Thinking Outside the Box in Marketing Cosmetic

SURGE
A PUBLICATION OF THE AMERICAN ACADEMY OF COSMETIC SURGERY | SUMMER 2013
16
18
26
Bringing the World of Liposuction to Broadway:
an Interview with Dr. Kevin Jovanovic
Augmentation of the Nasal Tip Projection
Using the Inferior Turbinate
Treating Another Surgeon’s Complications
Best Practices from
Consult to Post-Op
C
ontents
SUMMER 2013
FEATURES
16
18
26
Bringing the World of Liposuction to Broadway:
an Interview with Dr. Kevin Jovanovic
Augmentation of the Nasal Tip Projection
Using the Inferior Turbinate
Treating Another Surgeon’s Complications
INSIDE
Letter from the Editor4
President’s Column5
Your Delegates and the American Medical Association6
Online Review of Sites:
What’s the Difference and What Matters?
8
The Tao of HIPAA
9
Are You Prepared for the Conversion Cascade?
10
Thinking Outside the Box in Cosmetic Surgery Marketing12
Patients are Listening During Surgery
20
High-Definition Liposculpture22
In Pursuit of Pain Management24
News & Notes
Back Cover
Published quarterly for members of the American Academy of Cosmetic Surgery, the American Society
of Liposuction Surgery, American Society of Cosmetic Laser Surgery and the American Society of Hair
Restoration Surgery, non-profit organizations representing practitioners of medical disciplines including
dermatology, ophthalmology, otolaryngology, plastic and reconstructive surgery, oral and maxillofacial
surgery and general surgery. Views and opinions expressed are those of the authors and not those of
AACS, ASLS, ASCLS or ASHRS.
All contents ©2013, American Academy of Cosmetic Surgery.
For subscription information, address changes, AACS, ASLS, ASCLS and ASHRS membership inquiries,
contact: American Academy of Cosmetic Surgery, 737 N. Michigan Avenue, Suite 2100, Chicago, IL
60611-5641. Phone: 312.981.6760; Fax: 312.981.6787; Email: info@cosmeticsurgery.org;
website: www.cosmeticsurgery.org.
Editor-in-Chief:
Joseph Niamtu III, DMD,
FAACS
President:
Neil M. Sadick, MD, FAAD,
FAACS, FACP, FACPh
CEO/Executive Director:
Jennie Ward-Robinson, PhD
L etter from the Editor
The last time I wrote this editorial, it was snowing in Richmond, Virginia.
Now I find myself in the summer issue! I am proud to be the editor of Surge and
even more proud to be an AACS Fellow. Lately, I have been reminded of how much I enjoy what I do. Not every day is wine
and roses, but I appreciate the opportunity to make patients look and feel better. Joe Niamtu, III,
D.M.D.
Niamtu Cosmetic
Facial Surgery
Richmond, Virginia
Let’s face it: most of us were not trained in business and employee management.
Luckily, experience teaches us what to do (and what not to do). Over time, most
surgeons become better business people. The seasoned surgeon has probably
learned (the hard way) the ins and outs of hiring, firing and managing staff. They’re
more likely to have a cohesive team that understands the rules of the game. Seasoned surgeons are also less likely to accept difficult patients. By “difficult,” I
mean needy patients that don’t really have true post-op problems. Instead, they feel
entitled to extra attention and management without any real need. When surgeons
can spot that personality type during the consult, their life is greatly simplified.
It also helps to know that a surgeon doesn’t have to accept every case that walks
through the door.
In essence, the most enjoyable years of practice might be the
last years of practice. The resources and expertise that AACS
offers allows novice surgeons to “start at the ending.”
How do you embrace the “best last years” in your practice far before it is time
to retire?
One way is to discuss common practice issues with other AACS members. We all
experience the same issues at some point in time. Another way is to continuously
dissect your own practice to see how you can improve. Do you survey your patients? If you don’t ask people how to make your practice better, you may never find out. Do you value your staff and their input? Sharp staff members see things through
different goggles than do surgeons and can be great assets for improvement.
The AACS has given me access to hundreds of exceptional surgeons with whom I
can discuss issues. The Academy has given me many “a shoulder to cry on” when
I face the challenges of cosmetic surgery practice. Providing practice management
CME at our meetings has been another benefit of Academy membership. The AACS
has made me a better surgeon and provided many of the tools it takes to have a
successful practice. To be the best, we need to grow. That’s why it is my hope that every member brings
in a new member this year.
Have a great summer!
Joe Niamtu, III, D.M.D.
4
P resident’s Column
Dear Colleagues,
Neil Sadick, M.D.,
F.A.C.S.
2013 President
American
Academy of
Cosmetic Surgery
Sadick
Dermatology
New York,
New York
I’m pleased to report that in May the AACS Board of Trustees approved a three-year
strategic plan that will focus on revenue generation by enhancing our educational
offerings and strengthening our brand. As this plan is put into practice, you’ll see
a vibrant Academy that impacts patient safety across the entire surgical home. I’m
honored to be a member of this organization, and I’m excited about the progress
we’ve made thus far. I’ll certainly keep you posted as this strategic plan
is implemented.
I’m also looking forward to the upcoming “World Congress
of Advanced Liposculpture and Body Contouring” from
October 1–5. Not only is it in my own backyard—New York
City—but it will also feature a world-class faculty that will
teach the latest breakthroughs and techniques in cosmetic
surgery. The U.K.’s Grant Hamlet is one featured speaker that
you can’t miss. He’s one of the most sought-after liposuction
instructors in Europe.
In addition, the AACS will soon develop a procedural census that will be sent to
members. The results of that effort will be crucial in implementing a procedural
database that can be used to analyze outcomes. The Academy will be able to build
stronger relationships with not only its own members, but researchers and corporate
partners. It will give us the information we need to illustrate this organization’s
commitment to excellent outcomes and patient safety.
Of course, the Academy’s educational program is one of the main vehicles through
which our expertise is applied toward safer results. We’re fortunate to have a first
rate fellowship program with dedicated mentors and eager training fellows. But
cosmetic surgery is growing too quickly for us to be satisfied with the status quo.
One of my goals as president is to facilitate the growth of the fellowship program.
Be on the lookout for administrative changes that will centralize the application
and reporting process. Also, I hope to soon share with you some exciting curricular
changes that will be made to the Academy’s education delivery model. We’ve listened
to your feedback, we’re considering your needs, and we’re building a framework that
will deliver the knowledge and training you need to be at your best. Promising days
are ahead.
Thank you so much for your membership in AACS and commitment to cosmetic
surgery. We wouldn’t be able to make a difference without you.
