AestheticSociety News · Publishing of advertisements in ASN is not a guarantee, ... The Waldorf Astoria Hotel, New York, NY Contact: Liz Sullivan Tel 607.754.2765 Email: lsullivan@

Quarterly Newsletter of the American Society for Aesthetic Plastic Surgery Volume 15, Number 4 Fall 2011

INSIDE THIS

ISSUE:

Aesthetic Society News

What’s in a Name?See Page 7

Continued on Page 16

Get Your PassportSee Page 8

ASAPS Launches NewMarketing EffortSee Page 20

David Ralph Millard Jr.June 4, 1919 – June 19, 2011



By Leo McCafferty, MD

Joseph E. Murray once said“If you don’t know what to do, dowhat is right.” “Have a style boy!”Sir Harold Gilles was known tosay. Well, Dr. Millard did it right,made a difference and certainly hada style. He had a profound impact on ourspecialty and most everyone touched byplastic surgery in the latter half of the 20th

century benefited from him insome way.

He had no interest in the routine. Folklore has Dr.Millard, a young trainee, offeringDr. James Barrett Brown someadvice while assisting during aparticularly difficult case. The

stern, didactic Brown said to him “Godhelp the surgeon who changes his plan in

Benchmarking PlasticSurgery Revenue

For more than 10years, BSM Consulting and Allergan, Inc. haveconducted a benchmarkingsurvey for medical aestheticpractices across the UnitedStates. Included in thedatabase are plastic surgeryand dermatology practices

where a significant percentage of practice revenue is generated from cosmetic services. This reportsummarizes results for only the plastic surgery practices participating in the survey. Additionally,the summary report includes results for 2007,2008, and 2009 for practice surveys received andprocessed through November 30, 2010.

For each measure tracked, the mean andmedian values are calculated. Results for the 10th,25th, 75th, and 90th percentiles are also included,where a satisfactory number of respondents (arbitrary minimum of 25) have been received. Inaddition, a “healthy range” is provided for each ofthe management ratios. This range is based onresults for practices between the 25th and 75thpercentiles in the database. The “healthy range” isintended to recognize the differences that existbetween practices in terms of: mix of services, cash pay vs. third party, practice location, and thenumber of providers in the practice.

Phishing is fish-ing, except you are thefish and the bait is aseemingly legitimatee-mail from a trustedsource such as yourbank or the IRS:

PhishingforSurgeonsBy Bob Aicher

Bruce Maller

11262 Monarch StreetGarden Grove, CA 92841

PresortedFirst-Class Mail

US PostagePAID

Carol Stream, ILPermit #1096

Aesthetic Society NewsThe American Society for Aesthetic Plastic Surgery

The Aesthetic Surgery Education and Research Foundation

PresidentJeffrey M. Kenkel, MD

EditorCharles H. Thorne, MD

Associate EditorJulius W. Few, MD

Communications CommissionerDaniel C. Mills, II, MD

Director of Marketing and Public EducationJohn O’Leary

Products and Services Marketing ManagerKergan Edwards-Stout

Director of Public RelationsAdeena Babbitt

Communications ManagerJian Sun

Exhibits ManagerErika Ortiz-Ramos

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 2011–2012

December 1–3, 2011

The Cutting EdgeThe Waldorf Astoria Hotel,New York, NYContact: Liz Sullivan Tel 607.754.2765Email: [email protected]

January 12, 2012

5th Annual OculoplasticSymposium Intercontinental Hotel Buckhead Atlanta, GAContact: Susan RussellTel: 703.234.4067 Email: [email protected]/meetings

January 13–15, 2012

28th Annual Breast SurgerySymposium Intercontinental Hotel Buckhead Atlanta, GAContact: Susan RussellTel: 703.234.4067 Email: [email protected]/meetings

January 27–29, 2012

Expanding Horizons SymposiumEncore Las Vegas, Las Vegas, NVContact: ASPSTel: 847.228.9900www.plasticsurgery.org

February 1–5, 2012

Fourth American-BrazilianAesthetic MeetingEndorsed by ASAPS, ISAPS, SBCPIL Campanario Villaggio ResortFlorianopolis, BrazilContact: Susan RussellTel: 703.234.4067Email: [email protected]

February 9–12, 2012

46th Annual Baker GordonSymposium on Cosmetic SurgeryHyatt Miami, Miami, FLContact: Mary FelpetoTel: 305.859.8250www.bakergordonsymposium.com

March 7–8, 2012

15th Annual Dallas CosmeticSurgery SymposiumWestin Galleria, Dallas, TXContact: Veronica MasonTel: 214.648.2154Email: [email protected]

March 9–11, 2012

29th Annual Dallas RhinoplastySymposiumWestin Galleria, Dallas, TXContact: Veronica MasonTel: 214.648.2154Email: [email protected]

May 1–4, 2012

Society of Plastic Surgical Skin CareSpecialists 18th Annual MeetingHyatt Regency VancouverVancouver, BCTel: 562.799.0466Email: [email protected]/meeting2012

May 3, 2012

The 17th Annual Meeting of TheRhinoplasty SocietyJointly Sponsored by ASAPSHyatt Vancouver, BC, CanadaContact: Rhinoplasty SocietyTel: 904.786.1377www.rhinoplastysociety.org

May 3–8, 2012

The Aesthetic Meeting 2012Vancouver Convention CentreVancouver, BCTel: 562.799.2356Email: [email protected]/meeting2012

ASAPSCalendar

© 2011 The American Society for Aesthetic Plastic SurgeryASAPS Members Forum: www.surgery.org/members

ASAPS Website: www.surgery.orgASERF Website: www.aserf.org

®

The Aesthetic Surgery Education and Research Foundation

The American Society forAesthetic Plastic Surgery

2 Aesthetic Society News • Fall 2011

Aesthetic Society News • Fall 2011 3

Since I am nearly half way throughmy year serving as your President, I believeit is important to update you on the recentactivities and key efforts taking place tofurther strengthen our Society and addvalue for our members.

I am pleased to report that throughthe cost control efforts of leadership and staff, the Society’s fiscal year endedpositively, with a net profit of $153,000.We will continue our focus on fiscalresponsibility keeping in mind the need tofulfill our strategic initiatives throughoutthe current fiscal year.

In July, we held our Executive Retreatstrategic planning session and the need foran aggressive, cost effective and results-driven marketing plan was discussed as astrategic imperative for the organization.The reasons for this are two-fold:• The rapid acceleration of competing

societies and confusion concerningboard certification has diluted theASAPS brand among consumers anddiminished the value of membership.

• Practice issues, as evidenced by recentmember surveys, attendance of the prac-tice management session at the Bostonmeeting and the current and seeminglyon-going economic climate, are top ofmind for our members who are seeingpractice erosion and looking to theSociety for sound marketing programs.

For the above reasons, the Board ofDirectors has approved the formation of aMarketing Task Force and has committedfunds to the development and implemen-tation of a comprehensive marketing plan.The Task Force determined that the use ofa consultant, or consultants, with expertisein branding, digital marketing, and webdevelopment would be useful to our effortsand the RFP process is complete.

Concurrently, as part of this plan, we are negotiating arrangements for anenhanced web presence on EmpowHer,New Beauty, Plastic Surgery Channel, andRealSelf. EmpowHer is a women’s generalhealth website with over 1.5 million usersper month. They are seeking content onaesthetic plastic surgery and we have nego-tiated a relationship that will help informconsumers about how to choose a surgeonas well as procedural related information.If all goes well, a widget offering our“Find-a-Surgeon” feature will be added totheir site to help drive new patients to ourmember surgeon’s office.

The Board just approved the additionof the ASAPS logo to the Plastic SurgeryChannel website with the designation “rec-ognized by” believing that the site alignswith our messaging and provides anotheravenue to reach consumers.

Finally, we are in the process of negotiating enhanced involvement withRealSelf as this plastic surgery focusedwebsite has become very influential withconsumers and a growing number of ourmembers are participating in their “Ask-a-Surgeon” feature. More details are yet tocome on this potential opportunity.

Our goal is to proceed in a stepwisefashion with an initial roll-out of the program during The Aesthetic Meeting2012 in Vancouver BC.

On September first, we launched ournewest member benefit—access to freelegal advice provided by Bob Aicher, Esq.The scope of his service includes responsesto individual member queries, limited toissues arising within their practices and/orthe field of aesthetic medicine. Bob hasalready received several inquiries to dateand we believe this will be an incredible“value add” for our members. With thepermission of each member, he will providea sanitized case study of each situation forposting as a “legal blog” on our member’sonly website. Bob will continue to serve asLegal Counsel to the Society with the sameduties and responsibilities as in the past.

This is just a summary of our activitiesover the past several months with manymore projects in development, one of themost significant being an iPad applicationthat will serve as an educational platformfor ASAPS materials, ASJ, and ASN. Weare very excited about this app as the utilization of technology in a meaningful,useful fashion will help ASAPS remain relevant into the future.

