Dr. Body (

Now an established trend in the world of beauty, the Medi-Spa offers most of the creature comforts and indulgences found in regular day spas, along with lighter cosmetic surgical services like laser hair removal, microdermabrasion and a few other cosmetic medical procedures like Botox injections.

The facilities may be found in shopping centers and strip malls, attached to – or near — the offices of plastic and cosmetic surgeons or even at beauty salons.

But the field has grown so fast, there are no national standards regulating services, what constitutes a legitimate Medi-spa or even descriptions of the range of medical services that can be safely delivered to patrons.

Doctors Body and Face jointly belong to:

• The American Academy of Facial Plastic Surgery and Reconstructive Surgery.
• American Board of Plastic Surgery
• The American Medical Association

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Dr. Face: (Dr. Kotler) From where I sit, it appears the Medi-spa industry represents a $10 billion trend and seems like it is here to stay. But before asking for medical treatments, a client should ask him-or-herself a few questions first.

Dr. Body: (Dr. Linder) Such as?

Dr. Face: If a physician’s name is on the door, people should ask if the doctor is on — or close to — the site. And, for patients’ protection and safety, the medical director should ideally be a plastic surgeon, facial plastic surgeon or dermatologist. After all, these are the specialists who know skin the best. Having a proctologist or neurosurgeon lend his name to the facility’s signs would not be very reassuring to me. Plus, in most states, strict regulations exist about who can give injections for Botox, Restylane or other fillers. For instance, in California, only RNs and physician assistants may administer injections, under direction of an MD.

Dr. Body: Personally, I would ask who will be giving the injections and then ask about their qualifications, training and experience. Why? Because the results of facial fillers and wrinkle removers are what we surgeons refer to as highly “provider dependent.”  Translation: The result depends on the skill of the injector. Remember, it requires years and years of expert training and practice for anybody to develop a deft, precise touch with a needle to provide good results. You always want a superspecialist at your service.

Dr. Face: If you are going to have any injectable, peel or laser procedure, ask who is responsible for complications or other problems that may crop up. Again, is the Medi-spa of your choice located in, or next to, a physician’s office?

Dr. Body: I can imagine some consumers interested in cosmetic procedures would start by asking a physician if he or she can help with the person’s cosmetic goals, what any side effects of a treatment might be and what the best overall treatment plan is. The doctor should also as supervise – if not handle — the delivery of the actual treatment.

Dr. Face: Office, non-surgical procedures like Botox, Dysport, tissue fillers such as Restylane, Juvederm, Perlane or Sculptra and skin treatments with lasers and radiofrequency devices, along with milder skin peels, should be done under the direct supervision of a doctor specialist who knows skin. A patient receiving a deep peel must be under anesthesia and is precluded from doing the procedure in a Medi-spa. Deep peels must be done under general anesthesia in certified operating rooms and only by an MD, of course.

Dr. Body: If I were a consumer going in for a quick therapeutic whirlpool bath and a little Botox, I would sure want to know if the person giving me the injection is very practiced, with years of experience.  For instance, too much Botox into the area between your eyes or your forehead could result in a sagging eyelid. Imagine what you would look like with one eyelid at half mast!

Dr. Face: By the same token, an anesthetician, a licensed skin care specialist, is qualified to do the lighter chemical peels but not a medium or stronger-strength peel. What about the massages Medi-Spas advertise for patients who have just had some a major cosmetic plastic surgery of the body like tummy tucks, liposuction, buttocks lifts or breast reductions? Are those post surgical massages O.K. to have in a Medi-spa?

Dr. Body: I’ve seen them advertised, but in my opinion, the compression garments that those patients wear after surgery are more important than post-surgical massages to keep the lymphatic system going and clearing waste products from the body. At any rate, the massages can’t hurt.

Dr. Face: We urge Medi-spa patrons to ask questions about training and qualifications because some doctors who advertise themselves as “cosmetic doctors” may lack the specialized training that’s needed to deliver drugs and fillers to the deeper levels of skin. It also takes specialized training to handle some of the unforeseen medical complications that can crop up. Remember,  facial peels, injectable fillers, Botox, Dysport, micro-dermabrasion, laser hair removal and other less invasive cosmetic procedures are in a different medical league than facials, massages and other beauty treatments. Help yourself by first doing a little homework on the procedure in which you are interested.