5
Delegates and the
Y our
American Medical Association
In mid June, Drs. Anthony Geroulis, Rania Agha and I attended the 2013 American
Medical Association House of Delegates meeting in Chicago. During the week,
we were involved in reference committees and elections of incoming officers and
Trustees. In addition, Dr. Jennie Ward-Robinson, the Executive Director and CEO of
the AACS, attended meetings for the “AMA Section Council on Plastic, Reconstructive
and Maxillofacial Surgery.”
Robert Jackson,
MD, FACS
AMA House
of Delegates
Cosmetic Surgery
Representative
Noblesville,
Indiana
I’m happy to report that this meeting resulted in many changes that will have a
positive impact on cosmetic surgery and the Academy in particular. As a member of
AACS, you have every reason to be encouraged. For yet another year, the AACS will
have a presence in the AMA House of Delegates. I’m honored to serve for another
year as Vice Chairman of the AMA Section Council on Plastic, Reconstructive and
Maxillofacial Surgery. In addition, a good friend of Dr. Geroulis, Dr. William McDade,
was elected to the Council on Medical Education.
Here are some of the more remarkable developments from the House of
Delegates Meeting:
• Obesity as a Disease
The AMA recognized obesity as a disease and expressed the need for a range of
medical interventions to treat and prevent obesity in order to reduce the incidence
of heart disease and diabetes.
• Sunscreen and Schools
Many states prohibit students to carry over-the-counter medication in schools
without a doctor’s note. As such, in many states sunscreen is prohibited from
schools since it is considered an over-the-counter medication. To prevent skin
cancer, the AMA adopted a policy that encourages all schools to allow students to
possess sunscreen on campus.
• Insurance and Outpatient Surgery Centers
The AMA also committed to working with states to advocate that third party payers
be required to assess equal or lower facility coinsurance for lower-cost sites of
service (such as ambulatory surgical centers or office-based facilities) and allow
participating physicians to perform outpatient procedures at a site chosen by the
physician and patient.
• Maintenance of Licensure
The AMA also approved a policy stating that maintenance of licensure shouldn’t
be burdensome for physicians. This step will go a long way in persuading medical
boards that doctors can indeed stay current in their knowledge and skills without
placing burdensome obligations of time and cost.
Our AMA representation seeks to protect your interests
while demonstrating our shared commitment to patient
safety. But the only way that the Academy can effectively do
so is if more of our members join the AMA.
6
SPOTLIGHT ON AMA MEMBERSHIP
7
O nline Review of Sites
The Importance of Socially-based Review Sites
“You can no longer be a jerk and get away with it”
This quote is from a good friend of mine; a young, successful cosmetic surgeon
starting his new practice in a world that is unlike the one surgeons knew just ten
years ago. Of course, he is speaking about review sites. Cosmetic surgery practices
will thrive or die based upon online review sites. Surgeons can either stick their head
in the sand to ignore this reality or radically change the way that they look at the
decision-making tools used by prospective patients.
Jake Laban,
MBA
Total Social
Solutions
Las Vegas, Nevada
DIFFERENCES IN REVIEW SITES Generally, review sites can be broken down into two
types; the more traditional online review sites, and socially-based.
TRADITIONAL REIVEW SITES Sites such as Vitals, RateMDs, HealthGrades, ZocDocs,
and CitySearch have been popular for nearly 10 years as a repository of ‘crowdsourced’ reviews from people who may, or may not, leave their actual identity for
surgeons whom they may, or may not, have actually visited.
Over the past four years, these sites have become less popular as the legitimacy of
their reviews has become (rightfully) questioned. There are many reports of surgeons
using these sites to damage competitors’ reputations with anonymous and fraudulent
reviews. As these reports become more prevalent, the public’s level of trust in the
validity of the reviews on these sites has dropped, and their attention has turned
to more ‘legitimate’ sources of ‘real’ reviews. However; these sites are not without
controversy of their own.
SOCIALLY-BASED REVIEW SITES Review sites atop the backbone of social networks
(i.e. Yelp, Google+ or Facebook) have become far more popular over the past four years.
Through these sites, prospective patients can see the reviews of surgeons from people
in, or proximate to, their personal peer group. These sites represent the intersection
of local, social, and search, where geo-location mobile technology allows users to get
relevant and local reviews from their friends, instantly, on their mobile devices.
In other words, socially-based review sites represent word-of-mouth on a mass scale.
Through these review sites, every prospective patient has the ability to make or break
a cosmetic surgery practice with the use of their mobile device.
These sites give the aesthetic patient a great deal of
confidence in deciding whom to see for a consult.
Surgeons who ignore these sites today will fall behind their
competitors in years to come.
These sites are not without a great deal of controversy. They do employ strict filters
in response to the abuse suffered on the traditional review sites. Additionally, these
social media platforms force a user to use their actual identity on the social network,
or employ filters that will not allow anonymous or potentially fraudulent reviews.
Decision-making has changed forever. As tech giants such as Google, Yahoo, and
Microsoft focus their efforts on giving customers more relevant, geo-located search
results; social-media-based review sites will become a more important part of a
cosmetic surgeon’s marketing plan for years to come.
8
PRACTICE MANAGEMENT INSIGHTS
T he Tao of HIPAA
The Tao of HIPAA Best Marketing Practices & HIPAA, with a Twist
The HIPAA Privacy Rule identifies 12 national priority purposes which permit the use
and disclosure of protected health information without a patient’s consent. Guess
what? Marketing is not one of those purposes. As such, below are a few tips to keep
in mind when you are creating or re-evaluating your marketing plan.
Lori S. Varaich,
J.D.
Law Offices of
Lori S. Varaich
San Marcos,
California
Honesty – The AMA Code of Ethics states, “there are no restrictions on advertising
by physicians except those that can be specifically justified to protect the public from
deceptive practices.” The concept seems elementary, but the devil is in the details.
It is important to remember that wording that may seem necessary to grab a
consumers attention could also subject you to claims of false advertising. Indicating
that a procedure is painless, or that results are guaranteed, should be avoided.
Further, any advertising that includes pricing should either be exact or indicate what
factors are taken into account if the fee for service varies.
Images – A picture is worth a thousand words. But if you use a picture of a patient
without his or her consent it can cost you not just thousands, but hundreds of
thousands of dollars. In practices where “before” and “after” images are used to
demonstrate results of a procedure, you must have written authorization from the
patient before you can use it.
Including a HIPAA compliant photography consent form,
allowing the practice to take and use the patient’s images for
any purpose beyond patient care and treatment
(i.e. marketing), should be a part of each new patient
paperwork package.
