The Surgical Artist's Blog

Listen in on this previously recorded show about the significant differences between the specialty of Cosmetic Surgery and Plastic Surgery and learn why not all Plastic Surgeons are Cosmetic Surgeons. The public and the media in Chattanooga, North Georgia and North Alabama are often confused regarding the important differences between these specialties. Procedures like Facelifts, Liposuction, Breast Augmentations are all Cosmetic Procedures and not Plastic/Reconstructive!  The host, Leonard A. Rubinstein, M.D., is one of the original members of the American Academy of Cosmetic Surgery, a Diplomat of the International Board of Plastic, Aesthetic and Reconstructive Surgery and a Diplomat of the International Board of Cosmetic Surgery.  He discusses this topic with his colleague and immediate past President of the American Academy of Cosmetic Surgery, Dr. Angelo Cuzalina.

Listen here.

Dr. Nease and Dr. Deal are both Board-Certified Cosmetic Surgeons. Their practice at Southern Surgical Arts is 100% committed, focused, dedicated to cosmetic surgery.  They do nothing else but Face & Neck Lifts, Cosmetic Breast Surgery, Tummy Tucks, Liposuction and SmartLipo, Mommy Makeovers, Vaginal Rejuvenation and other cosmetic procedures and services that can enhance your appearance and improve your self-confidence.

During Dr. Nease's and Dr. Deal's cosmetic surgery fellowships, each performed more than 700 major cosmetic surgical procedures in their training year alone.  Since then, each of our surgeons have devoted their practices around the latest laser technology to bring the patients a practice dedicated to experience and excellence. After more than 5,000 cosmetic surgery cases, 3 Best of the Best Awards, 3 Reader's Choice Awards and many happy patients in the Before and After Gallery, we believe our surgeons are the best in the area and the Cosmetic Surgeons for you.

Should you smoke and have cosmetic surgery? Drs. Carey Nease and Chad Deal emphatically say no.

Most people only know of the long term affects of smoking such as its relationship to cancers and COPD, however there are immediate problems as well that tremendously affect the healing process of wounds. "I rarely see wound healing problems in non-smokers, and we know the risk of problems goes up significantly in those patient who actively smoke or are around second-hand smoke," said Dr. Carey Nease. Instantly when one begins to smoke even just one cigarette the small blood vessels constrict. This has disastrous effects on new wounds that can cause them to become necrotic and even completely open up.  "I can usually tell when a patient has not been forthcoming about smoking during their recovery after a breast lift," said Chad Deal, MD. "Nipples have a very hard time healing without the proper blood flow to them."  This is also especially true for other procedures such as facelifts, tummy tucks,and arm or thigh lifts.

There are also a host of other problems that come from smoking during the healing process such as: increased risk of infection, increased risk of capsular contraction with implants, increased risk of hypertrophic scars, and others. Even from a pure aesthetic standpoint there is loss of elasticity with the skin so that during the recovery phase the skin will loosen up and will ultimately lose some of the "lift" with facelifts, tummy tucks, etc.

At Southern Surgical Arts, our policy is that you must quit smoking 6-8 weeks before surgery. This policy is also applied to the post operative healing process. Since improvement is the goal in cosmetic surgery, minimizing the possibility of complications is optimal.

Have you stopped smoking or in the process of quitting and ready to move forward with your cosmetic surgery procedure? Call us and take advantage of our complimentary consultation with one of our highly trained and skilled surgeons.

Chattanooga, One North Shore: 423-266-3331
Calhoun: 706-629-8622

Southern Surgical Arts is pleased to be the first physician practice offering Xeomin®, an alternative to Botox and Dysport in Northwest Georgia area since November 19, 2011. The practice is also one of the first in the Chattanooga area to offer the new injectable. Xeomin will not be released to the public until March of 2012.

Unlike many cosmetic procedures, otoplasty, or cosmetic surgery for the ears, can be performed on patients as young as 5 years old. While often performed to reduce the appearance of protruding ears, otoplasty is more than just ear pinning.