Dr. Body: For many of the more involved cosmetic plastic surgery body procedures like breast reduction or breast revision surgery, seeing any cosmetic surgeon may not be a wise move. Medicine today is highly specialized and requires the right specialist to deliver good results! The best work is always done by the most specialized and the most focused.

Dr. Face: We should also add that those facial filler injection, such as Restylane and Juvederm are temporary. But scientific research will bring longer-lasting products, so stay tuned!

Dr. Body: One other thing patients can do.

Dr. Face: What’s that?

Dr. Body: Ask to see the Medi-spa’s patients before and after pictures!

In a seeming celebration of things American, two of Beverly Hills many eminent cosmetic plastic surgeons are being featured in this month’s American Way, the inflight magazine of American Airlines.

Your humble bloggers, the Beverly Hills board-certified cosmetic plastic surgeon Robert Kotler, M.D.  (who blogs as Dr. Face) and Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. (our Dr. Body blogger) tell more about  why Beverly Hills is widely regarded as the world Mecca of plastic surgery and why many patients come here from lands far outside the United States. Apparently, some fly the friendly skies of American Airlines.

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Dr. Face (Dr. Kotler): I’ve read a lot of amazing things about you, Dr. Linder, but according to this month’s American Way magazine, you are – and I quote  –  “one of the highest regarded breast revision surgeons….. in the world!” And, I would agree.

Dr. Body: (Dr. Linder): I’m humbled; there are many, many highly competent plastic surgeons in Beverly Hills, so it’s a real honor to receive that type of praise.

Dr. Face:  As the magazine so aptly points out, there are 39 cosmetic plastic surgeons on our street alone – and this is a very short block! Our other neighbors include 11 cosmetic dentists and 5 dermatologists, some of whom perform minor plastic surgery services like dermabrasion. You could almost call the talent in Beverly Hills an embarrassment of riches. No wonder the magazine wants its travelers to know more about the area.

Dr. Body: I’ve noticed on the television program, Dr. 90210, some surgeons tell patients, there are more plastic surgeons in one Beverly Hills office building alone than in the entire state of Montana.

Dr. Face: While we do sit cheek-by-jowl with Hollywood and its movie and T.V. industries, Beverly Hills cosmetic plastic surgery long ago stopped servicing only  the rich and famous. Sure, wealthy people still shop and use other exclusive services but the reality is that the explosive growth of Beverly Hills cosmetic plastic surgeons in the last several decades happened because the procedures became affordable for most American and International patients. The costs of face lift, rhinoplasty, breast augmentation, tummy tuck and other popular procedures came down due to:

• Better technology
• Better medications
• Shorter operating times
• Going from expensive hospitals to private outpatient surgery clinics.

Dr. Body: And so our and our colleagues’ work sits up there on the silver screen, allowing 60-year-old actors to look perhaps 40 or 45. Southern California is a huge area, so many ordinary people who also want surgical rejuvenation come to Beverly Hills. And apparently, thanks to the Internet, the word has spread to other U.S. states and foreign nations. For instance, how many patients from abroad have you served in your practice?

Dr. Face: At last count, it was patients from 33 foreign nations, and all 50 U.S. states. It’s easy for patients because they are picked up at the airport, taken to their choice of many, many local hotels and then, for the night after surgery, stay at one of several plastic surgery recovery centers which have been aptly been named “face lift hotels” by local wags.

Dr. Body: On my website, I have an interactive map of the world, showing where international patients have traveled from, including China, the Middle East and Australia. (Look at the map of Dr. Linder’s plastic surgery patients’ home nations.) I think the statistics are like yours with patients traveling in for surgery from 23 nations and 40 U.S. states.

Dr. Face: With loads of theaters, various ethnic restaurants, night-life clubs – some of which are frequented by celebs pictures in People, OK and other celebrity observers – there is much here to take in before returning home. There’s just no place like Beverly Hills and greater Los Angeles. For instance, this month’s Saveur Magazine, a guide to fine dining worldwide, devoted an entire issue to Los Angeles.

Dr. Body: A great deal of all this is possible, thanks to the Internet and the “virtual consultation.”  People in foreign nations can take some pictures of the body or facial areas they want treated and tell the surgeon a few other details so we can “virtually” consult through email, on the phone or via Skype.

Dr. Face:  But don’t get the idea it’s email-to-the-operating room. Once the patient arrives in one of our offices, we go through everything again with the concept that we have never seen this patient before.

Dr. Body:  And don’t forget economics! Currently, the U.S. dollar is relatively weak and creates some attractive bargains for people in Asia, Europe and the Middle East. Sure, exchange rates fluctuate, but right now, America looks “cheap” to much of the world.

