What is going on in the field of Plastic Surgery and body contouring? First there was simple Suction Assisted Lipectomy (Liposuction for short), then along came “Tumescent Liposuction” with one Dermatologist claiming he invented everything and only doctors trained in his seminar were qualified. “Ultrasonic” liposuction became the rage in the 90’s with claims of less pain, more fat removal and improved skin contraction. I bought the first one of these machines in Sacramento in 1995 and was a true believer until it was obvious that the pain actually lasted much longer (one patient required physical therapy). Also people stayed swollen longer and the skin didn’t really contract like they said. I found that the only real advantage was treating really challenging problems (male breasts and re-do patients with scar tissue). In those patients the prolonged swelling and pain was a compromise they were willing to make.
Well not to be outdone, other manufacturers of medical devices came out with a “better” ultrasonic (Vaser), several lasers (Smart Lipo, as if everything else is dumb lipo), Water Jet and even radio frequency ablation. It’s enough to make a Plastic Surgeon’s head spin. These companies used high-pressure tactics to convince Plastic Surgeons to buy the latest and greatest “Fat Killing Toy” or risk being left behind. They had slick advertising campaigns making all kinds of subjective claims of more fat removal, less pain and bruising and skin contraction. Notice I said subjective because these claims are not really measurable and so the manufacturers can say whatever they want without getting in legal trouble. Besides, if a new technology or machine is that good, every Plastic Surgeon would own one.
Well the next thing you know, the Plastic Surgeons became wise to these facts and stopped buying these “Newest Advances” because they were very expensive (can run into the hundreds of thousands of dollars) and really did not offer any significant advantage. An entertaining story I tell my patients was a meeting I attended in Miami where they performed live surgery via video link with the audience (400 Plastic Surgeons from around the world). One famous Plastic Surgeon showed how to use the most advanced fat removal machine available and the other was Marco Gasparotti, a famous Plastic Surgeon from Rome who pulled out this bent and beaten-up cannula that was probably 15 years old. It looked like it had been run over by a car before it was sterilized! They each championed their personal techniques and operated on their patients. A year later, before and after photographs of each patient was shown to the Plastic Surgeons in attendance. The High-tech patient had been turned into a “Man-butt” with few feminine curves. But a lot of fat had been removed! Marco’s patient was transformed from a frumpy mommy-of-4 to an attractive, curvy figure that would be chased down the beach by all the healthy men. Helllooooo! The lesson that hit home was that the single most important factor in getting a great result is choosing the best surgeon. These fancy machines really don’t matter. However, they are easy to market to an unknowing public, especially if they have a cool name with “laser” or other gimmicky word.
The next thing to happen was that manufacturers began marketing directly to women in magazines and other sources. Now Plastic Surgeons had patients coming in asking, “Does Dr. Hause have the way-cool-fat-sucky-trick-machine? I hear it can remove more fat! Because I only want the newest best thing!” My response has been “Of course not. Why would I buy a machine that does not matter and will cost you more money?” After all, when a sculptor chips away at a piece of marble, does anybody really care what is on the floor when they finish? It’s not how much fat that is removed, it is what is left behind that gives the final result that is most important.
Then came the big investment franchises. Most people have heard of Bosley Medical for Hair Restoration. In many respects, it is a Hair Transplant franchise with a large marketing budget and big referral system to corral patients into a centrally located surgery factory. It turns out that Hair Transplantation is an operation that requires a team much larger than just the surgeon. In fact, the surgeon’s part of the procedure can be very minor. Thus, it is the system that is more important than the doctor. I have seen a lot of their work and it is very good. It is expensive. But this is because they have huge marketing budgets and operating expenses. However, they will offer “discounts” to undercut the competition from time to time. Well, this business model is now being applied to cosmetic surgery. You now see franchises for Liposuction and Face Lifts that tout a specific machine or make claims of faster recovery, etc. It is common for them to hire any doctor without concern for their credentials or experience. After all, it’s hard to get a Gourmet Chef to work in a fast food drive-up window. I recently had a patient come in (she was a nurse so should have known better) who had gone to Mexico for her liposuction because the costs she was quoted for her surgery here was over 20 thousand dollars. However, if she went to their clinic in Mexico, it was only $7000.00! You should have seen her face when I told her that most of the Plastic Surgeons who were trained in the United States and were Board Certified by the American Board of Plastic Surgery would have done her surgery here for less than $7000.00. Talk about a ‘bait and switch”.
I could go on with more facts about the Body Contouring marketplace that now exists. Unfortunately it is becoming a “buyer beware” situation. The truth is that the most important factor in choosing a Plastic Surgeon is finding one who is experienced in all techniques in body contouring (not just one liposuction gimmick), is ethical and has the artistic vision and ability to obtain the best results with the highest safety. After all, since franchises view customers as nails, patients are more likely to get hammered. Most private practice Plastic Surgeons who have made the investment to become Board Certified by the American Board of Plastic Surgery and become expert in Cosmetic Surgery value their reputation more than working in a franchise. Choosing a Plastic Surgeon with these standards is really the “Smartest Lipo.”