The Do’s and Don’ts of Cosmetic Surgery

Doctor shouldn't rushed consultations

Do your research

Information overload can make research overwhelming. Marketing and turf battles between doctors makes it difficult to distinguish professionally credible information from financially motivated scare tactics. There are still a good number of actual caring and ethical doctors. Advancement in medical procedures and technologies combined with higher standards for results is an opportunity for patients to find the right super specialist for them. For example, As a Cosmetic Eyelid Surgery specialist in practice for over 20 years, I can assure my patients about the optimal strategy for their eyelid issues in a way that would be different from a general plastic surgeon who mostly performs body procedures.

Research into cosmetic procedures
Research can help in finding specialized doctors who are experts in your specific cosmetic issue.

Do expect your doctor to spend time with you

It’s often perceived that a busy practice is a sign that the doctor is good. Although I’m busy, I never rush through a consultation. The consultation is a critically important time for you to learn and see if the doctor has a personality you feel you can trust with your health and appearance. A consultation is also a discussion. In my practice, the patient isn’t only selecting me but I’m selecting the patient. I avoid performing procedures on people who I’m not comfortable with. You should be comfortable with your doctor’s technical abilities and their personality.

Doctor shouldn't rushed consultations
Consultations shouldn’t be rushed, and the personalities and expectations of the patient and the doctor should be a good fit

Do ask

If you don’t ask, you may be left with questions. Ask to look at your surgeon’s before and after pictures. Ask for a step-by-step explanation of the procedure you’re looking into, including what type of anesthesia. Ask about your surgeon’s specialty area and how often they have worked on similar cases such as yours. I find that a patient who asks questions also learns about options they didn’t think about and have a better outcome.

patient asking questions to Dr. Prasad
Ask your doctor whatever you can to make sure you’re getting the treatment and results you want.

Do tell your surgeon your full medical history

An issue, which appears to be a cosmetic problem may also be associated with a medical condition. For example, a condition such as eyelid ptosis occurs when the eyelid level droops down. Oftentimes, there is also hooded skin. A plastic surgeon may remove the hooded skin without treating the eyelid ptosis. The plastic surgeon may not have been made aware that the patient sees an ophthalmologist who has been treating the patient with steroid eye drops, which could have contributed to the eyelid ptosis. The take home message is to disclose every detail about your medical history so your cosmetic procedure can be performed safely and successfully.

Review your detailed medical history with your doctor
Review your detailed medical history with your doctor prior to any procedure to avoid complications

Do be open to a combination approach

One procedure can be part of a solution for a more comprehensive treatment strategy. There may be a combination of 2 or 3 different treatments which can lead to a better outcome. For example, if a patient has concerns about under eye bags, they may not appreciate the bone structure which is lacking and contributes to the prominence of the eye bags. I find that with education and reviewing the patient’s photos from different angles that my patients appreciate the knowledge gained and the opportunity to have a procedure such as fillers to enhance the cheekbones at the same time as surgery for under eye bags. I often combine laser procedures and PRP (platelet rich plasma) treatment to help the skin look more even toned and vibrant at the same time I perform injectable treatment or surgery.

PRP and Laser combined to treat dark under eye circles
A combination of surgical and non-surgical procedures most often leads to the best possible results

Don’t fall for shortcut miracle procedures.

Shortcuts in medicine do not end well. A company claiming to perform a “revolutionary facelift” procedure with multiple offices and a pop singer from the 70s advertising for them could not hide the countless botched surgeries and fake online reviews which they forced employees to write. As a multispecialty trained Board-certified cosmetic surgeon, I have no limits on the level of procedures I can perform. If I could do a procedure less invasively to get the same results as a more involved surgery, I’d do it. Yet, non-surgeons and non-physicians market irresponsibly procedures with names and language implying if not outright claiming that they can get the same results with lasers and threads that you would get from a surgery like a facelift. There often are better ways to do things, but there are no shortcuts.

Miracle treatments often lead to expensive complications
Miracle treatments often cost people a lot more in the long run because of botched results requiring revision procedures

Don’t assume that the doctor knows what you want and expect out of cosmetic surgery.

When you consult with a very experienced surgeon, you might think, “Oh, he or she has done a lot of these procedures before, they’ll know what to do right away.” However, your situation is still unique to you, because your body, your face, your medical history is unlike anyone else’s, so communication is key. It is important that you are able to articulate what your aesthetic goals are, so that the surgeon may be aligned with those goals and develop a proper understanding of who you are, what is important to you, and what is motivating you to take this step.

Communicate your aesthetic goals to your surgeon
Communicate your aesthetic goals clearly to your surgeon to get the results you want

Don’t assume that cosmetic or plastic surgeons are experts in every field of cosmetic surgery.

