, and women should be made aware of the risks of possible overtreatment and overdiagnosis, radiation exposure, and limitations of screening mammography in picking up some quickly growing breast cancers that can be deadly. MRI can also be useful in picking up some lesions and later stage cancers that mammography may miss.
I also have a personal interest in this topic as my mom’s life was saved by a screening mammogram. One year she had a normal study and the next year she had a breast cancer that was picked up on the yearly mammogram. It had already spread microscopically to her lymph node, meaning it was an aggressive tumor and if she had just skipped a year or blown off that year’s mammogram, she would have missed picking up the cancer and it would have likely spread beyond the breast and been metastatic by then which is often lethal. It should be noted she was in her late 60’s at the time of her diagnosis, which means she falls in the 50-70 year old category that studies have demonstrated a clear benefit of yearly screening mammography. So it’s hard to imagine backing down on mammograms in the absence of more sophisticated screening measures when you have a personal story like this one that make you so thankful for screening studies; many people besides myself have these stories since so many women are affected by breast cancer.
Does it sound to good to be true to increase your breast size and slim down your tummy or thighs at the same time? On Wednesday morning, Gretchen Carlson and Steve Doocey on cable TV’s top rated morning news show, Fox and Friends, interview Dr. Jennifer Walden on the newest procedure in breast enhancement by fat transfer from other areas of the body. Possible interference with mammography and breast cancer are discussed as well as the technique used for this method used to enhance the female breast. Dr. Jennifer Walden is the program director of the Dept of Plastic Surgery at Manhattan, Eye, Ear and Throat Hospital, and performs breast augmentation, lift, and reduction surgery in New York.
For years, saline and silicone implants have served as the most effective method for breast augmentation, and many studies and FDA approval declare both saline and silicone implants to be safe. Breast augmentation has been the most commonly performed cosmetic surgical procedure in recent years.
The relatively uncommon fat transfer breast augmentation procedure has women everywhere buzzing about the ‘benefits” of this seemingly more natural breast enhancement option. Present clinical evidence does not conclude that fat grafting is safer or better than saline or silicone implants, but the idea of taking one’s own fat and repositioning it to augment the breasts is rapidly capturing the attention of medicine, consumers, and the media.
Breast enhancement using fat grafts (lipoaugmentation) rather than silicone or saline implants employs fat suctioned from the patient’s buttocks, thighs or other fatty areas. This type of breast surgery can be used to increase the size of the breast or to fill in defects or abnormalities in existing breasts, including enhancing the appearance after breast reconstruction and softening the look of existing implants. Fat injections of the breasts may offer patients augmentation with a natural look and feel and the benefit of body contouring through liposuction—without the requirement for incisions or implants.
However, long-term safety and efficacy data as well as the effect of the procedure on breast cancer screening using mammography is still being evaluated in clinical studies. Concerns about fat grafting for breast enhancement include unpredictable or low survival rates of the transferred cells (which are frequently absorbed by the body), development of cysts, calcification and tissue scarring. Another major concern is long-term problems with breast cancer detection due to difficulties in telling the difference on mammograms between calcifications associated with breast cancer and calcifications associated with fat transfer.
This procedure does offer a modest opportunity for enhancement— specifically, about one cup size increase and the degree of enlargement will depend on the amount of spare fat that the patient has. But, numerous questions remain about this new technique: How much of the fat survives? Does the procedure have to be repeated? Are the breasts hard and uncomfortable for long periods after the procedure? And most importantly, what are the cancer implications of this technique? Research projects, funded by the Aesthetic Surgery Education and Research Foundation (ASERF) of the American Society for Aesthetic Plastic Surgery are being conducted to determine the safety and efficacy of breast enhancement with fat.
In the meantime, plastic surgeons will continue to study the intricate details of the procedure for the safety of our patients– namely, the techniques of harvesting, preparation, and placement of the fat tissue, who should receive fat transfer, when it is appropriate, and whether it is safe for the long term. Results of clinical studies this far seem promising—so maybe going up a cup size with the benefit of a little liposuction elsewhere will be common practice at some point. Anyone reading this should be aware that this procedure is very technique dependent and to avoid complications it must to be done correctly by a properly trained, board-certified plastic surgeon. Methods for tissue harvest and tissue injection have been refined, as fat cells are carefully removed by a specialized liposuction procedure using numerous syringes and transferred to the breast via dozens of minutely small injections. This technique results in increased survival of the fat cells.
Autologous fat grafting is currently used for touching up reconstructed breasts which it is safe and effective for given that the breast tissue has already been removed and these patients are getting routine surveillance imaging. The procedure can also soften the appearance of existing implants and hide visible rippling which is particularly apparent in very thin women with a bony chest wall and little skin or fat with which to work. The amount of fat injected with these procedures is usually a lot less than that used in breast augmentation as well. So, the take home message here is the more long-term clinical trials involving multiple centers as well as radiologist and oncologists need to be done before a blanket endorsement of the procedure can be made. It also serves to mention that this would not be the method of choice for breast augmentation in women who have had or have a family history of breast cancer.
On this week’s Medical Rewind segment on Fox News’ highly rated Fox and Friends morning show, Alisyn Camerota interviews Dr. Walden on three different topics. The topics include infant car seats affecting infant oxygen levels, how brown fat is better than white fat, and functional MRIs being used to detect those at risk for later developing Alzheimer’s disease.
