Local Anesthesia Safer for Plastic Surgery Procedures and Benefits Recovery

By Amiya Prasad, M.D., FACS

Cosmetic procedures continue to grow in popularity, especially as new techniques and advancements are made in the field of plastic surgery. Before undergoing a cosmetic procedure, it is critical for patients to consider the surgeon’s anesthesia preference. The difference should make or break your decision. Today, most, if not all, cosmetic procedures can be performed under local anesthesia, however, many plastic surgeons continue to place patients under general anesthesia despite the increased risk for complications.

Dermatologic Surgery (February 2012) published a study based on ten years of data from Florida and six years of data from Alabama and found that more than two-thirds of deaths and three-quarters of hospital transfers were associated with cosmetic surgery performed under general anesthesia. Liposuction, one of the most common cosmetic procedures, accounted for 32 percent of cosmetic procedure-related deaths and 22 percent of all cosmetic procedure-related complications under general anesthesia. No deaths were associated with liposuction under local anesthesia.

General anesthesia vs. local anesthesia with sedation
When a patient is placed under general anesthesia, the patient is placed on a respirator and an endotracheal tube is placed in the throat to help them breathe. A combination of drugs causes a deep sleep during the procedure and paralyzes the body. Some patients prefer general anesthesia because they want to make sure that they are completely knocked out and unable to remember anything about the actual procedure.

Unfortunately, complication rates are much greater under general anesthesia and the body is put at a greater risk. Following a surgical procedure, patients often have a sore throat from the endotracheal tube, are very fatigued and more likely to feel nauseated or actually vomit. Recovery is considerably longer because the body has to recover from the surgery and the general anesthesia.

Under local anesthesia with sedation, a patient is placed under intravenous (IV) sedation and the area that will be operated on is numbed. The patient is relaxed, comfortable and virtually unaware of the procedure thanks to light medication, but the whole body is not paralyzed. Local anesthesia is a much safer alternative to general anesthesia because it does not put the body under stress in the same way. Most importantly, fewer drugs are needed so recovery from the procedure is faster.

Following a surgical procedure where local anesthesia is used, a patient can walk easily out of the office and does not have the nausea common with general anesthesia. Under local anesthesia, a surgical procedure becomes much less invasive and the risks to the body diminish significantly.

Local anesthesia – a much safer option
The most recent studies by leading anesthesiologists, such as Barry Friedberg, M.D., share the professional opinion that most, if not all cosmetic surgery procedures, can be performed safely under local anesthesia with intravenous sedation. Despite this fact, a large percentage of people undergoing cosmetic surgery are still subjected to the risks of general anesthesia.

The reason for this may be financial. General anesthesia requires less prep time and more procedures can be performed in a day. However, the longer someone is under general anesthesia, the more stress it puts on the heart and lungs. With local anesthesia, the preparation time is longer and fewer patients can be accommodated in a day. But, the bottom line is that a patient’s safety should always come first – far more important than the financial bottom line.

Prasad Cosmetic Surgery and Medi-Spa uses LITE anesthesia (Local, Intravenous, Tumescent, Ease of recovery) with great success for our patients. LITE is safer and allows for a much quicker and easier recovery.

Deciding Factors For Choosing Your Cosmetic Surgeon

INTRO

Amiya Prasad, MD, chief Oculofacial Plastic and Reconstructive Surgeon of New York’s Prasad Cosmetic Surgery & Medi-Spa addresses the criteria for prospective patients choosing a cosmetic surgeon. For those opting for cosmetic surgery of the face, eyes, or body, Dr. Prasad stresses the importance of doing research before choosing a doctor for surgical procedures is necessary to achieve optimal results.  An innovator and author, Dr. Prasad shares his twenty years of knowledge in the field of plastic and reconstructive surgery and lends this to determining the factors for choosing a specialized cosmetic surgeon.

Expertise in Plastic Surgery is a controversial issue.  Many surgeons simply claim to be the “best” or advise that if you “Ask for a board certified surgeon” you have completed your research. However, if you want to determine a physician’s level of expertise, follow this straightforward assessment. The first level of expertise is based on the formal training pursued by a surgeon. For example, a neurosurgeon has expertise in brain surgery based on formal training. A neurosurgeon can be easily regarded as having a higher level of expertise in brain surgery when compared to a General Surgeon who had less exposure to neurosurgery during training and did not pursue this type of surgery after he or she finished training.

