Aesthetic Society News4 Aesthetic Society News • Fall 2009 Since ASN began its Focus onPhilanthropy series, the Editors have seen a common thread among all the organiza-tions and

Quarterly Newsletter of the American Society for Aesthetic Plastic Surgery Volume 13, Number 4 Fall 2009Quarterly Newsletter of the American Society for Aesthetic Plastic Surgery Volume 13, Number 4 Fall 2009

INSIDE THIS ISSUE:

Founding MembersSee page 14

Aesthetic Society News

Image RebornFoundationSee page 4

Continued on Page 21

Auditing Your PracticeSee page 16

• An extensive collection of “ask a surgeon” and other videos that make theconsumer experience more immediateand friendly

• An enhanced “Find a surgeon” featurethat utilizes Google mapping, providinga map to your office location and, forconsumers doing geographic search, alist of ASAPS members within a tenmile radius; of course, prospectivepatients can still search by your lastname or zip code

www.surgery.org, the Society’s officialpresence on the web, has been given a totaloverhaul of content, structure and accessi-bility, now providing to both members andthe public an easy to navigate and richeruser experience.

Structurally, the “new” surgery.orgemploys a content management systemthat makes updating, search engine optimization and the inclusion of moreextensive video not only possible but anintegral part of our site. Among its newfeatures are:

Aesthetic SocietyOffers NewFellowship Program

By Jeffrey M.Kenkel, MD

In keepingwith our Missionof providing exemplary aestheticsurgery education,the AestheticSociety, through agenerous grant byEthicon-EndoSurgery, has

recently started its first program for an aestheticsurgery fellowship.

The need for more fellowships is clear toany of us working in an academic setting. In the United States, the sub-specialty of aestheticsurgery currently has many contributing special-ties, including facial plastic surgery, dermatologyand oculoplastic surgery. These alternative specialties have very well organized national fellowship programs and standardization, a processwhich is currently lacking in plastic surgery.

To address this issue, The AestheticTraining Taskforce, which includes Fritz E.Barton, Jr., MD, Mark A. Codner, MD,Gregory Dumanian, MD, Julius W. Few, MD,Bahman Guyuron, MD, Daniel C. Mills, II,MD, Norman H. Schulman, MD, Michele A.Shermak, MD, James M. Stuzin, MD, AndrewP. Trussler, MD and I, developed the followingcurriculum and criteria; it is our vision that standardization of the plastic surgery-based aesthetic or cosmetic fellowships will provide the

Aesthetic Society LaunchesNew WebsiteMember Blog to be introduced over next several monthsBy Mark A. Codner, MD

Continued on Page 7

Aesthetic Society NewsThe American Society for Aesthetic Plastic Surgery

The Aesthetic Surgery Education and Research Foundation

PresidentRenato Saltz, MD

EditorCharles H. Thorne, MD

Associate EditorJulius W. Few, MD

Communications CommissionerMark A. Codner, MD

Director of Marketing and Public EducationJohn O’Leary

Marketing ManagerKristin Murphy-Aviña

Manager, Marketing and AdministrationNew York Office

Erika Ortiz-Ramos

Manager, Media RelationsAdeena Babbitt

Communications ManagerJian Sun

Marketing AssistantJanet Cottrell

DesignVia Media Graphic Design

Statements and opinions expressed in articles, editorials and communications published in ASNare those of the authors and do not necessarilyreflect the views of ASAPS or ASERF. Publishing of advertisements in ASN is not a guarantee, warrant or endorsement of any products and services advertised.

Send address changes and membership inquiries toMembership Department, American Society forAesthetic Plastic Surgery, 11262 Monarch Street,Garden Grove, CA 92841. Email [email protected]

Co-sponsored/Endorsed Events 2009 – 2010

October 23, 2009

ASPS/ASAPS SymposiumSeattle, WAContact: ASPS at 847.228.9900

November 29 –December 3, 2009

5th World Congress of IPRAS New Delhi, India Contact: Conference SecretariatTel: [email protected]

December 4 – 6, 2009

Aesthetic Plastic Surgery: TheNext GenerationWaldorf Astoria New York, NYEndorsed by: ASAPS/ISAPSContact: Francine [email protected]

January 14, 2010

Third Annual OculoplasticSymposiumEndorsed by: ASAPS/ASPS/ISAPSContact: Susan [email protected]

January 15 – 17, 2010

27th Annual Breast SurgerySymposiumAtlanta, GAEndorsed by: ASAPSContact: Susan [email protected]

January 29 – 31, 2010

Expanding Horizons: NewParadigms in AestheticSurgery of the Face andBreastLas Vegas, NVCo-sponsored by ASAPS/ASPSContact: ASPS at [email protected]

February 11 – 13, 2010

44th Annual Baker GordonSymposium on CosmeticMedicineHyatt Regency,Miami, FLEndorsed by: ASAPSContact: Mary Felpeto305.859.8250

April 20 – 23, 2010

SPSSCS 16th Annual MeetingGaylord National Hotel &Convention CenterWashington, DCContact: SPSSCS at 800.486.0611spsscs.org

April 22 – 27, 2010

The Aesthetic Meeting 2010A Capital Experience with aGlobal PerspectiveGaylord National Hotel &Convention CenterWashington, DCContact: ASAPS 800.364.2147562.799.2356

ASAPSCalendar

© 2009 The American Society for Aesthetic Plastic Surgery

ASAPS Members Forum: www.surgery.org/members

ASAPS Website: www.surgery.org

ASERF Website: www.aserf.org

®®

The Aesthetic Surgery Education and Research Foundation

The American Society forAesthetic Plastic Surgery

2 Aesthetic Society News • Fall 2009

Cert no. SCS-COC-001528

In my first column for ASN (summer2009) I described to you how humbledand honored I was when elected to becom-ing the 41st President of The AmericanSociety for Aesthetic Surgery. I describedmy Brazilian background, my training inthe US, and how this bilingual and bicul-tural upbringing could play an importantrole during my tenure as your President.

I am pleased to report that manyprojects are moving forward to secure ourplace as the outstanding educators in aes-thetic surgery world-wide, including theexpansion of the Traveling ProfessorProgram to an International level. Thiswill allow our distinguished educators tobring their knowledge and wisdom toResidency Programs throughout the world.To mark this milestone, Past President andASJ Editor-in-Chief Foad Nahai, MD hasaccepted my invitation to become ourFirst International Traveling Professor.

Of course, hands-on observation isusually the best. With that in mind, we areplanning an International Visiting Resident/Fellow Program to allow young interna-tional colleagues to have the uniqueopportunity to visit ASAPS members andtheir practices in a casual, educationalenvironment. We are currently seekingfunds to support the program.

The success of the first ASAPSWebinar on practice management hasencouraged us to expand this new educa-tional venue. A second webinar,“Marketing on a Budget: Internal andExternal Marketing Strategies” was held onOctober 8 featuring Practice RelationsCommittee Chair Daniel C. Mills, II,MD, practice management consultantCatherine Maley and social media expertTom Seery. More than 300 members, candidates and residents signed up for thesession. More webinar programs are planned,including one specifically addressing theneeds and concerns of residents.

The Physicians Coalition forInjectable Safety under the leadership ofPast-President Mark Jewell, MD continuesto grow. Two more large Societies havejoined us: The American Society forDermatological Surgery and AmericanAcademy of Dermatology; the BritishAssociation of Aesthetic Plastic Surgeons

has also expressed interest in joining theCoalition, which now represents nearly40,000 Board-certified physicians. We arethe leading and largest group in the worldregarding patient safety and patient educa-tion in injectables.

The newly developed CosmeticMedicine Commission has set a big agendaand is already at work. Stay tuned for neweducational and practice managementactivities from this very active group leadby Commissioner Julius Few, MD.

Leadership recently held an ExecutiveRetreat in Huntington Beach, CA to planand continue to secure our mission andfuture. I thank all the participants for alltheir hard work during an intense fourdays and a very busy agenda. A few of theissues addressed by your leadership:1. Our Education Commission under

Commissioner Jeffrey Kenkel, MD hasquickly established a long-awaitedAesthetic Fellowship through a generousgrant from Ethicon Endo-Surgery, Inc.Please review the criteria and submit anapplication to host and teach future colleagues. The group also felt TheAesthetic Society has a lot to offer inResidency Education. In that regard Dr. Kenkel and I have reached out to theProgram Directors and offer our helpwith Aesthetic Surgery Training. Ourrequest was welcomed and I see greaterand unprecedented interaction that canonly benefit our future colleagues andthe Specialty.

2. I am pleased to inform you that a newfocus on residents and their relationshipwith ASAPS is taking place. In my view,it is key to capture these young individ-uals and prepare them for the toughcompetition outside the residency environment. Under the direction ofmember Clyde Ishii, MD, a full platformof opportunities is being developed forresidents for inclusion in the existingbenefits such as free attendance to theAnnual Meeting and free access to theAesthetic Surgery Journal. We are alsoremodeling the Residents Forum andeven considering a Resident Category in ASAPS. A resident-dedicated section at our website will include amessage board, job opportunity board,

access to online educational materials,notices about upcoming teaching courses/webinars for residents, etc. As part ofthese many outreach initiatives the committee has already placed six residents on various committees andsubcommittees.