In this edition of Inside Cosmetic Surgery, we speak to Dr. Carey Nease, a facial plastic surgery specialist, about this delicate procedure.

Listen to the full interview or read through the transcript!

If you are interested in this procedure or any other cosmetic surgery procedure, please visit our office for you complimentary consultation with either Dr. Nease or Dr. Deal, both fellowship-trained and Board-Certified Cosmetic Surgeons.

Chattanooga, One North Shore: 423-266-3331
Calhoun: 706-629-8622

The Agency for Healthcare Research and Quality (AHRQ) launched an initiative with the Ad Council to encourage clinicians and patients to engage in effective two-way communication to ensure safer care and better health outcomes. At Southern Surgical Arts, we understand the importance of communicating the risks and benefits of cosmetic surgery with our patients. And we support the agency's efforts to help develop questions that help the patient make a good decision when choosing cosmetic surgery.

Here are a few questions that the agency suggests you ask in their interactive question builder. We believe the following questions are great conversation starters with your surgeon:
What kind of surgery do I need?
Have you done this surgery before?
Will I need anesthesia?
How long will it take me to recover?
What will happen after the surgery?

Dr. Nease and Dr. Deal have built a practice that focuses on the patient. This includes giving each patient the time they need to make a good decision about their cosmetic surgery procedure. "My goal is to answer all the questions that a patient has about the procedure I recommend. This includes discussing what happens before, during and after the surgery," said Dr. Deal. "I, as well as our clinical staff are available to answer questions for our patients throughout the entire process."

Southern Surgical Arts loves to hear from happy patients. One of Dr. Deal's patient, Danielle Webb had this to say about our communication process, "I cannot thank Dr. Deal enough for the awesome job he did. I felt comfortable with the staff and Dr. Deal immediately. He answered my questions, explained everything...I was just completely at ease. The day of the surgery, the follow up appts...everyone has been great!!."

Likewise, a patient named Heather wrote on our Dr. Nease's Google Places page, "Dr. Nease and his staff are excellent and knowledgeable. They were always available to answer my questions (and I had a lot!). The care before and after my surgery was above and beyond what was required."

Do you have questions about a cosmetic surgery procedure? What's keeping you from asking Dr. Deal or Dr. Nease? Our in-office and online consultations are complimentary and we look forward to seeing you soon.

Chattanooga, One North Shore: 423-266-3331
Calhoun: 706-629-8622

For years, economists have said that the baby boomer discretionary income has fueled the Face Lift market for cosmetic surgery practices. Pair that with cosmetic surgery becoming more widely accepted, and advancing laser technology and science, it's a recipe for any baby boomer to become overwhelmed with their options. Cosmetic surgery includes many elective procedures for the face and body, but studies show that baby boomers are ready to have their facial appearance reflect how they feel on the inside.

"I've done more than 2,000 face lifts and facial rejuvenation procedures, and we are seeing more patients who want a more natural look," said Dr. Nease, a Triple-Board Certified Cosmetic and Facial Plastic Surgeon at Southern Surgical Arts. Seniors in good physical health can be considered for most cosmetic surgeries. Advancing age is rarely a disqualifying factor. Those with any significant medical problems may be discouraged from any invasive surgery or anesthesia and may be steered toward less invasive procedures that may still be beneficial.

Last year there were 84,685 surgical procedures among patients age 65 and older, according to the American Society for Aesthetic Plastic Surgery. They included 26,635 facelifts; 24,783 cosmetic eyelid operations; 6,469 liposuctions; 5,874 breast reductions; 3,875 forehead lifts; 3,339 breast lifts; and 2,414 breast augmentations.

Except for a brief turndown during the recession, those numbers have been rising for years now, and experts say the trend seems likely to accelerate as baby boomers begin to pass age 65.

The Cosmetic Face Lift is a face lifting technique offered by our fellowship trained and Board-Certified Cosmetic Surgeons. Because Dr. Deal and Dr. Nease are trained in the latest techniques, the Cosmetic Facelift provides a more natural, refreshed, rejuvenated look that the traditional plastic surgery facelift. The ideal candidate is usually more than 50 years of age. Less invasive options such as Botox and the Laser Facelift are also available.