Policies – Having a set of standard policies and procedures, preferably written, on
how your practice and staff handle patient information could be worth its weight in
gold if done properly, and even more importantly, followed. Implementing policies
on how and what patient information can be used in marketing endeavors, especially
when used on social media platforms, can prevent an innocent mistake turning into a
legal fiasco. Staff and business associates should be provided with written copies of
these policies, and, when necessary, trained to ensure compliance.
Anonymity – A patient posting his or her experience with your practice on their own
is possible, but not likely. More often than not, providers post patient experiences
or results on the practices website, blog or any one of the seemingly infinite social
media platforms. Even when used with a patient’s consent, though, the information
should be scrubbed to comply with HIPAA’s requirement of de-identification.
Authorization – Just in case the subliminal message did not come through, the final
tip is to make sure you have the patient’s written authorization before using any of
his or her information to market your practice. Also, remember to keep a record
of how any given’s patient information is used in case a patient requests for an
accounting of the use and disclosure of his or her information.
9
A re You Prepared for the Conversion Cascade?
The Conversion Cascade – Defining Your Return on Investment
As a business owner, and remember that medicine is a business, we must know the
return on our investment. Each and every day we make decisions that affect our
profitability, like purchasing supplies and equipment, performing services and selling
retail products.
Jay A. Shorr, BA,
MBM-C, MAACSAH, CAC I, II, III
The Best Medical
Business
Solutions, Inc.
West Palm Beach,
Florida
Marketing and advertising is a necessary evil to bring new and prospective patients to
your facility. With all of the money you’re spending on your website and newspaper, TV
and radio advertising, not to mention numerous other sources, do you really know your
return on investment?
Have you ever heard of a conversion cascade? Simply put, it is the term used for all
of the steps needed to determine your ratio of marketing expense to revenue, which
eventually determines your profitability. What are the steps of the conversion cascade?
How do you figure them out? What data sets can you realize from the formula? And
lastly, what will you do with the data? All of the steps are like links in a chain.
THE CONVERSION CASCADE
• Creation of awareness. Let prospective new patients know your practice exists, and
give them a reason to choose you over the competition. Create an identifiable brand
for yourself, and that brand should be YOU and the services you perform. What is
your special niche? Work to come up with those concrete answers, using them in your
marketing materials.
• Awareness leads to a phone call to your office. A beautiful ad does nothing if it
doesn’t drive people to pick up the phone. Use tracking numbers, which are special
phone numbers (even vanity numbers) used for specific campaigns. This allows
you to know which campaign drew the results you are looking for. These results can
even tell you what day of the week and time of the day your phone rang, helpful for
staffing purposes to answer the next campaign’s anticipated calls.
• Phone call leads to a consult. Having a knowledgeable “director of first impressions”
answer your phone with a smile makes all the difference.
• Consult leads to a treatment. Make sure you “wow” your patient when s/he comes to
visit the office.
• Treatment leads to retreatments. Treating your patient well makes all the difference.
• Retreatments lead to other services. Be sure to let your new patient know of other
services you offer and add them to your email list for future updates.
• Other services lead to word-of-mouth referrals for new patients. A happy patient
is sure to tell his or her friends about the experience; track referrals in your CRM
system, and remember to say thank you!
Have a defined plan and budget, but be ready to modify and refine it when necessary.
Remember: what gets measured gets managed.
10
PRACTICE MANAGEMENT INSIGHTS
Advertising dynamics have changed over the years, but no matter how you choose
to spend your dollars, it’s all a waste if you don’t know which channels are
financially successful.
The conversion cascade tracks the effectiveness of advertising through each stage and identifies stage arrest. Look at
the following example to see how you come up with your return on investment.
Say that you spend $8,000 on a campaign, and receive 20 calls about this particular campaign. Divide the amount
of the campaign by the number of callers. So, $8,000/20 callers= $200 per caller.
Of those 20 callers, 50% of them convert to an actual consult. (Note this is the first 50% of the phone stage arrest;
be sure to identify WHY they aren’t booking a consult.) 20 callers x .5 (consults booked) = 10 consults.
Of those 10 consults, let’s say 50% of them convert to a procedure. (Again, that is the second 50% of the phone
stage arrest.) 10 consults x .5 (procedures booked)= 5 procedures.
Let’s now say the procedure you had advertised brings in $2,500 each. $2,500 x 5 procedures = $12,500.
If your total revenue from the procedures is $12,500, and you spent $8,000 in advertising, note your campaign can
be said to have a 1.6:1 return on investment through this formula: $12,500 revenue from procedures/ $8,000 cost of
marketing campaign = 1.6:1 or 60%
NOTABLE FORMULAS:
Cost of the campaign/number of callers about that campaign = Cost per caller
(Number of callers) x (Percentage of consults booked) x (Percentage of procedures booked) x (Price of advertised
procedure) = Revenue from Campaign
Revenue from campaign/Cost of Campaign = Return on Investment
Practice success involves tending to and optimizing each stage of the conversion cascade. Don’t go into an
advertising campaign if you don’t plan to measure its profitability in the end. Measure all that you do, or as much as
you can, and identify stage arrest so that you don’t make the same mistakes twice.
Consider the use of practice marketing software which has customer relationship management (CRM) built in so you
can track the results long term. Remember, what gets managed gets measured and what gets measured gets managed.
11
T
hinking Outside the Box in
Marketing Cosmetic Surgery
As young doctors enter the field, their eagerness to create beauty and use the skills
they have learned is expected. But what good are skills and training if no one is in the
waiting room? Every doctor needs to know how to sell themselves, but most medical
programs lack that aspect of training.
I went to the extent of getting an MBA to advance my knowledge of the business side
of medicine, but nothing compares to hands on experience. The goal of this article is
to share my wisdom in hopes that those in need will soon gain their own experiences.
Les James
Blackstock, M.D.
Enhance Clinic
Sydney, Australia
Although marketing trends vastly differ, I travel from Australia to the U.S. for training.
I am constantly intrigued when I hear marketing “experts” selling their services to
doctors. It sounds very much like a text book and what you read in many newspapers
and best sellers. I can understand why for many doctors it is much easier to hire the
services of those experts because we are so busy, or hope to be after we hire them.
With respect to the “experts,” I would argue that much of that spending is wasted.
Have a look at the web sites for any major search term. What do you notice? They all
look similar. Well that is because, “It works!” I hear the “experts” shouting from the
sidelines. But does it really?
Think back to 1987. There were numerous computer shops selling hardware in
complex places, with advertising espousing the technology. The machines were clever,
but they were confusing and you had to look at a developing support industry to get
the best from them. Then a little company from California decided to be different; they
approached the industry from the perspective of customer needs – not just technology
for technology’s sake. This company made computers that were user friendly and
accessible. Did it work to think outside the box? Well if you bought Apple shares then
you would certainly think so.
