Marit tells Kati about her concerns

Kati makes recommendations & Marit reacts to consult

1. What age is the “right age” to begin aesthetic procedures?
We at FUZION opt to reserve the right to refuse treatment to any person who is not physically or emotionally mature. It is not necessarily about a specific age, but it is preferred to operate on legally consenting patients who are physically mature. If a professional chooses to operate/perform an aesthetic procedure on a minor they must consider how that procedure will impact growth or future physical outcome. We have already established in previous blogs that there are plenty of teenagers who have moderate facial wrinkles. This is caused by excessive photodamage (tanning) or pure genetics. The most popular adolescent cosmetic surgery is rhinoplasty (“nosejob”), now I ask you, would you make your child suffer the taunting of other kids until they are 18?

2. Is the patient in front of you psychologically sound to undergo the proposed procedure(s)?
Each Board Certified Plastic Surgeon/ medical professional (like me, I’m a Certified Physician Assistant) is fully trained in psychologic evaluation. It is important to seek out medical professionals for your aesthetic procedure. During a consultation each patient is physically and psychologically evaluated. We screen for conditions including body dysmorphic disorder, anorexia, psychotic illness, histrionic or other personality disorders. If a prospective patient displays signs of these, or a number of other diseases, they will be referred to a mental health professional. Dr. Goodkind and I have many professional relationships with excellent mental health providers. It is never to be taken as a sign of disrespect if you are referred, it just means that we are concerned enough to take care of you. Remember, “DO NO HARM!”

3. Is the patient aware of the risks?
The risks of ALL procedures are thoroughly discussed as part of the informed consent process. If the patient doesn’t verbally express understanding the plan is thwarted. It is a huge responsibility, and a goal of ours at FUZION, to make sure that you, as the patient, are fully educated and understand all aspects of each procedure.

4. Do the desired effects outweigh the risk?
Example: if a patient asks for extraordinarily large breast implants, but we know that they will be too large for her small frame then she will be risking infection, delayed healing, increased risk of rupture, chronic pain and muscle imbalance of her chest wall. These risks outweigh the benefits and therefore would not be appropriate. We don’t like to trade one problem for another.

5. What are the longterm implications of these procedures?
We need to evaluate what these procedures mean for a patient’s future – example: when silicone  is injected into someone’s face it is permanent. As that person ages, the silicone may not appear natural – it does not age as they do and therefore makes them look unnatural. We see plenty of examples of this in Hollywood, New York and Miami. It may be a desirable look to start, but it may not end up that way.

6. What is the patient’s motivation?
During the consultation a patient’s motivation must be clearly established. Why are they seeking surgical or aesthetic procedures? Are they doing it for someone else?  To save a relationship? To “cure” depression?  These are all examples of poor motivation and would be deemed inappropriate candidates for surgery.

7. What are the patient’s expectations and are they realistic?
To achieve a natural look and excellent results, one must have realistic expectations. Aesthetics is ALL ABOUT setting realistic expectations. I encounter this everyday. Dermal fillers, in the right hands, can provide amazing non-surgical results, but the results are subtle and certainly NOT surgical results. It is about technique, skill of the injector, choosing the appropriate product and of course the right patient. I often times have to disappoint people by telling them that they are more apporpriate surgical candidates than filler candidates. This is a perfect example of why people look unnatural: the wrong amount of the wrong product in the wrong patient… (Mickey Rourke, Meg Ryan, “Cat Lady“)

8. When is enough enough?
If your Aesthetic Professional tells you that you need to lay off procedures, or that the procedure will give you an unnatural appearance you need to stop! Or seek mental health assistance if you have become obsessive. No professional should risk their reputation, and future in the field for one bad outcome that could have been avoided. This is the sole reason that I refuse to give people “DUCK LIPS!” Subtle is always more attractive and believeable. You want to be yourself, just more detailed.

Who is to say that Heidi went too far?  Her surgeon was a Professional Board Certified Plastic Surgeon, who has a stellar reputation (Dr. Frank Ryan). She thought about the procedures for three years prior to going ahead with them. Dr. Ryan performed multiple consultations about her procedures and states that she thoroughly and repeatedly expressed understanding her risks. Just because we may not agree with her decision to seek a significantly more mature, and augmented appearance does not mean that it was unethical on the part of the practitioner. All in all, on a professional level his work was impressively done – much more natural than some other examples. We must consider that if Ms. Montag had chosen to have one procedure at a time we would think nothing of this, but since she had multiple minor procedures (fat transfers and BOTOX) at the same time she had multiple surgeries it has been  sensationalized in the media. Don’t forget who we are talking about, “reality star”, Playboy model (to come), aspiring singer and 1/2 of the ”Speidi” duo… It all has to be taken with a grain of salt – a very big grain of salt.