Much in the same way that cosmetic surgeons and plastic surgeons practice separate and specialized disciplines, There are some surgeons who may be more focused on the eyes or face, while others may be more focused on body procedures. It is important that you seek out a cosmetic surgeon who specializes in the particular area that you want to have addressed. Going to a super specialist should significantly reduce the chances of complications and other undesirable outcomes.

lower eyelid blepharoplasty complication done somewhere else
Plastic and cosmetic surgeons are not specialists in every cosmetic procedure

Don’t have unrealistic expectations.

I have a core philosophy when it comes to cosmetic procedures: no one should be able to tell you’ve had a procedure. This means I enhance my patient’s appearance while retaining their character. You look like you; refreshed or well rested. I help my patients return to work typically in 1 week. I’ve made significant advances in the art of the procedures I perform, such as techniques to minimize bruising or swelling. I’ve made the sedation process easy to recover from and I get people back to work in typically one week. There is still a healing process which takes time to complete. Having realistic expectations as to the results and the speed of full healing needs to be well understood before having any procedure.

Don’t have unrealistic expectations.
Expect cosmetic procedures to make you look about 10 years younger, not several decades younger.

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    5 Things to Consider Before Having Cosmetic Surgery

    cosmetic procedure risks are reduced by doctor's knowledge
    Can your cosmetic concern be addressed by a lifestyle change?

    During consultation, I often begin by asking about lifestyle with a focus on healthy habits. Some people find themselves focusing on aspects of their appearance without factoring in lifestyle related actions which can also help them look better. There are often certain cosmetic issues which can be improved with diet, weight management, exercise and skin care.

    ideal body weight for cosmetic procedures
    Cosmetic medical procedures are best done when within 10 pounds of ideal body weight.

    For example, someone who complains of excess fat under the chin or love handles may see a significant difference after a change of diet which results in weight loss. This is particularly relevant for people who are more than 10 pounds over their optimal body weight. In terms of procedures such as liposuction, ideal candidates are those who are within 10 pounds of their ideal weight.

    What do you really want?
     have clear and focused aesthetic goals
    Have clear and focused aesthetic goals before consulting a cosmetic surgeon.

    Make sure that your goals for cosmetic surgery are clear and realistic. In my opinion, the purpose of cosmetic surgery is not to change your looks, but to enhance your appearance in a natural way. If you’re concerned about the appearance of your face and looking in detail on a particular area of concern will more likely result in being able to express specifically what you’d like to address. This is more helpful to the doctor something like “I don’t like my nose.” Of course, I am asked daily by patients “Doctor, look at my face and tell me what you think I need.” I’m always ready to offer my perception as an to what features are more significant in terms of the overall facial appearance.

    Be clear and detailed with your doctor
    Be clear and detailed with your doctor about you want to improve. If your doctor suggests something, make sure you understand it clearly before deciding on it.

    Nonetheless, being able to articulate as clearly as you can what bothers you helps the surgeon gain a better sense of what you want to achieve and what issues are most important to you.

    Are you ready to make lifestyle changes?

    After cosmetic surgery, a healthy lifestyle will continue to support and maintain the benefits of your surgery. This can include adopting a good skin care routine, protecting your skin against the sun, watching what you eat, and eliminating unhealthy habits such as smoking and excessive alcohol use. Cosmetic surgery is an enhancement of the external appearance which can be optimally sustained by taking care of your health.

    lifestyle changes after cosmetic procedures
    Lifestyle changes such as reduced to minimal sun exposure are needed right after certain procedures, and to maintain results of most procedures
    What are the risks?

    Like any surgery, cosmetic surgery comes with some risks. It is important that you sit down with your surgeon and discuss all the possible outcomes of your procedure so you can fully understand the risks and benefits of your planned procedure. An experienced and safety focused surgeon can minimize risk. Each surgeon is an individual with experience in specific procedures based on training and practice.

    cosmetic procedure risks are reduced by doctor's knowledge
    There are risks to any cosmetic procedure, but they are reduced by the experience, expertise, specialization of the doctor

    For example, as an oculoplastic Surgeon, my training was focused intensively on cosmetic eyelid surgery which is in contrast to a general plastic surgeon whose residency is typically hospital based reconstructive surgery. Understanding what specific areas your prospective surgeon is most proficient in is in my opinion a good way to lower the risks of the surgery you’re going to have. There is (in my experience) no surgeon who is great at “everything” .

    Are you doing it for yourself or for someone else?
    happy after cosmetic procedures
    When choosing to do a cosmetic procedure, it’s important that the person you want to please most is yourself

    Cosmetic surgery is a very personal decision, and while there is no harm in asking for the opinions of close friends or family members, the final decision is ultimately only yours to make. Some people will undergo surgery because they feel pressured by certain people in their lives to look a certain way, or they’re trying to make someone else happy by changing an aspect of their appearance. As long as you’re excited about improving your appearance for yourself, your happiness is the only thing that matters.