3. The Communications Commissionunder the leadership of Mark Codner,MD has been quite busy. A new contractwith Sage Publications has been signedfor the Aesthetic Surgery Journal. I welcome the new Aesthetic SurgeryNews editor Dr. Charles Thorne andmy sincere thanks to Dr. Julius Few forhis excellent work as editor of ASN forthe past four years.

4. The Social Media Task Force is off andrunning. An incredible and savvy groupof young members and candidates isnow allowing us to communicate withmembers and the public throughFacebook, Twitter, etc. Drs. GaryBrownstein and Sanjay Grover and theirsubcommittees have done a terrific jobin three short months to position us inthe world of social media.

Your leadership continues with anincredible number of weekly committee callsincluding our new monthly Commissioner’scall that keeps the Executive Committeeand Commissioners aware of all the manyoutstanding projects and activities goingon at The Aesthetic Society.

We are very fortunate to have hardworking officers, board members, commis-sioners, committee chairs, committeemembers and staff working diligently foryou, the Society and the Specialty.

As I told you recently, this Society isvery unique and there is no other like it. Itis made of “servants!” I could not be moreproud of the people I have been workingwith for the past six months.

Aesthetic Society News • Fall 2009 3

RENATO SALTZ, MD-

President’s REPORT


Since ASN began its Focus onPhilanthropy series, the Editors have seen acommon thread among all the organiza-tions and Aesthetic Society members whobegan them. From Dr. Louis Bonaldi andhis New Beginnings Program (ASN Spring,2008) to Dr. P. Craig Hobar and his LEAPFoundation, (ASN Summer, 2009) theseorganizations were conceived to meet amedical and spiritual need and are spear-headed by excellent surgeons with a com-mon thread of humility and public service.

In my opinion, one member whoexemplifies these qualities is our currentPresident Dr. Renato Saltz. In Septemberof this year, his Image Reborn Foundationcelebrated its tenth anniversary of address-ing the emotional needs of women recov-ering from breast cancer. Image Rebornholds weekend retreats for survivors thatfeatures, according to the organization’swebsite: “Education: opportunity to visitin a small group setting with healthcareprofessionals regarding available treatment,including conventional and integrativeapproaches, Nutrition: a positive and delicious approach to food, Exercise: gentlemovement and stretching specificallydesigned for women with breast cancer,Journaling: instruction on how to utilizejournaling to enhance life, MassageTherapy: light professional massage forrelaxation and pampering, and RejuvenationTime: private time to allow for rest, contemplation, or whatever each individualdesires.”

Many of us who maintain both reconstructive and aesthetic practices seeevery day the emotional turmoil breastcancer survivors endure—Dr. Renato

Saltz did something about it. Inorder to learn more about the beginningsof Image Reborn, I have asked several close colleagues of Dr. Saltz to share theirobservations:

All of us who know Renato were notsurprised when he saw a patient in needand decided to do something about it. As

Dr. Thorne commented above, many of uswho do or have done reconstructive breastsurgery see women who are not comfort-able discussing their emotional turmoileven with their closest family members and friends. This is perhaps even more pronounced in conservative or smallercities where outside resources may not beavailable or people “just don’t talk about”such personal issues.

As I remember the story, Renatowanted an option for these women wherethey could completely focus on their ownneeds—not worrying about children, family or work responsibilities.

This year, at the Annual ImageReborn Foundation fundraising gala, welearned that 1700 women had gonethrough the program, at absolutely no cost to them. It was obvious to anyoneattending the event that these women haveformed special and close bonds, as one ofthem said “I could look into the eyes of aperfect stranger (I met at the retreat) andknow that she completely understood theworry I had that I might not see my

daughter graduate from high school, college or get married. Attending theretreat changed my life.”

This was my first Image Reborn galabut it won’t be my last. I am humbled byboth Dr. Saltz for starting the program andto all of the breast cancer survivors whoattend them.

Felmont (Monte) Eaves, III, MDDr. Saltz’ enduring vision and com-

mitment to the mission of a foundation to help breast cancer survivors recover epitomizes the ASAPS spirit of communityservice and philanthropy. His amazingconcept, coupled with his passion for helping others has improved the lives ofcountless women. Dr. Saltz was the firstrecipient of the ASAPS CommunityService Award in 2006. The Image Rebornmodel is something that other ASAPSmembers can clone within their own communities to help women recover frombreast cancer.

Continued on Page 5

FOCUS ON: Philanthropy

Image Reborn Foundation Celebrates 10 Years ofHelping Women Recover From Breast CancerBy Charles H. Thorne, MD

Image Reborn receives a $30,000 check at the September gala.

Mark L. Jewell, MDDr. Saltz doesn’t just speak about

giving back to the specialty and to thecommunity. He has actively done this inmany ways. The best example is his ImageReborn Foundation. His dedication to this philanthropic endeavor should beapplauded by all.

Robert Singer, MDPlease join me in congratulating all of

the women who have gained strength andcamaraderie from attending the imageReborn Retreats and Dr. Saltz for offeringthem this important opportunity.

Dr. Charles H. Thorne is an aestheticsurgeon practicing in New York City, Editorof ASN and Chair of the Society’s PublicEducation Committee. Felmont (Monte)Eaves, III, MD is an aesthetic surgeon prac-ticing in Charlotte, NC and President-electof ASAPS. Mark L. Jewell, MD practices inEugene OR and is a Past-President of theSociety and Chair of the Physicians Coalitionfor Injectable Safety. Robert Singer, MD,practices in La Jolla, CA and is a PastPresident of ASAPS and is a Trustee ofAAAASF.

Image Reborn FoundationContinued from Page 4


Flavia and Dr. Renato Saltz at theImage Reborn gala


Continued on Page 7

Walk Towards the LightWhat’s the best part of traveling? The

food,the sights, the people you meet? I agree, all of these are highlights, but

I think the best part is discovering, onceagain, that the human experience is thesame, the whole world over. And while it iscliché, I was reminded of it again on theASAPS/ASPS Greece-Turkey Cruise eventthis last June.

The entire trip was so memorable—from the outstanding CME put togetherby Drs. Kenkel and Fisher, the ancientruins at exotic ports of call, the great new plastic surgeon friends I was able tomeet— and the shopping. (I think I was inshopping heaven.)

There were trinkets and souvenirs atevery port. One port even had a cobble-stone road called the street of gold, whichwasn’t a reference to the pavement. Thehand loomed rugs were at every corner,and then there was the jewelry. Heaven.The vendors cried out to us from all direc-tions—whether the plaka in Athens, theagora in Ephesus, or the spice market inIstanbul, they were, literally, in our faces.These people know how to market theirwares and they know how to sell. They’vebeen at it for thousands of years. Perhapsthey were too aggressive at times, but theywere going to get the sale if they could.The aspect that blew me away though, wasthe market for imitation luxury brands.No worries of the police raiding your fakepurse party here. And no need to wonderif it is genuine Rolex-nope, as you can seeby the photo, it is a Genuine Fake.

You Get What you Pay ForWhy do people buy a fake Rolex?

Price, obviously. Is there a difference in theproduct? Yes, obviously. The fake will last afew months and either fall apart or stopworking. The real one will outlast all of us,and probably end up being excavatedthousands of years from now, like the ruinsat Ephesus. I wonder what the 24th

century tourists will think we did with ourtime if our watches were so extravagant. So why even spend a cent on the cheapimitation? It’s the Brand, obviously. Weknow what we are getting without askingquestions. They have been so successful increating their quality product and thebrand Rolex, that everyone imitates them.And everyone wants one. “I’ll take three,thank you.”

Faux SurgeonsThe weather on the Aegean Sea in

June is my definition of perfect, not justmildly hot, but seriously hot, between 95°and 100° most days. The field of cosmeticplastic surgery is just as hot. Not just a little popular, it is Santorini hot (and trustme, this is the sweet spot of hot.) We areit, the real plastic surgeons—the problemwe are facing is the knock-off docs whowant to be us, and compete with us andsell a genuine fake facelift. The public does

not know our brand well enough to knowthe difference. They think they ARE getting the real thing, and it is too lateafter the fact. It is one thing to buy a fakewatch in the plaka in Greece, it is quiteanother to think you are getting a realplastic surgeon and later find out, yourdoctor is an emergency room physician ora cosmetic skin specialist doing surgery.This is not just trademark infringement,this goes against our own professionalHippocratic Oath, “first, do no harm.” It seems obvious (to us) that if you are nottrained in plastic surgery, you should not do it. But when money enters theequation, even the most level headedphysician—but not plastic surgeon—cancome down with a type of heat stoke called money fever. It is terminal whenthey hang out their faux surgeon shingle.

