Virtually every day, I am inundated with email and “snail-mail” solicitations, advertisements, and marketing materials advertising the newest and greatest techniques in plastic surgery and rejuvenation. Early in my training, I took many of these as gospel truth – if a claim was made on paper and published in a reputable media source, then it must be accurate. If a senior physician said something and sounded knowledgeable when doing so, I always trusted this information. Unfortunately (or fortunately for my patients), this glossy veneer was first tarnished as a medical student. I was on my neurology rotation and a senior resident would teach us by asking questions and then giving us answers if we did not know them. He wasn’t the most pleasant fellow and was quick to point out our ignorance. When proffering morsels of wisdom, he was very authoritative and gave the impression that he was the Alex Trebek of neurology. One day, a fellow student looked up one of the syndromes that was the subject of a morning lecture and found that almost all of the information given by the resident was incorrect. From that moment on, I took everything he said with a large dose of skepticism and looked up the information myself. As a surgical resident, we often had Journal Club meetings when we would analyze various surgical studies that were published in the literature. It was as important to find flaws in the result as it was to understand the result itself. From these meetings, I learned to question even articles that were included in peer-referenced journals and considered to be the most unbiased source of medical and surgical information.
You may be asking, what is the point of all this?
The reason for this long introduction is to help convey the fact that you should not always accept things at face value, even if they involve a person of authority. Now I am not advocating that we should be obstinate and challenge everything. However, I am encouraging patients to be discriminating when seeking medical care, especially when it comes to rejuvenation or cosmetic surgery. I recently have seen some patients who have come from other providers with complications or dissatisfaction with previous treatments. While nobody can claim to be perfect or have a 100% satisfaction, some of the concerns that were raised by these patients troubled me. One patient had minimally-invasive facelifting procedure 2 years before seeing me. The type of procedure that was performed was not designed to lift up sagging neck muscles. The surgeon who performed the procedure did not explain this to the patient but instead advertised the smaller incision and possible shorter recovery. The patient came to me upset that there was no improvement in her neck and that she didn’t look any younger than before the surgery. I explained to her the type of surgery that was performed along with its limitations as well as how I would attempt to correct her current situation.
One of the other patients that I saw received several syringes of a filler to her cheeks at one time. She ended up developing a reaction to the filler which led to conspicuous facial swelling. While multiple syringes may have been the best course of action, in my opinion, it is prudent to start with one syringe (or two syringes at most) to see how you react to the product as well as to avoid an overdone look. While the chance of a reaction to the non-permanent hyaluronic acid fillers is quite low, it does increase with the amount of product that is added. It is not uncommon for patients like this to tell me that they felt that the amount of product recommended was excessive, but they didn’t want to seem like they were causing trouble and so said nothing.
The need for critical thinking or analysis applies to both patients and doctors, especially when looking at new technology or treatments. I have written previously on the amount of marketing that accompanies many new cosmetic procedures that emphasizes best-case scenarios and downplays any potential side effects or disadvantages. One example of such a treatment that I was recently evaluating is the use of Platelet-rich Fibrin, or PRF. This is similar to the “Vampire Lift” that has been around for several years that used Platelet-rich Plasma, or PRP. Both procedures involve taking your own blood, isolating the platelet fraction. PRP contains platelets, fibrin, and white blood cells that can contribute to wound healing, collagen production, and improved tissue elasticity. PRF has been described as the next generation of PRP and contains very high concentrations of white blood cells, fibrin, and stem cells that are found in our circulating blood. PRF becomes a gel when injected into the face and body to improve volume and potentially skin quality. It is commonly combined with hyaluronic acid fillers to help improve skin quality along with volume. It is often performed as a series of treatments every 1-2 months and the initial volume effect will disappear after 1-3 weeks. The longer-term effects may be noticed 3-4 months after treatment and may last from 6-12 months.
While PRF may sound like an attractive option, as it uses our own materials to help rejuvenate our skin, it is important to look at the details of the treatment. There are very few well-designed studies in cosmetic medicine to support many treatments. As a doctor, I like to place myself in the position of a patient and try to see if the cost of the treatment is justified by its benefit. When this treatment was presented on “The Doctors”, its advertised cost ranged from $500 to $1500 per treatment. If this is repeated for a total of 3 treatments for 12 months’ worth of improvement, then you may quickly approach the cost of a more invasive laser or surgical treatment, either of which will have more reliable and long-term results, albeit with a little longer recovery time.
Since there is little evidence to compare different treatments with each other, it is difficult to prove that one treatment is superior to another. Additionally, because these treatments are cosmetic and elective, there is a not a right or wrong answer. However, it is definitely important for patients to feel that they have a clear understanding of what is being done to them, what to expect in terms of recovery as well as results, and possible complications associated with the treatment. If you do not feel comfortable with a recommendation, then perhaps it might be best to wait until you do so or find a provider that you trust.