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      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.

      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:

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

      Vampire Facelift™ Video – Performed by Dr. Prasad

      New York’s Dr. Amiya Prasad explains and performs The Vampire Facelift™ on a patient. Dr. Amiya Prasad was trained by Dr. Charles Runels, inventor of the “Vampire Facelift™, and now offers his patients in New York and Long Island The Vampire Facelift™. Used to treat hollowing under eye area and cheeks losing volume with age as well as the area around the mouth, The Vampire Facelift™ is a great non-surgical solution without any downtime.

      The patient undergoes a Vampire Facelift™ performed using a combination of hyaluronic acid (such as Restylane or Juvederm) with platelet rich fibrin matrix (activated platelet rich plasma or PRP) using the Selphyl of RegenLab system in an artistic way to restore the lost volume in the face. Dr. Prasad’s Vampire Facelift™ patients enjoy natural results using their own blood that is then specially processed for use as a natural filler for the face, eyes, cheeks and mouth with immediate results and minimal bruising and swelling.

      Administered like an injectable filler, the benefit of the Vampire Facelift™ continues over time after the procedure as the growth factors in the blood stimulate the body to create collagen and new blood vessels which create a beautiful complexion to the skin and enhance the face.

      Dr. Prasad offers the Vampire Facelift™ procedure at his offices in Manhattan and Garden City, Long Island.

      To schedule a consultation with Dr. Prasad for the Vampire Facelift™, call 212-265-8877 or email

      The Real Housewives of Jericho – VIP Event

      Prasad Cosmetic Surgery & Medi-Spa hosted a private VIP event “The Real Housewives of Jericho” offering guests their special VIP treatments at their Garden City, Long Island location. The procedures offered at Prasad Medi-Spa include HydraFacial™, Pelleve Skin Tightening, and Airbrush Body Bronzing. The HydraFacial™ is the new hydradermabrasion procedure hydrates, cleanses and extacts pores, exfoliates the skin simultaneously, without irritation or downtime. Pelleve Skin Tightening uses radiowave frequency technology to lightly heat the layers of skin, stimulating collagen production. Immediate wrinkle reduction after Pelleve treatment results, as well as continued collagen production for up to 6 weeks. Non-surgical Pelleve has no downtime and little discomfort. Airbrush Body Bronzing is the safe alternative to tanning beds. Using professional airbrush spray tanning solutions, we enhance the body with color and contour for a just off the beach look. Call 212-265-8877 for your Hydrafacial, Pelleve Skin tightening or airbrush body bronzing at our Garden City or Manhattan offices.

      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.

      Plastic Fantastic: Platelet Rich Plasma fillers

      Written by: Valentina Zannoni – Source:

      Between an eye-lift and a hair transplant, Dr Prasad took some time out of his busy schedule to talk to Swide about Platelet Rich Plasma (PRP) fillers, the latest must have age defying practice.

      But first here’s a brief biology lesson to get to grips with the terminology. Plasma is the yellow liquid which makes up over 50% of the blood. The actual blood cells are suspended in the plasma, making it the petrol of our organism. Platelets are those tiny cells that serve to create blood clots and therefore start the healing process of the skin.

      PRP has been used for a while in other medical specialities, such as in orthopaedics for the cure of joints and chronic injuries to help stimulate the healing process. While three years ago, medical professionals from the cosmetic sphere started to think about the uses of PRP in their field. Dr Prasad, a facial rejuvination specialist at the Prasad Cosmetic Surgery Clinic in New York City, has been using this substance as a filler for two years now. “By placing it [PRP] in the skin” Dr Prasad explains, “you are injuring the skin in a controlled way and you are essentially healing a wrinkle by filling it with a material that will recruit the body’s collagen and start the healing process.” In layman’s terms, unlike Botox, PRP is used to restore volume under the skin.

      PRP fillers are particularly effective on fine lines around the mouth, eyes, even bags under the eyes and also to reduce the depth of acne scars. The optimum age to undergo a treatment is when you are over forty, unless you want to treat acne scars, then the median age of the patient is halved.

      And how about those stubborn expression lines? Well PRP fillers can also work on those. Dr Prasad says that this treatment can be used“ anywhere where the lines are relatively small, forehead lines are shallow, Botox can relax them but there is no good filler to plump them out and we’ve been using PRP.”

      How do PRP fillers compare to more traditional chemical fillers like Restylane? Dr Prasad explains that it’s a matter of patience, the two provide more or less, equivalent results, its just a question of time. “With Restylane you get immediate results, because 1cc of liquid equals 1cc of correction. With PRP you may get immediate appearance of improvement but you have to wait to see the result because body has to respond by generating collagen. It’s a healing process.” Even though the results may come more slowly, the effects of PRPs however, can last a year or more, while other chemical fillers start fading after about six months. A PRP session, which can consist of 3 or 4 injections, is also better value for money, as typically it costs $1.500, while for one syringe of Restylane the retail price is $800.