Genuine Fake Watches for sale atASAPS/ASPS Biennial Cruise MeetingBy Anne Taylor, MD


Raise the Bar—Back to thewatches

The fake one looks like the real one.(don’t look too closely, though.) How doyou measure quality? The fake one doesn’thold up or have a warranty, or anyone tofix it when it breaks. A real Rolex is a quality piece of workmanship, with a vendor who knows what to do (when thereare complications,) if it breaks.

With this as our example, we need tobe providing the very best quality for ourpatients. We must continue to demandexcellence of ourselves, as well as adheringto the Hippocratic Oath: “First, do noharm,” must be your first thought after apatient asks you to do a procedure that iscurrently outside your scope of practice.We cannot be masters of everything. It’sOK to admit this. The right thing to do is to refer that case to a colleague who does have this expertise—or if you arecommitted to learning the new procedure,visit a colleague in another city who doesit. Read the textbooks and journals. Go tothe meeting and take the course. Commit.Just dabbling at a new procedure is riskyfor you and the patient.

As plastic surgeons we are trained tothink and learn to solve surgical problems.We are continually learning after residency.Our five plus years in as surgical residentsare the foundation for our lifelong learn-ing. But operating on a patient demands alevel of professionalism which includes notdoing a case that you don’t have any busi-ness doing. And if we hold ourselves tothis standard, then we can legitimately calla foul play when a patient comes to usafter the ob/gyn has done a facelift andthere are problems. Taking the next step iseven harder. We should counsel thepatients to contact the state’s medicalboard, the better business bureau and theTV stations. We need to speak up for ourpatients sake—”buyer beware” shouldnever apply to surgery.

Tea in TurkeyWe are the real plastic surgeons, so

some find it unbecoming to market ourselves. But we must if we are to succeedin this century, just as experts in other

fields did 3000 years ago too. It does notneed to be tacky or tasteless. The secret isto make an emotional connection withyour potential patient.

In the rug district in KushadasiTurkey, they serve you a cup of tea and apastry while they first educate you on theintricacies of making hand crafted rugs. By the time they are rolling out theirhandiworks, you are their personal friend,having a bite together, and the credit cardis out, even though you have wall to wallcarpeting at home. When the patient is in the office for the consultation, the connection must be made—either withtea, your dazzling staff or some othermethod. I serve coffee and buckeyes.

A little help from a friendAt the end of one of our longer bus

tours, our guide gave us his favorite storesand recommendations on dining. Done—close the guidebooks, we all had it, andwent to his “faves.” So much so, that it wascrowded at his picks while others, probablyjust as good, stood vacant. We should takethis lesson to heart as well, and improveour communication and outreach with ourreferral sources. A quick letter to anotherphysician keeps you “top of mind,” when a future patient asks “ who do you knowthat does…a facelift?” Being top of mindrequires work—letters, phone calls, attending meetings and tumor boards.This marketing is more effective than anymagazine or newspaper ad, and a heck of a lot less Turkish Lira.

The ASAPS/ ASPS biennial cruisenow holds the distinction as my favoritemeeting, and I plan on always attendingfuture cruise “meetings.” Who could askfor more? CME, venue, quality time spentwith family, and friends both old and new-the friendships, not the friends. Ontop of that, the marketing lessons learnedhave already been applied. That is a genuine deal.

Anne Taylor, MD is an aesthetic surgeon practicing in Columbus, OH, andan ASAPS member.

Genuine Fake WatchesContinued from Page 6

• Extensive linking: we currently havemore than 23,000 links externally andinternally to our site.

In keeping with our educationalmission, surgery.org now has the capability to develop a library of pastmember webinars, provide a smootheruser experience for our online educa-tional videos and allow members to bothregister for the Aesthetic Meeting, 2010and pay membership dues online.

Member Blog in theworks:

The new site, in addition to featur-ing links to our Facebook and Twitterpages, will soon have its own “blog.”Providing all members with an opportu-nity to answer ask a surgeon questionsin real time can comment on othermember’s suggestions.

“The member blog will give allASAPS members an opportunity to test the waters of social media in a safeand controlled environment,” said Sanjay Grover, MD, Chair of the blogSub-Committee and a member of theElectronic Communications Committee.“This is a ‘closed’ blog, meaning thatany entries from the public will be carefully reviewed before appearing onthe Aesthetic Society blog. Of course,individual member attacks, superfluouscomments or so-called ‘Dr. Reviews’ willnot be tolerated,” he added.

I urge every member to review and send us your comments on the new website. Increase our web presencecan only benefit both patient referralsand spreading accurate and factual information on patient safety in aesthetic surgery.

Mark A. Codner, MD is an aestheticsurgeon in Atlanta and Chair of theSociety’s Communication Commission.

New WebsiteContinued from Cover


The past several months have beenbusy for the Coalition (injectablesafety.org),a group comprised of the American Societyof Ophthalmic Plastic and ReconstructiveSurgery, the American Society for AestheticPlastic Surgery, The American Academy ofFacial Plastic and Reconstructive Surgery,The International Society of AestheticPlastic Surgery, The American Society ofPlastic Surgeons, The Canadian Society forAesthetic Plastic Surgery, The InternationalFederation of Facial Plastic Surgery Societiesand the American Society for DermatologicSurgery. Our group, whose mission is toeradicate the importation of off-shoreinjectables, provide public education forconsumers and clinical education forphysicians, represents a collaboration ofcore specialties united for patient safety.

Coalition Collaborates withELLE on injectable survey

Recently, through collaboration withthe beauty magazine Elle, the Coalitionconducted a consumer survey on the use of cosmetic injectables, reasons for nothaving a cosmetic injection and what safety measures were taken by theproviders of injectables. The survey wasdistributed to the ELLE Inner CircleReader Panel, a group of consumers thepublication uses for testing and research.The survey, conducted by MRI Interactive,had a 15.4% response rate. The results,which will be published in a future editionof ELLE, included the following:• Nine percent of respondents have

received a cosmetic injection to treatfacial wrinkles or improve appearance

• 49 percent have not received injectionsbecause they don’t think they need themat this time

• However, three out of four respondentsmight consider injectables in the future

• Botox Cosmetic, Restylane andJuvederm composed the lion’s share ofinjectable products received

Roger A. Dailey, MD

UPDATE ON:

• Three out of four respondents receivedtheir injections from a plastic surgeon(including oculofacial and facial plasticsurgeons) or a dermatologist

• 66 percent of the respondents whoreceived injections are likely to have afuture treatment

The full results of the survey can beseen at our website, www.injectablesafety.org

American Academy ofDermatology Joins Coalition

The Chair of our Coalition, Dr. MarkJewell, has been the driving force behindour project which began with a handshakebetween ASAPS, my organization, ASOPRS and the AAFPRS. From thesehumble beginnings we have grown to be areal force in the patient safety arena and amodel for inter-specialty relations. Markrecently informed us of the desire of theAmerican Academy of Dermatology to joinour group. We are, of course, delighted tohave them and now the Coalition repre-sents more than 37,000 board-certifiedphysicians committed to patient safety.

To those of us who were part of theCoalition from the beginning, this is anamazing achievement. Speaking on behalfof the Oculofacial plastic surgeons, we are delighted to be a part of this effort.Speaking for myself, I would like to thank the editors of ASN for allowing me to report on our activities to yourmembership.

Roger A. Dailey, MD, FACS is an oculofacial plastic surgeon in Portland, OR, aPast President of the American Society ofOphthalmic Plastic and ReconstructiveSurgery (ASOPRS), and a Professor and theholder of the Lester T. Jones endowed chair atthe Oregon Health and Sciences University(OHSU) in Portland. He is also the directorof the oculofacial plastic surgery training fel-lowship at OHSU.

September 27, 2009

Women’s Health Report:Change your life

BEAUTY: CHECK OUT A CATALOG OF WRINKLE CURES

If you get injections to help erasewrinkles, or you’re thinking about it,check out injectablesafety.org. Thiswebsite was set up by the PhysiciansCoalition for Injectable Safety, agroup of plastic surgery organiza-tions, to give consumers the latestunbiased info on dermal fillers.

The site lists 17 brands ofinjectable cosmetic treatments—including Sculptra, which is newlyapproved by the Food and DrugAdministration—and explains theirpurpose, cost, duration, side effectsand complications.

For the best results with the leastrisk, choose a board-certified plasticsurgeon or dermatologist who personally administers the injectionsin a medically equipped office. And be sure the injectable is an FDA-approved brand name, not ageneric.

The Physicians Coalitionfor Injectable Safety isgetting noticed by thenational press for theservice it provides to consumers. The followingstories ran in, respectively,USA Weekend and theNew York Times

The Physicians Coalition forInjectable Safety

Continued on Page 9

WEEKENDM A G A Z I N E

September 24, 2009

Fill in the Blanks First By CATHERINE SAINT LOUIS

INFORMED choice is crucial asSculptra Aesthetic, a filler made ofPoly-L-lactic acid, joins the crowdedinjectables market. Sculptra lastslonger than other wrinkle fillers and isused by doctors to restore broad areasof volume loss like sunken cheeks.

