By: Steve R. Fallek, M.D.
Board Certified Plastic and Reconstructive Surgeon
Englewood, NJ; New York, NY

There is a wonderful commercial on television on how certain products or services don’t go well together. For example, car wash and teeth whitening, divorces and carpeting, and baby-sitting and cesspools. The company states that they do one thing, and they do it right. I thought about this in regards to plastic surgery and vacations. In my opinion, these are two services which should almost never go together and ultimately may lead to disaster. I am continually amazed by how many people make bad decisions regarding plastic surgery. Hopefully, I can give you some insight into how this occurs and how to avoid serious risk. The best way is to compare the two. Since most plastic surgery tourism takes place in the Caribbean or south of the border (either Mexico, Central or South America), we’ll use it as an example.

Meet your doctor

Just to give you an idea, what does it take to become a practicing plastic surgeon in the United States? For me it was four years of college, four years of medical school, and a five-year general surgery residency followed by a 2-year plastic surgery fellowship. All of these have to be accredited by the state and national government. To become board certified, oral and written examinations as well as a periodic review of your cases performed. To operate in a hospital, evaluation of your training as well as peer review to determine whether or not you are capable of performing the procedures which you want to perform. Don’t forget malpractice coverage. I won’t even go into the government regulations necessary. Let’s say you want to check up on me. First step now, online research. Website looks nice, a bunch of articles and belongs to a few hospitals. Let’s dig a little deeper. Hey look, I can check with the state medical board or national societies to see if he’s a member in good standing. No malpractice suits. All checks out.

Now let’s check in on our foreign doctor. A friend of mine had a friend who said you can get cheap plastic surgery. Website looks very enticing. Great pictures, nice setting. But who do I call to check up on his schooling? How about any of his credentials? Is there board certification? Is this person really a plastic surgeon? Has he had any problems, deaths, complications? Who do you call? Where do you get any information? I haven’t the slightest idea. Just to make sure it wasn’t me, I checked with one of my hospital medical directors. She said the same thing. In fact, she told me of a notorious cosmetic surgeon who has been kicked out of New York, New Jersey, and Florida who just opened a clinic in the Dominican Republic. Don’t get me wrong; there are many excellent plastic surgeons abroad. Some are world famous. However, many of them are honorary members of American societies as well as authors of articles published in reputable journals. They usually work in big hospitals and charge just as much as their American counterparts. They are known. They are not running plastic surgery mills trying to squeeze every last dollar out of you.

The Consult

I spend at least 45 minutes to an hour with my cosmetic consultations where we discuss your operation, anesthesia, risks, recovery, costs, back to work issues, and any other concerns. You can sit with my patient coordinator for as long as you like, and you’ll come back again prior to surgery. We will discuss preoperative blood work or any other tests necessary. I operate at both hospitals and surgicenters so we will discuss that, too. If you want, you can check out the facilities or speak to the anesthesiologists. We want you to be as prepared as possible so you know what to expect and get the best result. Never forget that it is still surgery.

As for your foreign doctor, many of them come to town for a day or two and try to cram as many patients in one day as possible. That is, if they even come, for many times a representative of the doctor will come alone and try to recruit as many patients as he or she can. You may have to go to a different country to actually see the doctor. I know of a hair salon which hosts a Dominican doctor once a month, and he and his assistant see consults in a space behind the hair dryers. Maybe it’s just me, but I want to feel confident and comfortable with my surgeon. A consultation in a nail salon or empty storefront doesn’t do much for privacy, professionalism, or confidence. Good luck getting all your questions answered before you’re shoved out of there. Oh, and cash up front; no deposit and no refund.

The Operating Room

It would take me ten pages to document all the regulations, requirements, protocols, etc. for every single person or piece of equipment which is in a hospital or surgicenter. The accrediting process is unbelievable; and it goes on and on, including periodic unannounced inspections. For anything put in the body, you can triple the regulation and add the FDA. For the most part, that is not important. You live in an area and you know the local hospitals and their reputations. You will go to the one with which you are most comfortable. If you are traveling to another part of the country for surgery, most hospitals are the same and meet the same regulations by the government. Hopefully your biggest concern will be following the right signs in the hospital.

