The Los Angeles Times recently (Sunday July 24, 2011) published an article written by Susan Carpenter entitled “No Knife Needed”. 83% of all cosmetic procedures performed in 2010 were non-surgicalaccording to the American Society for Aesthetic Plastic Surgery and the American Society of Cosmetic Dermatology and Aesthetic Surgery. Jeffrey Kenkel, M.D., the president of the American Society for Aesthetic Plastic Surgery says that some of these non-invasive devices can be unpredictable. I respectively disagree with Dr. Kenkel, it is not the devices that can be unpredictable, but the due diligence that aesthetic physicians spend on investigating these devices before committing to the technology that is unreliable and “unpredictable”.
For many reasons in these Obama-Care medical economic times, too many “cosmetic” physicians, nurses, and med-spas are quick to jump on the band wagon of new non-invasive devices without scientifically investigating the treatment, or worst of all scenarios, knowing full well that a technology is “unpredictable” (i.e. a sham) and still greedily promoting it to unsuspecting patients.
In my past 26 years of private facial plastic surgical practice, there have been hundreds of “new” devices and treatments with bold promises. In my practice these new procedures are carefully evaluated before use on our patients. The criteria that must be met are : the treatment must be safe and effective with clinical scientific proof in accepted medical and surgical journals; it must be the “gold standard” or “Bentley” of it’s class of devices; it must serve a unique niche of indications that are not addressed by other available technologies; and it must have lasting results.
It is shameful that both medical device companies as well as the “hired gun” physicians who in the name of the mighty dollar tarnish their reputation by falsely promoting inferior and in some cases totally useless technology to their peers at medical/surgical conferences, journals, and TV shows such as The Doctors and Dr. Oz. This leads to confusion not only among the unsuspecting public, but even among aesthetic physicians. The hype needs to be separated from what is real. The first time that I heard Dr. Kenkel speak at a medical conference, he was presenting Zerona in a very positive fashion. Zerona has a very low patient satisfaction rate (only 37% according to RealSelf.com, not much higher than placebo). It is no wonder that Dr. Kenkel finds some of these devices such as Zerona “unpredictable”. Other physicians at medical conferences use the politically correct, “We must be “skeptical” about Zerona (or other treatments)”.
Below are the devices mentioned in the LA Times article, along with Dr. Persky’s thoughts on each. Zeltiq (CoolSculpting) freezes and kills fat cells. Zeltiq was developed by Rox Anderson M.D. and Dieter Manstein,M.D. at Massachusetts General Hospital. Dr. Manstein states, “The ideal candidate is somebody who’s in reasonalby good shape, somebody who has some love handles or a post-pregnancy pouch or back fat that doesn’t want to disappear.” After 2 years of due diligence, Dr. Persky was convinced that Zeltiq is safe and effective. We now offer CoolSculpting in our office. There is a high patient satisfaction rate (78% ,RealSelf.com).
Ultrasound therapy for lifting and tightening the skin of the face, neck, and eyes (Ulthera) was a treatment choice by one of the patients in the article who though 48 stated, “I think I could pass for 40” after getting the results that she wanted. After 1 1/2 years of investigation, Ulthera is now offered in our office. Our patient satisfaction rate is very high, as is the 89% RealSelf.com number. At the recently concluded American Academy of Facial Plastic and Reconstructive Surgery annual meetings, Ulthera was the emerging technology with the most buzz. I expect ultrasound rejuvenation to be the future “real deal” of not only the face, but the rest of the body; wherever one may find bothersome loose skin.
Fraxel laser(also developed by Dr. Anderson and Dr. Manstein) was the first fractionated laser used to rejuvenate aging skin. It is excellent in the treatment of acne and surgical scars as well as eyelid, neck, and facial skin rejuvenation. Dr. Persky was among the first physicians in the world to use all of the Fraxel lasers (based on the unquestioned reputation,scientific work, and genius of Dr. Anderson). As with most devices, the success rate is dependent on how the device is used by the physician. Our patient satisfaction is much higher than RealSelf’s 60%.
Thermage and Zerona are technologies that must be looked at in a politically correct manner, skeptically. Dr. Persky has studied both technologies since they came to the market, hoped that they would meet their promises, but has been as disappointed as the public with their effectiveness (or lack thereof). Thermage (40% patient satisfaction, RealSelf) is a radio-frequency device that claims to smooth the skin and soften wrinkles. Zerona uses the same wavelength laser light used in laser pointers and used to read bar codes in grocery stores. Patients are promised the loss of 3-4 inches in 2 weeks from their waist, hips, and thighs (combined) with the treatment and the niacin containing “dietary” supplement, Curva. We have never offered our patients either Thermage or Zerona.
Exilis (80% patient satisfaction) is the newest of radiofrequency devices that heat the skin to stimulate collagen production tightening the skin, shaping body contours, and smoothing wrinkles. Our practice used a similar radiofrequency device, Accent XL with mixed patient satisfaction.
Excel V Laser by Cutera is an excellent laser used to target the red in blood vessels, heating them to the point of collapse and disappearance. This is likely the next class of laser that we will add to our practice. At this time we refer our patients to other practices such as Mark Rubin, M.D. in Beverly Hills for treatment of “red lesions”.
Pearl Laser (55% patient satisfaction RealSelf) is another good laser by Cutera used for skin resurfacing. Our practice offers the Fraxel platform of lasers for this purpose.
Many cosmetic and aesthetic treatments performed today are surgery-free. The options are growing rapidly to keep up with public demand. If you can look great without the risks of surgery wihich include anesthesia, infection, bleeding, scars among other things, why wouldn’t the public demand more non-surgical treatments? When choosing a treatment for yourself and spending your hard earned money, be sure to do your due diligence about the safety, effectiveness, and predictability of the device. More importantly make sure that your treating physician has done their due diligence! Feel free to contact me with any concerns or questions regarding non-invasive cosmetic treatments. Be well.
Dr Michael Persky and Dr. Sarmela Sunder are located in Encino, California and Beverly Hills, California but service all of Los Angeles and the San Fernando Valley. Including, Beverly Hills, Hollywood, Hancock Park, Brentwood, Santa Monica, Pacific Palisades, Malibu, Sherman Oaks, Studio City, Calabasas, Woodland Hills, Tarzana, Westlake, Thousand Oaks, Agoura Hills and more