Seek out an injector who has expe-rience with an array of fillers, includingSculptra, to ensure that the rightinjectable is matched to your specificproblems. A consultation should coverfat transfer, since, like Sculptra, it canalso address extensive facial volumeloss. That procedure entails harvestingyour fat through liposuction theninjecting it in your face.

A list of questions to ask is availableat www.injectablesafety.org. At thevery least, ask the following:

What’s your core training? A plasticsurgeon or dermatologist certified withthe American Board of MedicalSpecialties is the gold standard. Checkat www.abms.org for verification. Afacial plastic surgeon certified by theAmerican Board of Facial Plastic andReconstructive Surgery is also qualifiedto administer anti-aging injectables.

Do you regularly provide dermalfiller treatment? A doctor with a thriving injectables practice uses thema few days of the week. But sinceSculptra Aesthetic is new, a few times a month is the bare minimum, said Dr. Karol A. Gutowski, the chief of plastic surgery at NorthShore UniversityHealth System in Illinois.

What’s your policy if complicationsarise? Doctors should discuss the benefits and risks of injectables duringconsultations. In the event of complica-tions, ask how certain problems wouldbe handled. Best to get a sense of theirpolicy before treatment.

Injectable SafetyContinued from Page 8

Aesthetic Surgery Journal, the Society’speer-reviewed, indexed publication, is proudto announce the retention of SagePublications as the new publisher for ASJ.

The decision to change publishers isthe result of a nearly year-long search,involving an extensive RFP Process, personal interviews of four finalists and aunanimous recommendation by thePublications Committee to the AestheticSociety Board of Directors.

Sage, a privately owned company with headquarters in Thousand Oaks CA,London, Singapore and New Delhi, offersmany advantages that ASJ will be able toutilize, some immediately. Among them are:

A Robust and Forward Web PresenceSage utilizes the Highwire Press plat-

form, a Division of the Stanford UniversityLibraries, which is considered the goldstandard in online journal publishing.This will provide ASJ with state of the artapplications used by such journals asJAMA, The British Medical Journal, and theNew England Journal of Medicine. Sage willbe developing a completely new websitefor us, featuring the ability to carry videoslasting anywhere from 2 to 20 minutes forseveral of the papers, the ability to rankcurrent and past articles as “most read” anda greatly improved search mechanism.

Highwire also has a program wherebyjournals that cite other journals on theHighwire platform are available to readersfree of charge. For example, if the journalAnesthesia & Analgesia were to site ASJ intheir publication, the reader would havefree access to both articles.

“I can’t stress enough how excitingthese online developments are for ASJ”said Editor-in-Chief Foad Nahai, MD.The new site will bring us into the twenty-first century and will debut with theJanuary/February 2010 issue.”

A new editorial management systemmaking submitting and reviewingpapers seamless and fast

Sage recommends that all of the journals in its family use the ManuscriptCentral™ online peer review system, whichallows authors, reviewers, and editors toelectronically access submitted manuscriptsand track them through the process. Prior

to this point, ASJ hasused EES, a propri-etary version ofEditorial Manager™

provided byElsevier. While EESwas certainly a reli-able and helpfulsystem that isemployed bymany journals,the proprietaryplatform laggedseveral versionsbehind the more up-to-date “open market” version of EditorialManager™ in terms of features and user-friendliness. With this conversion toManuscript Central™, we are confident that our users will benefit from a moreintuitive, interactive system with the bestfeatures available for peer review. We areconfident that this new system will aid infurther streamlining the time from submis-sion to first decision, which is an impor-tant part of ASJ’s promise to its authors.Sage (along with ScholarOne™, the parentcompany of Manuscript Central™) is offer-ing thorough training for our editorialoffice, members of our Editorial Board,our reviewers, and our authors in an effortto ensure that the transition to this newonline system will be smooth and seamless.

Targeted and ad sales and circulation promotion efforts:

Sage has dedicated ad sales and promotion personnel who will help tokeep ASJ revenue-positive and support ourpublication for the future. They also haveplanned attendance or presence at all ofthe major plastic surgery meetings, bothhere in the States and internationally.

The Publications Committee wouldlike to thank the outstanding contributionsof Elizabeth Sadati-Bernard in helping usthrough the publisher process.

Aesthetic Society members areencouraged to submit and to be on thelookout for the January-February issue of ASJ.

Alan H. Gold, MD is Chair of thePublications Committee and Immediate Past President of the Aesthetic Society.

Aesthetic Surgery Journal Names New PublisherBy Alan H. Gold, MD




Now that the Aesthetic Society has apermanent home in Garden Grove, CA,one of the most prized pieces of artworkon loan from the Penn family has also relocated to this new facility. The ‘BrenthurstClinic Tapestry,’ commissioned by the lateDr. Jack Penn (1909-1996) had hungproudly in the Communications Office ofthe Aesthetic Society in NY since 2001.His son and former President of ASAPS,John G. Penn, MD, offered the impressive6 ft. 6 in. high and 12 ft. wide velvet tapestry to the Aesthetic Society after retiring and closing his practice in WinterPark, FL.

The history of the tapestry is tightlyconnected to the late Dr. Penn, an inspir-ing plastic surgeon who founded and promoted programs, education, clinics andwritings featuring plastic and reconstruc-tive surgery. His early efforts were bestsummarized in the eulogy that his son,John wrote in the January 1997 issue ofAesthetic Surgery Journal:

[He]…established the BrenthurstMilitary Hospital (Johannesburg, South

Africa) during World War II, where thou-sands of servicemen were treated for burns,gunshot wounds, and other ravages of battle. [Also]… plastic and reconstructivesurgical service and caring for casualtiesduring the Israeli War of Independence in1948; traveling to Hiroshima and Nagasakiin 1956 to help care for and rehabilitatethe victims of the atomic bomb attacks on those cities; working with Dr. AlbertSchweitzer of Lamborene, Gabon, todevelop reconstructive techniques to rehabilitate people who had leprosy; andteaching and performing surgery in variousacademic centers in the US, Europe, andAsia.

Along with these great acts, Penn wasa prolific writer who developed the firstEnglish language journal of plastic surgery,the Brenthurst Papers, and authorednumerous articles and books. Like manyother plastic surgeons, he enjoyed art;though, his innate talents made him anaccomplished artist whose sculptures aredisplayed across his native South Africaand beyond.

It was this combination of art and science that led to the development of thetapestry back in the mid-1960s. In Penn’sautobiography, “The Right to LookHuman,” he tells the story of how hisfriend and local artist, Earnest Ullmannhad a severe heart attack and was broughtinto Penn’s Brenthurst Clinic when thenew wing was being constructed. The clinic was founded in 1950 with minimalfinancial support, but slowly became animportant part of the medical communityand set the standard for private hospitals inthe area. In an effort to bring Ullmann outof his tired and depressed disposition,Penn encouraged the artist, who createdrenowned tapestries with his wife Jo, tocreate original tapestries for each of thewards in the new wing.

This inspired proposal led to an effective psychological rehabilitation andaccelerated recovery for the artist and theresearch and creation of tapestries appreci-ated by patients and doctors alike. Theplastic surgery tapestry was the “master-piece” of the collection and was displayedin the main foyer. The idea that patient’srooms and recovery areas should be comfortable and be aesthetically pleasingwas the theme driving the design of thesewards, and eventually the tapestries themselves.

After the tapestry’s creation in 1966,Dr. Jack Penn wrote a description in theJanuary 1967 issue of the British Journalof Plastic Surgery describing it as a “trip-tych” or tri-panel work of art “depictingthe history of Reconstructive and PlasticSurgery.” There are six figures—(left toright) three historical and three modernperiod doctors holding or using “symbolicemblems relating to the various aspects ofthe specialty of surgery.” There is an ornatecenterpiece dividing the old vs. the newand everything sits on the BrenthurstClinic’s credo, “It is the Divine Right ofMan to Look Human.”

The Brenthurst Clinic Tapestry

Dr. John Penn points out detail in his father’s tapestry at the ASAPS open house.


The first historical figure is of anEgyptian surgeon holding the oldest surgical document, the Edwin Smithpapyrus. The second represents a HinduTile Maker, part of a caste in India 2,500years ago who commonly restored cut-offnoses (a form of punishment) with a razor—now called the “Indian Rhinoplasty.”The third person is Tagliacozzi, consideredthe “father of plastic surgery,” he publisheda treatise relating to reconstructive surgeryin 1597 while teaching at the University ofBologna.

On the modern side, there is a surgeondressed in a gown with gloves; the modernpatient, a symbol of beauty; and the modern nurse holding a bouquet of protea—named after the Greek God Proteus whocould change his form at will.

Separating the two eras are two treesin varying condition: one broken andwithered with the Aesculpian serpent onthe trunk, while the other has a graft andflowers beautifully. Representing the “causation of damage to external featuresand skin” are ruined symbols of aircraft,weapons, and industry. Flames surroundthe images with the Brenthurst Phoenixrising, symbolizing the many pilots whohad been “brought down in flames werelater to fly again” by the doctors’ efforts.

