The Future Perfect: Plastic Surgery Dangers -- In-Depth Doctor's Interview I

Carolyn Jacob, M.D., dermatologic surgeon at Chicago Cosmetic Surgery and Dermatology, talks about the dangers of cosmetic surgery.


What are some of the dangers people need to be aware of before they decide to get cosmetic surgery performed?



Dr. Jacob: When choosing to get cosmetic surgery performed, you really want to know who your physician is and know who is performing the procedure. Some of these procedures can be done while you are awake. Some of them are done while you are asleep. You want to make sure that whomever you talk to and have a consultation with is the one who is actually going to be performing the procedure. You also want to make sure that your physician is a board certified plastic surgeon or board certified dermatologist. There are other physicians who can claim to be cosmetic surgeons, but they are not necessarily cosmetic surgeons per se. Anyone can claim that title. It's not really a board certification that is recognized by the American Board of Medicine. Other physicians that also do plastic surgery or cosmetic surgery are ENT facial plastic surgeons and ophthalmologic plastic surgeons (eye surgeons).



What are some of the problems people encounter from cosmetic surgery?



Dr. Jacob: There is a vast array of complications that can occur from any elective or designated procedure that you choose to have. Some of those include bleeding or contour irregularities if you're having surgery such as liposuction. You can have asymmetry or scarring from other procedures such as (not sure where you were going with this so feel free to add). So you need to make sure you that you have a conversation with your physician before you undergo any procedure so you can go over the complications that could occur.



What are the dangers of Lipodissolve?



Dr. Jacob: Lipodissolve is actually a combination of two medications, phosphatidylcholine and a detergent, called deoxycholate, to make it mixed into a soluble form. It's used for some cardiac surgeries to unclog blood vessels. However, the deoxycholate is actually a detergent that can dissolve away blood vessel tissue, muscle, fat and skin. This could lead to a potential complication of scarring .This injectable solution is indiscriminant as to what it might dissolve away -- not just fat, but also skin, muscle … even bone.



What are the dangers to the liver of using Lipodissolve?



Dr. Jacob: One concern of using Lipodissolve is that if you have large amounts of fat that is being dissolved inside your body, where does it go? Well it's all broken down through the liver, and there is a risk of liver failure, which was seen in animal studies in Brazil. Because of those studies, its use has been banned in that country



Is Lipodissolve FDA approved?



Dr. Jacob: Lipodissolve is an injectable treatment to try to dissolve fat and reduce size of the abdomen or the thighs. Unfortunately, it's not FDA approved and there are very few placebo controlled studies performed with the medication. Current studies are underway examining the detergent, deoxycholate, as a fat dissolver on its own. The use of this medication is considered "off label" so it is not illegal, however, until we know more about its safety and efficacy, I would not recommend using it.



Are there other procedures that people should avoid?



Dr. Jacob: There is another term for Lipodissolve called mesotherapy, which is the overall general term of actually putting a substance into and under the skin for the benefit of the patient. So the original mesotherapy was injections of vitamins and other substances to improve the health of the person. Some practicioners add these vitamins in with the two ingredients that are in Lipodissolve and then inject it. So there isn't any standard as to what is being injected into your skin to then dissolve the fat. It's really scary because one physician might be using one product where another physician might be mixing their own product and there is absolutely no way for a patient to know.


Complications and problems that arise from having the Lipodissolve procedure include swelling in 100 percent of patients, pain in 100 percent of patients and lumps or nodules that form underneath the skin in about 80 to 90 percent of patients. Those lumps and nodules tend to go away over several weeks to months; however, this is meant to be a repeat procedure, where you are having five to six procedures which are done every four to six weeks. So you have to go through pain, swelling and lumpiness to try to achieve the final goal of possibly reducing your size. The other worry is that there have been patients who get ulcerations of their skin, which leads to permanent large scars on the skin.



Will you perofrm Lipodissolve?


Dr. Jacob: I will not perform Lipodissolve. It is not FDA approved. It is not safe. I have many other ways to improve patient's body shape and look great.


What are some of those ways?


Dr. Jacob: Well, first of all there is pure tumescent liposuction. It was developed by a dermatologist surgeon in 1987. The liposuction is performed under local anesthesia only, while the patient is awake. There have absolutely been no deaths or hospitalizations when just pure tumescent liposuction is performed. In the hands of a skilled surgeon, you can have excellent results with only about four or five days of downtime, and you get to have the shape that you've always wanted to have in a very safe way.



Are there any other procedures you recommend?


Dr. Jacob: There are non-surgical applications that can be used to try to reduce size. For instance, Thermage has what is called a deep contouring tip, which helps to tighten all of the skin in the fat areas to improve the appearance of the skin in the abdomen and thighs. They also have a cellulite reduction tip, so we can actually now improve the appearance of cellulite without having to do any surgery. There are many other devices that are under development right now which may be able to safely dissolve fat without injections at all. Those are going to be available for patient use in the next two to three years.



What are the best ways to reduce lines and improve facial appearance?


Dr. Jacob: When a patient comes to me and they say, "I don't like these lines on my face" or "I feel like I look tired" or "My face is sagging," we have a long conversation about how to fix wrinkles that are due to muscle movement and that's usually the use of FDA approved Botox cosmetic. If they have sagging of their skin, usually from volume loss, then we choose from one of the many FDA approved filler substances such as Restylane or Juvederm or Radiesse. You can also do fat transplantation to the face to revolumize the face. I'll go over all of those options with the patient and determine which one is a fit for that individual.



How does the fat transplant work and is that the most natural option?



Dr. Jacob: Fat transplantation is the most natural thing to use to fill and revolumize the face. We take fat from your body using pure tumescent liposuction and then put it into the area where the fat used to be in your face. So it's kind of a way of feeding back your own face and getting it the nice plumpness that it used to have. It's the only material that's not man made. However, the man made materials have been studied and have been used safely for years, both in Europe and Canada and now the United States. Revolumizing the face is one of the best ways to achieve a more youthful appearance.


END OF INTERVIEW