      PRP fillers are attracting an increasing amount of would be clients. “People do a lot of research, they learn a lot online, and they come and ask about it.” Dr Prasad has found that his role as surgeon has developed into teacher as well, “ often I have to educate them on what [fillers] can and can’t do. It takes the judgement of a professional to understand what they can do and how to apply them so you get the maximum benefit.”

      In recent years, cinema, TV and literature have resurfaced the public’s fascination and interest in Vampires- today, in cosmetic surgery, the benefits of blood go further than fantasy and are becoming reality.

      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 “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.”

      Lack of training can lead to unnecessary risks in Cosmetic Surgery

      Lack of training and experience is disastrous regardless of specialty.You may have seen the recent article in USA Today on Sept. 14th. “Cosmetic Surgery By Non-Certified Doctors May Cost Less But Also Bring Risks.”

      Although board certification in plastic surgery is one standard, it by no means guarantees the absence of complications and deaths. Most plastic surgery residencies fall short on experience related to cosmetic surgery hence a defined specialty of Cosmetic Surgery is needed.

      The American Board of Cosmetic Surgery certifies doctors as Diplomates in General Cosmetic Surgery, Facial Cosmetic Surgery and Body, Breast and Extremity Surgery. This status requires training through approved fellowships, a number of cases specifically in cosmetic surgery (far exceeds the standards for cosmetic surgery by the American Board of Plastic Surgery), and successful passing of a written and oral examination.

      risks in cosmetic surgeryBased on the relatively small number of doctors who meet this standard, the majority of doctors identifying themselves as Cosmetic Surgeons are not Diplomates as defined by the American Board of Cosmetic Surgery. The American Academy of Cosmetic Surgery provides an excellent open forum for doctors of all specialties to learn more about Cosmetic Surgery. In my opinion, physicians or surgeons considering expanding beyond their primary specialty (long after training has been completed) must apply the same standard in treating their patients as they would their own family members. This means proper didactic instruction with hands on training with ongoing supervision by an experienced surgeon until a level of comfort is attained.

      As a specialist, I have seen complications from many different doctors including board certified plastic surgeons (one only needs to look into the claims for malpractice to understand that there are many more claims against board certified plastic surgeons compared to the wide array of doctors identified as Cosmetic Surgeons). I have personally observed surgeons whose original specialty was in one area who have become exceptional in Cosmetic Surgery and teach their techniques to other surgeons. Sometimes it may be deceptive when a skilled surgeon teaches as it appears to the uninformed as “easy”. Mastery of technical skills and sound clinical judgment takes years to develop.

      Doctors whose egos are greater than their experience ultimately face a lot of problems. I encourage doctors who I teach to be conservative and be prepared for complications (by having an experienced surgeon as backup) before doing a procedure on their own for the first time. Tolerance for major complications is less for Cosmetic Surgeons than it is for Plastic Surgeons due to the political and economic forces which ultimately compromise patient care. I would go so far as to say that if there were a more collegial environment, less experienced doctors would be more willing to reach out to their more experienced colleagues when they need help. Instead, many of these doctors with limited experience offer low prices and work in unregulated environments.

      Of course there are many board certified plastic surgeons who also offer low fees with high volume surgery and have the same complications. Surgery requires time and focus on the health of the patient as well as the desired results of the same patient. There is no question that insurance reimbursements will continue to push physicians into choosing aesthetics in some form or another. The tragedy is that with more doctors leaving their primary specialty for aesthetics, there will be fewer qualified physicians to take care of people for actual medical care.

      Follow Up from this story below:

      The article “Lack of training can be deadly in cosmetic surgery” appropriately emphasizes the importance of choosing a surgeon who is properly trained and experienced in cosmetic surgery to minimize the risk of complications and poor outcomes.

      However, the article conveys misleading information implying that doctors who complete residencies in specialties other than plastic surgery, including “vision” doctors, lack the training necessary to competently perform cosmetic surgery. The American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) rejects this premise.

      We represent ophthalmic surgeons specializing in oculofacial surgery. The society has been the accrediting body for fellowships in this plastic surgical subspecialty for more than 40 years; our members have extensive training and experience in aesthetic surgery. Not only do our board-certified members complete a two-year fellowship program after three years of postgraduate surgical training, but they also have to pass qualifying examinations and demonstrate proficiency in a significant number of cosmetic and reconstructive surgical cases.

      As highly skilled and trained surgeons in the field of aesthetic surgery, our society endorses the message that patients should be selective when choosing a cosmetic surgeon and be informed about that surgeon’s education, certifications, reputation and experience.

      Jan W. Kronish, M.D., president

      ASOPRS; Delray Beach, Fla.

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