These powerful images tell the storyof the progression of plastic surgerythrough history and showcase the primaryobjective of every plastic surgeon—toimprove the quality of life for theirpatients. No other message could be moreappropriate for the members of theAesthetic Society who strive for excellenceand advancements in surgery every day.

On behalf of the staff and members ofthe American Society for Aesthetic PlasticSurgery, we thank John G. Penn, MD andhis family for their generous loan of theBrenthurst Clinic tapestry and for provid-ing us with the history of this artwork.

Chantix and Zyban to Get Boxed Warningon Serious Mental Health Events

On July 1, 2009, the U.S. Food andDrug Administration (FDA) announcedthat it is requiring manufacturers to put aBoxed Warning on the prescribing infor-mation for the smoking cessation drugsChantix (varenicline) and Zyban (bupro-prion). The warning will highlight therisk of serious mental health eventsincluding changes in behavior, depressedmood, hostility, and suicidal thoughtswhen taking these drugs.

Health care professionals who prescribe Chantix and Zyban shouldmonitor patients for any unusual changesin mood or behavior after starting thesedrugs. Patients should immediately contact their health care professional ifthey experience such changes.

Similar information on mentalhealth events will be required for buproprion marketed as the antidepres-sant Wellbutrin and for generic versionsof buproprion. These drugs already carrya Boxed Warning for suicidal behavior intreating psychiatric disorders.

Reports of ProblemsFDA’s request for additional warn-

ings is based on a review of reports submitted to the agency since the timethe products were marketed and on ananalysis of information from clinical trials and scientific literature.• Some people who have taken Chantix

and Zyban have reported experiencingunusual changes in behavior, becomedepressed or had their depressionworsen, and had thoughts of suicide ordying.

• In many cases, the problems beganshortly after starting the medicationand ended when the medication wasstopped.

• Some people continued to have symp-toms after stopping the medication.

• In a few cases, the problems beganafter the medication was stopped.

Neither Chantix nor Zyban containnicotine and some of these symptoms maybe a response to nicotine withdrawal.

People who stop smoking may experiencesymptoms such as depression, anxiety,irritability, restlessness, and sleep distur-bances. However, some patients whowere using these products experiencedthe reported adverse events while theywere still smoking.

“The risk of serious adverse eventswhile taking these products must beweighed against the significant healthbenefits of quitting smoking,” says JanetWoodcock, M.D., director of FDA’sCenter for Drug Evaluation andResearch. “Smoking is the leading causeof preventable disease, disability, anddeath in the United States and we know these products are effective aids in helping people quit.”

Additional ChangesIn addition to the Boxed Warning,

FDA also is requesting more informationin the Warnings section of the prescrib-ing information and updated informa-tion in the Medication Guide forpatients that further discuss the risk ofmental health events when using theseproducts.

Manufacturers also will be requiredto conduct a clinical trial to determinehow often serious neuropsychiatric symptoms occur in patients using varioussmoking cessation therapies, includingpatients who currently have psychiatricdisorders. FDA’s review of adverse eventsfor patients using nicotine patches didnot identify a clear link between thosemedications and suicidal events.

Chantix is manufactured by NewYork-based Pfizer Inc. Zyban is manufac-tured by GlaxoSmithKline, Brentford,Middlesex, United Kingdom.

This article appears on FDA’sConsumer Updates page, which featuresthe latest on all FDA-regulated products.

Date Posted: July 2, 2009

TapestryContinued from Page 6

UPDATE ON: Patient Safety


The Aesthetic Society Recognizes its 2009 CorThe Aesthetic Society sincerely thanks these companies for their continuehelping us achieve our educational and research mission.

Allergan Medical PresidentRobert Grant receives the ASAPSRuby Triangle Award.

Medicis Executive Vice President,Sales and Marketing, Vince Ippolitoreceives the ASAPS Sapphire Triangle Award.

Mentor Corporation’s Vice Presidentof Global Marketing and Sales,Brian Luedtke receives the ASAPSPlatinum Triangle Award.

Kamal Majeed, PhD, NexTechPresident, receives the ASAPSPlatinum Triangle Award.


Dennis Condon President and ChiefBusiness Officer of BioForm Medicalreceives the ASAPS Bronze TriangleAward.

orporate Supportersued support and for

Pictured presenting the awards are Immediate Past President Alan Gold, MD (left) and

Corporate Sponsorship Chair Al Aly, MD (right).

Jim Haney, Group Product Directorreceives the White Gold ASAPSTriangle Award.

Steve Parsons of Dermik, sanofi-aventis receives the ASAPS Gold Triangle Award.

Hani Zeini, Founder, President andChief Executive Officer of Sientra,receives the ASAPS Gold TriangleAward.


James B. Kahl, MDAs a founding member, Dr. Kahl has

plenty of stories about the history of theAesthetic Society and the many positionshe has held, but what sets him apart is hisbusy surgical schedule. At 77 years of age,he is still actively practicing plastic surgeryand researching new methods. Dr. Kahlmakes time for his patients and the localER; he plays a few rounds of golf a week;and catches the Bengals when they play athome. Lucky for us, he had time to sitdown with ASN.

Why did you choose plasticsurgery and who/whatinfluenced you the most in your career?

I grew up in Western PA and myfather was a general surgeon. He got meinterested in medicine and insisted that Igo into premed even though I really want-ed to be a history professor (he was right).When I finished my undergrad and wentto medical school I became interested inharelips, palates and burn treatments.

My first wife’s father was the firstplastic surgeon in Pittsburgh, so he furthered my interest in plastic surgery.Through my contact with him I got tomeet doctors like Robert Ivy, JamesBennett, J.B Brown, Peter Randall…etc.(some of the founding fathers of plasticsurgery) and that whetted my interest inplastic surgery even more.

I went into the residency program at theUniversity of Cincinnati with Dr. Longacreand Dr. Destefano. Yvo Pitanguy trainedthere and that’s how I got to know him.

Once Dr. (Jack) Longacre steppeddown as program director, I took over theprogram and did that for 25 years.

What I love about plastic surgery is

the variety—I saw my father doing thesame few surgeries over and over again. Icould do a hand case one day, then a breastaug, a facelift, facial fracture and so on. It offered opportunities for innovations,expressions, opinions and continuallyimproving results. My father, my father-in-law and Dr. Destefano were my biggestinfluences in plastic surgery. I got all threeof them to join ASAPS!

How did you get involvedwith The Aesthetic Societyand why?

In 1964 I finished my residency andwent directly into the Navy. When I gotback to Cincinnati, my partner, Dr.Destefano and a group of peers hadformed a travel club.

There were 20 or so plastic surgeonsand they would meet once or twice a yearand have meetings. It got a little moreinvolved as the years went on—(Doctors)Simon Fredericks, Tom Baker, John Lewiswanted to move forward with an actualsociety. In the big society meetings(ASPRS) it was always lips, palates, burns,trauma and no one wanted to give their(aesthetic) secrets away. So we thought,let’s have a group for aesthetics and discusshow we do aesthetic surgeries. The firstmeeting was in 1967 and we’ve all beenclose friends every since.

Did you know it wouldeventually become thelargest aesthetic plastic surgery organization?

We thought it would be 40-50 peoplebut the idea really caught on with the restof the membership. At first, some doctorsweren’t too happy with us, but they joinedin afterwards. We knew it was going to be agood organization and we were very selective.

Also, around that time ISAPS wasalso created and I got involved in that.When we started opening up these organi-zations to plastic surgeons who met therequirements, it just kept growing. I gotinvolved in a lot of other local and interna-tional groups, but I always loved attendingThe Aesthetic Meeting, giving courses andheading the residency program. I made allmy residents join!

What was your favoriterole or office held inASAPS?

I held a lot of offices between beingon ASAPS or ISAPS and while they wereall valuable roles and functions, I mostlyremember the experiences I had and theprograms that came out of them. We had ameeting on a cruise in the very beginningand I was treasurer at that point—it wasvery fulfilling to accomplish that (and itmight never happen again due to oursize!). It was all fun but it was very timeconsuming—we were able to get signifi-cant programs that were successful whichmade people who didn’t initially want toattend, to attend and then to join.

Who are the most difficultpatients and how do youdeal with them?

Patients want honesty and a doctorthat’s ethical. The most difficult patientsare those who have been misled by falseadvertising and ideas. A lot of other spe-cialties give different expectations andsometimes cause patients to anticipatesomething that can’t be achieved.

Personally though, I think the mostdifficult patients are children with birthdefects. The parents always feel guiltyabout the deformity—they feel like theydid something wrong. As a doctor, you letthem know that it’s not their fault but inorder to correct it, you’re going to have tomake an incision and that’s going to mostlikely lead to scars. You need to preparethem and tell them that it isn’t their faultand you will do your best with minimalscars and improving the deformity. It’simportant to give your patients the infor-mation they need to deal with the out-come.

What is your current schedule like?

I work five days a week in a solo prac-tice—surgeries in the morning and emer-gency room duties on the weekends. I dolipodissolve one afternoon for researchpurposes—I want to see if it’s a worthwhileprocedure.


