Sunday, June 1, 2014

#AAFPRS50 11th Int'l Symposium-Facial Plastic Surgery

May 27-31, 2014
MEDIA Breakfast Highlights

Last week, a very large international conference of plastic surgeons offered multiple panels on the latest trend and techniques for facial plastic surgery -sponsored by the Educational and Research Foundation of Facial and Reconstructive Surgery and the International Federation of Facial Plastic Surgery Societies.

A morning media meet featured a panel of four distinguished Plastic Surgeons: Edward H. Farrior, M.D., Ed WIlliams M.D., Anthony Sciafani M.D. and Jonathan M. Sykes, M.D.

Bad subway karma got us to the Marriott Hotel -the site of the conference-a tad late…but still in time for several comments-as  the well attended session highlighted several issues and realities we've written about in past posts…as well as offered up some insights as to how life changing, for the better, plastic surgery can be-and not just for the aging baby boomers not wanting a wrinkle-laden smile---but for the kids born without ears, or with facial deformities like cleft palates…victims of domestic violence , and returning veterans disfigured by the harsh realities of war…with free treatments provided by physicians via.FACE TO FACE 

Major Theme:

Fifty is the new thirty-seems to be the beauty standard these days in the USA-from the collarbone-up, anyway…with non-invasive, efficacious treatments-(no downtime, minimal- if any complications) -like Allergan's Botox (or its equivalent), injectable fillers, and subtle face lifts-targeted and full, and nose-Rhinoplasty/eyelid Blepharoplasty re-working… the top procedures requested.
image from AAFPR

All opt-in procedures by women and men---are seeing the average age of patients skewing younger---wanting to prevent visible signs of aging preserve youthful appearances... or correct a deformity-like overly protruding ears.

The impact of marketing without the science to back it up- by companies offering the latest in laser treatments and fillers (often used off-label, and not FDA approved-which is pricey---and served up by publicly traded companies who answer to shareholders -our thought))…and the influence of media-were refreshingly blunt topics discussed.

Let's face it (pun intended)-everyone's got a mortgage to pay off---or more pertinent here-an investment into purchasing a costly laser system-needs to earn back the $ layout-even when 4 years down the road, some other device-or technique- gets released- that may or may not perform better.

But that's not going to be a treatment option offered by a MedSpa or physician's office….with the bottom line being that consumers need to do their homework---when it comes to ultimately deciding what is best for them. And affordable too.

Products' evidence based science with comparative studies- were mentioned several times by all physicians on this panel-as lacking ---clearly a real help in deciding what is the best practice for a desired outcome.

An example mentioned - the heavily marketing Juvéderm's (a conference sponsor) Voluma® XC injectable gel-"the first and only FDA filler to correct age-related volume loss in the mid-face…" sold as lasting up to two years…which is about a year longer than other hyaluronic acid based fillers (that can be reversed-a big plus) or Radiesse®-all injected for the same mid-face volume/lift.

When we asked a Plastic Surgeon-about 6 months ago, what he thought of Voluma®-he shrugged his shoulders…and this panel also seemed to metaphorically arch an eyebrow -because-from what we heard- six syringes (YIKES) were use in the patients study- to test the time duration…which is more than is typically used for mid-face filling-so we thought. This seemed to imply that the duration was directly related to the amount injected---and as it's a commands a premium price in the market---really-raises questions about the cost benefit..though there is a time saving element here.

We have a gal pal who had Voluma® injected mid-face -in one area of her cheeks-who commented how she "needed" four syringes at $1000 per syringe to get a desirable result. This the first time she has ever had filler ---so it's an unknown- the amount/cost of competing product---- necessary to get the same results.

Still, $4000 is a serious chunk of change….works out to $20,000 for a decade's worth of lift. Geez.


The integrity and experience of Plastic Surgeons -who have years of additional training versus a dermatologist---or certainly, licensed (or not) spa employees… sited as one reason-and a rather compelling one-to opt for non-invasive treatments performed by plastic surgeons.

Interesting to us - the number of big-name Dermatologists who were presenting at the seminars over the course of this four day conference…on topics such as the pros of using fillers and stem cell loaded fat transfers (using the patients own-acquired by liposuction) vs plastic surgery to rejuvenate faces, and hair restoration.

Comments on the multi-cultural planet we live in-and the need for different techniques-and the changing aesthetic of what is 'natural' looking -sited…as was imo 'new normal' ---in this country, at least-on what is "realistic" aesthetically-varying by geographic region and influenced by what's on the screen-celebs, reality TV shows, the Internet etc.

An attendee recounted a family member's quest for -in her opinion---too much filler---not being satisfied with a more subtle look----when we thought the person telling the experience was overfilled in that Real Housewives kind of way. Beauty is certainly in the eye of the beholder.

The physicians all agreed that to under-promise and over deliver-(sort of)…is desirable-but also noted that potential customers can decide to find a doctor do to do what they want--even if another physician-declines. For these doctors-and we figure the overwhelming majority-the bottom line is to promise to do no harm (the Hippocratic Oath)…and that certain patients are not candidates for non-invasive procedures.

Future treatments on the horizon:

(1) longer lasting injectables and transdermal creams that perform like injectables-freezing/paralyzing muscles that cause wrinkles-by Revance Therapeutics…and Focused Cold Therapy™ by mioscience

(2) Cyrotherapy and other fat 'melting' techniques-(ultrasound, radio frequency) and injectables that shrink fat cells "a game changer" and widely available already here...

(3) Stem cell growth factors---from the patient's own body-(like fat---and not LaViv™-which no doctor present was a fan of -citing costs and involved procedural requirements)--- or made in a lab (we think of two popular products-SkinMedica®'s TMS and ReGenica®).

Summary-Plastic surgery and non/minimally invasive treatments for facial rejuvenation ---is a "quintessential marriage of art and science"---with evidence based data needing to become a reality.


PS: Having $ medical procedures-like hip replacement surgery-in cheaper overseas facilities-is a reality---and more and more Americans are opting for this consumer choice---if not flying to another state in the lower 48-to save money.

No doubt-same temporary migration is true for plastic surgery too---and given the international attendees at this conference (assuming-every physician is talented and experienced-who would even attend this conference in the first place)---we wonder if there is an authentic comparative price list/database available that includes overseas practitioners/procedures.