Here’s a typical scenario. You’re considering facial plastic surgery to take care of a bump on your nose, a droopy tip, or a sagging jaw line. The feature may be subtle, but it’s definitely there. And you’ve been thinking of doing something about it for so long.

 You’ve finally worked up the courage to tell your husband/mother/sister/brother/best friend (insert loved one here) about it and, instead of uncompromising support, you hear something like “Your nose is fine. Why would you mess with it?”. Other reactions are “Whatever makes you happy, honey” or, “I was wondering when you were gonna take care of that honker”. But, the overwhelming #1 reaction is the first one.

You’re crestfallen. You start to second guess yourself. You think “I’m not imagining this. There is a noticeable bump on my nose. Why doesn’t anyone else see it?”. Well, the answer is, they do and they don’t. They can see the feature you’re pointing to just as well as you can. The human eye is capable of incredible feats. Our eyes can discriminate between two objects down to 1/25th of an inch or about 1 mm. So, if we show you a photo of your nose and another photo with your bump shaved down just one millimeter, you’ll be able to see the difference every time. And, we all also have a built-in, hard-wired aesthetic sense of proportion, symmetry and ‘belonging’ness when we compare one feature to the rest of the whole. So, they know deep down that the bump is there.

But, your family or friends may not “see” what you’re talking about because they don’t wish to and they don’t attach the same level of importance to it as you do. They care for you as you are, as they should. And, they’re afraid for you. Afraid of the risk, even if it’s very small. And, afraid that you’ll change too much. After all, you may want a subtle change or a dramatic change, but they don’t necessarily see what you see.

 Some of our patients who are REALLY close to family and friends and look to them for advice are really freaked out by this. We’ve even had a few patients recently who’ve nearly psyched themselves out of their decision. The important thing here is not to try to force your loved one to feel about your proposed surgery the way you do. Family are never quite as enthusiastic as you may be. Instead, you should let them know how important this decision is to you, and how much better you’ll feel if you have a positive outcome. That will often turn them around because what’s important to you is often what’s important to them. The decision to have surgery is a very personal one and is ultimately yours. You can reassure them that, if you’ve chosen the right surgeon, your results will look natural and won’t remove your identity.

 What’s interesting is that the most resistant family member or friend is usually your most astonished and glowing supporter after the surgery once they see how happy you are with the change. This is just something to consider when you sit down to have “the talk”.

We’ve had doubts for a long time about the effectiveness of thread-lifts for revitalizing the face. For those who don’t know, this procedure involves a bunch of barbed sutures or threads that are placed under the skin under local anesthesia to lift sagging brows, cheeks, and necks.

That just doesn’t make sense to us. You can’t expect a thread to do what a real lift should without pulling through the tissues over time. More involved lifts work because the sagging tissues are widely lifted away from underlying tissues and allowed to reheal in a new desirable position. Thread-lifts aren’t even anywhere near the same ballpark. The threads can’t support the weight of the tissues and when they break and fragment, a whole host of problems can arise.

It’s one thing for guys who don’t like the idea and who’ve never used them to trash these threads. But, when docs who embraced the technique start raining on the parade, that’s a reason to take notice. In the latest issue of Archives of Facial Plastic Surgery, a report on thread-lifts by an experienced surgeon indicated that a whopping 30 out of 75 patients treated experienced a complication. In 14 patients, the thread was extruding, meaning it was popping out of the skin! They all required procedures to repair or remove the thread. Three patients needed threads removed for visible puckering or dimpling of the skin. Another 17 patients on top of that were unhappy with the result and had to undergo repeated or alternate procedures to achieve the change they were hoping for. Even in the patients who didn’t have a problem, the surgeon wasn’t impressed with the longevity of the results and has stopped offering the procedure.

Sounds like he’s not the only one. Recently, at least 1 manufacturer has removed their thread product from the North American Market. Are we finally hearing the death knell of this overhyped procedure? We think so. It’s about time plastic surgeons got back to procedures that work, even if their names aren’t on them…  

With the growing trend toward more permanent results, we are surprised that more than 6 months after receiving FDA approval, Glabella Furrow Relaxation(GFX), or “No-Tox”, has received little hype.