Finally, as most of you already know,Dr. Jim Matas resigned as President-Electfor personal reasons. By vote of the ActiveMembership, Dr. Leo McCafferty was elevated to President-Elect, and the Boardof Directors voted to fill the vacated VicePresident position with Dr. Jack Fisher. Dr.Jim Grotting was selected as our newTreasurer and the vacated Member-at-Largeposition was filled by Dr. Herluf Lund.

If you have any questions or concernsabout any of the above activities, pleasefeel free to contact me via email [email protected] or call214-645-3112.

JEFFREY M. KENKEL, MD

President’s REPORT

Update on ASAPS

In July, we held our Executive

Retreat strategic planning

session and the need for an

aggressive, cost effective and

results-driven marketing plan

was discussed as a strategic

imperative for the organization.


ASAPS Member LaunchesNational BRA Day in Canada

On October 19th 2011, Canada celebrated its first ever National BreastReconstruction Awareness Day (BRA-Day).Breast Reconstruction Awareness Day is aninitiative, created by ASAPS Member Dr.Mitchell H. Brown, designed to promoteeducation, awareness and access for women who may wish to consider post-mastectomy breast reconstruction.

Practicing in Toronto, Canada, Dr.Brown specializes in aesthetic and recon-structive breast surgery, body contouringand facial aesthetic surgery, and is thefounder and co-course director of theToronto Annual Breast Surgery Symposium,Canada’s largest annual medical symposiumof its kind. Dr. Brown took note of themany studies siting the lack of breastreconstruction taking place in both theU.S. and Canada, primarily becausewomen did not realize that reconstructionwas a viable option for them. He felt thatwomen needed access to such proceduresin a timelier manner. While breast cancerawareness is celebrated for an entire month,he felt that some measure of attentionneeded to be focused on reconstruction,which lead to his idea of BRA day.

Once the idea had struck, Dr. Brownput his thoughts into action, creating asteering committee to help oversee the

event. This committee included plastic surgeons specializing in breast surgery,plastic surgery nurse specialists, theCanadian Breast Cancer Foundation,Canadian Society of Plastic Surgeons,medical device industry representatives andbreast cancer support groups. His goal wasto have representation from all of theregions in Canada, and to ensure that eachmajor area had some kind of visible eventon the very same day.

To mark this historic day, events were held all across Canada to promoteboth awareness and patient access toreconstructive breast surgery. Events wereorganized on both the local and regionalgrass-roots level in order to take advantageof the unique environments, populations,and diverse resources that exist across Canada.

Working together, a variety of diverseefforts were created to help raise awarenessof BRA day. One store, Sleep Country, amajor mattress retailer, displayed BRA Dayposters in their stores throughout Ontarioand British Columbia. Okanagan HealthGroup (OHG) and their supporters had awrap-around bus banner traveling for fivedays, which held an image along with breastcancer statistics, which OHG entirely

self-funded. Fundraising T-shirts were created and sold, which helped raise bothawareness and funds, and Dr. Nick Guaylaunched the Canadian Collaboration onBreast Reconstruction Information website.One imaginative way to gain attention tookplace in Kelowna, BC, where a flash mobwas held on August 5th 2011 with almost100 people dancing in support of NationalBreast Reconstruction Awareness Day.

On BRA day itself, a variety of different events were held. At the RougeValley Ajax/Pickering and CentenaryHospitals, Informational Kiosks informedvisitors about BRA-day and offered educational materials. Throughout the country, leading experts presented educational sessions on such topics as thelatest techniques in breast reconstruction,navigating the medical system, healthylifestyle modifications, body image changesthat surround mastectomy and reconstruc-tion, and therapy options to enhance andimprove recovery. Participants had theopportunity to meet and speak with localsurgeons and health team members, viewexhibits of devices used in reconstruction,and link directly with breast cancer support

Breast Reconstruction Awareness Day

From Dr. Brown’s single thought,

an amazing array of participants

came together for a common

vision, where all women needing

breast cancer surgery will be

offered information about the

options for reconstructive breast

surgery and be provided access

to breast reconstruction in a safe

and timely manner.

Continued on Page 5


organizations. In some cases, attendees alsohad the opportunity to meet women whohad undergone reconstruction, seeing first-hand what the procedure can achieve.

For example, Scarborough GeneralHospital in Toronto held a PatientInformation Session, that included discussions on all aspects of breast reconstruction, including implant choices,pedicled and microvascular flaps, andancillary procedures such as nipple reconstruction and tattooing. Another session, called “Breast Reconstruction: MyStory,” featured four women talking abouttheir breast cancer journey, their decisionto have reconstructive surgery, and how ithas impacted their lives.

Other informational and educationalevents included sessions given by suchphysicians as Martin Jugenburg, MD, StanValnicek, MD, Scott Williamson, MD,Peter Lennox, MD, Sheina Macadam,Amanda Fortin, MD, Arianna Dal Cin,MD, Ronen Avra, MD, Joan Lipa, MD,Laura Snell, MD, Don Jones, MD,Melinda Musgrave, MD, and ChristineTang, MD, among others.

Dr. Brown envisions BRA day growing each year nationally, eventuallydeveloping into an internationally recognized event, and planning for nextyear is already underway. BRA day hasreceived vows of support from both TheAesthetic Society and ASPS, and many aretaking the concept to their own countries.

From Dr. Brown’s single thought, an amazing array of participants cametogether for a common vision, where allwomen needing breast cancer surgery willbe offered information about the optionsfor reconstructive breast surgery and beprovided access to breast reconstruction ina safe and timely manner.

ASAPS congratulates Dr. Brown onthe success of BRA day, and looks forwardto its future growth.

For more information about BRAday, please go to www.bra-day.com oremail [email protected]. BRA day is also onTwitter at http://twitter.com/mybraday andon Facebook at www.facebook.com/breastreconawareness.

BRA-DayContinued from Page 4

Traveling ProfessorProgramKiya Movassaghi, MD

As Co-Chair of the Residents andFellows Committee, I am extremely proudof the Traveling Professor Program, whichis an invaluable learning experience for residents and has always been and continuesto be a very successful program. Chairedby Clyde H. Ishii, MD, the Programbrings some of the best minds in aestheticsurgery to various medical school residencyprograms across the country.

This year we welcome Claudio L.DeLorenzi, MD, Joseph M. Serletti, MD,W. Grant Stevens, MD, and Simeon H.Wall, Jr., MD to the Program. We also welcome back Mark A. Codner, MD, JuliusW. Few, MD, Frank R. Lista, MD, JamesM. Stuzin, MD, V. Leroy Young, MD, andRichard J. Warren, MD who started theirtwo-year terms in 2010.

We would also like to thank FoadNahai, MD for his service and dedication asour first International Traveling Professor(Spring ASN). Drs. Nahai and RenatoSaltz were both instrumental in getting theInternational Traveling Professor Programup and running. So, it’s appropriate that wenow welcome Renato Saltz, MD, as our newInternational Traveling Professor for the2011-2012 fiscal year. We look forward tohearing his account of his travels, which wewill cover in ASN once his term is complete.

Traveling professors go to three residency programs every year for two yearsand speak on a variety of different topicsranging from procedural techniques likeaugmentation mastopexy and lipoab-dominoplasty to broader topics like digitalphotography and patient safety. Ideally,coordinating a visit to a school would alsocoincide with a regional society meeting so further reach is possible. A resident

program may only request one travelingprofessor per year, but along with the visit,a personal invitation to attend the ASAPSAnnual Meeting for free is extended toevery resident.

This program builds community anddevelops relationships with faculty at schoolsacross the country and throughout theworld. There is a sense of collective sharingto improve the field of aesthetic plastic surgeryand to ensure residents come out with thebest possible knowledge and skills. The traveling professor group is cross-linkedwith education-related committees and theBoard of Directors, ensuring that ideasgleaned and gaps found from their individualobservations in the field are addressed inthe educational planning process.

A resident packet is included at everyschool visit which contains a cover letterand invitation to join the ASAPS Residentsand Fellows program, which entitles themto receive ASN, ASJ, email notificationsfrom ASAPS regarding Free Webinars,educational opportunities, new events andproducts. There is also a Product Catalogand Membership and Candidate informa-tion so they can plan for the future anddetermine what they might need once theygraduate and become board-certified.

Working closely with residents andfurthering aesthetic education is a top priority for ASAPS and my thanks goesout to all the Resident Programs who reachout to us, the traveling professors for theirservice and our sponsors who make it possible. Together, we are fostering thefuture of aesthetic plastic surgery.

Kiya Movassaghi, MD is an aestheticplastic surgeon practicing in Nashville, TN andCo-Chair of Residents and Fellows Committee.


The Cast:Dr. Anne Taylor and her beloved hatProfessor Plum: W. Grant Stevens, MDColonel Mustard: Dan Mills, MDMrs. Peacock: Laurie Casas, MDMr. Green: Jack Fisher, MD

“Don’t make a sound, and no one getshurt” barked the kidnapper. Before theHat knew what had happened, it was in adark stuffy place. With no light or air, thestraw Hat felt panicked and claustropho-bic. “Let’s see how much you are worth tothe doctor” the abductor continued, andthen let out an evil chuckle. “With a fancyribbon like you have, and such lovelystraw, you don’t need to worry- the ransomwill be paid. But if not, a small snip ofthat ribbon with the ransom note maymake them pay-up faster.”