Eye plastic surgery training is specialized compared to general plastic surgery. This extra focused training as a specialist has served as the foundation for my expertise in Cosmetic Eyelid Surgery. As an Eye Plastic Surgeon, I have spent much more time than a general plastic surgeon on advanced eye plastic surgery and have spent many years instructing other eye surgeons on the topic.  A second level of expertise is based upon types of experience. This can be quantified by the type of training pursued after residency, the number of years spent during and after formal training on specific types of procedures and whether or not the person has engaged in teaching others his craft.

In addition, an experienced cosmetic surgeon has numerous before and after photos and can produce a list of patients who have undergone the same procedure you are inquiring about  who would be happy to speak to you about their procedure.

Finally, the last level of expertise to inquire about is the professional development that the surgeon has pursued in his career. Has he written books on his topic? Does he attend professional meetings and make presentations there? The field of cosmetic surgery, as in all disciplines, requires the pursuit of continued professional education, constant refining of our skills and knowledge and an unlimited curiosity to learn about the newest and most modern technologies available.

EXPERIENCE

Formal training is an excellent foundation for expertise. Experience, however, can bring expertise to a higher level. For example, a highly experienced pilot landed an airplane in an emergency situation onto the Hudson River. Would a recently trained pilot have been able to do the same?

Experience as a Cosmetic Eyelid Surgery specialist helps the clients who are considering eyelid surgery feel more secure about having a surgeon who has the “miles” to be more than familiar with their procedure. Author Malcolm Gladwell who wrote “The Tipping Point” and “Outliers” states that to master any skill requires “10,000 hours” of practice in order to be successful.  The same rule applies whether it is becoming a virtuoso performer, an Iron Chef, a master sculptor or a skilled surgeon.  Performing eyelid surgery daily for 17 years has enabled me to reach and surpass the “10,000 hour rule”.  Another mark of expertise is how well esteemed an artist is among his peers. It is important to ask whether a surgeon is called upon by others in his field to perform “revision surgery” or to fix undesired results. A surgeon who has been practicing for many years and is well respected by his peers will be able to describe to a patient the types of revision surgery he has performed over his career.

ARTISTRY

Any true artist will say that artistry is intrinsic, not learned.  The medical field uses a training structure which tends to attract more “square” personalities, that is people who are intelligent, detail-oriented and organized, but not typically creative and artistic. This essentially means that many plastic surgeons are not artists but rather surgeons who follow a visual formula for each problem. In some ways this explains the often seen “plastic” appearance found in many people who have undergone cosmetic surgery. As an artist, I recognized during my training that there was a certain disconnect between patients’ desires to look fresh and youthful and the results of the plastic surgeons’ procedures. I have learned to appreciate the “true character” of a person’s face and understand the balance of features so that I can create a more natural appearance instead of a “manufactured face”. I have found that the judgment of beauty and balance is intrinsic and an awareness  of the planes of the face and the dimensions of balance is difficult to communicate but easy to perceive.

COMMITMENT

Commitment in plastic surgery means that you will do your utmost to ensure that your patient achieves desired results. In order to accomplish that, you have to practice your craft ethically.  By that I mean that you have to listen to your patients and understand their aesthetic goals and their deep seated fears. You have to discuss honestly and openly how you will address all related issues. If a patient has unrealistic expectations, you need to tell them. If they are asking for a procedure that is outside of your expertise, you need to refer them to the right specialist. You should always encourage a second opinion.  And most importantly, never push a patient into a procedure if they don’t want it or don’t need it. It is imperative to be available for questions or concerns before and after surgery. The best cosmetic surgery practice provides all levels of care to its patients to make sure that they always look their best. We have an on-site spa which provides non-invasive skin care and we have our own line of skin care products to protect your skin and keep it healthy.

It’s hard to teach ethics to someone. Ethics is just something you have. Unfortunately, there is no measure for ethics when you screen physicians. Medical training for ethics is quite variable and ultimately depends on the trainee and his own experience.  As surgeons, we all have to determine which ideals will serve our mission. Caring for my patients the way I would care for my own family has been the core value which guides how I practice. It’s based on this core value that I developed techniques which make my patients comfortable, look natural and recover quickly. When choosing a surgeon, you should get a “caring, compassionate, and professional” feeling from the surgeon as well as the staff and the office environment. In order to achieve this goal, I work with the most qualified and attentive staff and I have invested in my state-of- the-art facilities to provide a cutting edge care in a comfortable environment.

I am committed to providing my patients with the best care possible.