So what does this mean for cosmetic surgery? Note, that I did not say what does this
mean to the cosmetic surgeon. I argue that it is in the best interest of everyone to stop
worrying about your slice of the pie and be more concerned with making the
pie bigger.
Don’t spend your time expressing how you are “better,” use the “latest technology”
or have the most “experience.” Stand out. Tell patients about the benefits that make
cosmetic surgery worthwhile. It is not vain. It is not trivial. Cosmetic surgery is a life
enhancement.
Of course, this can only work if you are passionate and committed to the field. If
you have come to cosmetic surgery to make lots of money, I respectfully believe that
you may have made a terrible mistake. You can make more working in the investment
fields, designing an app or buying in a depressed market. While there are many other
ways to make more money, cosmetic surgery gives us the opportunity to help people
feel confident. Additionally, being surrounded by beautiful people is a pleasant way to
spend your days.
If you’re truly passionate about this field, don’t stop seeking the best training. I travel
half way around the world at great expense and loss of income and travel costs so that
I can learn from the best.
12
INTERNATIONAL PERSPECTIVES
I suggest that you join the ACCS, or any organization that
is aimed at teaching skills and spreading the word about
cosmetic surgery. Share that teaching while sharing your
knowledge with the general public.
Your passion should be seen in your work. If you aren’t willing to have cosmetic surgery
on yourself then what are you doing in the industry? Those around you­—your staff,
relatives and friends—should all be signposts for your work.
However, here is where I diverge from classical thinking; don’t solely sell yourself.
Steve Jobs did not put his face on Apple computers.
Build a brand.
There are two important factors in building a brand. First, make the brand a reflection
of who you really are. You may be able to maintain an act for a while but it is much
easier to be yourself and to be honest. People will be much more receptive to that.
Secondly, understand what your market wants. Marketing is simple (just don’t tell
the experts). Ask someone what they want to buy, go get that and sell it to them. Your
brand will differ from market to market. Do you think you will do well selling Rolls
Royce cars in a poor area or selling cheap second hand cars in an affluent area.
Both will fail.
These ideas are reflections of my marketing. Instead of a prominent photo of me on
my website, there are small candid shots of all staff members. This emphasizes the
team approach that we embrace in the office. I’m not only clear with patients about
who I am – I’m also clear about what I’m not in terms of qualifications and experience.
If my services aren’t a good fit for the patient, I gladly direct them to someone with
the necessary qualifications and experience. I will let you all in on a secret that I know
because I asked people; most people don’t care about the doctors qualifications
because they don’t always understand the difference in training.
13
T
hinking Outside the Box in
Marketing Cosmetic Surgery, continued
Frankly, what people care about is not how much you know,
but how much you care.
I put videos of my consultations and processes on my web site so people can access
them before they visit me. Some may not like me and go to someone else. I speak
about cosmetic surgery with any referral suggestion as often as I can. Additionally, I
offer “freebies” and promotions on services to fill my booking spots where possible,
aiming to work with people who are in the greatest need of my services. This approach may not work for everyone. However, energy spent on image is the main
competitive edge that our rivals possess. If the marketing was directed to teaching
the general public how they can benefit from our services, imagine how much more
successful we all would be.
January 14 –19, 2014
The Westin Diplomat Hotel
Ft. Lauderdale, Florida
“We continue to attend the AACS annual meeting as it
attracts a large number of physicians doing aesthetic
procedures from all over the country. The physicians come
to the meeting to learn and stay up to date on the latest
procedures and technologies; and this includes visiting
the exhibit hall to see what’s new and learning from the
exhibitors. It’s a great way to interact with some of our key
customers and help grow our business.”
-Zubin Meshginpoosh
EVP, Chief Operating Officer, Enaltus
aacs2014.aacosmeticsurgery.org
15
B
ringing the World of
Liposuction to Broadway
An interview with Kevin Jovanovic, MD about the
“2013 World Congress on Advanced Liposculpture and Body Contouring Techniques”
Every show has its stars. On Broadway, actors and audiences alike flock to classics like
“Les Miserables,” “Cats” and “Wicked.” All the same, there’s still room for recent hits
like “The Book of Mormon.”
Kevin Jovanovic,
MD
2013 Chairman,
American Society
of Liposuction
Surgery
Believe it or not, cosmetic surgery has some parallels. Liposuction is the closest thing
you’ll find to a classic in cosmetic surgery. As a matter of fact, it was liposuction that
brought two cosmetic surgery organizations together to form the American Academy
of Cosmetic Surgery. But as Dr. Kevin Jovanovic will tell you, there isn’t much that’s
traditional about today’s liposuction.
Liposuction has evolved in a way that’s made room for
new stars: new approaches, cutting edge technologies and
safer results.
Dr. Jovanovic is collaborating with Drs. Peter Schmid and E. Antonio Mangubat as
program directors for the “2013 World Congress on Advanced Liposculpture and Body
Contouring Techniques.” The World Congress occurs once every three years, but this
event is especially significant for Dr. Jovanovic because it’ll be held in his own backyard
– New York City.
Dr. Jovanovic took some time to chat with Surge about this exciting event that’s slated
for October 1st to 5th at the Millennium Broadway Hotel.
Surge: What is the most important thing attendees will take away from this year’s World Congress?
The World Congress of Liposuction is the pinnacle event of the American Society
of Liposuction Surgery. So it’s only natural to focus on the latest and greatest in
liposuction. Five days is a lot of liposuction! There will be emphasis on both
non-invasive technology and High-Definition Liposuction.
I think the main takeaway will be that liposuction hasn’t just become more common
–it’s become more advanced; more flexible. We can do so much more with it now. We
can sculpt. Patients can be awake during procedures. Liposuction is not as dangerous
as it used to be. This is no longer about just removing fat. Today’s liposuction is where
medicine intersects with anatomy and art. One of the featured speakers is a renowned
sculptor and anatomy instructor – he even helps create special effects for Hollywood.
Surge: What topics are you particularly looking forward to?
That’s a tough question. This event will gather the world’s best surgeons in one room:
Dr. Grant Hamlet from the U.K., for example. The friendship and collegiality will make
for a great learning environment. That’s important because these workshops are all
about acquiring new skills and knowledge. If I absolutely had to choose, I’m most
looking forward to the technology demonstrations. That’s what usually makes the
biggest impact on my practice.
16
SPOTLIGHT ON EDUCATION
Another thing I’m looking forward to is the debate around these new advancements.
When it comes to new technologies, there should always be inquiry and exchange.