The deep blue water of the AdriaticSea rolled smoothly past the ship, as thefading evening sun warmed the passengerson the deck enjoying the scene. The cruisers enjoyed the sun and breeze,unaware of the most deplorable crimeoccurring, even as they relaxed. You maywonder about the motive for such a crime.Greed or Jealousy?

Every person was a suspect—for allhad been seen with the Hat. No one wasabove suspicion with a crime this heinous.Professor (Grant) Plum from Marina delRay, possibly the smartest person alive, aswell as dashing and debonair would need ahat like this to complement his already perfect wardrobe. Colonel (Dan) Mustard of Laguna Beach, tanned and trendy, also

The Great Hat Caper The Aesthetic Cruise 2012

By Anne Taylor, MD

Continued on Page 7

BIENNIAL

CRUISE

Z a d a r

K o t o r

C o r f u

A t h e n s

N a f p l i o n

G r e e c e

Mon t en e g r o

C r o a t i a

I t a l y

V e n i c e


What’s in a Name?Plenty when you’redealing with energy and light-based devices.By Michael Kulick, MD

For many of us, energy and light-baseddevices are playing an increasing more significant role in our practices. However,the nomenclature can be confusing toboth surgeon and patient. To try andremedy this situation, the Light andEnergy Based Therapies Committee (adhoc) has established definitions for thefollowing commonly used terms. We willbe working with industry to encouragethe use of these definitions that, we hope,will bring a more balanced discussion andpatient expectation to the table.

Downtime—Indicates the expectedtime after which a patient canresume his or her “normal”lifestyle

• Essentially no downtime: less than 24 hours

• Minimal downtime: 24–72 hours • Moderate downtime: three to seven days • Significant downtime: more than seven

days

Bruising—Ecchymosis that is visible on the skin without concealer

• Essentially no bruising: no ecchymosis/bruising, but patients may have someimmediate change in skin tone

• Minimal bruising: ecchymosis thatresolves in less than one week

• Moderate bruising: ecchymosis thatresolves in one to two weeks

• Significant bruising: ecchymosis thattakes more than two weeks to resolve

Redness—Skin demonstratingincreased redness without concealer applied

• Essentially none: skin returns to “normal” (pretreatment or improved)coloring in less than 24 hours, butpatients may have some immediatechange in skin tone

• Minimal: hyperemia that resolves inone to three days

• Moderate: hyperemia that resolves infour to seven days

• Significant: hyperemia that takes morethan seven days to resolve

Swelling—Obvious swelling inthe treated areas

• Essentially none: swelling that resolvesin less than three days

• Minimal: swelling that resolves in threeto seven days

• Moderate: swelling that resolves ineight to 14 days

• Significant: swelling takes more than14 days to resolve

Pain—Significant discomfort/pain associated with treatment

• Essentially none: no pretreatment medication, local anesthesia duringtreatment, or posttreatment pain management is required; over-the-counter medications may be used

• Minimal pain: requires pretreatmentoral medications (prescriptions), topicalagents and/or skin cooling during treatment, and/or post treatment prescriptions for pain management

• Moderate pain: same requirements as“minimal pain,” but with pretreatmentlocal anesthesia needed to obtain anticipated results

• Significant pain: same requirements as“minimal pain,” but with pretreatmentIV sedatives or general anesthesia neededto obtain anticipated clinical results.

We are hopeful that both consumersand surgeons will find these expandeddefinitions helpful when considering orexplaining a light-based procedure. That’swhere we need your help.

Michael Kulick, MD is an aestheticsurgeon practicing in San Francisco. He isChair of the Light and Energy BasedTherapies Committee.

would desire such a hat, to use on hismany golf outings. The lovely Mrs. LauriePeacock from Chicago had recently mentioned that she wanted to purchase ahat just like this one, the brim perfect toshield her from all UVA and UVB. Allwere suspects. But they all had alibis.

For the Professor, his alibi was air-tight. First, he noted that he didn’t “Do polka dots” unless Mr. (Jack) Greenfrom Nashville did. And since that was notthe case, he was off the hook. For theCalifornia Colonel, he too had a strongalibi with numerous witnesses placing him in the drawing room with his cigarand candlestick (used to light the cigarnaturally). As for Mrs. Peacock, she waswith Mr. Green in the kitchen inspectingthe knives. To make matters worse, andthe mystery even trickier, not only hadevery person on the cruise admired theHat, every person on the cruise had aphoto taken in it. Perhaps the secret couldbe found in the photos. Who looked themost smashing?

The ransom note- printed on a napkin, was terse. The Hat would bereturned for a price. If the demand was notmet—the Hat was history, in a waterygrave in the Adriatic.

The Hat patiently waited, while itsfate hung in the balance.

And then as quickly as the crime hadoccurred, it was over. The ransom was paid to ASERF. “You are one lucky Hat”…muttered the voice. And with that, the Hatwas free. Out in the fresh air, the Hatdetected a faint smell of a Cuban cigar,and then, nothing but fresh sea air. Themystery remains to this day, but one thingis for certain, the HAT will never be leftalone on an ASAPS cruise again, lest thecaper be repeated.

The outcome:After awarding a $500.00 check to

ASERF, Dr. Taylor’s hat was returned safeand sound.

Anne Taylor, MD is Associate Professor,Director of Aesthetic Surgery Department ofPlastic Surgery, Ohio State University Collegeof Medicine. Her hat was abducted on theAesthetic Cruise, 2011.

The Great Hat CaperContinued from Page 6


Stem cell and fat grafting research andapplications are the hottest topics at meet-ings, symposia and of course, on the newstoday. With all of the claims and questionson this very important topic, ASAPSanswered with an educational Webinar onTuesday, October 4th, 2011 investigatingthe biology, FDA regulations, currentresearch and relevant aesthetic applications.

Chair of the ASAPS/ASPS Joint TaskForce on Stem Cell/Fat Grafting and Chiefof Plastic & Reconstructive Surgery at theUniversity of Pittsburgh, Dr. J. PeterRubin led a panel of specialists in the fieldto explain the processes and challenges ofusing this technology. Drs. Adam J. Katz(University of Virgina), Sydney R. Coleman(NYU and University of Pittsburgh) andKotaro Yoshimura (University of Tokyo)provided exemplary information detailingthe tedious and meticulous process ofextracting, isolating, enriching and characterizing stem cells and fat grafts foruse. The hurdles of proving efficacy andthe dangers of these techniques wereaddressed, along with amazing before and

after results of successful fat grafts. Because of the interactive nature of

webinars, what was scheduled to be a 90-minute presentation with Q&A, easily ranover to just under two hours with over 200attendees actively engaged and inundatingthe panel with questions. This webinar hada 47% attendance rate—a landmark per-centage according to industry and ASAPSstandards. The audience rated the content4 out of 5 and 85% strongly believed thewebinar met their educational expectationsand needs.

ASAPS not only tracks what youliked, but also what you thought couldhave been done better. Attendees asked formore examples of complications or down-sides for stem cell/fat grafting procedures.Although Drs. Rubin and Katz explainedthe limitations to clinical application,viewers wanted to see more examples ofclinical work done in the plastic surgerypractice. Also, in spite of the alreadylengthy webinar, many wanted a longerQ&A session. We communicated theseconcerns to the panelists so they canaddress them at a future date, but alsoencourage participants to attend theAnnual Meeting in Vancouver 2012 sothat they can be updated on the topic andask more questions.

This webinar was also the first to beplagued with phantom audio trouble. We ran the usual tests and trial runs, since all four panelists were in differentlocations (one international) with all different devices and accessibility, but technology is not fool proof and failed usbriefly. Luckily, we were able to recoverquickly and still have a successful webinar.Like all ASAPS webinars, this one was

recorded and available for download onwww.surgery.org/professionals/webinars as well as the slides and accompanyingnotes for Dr. Rubin’s talk that experiencedaudio difficulty.

Our next webinar will come from theCosmetic Medicine Task Force and be afollow-up to last year’s Skincare in thePlastic Surgery Practice Webinar. Pleaselook out for emails with registration information for: Practical and Simple SkinCare Solutions: An Advanced Guide to anIntegrated Aesthetic Practice. This will be onNovember 16th, 2011 at 5:30 PM PST,moderated by Cosmetic MedicineCommissioner Dr. Julius W. Few and con-tributing on the panel will be PastPresident of the SPSSCS, Susan Wells andDermatologists, Drs. Jeannette O. Grafand Jeffrey Dover.

Any questions regarding webinarsshould be sent to [email protected] simply call Jian Sun at the ASAPSCommunications Office 212-921-0500.

Clyde H. Ishii, MD is an aesthetic surgeon and practices in Honolulu, HI and isChair of the Webinar Subcommittee.

