Effective cosmetic surgery is in eye of beholder

Do you see a difference in plastic surgery results?

 

The effectiveness of cosmetic plastic surgery procedures is in the eye of the beholder, just “deformities” that a patient sees in him/herself are.

I have written on what plastic surgery patients see when they look at themselves in a mirror:

https://tavmd.com/2012/08/13/the-eyes-have-it-not/

Aesthetic plastic surgery learning

Today I am writing about what you and I see as observers when we look at plastic surgery results and if effective cosmetic surgery really is in the eye of the beholder..

Every month, the American Society for Aesthetic Plastic Surgery (ASAPS) puts out a journal with the latest cosmetic plastic surgery articles. This is how plastic surgeons performing cosmetic surgery stay abreast of new techniques and research. The annual ASAPS meeting, to which I am going in a few days, is another way to learn what is going on.

 

ASAPS journal

This morning I was reading the March journal in between appointments. Some of the articles were excellent, and I learned a thing or two from them. I was also struck by several articles in which I saw:

  • no change after a plastic surgical procedure
  • a deleterious result after cosmetic surgery
  • an aesthetically horrible result after a procedure

All this is, mind you, in my opinion. I thought it would be interesting to see if you, the non-plastic-surgeon public, see beneficial changes worth the surgery!

 Case 1

Injection of Juvederm, a dermal filler, into the lips to make the lips larger. Boy, did the plastic surgeon make this poor woman’s lips larger! The lower lip is too large and the upper one has hardly been filled!

To me they look deformed. However, as the text says, “Both the investigator and the subject were very satisfied with the result.” Shame on them both, in my opinion, but what do you think?

before lip injection
before lip injection
after juvedrem injection
after juvedrem injection

 

juvederm injection

Case 2

Lipolysis, the destruction of fat from the skin by a series of injections of bile and other strange products that no one really seems to know much about, is another of those plastic surgery ideas that just will not die. Every so often it raises its ugly, dangerous and inefficient head. A group of followers, both plastic surgeons and patients, wishing for the wonder cure for flab end up mushrooming and then wilting away in disappointment. In this article, these were the before and after results provided by the proud authors. They see a difference and charged the patient several thousands of dollars no doubt. I see none.

Also, in the CT scan of the abdomen, where the fat is the white band going around  the dark area, do you see that there is some fat loss on one side but not on the other? They injected both sides, so what happened? Lipolysis is a technique that has no controlled or titrated result. I can inject anything into your skin and kill some fat cells. The difficulty is doing so in a measured  and efficacious manner. That is not what is happening here.

before lipolysis
before lipolysis

 

 

after lipolysis
after lipolysis

 

 

 

before after lipolysis photo

 

Case 3

Ever since I was a surgical resident, plastic surgeons have been trying to come up with a tissue glue that would miraculously cause tissues to adhere during surgery—a noble aim.

Tissue fibrinogen glue and similar products are supposed to be sprayed at the end of a facelift surgery between the skin and the muscles below to allow for attachment and healing. I even tried it once years ago, but I saw no difference in results or the patient’s bruising, swelling or pain. These are what the authors of this article were claiming to improve. They see a difference between the two sides of this patient, one side treated with the tissue fibrinogen glue and the other not. I won’t tell you which is which—peek at the caption if you want. I see no difference.

right side without tissue glue
Without glue

left side treated with tissue glue

Cosmetic plastic surgeons—or, for that matter, any author of a scientific article—cannot help but bring their desires, wishes, expectations and hopes to bear on their research. Where they see a huge difference, skeptics like me see none. Where they see progress, nihilists like me see their defeat, and where they see beauty, I shudder.

Make your own judgments and tell me if I am being too harsh. If you disagree with me, you may be easy pickings for some cosmetic plastic surgeons.

Morad Tavallali, M.D., FACS