I am writing this editorial Blog in response to an increasing number of patient inquiries regarding specific “New” Techniques and Cosmetic Surgery Franchises that have entered the market place. The typical question is “Do you do (pick a way-cool-sounding procedure or machine) or “What do you think of the (for example, Turbo-Intelligent-Suck-a-lot-o-fat) clinic that just opened up? I must point out that the information discussed below is my personal opinion as a practicing Plastic Surgeon for the last 15 years who is board certified by the American Board of Plastic Surgery. I specifically request that the reader does not presume that my opinion is that of any of the official representative organizations within the field of Plastic Surgery.

Over the last 20 years the field of Cosmetic Surgery has expanded rapidly and has become a growing multi-billion dollar a year industry. There have been and continue to be ever advancing technological improvements in surgical procedures, equipment and instrumentation. Many of these have improved patient outcomes and made possible results that were only imagined a few years earlier. However, because of the eternal quest for fame and fortune, some practitioners and companies have become obsessed with being the first to offer the newest, greatest thing in Cosmetic Surgery. There seems to be a new “Catchy” named technique or device every month that is touted as the latest and greatest must-have in Cosmetic Surgery. In fact, if a doctor does not offer this new “Miracle”, well, they are just behind the times and obsolete. Because of this trend and the massive marketing blitzes that accompany these “new” advances, many patients are lured into seeking out the one doctor or clinic that possesses this new device. Manufacturers have found success in marketing directly to patients and attempt to convince them about the exclusivity and uniqueness of their device or technique. In return, they try to convince doctors that if they buy the new device or join their group offering the technique, that it will bring them more patients. It’s a match made in Marketing Heaven but it has one major shortfall. This scheme has a huge potential to violate the standards of medical ethics and misrepresent or even deceive patients into thinking they are getting something that they are not.

These slick used-car-sales methods fly in the face of some rather important clinical facts and traditional methods of advancing surgical state-of-the-art and competence. Some basic rules of thumb are the following:

1. After all the years of medical school, surgical training and active practice, most Plastic Surgeons certified by the American Board of Plastic Surgery are smart enough to know what the state-of-the-art is. Medical Education is global and very rapid. If a specific surgical device, instrument or technique is really that good or an improvement, nearly all Plastic Surgeons will incorporate it into their practice. Most ethical and competent Plastic Surgeons are patient advocates and live by “if it really works and is better, I will do it.” If only “Special Doctors” or “Exclusive Clinics” do it, there is a reason and it usually is not because they are special or more qualified.
2. If a device is only offered in a special clinic (franchise), it usually means that the manufacturer was unable to sell enough devices or convince enough qualified Plastic Surgeons to use it. This is usually because the claims made about the device were either untrue or offered no real benefit over other alternatives to accomplishing the desired Cosmetic Surgery result. Sometimes the risks can even be higher than normal. If the device has Laser or some other high-tech or catchy name it may really be suspect.
3. If you hear of some new technique or device on a nationally televised show (I won’t name any, but you know which ones I mean) it is typically not because it is some great new advance or the doctor is so special. These shows exist primarily to entertain and sell advertising space. If they happen to give you some information that is helpful, okay. But if it is “new”, controversial or exclusive, it will sell no matter what. One of my mentors who was the first Plastic Surgeon to get a nationally televised interview told me that being seen on national TV was worth over two million dollars in new patient business. And that was in 1993! It is not hard to imagine that one way to make it rich in Cosmetic Surgery is to hire a prominent Public Relations Firm to get you on the air. It only takes money and an “amazing claim of result”, not superior ability. I don’t mean to be callous or harsh, but most people are aware of the Donda West tragedy. Her doctor was featured on one of those shows.
4. Lastly, if you hear about a certain new surgical “technique” only available in your area through a special (franchised) clinic or a certain select doctor, it usually means that the technique is so easy to perform that any doctor (not highly skilled surgeon) can do it. The business model being used in this circumstance is similar to the Hair Transplant Industry (more on that below). In the case of cosmetic surgery, it also usually means that the results are so mediocre or non-existent that the fully qualified surgeons in the area would not even consider doing it that way. The only thing special about it is the corporate sponsor and the polish.