Stem Cells: Science and Clinical Applications WebinarClyde H. Ishii, MD


Expert Legal Advice.

Exclusively for Members of The Aesthetic Society. With richlegal experience in the medical field, Bob Aicher, Esq., isuniquely qualified to provide free Member consultations in theareas of practice management, insurance, malpractice, scope ofpractice, ethics, and defamation.

To contact Bob Aicher, Esq., please email [email protected] or call via phone at (707) 321-6945.

This service is not intended to replace legal counsel.

Absolutely Free.Who Else Can Offer That?

For More InformationToll-Free 800.364.2147 or 562.799.2356

www.surgery.org


Managing your electronic communi-cation is a full time job these days, not tomention knowing all the things you needto know to keep up in a very competitiveand constantly changing environment. Thegood news is you have a proactive group ofvolunteer peers and fulltime staff at ASAPSmaking great things happen for you.

The Electronic CommunicationCommittee has grown tremendously over the last few years from a website management group to leading the way indisseminating information to the publicand improving communication among themembership.

Here are just a few of the things wehave been working on:

Online video promoting board certified plastic surgeons and providinggeneral information on the most commonlyperformed procedures. Video is a majordriver of search engines on the internetand this effort is increasing ASAPS exposure daily.

Social media efforts through portalslike Realself.com and the newly revisedAsk-a-Surgeon are putting your knowledgeto use in a direct to consumer forumincreasing not only the society profile but your own. We are on Facebook andtwitter daily.

Continued efforts in the developmentof the monitored and fair Doctor Reviewshas been successfully implemented in conjunction with Realself.com. Thesereviews are now being recognized byGoogle and impacting the members presence on the internet. By directing yourreviews to one site, true representation ofthe practice can be created and the numberof reviews will then show more favorablyin position against sites like RateMD.comand other such sites.

On the internet, content is king. Thecommittee has been generating content to improve the site ratings and we have

partnered recently with a company to further enhance this effort. The datareviewed at the last committee meeting hasdemonstrated significant improvement inthe website position as a direct result ofthese efforts.

Mobile applications and websites arethe next frontier in electronic communica-tion. The smart phone and tablets arebecoming a more prominent way in whichour consumers acquire information. Wehave created and are currently exploringthis media with the ASAPS app.Download it and see your membershipdues at work.

As far as internal member issues wecontinue to explore means of improvingelectronic communications between thecommittee members as well as the membersthemselves. The Aesthetic Meeting hadtwitter updates to the members updatingrelevant information for improving your aesthetic practices. We are conferencingelectronically on a regular basis which is expediting completion of projects,enhancing the efficiency of the process thusallowing more projects to be completed inshorter periods of time.

Future projects include updating andimproving the photo gallery, expanding themobile presence, a reputation managementand anti defamation manual, creating amore user friendly interface with the membership and merging existing successfulprograms like Project Beauty to enhancethe status of surgery.org while maintainingthe brisk tempo with our current projects.

The goal of the ElectronicCommunication Committee is to establishASAPS and its members as the authority inaesthetic surgery and medicine. TheElectronic Communication Committee ismaking dramatic advances in this area tofurther deliver value to you our members. Iencourage you to visit surgery.org and seethe improvements which have been made,

participate in Ask-a-Surgeon to see howthis can benefit your practice and submitphotos the photo gallery, follow us onFacebook and twitter, encourage yourpatients to submit reviews to Realself.com.The more you are involved the greater therewards.

Robert Kessler, MD is an aesthetic surgeon practicing in Newport Beach, CA.He is Vice Chair of the ElectronicCommunications Committee

e-newsShare & Learn,Confidentially

To help physicians learn fromeach other, check out Wimed.org/asaps,a confidential, Federally-protectedspace for sharing highly-sensitive “nearmiss” information. As other plasticsurgery-related bulletin boards such assurgery.org and plasticsurgery.org arenot federally protected, with all postsbeing discoverable and admissible inCourt, ASAPS members should usewimed.org/asaps to post about a prob-lem that has the capacity for patientharm--whether the problem reachedthe patient or not. The AestheticSociety encourages all members tojoin and use this new communicationtool to improve outcomes across theSpecialty. And it’s free!

Safe Surgery ChecklistASAPS has created a new checklist

for its Members, www.surgery.org/professionals/patient-safety/aesthetic-surgery-checklists which can help provide a safe environment for thepatient.

Update on The Electronic Communications Committee

By Robert Kessler, MD

Eighty-three percent of all cosmeticprocedures performed in the officesof cosmetic plastic surgeons in 2010were nonsurgical, according to TheAmerican Society for AestheticPlastic Surgery—and the AmericanSociety of Cosmetic Dermatology andAesthetic Surgery reports a similartrend. What does that mean in terms of volume? Almost 8 millionnonsurgical cosmetic procedureswere performed last year at a cost of$4.1 billion dollars. “There’s a hugedemand for nonsurgical procedures,”said Dr. Jeffrey Kenkel, president ofThe American Society for AestheticPlastic Surgery. The reasons are simple, Kenkel, a

Dallas cosmetic plastic surgeon, said.“Some patients only want a little bit of change,” he said. Others “just aren’t interested in a surgicaloption.” They’re seeking proceduresthat are less expensive, less painfuland less disruptive than, say, a facelift, which costs an average of $6,600and takes weeks of recovery time.

Nonsurgical Cosmetic Treatments Growing in Popularity

The Los Angeles TimesJuly 24, 2011

I’ve seen lots of fit, lean and muscularwomen working out who have cellulite, and it made me wonder if itis something that diet and exercisecan deal with. So I endeavored tofind out. According to The AmericanSociety for Aesthetic Plastic Surgery,“Almost all women (and some men)have cellulite, stemming from geneticpredisposition, hormonal changesand weight gain.” And it’s worthnoting that an entire Photoshopindustry is built around air-brushingcellulite from the images of anorexicactresses who in real life look likethey’ve been cross-bred with cottagecheese.

A Few Dents in Those Cellulite TheoriesThe Los Angeles Times

October 3, 2011

Every day seems to bring fresh newsabout stem cells, the molecular building blocks that researchers hope may one day be used to rebuild damaged and diseased tissuethroughout the body. Recently wehave been reading (and watching onYouTube) claims from doctors aboutthe clock-stopping properties of stemcells derived from fat when injectedduring plastic surgery—the so-calledstem-cell facelift. But does it work?Doctors across the country offer similar procedures, claiming resultssuperior to conventional fat injection.But mainstream medicine has yet togive its approval. According to arecent position paper jointly issuedby the American Society of PlasticSurgeons and The American Societyfor Aesthetic Plastic Surgery, “Stemcells in aesthetic surgery are promis-ing, but marketing claims are too farahead of the science.”

Stem-Cell Facelifts: Hype or Reality?Allure.com (Allure Magazine’s Website)

October 2011

Even when patients survive, botchedsurgeries can be painful, disfiguringand costly. Absent regulation, however, any doctor with a license to practice medicine can perform any procedure a patient wants done.Many non-plastic-surgeons havedecided to go into areas in whichthere’s limited oversight, more moneyand little, if any, interference frominsurers because elective cosmeticsurgery typically isn’t covered.In medicine, board certification

occurs when a doctor has met all ofthe qualifications required by one ofthe American Board of MedicalSpecialties’ 24 member boards, whichrepresent the main areas of medicine,including plastic surgery. ABMS’member boards include the AmericanBoard of Plastic Surgery but none ofthe other cosmetic surgery boards,including the similar-soundingAmerican Board of Cosmetic Surgery,that many surgeons say they are certified by.

Lack of Training Can Be Deadly In Cosmetic Surgery

USA TodaySeptember 14, 2011

A new generation is turning to plastic surgery to mold the perfectbodies they’ve always craved: seniors.According to The American Societyfor Aesthetic Plastic Surgery, nearly85,000 people age 65 and olderchose to enhance their appearanceby going under the knife in 2010.

Never Too Old? 75-Year-Old Gets Breast Implants

MSNBC.ComAugust 23, 2011

According to The American Societyfor Aesthetic Plastic Surgery, in 2010 there were 84,685 surgical procedures among patients age 65and older. They included 26,635 face-lifts; 24,783 cosmetic eyelidoperations; 6,469 liposuctions; 5,874breast reductions; 3,875 foreheadlifts; 3,339 breast lifts and 2,414breast augmentations. There are asmany reasons for getting plastic surgery as there are older patients,experts say.

