Robert Kotler, M.D. (“Dr. Face”) and Stuart Linder, M.D. (“Dr. Body”) have noticed that many patients interested in cosmetic plastic surgery often take advantage of services offered at MediSpas.

MediSpas are typical day spas where one can take the waters and have a massage or other beauty treatments. During the last several years, many MediSpas have opened next to, or in association with, cosmetic surgeons. So in addition to a soothing soak you can have Botox or a facial filler, along with the less invasive cosmetic surgeries like dermabrasion or laser hair removal.

But many issues have recently come to light about MediSpas, so consumers may want to take caution.

As the ultimate cosmetic plastic surgery insiders, Drs Face-Body have kept a weather eye on the development of cosmetic medical services at MediSpas.

(Follow Beverly Hills cosmetic plastic surgeons Drs Face-Body on their Facebook page.)

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Dr. Face (Dr. Kotler): New statistics have been released by the American Academy of Facial Plastic and Reconstructive Surgeons (AAFPRS) showing how many and who have had which invasive and non-invasive cosmetic surgery procedures.

Dr. Body (Dr. Linder): Sure, I usually read the statistics with an eye toward learning how many people have returned home after having a botched surgery in a Third World nation. It’s become a real problem for the National Health Service in England to care for all the returnees.

Dr. Face: Here’s one that shocked me: Of 2,700 Plastic surgeon members in AAFPRS, 40 percent reported they had treated a patient who suffered a bad facial procedure in a developing nation.

Dr. Body: I also noticed some really shocking statistics that took place right here in America. The AAFPRS also found that 74 percent of in-the-know surgeons knew about medical directors at MediSpas who were not on the site, actually doing or overseeing, the cosmetic treatments.

Dr. Face: I suppose those members knew about that situation because so many of their colleagues had opened a MediSpa or located one near their offices?

Dr. Body: That’s right. The original idea was that a cosmetic surgeon could interrupt your facial long enough to give you some wrinkle-reducing Botox or perhaps plump up some sagging facial areas with Juvederm or Restylane.

Dr. Face: How did all that turn out?

Dr. Body: It appears that lesser qualified MediSpas employees, perhaps those with little — if any — surgical training, were performing the procedures. And in many cases, the procedures were not being supervised by a qualified M.D.

Dr. Face: So let me guess: that would result in many patients complaining of burns from lasers, unbalanced results and from facial fillers placed, not in the trenches of folds and deep wrinkles, but on the sides of the folds.

Dr. Body: Which would make the folds and deep wrinkles appear worse!

Dr. Face:  Right. Not placing the fillers in exactly the right spot would also create what physicians know as granulomas which are clumps and lumps that can be seen and felt under the skin.

Dr. Body: So, supposing one of our international patients comes to American and wants to visit a MediSpa. How does one know if and when getting a light cosmetic surgery is safe?

Dr. Face: Biggest dead bang giveaway: if you see a physician’s name on the door as the medical director, ask where he is. Don’t be misled by the grandeur of the facility; the MediSpa trend is reported to be a $10 billion industry in America so spiffy, highly upscale MediSpas are often found in shopping centers and strip malls or anywhere else where foot traffic is found. Ideally, the medical director should be a board certified plastic surgeon, a board certified head and neck surgeon or a board certified dermatologist. Those specialists are the right match for skin care.

Dr. Body: Sure, having “work” done by a radiologist or gynecologist would not float my boat. Another good question to ask: in this state, what are the regulations about who can provide injections? For instance, in the “Golden State” (California) only Registered Nurses and M.D.s can give injections.

Dr. Face: The next question I would ask is: who is responsible for complications in case a problem crops up. And how far away is he or she?

Dr. Body: That makes good sense, because the more technical the procedure, the more opportunities for problems. For instance, skin treatments with lasers, radiofrequency procedures and deep skin peels – which must be done under general anesthesia, should be done by a board-certified plastic surgeon or dermatologist. Plus, a certified operating room is required for a deep peel.

Dr. Face: But if your peel is a very light chemical or fruit peel, a licensed aesthetician is qualified.