Tell me what you think! I would love to hear what you have to say about all of this.

-Kati

It has already been established that Botox injections can help the symptoms of rhinitis, which include a chronically runny nose, sneezing and congestion. German researchers, testing an alternative to injections, inserted sponges filled with Botox into participants’ nostrils for 30 minutes, and then had the participants keep a “nose diary” for three months.

Patients who received the Botox sponge treatment scored higher in all aspects of symptom relief than those who did not, leading researchers to believe that this could be an effective implementation.

Experts are now showing that the minimally invasive application method of BTA (botulinum toxin A) with a sponge is a safe, painless method which can lead to a long lasting reduction of nasal symptoms. This is one area of intervention beign further investigated.

The anatomy of the nostril is different than that of the forehead and other areas where Botox may be used for cosmetic purposes, so the potency of the sponge method is hard to predict in the aesthetic arena. However, those of us who are disinclined to opt for injections are hopeful that further research shows promise for wrinkle relaxation.

BOTOX, as an injectable, has been used effectively in the treatment of migranes, cerebral palsy spasticity, gastric emptying, strabysmus (cross-eyedness), peripheral neuropathy and depression.

We at FUZION have used BOTOX to effectively treat trigeminal neuralgia – a painful syndrome involving the facial nerve. This patient has reduced her required pain medicine from 16-20 pills per day to 4!

BOTOX is not just for beauty, but it is a beautiful thing.

I was honored to discuss Vitamin A based skin care with Dr. Fulton, the co-creator of retin A. Dr. Fulton is a genius when it comes to skin care and resurfacing. Needless to say, he has a wealth of knowledge and it was great to hear that we at FUZION are meeting his standards of Vitamin A based products. Cosmedix is a chirally correct (protein perfect) skin care system that is based on Vit. A, antioxidants, organically pure growth factors and PHYSICAL sunscreens. Dr. Fulton spoke about the importance of medical grade sunscreens that are physical NOT chemical. There are actually reports of those over the counter high SPF chemically based sunscreens CAUSING cancer because of the free radicals it creates upon penetration to the skin. Think about it, one molecule binds with another, but leaves an extra causing another free radical floating in your system. Watch the news for the latest studies coming out soon.

I also was priviledged to speak with Dr. Micheal Kane, the author, and leading expert, of “The BOTOX Book.” Dr. Kane is one of the most sought after speakers in the world of Aesthetic Medicine. He has been at the forefront of all neurotoxin (BOTOX and Dysport) studies and the micro-injection dermal filler technique. It’s a great concept. Instead of laying large amounts of filler in one area, to fix a specific wrinkle, use tiny amounts in surrounding areas to support the skin, thereby lifting the wrinkle. Think of it like pulling saran wrap over a bowl, pull it in one direction and you will create more of a wrinkle, pull it evenly in all directions and it lays flat. Just simple physics!

Dr. Tsekas was on hand to discuss fat transfers, and deep dermal fillers. I am thrilled to know that one of the US top docs in injectables approves of how we do things, and likes our philosophies. He was able to share various techniques that will minimize bruising and maximize flow of product and fluidity of result. He is an artist in its truest form.

Last but not least, there was a consortium of laser experts. They all agreed that the latest and greatest intervention for acne scars, burns, wrinkles, skin laxity, age spots and skin texture is CO2. Not all lasers are equal. The Fraxel re:pair CO2 won hands down for best results! Happy to say that FUZION is right there on the forefront of laser technology. There was also discussion of body scultping lasers. Smart Lipo MPX is still at the top. I asked the panel about non-invasive fat reduction systems, such as the Zerona and the consensus was that the science had not yet been proven. Bottom line, if you leave the fat in the jar when you are done – you know it has to be effective! Erica’s SmartLipo MPX treatment has left her inches smaller and counting!

I was honored to have been appointed to the Board of Directors of AAMEP. What does this mean for you, my patients? It means that I commit to staying up to date with all of the latest technology, practicing safe and legal aesthetic medicine and that I will work to improve the field. Did you know that in Europe Aesthetic Medicine is its own specialty? Tell me what you think…

Let me know if you have any questions on dermal fillers, BOTOX, etc!

KT