FOCUS ON: Founding Members


For diamond perfect performance™

ACCURATE SURGICAL & SCIENTIFIC INSTRUMENTS®

ASSI® Breast Retractors are like Diamonds...Created for Performance

Crafted for PerfectionCut with Precision

...the way you do

ASSI •ABR 35826180x16mm wide blademolded handle, with fiber optic

ASSI •ABR 35426180x16mm wide bladewith fiber optic



ASSI •ABR 234932680x16mm wide blade,without teethwith fiber optic & suction

ASSI •ABR 218052680x16mm wide blade,with teethwith fiber optic & suction

ASSI •ABR 25926180x25mm wide bladewith fiber optic & suction

ASSI •ABR 27326150x16mm wide bladewith fiber optic & suction

ASSI •ABR 13726180x25mm wide bladewith 5mm endoscopic scope sheath, single stop-cock



ASSI •ABR 77026180x30mm wide blade,with 120˚ & 130˚ angles, with suction




accurate surgical & scientific instruments corporation800.645.3569 fax: 516.997.4948 west coast: 800.255.9378 516.333.2570

www.accuratesurgical.com

ASSI •ABR 38326180x25mm wide blade,without endoscopicscope sheath

©2008 A

SS

I®

That’s amazing, what areyou doing outside of yourbusy surgery schedule?

My first wife died in 2001 and a yearafterwards I went to my hometown for asurprise birthday party. A girl that I datedfor six years when I was younger cameback for the reunion and we ended up get-ting married. I hadn’t seen her for 49 years! She keeps me active and likes to playbridge, golf and go out. In 1974 I built ahome in the Dominican Republic and I dosurgery there for the children. That’s veryfun and rewarding. I play a lot of golf tooand we have as many friends there as wedo here in our home town.

You’ve achieved a greatdeal in your career—whatare you most proud of afterall this time?

In terms of my plastic surgery career,I’m proud of the residents and fellows I’vetrained in plastic surgery and the patients

I was able to help. Learning from my colleagues and developing good skills hasbeen very important. My friendships withmy peer group and patient relationshipshave all been great. I had helped somecongressman with surgeries and theythanked me by flying the flag over the USCapitol building in my honor a couple oftimes. Those moments meant a lot to me.

What about outside of yourcareer?

One of my grandchildren has a geneticdisorder Niemann-Pick Type C Disease(the build-up of cholesterol in cells result-ing in damage to the nervous system). AraParseghian, the great Notre Dame coachstarted a foundation for his three grand-children that died of this disease and hasraised over $30 million. I’m active in thiscause and held five charity golf tourna-ments in Cincinnati that have raised over$500,000.

What advice would yougive residents today?

I tell residents, you must maintainyour honesty and ethics, bridle your ego—have compassion for your patients andhave respect for your office staff and hospital personnel. It’s your responsibilityto hone your skills, teach, innovate andpublish. If you have the chance to meet anoutstanding surgeon, try to talk to themand learn something from them. Try newthings and report on them—this is how wemove forward in our specialty.

Also a specific word of advice: whenyou have a consultation don’t visuallyanticipate what the problem is—that couldget very embarrassing. I remember oncewhen I first started, I introduced myself tothis young boy and his parents then askedthem “I guess we’re going to talk aboutBobby’s ears?” His mom said “What’swrong with his ears? He’s got webbed fingers.” It’s best to just start out with“What are we going to talk about today?”

Founding MembersContinued from Page 14


Today’s economy has many practiceslooking at the bottom line. I regularly hearaesthetic surgeons say, “its never going toreturn to the way it was.” The reality is it shouldn’t. The past few years createdunrealistic growth, excessive mismanage-ment that resulted from easy money, andtaught us all (aesthetic surgeons and nearly every other business in a first world-society) to focus on money as the onlymeasure of health, growth or satisfaction.

One may be inclined to call anaccountant to audit your books in hopes of finding missing money. Instead, or concurrently, consider the value of takingthe time to audit the non-financial valuesin your practice and find where there are weaknesses that either threaten yoursurvival, or stymie your opportunities to thrive.

A non-financial audit is somethingyou should undertake to measure the stateof your practice, collect valuable data andimprove operations. Unlike a financialaudit, this is not tedious, nor is it an exercise to find blame for shortfalls. Unlikea financial audit, you don’t have to freezethe cash flow or operations for a period oftime and complete the exercise all at once.Take it in phases, review and update thosephases at the same time each quarter (or atthe very least each year) and along the waycollect data to trend, learn and grow.

Audit for quality improvement. Don’tjust consider an audit when growth ordown-sizing is on your agenda; at any time in your practice cycle look for costefficiencies, and consider the impact ofcompetition, future planning and newopportunities. The key terms to implementin your audit are value, objectivity, sincerity and teamwork.

Human ResourcesAuditing the people who work for

you is not as easy as performance reviews.As the business owner or leader:• Annually, have you had a complete

health review? • Do you have all the necessary insurance:

risk, key person life insurance, liability,accidental death, disability? If you don’tand something happens, will it put youout of business?

• Legally is your business/partnership planup-to-date?

Strategically, what are your goals—personally and professionally? Not onlymust goals be defined, but you must alsomeasure achievement, and critically reviewyour leadership and administrative respon-sibilities. Are you optimally productive oris your time heavily taxed with a burdensomeone else might bear? When defininggoals or reviewing productivity, rememberto define a balance between work andhome: don’t save your free time for retirement. You deserve a balanced qualityof life.

In terms of your entire team, all thosewho work for you, including you, there arebasics to review and keep up to date innon-financial auditing:• Emergency contact. If a staff member

has an accident or critical illness on thejob, who will you contact? Who do youhave permission to contact?

• Drug screening. Those who don’t have asubstance abuse problem don’t have anissue with drug screening. Regularlytesting the group can uncover a situa-tion that if left to chance, could result ina liability to your practice.

• HIPAA compliance agreements are abasic. Does every member of your staffunderstand that privacy is more than apolicy? A failure here could ruin yourpractice image.

Look at your administrative and service providers in terms of productivity,performance and dedication. Set goals,measure and, if necessary, set new goals.Review how the team performs together.Accept that the speed of the team is not

Auditing your Practice: Non-financial Variables to Survive, or ThriveBy Marie Czenko Kuechel



the only important factor; consider itsstress factor as well. For example, is a productive individual also one whose constant complaints stress others? Don’tthink it will go away. Look at it critically;if it comes up in an audit, it’s not criticism, it’s room for improvement.

MarketingThe questions and answers about

marketing are endless and this is likely themost dynamic part of your practice. Toaudit requires that you regularly and critically review your exposure, the messages you send, what it costs and thevalue that results. The bottom line is thatif your marketing succeeds in deliveringpatients to your door, it must not fail inachieving success with a captive audience.If this happens, it’s not the prospectivepatient’s fault; the blame lies in the messages you send.• Externally, you must look at the accuracy

and appropriateness of your content—every time you renew or revise, or placea message.

• Legally, as an advertiser, it’s your respon-sibility to know the letter of the law inyour state. As regulation changes, stayon top. Something as simple as boardcertification not clearly defined on yourwebsite or a directory listing could landyou in trouble.

• Consider how your market changes.Your message and how it is deliveredmust connect with your market today,and in the future. Anything in an electronic environment today lives onindefinitely. Don’t make costly imagemistakes.

• Measure your return. You could have thebest optimized site, and exist on the bestoptimized directories. But there existslittle or no value unless those “hits”translate to patients who remain loyal toyou and your services. The argumentthat patients don’t regularly respond toquestions like “where did you hear aboutus?” is lame. Don’t trust collecting thisinformation to a form; ask as a sincerepart of the initial consultation andlearning experience about this individ-ual. And track the trends not just the

vehicles, as the Google ranking stratumchanges faster than an escalator revolves.

• Internally, once you have that patient,critically review when and how you connect. There exists no value in overselling or losing touch with those whohave trusted you now and in the past.The messages, the means, the opportu-nities to connect change, but unless youregularly review those connections andthe response, you’re throwing darts inthe dark.

Service and ProductivityTracking who does what and in what

amount of time is essential. The providerwho is always 30 minutes late is not themagnet of patients who are all 30 minuteslate. Look at your practice as a whole: howmuch time is spent per procedure by theprovider and per administrator necessaryto complete the entire office visit, proce-dure, or course of treatment? Per provider,how much time is spent in treatment,administration, educating patients, or simply in training to keep up with the mostappropriate and innovative techniques?Don’t stop with those individuals who area direct revenue stream. Is your adminis-trative staff proactive or reactive and towhat issues? Are they task oriented?Consider the accuracy, repetition andredundancy of tasks. Look for opportuni-ties to review, change and improve. If youdon’t regularly review where the baselinestands, you have no measure from whichto improve—in terms or productivity orquality service.

Your patient’s satisfaction and loyaltyare also critical factors to service and productivity. If your practice offers cosmeticmedicine, or skincare, loyalty is a biggermeasure of your success than revenue. Asingle product sale without repurchase, asingle skincare or laser treatment withoutretreatment demonstrates there is clearly amissing link—whether over promising,underperforming or simply pushing toohard to make the original sale. Improvingon loyalty can be the single greatest non-financial variable that will result inimproved revenue.