General anesthesia, combo procedures boost risk

General anesthesia, combo procedures boost risk
By:  Bill Gillette
Source: Cosmetic Surgery Time eNews

Cincinnati — Use of general anesthesia, performance of liposuction under general anesthesia, and combining surgical procedures significantly increase the risk for adverse events (AEs) in office-based surgery, a new review suggests.

A review of mandatory adverse-event reporting, derived from 10-year data from Florida and six-year data from Alabama, “confirms trends that have been previously identified in earlier analyses of this data,” wrote lead author John Starling III, M.D, of the University of Cincinnati’s department of dermatology.

Medscape Today reports that according to the study, which appears in the February issue of Dermatologic Surgery, more than two-thirds of deaths and three-quarters of hospital transfers were associated with cosmetic surgery performed under general anesthesia.

The study is especially critical of liposuction performed under general anesthesia, noting that while liposuction is one of the most common cosmetic procedures, no deaths occurred with local anesthesia. “Liposuction under general anesthesia accounted for 32 percent of cosmetic procedure-related deaths and 22 percent of all cosmetic procedure-related complications,” the researchers wrote.

In the Florida statistics, a total of 309 AEs were reported during office-based surgery, including 46 deaths and 263 reportable complications or transfers to hospital. Cosmetic surgeries performed under general anesthesia accounted for the vast majority of deaths in Florida, with liposuction and abdominoplasty the most frequently reported procedures.

In the Alabama data, 52 AEs were reported, including 49 complications or hospital transfers and three deaths. General anesthesia was implicated in 89 percent of reported incidents, of which 42 percent were cosmetic surgeries. Pulmonary complications, including pulmonary emboli and pulmonary edema, were implicated in many deaths in both states.

The authors noted one limitation in their study, which was that case logs of procedures performed under general and intravenous sedation are required in Florida, but are not in the public domain and so were unavailable for analysis. Also, researchers were unable to obtain data on the total number of liposuction procedures performed in either state, which prevented them from calculating the overall fatality rate.

Why LITE™ Anesthesia at Prasad Cosmetic Surgery

Anesthesia Safety

Leading anesthesiologists like Barry Friedberg, M.D. share our professional opinion that most, if not all cosmetic surgery procedures, can be performed safely under local anesthesia with IV or intravenous sedation. Despite this fact, a large percentage of people undergoing cosmetic surgery are subjected to the risks of general anesthesia.

Based on the work of innovators such as Jeffrey Klein, M.D. (inventor of tumescent anesthesia for safe liposuction) and Barry Friedberg, M.D. (inventor of PK anesthesia), Dr. Prasad modified his local anesthesia techniques and created LITE™ anesthesia. LITE™ anesthesia is an acronym for Local, Intravenous, Tumescent/Twilight with Ease of recovery.

Safe sedation using a brain monitor (BIS) monitor and Dr. Friedberg’s PK anesthesia techniques have been the cornerstone to LITE™ anesthesia. Sedation or “twilight” anesthesia helps people who come to our practice recover quickly and often “not remember” the surgery.

LITE™ anesthesia is used in our practice for procedures such as:

Browlift
Blepharoplasty (eyelid surgery)
Hair transplant
Facelift
Breast augmentation
Breast lift
Breast reduction
Tummy tuck
Cosmetic gynecology
Liposuction

A New Face for the New Year!

facelift for a new youAs is always the case with the New Year comes our New Year resolutions – for many of our patients the colder winter months and lack of major Holidays is the best time to consider their cosmetic surgery options. One of the most popular procedures is a Facelift. In recent years, partly due to the dramatic increase in nonsurgical options for facial rejuvenation, patients often are confused as to what is the best solution for them. How do nonsurgical options really compare to a facelift?

Recovery: A short recovery time is one of the main advantages of nonsurgical treatments like BOTOX Cosmetic, injectable fillers and skin tightening lasers. These procedures can be performed on your lunch hour, taking only twenty or thirty minutes, and you can return to work–immediately after. No downtime, and little discomfort. A traditional surgical facelift, on the other hand, usually involves an overnight hospital stay with a private duty nurse. A traditional facelift can also result in a slanted or pulled look.

For patients who seek a better alternative to other facelifting procedures available, the Quick Recovery Facelift developed by Dr. Prasad has many advantages compared to a traditional face lift. The Quick Recovery Facelift is performed under local LITE™ Anesthesia, which is safer than general anesthesia used for most face lift surgeries. The Quick Recovery Facelift produces a shorter scar as the incision is a lot smaller and does not go to the temple. Because of the way the incision is made, hair loss is minimal (if any) and the sideburn is preserved. With the Quick Recovery Facelift, the patient goes home on the same day of surgery. The Quick Recovery Facelift restores the natural relationships of the skin, tissue and muscles of the face, resulting in a natural, youthful appearance that will last long.