The Golden Years; Polished With SurgeryThe New York Times

August 8, 2011

Media Notes and QuotesA sampling of current media coverage on The Aesthetic Society

Media Placements6 Months of PlacementsMay–October 2011Confirmed Placements ..............979Reach (Audience).........393,805,945

Social Media StatisticsFacebook “Likes”ASAPS ......................................3,129Project Beauty.........................1,312

Twitter FollwersASAPS ......................................3,916Project Beauty............................796

YouTube ViewsProject Beauty.......................15,621



I don’t believe any of our memberstruly believe he or she is the “closestSurviving relation” to an unclaimed $8.37million in Malaysia or Nigeria, but greedcontinues to inspire creativity:

Phishing attempts also target plasticsurgeons. Here is one received by ourmember, Dr. Michael Edwards. The phisheris attempting to arrange for a foreignpatient to receive a breast augmentation by using a stolen credit card; our memberDr. Grant Stevens immediately noticed the signature:

Fortunately most phishing attemptsare rife with punctuation, spelling andgrammatical errors, even from the “IRS”(there were ten in case you didn’t lookclosely). In an effort to appear legitimate,phishers (technically “skimmers”) for several years have been using ATMmachines, either with secondary card readers to capture your informationwww.fbi.gov/news/stories/2011/july/atm_071411, or more recently with completelyfake ATM machines.

The fake ATMs are quietly placed inpublic places, such as the Rivera Hotel inLas Vegas www.computerworld.com/s/article/9136179/Fake_ATM_doesn_t_last_long_at_hacker_meet. Plugged in as stand-alone units, they occasionally dispense limited cash but always give anOut of Order message after recording youraccount information and PIN. The photobelow happens to be a legitimate machine,but as of October 24th there were 17ATMs for sale on eBaywww.ebay.com/sch/i.html?_nkw=used+atm+machine for as little as $300 each.

Be careful out there.

Phishing for SurgeonsContinued from Cover

GREETINGS FROM MALAYSIADear Friend,

Compliments of the day to you.By way of introduction,I am Siti Ghazali, a staff of PrivateBanking Services at the CIMBBank (Malaysia). I wouldrespectfully request that youkeep the contents of this mailconfidential and respect theintegrity of the information youcome by as a result of thismail. I have a business proposalwhich I believe would be ofinterest to you. It concerns adeceased client and an estate heleft behind, without naming abeneficiary to There is US$8,370,000.00 deposited , I alonehave the deposit details… theyhave investigated for months and have found no family… I amprepared to place you in a position to give instruction forthe release of the deposit toyou as the closest Survivingrelation… I will simply nominateyou as the next of kin and havethem release the deposit to you.We share the proceeds 50/50… Ianticipate your cooperation.

Regards,Siti Ghazali.

Hello Mr Michael,

Thanks for your email,we want toproceed immediately with the pay-ment for the breast augmentationsurgery,as part of the travelarrangement,we want to make allbookings now to avoid any form ofdisappointment. According to yourquote the estimated cost for thebreast augmentation is $6400. Wewill make a full payment of $6400with a credit card (Master card).She will make other outstandingpayments when she arrives. I willsend the credit card details toyou so that you can be able tocharge the entire amount from thecredit card with your credit cardmachine.

We made an arrangement with atransport/logistics agent and concluded with him to take careof her travel arrangement andother local needs. You arerequired to charge the creditcard for a total amount of$14,000. This will cover thetotal cost for the surgery andmoney meant for the transport/logistics agent. As soon as youreceive the money $14,000 in youraccount, you deduct your cost$6,400 and send the balance$7,600 to the transport/logisticsagent to enable him reserve ahotel for her and offset otherlocal bills. This arrangementarise because the agents creditcard machine is faulty and alsoreduce over exposure of thecredit card details.

Please be advised that allexpenses/tax and fees incurred asa result of the entire amount tobe charged should be deductedfrom the credit card.

Confirm this message and getback to me with the followinginformation.

1)Your full name-2)Contact address-3)Phone Number-4)The credit card information youneedI await your prompt reply.

Do have a nice day.

RegardsMr Youmustbea Fool26 Cornwallis Close,Long Eaton, Long Eaton,NOTTINGHAM, NG10 1DW

+44(0)7045717821


As the only Society completely dedicated to theexclusive needs of the Aesthetic Plastic Surgeon,ASAPS has long maintained rigorous standards forapplication, ensuring that our Members share thehighest commitment to education, training, andpatient safety. At the same time, we have realizedthat waiting an entire year for the application datehas caused issues for many of our Candidates, andthe Society recently approved a second applicationdate to make the process easier for all. Now, applicants may apply by both January 5 and July 1 of each year.

Having two dates means that prospective memberswill no longer have to wait an entire year beforebeing able to apply, giving them more time to submit all needed material, as well as to acquire therequisite number of cases.

The Aesthetic Society continues to provide value to its Members through discounted early bird registration for our annual Aesthetic Meeting (the premier venue for aesthetic education), complimentary subscriptions to both AestheticSurgery Journal and “Aesthetic Society News,” freeinformative webinars, three potential referral sources(Find-a-Surgeon, Enhanced Practice Profile (EPP) WebPages, and Ask-a-Surgeon), free video content viaProjectbeauty.com, and so much more. And, as Dr.Sanjay Grover notes in his article on the ASAPSMarketing Initiative (also found in this issue of ASN),there are more Member benefits on the way.

To apply for Membership, an applicant must have anActive member contact the Society in writing andrequest that application materials be sent. The applicant will then receive a “Checklist” with fivequestions that must be completed and returned.Once the completed Checklist is received, and theapplicant is able to answer “yes” to all questions, thefull application will be sent. ASAPS must then receivethe completed application by January 5 or July 1.

ASAPS strives to provide the best in resources, education, and Member benefits, and we hope having both January 5 and July 1 as our applicationdeadlines will help make the process easier for ourapplicants. While we will always keep our high standards for Membership, if you have suggestionson how we can further refine our ApplicationProcess, I welcome your comments.

R. Bruce Shack, MD, practices in Nashville, TN, andserves as Chair of the ASAPS Application ReviewCommittee.

New Membership DeadlineMakes Applying Even EasierBy R. Bruce Shack, MD


BenchmarkingContinued from Cover


Limiting FactorsPlease note there are several factors

which may impact the validity of theresults including, but not limited to, thenumber of respondents to the survey. Inaddition, practices report financial resultson the cash basis of accounting, whichmay serve to distort true measure of performance. Also, practices use differentmethods of classifying expenses, which can make it difficult to draw meaningfulconclusions concerning inter-practice variances. As such, practices are stronglyencouraged to view the report results andbenchmark comparisons as directional innature.

Database PracticeParticipation

Participation in the program is voluntary. Each practice is identified bythe Allergan® Practice Consulting teamand may not reflect the “average” plasticsurgery practice. Each practice submits thefollowing source data to create a report:• Practice Financial Statements or Income

Tax Returns• Productivity Reports• Employee Census Data

Three years of data is collected fornew practices participating in the survey.As new survey data are collected in 2011,it is expected the number of practices with2008 and 2009 results will increase fromthose indicated in Fig. 1-1.

Demographic AnalysisPractices specializing in plastic surgery

make up 58% of the total respondents tothe survey. Approximately 64% of thesesurvey participants are in solo private practice, 30% in practices with two orthree physicians, and the remaining 6% ofrespondents in groups with four or morephysicians.

The benchmarking results are seg-mented by region, which are consistentwith the regional alignment set forth in theMedical Group Management AssociationAnnual Cost Survey. The participants specializing in plastic surgery are illustratedin Fig. 2-1.

DiscussionOver the past few years, economic

conditions have posed significant chal-lenges for the medical aesthetic industry.Although the results indicate a slightdecline in physician revenue from 2008 to2009, there has been an increase in non-physician provider revenue of almost 20%from 2008 to 2009 as well as an 8%increase in revenue generated by other cosmetic providers. A non-physicianprovider includes physician assistants andnurse practitioners. Cosmetic providersinclude RNs, LPNs, medical assistants,cosmetologists, and others who are performing injections, laser procedures,and other cosmetic services.

Also, the demand for higher-pricedelective, surgical procedures has declined,but there has been a slight increase in some non-surgical procedure volume. Forexample, neurotoxin injections increased8% in 2009 as compared with 2008.

The median net collected revenue perfull-time-equivalent (FTE) physiciandeclined $90,557 (7.3%) in 2009 as compared with 2008. Median net collectedrevenue per FTE non-physician providerincreased by $64,692 (almost 20%) andcosmetic provider revenue increased by$13,146 (8.1%) during the same timeframe. Revenue generated by aestheticiansand retail sales declined $8,497 (7.3%)and $8,015 (11.0%), respectively.

It is impressive that practitioners in allparts of the country have been able tomaintain practice efficiency in spite of thechallenges brought about by the economicslowdown that continued throughout2009. Staffing, facility, and marketingexpenses, measured as a percentage of revenue, were relatively flat year over year.Additionally, the median operating expenseratio for the practices in the databaseincreased slightly, from 65.3% to 66.0%,suggesting that practice owners were diligent about holding the line on operat-ing costs. This is illustrated by the slightdecline (4.64 to 4.12) in the median number of FTE support staff per FTEprovider. See Fig. 3-1.

As seen in past surveys, there weresome interesting regional differences inproduction and efficiency measures. Thesedifferences are summarized in Fig 3-2.

Fig 4-1 illustrates that there was adecline in the median number of majorsurgical procedures performed in 2009 ascompared with 2008. Eyelid surgerydeclined by about 8%, facelifts declined by7%, abdominoplasty was down 24%, liposuction was down 15%, and breastaugmentation procedures were down about14%. The tables below illustrate the median number of procedures per FTEphysician for each listed procedure, asreported by survey participants.