We’re going to have multiple experts share multiple perspectives. These are physicians
with a lot of training and experience in these technologies who are going to share
insights so the audience can judge for themselves. What are the benefits and tradeoffs
of invasive versus non-invasive approaches? Stem cells? What do the research, studies
and results tell us?
To explore further, we’re going to have actual experts debate the more controversial
aspects of those questions. Think of it as a “Supreme Court of Cosmetic Surgery” for
fat removal and fat transfer! Who wouldn’t want to see that?
Surge: You’ve attended this event in the past and now you’re one of the program
directors. After everything is said and done, what’s the one thing that would
have to happen for you to feel like the 2013 World Congress was a success?
I believe the World Congress is already a success! Dr. Schmid and Dr. Mangubat and
I have been planning this for three years.
It’s no accident that this is taking place in my hometown just
steps from Times Square. Moreover, the actual venue is a
former Broadway stage. The space is really cool.
It’s not just the three year interval that makes this event rare: it’s the assembly of
talent and expertise. In planning this event, I’m starting to realize that five days
might not even be enough to cover the advances: High Definition Liposuction,
Cosmetogynecology, fat transfer and stem cells. Anyone with an interest in liposuction
needs to be in New York for this!
Editor’s note: For more information on the World Congress on Advanced Liposculpture and Body Contouring Techniques, visit:
wcl2013.aacosmeticsurgery.org
17
A
ugmentation of Nasal Tip Projection
Using the Inferior Turbinate
For a study I coauthored in Archives of Facial Plastic Surgery (2008), 13 patients
underwent closed Rhinoplasty for increased nasal tip projection. The focus of the study
was to evaluate the novel use of the inferior turbinate bone as an autograph for
the augmentation.
Michael E.
Jones, M.D
Lexington Plastic
Surgeons
New York,
New York
After undergoing the procedure, the patient’s nasal tip projection was measured,
immediately and at 30 months, using both the Goode ratio and visual assessment.
In all cases, both the immediate nasal tip projection as well as the 30-month
measurements displayed a statistically significant difference from
preoperative measurements.
The implications of these significant results require further discussion on a number of
counts. First, it should be considered that, in the case of ethnic patients, augmentation
of the dorsum and tip are often required. In these cases, to create the desired
projection and rotation of the tip we must use the quadrangle plate to harvest and
graft a columellar strut. What is available on the quadrangle plate is often insufficient
for these purposes, so we may attempt the harvest of autologous material from a
second site on the body such as the rib or iliac crest. However, adding a second
harvest site increases patient preparation and operation time and the chance
for morbidity.
In an effort to avoid the complications associated with a second harvest site, some
surgeons have chosen to use synthetic materials including, but not limited to,
expanded polytetrafluoroethylene, high-density polyethylene and silicone. However,
along with the use of alloplastic material there is still a higher complication rate than
that associated with autographs.
Additionally, when ethnic patients are involved, it is important to note that a concurrent
inferior turbinate reduction surgery is indicated anyhow, due to predominate airflow
through the inferior meatus.
Harvest and preparation of the inferior turbinate (for use
as a columellar strut) requires skill in turbinectomy and
soft tissue techniques. However, these are skills that most
surgeons can easily master. The only potential disadvantages of the
procedure include increased intraoperative and postoperative bleeding from the
turbinectomy and the increased risk for fracture that accompanies an osseous graft.
Moreover, the harvesting process does increase operative time by approximately
10 minutes.
It should be noted that during our study none of the patients experienced
postoperative hemorrhages. Fracture was easily avoided with the use of a Mayo scissor
for shaping. Also, 10 minutes is still less time than is required for harvesting auricular
or costal cartilage.
One small note– during the perioperative period, mild increases in nasal tip stiffness
were recorded. However, they were not significantly different from changes observed
consistently with the use of a columellar strut. Additionally, our patients self-reported
no personal issues with this side effect, and nothing significant was recorded in the
long-term evaluations.
18
IN THE O.R.
In conclusion, the use of the inferior turbinate bone in
augmentation of nasal tip projection is a viable alternative.
It assists projection and minimizes patient risk factors
associated with a second operative site such as increased
rates of morbidity.
Since this initial study, I have employed the use of the inferior turbinate bone graft
consistently in ethnic-focused Rhinoplasty procedures.
We have used the ITBG as a dorsal implant in over 100 patients to date. As it is
shaped and layered to provide adequate dorsal height, it molds remarkably well. Plus,
when the bone heals it re-ossifies into a permanent, firm implant. We have even used
the ITBG as an alar batten and spreader graft. I see the ITBG as a new and exciting
addition to the armamentarium of any Rhinoplasty surgeon.
World Congress on
Advanced Liposculpture
and Body Contouring
October 1–5, 2013
New York, New York
Call for Abstracts and
Registration are now open
FOR MORE INFORMATION, PLEASE VISIT
WCL2013.AACOSMETICSURGERY.ORG
P
atients are Listening
During Surgery
While in the past most surgery was performed under general anesthesia, cosmetic
surgery has recently changed to being performed under a significant percentage of
local anesthesia with sedation or often light sedation. Patients are aware of not only
the surroundings, but also have memory of everything said by the surgeon and/or the
staff before, during, and after the procedure. The awareness and memory may affect
the patient’s perception of the operation and potentially taint their overall satisfaction.
Michael Gellis,
MD
Star Plastic
Surgery
Novi, Michigan
One patient in Vancouver, Canada who underwent eye surgery under local anesthesia
was so upset after listening to the surgeon talk to the staff about a hockey game that
he wrote a complaint letter to the registrar of the Province College of Physicians and
Surgeons. The man was concerned that the idle chatter might have led the surgeon to
make a mistake, which wasn’t the case at all.
The concern, of course, is with patients who are intently listening to everything that
is transpiring in the OR: music, conversations, doctors talking about other patients,
noises from the outside hall, etc. We must care about all noises and conversations in the
OR, since the final patient’s evaluation of their care may be
affected by extraneous sounds.
One study evaluated the patient’s response to those ambient sounds and conversations
in the operating room, and whether the experience was positive or negative. All
patients were kept under minimal sedation. The survey was given to 120 patients upon
their discharge from the outpatient clinic. There was a 43.3% return rate (52 surveys).
The following questions were answered with Yes, No, Don’t Remember, or
Not Applicable (N/A):
1. Did you enjoy conversing with your surgeon/ nurse during your surgery?
2. Was music or radio being playing during your surgery?
3. Did anyone ask if you wanted radio/music played or what type of music you
would like played?
4. Was the music or radio helpful to relax you during your surgery?
5. Was the surgeon/nurse attentive to your needs during surgery?
6. Would silence be better in the operating room?
7. Did the surgeon talk to you during the surgery?
8. Did the conversation with the surgeon help to relax you?
9. Before or after the operation, was the conversation between staff members (nurse to nurse, doctor to nurse) appropriate?