The minimally invasive procedure uses radiofrequency thermal energy to “shock” the nerves that allow you to frown (and only those nerves, avoiding the all-over frozen look that many women are scared of when considering Botox). The results appear to last at least 2 years, and essentially replace those painful Botox shots between the eyes.  Of course that doesn’t mean no more Botox because the procedure is only for the frown lines and does not replace Botox in other areas, such as around the eyes.

GFX sounds like an ideal alternative for those who get Botox routinely or those too scared of being injected with a toxin. There are, however, two drawbacks:

1. Only two doctors in the entire United States are performing the procedure right now, and…

2. For the $2000-3000 price tag, you may be able to just get a brow lift.

Happy Fourth of July!!!

We don’t write that often about larger political issues as they relate to Medicine. In honor of American Independence Day, we thought we’d say something positive about America. I want to thank Dr. Rob Oliver for bringing my attention to an article from the Investor’s Business Daily about the awful state of Canada’s health care system. Canada’s socialized health care is often compared to its counterpart in the US, usually by someone who would like to see the same sort of system here. Take the movie Sicko, for example, which held up Canada’s system as the shining beacon for us all to look towards for inspiration.

The article quoted one of the father’s of the Canadian system talking about its ruinous state and advocating for some privatization. The article mistakenly referred to Claude Castonguay as the architect of Canada’s socialized medicare when, in fact, this distinction belongs to Tommy Douglas who, while Premier of Saskatchewan in the early 1960’s, instituted a number of government interventions into the corporate and medical world. These changes have influenced the self-perception of Canadians until this day, and many do still see Canada as a kinder, gentler nation for it. To give you an idea of how much Canadians have thought of these events, they recently voted Tommy Douglas as ”The Greatest Canadian” of all time in a nationally-televised contest.

Having lived and worked in both systems, I’ve had a unique opportunity to see both in action. The US system’s treatment of the underinsured is without a doubt less than ideal, with most having poor access to preventive care and using the ER as a walk-in clinic. I was amazed though, when I was training in New York, that even patients with Medicaid could walk-in same-day and see a specialist without a referral. That kind of thing doesn’t EVER happen in Canada. Wait lists to see a specialist can range from weeks to months. If you don’t have a family doctor to refer you, you might be out of luck because they’re hard to find these days. And access to highly specialized testing, treatments and surgery is far slower than it is here.

In Canada, the system is far more equal for all…not completely, mind you. A whole underground network has evolved where favors and influence can move someone up the list, known as ‘jumping the queue’. The costs are contained (somewhat) by rationing services. My most memorable run-in with the Canadian system was when a surgery I had scheduled was cancelled by the hospital because I ran later than expected with my previous case which, in turn, had been bumped by a slash wound neck trauma that I had been dealing with the night before.

It devastated me to have to come out to the patient waiting room at 3 in the afternoon to break it to this poor woman that I was sorry she had been left starving all day, and that she would have to wait weeks longer for a necessary surgery that had taken 4 months to schedule in the first place, even though I was more than willing to proceed. My hands were tied. She swallowed the bitter pill quietly. What choice did she have? And that was the breaking point for me. I’m not sure any American would put up with that, or even knows that this goes on.

That type of event symbolizes for me the differences between Canada and the US. Canada is like the friend who says “Sorry you’re hurt, hope you feel better”….kind, but passive. The US is more likely to say “What are we gonna do about it?”….headstrong, but taking action. If you ask Americans, theirs is the greatest country in the world. Canadians?? Same thing. Neither one has a perfect answer to Medicare in the modern age.

If you ask me, I don’t trust pencil pushers on either side of the fence, government or private. Private medicine has its problems, but don’t count on politicians to ride in and save the day with universal healthcare! Anything that’s completely free loses its value, gets taken for granted, and ultimately gets thrown away like a wet rag, as I saw in Canada. I found it interesting that the number of patients we saw in New York for the sniffles and other frivolous visits went down by 60% when a small $2 co-pay was instituted. So, if every doctor and patient takes personal responsibility for how we use the system, we could save a lot of money and a lot of wasted air-time, and still take care of those who need it.

Rant over. Just one opinion of a cross-border doctor. Easy for me to say, I do elective surgery most of the time…