Longevity Comparison of Surgical to Non Surgical Facial Rejuvenation:  Surgical facelifts give much longer-lasting results than nonsurgical treatments. A recent survey showed that 69% of facelift patients still saw significant results from their facelift over 12 years after surgery. On the other hand, nonsurgical treatments have a much shorter lifespan. From 3 months for BOTOX Cosmetic to a year for Juvederm, no nonsurgical treatment even approaches the lifespan of a facelift.

Cost comparison:  Cost is another factor that may drive patients to select a nonsurgical treatment. People see the $12,000 average price tag for a facelift and balk, but the $500 for a BOTOX Cosmetic injection seems reasonable. But is it when you compare the costs over the lifespan of a facelift? Let’s assume that you get longer-than-average results from BOTOX Cosmetic, about four months, which means you need three sessions a year. Three sessions a year for ten years is $15,000, significantly more than the cost of a facelift. Even if you finance a facelift and end up paying more, the overall cost for the two procedures is comparable.

Get the Best Rejuvenation for Your Face
Another important factor in this comparison is remembering that these two procedures are not really directly comparable because they treat different symptoms of facial aging. Before making a decision, you really need a personal evaluation with Dr. Prasad to determine what is the most appropriate procedure(s) for your specific case.

Economy impacts patients’ cosmetic surgery choices

By: Bill Gillette
Cosmetic Surgery Times E-News

New York — Results of two recent surveys show how much the stagnant economy has affected patients’ decisions about elective facial plastic surgery — and shed light on doctors’ misperceptions about what patients want.

The two surveys — one administered to potential patients and one to members of the American Society for Aesthetic Plastic Surgery — reveal that due to the recession, many patients are delaying facial plastic surgery and seeking less costly nonsurgical options. The surveys also reveal that physician knowledge of patient preferences differs widely from actual patient preferences in terms of treatment cost and durability, according to an ASAPS statement.

The great majority of patients prefer treatments with longer-lasting results over those with immediate effects, and most patients felt that duration of effect was more important than cost in selecting a medical anti-aging treatment, survey results show. Physicians, on the other hand, perceived patients as desiring immediate effects and valuing cost over longer-lasting results.

The ASAPS release quotes lead author T. Jonathan Kurkjian, M.D., of the University of Texas Southwestern Medical Center, as saying, “That the current economy is affecting patients’ choices around facial rejuvenation isn’t so surprising. … What is surprising, however, is the disconnect between physicians’ perceptions of patient preferences and actual patient preferences on costs and treatment longevity. Contrary to physician views, the survey results suggest that even for nonsurgical facial aesthetic options, treatment plans should focus more on longevity than on immediate impact.”

The full results of the two surveys are published in the September issue of Aesthetic Surgery Journal.

Dr Prsad’s Response:

The ASAPS did a survey that revealed that during a recession, physicians had perceived that patients wanted less invasive short term procedures such as fillers and that the patients were deferring surgical procedures. It appears that people actually were more interested in longer lasting surgery procedures which meant spending more but getting long term benefits. Here is my response:

The effects of aging during a recession continues (maybe a little faster). The principles for helping people look better remain constant. As I state in my book “The Fine Art of Looking Younger”, facial aging is a combination of volume loss (skin, muscle, fat resulting in hollowing of the cheeks and thinning lips) and descent (loose skin over the eyes, loss of jawline and neck definition).

As Cosmetic physicians and surgeons, we have a reponsibility to understand these processes and educate our patients accordingly. Unfortunately, many doctors and related paraprofessionals promoted the concept that fillers and nonsurgical procedures would help people look younger without surgery and further propagated the interpretation of patients preferring injections to surgery.

Many people who were looking to improve their appearance for job interviews chose the option of avoiding surgery for fillers only to end up looking swollen and unnatural (making them less desirable for employment during their interview). Think about it. If nonsurgical solutions were as effective as surgery, there would be no more need for surgeons and operating rooms.