Southern Surgical Arts offers complimentary consultations to all cosmetic surgery patients. For more information on facial rejuvenation procedures and face lifting techniques, please call for an appointment or visit our website at www.southernsurgicalarts.com.

Chattanooga, Tennessee
One North Shore
423-266-3331

Calhoun, Georgia
706-629-8622

Recap of statistics:
84,685 surgical procedures in 2010 among patients 65 and older, a 21 percent rise from 2009

Cosmetic surgeries done for people older than 65 in 2010 include:
26,635 facelifts
24,783 cosmetic eyelid surgeries
6,469 liposuctions
5,874 breast reductions
3,875 forehead lifts
3,339 breast lifts
2,414 breast augmentations
Source: American Society for Aesthetic Plastic Surgery

Original article found here.

What Patients Should Know About Cosmetic Surgery and Their Cosmetic Surgeons

Jayne O'Donnell's articles of September 14-15, 2011 entitled "These Women died after having liposuction" and "Cosmetic surgery gets cheaper, faster, scarier: Commoditization opens door to dubious practices" (collectively "Article") jeopardize the safety of your readers considering cosmetic surgery. The Article is filled with false information, and misleads patients regarding how to choose a cosmetic surgeon placing patients at risk.

In order to protect cosmetic surgery patients who read your Article, the American Academy of Cosmetic Surgery ("AACS"), American Board of Cosmetic Surgery ("ABCS"), the Cosmetic Surgery Foundation for Education, Research and Patient Safety ("CSF"), and the cosmetic surgeons who represent the specialty of cosmetic surgery on the American Medical Association ("AMA") House of Delegates, respectfully urge USA Today to correct the false and misleading statements contained in the Article. The authors hereof, and the groups they represent, share the goal of patient safety through education. We were disturbed to learn of the tragedies subject to the Article, and it reminded us why we tirelessly advocate to ensure that only physicians who obtain the necessary education, training, and experience perform cosmetic surgery. Unfortunately, Ms. O'Donnell was misinformed, and the Article relies on anecdotal information rather than peer reviewed articles and fact based evidence.

It is our goal to provide cosmetic surgery patients with valuable and credible information regarding cosmetic surgery, and the education, training, and experience necessary to perform it. To help USA Today correct the misinformation included in the Articles, below is fact-based information regarding cosmetic surgery and who is qualified to perform it:

Plastic Surgery and Cosmetic Surgery Are Not the Same Thing.

Cosmetic surgery and plastic surgery are different specialties requiring different education, training, and experience. Cosmetic surgery involves procedures designed to enhance appearance (Common procedures include breast implants; chemical peels; chin, cheek, and nose augmentation; face lifts; hair transplants; liposuction, and tummy-tucks). Cosmetic surgery was developed, and is practiced, by dermatologists, facial plastic surgeons, general surgeons, gynecologists, oral and maxillofacial surgeons, ophthalmologists, otolaryngologists, plastic surgeons, and doctors from other fields. Unlike cosmetic surgery, plastic surgery is dedicated to reconstruction of facial and body defects due to birth disorders, trauma, burns, and disease.

There are currently no residency programs in the U.S. devoted exclusively to cosmetic surgery. And, residency programs in dermatology, general surgery, obstetrics and gynecology, oral and maxillofacial surgery, ophthalmology, otolaryngology, and plastic surgery do not include training on every cosmetic procedure. Therefore, doctors seeking to learn the vast array of cosmetic surgery procedures must do so after completing their residency training. Understanding this fact is necessary to understanding the difference between "cosmetic surgery" and "plastic surgery."