Dr. Body: International patients need to know that, in America, an M.D. who advertises him-or-herself as a “cosmetic surgeon” may not have had the extra four to seven years surgical training required of board-certified plastic surgeons or head and neck surgeons (who are technically known as otolaryngologists) and specialize in cosmetic procedures of the head and neck only.

Dr. Face: Statistics! They can tell you a lot or totally mislead you.

Dr. Body: If I can borrow a line from Mark Twain, “There are three kinds of lies: lies, damn lies, and statistics.”

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Known as superspecialists, Drs Body and Face specialize in revision surgery which repairs unsatisfactory results done by other surgeons in other locations.

Read more about Dr. Kotler’s International and revision cosmetic surgery patients.

Learn more about Dr. Linder’s worldwide plastic surgery revision patients.

Here’s their take on plastic surgery and New Rules.

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Dr. Face (Dr. Kotler): By now, everybody knows that California now requires – under the so-called “Donda West law” — a physical exam for every patient going under the knife of a plastic surgeon or a cosmetic surgeon.

Dr. Body (Dr. Linder): That is basically just good medical practice, supported by the American Association of Plastic Surgeons (ASPS), The American Society for Aesthetic Plastic Surgery (ASAPS) and others to make sure that a cosmetic plastic surgery patient is healthy enough for surgery.

Dr. Face: But I noticed a new law in New York State that requires all plastic surgery procedures to take place in a certified facility. (For a quick reminder of the certifications a surgical center can have, take a quick look at our previous blog post about plastic surgery center certifications.)

Dr. Body: Unfortunately, in America, there is no national law requiring surgeries to take place in certified facilities.

Dr. Face: So the consumer has to check it out on his or her own. But it’s an important consideration because many private American doctors have operatories within their office complexes.

Dr. Body: And if you look around at some new rules and laws worldwide, you’ll see a few more things that could make plastic surgery even safer.

Dr. Face: For instance?

Dr. Body: In Canada, a court has upheld the right of the college overseeing doctors to send inspectors into private clinics to examine their practices.

Dr. Face: So the college that oversees my specialty, head and neck surgery, could send a professor to see how I do things?

Dr. Body: Right!

Dr. Face: Not a bad idea. I recently read that the College of Cosmetic Surgery in Australia requires plastic surgeons to fully explain the risks of all procedures and to standardize the way before and after plastic surgery pictures are taken.

Dr. Body: That’s also good idea and something that any American plastic surgeon would be pleased to do.

Dr. Face:  I can think of a few new rules, I would like to add.

Dr. Body:  Such as?

Dr. Face: Any cosmetic surgeon performing surgery should have hospital privileges. That means the physician must have at least one hospital appointment so that, in an emergency, he can immediately get his patient into a full-service environment.

Dr. Body: Yes, and speaking of hospitals, prospective patients need to know that hospitals are expert in credentialing. Choosing a plastic surgeon who has excellent hospital privileges means that doctor has been fully cleared to perform the procedure – the face lift, the breast augmentation or whatever – you are considering.

Dr. Face:  Another new rule I would like to see is one that requires physicians to advertise their specialty only if they have board certification in that specialty.

Dr. Body: I’ve noticed that, too. Some cosmetic plastic surgeons advertise they are “board certified.” But the certification is in gynecology, internal medicine, neurology or some other discipline not related to the cosmetic plastic surgery arts.

Dr. Face: Muddying the waters even more are non-boards like the Board of Laser Surgery. But the American Board of Medical Specialties (ABMS) only recognizes 23 major medical specialties.

Dr. Body: So it’s up to the consumer to check on the board or ask a potential surgeon during the first consultation: “Which board has certified you?”

Dr. Face:  You can also do that on your computer. Just go to the ABMS website, (http://www.abms.org) register and type the first and last name of the plastic surgeon you are considering into the box on the left that reads “Is Your Doctor Certified.”

Dr. Body: Consumers should do all this because, in America, any physician with a proper medical license can offer plastic surgery.