10.Did you feel their side conversation prevented them from caring for you?
After receiving the returned questionnaire and collecting the data, interesting results
were tabulated.
When asked if silence would be better in the operating room 86% answered no.
When asked if music or radio played during surgery helped them to relax 65.3% said
yes, but 20% could not remember.
20
IN THE O.R.
When asked if the surgeon talked to the patient during surgery 81.6% responded yes
and 75.5% felt the conversation helped them relax.
When considering side conversations, when asked in the chatter among the staff
prevented them from giving appropriate care, 85.7% said no and there were no
yes responses.
The conclusions gleaned from the data may give insight to the need to monitor idle
chatter and noise in the OR when the patient is under local anesthesia.
• Many patients would like to hear music or radio played while in the operating room. It is recommended that the patient choose the music.
• The chatter between personnel does not seem to upset patients since 85.7% responded ‘No’ when asked if the patients felt side conversations prevented the personnel from caring for the patient.
• It is always wise to remember that all conversations are being recorded in the patient’s memory bank.
21
H
igh Definition Liposculpture
Everything we do as cosmetic surgeons should keep patient safety and satisfaction
in mind. Despite participating in many seminars, I often found myself looking for a
procedure that would provide something truly unique to my patients (giving me an
edge over competitors). Once I received training in High-Definition Liposculpture from
Dr. John Millard of the Advanced Body Sculpting Institute, I didn’t have to look
any longer.
Firas A.
Hamdan, M.D.,
F.A.C.S.
Integrating this new concept into my practice has been very rewarding for both me and
my patients. Their enthusiasm with the result (and renewed confidence in how they
look) has done more than just increase my patient base – it makes me look forward to
performing this procedure each time.
AACS Hospital
High definition liposuction is extremely flexible: it can be performed on a variety of
patients to solve an array of problems.
Dubai, United
Arab Emirates
High Definition Liposuction opened up my practice to a new category of patients who
are not overweight or have either lipodystrophy or excessive localized fat deposits.
These patients are traditionally considered “fit” because
they’re within the normal BMI range.
So, they would not have been candidates for conventional tumescent liposuction.
Even a reasonable degree of diet and exercise would not provide these patients with
“definition” in their abdominals, pectorals, arms, back and calves. To be sure – they
were fit. But they weren’t able to demonstrate that in how they look.
High definition liposuction provides those patients with true “Surgical Body Sculpting”
where the sub-dermal release concept is applied and the natural lines and valleys of
the muscle are made more pronounced. This could be associated with autologous fat
transfer to augment the muscle bulges.
It’s particularly rewarding to work with these patients because you can see them on
the beach, at the pool or wearing tight clothes showing their new curves. I often get a
discrete “thank you nod” expressing their gratitude for helping them get their body to
a place that they couldn’t necessarily achieve on their own. That gratitude also helps
most of my patients put a lot of effort into maintaining that result with diet
and exercise.
On another front, the majority of my patients seeking High Definition Liposculpture are
those with marked Lipodystrophy and even some associated skin laxity. High Definition
Liposculpture also includes a component that shrinks the skin to accommodate the
trimmer body look without worsening skin looseness or laxity. Many of these patients
are drawn in by the “sexiness” of the concept of “High Definition.” But when I explain
to them the potential of shrinking the skin to match the results from the liposculpture,
they get really enthusiastic.
And to my surprise, the satisfaction rate with this more common group of patients was
even greater than the “fit” group. The more experience I gained with this group, the
more I understood why.
22
IN THE O.R.
The most common liposuction patient is mostly unpleased with their body shape and
would feel uncomfortable wearing certain clothes. Some of them are discouraged from
dieting because the loss of even ten pounds wouldn’t show on their body because of
the overwhelming fatty deposits in certain areas. Improving their body shape while
helping them with skin retraction offers more than just a major confidence boost – it’s
also the first step to a healthier life with diet and exercise. In my experience, I’ve found
that patients are far more motivated to commit to dieting and exercise when they
aren’t feeling helpless.
As with any procedure, the patient should be fully counseled that High Definition
Liposuction is not a weight loss solution. Be clear that this is “body shaping” at the
current weight, and that this procedure is only a step in the right direction. They will
need to continue the path to maintain their results and their new looks for years to
come by conditioning their body.
Cosmetic surgeons have a lot of different reasons for
choosing their particular line of work. Fundamentally,
we’re in the business of helping people look and feel better.
For that reason, High Definition Liposuction has been a
necessary component of my practice.
23
I
n Pursuit of Pain Management
An Interview with Robert Burke, M.D., F.A.C.S.
While he’s most commonly known as a cosmetic surgeon, researcher and educator,
Dr. Robert Burke also has a knack for improving things. Most of Dr. Burke’s focus is
dedicated to his practice: the Michigan Center for Cosmetic Surgery. However, he also
sets aside time outside the O.R. as a member of the AACS Board of Trustees, a clinical
faculty member at the University of Michigan and as an editor of the American Journal
of Cosmetic Surgery.
Robert Burke,
MD, FACS
Michigan Center
for Cosmetic
Surgery
Ann Arbor,
Michigan
In those various roles, Dr. Burke sees how technology, research and cosmetic surgery
can intersect to accomplish amazing things. Through collaboration with Erchonia,
Dr. Burke is about to undertake an exciting study that will apply an existing technology
towards a purpose that is far bigger than cosmetic surgery – pain management.
Surge: What gave you the idea to pivot this technology into something as broad as
pain management?
The potential for this application occurred to me five or six years ago. It helps that
the concept is based on existing equipment, because it doesn’t require a great leap in
technology to achieve a pain management solution. The hard work is in the research
and finding an evidence-based application. The purpose of this study is simple but
potentially powerful – can we harness this laser technology through a controlled
process to relieve pain. Will this reliably and scientifically work? If so, through what
biological mechanism?
Surge: It sounds like this innovation is about more than just cosmetic surgery – but revolutionizing pain management.
Pain management is more than just cosmetic surgery, but it’s important to understand
that this all starts with cosmetic surgery. Erchonia’s technology has been traditionally
used for fat volume reduction, post-op pain – all FDA approved applications. The postop pain aspect is important because it suggests a bigger picture. Approximately 45%
of the U.S. population suffers from some kind of chronic pain. I hope this study allows
for a new focus on intense pain to improve quality of life for those who suffer from
severe chronic pain like TMJ.
Yes, if this can help with post-op recovery then it’s a big breakthrough. But, if it can
eliminate the need for analgesics or narcotics altogether then it could be
truly significant.