If the odds aren’t stacked against you yet, here’s where it gets really dicey. First of all, if you are still ready to go abroad, make sure you speak the language. I have enough problems in a foreign country asking directions; I can’t imagine if I had a real emergency. Don’t ask for directions to the local hospital because many times the surgery is not done in a hospital but in an operating room/clinic somewhere. Accreditation is a joke. Sterility non-existent. Anesthesia iffy. Materials re-used as many times as possible. There is no such thing as a disposable. Disposables cost money; and remember, it’s about making money. Just to give you an idea, here are some items I’ve removed from patients who’ve had plastic surgery in another country: numerous infected breasts implants, regular cotton threads instead of sutures, liquid silicone, metal plates, wires, and sponges left in during surgery.

The Recovery

After surgery we call you up to make sure everything is okay. Stay at home, relax with loved ones, and take it easy. Watch television with your feet up.
But here’s where there is the supposed pay-off for a plastic surgery vacation. Beautiful island. Sun, surf, frosty drinks. But wait a minute. You need to stay out of the sun after surgery. Can you go out? Sure, but you think you’re sitting out on a lounge chair? What about the garment or bandages which you have to wear? No chance. And forget about tennis, golf, a massage, and the pool. I’m sure your spouse is going to feel great playing golf all day while you’re stuck inside with CNN International. I hope you’re staying at a ritzy place where they’ll carry your luggage and speed you through customs. If not, enjoy a crammed bus or van to the airport, followed by waiting in line for an hour, and a fun plane ride home. You think that’s bad after a regular vacation. Try it after an operation. You’ll be ready to lie in bed for another week.

The Follow-up

There is nothing to compare here. On a plastic surgery vacation like any other vacation, once it’s over, it’s over. No follow-up, no phone calls, nothing. I can’t tell you the number of times patients have had plastic surgery in another country, and they follow- up with me because that’s what they are told. “If you have a problem, find a local plastic surgeon or go to the emergency room.” If I did this, I’d be out of business. If you are unhappy with the surgery, tough luck. Call and complain? Good luck speaking to the doctor. Think you’ll get a refund? No chance. Get a copy of the operative report? There isn’t one. Sue for malpractice? Doesn’t exist outside of the U.S.
What if there is a serious complication? If you have insurance, it’s of no help because most of the time they will not cover complications arising from foreign plastic surgery. If you have to be hospitalized, you are looking at a bill in the tens of thousands of dollars. As for corrective plastic surgery, it is much harder to perform, costlier, and not always 100% restorative.

The Bottom Line

Congratulations on your foreign plastic surgery. Best case scenario, you’ve saved yourself $1000.00. Worst case scenario, take your pick. I always tell my patients there are times to save your money and other times to spend it. Spend it on surgery and safety. If a hospital costs a little more and it gives you peace of mind, that is money well spent. I don’t want to be a downer; but if I’ve scared one of you out of going abroad for surgery, I’ve done my job. It is my job to inform you and give you the right information. I hate it when a patient comes in and wants me to correct a botched operation. There is no guarantee to surgery; and there is no guarantee that even here there won’t be a less than optimal outcome, but you do want the odds in your favor. I do my best, but with no knowledge of the operation, the surgeon, what’s in there, or whether it can come out, it makes my job very difficult, and I want a happy patient population. When I can fix these problems, patients are very grateful and some of my happiest patients. Good luck.

About Dr. Steve Fallek

Dr. Fallek obtained his B.A. degree from the University of Pennsylvania, cum laude, in 1987, and received his M.D. from Mount Sinai School of Medicine New York, NY in 1991. After medical school, he completed a general surgery residency at the University of Medicine and Dentistry of New Jersey, where he then received fellowship training in Plastic and Reconstructive Surgery. For more information please visit www.fallekplasticsurgery.com.

Childbirth can be extremely stressful. There is much to worry about including staying healthy, birth complications, and how life will change after delivering a baby. One major concern many women have about childbirth is how their bodies will be damaged from the immense amount of changes which occur over the course of the pregnancy. In our society today women are surrounded with images of celebrity moms posing their perfect bodies soon after delivery, yet the rest of the population may not always have such easy access to personal trainers or cosmetic surgeons to create quick transformations. However, there are now more options becoming mainstream among new mothers to help them feel more confident and improve overall health and self-esteem following childbirth.