As illustrated in Fig 4-2, neurotoxininjections increased by 8% in 2009 ascompared with 2008, while “all filler injec-tions” remained flat. Microdermabrasionand laser hair removal procedures declinedby 18% and 13%, respectively. There wasa significant increase in the median number of chemical peel procedures,which more than doubled in 2009 as compared with 2008. It is important topoint out that many survey participantshave physicians, registered nurses, andother non-physician providers performingnon-surgical procedures.

As the economy continues its slowand steady path towards recovery, manyplastic surgery practices are expected toexperience modest growth in the comingyears. As this article goes to press, a reviewof about 60 practices with 2010 informa-tion has been completed. The early 2010results show across-the-board improvementin operating revenue and profitability ascompared with 2009. It is nice to note thatthis positive trend has continued in theearly part of 2011.

About the author: Bruce Maller is thefounder and president of BSM Consulting, a nationally recognized health care technology and consulting firm with offices inScottsdale, Arizona and Incline Village,Nevada. Mr. Maller is a frequent lecturer for various medical societies and nationalconventions. He is a regular contributor tomany health care publications on differentfacets of practice management.

Fig. 1-1: Plastic SurgeryDemographic Analysis

Year East South Midwest West Total U.S.2006 46 61 20 36 1632007 52 65 21 46 1842008 53 50 19 39 1612009 33 34 11 28 106

Fig. 3-1: Plastic Surgery Financial Benchmarking Database Median Results

Fig. 3-2: PlasticSurgery RegionalFinancialBenchmarkingDatabaseMedian Results

Fig 4-2: Non-Surgical Procedure Results (Median per FTE MD


BenchmarkingContinued from Page 16

Fig 4-1: Surgical Procedure Results (Median per FTE MD)

Fig. 2-1: Plastic Surgery by Region


The Aesthetic Society returns to thescene of one of our best attended Meetingswhen we journey back to the vibrant city ofVancouver, B.C., next year. The AestheticMeeting 2012 is set for May 3–8, and wehope you’ll plan to join us as we bring youthe best in higher education presented in a dazzling city, surrounded by beautifulnatural scenery.

Savings, Shopping &Sights!

With our new “Show Your Badge”program, Aesthetic Meeting participantswill receive discounts at local retailers,restaurants, and attractions. And with so much to do in Vancouver, there are outings the entire family can enjoy.Consider a stroll or bike ride in the 1,000acre Stanley Park, an afternoon at theVancouver Art Gallery or Aquarium, orexplore Granville Island, with its quaintshops and public market.

Your Passport to HigherLearning

Of course, the real reason to come tothe 2012 Aesthetic Meeting is our excep-tional educational offerings. Not only aresome of your favorite sessions returning,such as “Global Hot Topics,” “CosmeticMedicine 2012,” and “Facelift: Planningand Technique,” but we have some exciting new courses as well. Dr. WalterSullivan will be presenting “Stark/Anti-Kickback Laws and Plastic Surgeons,”Dr. J. William Little will instruct us on“Fat Grafting During Facelift &

Blepharoplasty: Principals and Art,” andDavid Evans, PhD, & Barry Eppley, MDwill lead “Maximizing Your OnlineMarketing ROI,” to name but a few of ourdynamic offerings. And make sure to stayfor Tuesday’s session on Social Media, ledby W. Grant Stevens, MD, which waswidely praised in Boston. The AestheticMeeting 2012 will see even more interac-tion and dynamic courses, with the latestin Evidence-Based Medicine.

Starting in January, BookYour Room at an ASAPSRecommended Hotel

For each Annual Meeting, theAesthetic Society enters into contractualagreements with conference hotels, basedon past and anticipated meeting attendance,at the lowest possible rates. When ASAPSattendees fill our room block, your meetingregistration fees are controlled.

Ultimately, if many ASAPS membersstay at non-conference hotels, the registra-tion fee will be affected in future years.Once our room block opens up in January,please book through any of the ASAPShotels to ensure we meet our contractualobligations and keep your registration feesat their lowest possible level.

To assure a reservation, please bookyour room as soon as the ASAPS roomblock is open, as there are other eventsoccurring in Vancouver at the same time asthe Aesthetic Meeting 2012.

Skin Care 2012 As always, plan to send your skin care

specialist to the Society of Plastic SurgicalSkin Care Specialists 17th AnnualMeeting, also in Vancouver, just prior tothe Aesthetic Meeting, on May 1–4, 2012.Skin Care 2012 brings you the latest innovations by the experts in the field, andis a great opportunity for networking. Itfeatures 50 exhibits, as well as unbiasededucational sessions covering everythingfrom the latest in treatments, products,marketing, and more—everything yourstaff needs to help build a first class Plastic Surgical Skin Care Practice. Visit www.spsscs.org/meeting2012 formore details.

Renew Your Passport!Make sure and renew your passport

(http://travel.state.gov/passport/), as theAesthetic Meeting 2012 in Vancouver isnot to be missed! For more information,go to http://surgery.org/meeting2012

Jack Fisher, MD, is an aesthetic surgeonpracticing in Nashville, TN, and is theAesthetic Society’s Vice President andEducation Commissioner. James C. Grotting,MD, is an aesthetic surgeon practicing inBirmingham, AL, and is Vice-Chair of theAesthetic Society’s Education Commissionand Treasurer.

Get Your Passport and Meet Me in Vancouver!

The Aesthetic Meeting 2012: May 3–8 in Vancouver, B.C., CanadaBy Jack Fisher, MD, and James C. Grotting, MD

V A N C O U V E R

www.surgery.org/meeting2012

TheAesthetic Meeting 2012TheAesthetic Meeting 2012

F O C U S I N G O N T H E F U T U R E —The Changing Landscape of Aesthetic Plastic Surgery

Annual Meeting of

THE AMERICAN SOCIETY FORAESTHETIC PLASTIC SURGERY, INC.

AESTHETIC SURGERY EDUCATIONAND RESEARCH FOUNDATION

®

Save the DateMAY 3–8, 2012

Vancouver Convention & Exhibition Centre

• Interactive and Informative, with the Latest in Evidence-Based Medicine• Global Perspectives, Dynamic Panels, Thought-Provoking Papers• Hot Topics: Compelling and Controversial

C A L L F O R A B S T R A C T S• Submit Your Abstracts Online for Residents & Fellows Forum by December 1, 2011 at surgery.org/abstracts


After listening carefully to Membersthrough both Member Surveys and in-person discussions, the Aesthetic Society hasembarked on an ambitious effort gearedtoward creating new value for membersthrough public education, agreements withbroad-based web partners and the creationof various member tool kits to help youcompete in your local markets and showconsumers the real value of your AestheticSociety membership.

At the recent Executive Retreat, conversation focused on the need to distinguish ASAPS from other organizations,(particularly those that do not have ourlevel of training and expertise in cosmeticsurgery and medicine procedures).

To help in this, the Board ofDirectors made a commitment to dedicateresources and energy to a new brandingand public education initiative, startingwith the founding of a Marketing TaskForce, to help implement this vision. Thecharge of the Task Force is to help brandASAPS to the general public, increaseawareness within membership, and to market the Society to other non-ASAPSsurgeons and residents.

The Task Force is led by me andincludes members Robert Singer, MD,Rob Whitfield, MD, Brian Regan, MD,Brad O’Connell, MD, Gary Brownstein,MD, Grant Stevens, MD, Kent Hasen,MD, Herluf Lund, MD, with oversightfrom Dan Mills, MD, CommunicationsCommissioner, President-elect Leo

McCafferty, MD and President JefferyKenkel, MD.

To help us with the charge, the TaskForce has hired two consultants, based ona Request for Proposals (RFP) to helpoversee these efforts; one of whom willfocus on brand elements, and the otherwith digital elements execution. Theseconsultants will be leading an in-depthbranding session, conduct analysis of thecurrent ASAPS communication tools, anddevelop a refreshed look, tone, and feel for the Society’s image. Additionally, they will be looking at ways to enhance the Society’s websites, to ensure theybecome more user friendly, with enhanced capabilities and focus.

Additionally, the ProductDevelopment Committee, led by JohnGross, MD, is overseeing development ofseveral new value-added products that willbe a benefit of dues to help enhance andgrow our practices. These new productswill be available only for ASAPS Members.

Although only created in July, the TaskForce has already entered into an excitingnew partnership with Empowher.com(www.empowher.com), a health and beautysite for women with 1.5 million uniquevisitors per month. In this new endeavor,Empowher will be utilizing ASAPS con-tent, such as our “Ask-a-Surgeon” forum,Find-a-Surgeon and Project Beauty videos,on their website. Empowher also hasstrong ties with Glam.com, which has 10million followers, and this partnership will

result in increased visibility for doctorswho choose to participate in “Ask-A-Surgeon,” which is open to all Members.ASAPS is also forming stronger ties withRealSelf.com, the Plastic Surgery Channel,and New Beauty, among others.