Residency training required to become board certified in plastic surgery may not include training with respect to many common cosmetic procedures. Therefore, while the title "board certified plastic surgeon" tells you the doctor has received certain training and experience with respect to "plastic surgery," it does not tell you the same thing with respect to "cosmetic surgery," and it does not tell you the doctor has more or less "cosmetic surgery" training than a board certified dermatologist, facial plastic and reconstructive surgeon, general surgeon, gynecologist, oral and maxillofacial surgeon, ophthalmologist, otolaryngologist, or other doctor. Therefore, to find the most qualified doctor for a specific cosmetic procedure, patients must compare doctors' overall (residency and post-residency) training and experience with respect to that procedure.

Cosmetic surgery patients need to understand that the education, training, and experience required for a doctor to become competent in cosmetic surgery is not the same as that required to become competent in plastic surgery. The Article's suggestion to the contrary is simply false. See Diagram A.

Diagram A

Diagram A illustrates the Article's false premises that all board certified plastic surgeons, and only board certified plastic surgeons, are qualified to perform all cosmetic procedures. Cosmetic surgery patients who believe these false premises are misled into relying on incomplete and inaccurate information when choosing their physician. As a result, patients fail to consider many well-qualified cosmetic surgeons, and fail to properly evaluate physicians' education, training, and experience regarding their cosmetic procedure. As a result, their safety is jeopardized by: (1) having their choice of qualified cosmetic surgeons arbitrarily reduced;1 and (2) potentially being directed to physicians with little or no cosmetic surgery experience.

The fact is that there are physicians in various specialties who obtain the necessary post-residency education, experience and training to become qualified to perform cosmetic surgery, and there are others who do not. Therefore, a physician's competence, skill, and ability with respect to a cosmetic surgery procedure depends on their education, training, and experience regarding that procedure, and not on their particular board certification. See Diagram B.

Diagram B

Diagram B correctly illustrates that within each discipline there are physicians who received specialized education, training, and experience in cosmetic surgery (inner circle -- "Qualified Cosmetic Surgeons") as well as physicians who have not and are, therefore, not qualified to perform cosmetic surgery. Whether physicians from among the various disciplines are qualified to perform cosmetic surgery is determined by their education, training, experience, and proven competence with respect to the contemplated cosmetic procedure, and not by their underlying board certification. It is imperative that cosmetic surgery patients understand this fact. Those who only consider a physician's underlying board certification when choosing their doctor base their decision on incomplete information and reduce their choice of qualified cosmetic surgeons. See Diagram A.

Cosmetic surgery patients who believe that all board certified plastic surgeons, and only board certified plastic surgeons, are competent in cosmetic surgery may choose an unqualified physician (i.e., board certified plastic surgeon with inadequate or no training with respect to the given cosmetic procedure) and are, therefore, at risk. Compare Diagrams A and B.

Criteria for Evaluating Physicians.

The Article falsely suggests that hospitals evaluate doctors based on their board certification, and therefore patients should do the same. On the contrary, the criteria hospitals use to evaluate physicians specifically opposes relying on a doctor's board certification. Instead, the criteria for evaluating physicians applied by national healthcare organizations requires an assessment of the physician's education, training, experience, and proven competence. This criteria is consistently published by the American Medical Association ("AMA"), American Osteopathic Association's Healthcare Facilities Accreditation Program (HFAP), the Joint Commission, which accredits hospitals in the U.S., and the Federal Government. In fact, the U.S. Department of Health and Human Services expressly prohibits the granting of staff membership or hospital privileges solely on certification or membership in a specialty body or society.

Recognizing the potential abuse of specialty certification, AMA's House of Delegates adopted Substitute Resolution 88 regarding the delineation of clinical privileges:

Resolved that it is the American Medical Association policy that individual character, training, competence, experience, and judgment be the criteria for granting privileges in hospitals; and be it further resolved, that the physicians representing several specialties can and should be permitted to perform same procedures if they meet this criteria.

AMA's policy on "Board Certification and Discrimination" specifically opposes discrimination against physicians based solely on lack of ABMS or equivalent American Osteopathic Board certification. Importantly, all of these authorities agree the use of a single criterion, including board certification, in evaluating a physician is inappropriate and inconsistent with providing quality patient care.