Being able to exercise following childbirth is extremely important to both the health and psyche of a new mother. In addition to obvious benefits of exercise such as helping reduce the risk of developing certain diseases, like heart disease, exercise may also help you cope with postpartum depression. The University of Michigan Health Services reports that exercise helps by releasing the body’s mood-elevating compound and reducing the depression-causing hormone cortisol. This is why exercise often makes you feel better and provides feelings of increased self-esteem. As a New York Plastic Surgeon and Board Certified OB/GYN, I specialize in helping women deal with body changes from childbirth and help them get back on track physically and emotionally.

Traditionally women who had excessive skin or damage from vaginal delivery were often so embarrassed about the issue that it took years before they sought medical advice for correction of the problem. They lived day to day uncomfortable and struggled getting their bodies back because they couldn’t exercise comfortably. Now more and more women are seeking labiaplasty and/or vaginoplasty for effective solutions to their discomfort and distress. The American Society of Plastic Surgeons believes labiaplasty and vaginal cosmetic surgery are the fastest growing emerging growth trends in cosmetic plastic surgery. While the organization has no exact numbers yet nationwide, more and more doctors are contacting the organization inquiring about learning the procedure. In addition, the physicians who perform vaginal cosmetic surgery have reported enormous increases in patients, particularly over the past decade.

In the beginning I heard concerns time and again from nervous female patients who had damage from vaginal deliveries who were reluctant to tell their doctors about damage. In response to these issues, I set out to help women with ways to not only prevent damage but provide them with solutions to anatomic change after childbirth. During childbirth delicate vaginal tissues are inevitably strained, bruised, and torn – and many times muscle is traumatized. For most women this stretching poses no problem. But for some the vagina becomes extremely “loose.” I offer women reconstructive procedures which restore the optimum structural architecture of the vagina for a comfortable result. Women visit Manhattan Center for Vaginal Surgery for a variety of gynecological reasons following childbirth including enlarged labia, general irritation, problems with personal hygiene and sexual intercourse, as well as discomfort during life’s daily activities such as exercising, walking, or even sitting. I strongly advise women to be proactive and talk to their doctor if they are experiencing pain, discomfort, or overall dissatisfaction with their body following childbirth. Pursuing a vaginoplasy or labiaplasty can make life easier and allow women to focus more attention on the newest addition to their families. For more information on these procedures or to arrange an appointment with please visit www.centerforvaginalsurgery.com or call (212) 308-4988.

Meet Dr. Ronald D. Blatt M.D.
Ronald D. Blatt, M.D., is a Board Certified OB/GYN who has been in practice since 1986. Dedicated to being the best in his field to best help women with the most sensitive of subjects, Dr. Blatt has an extensive and impressive educational background. Upon graduating Summa Cum Laude from S.U.N.Y Albany, Dr. Blatt went on to receive his medical degree from the University of Vermont Medical School. Since 1986 he has been a staple in gynecology and vaginal reconstruction affiliated with Lenox Hill Hospital in New York City. Furthermore, Dr. Blatt has been an active fellow of the American College of Obstetrics and Gynecology as well as a member of the Medical Society of the State of New York. Currently, Dr. Blatt is the Medical Director for the Manhattan Center for Vaginal Surgery specializing in the niche area of Vaginal Reconstruction. For more information visit www.centerforvaginalsurgery.com

By: Sam Assassa, M.D.
Beverly Hills Aesthetics
866-dr90210
www.bhaesthetics.com

About 40% of women around the world will suffer from thinning hair or hair loss, while 50% of men will experience some type of hair loss by age 50. Losing hair for women is like losing their “crowning glory” while men associate hair loss with loss of youth and sex appeal. Now there is MesoHair, a series of virtually painless injections of vitamins, minerals, and DHT blockers directed into the scalp to effectively aid in hair re-growth in women experiencing certain types of hair loss and reversing male pattern baldness in men.

Mesotherapy can be used in women experiencing postpartum hair loss and peri-menopausal or menopausal hair loss. In addition, Mesotherapy has elicited a good response in younger men experiencing early stages of male pattern baldness.