Project Beauty continues to evolve,with new video content, including bothnews and first-person interviews, rollingout in the coming months. The ProjectBeauty Task Force is working diligently torefocus the site to more closely align thevideos, news, and blog posts with our corecompetencies. In the Spring 2012, ProjectBeauty will have a supplemental insert in10 major metropolitan newspapers, withcontrol over all content and advertising.Members will be receiving complimentarycopies of the supplement for their ownpromotional use as well as quarterly DVDof all project Beauty content for use inyour waiting rooms or consultation areas.

If you have further suggestions onhow ASAPS can better serve its Membersor communicate our message more effectively to both prospective Membersand the general public, we welcome yourinput. Together, we believe the efforts weare undertaking will result in a strongerand more productive Society, as well asproviding our Members with more robustMember benefits. Thank you.

Sanjay Grover, MD, practices inNewport Beach, CA, and serves as Chair ofthe Marketing Task Force and as the Vice-Chair of the Communications Commission.

ASAPS Launches New Marketing EffortBy Sanjay Grover, MD



Editor’s note: Many AestheticSociety members have attendedthe ASPS-sponsored Pathways toLeadership Program, the multi-part development sessions headedby Dr. Margaret Skiles. Below isan edited email that Dr. Skilessent to past attendees. TheAesthetic Society feels that this is a beneficial program anddeserving of your help.

“Since I last wrote you, we were finallyable to have an advanced training sessionin June for six of our graduates, focusingon skills review and included a ropes train-ing session. At ASPS there has been a focuson finances, both decreasing expenses andincreasing revenue--which is in response tothe economy and the changing health carescene, specifically the change in Pharmaregulations which meant Pathways toLeadership lost one of its major sources of funding.

To make a long story short, ASPSfeels it is unable to support the Pathwaysprogram financially and has told us that wemust raise the entire cost of the Pathways toLeadership Program or it will cease to exist.The Leadership Development Committee(of ASPS) is committed to continuing P2Land has spent most of the year working todecrease the expenses of the program whilemaintaining the core curriculum. We weresuccessful and have brought the budget forthe Class of 2013 down to $100,000which is half of what our former sponsorsspent per class. If we are to continue thePathways program and start another classnext July, we need to raise $100,000 by theend of this year.

The Plea for HelpWe need your help; we need everyone’s help to raise this moneyso the program can continue.

The good news is we already havealmost $50,000. The LeadershipDevelopment Committee has stepped up to the plate with 100% participationand pledged over $12,000. ASAPS haspledged $10,000. David Watson of myBody,a new skin care company has pledged$20,000 [They make great products; givethem a try. And David says that if thecompany is doing well, they may be ableto provide a higher level of support.] Anda number of graduates have pledged aswell. But we still need over $50,000.

Here are ways that you can help: 1. Pledge as much as you can (please dig

deep!). The Pathways training wereceived was a valuable experience; helppay it back so someone else can benefit.The cost of training a participant is$5000. Now is the time to give back. Itwould be great if we could get 100%participation by graduates. We couldeven make it a contest and see whichclass can raise the most! If every one ofthe 100 grads gave $500 that would putus over the top. It has been suggestedthat we each pledge $1000 so we canstart a fund for ongoing support. I haveand challenge you to join me.

2. Ask your colleagues who have not beenthrough P2L to support it.

3. Ask sister societies that will benefit from having trained plastic surgeons asleaders (ASAPS has already pledged) for support.

4. Ask any industry contacts you have tosupport us. At the request of theExecutive Committee we cannot solicitthe members of the CorporateLeadership Council who are listed onthe ASPS website. However, if you havea personal relationship with someonewithin the Corporate LeadershipCouncil there is nothing wrong withasking if they would like to contributeas an individual.

5. Submit a grant proposal to an organiza-tion that gives money for leadershiptraining.

6. Ask anyone you know who would bewilling to support P2L—consider askingretired colleagues or mentors.

7. Get creative and think outside the boxbut get pledges!

FYI: We need pledges ASAP so wecan reach our goal and start recruiting thenext class but until we are 100% sure thenext class will start, we will not be accept-ing anything but pledges. Individuals willbe able to make their donations taxdeductible. Send your pledges to me viaemail, snail mail or any way you want. Wehave a promotional brochure that describesthe program; let me know if you wantsome to give to others. I would be glad toanswer any questions you may have andhelp coordinate contacting others.

As you know, Pathways is an excep-tional program. It is up to us to keep italive for the benefit of our specialty andour colleagues. Please help as much as youcan. I know that as a group we are morethan capable of meeting this challenge.”

The editors of ASN commend Dr.Skiles’ dedication to the program and encourage you to contact her with any questions or offers to help. She can bereached at [email protected]

A Special Message from the Pathways to Leadership ProgramBy Margaret Skiles, MD

The Premier Industry Partnership Program matches your professional goals

and the strength of the ASAPS organization, with the innovation of our

industry partners. Together, we are advancing the science, art, and safe

practice of aesthetic plastic surgery among qualified plastic surgeons.

Be the first to step out and introduce yourself to our partners.

PA R T N E R

PREMIER INDUSTRY


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SOCIETY OFPLASTIC SURGICAL

SKIN CARE SPECIALISTS

18TH ANNUAL MEETING

Could Your Staff Benefit from Unbiased Plastic Surgical Skin Care Education?

www.spsscs .org

May 1–4, 2012Hyatt Regency Vancouver

Vancouver, BC, Canada

Go for the Gold in VancouverScience, Technology and Skin Care

“My medical skin care practice is a major driver to my surgical practice. I always make sure at least one of our master aestheticians attends the

SPSSCS annual skin care meeting. It’s the best ‘must attend’ event for any practice

in the cosmetic medicine world.”Renato Saltz, MDSalt Lake City, UT

The Aesthetic Surgery Education andResearch Foundation (ASERF) works diligently to ensure that our research andeducation benefits patients, physicians, andthe larger field of medicine. Recently theASERF Board of Directors met in Denver,and I am happy to update you as to someof our important items:

Requests for Assistancewith Research

Recently, ASERF has had manyrequests from companies looking for physi-cians interested in doing clinical research.We currently have several opportunitiesavailable with industry, so please letASERF know if you are interested in moreinformation by emailing Tom Purcell [email protected]

Data Collection andEvidence Based Medicine

A hot topic at our meeting was theissue of data, given its importance toEvidence Based Medicine (EBM), and theneed for us to move more quickly intoestablishing a clinical data collection system. Some of our doctors have extensivedata collection systems in place, but thereis a real need for ASERF to have its own,and we are investigating the best systemfor doing so.

Vice President William P. Adams Jr,MD, updated us on the efforts of theScientific Research Committee. With 11research grants received, 8 have gone outto the committee for full review. Fromprior grants, there are some insightful newfinal reports, which are posted on theASERF website www.aserf.org and I wouldhighly encourage you to read them.

As always, the research we do is funded by our loyal Members, and if youhaven’t yet become a Member, your $200

donation will ensure that we continue tofund grants, the findings of which willbenefit us all. Or if you would like tomake an additional donation to ASERF,please speak with Tom [email protected] for further information.

ASERF Study Widely Quoted, Abstracted in Pub MedImpact of the current economy onfacial aesthetic surgery.

AbstractBackground: American Society for

Aesthetic Plastic Surgery (ASAPS) surveydata showed a 16.7% decrease in the totalnumber of aesthetic surgical proceduresfrom 2008 to 2009, whereas plastic surgeons have seen an increase of 0.6% intheir nonsurgical cosmetic procedures.Objective: The authors describe the resultsof two surveys—one administered topotential patients, one to physicians—assessing the impact of the economy onpatient choices in aesthetic facial surgery.Methods: Two surveys were conducted forthis study—one from the AmericanAcademy of Facial Plastic andReconstructive Surgeons (AAFPRS) andone from the Aesthetic Surgery Educationand Research Foundation (ASERF). Bothsurveys utilized the unique maximum difference (MaxDiff ) scaling format, whichassesses respondent opinions throughattribute/question grouping and multipleexposures to the same parameter, ratherthan traditional one-time questioning. Inthis way, MaxDiff analysis helped identifythe varied drivers of patients’ medical antiaging treatment (MAT) selection. TheAAFPRS survey was conducted onlinethrough Synovate’s Global Opinion Panelto identify an appropriate audience of

potential patients. The ASERF survey contained both MaxDiff and traditionalquestions and was e-mailed to 2267ASAPS members. Results: Data from theAAFPRS patient survey showed that 53%of respondents had been affected by theeconomy in their decisions regarding MATprocedures, with many seeking out less-costly options such as microdermabrasion.An overwhelming majority (95%) alsoreported that they would prefer a longer-lasting treatment over an immediate effectwith shorter duration; furthermore, 60%felt that duration of treatment was moreimportant than cost in selecting a facialaesthetic procedure. In the ASERF surgeon-based portion of the study, 61% ofplastic surgeons felt that patients preferredlong-lasting results over immediate ones,but 63% also reported that cost was amore important factor for their patientsthan duration. Conclusions: Extrapolatingfrom the patient-reported survey prefer-ences, the authors conclude that nonsurgi-cal facial aesthetic treatment plans shouldcurrently be focused more on longevityrather than on immediate impact. There iscurrently a disconnect between patientpreferences and surgeon perception ofthose preferences, which may be remediedwith increased education for both groups.It is worth noting that many patientswould be willing to accept a higher cost if it was correlated with a longer-lastingresult.