As a specialist in facial aging solutions, my perception was that people heard about nonsurgical options from hype about gadgets and injectables and had to be educated about the proper management of their concern. I see pateints every week who are disappointed with nonsurgical treatment for problems that require surgery. Ultimately, I help these people by recommending what they need and then having them make an informed decision. In our practice, the most common procedures to address facial aging changes are for the eyes and the jawline/neck. These patients recover typically in 1 week and enjoy the benefits for years. I routinely use injectables to further enhance the benefits of surgery to address changes related to volume loss.

I think the take home message from this article is that we need to listen to our patients and be honest about the choices they have to address their concerns.

Patient Reviews of HydraFacial™

More HydraFacial™ Testimonials

The last time I had a facial, all my friends asked “What happened to your face?” (since it was so irritated) and I explained I that had a facial. Being a guy, a lot of my guy friends made fun of me for having a facial done! However, I just had the HydraFacial™ and instead of looking worse for a few days until the skin on my face settles back down – the HydraFacial™ was instant positive results. It only took 20 minutes and after I can feel my skin breathing and I feel refreshed. I’ve been happy with the results of other types of facials, however the HydraFacial™ allowed me to get on with my day without feeling self-conscious about the appearance of my skin just after. I definitely would recommend HydraFacial™ if you have an event to go to or a busy week or weekend planned – or if you are just a guy in general because you don’t have to lie there a very long time.

The process was really cool and quick. The esthetician at Prasad Medi-Spa started off the HydraFacial™ by putting a hydrating gel on my face to hydrate my very dry skin – this is good because I have to shave every 2 days, so my beard area gets extremely dry and sensitive from shaving so often. After she then infused the glycolic acid onto my my face, and using the special HydraFacial™ wand, began the extractions. There is no discomfort or pain, it is like a little suction – like a mini-vacuum that you can feel cleaning your facial pores and skin. I’ve noticed the most difference after HydraFacial™ on my nose – which gets very congested, dirty pores. My nose now looks very smooth with healthy skin. After the extractions, she re-hydrated my skin with the product. Then, she applied a green tea eye cream and also hydraluronic acid all over for extra rejuvenating.

Vampire Facelift (TM)

Vampire Facelift (TM) doctors
Drs. Charles Runels and Amiya Prasad

I had the unique opportunity this past weekend to visit Dr. Charles Runels in beautiful Fairhope, Alabama. Dr. Runels is the creator of the famous “Vampire Facelift (TM)”. The day with Dr. Runels and his assistant Laura left me with a great impression. Many of my colleagues perceive Dr. Runels from his videos and website as being a “fringe” physician. Nothing could be further from the truth. Although his personal style (which is seen on his YouTube videos) and passionate desire to protect the quality of his creation “The Vampire Facelift (TM) can be interpreted as “strange”, my feeling is that he is an exceptionally creative and caring physician whose mission is help people live life to their fullest potential.

He was very gracious and specific in instructing me on how to perform the Vampire Facelift (TM) which is a method to enhance areas of the face which are sunken using hyaluronic acid (such as Juvederm and Restylane) and your own blood’s growth factors (drawn like you would for a routine blood test) which are processed into something called “PRP or Platelet Rich Plasma”. This combination as designed by Dr. Runels is very safe and creates instant results with typically no downtime. The clients of Dr. Runels I met at his office were huge fans of the procedure and could not say enough about how happy they were. In unapologetic Southern style, one client said “I’d follow Dr. Runels anywhere for my Vampire Facelift!” (the accent and voice made the phrase unforgettable). The idea of using your own blood to create a youthful appearance is a concept which has great appeal to many of our clients who have heard about the “Vampire Facelift (TM) on the TV show “The Doctors”.

My wife and I enjoyed a very educational day with Dr. Runels and Laura with only a little time to enjoy the beauty of Fairhope. We did have a wonderful dinner at Camellia Cafe with them and I have to say the service and food was on par with top Manhattan restaurants we’ve been to.

Just in time for Halloween, the “Vampire Facelift (TM)” is now a procedure we are offering at our offices in Manhattan and Garden City, Long Island.

Once again, I want to acknowledge Dr. Runels for his creativity and passion and thank him for his instruction and hospitality.

Is a browlift or upper blepharoplasty procedure right for you?

NY Oculofacial Cosmetic Surgeon, Dr. Amiya Prasad answers RealSelf.com Question on browlift surgery and upper blepharoplasty procedure:

“What is more invasive: a browlift or upper blepharoplasty?”

Dr. Prasad is an expert at facial surgery and eyelift surgery. He explains why a patient must first determine if a blepharoplasty (eye lift surgery) or a brow lift is needed. In some cases a patient may need a combination of both eyelift and browlift surgery.