SafetyThe firemen come through as

required and test your sprinklers, inspectyour extinguishers and review the path ofyour emergency exit. But there is more tothe safety of staff, patients and visitors toyour practice. If you don’t have emergencyplans and procedures to audit, put them inplace. Audit them regularly as key rolesmay change, and conduct drills regularly.If you have a storefront is it possible a carout of control could spin through yourwindow? If this happens, do you haveplans in place or will everyone be expectedto react? Consider plans and drills forweather incidents, accidents, and even violence. A drill does not mean you gothrough the actions, but as a team,rehearse, and audit. Look for the safest,most efficient course. Consider that in the recent past plastic surgery offices have been:• In a building with bomb threats• Next door to banks that were held up

with hostages taken• In the line of fire and forced to immedi-

ately evacuate in the middle of a busyclinic day without so much as the timeto grab the patient records and cancelthe day’s remaining appointments

Being unprepared in any of these situations is a critical event that could notonly jeopardize the safety of your practiceand people, but also the data, and the reputation that are your greatest assets.

For those who believe that a non-financial audit will be too stressful, or difficult to initiate today, and implementand continue with over time, heed thewords of General George S. Patton:“Pressure makes diamonds.” Every facet ofyour practice beyond your financial healthis a critical variable that may be diamond-hard to change, but can always use a littlepolish.

Practice Consultant Marie CzenkoKuechel is author of Aesthetic Medicine:Growing Your Practice and a frequent contributor to ASN. Her website isczenkokuechel.com

Auditing Your PracticeContinued from Page 16

Media Notes and QuotesA Sampling of current media coverage on the Aesthetic Society

Dr. David Rowe, a plastic surgeon,was operating on a patient when henoticed an unusual amount of bleed-ing. “The tissue was just oozing, andwe couldn’t figure out why,” heremembered, noting that the patienthad told him he wasn’t taking anysupplements. “After the surgery Iasked the patient, ‘Are you sureyou’re not taking anything?’ and hesaid, ‘Oh, yes, I’m taking this, thisand this.’”

In a paper published this year inthe Aesthetic Surgery Journal,Rowe listed about a dozen herbs thatshould be avoided within two weeks of surgery, including commonones such as garlic, ginseng and echinacea. Some increase bleedingand some affect the heart, and others interfere with anesthesia orother drugs.

Herbs, Vitamins that Can Hurt You CNN

August 20, 2009

In fact, laser treatment for spiderveins on the legs jumped to 133,192procedures in 2008 from 85,907 in2000, according to the AmericanSociety for Aesthetic PlasticSurgery. And that’s just countingwhat the society’s membership per-formed. Although both sclerotherapyand laser treatments are commonlyperformed to eradicate spider veins,there is some pain and up to eightweeks of healing time. Both treat-ments usually involve repeated visits.And there are no guarantees—spiderveins may return to a treated areaand there is no way to prevent newones from forming. Since spider veintreatments are considered cosmetic,they are rarely covered by insurance.

Removing the Web of Spider VeinsNew York Times

September 10, 2009

More than 350,000 women getbreast implants every year, making itthe most popular kind of plastic surgery. No surprise there. But a newstudy in Aesthetic Surgery Journalshows that most women still getsaline implants, despite the return ofsilicone in 2006 after 14 years off themarket due to safety concerns. Here,what’s most popular when it comesto implant type, size, shape andmore.

What Women Want (in a Boob Job)Health Magazine

September 2009

One month before 39-year-oldTiffany Barton got remarried, shedecided to plump up her lips. Therewas a “doctor,” Mario Nieves Perez,who made frequent visits to the hairsalon where she worked as a stylist-the BellaSera Salon in Fresno, CA—offering bargain injections ofRestylane for $100. (The nationalaverage is $500, according to theAmerican Society for AestheticPlastic Surgery.) “I saw the womenwith Gucci purses coming in to visithim, and it gave me a certainamount of confidence,” Barton says.After Perez showed her and herfiancé pictures on a website of whathe claimed was his work, she wentahead with the procedure. A monthlater, on the day of her Las Vegaswedding, she woke up with raisedred welts on her throbbing lips(which, thankfully, weren’t yetdetectable in the photos).

Plastic Surgery NightmaresMarie ClaireOctober 2009

Hope learned a classic plastic-surgerylesson the hard way: Cosmetic procedures, especially rhinoplasty,are not to be indulged in lightly. Theoperation, surgeons say, may be themost challenging and difficult of allcosmetic surgeries, and yet, accord-ing to the most recent statistics from the American Society forAesthetic Plastic Surgery, we nowundergo some 150,000 rhinoplastiesper year, and the American Academyof Facial Plastic and ReconstructiveSurgery estimates there are around40,000 do-overs annually. A certainpercentage require revisions, includ-ing small tweaking as well as bigoperations, says Jack Gunter, MD,professor of plastic surgery atUniversity of Texas SouthwesternMedical Center in Dallas. The statisticthats reported is 10 to 15 percentoverall.

Second ChancesElle Magazine

October 2009

Botox is a much cheaper alternativeto plastic surgery and has been seenas holding up well in a recession.Almost 2.5 million people got Botoxinjections to treat wrinkles in the U.S.last year, according to the AmericanSociety for Aesthetic PlasticSurgery. That’s almost a quarter ofall cosmetic procedures done in 2008,the group’s data show. In fact, Botoxshots and other non-surgical proce-dures have been keeping plastic sur-geons afloat in the down economy.While people are holding off on facelifts that can costs tens of thousandsof dollars, Botox shots cost an average of $443, according to thesurgeon’s group. “Every three or fourmonths, people come in: they feelgood, they look good and then theycome back,” says Dr. Renato Saltz,a Salt Lake City surgeon and presi-dent of the trade group.

Botox Shows Signs of StressPortfolio.com

August 17, 2009


The Aesthetic Meeting 2010

THE ANNUAL MEETING OF ASAPS & ASERF

A Capital Experience

with a Global

Perspective

April 22–27Washington, DC

Gaylord National Hotel & Convention Center

Optional Courses • April 22 – 26Scientific Sessions • April 24 – 27

Exhibits • April 24 – 26

Call for AbstractsSubmit Your Abstracts On-line by Sunday, November 1, 2009 • surgery.org/abstracts

Scientific Sessions • International Hot Topics • Research & Innovative Technology LuncheonE-Posters • Residents & Fellows Forum (deadline for submission January 22, 2010)


I was asked to contribute an article tothe candidate corner for ASN wherein Idescribe my most inspirational patient. Asnot one individual patient stood out asbeing more inspirational than another, I ofcourse Googled “inspiration” which hasmany meanings: “to heighten, to prompt,to revolutionize, and to breathe.” I wasthen able to reflect on my diverse practiceand identify a patient, however, with muchthought; I deemed it more meaningful topresent my most inspirational patient groupinstead: my breast reconstruction patients.

Breast cancer treatment has been alarge part of both my general surgery andplastic surgery training. It is a unique anddiverse patient population, which in generalare young, healthy, well-informed and stoicwomen. I feel fortunate to have experiencefrom both the oncologic and reconstructiveaspects of the treatment, and have incorpo-rated a significant amount of my formalaesthetic training into their management.This aesthetic application has pushed myreconstructive end-points and inspired meto think outside the box in the process.

My reconstructive patients do notwant just a breast mound; they want a natural appearing and feeling breast. Theydo not want one reconstructive option, theywant five. They do not want me to harvesttheir rectus muscle, they want DIEPs. Theydon’t want a silicone gel implant, theywant a cohesive gel implant. They don’twant an insensate flap, they want it neuro-tized. They do not want a small, flaccidnipple, they want one with projection.These requests have inspired me to expandmy reconstruction armamentarium andelevate the bar for reconstructive results.

The immediate breast reconstructionpatient on the first consultation presentswith the impossible task of deciding on areconstructive modality while still dealing

with the thought of an active oncologicprocess and the time crunch of makingdecisions in a very stressful time. I am constantly challenged in the communicationof the reconstructive goals and walking thepatient through their individual options.The majority are more demanding thanmy aesthetic consultations with multiplequestions gathered through extensive Internetsearches and the desire to see multiplephotographic reconstructive examples. Thedelayed reconstructive patient presentsalready battle weary and scarred from theirtreatment and presents an even more difficult reconstructive/aesthetic challengewith the effects of previous surgery andradiation. All of these patients have height-ened my response to individualize theirtreatment and offer the best reconstructivemodality for their breast defects.

One subset of patients that have beenextraordinarily challenging and inspirationalis the post-bariatric patient with breastcancer. These patients have significantamount of excess skin which can be utilizedfor autologous reconstruction. The experi-ence of body contouring after massive weightloss combined with our ever expandingknowledge of perforator blood supply tothese excisional areas has enabled us toindividualize each patient’s autologousoptions based on their body habitus andutilize the tissue best served for breastreconstruction: abdomen, inner or outerthigh, and buttock.