As a perspective, let me describe two of the business models commonly encountered by patients seeking Cosmetic Surgery and Aesthetic Services. Both models are legitimate but differ greatly.

Traditionally an individual wanting to be a Plastic Surgeon went to Medical School, trained for 5 to 7 years in General Surgery and Plastic Surgery and then found a place to live and practice. If they wanted to do Cosmetic Surgery they may have given seminars or market locally. As their career and reputation progressed, they would continue their education at professional meetings and incorporate improvements into their practice for the benefit of their patients. This process takes years and is based on improving knowledge and experience, again always primarily for the benefit of the patient. Although making a living is a fact of life, ethical surgeons kept the need for income well down on the priority ladder. They believed that their integrity and good reputation would be the basis for patients seeking them out for services. Because of their extensive education and experience, they can be thought of as a “Master Chef.” That analogy will make sense as you read below.

Contrast that model with the one that is commonly employed in Hair Restoration Clinics. Hair Restoration is dominated by “Franchised” clinics that spend heavily on marketing and centralize their surgery facilities. Patients initially visit outlying offices and undergo consultations with Patient Coordinators who then schedule patients to go to the regional clinics and have surgery by one of their “Surgeons.” This model optimizes the surgeon’s time by keeping them busy performing the service that generates money for the “Franchise.”. These Clinics, for the most part, get good results and most of their patients are happy. However there are some unique characteristics of a Hair Transplant Clinic that make it work well with this model. From a technical standpoint, the procedure of Hair Transplantation, while very labor intensive, is a relatively simple surgery that most doctors, regardless of their background, can learn to do by attending some short courses of instruction. That is why there are Family Practitioners, Emergency Room Doctors, Dermatologists and some formally trained surgeons working at these clinics. At the risk of sounding harsh, the doctor who “performs” the surgery is not really the most important team member of the clinic. The most important factor is actually the Clinic Brand Name, their marketing strategies and the staffing of the facility, namely the technicians who do most of the work of the procedure. Hair technicians, usually highly skilled medical assistants, are the ones who meticulously prepare and implant the Hair Grafts in the patient. The doctors mostly supervise to make sure it is done correctly. So in essence, these Franchises succeed based upon their Marketing Program and their investment in the “Team” to make this procedure profitable. Simply put, Hair Transplantation in not an “Operator Dependent Procedure” because the expertise needed by the Doctor to successfully perform the surgery is not that difficult to obtain. Although not a perfect analogy, Hair Transplant doctors function as the short-order cook in the diner. They are not really master chefs.

The problem occurs when Investors or Corporations try to Franchise an “Operator Dependent Procedure” (the talent and artistry of the surgeon is critical to patient outcome). There are many such examples in the marketplace. For obvious legal reasons, they will remain nameless. They are typically oriented around a specific procedure name or surgical device and claim exclusivity, great advantages or other difficult-to-measure-and-compare factors. Most of these have very aggressive marketing campaigns, aggressive consult follow-ups and pressure tactics. The catalyst for writing this editorial was a long discussion with one of my patients who had visited one of these clinics out of curiosity. She complained, that since her visit (two weeks), they would not stop calling her daily to schedule her surgery. Imagine that! Some of these clinics actually may have successful results, but it is rare that they are better than those achieved with conventional techniques. Many of these clinics just specialize in “Branding” and really offer the same or less result with a nice label.

In the final analysis the fact remains that most communities in the United States have dedicated and competent board certified Plastic Surgeons who spend their careers improving their skills and results for the benefit of their patients. They appreciate the fact that each patient is unique and deserves a thorough evaluation by someone who can offer many different approaches to solving a problem. “One size does not really fit all” in the world of Cosmetic Surgery. These dedicated professionals really are “Master Chefs” in the increasing environment of aggressive “Fast-Food Franchises.”