When getting a browlifting surgery (or performing the surgery), it is important that the brows aren’t overdone or pulled too much because it could result in a “constant surprised” look or expression as the brows have become too arched. A combination surgical procedure of a browlift and eye lift may be needed. After the browlifting surgery, it can then be determined how much excess skin is to be removed during the upper eyelid surgery. Both a brow lift and upper blepharoplasty are invasive surgical procedures, however they are invasive for different cosmetic goals.

Hair Restoration Surgery – More Comfortable and Better Results

New York Cosmetic Surgeon Dr. Amiya Prasad has adapted his own concept of light intravenous sedation under local anesthesia used in cosmetic surgery to the face and eyes to hair restoration surgery. IV Sedation, when  used during hair transplantation, helps to regulate the patients blood pressure which reduces an effect known as “popping”, in which the scalp bleeds during hair transplant surgery. IV Sedation reduces bleeding during the hair transplant, which allows the grafts to be placed easier, thus the donor hairs are out of the body for less time,  thus increasing the effectiveness of the hair transplant results. This safe method of hair transplant using IV sedation yields is greater hair density because there are less complications and more comfortability for the patient. The more hair grafts that take, the more successful the hair restoration.

Study: Makeup makes women look competent, trustworthy

The article below reports the benefits of wearing makeup and the impact on how others perceive you misses the big picture entirely. It’s not makeup alone tha that has this effect. The photos shown in the article are of women who have youthful features which the artful application of makeup enhanced. The key elements to looking competent and trustworthy overlap with the elements of being attractive (what we see biologically as “strong”). Each of the faces shown have nice eyes, cheek bones and well defined youthful jawline. Artistically applied makeup accentuates these features making them look even better.

The key is that good foundation (facial structure) can be enhanced with makeup. In my practice, I’ve observed that as many people experience aging changes, they compensate by trying to cover the puffy bags under the eyes and the area of the cheek and jowls with makeup which makes these areas look worse. Just like fine clothes look great on a fit and healthy body, beautifully applied makeup looks great on a balanced face.
Amiya Prasad, MD

Models without makeup and with natural, professional and glamorous makeup, as shown in a recent study.

By Rina Raphael

models with and without makeupIn beauty, less is often more.

It turns out a little makeup goes a long way in how the public perceives you, but piling on the products does you no favors. Researchers found that makeup makes women more attractive, competent and trustworthy as opposed to their bare-faced peers, according to a new study, funded by cosmetics giant Procter & Gamble and carried out by scientists at Massachusetts General Hospital, Harvard Medical School, Boston University and the Dana-Farber Cancer Institute.

The study’s participants were given just 250 milliseconds to look at several photos of women in various degrees of makeup – no makeup, “natural”, “professional”, and “glamorous” – with the ratings increasing with the amount of beauty product used. “We found that when faces were shown very quickly, all ratings went up with cosmetics in all different looks,” lead author Nancy Etcoff, associate researcher at Massachusetts General Hospital, told ABC News.

That should be no surprise, as many a study has confirmed that attractive people are often deemed more likeable and are “expected to do better on the job, in school and in life,” the study says. “This phenomenon is present from birth,” Tiffany Field, a research professor at the University of Miami’s Miller School of Medicine told ABC. “Even newborns and young infants have a preference for attractive faces.”

But before you get carried away at vanity table, there’s a limit: Positive perception declines as makeup gets heavier.

When those same participants were given time to study the images for a lengthier amount of time, the ratings changed. Instead, for the dramatic makeup looks, “people saw them as equally likable and much more attractive and competent, but less trustworthy,” Etcoff told ABC.

Is the “Housewives” look less desirable? “Too much makeup can appear as a shield, something you’re trying to either hide behind, or use to change who you are,” TODAY style editor Bobbie Thomas said.

While the findings seem plausible, some are a tad wary the study, in part because it was funded by Procter &  Gamble, which owns CoverGirl cosmetics. “Any time a study is funded by a corporation with an interest in its outcome, you have to take the results with a grain of salt,” Jamie Peck,  contributing editor at The Gloss, told TODAY.com. “However, I do not find it that hard to believe that people would subconsciously penalize women for failing to conform to a normative concept of gender (of which makeup is a part).”

Of course, makeup can help empower and express a sense of self-worth, said Thomas, but it’s not the guiding factor in a woman’s image. “It comes down to a fine line between confidence and fear or insecurity.”