Originally a medical technique devised in 1952 by Frenchman Dr. Michel Pistor to treat such conditions as rheumatology, sports traumatology, infectious diseases, vascular diseases, and the improvement of circulation, Mesotherapy has subsequently been extremely successful in the treatment of aesthetic conditions, most commonly spot fat reduction and the elimination of cellulite. I have found that Mesotherapy used as a prolonged treatment of a series of eight to twelve monthly injections should help both men and women with hair loss. Once-a-month maintenance therapy continues to enhance the existing hair.

Mesotherapy replaces the vitamins and minerals which the body loses as we age. The medications in Mesotherapy treatments cause an increase in blood circulation to the scalp area and stimulate the hair follicles. MesoHair, through micro-injections, delivers specially formulated FDA approved concoction under the scalp straight to the hair follicles. This mixture delivers long-acting neutralizing effects on the DHT hormone produced in the body, allowing for hairs to grow. An excess of the DHT (dehydrotestosterone) hormone causes hair loss.

This is not a cure for hair loss, but certainly a safe, simple, and cost-effective option to treat certain conditions. MesoHair restoration therapy can in some cases eliminate the need for hair transplant.

Additional non-invasive aesthetic services which can preserve your youthfulness and reverse the signs of aging are as follows:

Visia Skin Analysis
VISIA provides breakthrough digital high-resolution photographs and computer analysis of the skin’s complexion, enabling you to discover what issues may be causing additional signs of aging.

CosmoFaceLift™
Those who want the benefits of an instant face-lift in a non-invasive, 30-minute-and-you’re-out-the-door method should consider the Cosmo-Facelifts™. It is much superior to feather-lift, thread-lift, or the contour-lift. Cosmolift ™ is latest innovation in non-surgical procedure which smoothes and lifts drooping brows, cheeks, jowls, and neck.

MesoLift™
This non-surgical mini facelift is a step forward in skin and facial rejuvenation which dramatically restores skin’s youth and literally reverses the aging process.

MesoSculpting™
A series of microinjections of fat melting concoctions which easily replaces liposuction and provides permanent body contouring of troubled areas such as tummy, love handles, saddlebags, eye bags, and double chin. Nothing comes close to the results you can achieve to improve cellulite like MesoSculpting™.

Botox
Botox removes and softens dynamic wrinkles, erases lines, and overall “de-ages” the skin. This popular cosmetic procedure is not just for frown lines anymore. Botox can effectively be used on the entire face, neck area, and even on the chest.

Peels
Specially formulated peels will return your face to its soft, supple complexion by renewing collagen and elastin, eliminating wrinkles, reducing pores, treating and improving acne and its scars, and blending uneven skin tone.

Fillers
Eliminate wrinkles and sculpt, lift and enhance your face using superior products.

Lip Enhancements
A plump pout is considered a sign of youth and an icon of sensuality. We use long-lasting fillers to create a fuller, smoother, and greater defined lip line.

Foto Facial
Intense Pulsed Light (IPL) technology is a breakthrough treatment which will rejuvenate the skin and correct sun damaged skin, large pores, acne scars, freckling, discoloration, redness, flushing and rosacea, all with no down time.

MesoCellulite™
Offered exclusively by Beverly Hills Aesthetics, MesoCellulite is considered the “home run” of the cosmetic treatment of cellulite. Nothing comes close to the results you can achieve to remove cellulite like Mesocellulite.

Since 1995, Dr. Assassa has been exclusively practicing aesthetic medicine in Beverly Hills, California. He is an associate member of the American College of Physicians, a member of the American Mesotherapy Association, and the American Academy of Anti-Aging Medicine as well as serving on the advisory committee of the American Aesthetic Medicine Association. He is also a member of the American Society of Aesthetics and Mesotherapy (ASAM) www.mesotherapy-us.com and lectures on aesthetic techniques at ASAM’s conferences worldwide. Dr. Assassa is board certified in internal medicine and received his medical degree, with honors, in 1980, then held a series of internships and residencies in Chicago at Loyola University-affiliated hospitals, and in Cleveland at Case Western University-affiliated hospitals.

By: Robert Craig
Creator of Robert Craig Salon Products

What’s a girl to do if she doesn’t want major chemicals lousing up her hair? Don’t despair, I created a new, gentle permanent hair color developed without a trace of harmful agents like peroxide, ammonia, alcohol, perfume, or resorcinol. Additionally, my No More Bad Hair Days Kit is the perfect solution to maintaining color treated hair.