Dr. Face: Maybe we need another new law! Just look at all the extra training required to be certified in head and neck surgery: the physician must have – after getting the M.D. degree — two years of general surgery training and another four in head and neck surgery.

Dr. Body: To be board certified in plastic surgery, the physician needs three years general surgery training after getting the M.D. degree and then three to five years more training in plastic surgery.

Dr. Body: To receive the certification, a three to five person board of professors and other super specialists examine two years of the applicant’s cases, business practices and character.

Dr. Face:  And then it’s written and oral exams every ten years for re-certification.

Dr. Body: Is it any wonder we have gray hair by the time we start our practices?

Dr. Face: If we have any hair at all!

Read more about the cosmetic plastic surgery training of Dr. Face.

Here is the page about Dr. Body’s education and training in plastic surgery.

Infectious agents are always lurking in some corner and watching over a surgeon’s shoulder  for a happy place to land and multiply.

Even in the most experienced of hands that follow all the sterilization guidelines in the cleanest and most sterile of operating rooms, the standard rate for infection everywhere is about one patient per hundred.

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Dr. Face: (Dr. Kotler) Have you been stern lately, doctor?

Dr. Body:  (Dr. Linder) Yes, I had a patient recently to whom I gave an absolutely beautiful breast augmentation that healed nicely. But when she went home, she thought that she – and perhaps others – could see that one breast was a tad larger than the other. And she wanted a redo – she wanted the equivalent of a shot glass worth of silicone (50cc’s) added to the breast implant she perceived as smaller.

Dr. Face:  What did you do?

Dr. Body: I explained the risks that attend any plastic surgery and that such a tiny adjustment was not worth risking a possible infection or other complication and thanks for asking but I could not do the procedure. She went elsewhere, had the surgery, got a terrible infection and had to have one implant removed while that breast healed for six months.

Dr. Face: Plastic surgeons are, by nature, perfectionists but that is a perfect case of what we mean by “reasonable expectations.” Most people, including her significant others, only saw a huge, healthy improvement. But any time the surgeon opens a chest or takes a breast implant out of its sterilized package and exposes it to air, the slight risk of an undesirable complication like infections is present.

Dr. Body: Unfortunately, most rejuvenation surgeons are wont to talk about a negative issue like infection. But the truth is:  infective agents are floating around in the cleanest, most sterile of operating rooms. Also, human skin is alive with all sorts of flora, including bacteria that can get into an open wound. Of course, the surgical area is painted with germ killers but there are super resistant bugs that can survive and start their own colonies.

Dr. Face:  Make that, their own colonies even though every precaution is taken. Implants for the face and body are packed in sterile materials, the implants are soaked in sterile agents after opening and the surgical site of the body or face is irrigated with an antibacterial solution before closing.

Dr. Body: That’s one of the reasons we want to see plastic surgery patients in the morning after the procedure. It’s apparent to us — even before the patients — when an infection is developing so we leap on it as early as possible. Some infections are so powerful, they can digest cartilage. But if the surgical area can go three to six days with no infection, we can be relatively sure we are home free.

Dr. Face: American plastic surgeons and the U.S. medical care system is very concerned about infections and also happens to be very good at tracking down the source.

Dr. Body: I bet you are talking about the case several years ago when the U.S. Centers for Disease Control (CDC) got involved in solving an infection outbreak in New Jersey.

Dr. Face: That’s right. An unusually large number of women were reporting to their doctors with infections in what appeared to be liposuction cases. The CDC interviewed the women and found they all had liposuction in the Dominican Republic at a particular clinic. The source of the infections turned out to be  unsterilized liposuction wands.

Dr. Body: So it’s more important than ever to check your surgeon’s website for information about his or her surgery center. Those facilities marked:

• AAAASF (American Association for Accreditation of Ambulatory Surgical Facilities)
• JACHO, (Joint Commission on Accreditation of Healthcare Organizations)
• AAAHC (Accreditation Association for Ambulatory Health Care)  
• Medicare certified

and will be following all the the standard sterilization procedures known.