The risk of complications is greater for patients who’re
taking NSAID’s within two weeks of surgery. The potential
of narcotic addiction and other side effects – having the
capacity to avoid all of those risks altogether would make a
tangible impact on patient safety. Patients could even have
treatments before and after procedures.
24
SPOTLIGHT ON RESEARCH
Surge: Talk about your methodology. It sounds like the partnership with Erchonia will help drive some great research.
Erchonia has been great about pushing the boundaries of what lasers can do beyond
conventional cosmetic surgery applications. Without the prototype, this study wouldn’t
be possible. More or less, the initial objective will be to teach the feasibility of this new
application. We have an IRB, so we’re ready to get started soon. The initial focus will be
on pain originating from TMJ or some similar condition.
The preliminary study will apply the prototype to approximately 20 patients with no
placebo control. As with any IRB study, strict patient selection criteria will be followed.
If a statistically significant result is there, then we’ll do an independent samples study
with placebo control.
The selection criteria for patients are pretty straightforward. We’ll ask potential
subjects to use a VAS scale to rank pain (on a scale of 0 to 100 – 100 being the
most painful). Ratings must be 40 or higher over a period longer than three months.
Subjects must have experienced this chronic pain at least 50% of the time, and have
limited oral motion of no more than 40 mm. They also must be diagnosed with TMJ by
a qualified medical professional. Nor can they have dental treatment or surgery within
a reasonable window of time before or after the study.
Surge: Great research doesn’t happen on its own. It’s a considerable investment of time and resources. For you, what’s the most rewarding part of a research project like this?
It’s the opportunity to learn something new – to take an evidence-based approach that
seeks to solve actual problems. Even if you don’t get the result you’re looking for, that’s
not necessarily a failure because it adds to the wealth of knowledge that’s out there.
I’m lucky because with my practice I get to confront challenges hands-on. But with all
of my academic relationships, I get to take what I see on a daily basis and pull back in
order to ask broader questions. Being a cosmetic surgeon gives me opportunities to
pursue both concurrently. It’s presented some wonderful opportunities.
25
T
reating Another
Surgeon’s Complications
In cosmetic surgery, we as surgeons hold ourselves out to the public. We often
advertise, speak at workshops, or optimize our website in hopes to be selected as
surgeon of choice by a potential patient. We design our office, train our staff, and hone
our customer service skills to provide an experience that exceeds expectations and
creates confidence and comfort. In the end, patients have options and we know it.
At the same time, we also know that not every person who walks into our office is a
surgical candidate. We pride ourselves on our selective judgment.
Samir Pancholi,
DO
Pancholi Cosmetic
Surgery
Las Vegas, Nevada
Patients choose their surgeons and surgeons select their
patients. But what happens when a patient from another
surgeon comes in with a complication or concern?
Some surgeons will flat out refuse to operate on another surgeon’s patient while
others will rise to the occasion. It may be seen as an opportunity to be the hero. To fix,
correct, or finish where another surgeon was unable to succeed. The patient will feel
great, you will feel satisfaction; everything will be perfect. But beware, often times there
is more to the story than a surgeon who couldn’t get it done.
The Husband
A 35 year old female presented for primary rhinoplasty. Her requests, demeanor, and
expectations were all appropriate. Computer imaging was performed, the procedure
and pre and post operative courses were outlined, and all questions were answered.
This was performed at both her initial and second consultations. She was excited
and ready.
She underwent the procedure, a week had passed, and it was time to remove the
splint. I had prepared her for the swelling, and how the nose would change little by
little over time, and she was excited and ready to see her new nose. I handed her
the mirror and she smiled; Happy. Still smiling, she looked over at her husband who
started laughing and said she looked “cartoonish.” The smile went away and tears
arrived. In that instant, her results went from happiness and pride to embarrassment
and sadness.
I would see her weekly and then monthly, counseling her about the expected healing
course. Mixed with gratitude, she would express dissatisfaction while at the same time
unable to articulate what she was unhappy with. Over time, she would reveal being
teased by both her husband and young daughter. I would continue to see her for over
a year and half. During this time she has become more accepting of her result but
continues to be critical and sensitive about her nose overall.
Odds are this patient wouldn’t reveal her social situation to another surgeon, but rather
her dissatisfaction with the result. If only my operative report were requested by the
other surgeon, the social history would not be lost as my progress notes are where the
details reside.
26
POST OP PEARLS
Fuller Breasts
A 32 year old woman traumatically avulsed part of her nipple. She held pressure, got
online and contacted a few surgeons in town for treatment. We were able to get her in
promptly and repair the nipple. At her month check up, everything was healing well
and she professed how grateful she was to have found us. She had full confidence in
our office and knew we would give her the results she wanted with a breast implant
exchange. She defined her expectations, brought in photos and was very well versed
and researched in her desires and options.
Her initial augmentation was in Europe 10 years ago and since then she had an
implant exchange in California. Her goal was to have more superior pole fullness.
After showing her what to expect, she acknowledged understanding by redirecting
her breasts superiorly about 4 inches past the expected position. This cycle would
repeat itself 2 or 3 more times. Eventually she resigned her expectations to what I’d
shown her. Another element to her breasts was the easy visibility and palpability of
the implants. She had done her research and presented various options to me and
what she thought would work best for her situation. We discussed the options and then
scheduled a second consultation.
In the interim, I received her records from the California surgeon. Within, I discovered
a “Contract Agreement As To Resolution of Concerns” stating: “On multiple occasions
Dr. X has told me that we need to stop doing breast surgeries for cosmetic reasons and
that the dangers of each new surgery creates many more potential complications…I
promise that this is the last Redo Breast Augmentation I will ever ask Dr. X to do and I
understand that this is last time he will operate on my breasts”.
The records revealed she had undergone four prior implant exchanges with adjunctive
capsulotomies, capsulectomies, and capsulorrhaphies with smaller and larger implants
being at one time in either the subglandular or subpectoral planes. I called and spoke
with her surgeon who almost seemed happy his patient had found me. Judgment to
operate now became very simple.
Unfortunately (or fortunately for her) she was able to find
someone else in town who was willing to take her case.
27
T
reating Another
Surgeon’s Complications, continued
Memories
A 34 year old woman presented to the office seeking rhinoplasty. Although she had
placed a deposit elsewhere, she was consulting because her friends had urged her to
seek multiple opinions before proceeding with surgery.
Her consultation started with an admission that most people don’t see anything
wrong with her nose but she just doesn’t like it. She was vague and unable to
articulate her desires stating she would just like things changed a little. A cursory
assessment revealed areas that could be refined, but she appeared unaware of these.