We cannot continue to fund theresearch that we do without your ongoingsupport. We appreciate your efforts.

V. Leroy Young, MD, is an aestheticplastic surgeon, practicing in St. Louis,Missouri, and is President of the AestheticSurgery Education and Research Foundation

V. LEROY YOUNG, MD

UPDATE ON: ASERF


the middle of the operation” to which Dr.Millard retorted “God help the surgeonwho can’t.” Dr. Millard was then fired.“Thou shalt not have a routine” was Gilles’ninth of 10 commandments of plastic surgery. Dr. Millard’s plastic surgery lightbulb was turned on in a brilliant way whileat Rooksdown House, Basingstoke,

England studying under Sir Harold DelfGilles. Dr. Millard said it best: “Gillescombined cruelty with compassion as he cuffed, cajoled, and challenged his students. After 8 months of blunderingstumbling and falling, I was literally lyingon the canvas starring at the lights andfeeling sorry for myself when suddenly it

dawned on me that these homespun commonsense rules were empirical principles in sheep’s clothing and held thepotential key to the specialty.”

Dr. Millard published Gilles principlesas 10 commandments in 1950 andexpanded these to 33 principles in his1986 landmark book “Principlization of Plastic Surgery” which should be compulsory for all plastic surgeons. Eventhe title bucks routine. Principlization isnot a word and Millard, a Yale Englishmajor, knew it but convinced the publishersto use it. Early in my training (1985-1987), I was able to read the complete galley proofs of this soon-to-be publishedbook in the Gilles Memorial Library onthe second floor of Dr. Millard’s office. Iwas stunned. I had read the Converse 7volume, 3,970 page text prior to my residency and felt I had a pretty good handle on the specialty but then sadly andsuddenly realized I didn’t have a clue.

Principle 30: Teaching our Specialty Is Its Best Legacy. Great leaders motivateand teach and he did both in the office,operating room, surgical lounge, car, elevator, over dinner at his home and atfootball games. He demanded seeing actualpatients during Grand Rounds. A commonoccurrence: The first year resident presentshis first patient to Dr. Millard proudly listing the differential diagnosis and robotically begins to recite textbook alternatives complete with references fortreatment. Dr. Millard would swiftly, decisively, and somewhat brutally interruptsaying “I don’t care one bit about what thetextbooks say. Look at the patient! Whatdo you think? What is your plan? What isyour pattern for the plan? Do you have adrawing? What is your lifeboat? Think,imagine, innovate! Those Wednesdaymorning rounds were packed with intellec-tual energy and he had little use for didac-tic lectures that seem to consume so manyGrand Rounds today. He expected you toknow the literature (principle 9) but hadno tolerance for it being regurgitated.

S. Anthony Wolfe, Dr. Millard’s longtime associate, would urge residents to“watch how Dr. Millard handles tissue.”Dr. Millard was a towering man physically

David Ralph Millard, Jr. Continued from Cover


with huge hands that were delicate, lightand ever so respectful of tissue. Walter“Buster” Mullen, another associate andconsummate surgeon, would often jokethat the “air conditioning in Dr. Millard’sOperating Room must be different”because of his great surgical results.Despite Dr. Millard’s 9 books, 53 bookchapters, 202 publications, and hundredsof presentations, much of his surgicalmagic was not published. It is rare indeedfor an individual to be both such anaccomplished academician and technicallyunmatched.

I refer you to the link:calder.med.miami.edu/Ralph_Millard forthe complete story, but what follows are some interesting tales all publishedsomewhere.

He attended Yale and played football,wrestled and boxed. The boxing team wasundefeated and he developed a lifelongfriendship teammate Dave Williams (Mr.Williams grew up in Pittsburgh, two doorsdown from my dad).

Dr. Millard was a prankster at HarvardMedical School. He once harvested fiveears from cadavers towards the end of hisanatomy class, bought five earrings andsent the ears with earrings attached to family members. The gifts received mixedreviews! Another instance had him feign-ing distress after hearing a test result. Hepulled out a revolver, put it to his head,and pulled the trigger, another studentmade a popping sound, and Dr. Millardfell into his lap. The professor’s jawdropped, but eventually he was able to finish the lecture. This story was verifiedby Dr. Al Ferguson, Harvard classmate ofDr. Millard and Chief of Orthopedics atthe University of Pittsburgh from 1953until 1986. Henry Bahnson, Chief ofSurgery from 1963 to 1987 at theUniversity Of Pittsburgh School OfMedicine and first to perform a hearttransplant at that school, was anotherHarvard classmate. He was also an expertequestrian and Dr. Millard an expert witha lasso. Together they would entertain children at a summer camp in NorthCarolina, as Dr. Millard, the Indian, wouldrope Dr. Bahnson, the cowboy, on hiswhite horse. Thomas Starzl, transplant

surgeon pioneer, relocated to Pittsburgh in1981 because of Dr. Bahnson. Of note,Dr. Starzl also spent time on Dr. Millard’sservice during his surgical training inMiami. Dr. Millard encouraged PlasticSurgery and was pleased Dr. Starzl did notdrift too far off course selecting transplan-tation as a career.

Dr. Millard relied on his lasso toentertain sick children while a pediatricsurgical intern at Boston Children’sHospital. His first exposure to clefts wasduring the last rotation. He was “horrifiedat the results of failed embryogenesis.” Hewas a general surgery resident at Vanderbiltand most proud of his Plastic Surgerytraining with Gilles. He coauthored thePrinciples and Art of Plastic Surgery withGilles which was an enormous undertakingthat covered Gilles 40-year career spanningboth World Wars. Eleven thousand casesfrom World War I alone were reviewed inpreparation for this book. War, along withdevastation, brings medical advances. Dr.Millard designed the Rotation–Advancement Closure of the cleft lip,while resting on his back on a cot in aMASH unit in Korea. Looking at thephoto of a cleft child dangling askew, henoticed the entire lip was present, but outof position. His design ingeniously putnormal into normal position (Principle14). He presented the technique at theFirst Congress of the International Societyof Plastic Surgeons in Stockholm in 1955.He was allotted only five minutes, butknew he needed a few more. He noted thefive-minute clock did not start until thepresenter reached the podium, so he sat inthe back and when introduced began hispresentation as he walked slowly to thepodium. Some complained, but Gilles gavehim a “wink” of approval.

His career at the University of Miamistarted in 1956. In the early days, goodassistants were scarce and he was known tohave scrubbed, gloved, and then drape apatient’s hand into the field so she couldhelp retract with a hook. The Chief ofSurgery was puzzled when he peeked intothe room and noticed an extra hand in thesurgical field. He became Clinical Professorand Chief of Plastic Surgery at theUniversity Of Miami School Of Medicine

in 1967 and developed one of the bestmost innovative Plastic Surgery trainingprograms in the world. He trained approx-imately 200 Plastic Surgeons that practiceon every continent on the planet. Manyhave become leaders. His honors are many,including Honorary Fellowship of theRoyal College of Surgeons, Edinburgh andEngland, Honorary Medal from thePeoples Republic of China, Order ofDistinction Jamaica, Hunterian Award (theonly American Plastic Surgeon recipient)and voted one of the Plastic Surgeons ofthe Millennium by the American Societyof Plastic Surgeons.

“The most important thing is family,the rest—just tiddlywinks,” he once said.He loved his family and always had anextra spring in his step when his childrenwere home visiting. His beautiful wife,Barbara, was a kind, brilliant, spirited souldedicated to her husband, children and Dr. Millard’s second family—his residents.Often the Millard’s would host aThanksgiving meal for residents, realizinghow difficult it was for trainees to be awayfrom their families during the holidays.She once arranged a robe and slipper birth-day party for Dr. Millard. He had a habitof coming home, showering, and puttingon his robe, knee socks and slippers beforedinner. That birthday he was momentarilyspeechless when all of his residents showedup for dinner in identical robes, kneesocks, and slippers. Dr. Millard was a shy,kind, gentle, family man with a keen senseof humor. He was also quietly generousespecially to those in need, often nevercharging a fee. He is survived by threebeautiful children, inside and out, Duke,Bond, and Meleney and six wonderfulgrandchildren.

Our specialty is blessed to have beengraced by his brilliance and his principles(side bar) that will forever continue tospark innovation and benefit patients.Principle 25 typified this great man’s life—“Boy, avoid the quagmire and rut of routine!”

Leo McCafferty, MD is an aesthetic surgeon practicing in Pittsburgh. He isPresident-elect of The Aesthetic Society.


David Ralph Millard, Jr. Continued from Page 26

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