At home hair colors can contain over 40 different ingredients/chemicals. Color by Robert Craig contains, on average, 11 essential ingredients to cover grays, turn grays into highlights, go a few shades darker, tone down highlights, or create lowlights. The innovative technology developed for the line is highly effective so that color will not wash or fade away; however, it is gentle enough so that it won’t damage the structure of the hair. It is available in 21 intermixable, luxurious shades plus a special Clear Color to add shine or fine-tune the other colors. The line is water-activated, which means that there is no separate chemical developer to worry about. Because there is no ammonia or peroxide, Color by Robert Craig does not have the unpleasant odors associated with typical hair colors. Without these damaging chemicals, color fades less and slower, even in the sun and chlorinated water. Plus, the built-in conditioners leave hair shiny, silky to the touch, and tame the wiry hairs that come with grays.

In order to maintain your freshly colored new do and protect it from the elements of the environment, I recommend using my signature No More Bad Hair Days kit. Most of us blame our “bad hair days” on either our shampoo, hormone changes, or the weather. The real culprit is the water! Water varies widely all around the U.S. and even within the same city. Extremely hard and moderately hard water contains minerals that cling to hair and make it difficult for shampoo to clean properly and can cause color treated hair to fade. Soft water makes rinsing out shampoo a challenge and can leave hair limp and dull. When traveling for vacation, business or a big event, don’t let bad hair days add extra stress to your life.

The No More Bad Hair Days Kit comes with twelve test strips, three shampoos for different water (soft, moderately hard and extremely hard), and a spray-on, leave-in conditioner. If you’re traveling frequently and your hair is color-treated, water can wreak havoc on your hair. These travel-sized shampoos really do perform mini-miracles, and the spray-on conditioner is nice, too. Now, my trio of shampoo formulations addresses the problems water can cause, which make it hard for us to tame our hair. I went to work on this problem after my clients who traveled on business came back complaining that their usual shampoo didn’t perform the way it did at home.

Color by Robert Craig retails for $9.99, while the No More Bad Hair Days Kit is available for $19.99. Both products are sold via the company’s website, www.robertcraig.com, or by calling the toll free number, 1-800-917-2566.

About Robert Craig
Robert Craig is known as ‘one of the country’s top hair color artists’ specializing in corrective and natural hair color techniques that result in healthy, shiny, and believable hair. Entering the business in 1983, Robert trained under New York’s top talent before opening his first Manhattan salon in 1987. His clientele has included actors, beauty editors, business professionals, and artists. His work has been seen in print, television, movies and on Broadway. He brings his 20 years of experience to consumers and professionals alike on this award-winning website. To date Robert has helped over two million people solve their hair color and hair care problems. Due to the overwhelming success of this venture, Robert closed the New York salon that he co-owned with Karin Hiebert to devote his time completely to this website. Today, Robert travels extensively and works from wherever he can plug in his computer.

Boris M. Ackerman, M.D.
Board Certified Plastic Surgeon
Newport Beach, CA

The birth of a child is one of the most exciting events in a woman’s life. However, it is often distressing, especially to first-time moms, when their bodies do not spring back into pre-pregnancy shape, often leaving them with sagging breasts, stretched abdomens, and an overall matronly feeling. Motherhood now has a new shape. Thanks to advances in cosmetic surgery, postpartum mothers can now reclaim their bikini bodies faster than ever before. Many women, although ecstatic about newfound motherhood, are riddled with insecurity after childbirth due to excessive weight gain in areas which may not have been troublesome before. Women primarily seek two forms of surgery as postpartum “tune-ups”— abdominoplasty (commonly referred to as a tummy tuck), and breast enhancement surgery (including breast lift and breast augmentation).

Unlike women who are simply overweight, pregnancy puts a certain strain on the body which cannot always be combated by diet and exercise alone. The midsection of the abdomen can be compared to a girdle, a garment which is composed of an elastic portion which, when stretched, is likely to become one size too big. In the abdominal section, women often lose the desired “girdling” effect after childbirth, which can occur in varying degrees. Pregnancy not only weakens the muscles, but stretches out the connective tissue, which for most women will not revert to original form on its own. A tummy tuck not only targets excess skin, but also works to retighten the connective tissue so that the abdominal wall reacts to give the waistline a desirable indentation. Without tightening the connective tissue and exerting a girdling effect on intra-abdominal contents, women cannot achieve their pre-pregnancy appearance.

