Plastic surgery continues to redifine its place in medicine. Plastic surgery is becoming pop culture with the reality TV shows and rumors of celebrities that have had cosmetic surgery. Some of the procedures that seem to get the most attention are "fringe" plastic surgery procedures. There are a number of procedures that have an excellent track record of safety, effectiveness, and patient satisfaction. In my opinion procedures like breast augmentation, abdominoplasty, face lift, blepharoplasty, and liposuction would fit into this criteria. There are other procedures that are being done on a routine basis that are in principle at the least silly and possibly even dangerous. This is the authors current top ten list of plastic surgery procedures to avoid: 1. Lipodissolve and mesotherapy - this involves the injection of a non-standardized mix of chemicals which claims to dissolve the fat away. The amount of fat dissolved is unpredictable and usually little to none. The broken down fat cells and cholesterol are reportedly excreted as waste. There is some concern that this could deposit in the arteries leading to premature heart disease. Mostly, this is a waste of money with little proven benefit. 2. Buttock augmentation - I am not talking about correcting irregularities with fat grafts. I am talking about implants used to add buttock fullness. High risk of infection and implant complications. I think the fad will end quicker than the pain from sitting on these implants. 3. Permanent Fillers - Never, ever let anyone inject silicone into your face. Temporary fillers (Radiesse, Restylane ...) or natural fat injection is O.K. 4. Injection for Breast Augmentation - Injection of soft tissue fillers to increase the breast volume. The procedure is expensive and the duration of effect can be short lived. Risks include breast lumps that can be difficult to rule out breast cancer. 5. Transumbilical breast augmentation (TUBA) - The scar for breast augmentation is almost never an issue after surgery. The scar around the belly button is visible in a bra or bikini. The revision rate is very high and the implants tend to sit too wide and move unnaturally with exercise. Silicone implants cannot be used. If a revision is required, a much longer incision on the breast is needed. This is marketing hype and has no place in breast augmentation. 6. Cosmetic Leg Lengthening Surgery - The leg bones are broken and lengthened over time in a procedure called "distraction osteogenesis". Actually a very rare procedure. 7. Pectoral implants - Similar to buttock implants. 8. Laser lipo or smartlipo - No proven advantage to tumescent liposuction but there are disadvantages. Disadvantages include the cost of the technology and the generally poorly trained physicians currently using this technology. Very few plastic surgeons have embraced this technology as the studies have not demonstrated advantage. This may change in the future if studies can demonstrate improved safety, efficacy or both as compared to traditional techniques. 9. Phenol peels - Very deep chemical peel that can make a patient look like a pale burn victim. There are much better alternatives including laser therapy and moderate peels such as TCA peels. 10. Physicians without proper training - This is truly most important. Pick a board certified plastic surgeon and you are on the right step. To become board certified by the American Board of Plastic Surgery, a plastic surgeon must first complete intensive training in an accredited training program. Thereafter, the surgeon must pass rigorous written and oral examinations given by the board. The American Board of Plastic Surgery is one of only 24 accredited specialty boards recognized by the American Board of Medical Specialties (ABMS) and is the only board recognized by the ABMS to certify a surgeon in plastic surgery. There are a number of other boarding organizations that include "facial", "aesthetic" or "cosmetic" in the title. These are not recognized by the ABMS and do not have the same training requirements. To verify a physician's board status, contact the American Board of Plastic Surgery at (215) 587-9322. You may also contact the American Board of Medical Specialties at 1(800) 776-2378 or http://www.abms.org
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