Dr. Face: For instance, a man in Italy told me it would be more cost-effective for him to come to Beverly Hills, have nose surgery, stay for seven to ten days and fly home than to have plastic surgery in Switzerland, which was about two hours from his home.

Dr. Body: Well, here we are, doctor, talking all about the American Way article when, thanks to the Internet, we can send people there to read about for themselves.

Dr. Face: Capital suggestion! Read the plastic-surgery-in-Beverly-Hills article in American Way. Enjoy!

American plastic surgeons frequently discuss why Beverly Hills is so often considered the world Mecca of cosmetic plastic surgery.

While you might get an argument from New York  City rejuvenation surgeons, the eminent Beverly Hills board-certified plastic surgeon, Stuart Linder, M.D. who blogs as Dr. Body) and the equally eminent Beverly Hills board-certified facial plastic surgeon Robert Kotler, M.D. (Dr. Face) tell why Beverly Hills is widely regarded as the world capital of plastic surgery.

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Dr. Face: (Dr. Kotler) Plastic surgery has become extremely popular worldwide, with a new multi-million dollar hospital dedicated to rejuvenation surgery in the Middle East while more U.S. and U.K. trained surgeons offering their services – along with an exotic vacation – in some of the more lovely parts of Thailand and a few other up-and-coming Third World nations.

Dr. Body: (Dr. Linder) True, but there is one place, also in the sun, that is still consider the world capital of cosmetic plastic surgery.

Dr. Face: Let’s end the suspense – we’re talking about Beverly Hills!

Dr. Body: I frequently have, ah, spirited conversations with my colleagues in Manhattan about why Beverly Hills is still THE place for top of the line cosmetic plastic surgery for people from all over the world.

Dr. Face: To be a leader in plastic surgery, a major university teaching hospital must be nearby; UCLA is ten minutes from Beverly Hills. Also, it’s important to have a large compliment of other highly specialized cosmetic plastic surgeons on the same medical campus for ease of consultation and referral. There should be professional post-operative recovery facilities – a “hideaway”, exclusively for the post-operative care of cosmetic surgery patients. (That concept was originated right here in Beverly Hills.) For some procedures such as face and neck lift, chemical facial wrinkle removal or major tummy-tuck or breast surgery, an impersonal hospital is not satisfactory, nor is a hotel or the home of a friend of relative.

For the first two to three days, the ideal post-operative venue is a private, quiet hideaway retreat with round-the-clock nursing care, meal service and even limo transport to the office . A safe and practical environment for patients who have every need “covered”.  Of course, when patients come from afar and are accompanied by friends or family, it is important that the city also provide some cultural and entertainment resources and of course, the greater Los Angeles area is rich in that department.

Dr. Body: But you have to admit, both Beverly Hills and Manhattan offer all those things. New York City may be a bit lacking in sunshine during the winter but one could argue both areas seem to offer the same attractions.

Dr. Face:  That’s true, doctor, but there are big differences.

Dr. Body: Such as?

Dr. Face: Beverly Hills is – no pun intended – cutting edge because we lead the way in innovation. One for instance: we had outpatient surgical centers and more surgeries being done in doctors’ offices long before Manhattan where surgeons seemed to prefer doing their procedures in hospitals.

Dr. Body: You’re correct. One of the differences I see is that in Southern California, the interest in cosmetic plastic surgery dips into the middle class, too. But in New York City, it seems the ultra wealthy are the ones who support the surgical rejuvenation arts. So it is possible Beverly Hills surgeons do more surgery and become adept through constant repetition. Concentrated, focused specialists, as it were.

Dr. Face: Because of the beautiful Southern California weather, we spend more time on the beach and at pool side so appearance is highly valued. But on the East Coast, old money, social status and family lines are more important. For instance, while Eunice Shriver was a wonderful and accomplished humanitarian, I would bet my bottom dollar, she would have had long ago had a face lift if she lived in Southern California. Same for many of the other Kennedy women.

Dr. Body: I can think of one other area in which Beverly Hills leads the way over New York City.

Dr. Face: Which is?

Dr. Body: A high concentration of celebrities, top models and film actors. Plus, when it’s 100 degrees in New York, it’s 72 in Los Angeles.  And when its 20 degrees in New York, it’s still 72 in Los Angeles!

NEXT: Drs. Face and Body tell about some typical international cosmetic surgery patients.