Breast augmentation and breast lift surgery are suitable solutions for postpartum women who are dissatisfied with the new shape of their breasts. Most women, after having one or more children, start to lose volume in the upper portion of their chest, and get a hollowed appearance in the upper outer quadrant of the breast. I also notice that women begin to show signs of sagging in the lower portion. The sagging of the breast is referred to as breast ptosis; and in such cases, I may perform a mastopexy (breast lift), and often insert an implant in the breast to replace the lost volume. The size of a woman’s breast depends on the volume of tissue in the breast; but the position of the breast depends on tautness within the skin envelope, which retains that volume. If a patient has sufficient volume, I simply lift it, giving the woman a tighter skin envelope, thus making the breast stand high and firm.

Many women begin to feel psychologically affected after childbirth. With a fair amount of weight gain, women may feel undesirable, unmotivated, or even frustrated if they are working out at the gym and still cannot seem to shed those last few pounds. By tightening a woman’s body, a surgeon can improve a woman’s self-esteem and her overall attitude about herself.

What about liposuction? Is it still a viable option for someone who wants to rid himself or herself of unwanted weight? A good candidate for liposuction is someone who is in fairly good shape, relatively close to his or her ideal weight, but wants to trim down localized areas. The person should be physically healthy, psychologically stable with realistic expectations. The fat will not re-accumulate in these areas in the same manner as before and leaves small, if any, scars. I have many patients who come to me after they have given birth and request liposuction. Even though they have returned to their previous weight, many of these women have some resistant areas as a result of the pregnancy. One common place where women retain fat is the outer hips. These patients are ideal because the fat is localized so it is not difficult to suction and sculpt the surrounding area to create the desired contour.

Mini tummy tucks are also for someone who is basically in good shape and may be recommended for patients who are within 10% of their ideal body weight. This procedure is less invasive than a full tummy tuck. A mini tummy tuck is a surgical procedure to remove excess skin and fat from the middle and lower abdomen and tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a large or protruding abdomen and can significantly narrow the waistline. The surgery is ideal for women who have been pregnant and have stretched their abdominal muscles and skin beyond the point where they can return to normal, thereby resulting in “stretch marks.” I advise my patients not to undergo a tummy tuck until they are done having children. There have been a number of case reports where women have accidentally become pregnant after having had a tummy tuck and deliver the baby successfully. However, theoretically there are potential problems which can occur. Aesthetically speaking, if a woman becomes pregnant after a tummy tuck, there will be new damage to repair after the delivery. For this reason, I would not advise women to undergo this procedure until they have completed their family.

Some women even opt for a C-section with a tummy tuck. These two procedures can be done in combination, but I advise against it because the body needs time to re-stabilize. Right after delivery, the tissue of the abdomen needs time to shrink down, or the results will not be optimal. A woman should allow for some time to return to her pre-pregnancy weight and allow for the skin and muscles to rejuvenate. Women should wait at least 3-6 months after any delivery (C-section or vaginal delivery) to have abdominal surgery. The abdominal muscles need time to repair themselves from delivery before undergoing more surgery in order to yield the best results possible.

With the latest advances which modern plastic surgery has to offer, motherhood now looks quite different than it did a generation ago. Mothers can now revel in the joy of their infants, while knowing that they can quickly regain their pre-pregnancy shape and self-esteem.

Boris M. Ackerman, M.D., is a Board Certified Plastic Surgeon specializing in facial rejuvenation with Endoscopy and Laser Liposculpture and Breast Surgery. He was one of the first surgeons in California to utilize the laser in plastic surgery. Dr. Ackerman has been in private practice in Newport Beach since 1987. He graduated from the Massachusetts Institute of Technology and received his Doctorate of Medicine from the Dartmouth Medical School. He performed his postgraduate training at Cedars-Sinai Medical Center in Los Angeles. Dr. Ackerman is on staff at Hoag Hospital in Newport Beach. He is an active member of the American Society of Plastic and Reconstructive Surgeons and the Orange County Medical Association. He was recently seen on the Discovery Channel’s Plastic Surgery Before and After, and MTV’s I Want A Famous Face. For more information, please visit www.doctorackerman.com.