After revisiting her motivation for rhinoplasty, she admitted that a year ago she was
assaulted by her boyfriend and her nose was broken. Now, every time she looked in the
mirror, she saw her nose and remembered the assault.
Some may say, if operated upon, she wouldn’t see her old nose and hence not recall the
assault. Others feel she needs to deal with the trauma of her assault first. I referred her
for psychological evaluation. Unfortunately, she now also has the burden of reclaiming
her deposit from a surgeon who is unaware of what her nose represents to her.
The above are examples of patients that may walk into your office seeking
improvement or correction. Depending on your interview skills and data gathering,
you may or may not choose to operate on them. It is important to gather as much
information as possible to avoid a pitfall, particularly when a patient is from another
surgeon. History and patient interview are vital to determining if:
• Both psychological and surgical goals are specific and definable;
• Your experience, skills, and patient rapport will likely lead to achieving these goals
• Your patient understands no guarantee exists to achieving a specific, perfect, or
psychological result;
• Your patient is demanding or a perfectionist, they should either be turned away or
referred for psychiatric evaluation.
Many of the following personalities are presented in one form or another in the cases
presented above. Being aware of these personalities can help you avoid situations
where patient, surgeon, and staff satisfaction can be limited:
Life Crisis – A recent loss of a job, loved one, marriage, etc. Your patient’s satisfaction
is more likely if their motivation is based on self improvement rather than a concept
that a positive change in appearance will lead to positive results with their personal or
professional life;
Psychological Attachment – These patients have a psychological basis to their
unhappiness.It can be a traumatic incident as described above or something they’ve
been teased about their entire life. With this situation, it’s important to assess their
desires as some may demand overcorrection due to the negative association;
Body Dysmorphia – With a distorted self image, these patients may be very critical
and become obsessed over minor deformities. They may minimize the effort needed
to surgically resolve the issue stating “all you need to do is...” Dissatisfaction tends to
be high as the altered self image will usually result in a new or associated concern and
multiple revision surgeries;
Pictures – These patients arrive with multiple pictures. This can be a good way for
you to assess their expectations. If the photos reveal results that are technically or
anatomically unachievable or they show perfect results without any perceivable defect
you may need to have a discussion. This should help you determine whether they were
simply uninformed or truly have unrealistic expectations;
28
POST OP PEARLS
The Narcissist – These patients will often reschedule, arrive late, spend little time completing
forms, ask how long they have to wait and how soon they can have surgery, only want to speak
with the surgeon, and have an overall inflated sense of self importance. Typically, they’ll take
little responsibility in the preoperative process, poorly follow post operative instructions, and
be critical of less than desirable results;
My Theory Syndrome – These patients will present their “surgical knowledge” as rationale for
a self chosen surgical approach to the surgeon. They have extensively researched how their
problem should be addressed; typically spending time drawing or altering pictures to make their
point. You may find they are poor listeners, interrupt often and rarely absorb what you have to
say. This often leads to unawareness of risks, complications, or the possibility for a less than
perfect result as the outcome has already been predicted and rationalized in their mind;
The Exhaustive Search – This patient has seen every surgeon in town and has chosen you.
They can be manipulative and quick to offer praise to you and your staff such as “You are the
only one who understands my goals.” or “You have the best reputation in town and I know you
can help me.” After surgery, they can be quick to criticize if things don’t go perfectly and seek
another surgeons’ opinion;
The Unfocused Patient – They are not really sure what they want. Often stating
“You are the doctor, you know what to do.” If they are unable to express their concerns
preoperatively and you operate, you may not achieve their goals. Sometimes, the patient’s
inability to express their goals is due to someone else motivating their surgery.
Being aware of these personalities is important and will hopefully
avoid situations that fail for both the patient and surgeon. Delving
a little deeper into the history of patients from other doctors will provide the answer. Gather
your data, ask more questions, request all of the records, evaluate preoperative photos closely,
obtain imaging studies when needed and pick up the phone and call the operating surgeon.
You will be surprised at what you’ll learn. Moreover, be honest with yourself and your abilities,
be comfortable with the procedure, don’t operate outside your means, and be aware of patient
nuances so that you can avoid being the “other surgeon” your patient talks about to
a competitor.
References:
Adamson PA,
Chen T. The
Dangerous Dozen –
Avoiding Potential
Problem Patients in
Cosmetic Surgery.
Facial Plast Surg
Clin N Am 16
(2008) 195-202.
Tobin HA. What
Makes a Patient
Unhappy. Facial
Plast Surg Clin N
Am 16 (2008)
157-163.
Blackburn VF,
Blackburn AV.
Taking a History
in Aesthetic
Surgery: SAGA –the
surgeon’s tool for
patient selection.
Journal of Plastic,
Reconstructive &
Aesthetic Surgery
(2008) 61,
723-729.
*Presented cases have
been altered to protect
the identity of patients
29
September 21-22, 2013
Tulsa Surgical Arts
Tulsa, Oklahoma
A
Innovations in
esthetic Breast Surgery
Learn from the best
Over 10,000 cosmetic surgery procedures and 3,000
breast augmentations.
Become the best
Perform advanced procedures.
Address the most challenging complications.
• Ten live breast surgery cases from basic augmentation to
simultaneous mastopexy and implant exchange
• Procedures using the newly approved form stable implant
• Insights on patient selection and managing complications
Deliver the best outcomes
Apply the latest in breast to your practice.
Register today at:
cosmeticsurgery.org/education/2013_aestheticbreastworkshop.cfm
For more information contact LaTanya Morris at
lmorris@cosmeticsurgery.org or 312.981.6775.
737 N. Michigan Avenue
Suite 2100
Chicago, Illinois 60611-5641
cosmeticsurgery.org
N
ews & Notes
The American Academy of Cosmetic Surgery,
American Society of Cosmetic Laser Surgery,
American Society of Liposuction Surgery, and the
American Society of Hair Restoration Surgery would
like to welcome the following who have been recently
approved for membership. Congratulations and
welcome to the AACS community! To recommend a
colleague for membership, please contact Khai Huynh
at 312.981.6767 or khuynh@cosmeticsurgery.org.
AACS ASSOCIATE
Barnett Edward O’Dell, MD
AACS COSMETIC MEDICINE AFFILIATE
Jong M. Kim, MD
Christopher L. Hankins, MD
AACS INTERNATIONAL
Ernesto Ceballos, MD
Submit an Article
Surge is dedicated to bringing you the latest news
and information about AACS members and cosmetic
surgery. Each issue of Surge features articles on
procedures, technologies, current news, member
activities and updates. We encourage you to submit
articles, news or other items of interest. Submissions
may be sent to Charles Simpson at csimpson@
cosmeticsurgery.org. Questions? Call 312.981.6771.