Board Certification in Cosmetic Surgery.

Contrary to the Article's false information, there are multiple valid certifying boards that are not members of the American Board of Medical Specialties ("ABMS"), and, importantly, none of the ABMS member boards certify physicians in cosmetic surgery.

ABMS is only one of several private organizations that recognize medical specialty certifying boards that meet their membership requirements. Today, the three largest organizations that provide medical specialty board recognition include the ABMS (recognizing 24 specialty boards), the American Osteopathic Association's Bureau of Osteopathic Specialists (recognizing 18 specialty boards), and the American Board of Physician Specialties (recognizing 18 specialty boards). All three organizations assist their member boards in developing educational and professional standards to evaluate and certify physicians in their respective specialties. And, all three are private membership organizations that must consider, address, and foster the interests of their members. What a board's certification evidences about the education, training, and experience of those it certifies depends on its certification requirements; not on the membership association to which it belongs.

The American Board of Cosmetic Surgery ("ABCS") certifies physicians exclusively in cosmetic surgery. In addition to other certification requirements, all applicants for certification by ABCS must first be certified by one of the following ABMS or AOA member boards:

American Board of Dermatology;
American Board of Surgery;
American Board of Obstetrics and Gynecology;
American Board of Ophthalmology (with completion of an American Society of Ophthalmic Plastic and Reconstructive Surgery approved Oculoplastic Fellowship);
American Board of Otolaryngology;
American Board of Plastic Surgery;

or be recognized by the American Board of Oral and Maxillofacial Surgery (ABOMS) and have an MD degree. In determining certification, ABCS considers only eligible candidates who, by definition, have completed certain general surgical training and specific additional cosmetic surgery training. The residency and post-residency training required by an ABMS candidate's core board coupled with the additional training required by ABCS for certification meets or exceeds that which eligible candidates to any ABMS board (including plastic surgery) must obtain with respect to any certified cosmetic procedure. Without substantial post-residency training in cosmetic surgery, many if not most board certified plastic surgeons do not qualify for certification by ABCS.

Liposuction and the Tumescent Technique.

Importantly, the Article misrepresents facts about liposuction suggesting it is safer if performed under general anesthesia rather than local anesthesia when, in fact, the opposite is true. From the pioneering liposuction techniques introduced in Europe in the 1970s through the time it was introduced in the U.S. in the early 1980s, liposuction procedures were performed under general anesthesia. This changed in the mid-1980s when dermatologist, Jeffrey A. Klein, M.D., developed the tumescent technique. The tumescent technique, which involves local anesthesia, revolutionized liposuction and is much safer than liposuction under general anesthesia.

As confirmed in an article published in the Journal of Clinical Anesthesia (Liposuction: contemporary issues for the anesthesiologist), many physicians who perform liposuction have not made the effort to learn the new, safer procedure:

Unfortunately, many physicians and anesthesiologists, due to their limited training in tumescent anesthesia, still believe that modern general anesthesia is the safest route for liposuction. Consequently, many do not make the effort to learn the new technique that allows liposuction totally by local anesthesia. Although modern general anesthesia is considered safe, it may expose the patient to unnecessary risk given that a safer alternative is available. Now that liposuction can be performed totally by local anesthesia, it might be considered that general anesthesia is often abused in the world of cosmetic surgery. Kucera, M.D., Ian J., Liposuction: contemporary issues for the anesthesiologist. Journal of Clinical Anesthesia, 2006, 18: 380).

Most importantly, and as further confirmed by multiple fact based studies and articles over the past decade, liposuction patients of board certified plastic surgeons experienced a significantly higher death rate, insurance claims, and malpractice complaints, compared to other specialties performing cosmetic procedures.

How to Choose Your Cosmetic Surgeon.

Cosmetic surgery patients should ask their cosmetic surgeon the following:

How long have you been performing the specific cosmetic procedure?

What are the risks and possible complications? Before the surgery, your doctor should explain to you the risks and possible complications, and potential side effects, including the pros and cons of the procedure.

