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I recently attended our national plastic surgery meeting in Chicago.  One of may favorite sessions is called hot topics.  In this full day course, all of the new technologies and products that are already or soon to be available are reviewed with regard to the science, effectiveness and proven results.  We spent a fair amount of time discussing the newest Botox like injectables.  Reloxin and Puretox will both be available sometime later this coming year. While they are not exactly the same as Botox, it will be nice to have some choices and this may keep the cost of Botox in check. There were some new ways of melting fat using ice and targeted high power ultrasound.  The results after one treatment with these modalities were modest at best but if they can be done in an office setting without the need for anesthesia or cutting, they may have a place.  Stay tuned for more information in the coming months.  None of the cellulite treating machines (Velasmooth, Velashape, and Smoothshape) generated any positive lasting results.  I’m glad we did not buy into any of these technologies as the vast majority of patients are disappointed in their results after multiple treatments. Laser lipolysis did however look very promising.  In the technique I have helped to develop using a blended mode of two different laser wavelengths, many nice results with better skin retraction were demonstrated. Many of the newest fractional lasers that use an ablative wavelength to improve the appearance of wrinkles, discoloration and texture were compared.  It is still not clear what depth and size of injury will produce the best result with the shortest downtimes.  We are going to try a few of these and pick the best one.  All in all it was a day well spent to reinforce to me that we try to evaluate and choose the best technologies for our patients.

It’s been awhile since we started embarking on the newest laser liposuction method that I call LiteShape™. In the last few weeks, we have begun to blend the two wavelengths of laser together to be delivered at the same time. We can now customize each treatment by the amount and type of fat in the different locations of the body. One laser seems to be better for melting the fat and the other for heating the skin. By blending a percentage of each into an area we can optimize our result. In the last few weeks, I have been traveling to Dallas, Chicago and St. Louis to teach this exciting new method to other doctors. Physicians from around the USA come to our office to learn this new technique first hand. On October 27, NBC Wave 3 did a documentary expose featuring the LiteShape™ method of laser liposuction. If you want to see it, it is in the video section of the website. Happy Halloween to all!

This past week, as President of the Kentucky Society of Plastic Surgeons, I was responsible for arranging and running the yearly meeting here in Louisville. I spent a fair amount of time organizing a fun and informative learning opportunity for the residents of UK and UL as well as the academic and private practice plastic surgeons from around the state. I had visiting a plastic surgeon from my alma mater at Duke, a Ph.D. from Santa Barbara and practice consultant from Ohio all make outstanding presentations to a record crowd. It was so nice to hear many compliments from my peers about what a great meeting experience it was. One of the lectures that I devised was a panel where difficult plastic surgery problems were addressed by several surgeons from around the state. In our specialty, there is often many solutions to a given problem and that is where the “art” of plastic surgery lies. We did have a little scare for our dinner plans which were scheduled for a steakhouse near my office. Apparently, there was no power at that establishment. It was Ryder Cup week in Louisville and most restaurants that could accommodate large groups had been booked long in advance. Fortunately, for us, another steakhouse had a cancellation that morning. As some of our local patients may know, hurricane force winds had wreaked havoc in greater Louisville earlier that week. We were fortunate that another group had to back out at the last minute. 

Today I saw a patient that exemplifies some of the positive effects we as plastic surgeons can have on our patients.  A few weeks ago a very nervous teenager came in with her mother to be evaluated for small breasts.  She seemed shy and was quite hesitant to let me examine her.  Her mother said that her daughter hated summertime because she refused to be seen in a bathing suit.  She had more than just small breasts.  She had a breast deformity that we see quite often called tubular breasts.  In this condition, the base of the breast does not form correctly leaving the nipple and areola pointing downward.  I will usually not do breast surgery on a teenager but in these situations of deformity at an age where body image is vastly important to the psyche, I think it is warranted. About a week ago, she had expandable breast implants placed so that we could gradually increase her size over several months and she could determine the final size before the port is removed.  What a change a week made.  She came in all bubbly and excited.  Her mother states she can’t keep her out of a bathing suit.  The same girl who several weeks ago was hesitant to be examined had to be reminded that we have finished looking at her and she could replace her robe.  While I don’t cure cancer or return trauma patients to health anymore, it’s days like these that remind me why I choose to be a plastic surgeon in the first place.  Happy patients.

Plastic surgery and all of organized medicine celebrated a major victory on April 28 when the California Court of Appeals denied a bid by the American Board of Cosmetic Surgery (ABCS) to gain specialty equivalency to the American Board of Plastic Surgery (ABPS). I feel strongly, as do all real Plastic surgeons, that these “Bogus Boards” are an attempt to confuse the public and gain market share in the cosmetic surgery marketplace. The ABCS does not require a residency in plastic surgery. Residency is where, after medical school, a young physician trains under a consummate, board certified physician in a University setting to gain the knowledge and skill required to safely and successfully practice plastic surgery. This physician is then rigorously tested, with a review of a years worth of cases, that they have the skill, integrity and knowledge base to be a board certified plastic surgeon. Without a formal training program requirement, the ABCS recipient has either been self taught or attended a weekend seminar to learn these skill sets. My residency was 8 years. Five years in General Surgery and three in Plastic Surgery. Either I’m an idiot, or there is clearly more to be learned than a weekend course can satisfy. I welcome the time when all states will only allow claims of board certification by boards recognized by the American Board of Medical Specialties (ABMS). The ABMS contains the boards that we have all heard of: American Board of Surgery, American Board of Pediatrics, American Board of Obstetrics and Gynecology among many others. I’m not against a career change by any physician. Just get the proper training first. Any physician in Kentucky can call themselves a plastic surgeon. They may also say board certified in their advertisements. Which board they are certified by may not be stated. If you have questions check the ABMS website.

Last week, at the dinner honoring the graduating plastic surgery residents at the University of Louisville, I was honored with an award as having the outstanding lecture series in Cosmetic Surgery. As an actively involved Assistant Professor of Plastic Surgery at U of L, I regularly give the residents and faculty a lecture about the various topics that encompass aesthetic plastic surgery. I still very much enjoy teaching and find it challenging to continually update the cosmetic surgery realm. I also teach other plastic surgeons my unique methods that I have developed. Recently, we have had physicians from Minnesota and Texas in the office to learn about the Liteshape™ technique of liposculpture. It is a great feeling to see physicians at our national meetings, years after they have finished their training, come up and say, “Thank you again for all that you did to help me become a better plastic surgeon.” My deal with them is: I will show you all that I know, move far from Louisville and take me to dinner when the meeting is in your town. I’ve had a few good meals to date.

I love what I do and keep up with all of the new technology, treatments and procedures. Unfortunately, with vast media coverage of these same new materials through the internet, magazines and TV, I believe lots of misinformation is passed on to the public. This is my opportunity to comment on what’s happening out there and interpret the good and bad for my patients.  I also plan on relaying poignant stories that happen daily in our office.  I will, without breaching patient confidentiality, relate to other patients how plastic surgery and its wonderful possibilities have impacted my patient’s lives.

So here it is:  Plastic Surgery - Louisville Style

by Dr. Marc J. Salzman.