This has been the most interestingprocess in applying the advanced aesthetictechniques from our excisional experienceand combining it with the formal anatomicmapping of arterial perfusion studies to helpoptimize flap design and pedicle dissection.This process combined with a close atten-tion to the insetting and molding of theflap, as well as the aesthetic based donor

site closure has led to the delivery of anearly one stage reconstruction.

At this point the bravery of thesepatients is truly amazing as you get themthrough any adjunctive treatments theymay need. During the time after their firststage, their main concern is the timing oftheir implant exchange or flap revision,and not the ill-effects of chemotherapy orradiation. I have found that these patientsdo well with skin care and massage therapyduring the adjunctive treatment phase, aswell as Latisse™ for eyelash growth andBotox™ injections. Having these availableimproves the patient’s self esteem and yourrelationship with your patient.

Once through with their adjunctivetreatments, the safe delivery of reconstructiveprocedures is important, including address-ing hormone therapy and cardiotoxic chemo-therapy. My patients push me for excellencein their reconstructive process; I haveapplied adjunctive modalites such as fatgrafting, dermal fat grafts and laser therapy.

Through this long journey I feel thatthese patients are transformed and oftenmore friends than patients. Post-surgicalfollow-ups are more for catching up on ourfamilies rather than discussing scar care.My breast reconstruction patients are mypatients for life, and their family membersare now my patients. I would say thatthese patients have inspired me to not onlybe a better surgeon, but a better physician.I hope I have given my breast reconstruc-tion patients a chance to breathe new lifeafter their journey through their treatmentof breast cancer; I know that they havegiven me the gift of inspiration.

Andrew P. Trussler, M.D., is a board-certified plastic surgeon and Assistant Professorof the Department of Plastic Surgery at TheUniversity of Texas Southwestern MedicalCenter at Dallas.

ANDREW P. TRUSSLER, MD

CANDIDATESCorner

Desire to Inspire: My Breast Reconstruction Patients

Call for Grant Requests:The Aesthetic Society Education and

Research Foundation, through yourdonations and the careful planning andprudence of its Past Presidents and staff,now has the capacity to consider grantsrequests in any denomination.

This is a milestone that all of us whohave been working with ASERF areextremely proud of. In order for yourrequest to be considered, please be awareof the following guidelines:

Purpose—A statement on the clini-cal relevance of the project is perhaps themost important that you can provide.List your hypothesis and specific aims.

Background/References—List a concise summary of your previous work.State your understanding of the availableknowledge pertaining to the subject.Include your critical analysis of past deficiencies. If you have preliminary dataof your own, include it here.

Eligibility—Applicant must be aPlastic Surgeon, MD, or PhD working inPlastic Surgery. Only ONE concurrentproject will be funded per investigator.

Methods—We need to know exactlyhow you are going to do your research.For human subject review, simply tell uswhat safeguards you have selected (patientpermission forms, etc., or use guidelinesestablished by nearby medical schools orthose of your own hospital).

Facilities—Tell us where you aregoing to perform these studies. Youroffice? Laboratory? Other location?

Budget—ASERF will considerbudget requests for projects for anyamount up to $100,000.00. A compre-hensive budget must be submitted withthe proposal. The ultimate decision on

the funding organization will be deter-mined by the Committee. ASERF doesnot pay for indirect or administrativecosts.

Sponsor—Note that Residents,Fellows and non-members require thesponsorship of a Member or Candidate ofthe Aesthetic Society. The majority ofprojects should be completed within 12months following the award. Longerterms for projects must be documentedon the grant application.

Human or Animal ResearchProtocol —It is your responsibility tosubmit the grant application for reviewby your animal utilization of human subjects review committee for experimen-tal work and to ensure it complies withthe institution’s regulations. All projectsmust receive a prior approval letter fromyour animal or human investigativereview board. Applications without thisapproval letter will not be processed.

A detailed grant request form can bedownloaded at www.aserf.org

Planning for the Future:Any Foundation is reliant on the

generosity of its donators and funders tostay fiscally healthy and stay to itsMission. The Foundation has a numberof plans either in deployment or develop-ment including a plan giving program, anamed grant program, an “honor yourmentor” program and several others thatwill be discussed in future issues of ASN.

Laurie A. Casas, MD is an aestheticsurgeon in private practice in Glenview, ILand Clinical Associate Professor, Universityof Chicago, Pritzker School of Medicine,Section of Plastic Surgery. She is President ofthe Aesthetic Surgery Education andResearch Foundation

LAURIE A. CASAS, MD

UPDATE ON: ASERF

training, consistency and quality whichpatients seek when they choose a surgeonfor an aesthetic procedure.

The Program, which was approved bythe ASAPS Board of Directors, includesthe following criteria: • Applicant must be an ASAPS Active

Member based in the US or Canada• Fellowship must be 12 months in length

and scheduled to begin July, 2010• Must be a new Fellowship or the addi-

tion of a Fellow to an existing program• Must agree to follow the ASAPS

Fellowship Curriculum• Fellowship must include a research

componentTo see complete details, including the

curriculum, criteria and application, pleasevisit: http://www.surgery.org/sites/default/files/aestheticfellowshipgrantapplication2010.pdf

We encourage those who are involvedin Fellowships to take advantage of thisnew opportunity. It is imperative that aesthetic surgeons continue the commit-ment to innovation and learning that wasstarted by our founding members and willprepare us for the practices of tomorrow.

Jeffrey M. Kenkel, MD, is Professor andVice-Chairman, Director, The ClinicalCenter for Cosmetic Laser Treatment, TheRod J. Rohrich, M.D. DistinguishedProfessorship in Wound Healing and PlasticSurgery Department of Plastic Surgery TheUniversity of Texas Southwestern at Dallas.He is Chair of the Aesthetic Society’sEducation Commission and Vice President of the Society.

Fellowship ProgramContinued from Cover



New legislation which states it is“declaratory of existing law” sounds unnecessary, but sometimes you have tosay it more than once, and clearer, so even criminals understand. Case in point: the unauthorized corporate practice ofmedicine in California.

Mines versus The Miners The prohibition initially arose in the

early 1900s when mining companies hireddoctors for their employees. When thedoctors’ loyalty to their employers trumpedthe medical needs of the patients, variouslegislation and court decisions arose whichcreated, as a matter of public policy, a prohibition on medical practice by corpo-rations so as to maintain lay control overphysicians, prevent divided loyalties, andput patients over profit.

Exceptions: HMOs When prepaid health plans arose in

the 1930s, and hospitals began to employphysicians in the 1950s, the corporatepractice of medicine (CPM) doctrine wasused to unravel such ventures. However, asmanaged care became mainstay in the1970s, legislatures created an exception tothe CPM prohibition for HMOs, teachinghospitals, community clinics, narcotictreatment programs and some non-profitorganizations. Even the AMA’s ethicalrestrictions upon physician employmentwere found by the Federal TradeCommission to be anti-competitive.

Medi-Spa “MedicalDirectors”

Existing law already states that neitherlay persons nor lay entities may own anypart of a medical practice (Business &Professions Code §2400), yet physicians

are routinely employed as “medical directors” to supposedly oversee servicesprovided by nurses, nurse practitioners and physician assistants.

AB 252 To make it absolutely clear that such a

practice is prohibited, California’s legisla-ture passed AB 252 (awaiting GovernorSchwarzenegger’s signature as of July 16,2009) which:• authorizes license revocation of any

physician who knowingly contracts withor is employed by a non-exempt B&P§2400 organization which provides outpatient elective cosmetic medicalprocedures or treatments, and

• makes the employer guilty of a misde-meanor or felony, regardless whetherthey knew they were engaging in theunauthorized corporate practice of medicine.

Each state has its own view of the corporate practice of medicine, butCalifornia has taken a clear and aggressivestance, one that is supported by theCalifornia Society of Plastic Surgeons. The Medical Board of California has evenplaced clear language on its websitehttp://www.mbc.ca.gov/licensee/corporate_practice.html:

“The following types of medical practice ownership and operating structuresalso are prohibited:• A physician acting as ‘medical director’

when the physician does not own thepractice. For example, a business offering spa treatments that includemedical procedures such as Botoxinjections, laser hair removal, and medical microdermabrasion, that contracts with or hires a physician as its‘medical director.’”

AB 252’s purpose is two-fold: to prevent unlicensed persons from interfer-ing with or influencing the physician’s professional judgment, and to preventphysicians from aiding and abetting theunlicensed practice of medicine, bothunassailable goals. To read the bills entiretext, go to http://info.sen.ca.gov/pub/09-10/bill/asm/ab_0251-0300/ab_252_bill_20090211_introduced.pdf

ROBERT H. AICHER, ESQ.

LEGALUpdate:

Fronting for Medi-Spas

Documents

Aesthetic Society News4 Aesthetic Society News • Fall 2009 Since ASN began its Focus onPhilanthropy series, the Editors have seen a common thread among all the organiza-tions and