Q: I know plastic surgeons have historically performed cosmetic surgery, but today it seems many different types of doctors do it. How is it legal that so many doctors do it even though their training and specialties are obviously different? This same situation doesn’t exist, for example, in heart surgery, so why is it so for cosmetic surgery?
A: The rise of so many different doctors with widely discrepant cosmetic procedure training is fueled by many factors. The most significant is the fee-for-service basis of cosmetic surgery, which leaves it outside the boundaries of insurance-reimbursed medicine where hospital and federal regulations are much more rigid. While cosmetic surgery is not new, the number of available treatment options has exploded in the past two decades, and the law has yet to catch up. That being said, changes might be in the future. Last year, Puerto Rico passed a law that restricted the practice of cosmetic procedures to doctors who are board certified in either plastic surgery or dermatology. This precedent law was based on the desire for improved patient safety. In essence, base training in the rudiments of the medical procedures should make for better outcomes and lower complication rates. While such a law might be easier to pass and enforce on an island with a small population, it is not clear what impact, if any, it will have on any other state. Hopefully someday we will have better definition as to what constitutes adequate training to perform cosmetic procedures.
Q: I have previously had liposuction and a breast augmentation. I am now looking into a cellulite treatment. I am seeing that the most recommended treatment is mesotherapy. I would appreciate more information, such as costs and before and after pictures.
A: The best thing that I can tell you about cellulite treatment is that there is no really effective method that produces consistent improvement, no matter what you hear and have read. Many methods are available, such as external suction and massage, topical creams, mesotherapy injections and energy-based devices. Almost all of the success from these efforts is anecdotal – reports with few clinical trials done that show satisfactory improvement in more than a handful of patients. This is not to say that some of them don’t offer mild improvement, just usually not enough to satisfy most patients, especially once the cost is factored in. The only promising current method that can provide long-term improvement with a single treatment is the Cellulaze laser method. This is more of an invasive method that is a spin-off of the Smartlipo or laser liposuction method. The improvement with Cellulaze is very visible and studies show sustained results after two years.