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Theses days I’m seeing more and more outrageous claims for cosmetic improvements mostly by non traditional aesthetic services providers.  By that I mean practitioners other than board certified plastic surgeons and dermatologists.  Injectable concoctions such as “lipodissolve” that can reduce the patient by several dress sizes and non invasive massage using ultrasound that removes inches of fat over 6 to 8 treatment sessions have both been recently touted in the media.  While our office has had some experience using Lipodissolve, our outcomes have been very modest and we use this method in a very few selected fashions for very small areas.  Focused high energy ultrasound is presently being evaluated in clinical trials here in the US.  Early reports have shown some fat reduction after 2 to 3 treatments.  No one in the Kentuckiana region has either of these experimental machines. We as board certified plastic surgeons, evaluate all new technologies very carefully.  Sometimes, the early claims of improvement can not be repeated by subsequent physicians.  New treatment modalities are tried and compared to the already existing standards and these outcomes are presented at our meetings and reported in peer reviewed journals. Not until the safety and efficacy (they work) are proven can these new breakthroughs be utilized by all physicians.  I have trouble with physicians who are new to the aesthetic arena recommending the newest technologies as being the greatest thing since sliced bread when they have had little or no experience in what this new technique will supposedly replace.  Unfortunately, it is a case of buyer beware.  Ask yourselves why, if this new machine, concoction, technique is sooo much better than the standard method that everyone doesn’t have it or do it.  Sometimes, when it sounds to good to be true maybe getting the opinion of an expert in the field would be prudent.  As it stands today, there is no machine that tightens skin like a facelift, no fat treatment that equals liposuction results and nothing that has been shown to be effective long term in treating cellulite.

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.

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 Styleby Dr. Marc J. Salzman.