Where did you receive your training with respect to the procedure?

How much experience do you have performing the procedure? How many have you performed in total? How many have you performed over the past year?

How do you define success with regard to the procedure? What is your success rate performing the procedure? How many of your patients have returned for revisions or corrections with respect to the procedure? How many of your patients have returned for revisions or corrections in general?

May I review "before and after" pictures of those who have had the procedure performed by you?

Where will you perform my procedure? Is the facility accredited? Cosmetic surgery is performed in various facilities such as hospitals, surgical centers, and office settings. An accredited surgical facility must meet certain minimum standards to obtain and maintain its accreditation. Some certifying organizations include the Joint Commission (formerly "JCAHO"), the Accreditation Association for Ambulatory Health Care ("AAAHC"), and the American Association for Accreditation of Ambulatory Surgery Facilities ("AAAASF").

Are there any alternatives to the procedure that may exist considering my desired result?

The Article was based on false and misleading information. Accordingly, we respectfully urge USA Today to correct the misinformation before cosmetic surgery patients rely on the Article and are harmed.

Respectfully Submitted on behalf of:

American Academy of Cosmetic Surgery, Angelo Cuzalina, MD, DDS, President
American Board of Cosmetic Surgery, Michael Will, MD, DDS, President
Cosmetic Surgery Foundation for Education, Research and Patient Safety, Suzan Obagi, MD, President; Jane Petro, MD, FACS, Executive Director
Robert Jackson, MD, AMA House of Delegates Cosmetic Surgery Representative

1 The total number of physicians board certified in the named specialties since the Boards' inceptions (dermatology, general surgery, gynecology, ophthalmology, otolaryngology, oral and maxillofacial surgery, and plastic surgery) exceeds 176,840; with approximately the following breakdown among specialties: Dermatology: 14,330; General Surgery: 57,810; Gynecology: 49,110; Ophthalmology: 24,800; Otolaryngology: 15,960; Oral and Maxillofacial Surgery: 7,060; and Plastic Surgery: 7,770. Board certified plastic surgeons make up only 4.4% of the total number of board certified physicians shown. (ABMS 2010 Certificate Statistics; and Report of the ADA-Recognized Specialty Certifying Boards April 2011).

When patients start their research for cosmetic surgery, one of the first places the patient visits is a surgeon's before and after gallery. We know the importance of the gallery, which is why we have a plethora of images to share with our potential patients -- both online and in-office. We have more photos on our Web site than any of our competitors in North Georgia and Chattanooga. In addition, we know how crucial it is to present untouched photos so that the potential patient can have realistic expectations of their own surgical outcome.

"Because Dr. Nease and I have performed over 5,000 surgical cosmetic surgery cases combined, we have numerous photos to post to our before and after gallery," said Chad Deal, MD. "Additionally, each photo is shot with our own cameras and are not touched up. We show real people with real results." And real results are what patients look for when researching their procedure.

Plastic Surgery Practice recently wrote an article titled, Is It Photoshopped, or Is It Real? In the article, the author says that television commercials and even trade show booths selling a product will Photoshop images. We, at Southern Surgical Arts, want to assure our patients that none of our photos have been altered or PhotoShopped. Each picture you see in our before and after gallery is an actual patient. The images are real and untouched to provide you with realistic results. Additionally, each model that is shown on our Web site are actual patients. We do not use stock images to portray beauty that is not obtainable and that has often been altered.

When researching a cosmetic surgeon for breast surgery, body surgery or face surgery, you should demand to see before and after pictures of actual patients. And don't just ask for two or three. Expect the surgeon to show you competence and consistency over his/her career. It's not hard to find two or three images that show a surgeon's best work. It is, however, difficult to show numerous cases that prove experience and education. At Southern Surgical Arts, our surgeons are highly qualified Board-Certified Cosmetic Surgeons who strive to give you the best patient experience.

To make sure you hear it again, we DO NOT alter our before and after gallery images. So, feel free to peruse our gallery to see how our patients benefited from our expert surgeons.